Abstract
This study consisted of two parts: 1) a description the contribution of renal disease to all cause mortality in Australia; and 2) an assessment of the agreement in reporting of cause of death among Australian end stage renal disease patients in two national data sets. Two manuscripts have been prepared and formatted for submission to peer-reviewed journals. In part one, data from the Australian Bureau of Statistics on underlying and associated causes of death, based on death certificates, were examined for all deaths that occurred in Australia in 1997-99 and were registered by the end of 1999. Causes of death were coded according to the International Classification of Diseases, ~10th Revision (ICD-10). We included as renal deaths a number of causes outside the ICD-10 chapter on diseases of the genitourinary system (e.g. diabetic renal disease, hypertensive renal disease and congenital malformations of the kidney). Of the 378,832 deaths recorded during the period, renal disease was coded as the underlying cause for 7,888 deaths (2.1 %), and as one of the associated causes for an additional 28,012 deaths (7.4%). Among deaths with renal disease as the underlying cause, almost one in four (23.1%) were outside the ICD-10 genitourinary chapter and therefore unlikely to be classified as a renal death in official statistics. Renal disease was commonly recorded with other chronic diseases, especially cardiovasculardiseases.
In part two, agreement on cause of death as recorded in the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) and by the Australian Bureau of Statistics (ABS) was examined for people with end stage renal disease (ESRD) who died during 1997-1999. We used data on cause of death and primary renal disease from ANZDATA, and on underlying and associated causes of death, based on death certificates, from the ABS. Date of birth, date of death and sex were used to identify the same individuals in the two data sets, and cause of death was compared at ICD-10 chapter level. Among 3,035 ANZDATA patients who died during 1997-99, 1,144 (38%) could be matched to a record in the ABS data set. Of these, 237 (21%) had no mention of non-acute renal failure on their ~death certificates. Agreement on cause of death at ICD-10 chapter level ranged from 37% using only the information on ANZDATA cause of death and ABS underlying cause of death, to 91 % using additional information on primary renal disease and/or any of up to 12 associated causes of death. The number of people with non-acute renal failure recorded as the underlying cause of death on their death certificates (5,293) exceeded the number of ANZDATA patients who died (3,035), which suggests that many people with renal failure die untreated.
Overall, the study found that the contribution of renal disease to Australian mortality has been underestimated due to historical reliance on a single (underlying) cause of death and because the coding of many renal deaths places them outside the category typically included as renal in official mortality statistics. Death certificates and ANZDATA records provided different descriptions of cause of death for Australian ESRD patients, and information from these two sources was not directly comparable. Neither data set provided a complete picture of renal disease as a cause of death in Australia.
| Date of Award | Jun 2002 |
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| Original language | English |
| Supervisor | Joan Cunningham (Supervisor) & Alan Cass (Supervisor) |