Chapter 1Introduction
1.1Australia’s life expectancy is the third highest in the world, sitting behind Monaco and Japan. Australia’s life expectancies at birth have also increased over the last 30 years, from 75.0 years for males and 80.9 years for females in 1993, to 81.2 years for males and 85.3 for females in 2020–2022.
1.2The leading causes of death in 2021 were also unchanged from 2012: ischaemic heart diseases, dementia including Alzheimer’s disease, cerebrovascular diseases, lung cancers and chronic lower respiratory diseases.
1.3However, in 2020, just like the rest of the world, Australia grappled with the effects of a pandemic that would come to be known as COVID-19. According to the Australian Bureau of Statistics (the ABS), it was evident that when ‘COVID‑19 hit, it was clear that having frequent, timely information about people who died during the pandemic was important’.
1.4Consequently, the ABS began intensifying its analysis of death registrations supplied by the state and territory Registries of Births, Deaths and Marriages. From June 2020, the ABS started publishing monthly provisional mortality data to provide up-to-date information to the community and support the government’s response to the pandemic.
1.5The purpose of this inquiry is to explore excess mortality in Australia, including: all-cause provisional mortality data, contributing factors to excess morality in 2021, 2022 and 2023, and addressing identified preventable drivers of excess mortality.
Referral of the inquiry
1.6On 26 March 2024, the following matter was referred to the Senate Community Affairs References Committee (the committee) for inquiry and report by 31 August 2024:
Excess Mortality with particular reference to:
(a)Australian Bureau of Statistics (ABS) data showing excess deaths in recent years, with particular reference to:
(i)all-cause provisional mortality data reported by the states and territories to the ABS, and
(ii)the difference between all-cause provisional mortality data for 2021, 2022 and 2023 and the preceding years of 2015 to 2020 (inclusive)
(b)factors contributing to excess mortality in 2021, 2022 and 2023;
(c)recommendations on how to address any identified preventable drivers of excess mortality; and
(d)any other related matter.
Conduct of the inquiry
1.7Details of the inquiry were published on the committee’s website and the committee invited a number of organisations and individuals to lodge submissions. The committee received 59 submissions, which are listed at Appendix 1.
1.8The committee also held a public hearing in Canberra on 13 June 2024. A list of witnesses who gave evidence at the public hearing is available at Appendix 2.
1.9In this report, references to Committee Hansard are to proof transcripts. Page numbers may vary between proof and official transcripts.
Structure of the report
1.10This chapter sets out general information outlining the conduct of the inquiry and provides background information relating to excess mortality in Australia.
1.11Chapter 2 discusses the provisional mortality data provided by the ABS, focussing on COVID-19 both directly and indirectly contributing to excess mortality across the years 2021–2023. The chapter then examines other areas in which deaths rose, as well as explanations for increased mortality raised by submitters over the course of the inquiry.
1.12Chapter 3 canvasses preventable drivers of excess mortality during 2021–2023, and then considers recommendations on how to address drivers of excess mortality in the future by exploring preventive health measures, vaccination, and government information and messaging.
1.13Chapter 4 concludes with the committee’s views on the evidence it received and its recommendations.
Acknowledgements
1.14The committee thanks all those who contributed to the inquiry by making submissions and appearing at the public hearing.
1.15The committee also acknowledges the large volume of correspondence that it received over the course of the inquiry and thanks all the individuals who took the time to write and share their views and personal experiences on this matter. Statements received as correspondence helped the committee progress its understanding of the issues it considered as part of this inquiry.
What is ‘excess mortality’ and why track it?
1.16The Department of Health and Aged Care (the Department) defines excess mortality as:
… an epidemiological concept typically defined as the difference between the observed number of deaths in a specified time period and the expected number of deaths in the same period.
1.17The ABS noted that excess mortality estimates have been historically used in a range of studies, for example, to measure the effects of diseases and natural disasters. The Actuaries Institute similarly provided that excess mortality is a key measure of the impact of a pandemic, as it captures:
pandemic-related deaths (including those not reported as such);
reduced deaths from defence measures (e.g., Australia’s border closures and lockdowns); and
increases in other deaths that may be indirectly caused by the pandemic (such as those due to delayed medical attention).
1.18As such, the ABS noted that during the COVID-19 pandemic, it was recognised that excess mortality estimates could ‘provide a more complete picture of mortality’ rather than ‘focusing on deaths due to COVID-19 alone’. It explained that:
… mortality at the all-cause level can account not only for deaths identified as being due to the virus, but also potentially misclassified or undiagnosed COVID-19 deaths and mortality that may be indirectly related to the pandemic (e.g. relating to social isolation or changed access to health care).
How does the ABS estimate excess mortality?
1.19As the Department noted in its submission, the ABS is the definitive authority on mortality statistics and data in Australia. As such, in addition to the ABS’ reports on annual ‘Deaths, Australia’ and ‘Causes of Death, Australia’, the Department also ‘commissioned the ABS to produce a series of Provisional Mortality Statistics reports and excess mortality reports from June 2020 onwards to provide early indications of mortality patterns in Australia’.
1.20In its submission, the ABS provided that its excess mortality figures represent a response to the following question: ‘How does the number of deaths which has occurred during the COVID-19 pandemic (2020–2023) compare to the number of deaths expected had the pandemic not occurred?’.
1.21The ABS observed that estimating excess mortality is complex as it is dependent on the expected number of deaths. The ABS provided that the expected number of deaths is an estimate that is forecasted from historical deaths data and stated that the premise is that recent mortality patterns provide an appropriate baseline of what future mortality may look like.
1.22The Actuaries Institute also stressed that the predicted number of deaths used in excess mortality calculations is an estimate based on certain assumptions, and further underlined that excess mortality can only ever be an estimate, stating that ‘it is not, and cannot be, a known quantity’.
1.23As such, in its submission, the ABS outlined that in order to obtain a ‘robust estimated number of expected deaths’, methodological decisions must be made regarding the mortality trend (the baseline), as well as the age-structure and size of a population. In its submission, the ABS provided the methodological decisions it made, which are explored below.
Pandemic years were intentionally excluded from the baseline
1.24The ABS intentionally excluded the pandemic years from its baseline. It explained that the low mortality rate in 2020 was likely an ‘indirect effect of the pandemic’ due to the health measures that were in place. Consequently, using 2020 in the baseline would mean that estimated excess deaths would not represent ‘mortality expected in the absence of a pandemic’.
1.25As such, the ABS advised that it instead uses data from 2013 to 2019 in its baseline.
Use of age-specific rates
1.26The ABS modelled ‘age-specific rates’ instead of raw numbers of deaths to measure expected mortality figures. The ABS explained that it made this decision as Australia has an ageing population, therefore the number of deaths per year should increase over time. It justified that an age-specific rate ‘accounts for the base population as well as the age structure of that population’.
Allowing for the trend in decreasing mortality rates
1.27The ABS also allowed for decreasing mortality rates due to the improvements in health care and interventions. The ABS explained that this means while an ageing population leads to an increase in overall deaths over time, there is a decrease in the age-standardised mortality rate.
1.28It stated that this is due to reductions in mortality, particularly in younger to middle-age groups.
Separate modelling for Australia and the states and territories
1.29The ABS also highlighted that expected mortality and subsequent excess mortality estimates were separately modelled for Australia and the states and territories, which allowed the ABS to consider mortality patterns by jurisdiction and make ‘appropriate adjustments’.
1.30The ABS provided an example where many jurisdictions had ‘a severe influenza season in 2017’ which caused some excess mortality, which:
… required some adjustment in the baseline when extrapolating expected mortality for those jurisdictions. These adjustments were not necessary for jurisdictions where no excess mortality was recorded in 2017.
ABS reporting of mortality
1.31The ABS’ annual ‘Deaths, Australia’ and ‘Causes of Deaths, Australia’ publications were the key sources of mortality information that were published prior to the COVID-19 pandemic. However, the ABS recognised in its submission that these publications did not meet ‘the need for timely insights into patterns of mortality during the pandemic or provide numbers of excess deaths’.
1.32Hence, as earlier discussed, the ABS began publishing provisional mortality data in June 2020 to address these data gaps. This continued from 2021–22, when the Department provided funding to the ABS to continue provisional mortality reporting due to its importance in monitoring pandemic impacts.
1.33In its provisional mortality reports, the ABS publishes death registration data after receiving information from the state and territory Registries of Births, Deaths and Marriages. According to the ABS, ‘[t]hese reports aim to provide early indications of patterns of mortality, rather than fully complete accounts of death’.
1.34The ABS provided that provisional mortality data informs the following publications discussed below.
‘Provisional Mortality Statistics’ reports
1.35According to the ABS, these statistics provide ‘timely summary mortality data by week and month of death’. Information is published by age, sex, jurisdiction and selected causes of death.
1.36The ABS stressed that these monthly reports ‘should not be used as a source of official excess mortality estimates’. The ABS explained that this is due to the way that its baseline average is calculated:
For publications reporting on data up to the end of 2023, the ABS included analysis comparing the most recently occurring deaths to an average number of deaths occurring previously, referred to as the baseline average. The baseline average is calculated as the average number of deaths occurring in a week over a five-year period. For example, for the first two years of the pandemic, the baseline average was calculated from the weekly number of deaths occurring over 2015-2019. The purpose of the baseline average was to provide a simple picture of how current mortality compared to mortality in recent years.
1.37In its submission, the ABS also identified that these reports have been ‘mistakenly used as a source of official excess mortality estimates’, and noted that it provides the following advice in the Provisional Mortality Statistics reports:
While this publication can provide an indication of where counts of deaths are above or below expectations, it does not provide official estimates of excess mortality. Using the number of deaths from the previous years as the predictor for the expected number of deaths does not take into account changes in population size and age-structures of that population, as well as expected improvements in mortality rates over time.
‘COVID-19 Mortality in Australia’ reports
1.38The ABS explained that ‘COVID-19 Mortality in Australia’ reports include information on deaths associated with COVID-19, as ‘recorded on the medical certificate as cause of death’.
1.39These deaths include both:
deaths from COVID-19: this captures the people who died directly because of the virus; and
death with COVID-19: this captures deaths where a person died from a cause other than COVID-19, but the virus was certified as a contributing factor.
1.40The ABS commented that these reports include information such as whether COVID-19 caused or contributed to death, details of associated causes of death, and also includes detailed demographic information, such as age and sex.
‘Measuring Australia’s excess mortality during the COVID-19 pandemic’ reports
1.41According to the ABS, these reports provide official estimates of excess mortality every six months. In its submission, the ABS provided the methodology it uses to calculate these estimates:
The methodology used to produce these excess mortality estimates applies a cyclical linear regression to historical data to produce an expected number of deaths. These estimates account for age-structure, change over time within a population and historical trends.
1.42The ABS underlined that these reports should be used when reporting on ABS figures of excess mortality, and that all excess mortality figures in its submission come from this report.
Broader government publications and activities
1.43In addition to the ABS’ publications on mortality in Australia, the Australian Institute of Health and Welfare (AIHW) also plays a role in publishing and reporting on mortality statistics. In its submission, the AIHW stated that it:
conducts analysis and reporting of mortality data from the National Mortality Database;
authors and publishes the annual ‘Deaths in Australia report’, which provides data on deaths, causes of death and life expectancy;
annually analyses and publishes excel workbooks and visualisations on historical trends in cause of death in the ‘General Record of Incidence of Mortality data’ publication, and leading causes of death for different Australian geographic areas in the ‘Mortality Over Regions and Time data’;
authors and publishes bespoke reports;
reports on mortality indicators in the Australian Health Performance Framework;
conducts data custodian activities;
responds to data requests for information derived from the National mortality database; and
links deaths of data from the National Death Index to other health and welfare data collections.
1.44The Department also submitted that it monitors patterns of death from a range of sources, including the ABS data on registered deaths, and other sources such as:
the National Notifiable Diseases Surveillance System;
the Therapeutic Goods Administration’s Database of Adverse Event Notifications;
the AIHW’s National Mortality Database; and
the deaths in residential aged care through the My Aged Care Portal.
Other data considerations
1.45Some submitters also drew the committee’s attention to other important considerations when examining mortality in Australia. For example, the AIHW noted the importance of measuring years of life lost due to premature mortality (referred to as fatal burden or YLL), as well as estimates of years of healthy life lost due to disease or injury (non-fatal burden or YLD).
1.46Consequently, the AIHW suggested that work could be undertaken to calculate YLL for each year from 2020–23:
Work could be undertaken to calculate YLL estimates based on ‘actual’ deaths registered (rather than projected deaths) for each of the COVID years (2020–2023) to assess whether there has been excess fatal burden as a result of the pandemic and how this compares to excess deaths for Australia. This may provide additional insight into the impact of COVID-19 on mortality and the health of the population.
1.47Demographers Associate Professor Tim Adair, Associate Professor Brian Houle and Professor Vladimir Canudas-Romo submitted the importance of using life expectancy as a measure of mortality. They explained that ‘when death rates rise, life expectancy falls; when deaths rates fall, life expectancy rises’ and subsequently noted that life expectancy is a wisely used measure of mortality.
1.48Associate Professor Adair, Associate Professor Houle and Professor Canudas‑Romo went onto suggest that:
Compared with the measurement of mortality using age-standardised death rates, which is used by the ABS to calculate excess mortality, life expectancy places greater weight on deaths at younger ages. For example, a death at age 30 will have a larger impact on life expectancy than a death at age 90, whereas for age-standardised death rates the impact will be the same. If most deaths occur at older ages, as they do in Australia, changes in life expectancy can seem relatively small compared with excess mortality measured using age-standardised death rates.