Aboriginal and Torres Strait Islander Health Performance Framework - 2010

Technical Appendix

Page last updated: 26 May 2011

This appendix provides more detailed information on data sources, caveats and statistical methods.

Aboriginal and Torres Strait Islander peoples and non-Indigenous population descriptors

‘Aboriginal and Torres Strait Islander peoples’ is the preferred descriptor used throughout the report. ‘People’ is an acceptable alternative to ‘peoples’ depending on context, but in general, the collective term ‘peoples’ is used. The ‘Indigenous Australians’ descriptor is inclusive of all Aboriginal and Torres Strait Islander groups, and is used where it is impractical to use ‘Aboriginal and Torres Strait Islander peoples’ (e.g. in tables, charts, figures, and where the text requires the term to be repeated a number of times).

The ‘non-Indigenous’ descriptor is used where the data collection allows for the separate identification of people who are neither Aboriginal nor Torres Strait Islander. The label ‘other Australians’ is used to refer to the combined data for non-Indigenous people, and those for whom Indigenous status was not stated.

Age-standardisation

Age-standardisation controls for the effect of age, to allow comparisons of summary rates between two populations that have different age structures. Age-standardisation is used throughout this report when comparing Aboriginal and Torres Strait Islander Australians with non-Indigenous Australians for a range of variables where age is a factor e.g. health-related measures. The main disadvantages with age-standardisation are that the resulting rates are not the real or ‘reported’ rates for the population. Age-standardised rates are therefore only meaningful as a means of comparison, and may hide important differences in distribution within a population, such as rates for particular ages. Lastly, for age-standardisation to be effective the relationship between age and the variable needs to be approximately consistent between the two populations.

Main Sources

The data in this report are mainly drawn from national data collections and surveys. These include the following:

The National Aboriginal and Torres Strait Islander Social Survey (NATSISS):

The 2008 NATSISS was conducted between August 2008 and April 2009. Information was collected by personal interview from approximately 13,300 Aboriginal and Torres Strait Islander Australians; 5,500 aged 0–14 years and 7,800 aged 15 years and over throughout Australia, including those living in remote areas. The NATSISS sample was specifically designed to select a representative sample of Aboriginal and Torres Strait Islander Australians. The NATSISS uses the standard Indigenous status question to identify Indigenous households from which the sampling process is then undertaken. Information recorded in this survey is ‘as reported’ by respondents, or from child proxies (usually parents), on behalf of selected children aged 0–14 years. Data may differ from that which might be obtained from other sources or by using other collection methodologies. Responses may also be affected by imperfect recall or individual interpretation of survey questions. Selected non-Indigenous comparisons are available from the 2007–08 National Health Survey and a range of other surveys. Further details can be obtained from ABS cat. no. 4714.0 ABS 2009. Time-series comparisons are available through from the 2002 NATSISS and the 1994 National Aboriginal and Torres Strait Islander Survey (NATSIS).

National Aboriginal and Torres Strait Islander Health Survey (NATSIHS):

The 2004–05 NATSIHS included a sample of 10,439 Aboriginal and Torres Strait Islander Australians. This was considerably larger than the supplementary Indigenous samples in the 1995 and 2001 National Health Surveys (NHS) (3,681 in 2001). The NATSIHS sample was specifically designed to select a representative sample of Aboriginal and Torres Strait Islander Australians and thus overcome the problem inherent in most national surveys i.e. small and unrepresentative Indigenous samples Information recorded in this survey is ‘as reported’ by respondents. Responses may be affected by imperfect recall or individual interpretation of survey questions. Any data that are self-reported are also likely to underestimate circumstances about which the respondent is unaware, or may be reluctant to report e.g. certain health conditions, weight, drug use. Computer assisted interviewing (CAI) was used in non-remote areas and paper forms were used in remote areas. Selected non-Indigenous comparisons are available through the National Health Survey (NHS). The NHS was conducted in major cities, regional and remote areas, but very remote areas were excluded from the sample. Further information on NATSIHS data quality issues can be found in the national publication ABS cat. no. 4715.0 ABS 2006b.

Census:

The Census uses the standard Indigenous status question and it is asked for each household member.

There are 4 principal sources of error in Census data: respondent error, processing error, partial response and undercount. Quality management of the Census program aims to reduce error as much as possible, and to provide a measure of the remaining error to data users, to allow them to use the data in an informed way.

In 2006, the ABS enhanced the sample for the Post-Enumeration Survey to include remote areas. The measured undercount for Indigenous Australians was 11.5%.

The Census form may be completed by one household member on behalf of others. Incorrect answers can be introduced to the Census form if the respondent does not understand the question or does not know the correct information about other household members. Many of these errors remain in the final data.

The processing of information from Census forms is now mostly automated. Quality assurance procedures are used during Census processing to ensure processing errors are kept at an acceptable level. Sample checking is undertaken during coding operations, and corrections are made where necessary.

When completing their Census form, some people do not answer all the questions which apply to them. In these instances, a ‘not stated’ code is allocated during processing, with the exception of non-response to age, sex, marital status and place of usual residence. These variables are needed for population estimates, so they are imputed using other information on the Census form, as well as information from the previous Census.

Other Census data issues relate to the accuracy of the Census count itself, e.g. whether people are counted more than once, or are undercounted.

The significant volatility in Indigenous census counts and the quality of data on births, deaths and migration of Indigenous persons do not support the use of the standard approach to population estimation. Due to the inherent uncertainties in estimating the Indigenous population, estimates are referred to as experimental and data which use these estimates should be interpreted with caution (e.g. life expectancy estimates, mortality rates). Given these uncertainties, changes in health outcomes such as mortality rates are difficult to assess over the long-term.

Following each Census, assumptions are made about past levels of mortality to produce back cast population estimates.

A comparison of mortality rates using 2001 Census-based estimates and 2006 Census-based estimates produce different results. A number of investigations were undertaken to seek to understand the results and recommend options for future reporting on trends. This analysis found significant problems with the 2001 based estimates, particularly with the older age groups. In this report, trend analysis is based on 2006 Census estimates of back cast and projections (Series B).

In 2011 the ABS will implement improvements to Census Indigenous enumeration procedures and will expand the scope of the Census Post Enumeration Survey to include very remote areas and discrete Indigenous communities.

Community Housing and Infrastructure Needs Survey (CHINS):

The CHINS collects data about discrete Indigenous communities. In 2006, a total of 1,187 communities were surveyed, with a combined usual , population of 92,960 Aboriginal and Torres Strait Islander peoples or 18% of the total estimated Indigenous population. The survey was also conducted in 2001 and 1999. The data are collected from key personnel in Indigenous communities and housing organisations knowledgeable about housing and infrastructure issues. This collection is not a population survey.

National Perinatal Data Collection:

Birth notification forms are completed for all births of 20 weeks or more gestation, or a birthweight of 400 grams or more. The Perinatal National Minimum Data Set includes all births in Australia in hospitals, birth centres and the community. The state/territory of birth is provided for all births in each state/territory. State-level data are based on place where birth occurred, not place of usual residence. Complicated pregnancies from surrounding New South Wales may be referred to the Australian Capital Territory and hence there may be poorer outcomes attributed to Australian Capital Territory births. Because of this and the small numbers involved, care should be taken in interpreting data from the Australian Capital Territory (Laws & Sullivan 2004a9). A standard data item for Indigenous status is specified in the Perinatal National Minimum Data Set. However, at this stage not all states and territories use this standard wording for the Indigenous status question on their forms. This impacts on the quality and comparability of the data collected (ABS & AIHW 2005). All jurisdictions collect Indigenous status of the mother for each baby. Work is underway to include the Indigenous status of the baby in the Perinatal National Minimum Data Set. Studies in Australia linking perinatal data with birth registration data and hospital admissions show that Indigenous data are under-reported (Taylor L & Lim K 2000; Comino EJ, et al 2007; Kennedy B, et al 2009). In 2007, the AIHW completed an assessment of the quality of Indigenous status information in perinatal data in each state and territory. This involved a survey which was sent to the midwifery managers across Australia to determine how many hospitals in each jurisdiction obtain Indigenous status information of mothers giving birth from admission records and how many collect this information independently. The assessment also involved analysis of the variability in the number and proportion of mothers recorded as Indigenous in the perinatal data collection over time and across jurisdictions for the period 1991–2004. The outcomes of this assessment showed that Indigenous status data from New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory are suitable for trends analysis and national reporting. Perinatal data from Tasmania, although improving, were deemed to be of insufficient quality. Although the most recent data in the Australian Capital Territory were of publishable quality, the data were not yet of sufficient stability to support trends analysis (AIHW: Leeds KL et al. 2007). All jurisdictions are working towards improving the quality of the Indigenous status data. States and Territories have agreed to improve Indigenous data collection procedures in key data collections including implementation of the Best Practice Guidelines for the collection of Indigenous status in health data sets. Data on Indigenous status are not reported for Tasmania prior to 2005 as the not stated category for Indigenous status was included with the non-Indigenous category. The not stated category for Indigenous status was high for Tasmania (around 75%) and low for the other jurisdictions, not more than 0.5% (Laws & Sullivan 2004b). The ‘not stated’ category for birthweight was found to be small nationally in the evaluation of the Perinatal National Minimum Data Set. Therefore, the exclusion of not stated for birthweight will not have a significant impact on these data.

AIHW will work with the States and Territories in the development of an enhanced Perinatal National Minimum Data Set to be operational by 2013. This will include nationally consistent data items on antenatal care, smoking and alcohol use during pregnancy, and Indigenous status of the baby.

National Hospital Morbidity Data:

This is a data collection including all completed admitted patient episodes in public and private hospitals across Australia. The number and pattern of hospitalisations can be affected by differing admission practices among the jurisdictions and from year to year, and differing levels and patterns of service delivery. Some jurisdictions have slightly different approaches to the collection and storage of the standard Indigenous status question and categories in their hospital collections. The not stated category is missing from several collections. The incompleteness of Indigenous identification means the number of hospital separations recorded as Indigenous is an underestimate of hospitalisations involving Aboriginal and Torres Strait Islander people. For several years, Queensland, South Australia, Western Australia and the Northern Territory reported that Indigenous status in their hospital separations data was of acceptable quality (AIHW 2007). Between 2006 to 2008, the AIHW completed an assessment of the level of Indigenous under-identification in selected public hospitals in all states and territories. Results from this assessment indicate that New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory have adequate Indigenous identification (20% or less overall under-identification of Indigenous patients) in their hospital separations data. It has therefore been recommended that reporting of Indigenous hospital separations data be limited to aggregated information from New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory. Tasmania and ACT data are presented at the State/Territory level and should be used with caution, but they are not aggregated with the other 6 jurisdictions. AIHW will commence another audit process with audits in all states and territories and invite full participation of jurisdictions in the process to assess improvements in the data quality.

Interpretation of results should take into account the relative quality of the data from the jurisdictions.

The proportion of the Indigenous population covered by the 6 jurisdictions is 96% (ABS & AIHW 2010). Hospitalisation data for these 6 jurisdictions should not be assumed to represent the hospitalisation experience in the Australian Capital Territory and Tasmania.

From the AIHW study it was possible to produce correction factors for the level of Indigenous under-identification in hospital data at the national level.

National Mortality Database:

The count of Indigenous deaths for Indigenous Australians can be influenced by the accuracy of identification of Indigenous deaths, late registration of deaths, as a result of coronial inquiry, and changes to death forms and/or processing systems. Due to the small size of the Indigenous population these factors can significantly impact on trends over time and between jurisdictions.

All jurisdictions comply with the standard wording for the Indigenous status question and categories for their death registration forms. However, Victoria, South Australia, the Northern Territory and the Australian Capital Territory all have slightly different wording to the national standard for the instruction on those with both Aboriginal and Torres Strait Islander origin (ABS & AIHW 2005.

Almost all deaths in Australia are registered. However, the Indigenous status of the deceased is not always recorded/reported and/or recorded correctly. The incompleteness of Indigenous identification means the number of deaths registered as Indigenous is an underestimate of deaths occurring in the Aboriginal and Torres Strait Islander population (ABS 1997). As a result, the observed differences between Indigenous and non-Indigenous mortality are underestimates of the true differences.

While the identification of Indigenous Australians in deaths data is incomplete in all state and territory registration systems, 5 jurisdictions (New South Wales. Queensland, Western Australia, South Australia and the Northern Territory) have been assessed by the ABS and the AIHW as having adequate identification. Longer term mortality trend data are limited to 3 jurisdictions (Western Australia, South Australia and the Northern Territory) with 10 years of adequate identification of Indigenous deaths in their recording systems. The quality of the time-series data is also influenced by the late inclusion of a not stated category for Indigenous status in 1998. Prior to this time, the not stated responses were probably included with the non-Indigenous. The ABS calculated the identification rate of Indigenous deaths for the period 2006–2007 through data linkage between the Census and death registration records to examine differences in reporting of Indigenous status across the two datasets (ABS 2009b).

Table 74 – Indigenous deaths identification rate, state/territory and Australia, 2006–2007

State/territoryIdentification Rate
NSW0.87
Qld0.94
WA1.11
NT1.09
Vic, SA, Tas, ACT, Overseas territories0.65
Australia0.92
Source: ABS 2009b

As part of the data development work funded under the National Indigenous Reform Agreement (NIRA) the ABS will link Census records with death registration records to assess the level of identification again in 2011.

States and Territories have agreed to the implementation of the Best Practice Guidelines for the collection of Indigenous status in health data sets.

BEACH.

The Bettering the Evaluation And Care of Health (BEACH) survey collects information about consultations with GPs, including GP and patient characteristics, patient reasons for the visit, problems managed and treatments provided. The survey has been conducted annually since April 1998. Information is collected from a random sample of approximately 1,000 GPs from across Australia each year. Each GP provides details of 100 consecutive consultations.

Although the questionnaire contains an Indigenous identifier, it is unknown whether all GPs ask their patients this question. In a sub-study Supplementary Analysis of Nominated Data of approximately 9,000 patients, it was found that if the question on Indigenous status was asked within the context of a series of questions about origin and cultural background, 1.3% identified as Indigenous. This is twice the rate routinely recorded in BEACH, indicating that BEACH may under-estimate the number of Indigenous consultations.

Under the NIRA, governments have agreed to the implementation of the Best Practice Guidelines for the collection of Indigenous status in health data collection, which include recommended strategies for local service providers such as GPs and practice nurses to improve Indigenous identification data.

The Commonwealth’s contribution to the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes is an $805.5 million Indigenous Chronic Disease Package, which includes a number of measures that encourages GPs to identify their Aboriginal and Torres Strait Islander clients. Accredited general practices and Indigenous health services are eligible for financial incentives when they sign-on to the new Practice Incentives Program Indigenous Health Incentive (IHI), obtain consent from their Aboriginal and Torres Strait Islander clients to be registered for chronic disease management through the IHI, and provide a targeted level of care for each registered patient. Participation in the PIP IHI also provides eligibility for other initiatives under the Indigenous Chronic Disease Package such as the Care Coordination and Supplementary Services Program.

Data development

There are well documented problems with the quality and availability of data about Aboriginal and Torres Strait Islander health issues. These limitations include the quality of data on all key health measures including mortality and morbidity, uncertainty about the size and composition of the Indigenous population and a paucity of available data on other health-related issues such as access to health services.

The following information has been provided by the jurisdictions to provide information on action being undertaken in relation to data collection.

Australian Government

The Australian Government is committed to improving the availability of good quality Indigenous health data. Through the National Advisory Group on Aboriginal and Torres Strait Islander Health Information Development (NAGATSIHID), the Australian Government is actively engaged with key stakeholders, State and Territory Governments, the ABS and the AIHW to improve Indigenous health statistics. The Health Performance Framework has established priorities for data development linked to policy objectives.

In July 2009, COAG committed to a range of activities to improve the quality of Indigenous data, including a Commonwealth commitment of $46.4 million over four years to June 2013 under the NIRA (COAG 2008). This work covers the key datasets required for NIRA Indigenous reporting eg mortality, morbidity, perinatal data and population estimates. Jurisdictions have committed to undertaking the work outlined under Schedule F to the NIRA, in liaison with the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics (ABS).

These data development projects include:

ABS will implement improvements to Census Indigenous enumeration procedures and will expand the scope of the Census Post Enumeration Survey to include very remote areas and discrete Indigenous communities.

ABS and AIHW to work in partnership with jurisdictions to ‘lead analysis of the level of Indigenous identification in key datasets, including a baseline report and ongoing five-yearly studies to monitor identification over time’. From this analysis, the ABS and AIHW will provide a report in 2010 with recommendations about strategies for improving identification, and methods for assessing coverage rates.

States and Territories have agreed to adopt the standard ABS Indigenous status question and recording categories on data collection and information systems for key data sets.

States and Territories have agreed to improve Indigenous data collection procedures in key data collections including implementation of the Best Practice Guidelines:

The report on Best practice guidelines for the collection of Indigenous status in health data collections was published by the AIHW on 8 April 2010.

It is expected that jurisdictions will implement the guidelines in their different data sets during the period 2010 to 2012. Evaluation of implementation will begin in 2012–2013 and will be undertaken every 3 years.

The AIHW’s National Indigenous Data Improvement Support Centre (NIDISC) has been established to support jurisdictions and service providers to implement the guidelines.

States and Territories have agreed to develop and implement a program to raise the Indigenous community’s awareness about the importance of identifying as Indigenous.

ABS will link Census records with death registration records to assess the level of Indigenous identification.

The AIHW and ABS in partnership with the jurisdictions will lead the development of national best practice guidelines for data linkage and an examination of current and planned data linkage work relevant to Indigenous identification.

AIHW will work with the States and Territories in the development of an enhanced Perinatal National Minimum Data Set.

The expanded dataset is expected to be operational by 2013.

AIHW is developing a business case for the implementation of a nationally consistent pathology data collection, including Indigenous status.

The Commonwealth is working with the States and Territories to develop a national Key Performance Indicator (KPI) framework for Indigenous primary health care services.

The ABS has developed an ongoing 6-yearly Indigenous health survey program (with additional funding from the Department of Health and Ageing). They have also funded an ongoing 6-yearly Indigenous social survey program. The Community Housing and Infrastructure Needs Survey has been run every 5 years in conjunction with the 2001 and 2006 censuses, with funding from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs and OATSIH.

The ABS continues to work on the Indigenous Administrative Data Project. This project aims to improve the level and quality of Indigenous identification in key administrative data sets held and managed by Australian governments. In this capacity, and complementing the COAG-funded activities the ABS has been conducting various engagement and education activities; liaising with government departments about best practice in Indigenous data collection, and conducting data linkage programs to assess and improve Indigenous identification status.

The ABS continues to utilise an Indigenous Community Engagement Strategy to improve the collection and dissemination of statistics, in partnership with Indigenous communities. Through the use of Indigenous Engagement Managers in ABS offices across Australia, the ABS is building relationships with communities to improve the quality and relevance of Aboriginal and Torres Strait Islander statistics.

More information on ABS key directions in Aboriginal and Torres Strait Islander statistics can be obtained from ABS cat. no. 4700.0 ABS 2007.

Since the previous report, the AIHW has finalised reports on the assessment of the quality of Indigenous identification in labour force data collections, the National Cancer Registry, and the National Diabetes Register.

AIHW has redeveloped a web portal on Indigenous identification in the community services which provides information and resources related to improving Indigenous identification in health, community services and housing data sets.

A Voluntary Indigenous Identifier was introduced into the Medicare database from November 2002. By 1 November 2010, 289,350 people had identified as Aboriginal, Torres Strait Islander, or both. Work is underway to make use of this potentially very valuable data source.

As part of the Healthy for Life program, the AIHW is leading the refinement of indicators, data standards and analyses and reporting back to all services involved in the Healthy for Life program (about 100 services). The main areas covered by the current indicators and reports are maternal and child health and chronic disease management.

A project was undertaken by the AIHW in collaboration with the Centre for Health Research in Criminal Justice (CHRCJ), located within NSW Justice Health, as well as other stakeholders, to develop a national prisoner health data set to enable the monitoring of the health of prisoners. The project has involved an audit of current data collection on prisoner health in prisons; the development of a range of policy-relevant draft indicators for prisoners mapped to the National Health Performance Framework; and the development of detailed specifications for the data supporting these measures. Further AHMAC funding was provided to support the work program for 2008–09, including a national data collection. In 2010, the AIHW has released The health of Australia’s prisoners 2009 report. This report represents a major milestone on the road to a national data collection, including valuable data on the health of Aboriginal and Torres Strait Islander prisoners.

Australian Capital Territory

The ACT Department of Health continue to undertake a number of data quality improvement activities regarding Aboriginal and Torres Strait Islander data. These include:

- ACT Pathology project. The under-identification of Aboriginal and Torres Strait Islander patients in administrative data leads to a biased estimation of the true use of health services, which impacts on estimates of health expenditures and affects accurate planning and delivery of health services to Aboriginal and Torres Strait Islander people. ACT Health has entered an Aboriginal and Torres Strait Islander identifier as a mandatory field on ACT Pathology forms. Training has been conducted with Pathology staff on how best to ask clients to identify and a handout and brochure that encourages clients to identify has been made available in waiting areas. Improving identification on pathology forms has flow-on effects of improving identification in other data sets e.g. ACT Cancer Registry, Communicable Disease Register and hospital data.

- ACT Health PMI Hub project. To improve quality of Aboriginal and Torres Strait Islander identification in key vitals and administrative data sets, ACT Health has commenced collection of the Aboriginal and Torres Strait Islander identifier within the Patient Master Index (PMI), which will enable the identification status of a person to be shared throughout ACT Health IT systems. ACT Health is working to ensure that adherence to standards ensuring ethical and privacy considerations are taken into account.

- Data linking project. The aim of this project is to ascertain the level of under-identification of Aboriginal and/or Torres Strait Islander patients in ACT Health administrative datasets. The person’s identification status data from the local Aboriginal Medical Service will be compared to the same person’s status recorded in ACT Health administrative data. Ethics approval has been obtained and ACT Health is currently loading data sets into the master linkage key to proceed with linkages.

- Identification information and awareness program. ACT Health is developing a specific information and awareness program to support and encourage ACT Health staff to identify Aboriginal and Torres Strait Islander clients and Aboriginal and Torres Strait Islander patients to identify. The program was piloted with Pathology staff and included staff training on how best to ask clients to identify and providing handouts and brochures that encourage clients to identify in waiting areas.

New South Wales

In New South Wales, Indigenous status is collected in a range of health datasets, including the NSW Midwives Data Collection (MDC), the NSW Admitted Patient Data Collection (APDC), the NSW Emergency Department Data Collection (EDDC), the Non-admitted Patient Data Collection, the NSW Notifiable Conditions Information Management System (NCIMS), the NSW Health Survey Program, and the NSW Central Cancer Registry (CCR).

The asking of, and recording of, Indigenous status is mandatory for the core data collections listed above. The NSW Health 2005 policy (PD2005_547), which is a reissue of a 2002 Policy, on identifying Indigenous status is mandatory in all facilities and Area Health Services. This policy is being reviewed and new projects aimed at improving the Aboriginal identification are being planned for implementation in 2011, 2012 and 2013 as part of the National Partnership Agreement Closing the Gap in Indigenous Health Outcomes.

A 2007 survey undertaken by NSW Health of nearly 3,000 admitted patients in 20 hospitals drawn from metropolitan, inner regional, outer regional and remote locations found New South Wales admitted patient data are 89% correct in relation to Indigenous status, ranging from 82% in metropolitan hospitals to 100% in remote hospitals. This survey was repeated in 2010. As at November 2010 the analysis has not yet been finally completed, however, the preliminary figures show a result similar to the 2007 survey.

In 2009 the NSW Department of Health initiated a 2-year project to investigate the feasibility of using record linkage to help correct the under-reporting of Aboriginal and Torres Strait Islander peoples on routinely collected NSW Health datasets. The project uses linked records of the following data collections: APDC, EDDC, MDC, the Registry of Births Deaths and Marriages (RBDM) birth and death registration data, the Australian Bureau of Statistics (ABS) Mortality data and the CCR. In total the linked dataset contains over 29.5 million records for over 6.6 million people. The aim of the project is to develop algorithms to enhance the reporting of Aboriginal and Torres Strait Islander Peoples for each data collection using information from the other linked datasets.

A range of communicable diseases are notified under the Public Health Act (1991) and captured in the NCIMS. The completeness of recording of Indigenous status in for each of these diseases in NCIMS varies and is influenced by the degree of public health follow-up of cases of each of the communicable diseases.

The NSW Department of Health is currently undertaking a pilot project linking the NCIMS data with data from the MDC, APDC and RBDM birth and death registration data. The aim of the project is to improve recording of Indigenous status through updating the data field, from records identified through the linkage, in an epidemiologic dataset. The project has received approval from the NSW Population & Health Services Research Ethics Committee and the Aboriginal Health & Medical Research Council Ethics Committee. Data linkage is now complete and analysis of the linked data is underway.

Northern Territory

The Department of Health has rolled out a number of e-health initiatives across the Northern Territory that will have major implications for the use and collection of data. These improvements assist in the provision of seamless care for health consumers. Brief outlines for these initiatives are as follows:

eHealthNT Shared Electronic Health Record (SEHR) – as at 31 December 2010 the SHER ensures that access to important health information is available with consent 24 hours per day, 7 days per week for 37,500 patients (including 67% of Indigenous people living in rural and remote communities in the NT) at any of the 104 participating health centres (including correctional facilities), GP clinics and public hospitals. The SEHR is used by over 2500 authorised clinical users, every month sending >58,500 healthcare event summaries (up from >45,000 in 09/10) and accessing on >10,000 occasions (up from >3,500 in 09/10), as part of providing healthcare. The SEHR is proving to be of major benefit for mobile populations, and people from rural and remote accessing services in regional towns or cities, by ensuring up-to-date information is easily accessible at the point of care, whether that is at a remote health centre operated by the Department or an Aboriginal Community Controlled Health Service or at a public hospital in a regional or major urban centre.

Secure Electronic Messaging Service SEMS – ensures that specific information regarding clinical referrals can be communicated electronically securely between service providers. This assists in a seamless care in relation to managing transition from GPs/Health Centres to appointments with specialists or hospital outpatient clinics. Electronic medications and discharge summary information is forwarded by hospitals to communities of residence, so that information is available locally for consumers on their return to country.

Primary Care Information System (PCIS)—in 2009–10 the Department completed the rollout of PCIS to the 22 remaining remote health centres, making a total of 54 Departmental health centres transitioned to using fully electronic health records (eliminating the use of paper records) integrated with the eHealthNT SEHR service and SEMS for eReferrals and eDischarge. As at 31 December 2010 PCIS had expanded its coverage to include health services in the two (2) NT Prisons and one (1) Juvenile Detention facility. PCIS includes a number of tools to assist in patient care, eg automatic alerts for service providers about patients to be recalled for follow-up treatments/services, providing a technological advantage to making service delivery easier. PCIS facilitates extensive coded clinical data collection for each service episode with the capacity to capture all required national Aboriginal and Torres Strait Islander health performance indicator data.

Aboriginal Health Key Performance Indicator (AHKPI) project – initiated by the Aboriginal Health Forum (AHF) to develop to structure a collection and reporting of 19 agreed Key Performance Indicators that cover both DHCS Remote Health Centres and Aboriginal Community Controlled Health Services. The project is managed cooperatively by the NTG, the Department of Health and Ageing and AMSANT under the auspices of the AHF Banner and maintains the NT Aboriginal Health KPI collection covering the Government and Non-Government sectors to improve the quality and robustness of data for use in service planning and management through continuous quality improvement.

In 2010–11 the Department commenced the Health eTowns Program jointly funded with the Australian Government under the Digital Regions Initiative, which will develop the following over the next two (2) financial years, 10/11 and 11/12:

Telehealth Project – a Telehealth network supporting remote service delivery in 17 of the 20 Territory Growth Towns, making it possible for patients and clinicians to access the expertise of specialists and allied health professionals in their community and supporting patient recovery by enabling patient in hospital to remain connected with their families in remote communities.

Queensland

Over a two year period from 2009 to 2011, Queensland Health has undertaken a project to improve the identification of Aboriginal and Torres Strait Islander people accessing services. The initial aim was to improve identification rates in admitted patient data in public hospitals. Synthetic estimate of the proportion of patients identifying as Aboriginal and/or Torres Strait Islander in admitted patient data is used as a key performance indicator in District Chief Executive Officer service level agreements. The state-wide project focuses on understanding issues and implementing solutions at both state-wide and local level. The state-wide project has analysed cultural, systems and administrative influences on identification. The project's approach is to develop state-wide resources including audit tools, cultural and educational material, information technology solutions, policy and procedures. The project also resourced and supported a number of projects within Health Service Districts. At the time of writing, most Health Service Districts had, or were in the process of undertaking local projects aimed at understanding the cultural and administrative barriers to patient attendance and identification. Local solutions are in the process of development and implementation to address local findings.

The assessment of the Queensland prevalence of risk factors such as smoking, under consumption of fruit and vegetables, alcohol consumption and physical inactivity will be obtained from the 2011 Australian Health Survey. No information is available for risk factor prevalence in sub-state areas.

The burden of disease and injury of Indigenous Queenslanders has been reassessed in 2009 and released within a suite of reports on the internet.

Queensland Health is committed to improving Indigenous identification in communicable disease reporting. The Communicable Diseases Branch of Queensland Health routinely monitors Indigenous identification completeness for notifiable conditions; and is participating in national initiatives, through the Communicable Diseases Network Australia (CDNA), to bring about improvements.

Queensland hospital separations data are known to have more complete indigenous identification than the Queensland Notifiable Conditions System (NOCS). In 2007 a large data linkage exercise, which matched records from disease notifications with an extract of records from hospitalisations within Queensland, was undertaken. Notifications in NOCS with no Indigenous status were updated with the Indigenous status from the hospital record. However, this resulted in only a seven percent improvement in Indigenous status completeness in NOCS. More efficient ways to improve indigenous identification completeness need to be developed and will be progressed in Queensland Health.

South Australia

Improving Aboriginal Identification

ABS has been funded through SA Health’s COAG investment to develop a training package for recording the ‘Indigenous identifier’ in health data collections; as well as training staff who manage data and/or perform data entry about the importance of collecting the Indigenous identifier information; the correct way of asking the standard question and recording the response; and strategies for dealing with special circumstances, such as determining the Indigenous status of children and patients who are unconscious. The training targets frontline staff working across hospital sites in metropolitan Adelaide and regional communities, as well as various mainstream primary care services throughout SA. This training approach has been informed by the AIHW’s Best Practice Guidelines for Collecting Indigenous Status. SA Health has also indicated support to feed its initiative into the AIHW and ABS National Data Linkage Project on Indigenous identification. The Department continues to operate a case mix payment system which applies a 30% loading to Indigenous hospital separations, and this provides an incentive for improved Indigenous identification.

SA Pathology does not currently provide a field for Indigenous status on their pathology request form. The Department of Health and SA Pathology are working together to address this issue: a project scope is under development, which includes a review of downstream impacts on affected registries such as Cancer and modifications to SA Pathology’s information and technology system to record and receive this information. Importantly, SA Pathology will be taking a legislative approach to enable amendments to their Pathology request forms to include Indigenous status; and ‘Aboriginal Identifier’ training for relevant staff in SA Pathology will follow. SA Pathology (trading as IMVS Pathology) provides a comprehensive diagnostic pathology service delivered via a network of 19 state-wide laboratories and more than 50 patient collection centres. It is the sole provider of pathology in the Public Hospital sector and a major provider to the private GP and Specialist market.

In 2007, SA participated in a national Audit of Indigenous Identification in Public Hospitals project, coordinated by the AIHW. Surveys were conducted in metropolitan and regional hospitals across SA, and the results contributed to reports from other jurisdictions to calculate adjustment factors to be applied to hospital separations data for Expenditure on Health reporting. A follow-up audit is being conducted in 2011. The audit will independently verify the Indigenous Status of a sample of patients in selected metropolitan and country hospitals through face to face interviews. The results will be matched against data held in hospital systems, to assess the quality of identification by hospital staff. More than 1,500 patient interviews will be conducted during the audit. Results from the audit will be used to determine correction factors for adjusting national Indigenous performance indicator data for under identification.

Aboriginal Life Expectancy Measures

SA Health is required under the South Australian Strategic Plan (SASP) and under COAG targets, to monitor Aboriginal life expectancy. However, ABS has not been able to produce Aboriginal life expectancy figures for smaller jurisdictions such as South Australia due to small population numbers of Aboriginal people in the 2006 Census. SA Health has been informed of a project being undertaken by AIHW on "An Enhancement Mortality Database for Estimating Indigenous life expectancy: A feasibility study of South Australia". The AIHW study focuses on a one point time period for estimate figures for SA Aboriginal life expectancy at birth for the period 2001–2006. The findings are currently in draft form and not for circulation. Before knowing the AIHW approach SA Health has been undertaking its own project on Aboriginal Life Expectancy Measure by using life table material from the Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003 study with a view to developing and refining work using linked data. The ‘burden of disease framework’ has provided SA Health the ability to provide some level of life expectancy estimates for Aboriginal South Australians at state and smaller area where possible (South Australian Department of Health, 2005). Four important developments have occurred since May 2010:

SA Health internally circulated initial healthy life expectancy estimates for Aboriginal South Australians. These estimates were based on the Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003 and The burden of disease and injury in Australia, 2003 (AusBoD) which provide a base for the SA Burden of Disease (SABoD) Series. The estimates inform Target T2.5 “Aboriginal healthy life expectancy” in the SA Strategic Plan (SASP). The Plan and its targets are currently being reviewed.

AIHW completed a feasibility study into data linkage methods that facilitate the calculation of South Australia level Indigenous life expectancy estimates (AIHW 2010e). While the estimates are not publicly available yet, they include a 95% confidence range of values for life expectancy at birth. The SABoD estimates are toward the upper end of the range in the AIHW report.

SA NT DataLink is now operational and provides a statistical data linkage service within SA. Current, relevant de-identified datasets available include public hospital inpatient records and most metropolitan public hospital emergency departments. There are also good prospects of death and other important collections becoming available to that process. This has potential to become a sustainable environment for accessing data relevant to healthy life expectancy calculation. The possibility of imputation of Indigenous identification across linked datasets is a particular strength of data linkage projects.

The first SA Aboriginal Health Survey is being undertaken. The survey includes questions on health risk factors, health conditions and health related quality of life. There are two major parts of the ongoing healthy life expectancy work in South Australia: mortality (life expectancy) and morbidity (health related quality of life, or the amount and severity of illness experienced). The following summarises the particular activities underway and other pathways available to support continuing work in these areas.

Mortality - Life Expectancy

To improve identification of Aboriginal deaths in SA, a revised proposal to link South Australian public hospital inpatient records with death records through SA NT DataLink is anticipated in the second half of 2011. This is contingent on the data collections becoming available and the longer-term nature of the statistical linkage system developed. This approach would provide a means by which SA can be more self-reliant in monitoring Aboriginal life expectancy (both across time and within the state). This work is being pursued in the context of a wider, routine approach to monitoring population health outcomes using a burden of disease framework to provide for greater consistency and comparability, and as an important intellectual base for jurisdiction level work. The coaching and support of those involved in the AusBoD Study has been integral to SA carrying out current activities.

Morbidity - the amount and severity of illness

The availability of population morbidity estimates among Aboriginal South Australians via SABoD is a significant step but also an area requiring ongoing improvement. The SA Aboriginal Health Survey will provide relevant, localised, general information about the amount, experience and distribution of morbid conditions and risk factors among Aboriginal people. Some questions also measure functional health status. Each of these information areas can contribute to health expectancy calculations (applying methods from Nusselder & Looman, 2004; Committee on Leading Health Indicators for Healthy People, 2011). The existing work and new survey results provide an opportunity to examine how the two sources of information harmonise, or how consistent they are with each other, in describing the amount and severity of illness experienced by Aboriginal South Australians. SA Health is investigating ways to ensure that its local level work does not diverge from the national work previously begun as it could potentially lessen the comparability of results from other jurisdictions. As with the mortality work, it would be preferable if analysis and development was part of a national program. Such an approach would add to the scientific rigour of the work and its relevance to policy applications and supporting decision-making.

Data Sets

Having identified the need for improvements in the way that the health sector describes and measures primary health care activities, SA has established an Out-of-Hospital Services Minimum Data Set, which includes the National Data Dictionary definition of Indigenous status, represents the agreed core elements that are collected for describing out-of-hospital care services in SA. A central repository of out-of-hospital services data has been established covering: community health, community mental health, public dental services, drug and alcohol services, child and family services, district nursing services, palliative care. It is now possible to track the use of the above services by Indigenous people.

Data Sharing

The Aboriginal Health Council of SA (AHCSA) has been funded for data sharing initiatives under SA Health’s COAG investment. The spirit of the funding agreement is to enhance and influence cross sectoral Aboriginal Health planning and priority setting through data sharing between the Aboriginal community controlled health sector and SA Health. AHCSA is the peak community body on Aboriginal health matters in South Australia and provides secretariat services to ten member Aboriginal Community Controlled Health Organisations (ACCHOs). AHCSAs funding enables the agency to undertake two key data projects, the first being the engagement of a Patient Information Management System’s (PIMS) Officer for the term of the COAG National Partnership Agreement. The AHCSA project officer is responsible for developing a set of standard PIMS procedures and complementary templates to support standardisation and consistency of data across the Aboriginal Community Controlled Health Sector. AHCSAs second initiative involves the engagement of a short-term consultant to conduct Data Sharing Needs Analysis across the Aboriginal Community Health Sector. AHCSA will take lead in facilitating and negotiating the participation of ACCHOs in data sharing with SA Health. The consultant will have the responsibility of identifying and formalising an appropriate set of data for collection across ACCHOs. The AHCSA consultant has responsibility for:
  • Consulting with relevant SA Health personnel to ascertain what health-related data they consider would be useful to obtain from ACCHOs (and for what reasons), and what data SA Health would be amenable to provide to ACCHOs (and for what reasons);
  • Consulting with relevant personnel from ACCHOs to ascertain what health-related data they consider would be useful to obtain from SA Health (and for what reasons); and what data ACCHOs would be amenable to provide to SA Health (and for what reasons);
  • Monitoring national and state developments in the area of e-Health, on AHCSA’s behalf, and prepare a short e-Health situational analysis for AHCSA;
  • Preparing a report on potential data-sharing arrangements between SA Health and ACCHOs.

Tasmania

The collection of Indigenous status is mandatory in core Tasmanian health data collections such as admitted, non admitted and perinatal data collections. Notwithstanding this, there is room for improvement and Tasmanian Government agencies are working with Australian Government agencies to improve Indigenous identification in key administrative datasets. Whilst this work is focussing on hospital and deaths administrative data, it will also address improvements to a broad range of data collections. Implementation of the Best Practice Guidelines for the collection of Indigenous status in health data sets forms part of this body of work.

The Department of Health and Human Services has employed an Aboriginal Health Development Officer. This position sits within the Aboriginal Health Unit in Population Health Priorities. One of the requirements of this position is to develop and deliver Cultural safety training. One component of this training package focuses on improving the collection of Indigenous data throughout the Agency. This training package has been successfully delivered since June 2006.

Victoria

Data collection

In Victoria, Aboriginal status is a mandatory field in all major health datasets. The Victorian Admitted Episodes Dataset (VAED), the Victorian Emergency Minimum Dataset (VEMD),and the Victorian Perinatal Data Collection (VPDC) contain good-quality data on Aboriginal identification. Aboriginal identification is also collected through the Alcohol and Drug Information System (ADIS), the Notification of Infectious Diseases System (NIDS) and community health direct care database.

The Aboriginal population of Victoria forms a small percentage within a large mainly urban population. Correct identification of Aboriginal people is difficult in all datasets.

Measures to improve data

In July 2004, the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program was implemented. The program combined 2 previously separate funding streams: the Aboriginal Hospital Liaison Officer program and the Weighted Inlier Equivalent Separation (WIES) copayment for admitted Aboriginal patients. At this time the WIES copayment was increased from 10% to 30%. Amongst other objectives, ICAP encourages an outcome focus leading to improved identification and health care for Aboriginal patients. The number of Aboriginal patients identified by Victorian public hospitals has risen steadily since 2004.

Victorian hospitals include two additional fields in the standard Aboriginal status question: ‘Question unable to be asked’ and ‘Patient refused to answer’. The addition of these fields has enabled the Department of Health to identify instances of misuse of either field very quickly.

Changes in access to data systems have also meant that more frequent monitoring of Aboriginal hospital separations is possible, and errors can be discovered and rectified.

In January 2009 the Victorian Perinatal Data Collection (VPDC) allowed the recording of the Indigenous status of babies as separate from the mother. This will accommodate the large percentage of Aboriginal babies born in Victoria who have an Aboriginal father and non-Aboriginal mother. At the same time the VPDC also included antenatal care and maternal tobacco smoking.

The Department of Health and PapScreen Victoria have developed a system for recording and reporting the Aboriginal status of women participating in Pap screens. A pilot study has been completed and was successful in training nurses to collect Aboriginal status.

The Department of Health is planning to conduct a Victorian Aboriginal and Torres Strait Islander population health survey in 2011. The sample size will be 1000 Aboriginal people.

AIHW has completed a pilot project matching data on Aboriginal deaths recorded in several databases. Although Victorian data is not included in the measures concerned with mortality, the AIHW project has allowed an estimate of Aboriginal life expectancy in Victoria. Work will continue on this project.

The Victorian Aboriginal Child Mortality Study, based at the University of Melbourne, will bring together birth and death information from a number of data sources to give an accurate report of the number of Aboriginal babies born between 1988 and 2008, and the number and causes of death for Aboriginal children who died during this period.

Western Australia

In Western Australia, Aboriginal status is collected in a range of health data collections, including the admitted patient data collection, the emergency department data collection, the outpatient care data collection, the Notifiable disease Data Collection, the WA Health and Well Being Surveillance System, the Midwives Data Collection, the Breast screening Data Collection, the Mental health Information system and the Cancer Registry. It is also stored on ABS Mortality data held by the Department of Health.

The WA Health and Wellbeing Surveillance System asks respondents if they are of Aboriginal or Torres Strait Islander origin. Less than 0.2% reply ‘do not know’ or refuse to answer the question and the proportion who say that they are Aboriginal ranged from between 3.4% in 2007 to 2.0% in 2009. The average proportion over the last five years was 2.4% which is about 0.9% less than the proportion of Aboriginal people in the WA population. Reports from the HWSS do not disaggregate results by Aboriginality as they are unlikely to be representative of the Aboriginal population in WA on a yearly basis, due to the method used to collect the data.

Over the last decade the number of death records with unknown Aboriginal status registered by the WA Office of Registry of Birth, Deaths and Marriages has represented a substantial proportion of cases. For deaths of unknown Aboriginality, status is determined through data linkage by comparing the Aboriginality of the records of the same individuals in other data sources. Mortality measures are reported by the Department of Health, Western Australia using the enhanced Aboriginal status field.

Reporting of Aboriginality in Midwives Notification System is based on the mothers Aboriginality; therefore the number of Aboriginal births recorded is likely to be underestimated. There has been recent Agreement to commence the collection of Aboriginal status of the baby on the WA Midwives Notification of Case Attended form from 1 July 2012.

Western Australia has agreed to undertake a further project in 2011, funded by the Australian Government Department of Health and Ageing, to improve Aboriginal identification among hospital patients.

The Data Integrity Directorate is hoping to recruit a Quality Assurance Coordinator who can arrange refresher training for hospital staff in collecting data on Aboriginal identification.

The Directorate has completed an exercise to compare Aboriginal status from the Midwives Notification System with Aboriginal status on the associated hospital records. The study found that there were about 15% less Aboriginal births recorded among birth registrations than among the Midwives collection of births data. This is because reporting of Aboriginal Status in birth registration data is non-compulsory.

The elective surgery wait list data collection also includes Aboriginal status and this collection is linked to admitted patient records for further verification of Aboriginal status.

There is a collaborative project between Australian Bureau of Statics (ABS) and Department of Health to investigate methods for deriving improved Aboriginal status measures by linking administrative data collections. Data collections are included from Department of Health, Department of Education, Department of the Attorney General and from the ABS. A joint Department of Health and ABS report will be released by July 2011.

Health Status and Health Outcomes (Tier 1)

1.01 Low birthweight infants

Data on birthweight is collected as part of the Perinatal National Minimum Data Set. It includes live births of 20 weeks gestation or more, or of 400 grams or more birthweight. Low birthweight is defined as less than 2,500 grams. Data relate to the Indigenous status of the mother only and therefore underestimates Indigenous births. Unless otherwise stated, Indigenous and non-Indigenous data excludes births where the mother’s Indigenous status is not stated. In 2007, there were 282 births with a ‘not stated’ Indigenous status (0.1%) in the National Perinatal Data Collection. Earlier years data are not available for Tasmania, as the ‘not stated’ category for Indigenous status was unable to be distinguished from the ‘non-Indigenous’ until 2005.

Figure 3: The time series data includes non-Indigenous mothers and mothers for whom Indigenous status was not stated. Excludes Tasmania and the Australian Capital Territory, as data from these jurisdictions are not considered stable enough to be included in trend analyses, mainly because of small population size and some issues with data quality over the reporting period.

Table 6: Data are presented in 3-year groupings because of small numbers each year. These groupings represent three calendar years. State-level data are based on place where birth occurred, not place of usual residence. Cross-border issues need to be considered here. ACT percentages are influenced by both small numbers and high proportions of non-ACT residents who gave birth in the Australian Capital Territory, and must be interpreted with caution. In 2005–2007, the ACT resident proportion was 13.3% for low birthweight Indigenous babies and 6.3% for non-Indigenous babies.

1.02 Top reasons for hospitalisation

Data for this measure come from the AIHW’s analysis of the National Hospital Morbidity Database. Data are from public and most private hospitals. Data exclude private hospitals in the Northern Territory. ‘Other Australians’ includes hospitalisations of non-Indigenous people and those for whom Indigenous status was not stated. Care types 7.3, 9 & 10 (Newborn – unqualified days only; organ procurement; hospital boarder) excluded from analysis, unless otherwise stated. Rates have been directly age-standardised using the 2006 Australian standard population unless otherwise stated. Rates for Indigenous are calculated using population estimates based on the 2006 Census (SERIES B). Rate ratio is the proportion of Indigenous to Other Australians. Principal diagnosis categories are based on the ICD-10-AM fifth edition (National Centre for Classification in Health 2006). Data related to principal diagnosis are reported by state/territory of usual residence of the patient hospitalised, and are for New South Wales, Victoria, Western Australia, South Australia, the Northern Territory and Queensland only. These six jurisdictions are considered to have adequate levels of Indigenous identification, although the level of accuracy varies by jurisdiction and hospital.

Figure 5: Care types 7.3, 9 & 10 (Newborn – unqualified days only; organ procurement; hospital boarder) included in analysis because of changes in coding since earlier years.

Figures 5 and 7: Rates have been directly age-standardised using the 2001 Australian standard population.

Figure 7 and 8: Rates and rate ratios for ‘Pregnancy and child birth’ are for females only. ‘Other’ includes: diseases of the musculoskeletal system and connective tissue; neoplasms; diseases of the nervous system; certain conditions originating in the perinatal period; diseases of the ear and mastoid process; diseases of the eye and adnexa; diseases of the blood and blood-forming organs and certain disorders involving the immune system; congenital malformations, deformations and chromosomal abnormalities; and factors influencing health status and contact with health services (except dialysis). Total includes hospitalizations for which no principal diagnosis was recorded.

1.03 Hospitalisation for injury and poisoning

Data for this measure comes from AIHW’s analysis of the National Hospital Morbidity Database. Refer to notes for measure 1.02 regarding this data. Cause of injury is based on the first reported external causes where the principle diagnosis was ‘injury, poisoning and certain other consequences of external causes’; ICD-10-AM codes V01–Y98.

Table 7: ‘Persons’ includes hospitalisations for which sex was indeterminable or not stated. Percentage refers to the proportion of male, female and total hospitalisations for injury and poisoning of Indigenous persons in the period 2006–07 to 2007–08. Rates were directly age-standardised using the Australian 2001 standard population. ICD-10-AM codes are: Assault (X85–Y09), Falls (W00–W19), Exposure to inanimate mechanical forces (W20–W49), Complications of medical and surgical care (Y40–Y84), Transport accidents (V01–V99), Intentional self-harm (X60–X84), Exposure to animate mechanical forces (W50–W64), and Accidental poisoning by and exposure to noxious substances (X40–X49). ‘Other accidental exposures’ includes accidental drowning and submersion (W65–W74), accidental threats to breathing (W75–W84), overexertion, travel and privation (X50–X57), and accidental exposure to other and unspecified factors (X58–X59). ‘Exposure to electric current/smoke/fire/animals/nature’ includes exposure to electrical current, radiation and extreme ambient air temperature and pressure (W85–W99), smoke, fire and flames (X00–X09), contact with heat and hot substances (X10–X19), contact with venomous animals and plants (X20–X29), and exposure to forces of nature (X30–X39). ‘Other external causes’ includes event of undetermined intent (Y10–Y34), legal intervention and operation of war (Y35–Y36), sequelae of external causes of morbidity and mortality (Y85–Y89), and supplementary factors classified elsewhere (Y90–Y98). ‘Total’ includes injuries where no external cause was reported.

Table 8: Excludes private hospitals in the Northern Territory, Tasmania and the Australian Capital Territory. Data are reported by state/territory of usual residence of the patient hospitalised. Age-standardised rates for New South Wales, Victoria, Queensland, Western Australia, South Australia, the Northern Territory and Australia have been age-standardised by 5 year age group to 75+ using the direct method using the Australian 2001 standard population.

1.04 Hospitalisation for pneumonia

Data for this measure mainly comes from AIHW’s analysis of the National Hospital Morbidity Database. Refer to notes for measure 1.02 regarding this data. Exceptions are noted below. ICD-10-AM codes J12–J18.

Data for Figure 14 comes from the AIHW analysis of National Notifiable Disease Surveillance System. The level of under-reporting can vary by disease, jurisdiction and by time. The method of surveillance can vary between jurisdictions with different requirements for notification by medical practitioners, laboratories and hospitals. The case definitions for surveillance also vary among jurisdictions. These can also change over time.

Figure 14: Calendar year reporting. Data are presented in 3-year groupings because of small numbers each year. Age-specific rates are calculated using the average Indigenous June population for the relevant years. Data are reported for New South Wales, Victoria, Queensland, Western Australia, South Australia, Tasmania and the Northern Territory (2008 Northern Territory data is preliminary). These three jurisdictions are considered to have adequate levels of Indigenous identification in these data. They do not represent a quasi-Australian figure. ‘Other Australians’ includes notifications for non-Indigenous Australians and those for whom Indigenous status was not stated.

Table 9: Refer to notes on Table 8 in measure 1.03.

1.05 Circulatory disease

Refer to notes for measure 1.02 regarding hospitalisation data. ICD-10-AM codes I00–I99.

Table 10: Rates were directly age-standardised using the Australian 2001 standard population. ICD-10-AM codes are: Ischaemic heart disease (I20–I25), Acute myocardial infarction (I21), Subsequent myocardial infarction (I22), Pulmonary heart disease and other forms of heart disease (I26–I52), Cerebrovascular disease (I60–I69), Stroke (I60–I64), Acute rheumatic fever and chronic rheumatic heart disease (I00–I09), and Hypertension disease (I10–I15).Table 10: Percentage refers to proportion of male, female and total hospitalisations of Indigenous persons in the period 2006–07 to 2007–08. ‘Other diseases of the circulatory system’ includes disease of arteries, arterioles and capillaries, diseases of veins, lymphatic vessels and lymph nodes and other unspecified disorders of the circulatory system.

Table 11: Data are reported by state/territory of usual residence of the patient hospitalised. Refer to notes on Table 8 in measure 1.03.

1.06 Acute rheumatic fever and rheumatic heart disease

Data for this measure comes from the Northern Territory Rheumatic Heart Disease Program.

Figure 17: Crude rates calculated using the 2006 estimated resident Indigenous population for the Top End, Central Australia and total Northern Territory.

Table 12: Age-specific rates calculated using the 2006 estimated resident Indigenous population for the Northern Territory. Rate ratio is the ratio of indigenous to non-indigenous.

1.07 High blood pressure

Table 13: Remote data are not available for the 1995 National Health Survey.

Figure 18: Self-reported data from the National Aboriginal and Torres Strait Islander Health Survey 2004–05 and the National Health Survey 2004–05 consisting of persons ever told has condition, still current and long-term, and ever told has condition, current and not long-term. The females in all age groups, the male ‘35–44’ age group and the standardized total represents statistically significant differences in the Indigenous/non-Indigenous comparisons. The estimate for the female ‘25–34’ age group has a relative standard error of 25% to 50% and should be used with caution. Total is age-standardised.

Figure 19: Refer to notes for measure 1.02 regarding hospitalisation data. ICD-10-AM codes I10–I15.

1.08 Diabetes

Figure 20: Self-reported data from the National Aboriginal and Torres Strait Islander Health Survey 2004–05. Total is age-standardised. Differences in the Indigenous/non-Indigenous comparisons are all statistically significant.

Figures 21 and 22: Refer to notes for measure 1.02 regarding hospitalisation data. ICD-10-AM codes E10–E14.

Table 15: Data is from the AIHW analysis of BEACH survey of general practice. Diabetes problems are classified according to ICPC-2 codes (Classification Committee of the World Organization of Family Doctors (WICC) 1998). ICPC-2 codes T90, T89, W85. These survey results are likely to undercount the number of Indigenous Australians visiting doctors. Combined financial year data for five years. Data for Indigenous and other Australians have not been weighted. Rates are directly age-standardised rate per 100 encounters. ‘Other’ includes non-Indigenous patients and patients for whom Indigenous status was not stated. Ratio is the Indigenous rate divided by rate for non-Indigenous. ‘Gestational diabetes’ rates and ratio are for females only,

1.09 End stage renal disease

Data for this measure come from the Australian and New Zealand Dialysis and Transplant Registry. Indigenous identification in the Registry is based on self-identification in hospital records. However, because of the heightened awareness of the extent of renal disease in Indigenous Australians and the prolonged and repeated contact with renal units in hospitals, it is believed that Indigenous identification in the Registry is more complete than in general hospital data. Uses calendar year reporting. Total rates are directly age-standardised using the Australian 2001 Standard population. ‘Other Australians’ includes registrations for non-Indigenous people and those for whom Indigenous status was ‘not stated’. Rate ratio is the Indigenous rate divided by the rate for other Australians.

Figure 24 and 25, and Table 17: Data are presented in 3-year groupings because of small numbers each year.

Figure 25: ‘Australia’ total includes cases where remoteness category was not known.

Table 17: ACT rates are based on very small numbers and would be expected to fluctuate from year to year.

1.10 Decayed, missing, filled teeth

Table 18: Excludes children who do not have teeth. ‘Total has teeth or gum problems’ will be less than the sum of the components as a child can have more than one tooth or gum problem. Total excludes not known responses.

Table 19: The estimate for ‘4–6 year olds’ are estimated as the average of the mean for 4, 5 and 6 year olds and are not age-standardised. Similar methodology is used to estimate the mean for ‘8–10 year olds’ and ‘12–14 year olds’.

Figure 27: The estimate for the Aboriginal and Torres Strait Islander peoples ‘15–34’ age group has a relative standard error of 25% to 50% and should be used with caution. Excludes those with no natural teeth.

1.11 HIV/AIDS, hepatitis C and sexually transmissible infections

Refer to notes in measure 1.04 for notes on the National Notifiable Disease Surveillance System. Rates have been directly age-standardised using the 2001 Australian population. Uses calendar year reporting. Data are presented in two-year or three-year groupings due to small numbers each year. ‘Other Australians’ includes notifications for non-Indigenous Australians and those for whom Indigenous status was ‘not stated’.

Figures 30 and 32: Chlamydia data are reported for Western Australia, South Australia, Tasmania and the Northern Territory. Syphilis and Gonorrhoea data are reported for Victoria, Queensland, Western Australia, South Australia, Tasmania and the Northern Territory. Hepatitis data are reported for New South Wales, Victoria, Western Australia, South Australia, Tasmania and the Northern Territory. These jurisdictions are considered to have adequate levels of Indigenous identification in the respective data. They do not represent a quasi-Australian figure. 2008 data for Northern Territory is preliminary.

Figure 30: Age-specific rates are calculated using the average Indigenous June population for the relevant years.

Figure 31: AIDS data excludes 2008 data from NSW, data not available due to incompleteness.

1.12 Children’s hearing loss

Figure 33: Refer to notes for measure 1.02 regarding hospitalisation data. ICD-10-AM codes H60–H95.

Table 21: Data for the National Aboriginal and Torres Strait Islander Health Survey 1995 are available for non-remote regions only. The estimate for Remote areas and the 2001 non-remote data for Males have a relative standard error between 25% and 50% and should be used with caution.

1.13 Disability

Figure 34: Includes psychological disability. Therefore this variable is only appropriate for comparison with other surveys where the population is limited to non-remote areas, where questions on mental illness were included. Totals are directly age-standardised.

Table 22: Excluding psychological disability. ‘Total with a disability or long-term health condition’ includes disability type not specified. Note that more than one disability type may be reported and thus the sum of the components may add to more than the total.

Figure 36: Australia total includes Other Territories for the non-indigenous data No Usual Address for the indigenous data.

1.14 Community Functioning

Table 23: Unless otherwise indicated percentages are of the estimated total Aboriginal and Torres Strait Islander population aged 15 years and over.

1.15 Perceived health status

Figure 41: Data is age-standardised.

Figure 42: Includes chronic long-term conditions and injury only. The indigenous estimate for 0 and 1 ‘fair/poor’ long-term conditions and the non-indigenous estimate for 0 ‘fair/poor’ long-term condition has a relative standard error of between 25% and 50% and should be used with caution.

1.16 Social and emotional wellbeing

The data for Figure 44 comes from the AIHW National Mortality Database. Data are reported for New South Wales, Queensland, Western Australia, South Australia and the Northern Territory only. These five states and territories are considered to have adequate levels of Indigenous identification in mortality data. Data for these five jurisdictions over-represent Indigenous populations in less urbanised and more remote locations. Mortality data for the five jurisdictions should not be assumed to represent the experience in the other jurisdictions. Queensland and New South Wales has only had adequate and reliable identification of Indigenous deaths in their recording systems since 1998 and 2007 respectively and may be excluded from time series figures.

Although most deaths of Indigenous Australians are registered, it is likely that some are not accurately identified as Indigenous. Therefore, these statistics are likely to underestimate the Indigenous all-causes mortality rate. It should also be noted that different causes of death may have different levels of completeness of identification of Indigenous deaths that differ from the ‘all cause’ under-identification (coverage) estimates. Due to changes in the level of accuracy of Indigenous identification in the births and deaths data over time, caution should be used in interpreting changes in Indigenous mortality rates. It is also difficult to exactly identify the difference between the Indigenous and non-Indigenous mortality rates because of these data quality issues.

While most deaths of Indigenous Australians are registered, it is likely that some are not accurately identified as Indigenous. Therefore, these statistics are likely to underestimate the Indigenous infant deaths and depending on the under coverage in births may either underestimate or overestimate the rates. It is also difficult to exactly identify the difference between the Indigenous and non-Indigenous mortality rates due to these data quality issues. Deaths prior to 2007 are by year of registration and state/territory of usual residence. Deaths from 2007 onwards are by reference year and state/territory of usual residence. Registration year prior to 2007 is equivalent to reference year from 2007 onwards. Causes of death data for 2007 have been revised and are subject to further revisions. 2008 data have been subject to a process improvement which has increased the quality of these data. Causes of death data for 2008 are preliminary and subject to a revisions process. See Causes of Death, Australia, 2008 (cat. No. 3303.0) Technical Note 1: 2008 COD Collection—Process Improvement and Technical Note 2: Revisions Process for further information.

Some data are presented in 2-year, 3-year, 4-year or 5-year groupings because of small numbers each year. Unless otherwise stated, rates have been directly age-standardised using the 2006 Australian standard population. ‘Non-indigenous’ includes deaths of non-Indigenous people and those for whom Indigenous status was not stated, unless otherwise stated. Rate ratio is the Indigenous rate divided by rate for non-Indigenous.

Figure 43: The rates for total persons were directly age-standardised, while the rates for each age group are crude rates.

Figure 44: ICD-10 codes: F00–F99, G30, G47.0, G47.1, G47.2, G47.8, G47.9, O99.3, R44, R45.0, R45.1, R45.4, R48. These data exclude registered deaths where the Indigenous status is not stated. Rates are age-specific death rates per 1,000 using the midpoint populations for the relevant years. The completeness of identification of Indigenous deaths can vary by age.

Figure 45: Average number of stressors per person is based on all persons reporting stressor(s).

Table 24: Level of psychological distress is based on the Kessler-5 (K5) measure of psychological distress. Overall levels of distress are based on frequency responses to the following five questions about feelings in the last 4 weeks: About how often did you feel nervous?; About how often did you feel without hope?; About how often did you feel restless or jumpy?; About how often did you feel everything was an effort?; and About how often did you feel so sad that nothing could cheer you up? ‘Low/moderate’ includes persons who said they had not had any of these feelings in the last 4 weeks (score of 5). ‘Owner’ comprises persons living in a dwelling that was owned without a mortgage, owned with a mortgage or being purchased under a rent/buy scheme. ‘Highest year of school completed’ excludes persons who were attending secondary school.

Figures 46 and 47 and Table 25: Refer to notes for measure 1.02 regarding hospitalisation data.

Table 25: Includes hospitalisations for which sex was indeterminate or not stated. Directly age-standardised using the Australian 2001 standard population. Total mental health-related conditions include Mental & behavioural disorders due to psychoactive substance use (F10–F19), Schizophrenia, schizotypal and delusional disorders (F20–F29), Mood disorders (F30–F39), Neurotic, stress-related disorders (F40–F49), Disorders of adult personality and behaviour (F60–F69), Behavioural and emotional disorders (F90–F98), Organic, including symptomatic, mental disorders (F00–F09), Behavioural syndromes assoc. with physiological disturbances (F50–F59), Unspecified mental disorder (F99), Mental retardation (F70–F79), Disorders of psych. development (F80–F89) and other. Other includes ICD-10-AM codes relating to mental health: G30, G47.0, G47.1, G47.2, G47.8, G47.9, O99.3, R44, R45.0, R45.1, R45.4, R48, Z00.4, Z03.2, Z04.6, Z09.3, Z13.3, Z50.2, Z50.3, Z54.3, Z61.9, Z63.1, Z63.8, Z63.9, Z65.8, Z65.9, Z71.4, Z71.5, Z76.0.

1.17 Life expectancy at birth

Figure 48 and Table 26: Due to significant changes in methodology, estimates of life expectancy at birth for 2005–07 are not comparable to previously published estimates. ‘Australia’ includes all states and territories.

Figure 49: Life expectancy estimates for Aboriginal and Torres Strait Islander peoples and all Australians are for 2005–2007. Life expectancy estimates for Canada are for 2001. First Nations refers to the total North American Indian population including both Registered Indians and Non-Status Indians. Registered Indians are individuals who are registered under the Indian Act. Métis refers to individuals with mixed Aboriginal and European ancestry. Inuit are the original inhabitants of Arctic Canada. Life expectancy estimates for Maoris and the total New Zealand population are for 2005–2007.

1.18 Median age at death

Refer to notes for measure 1.16 regarding mortality data.

The median age at death represents the age at which exactly half the deaths registered (or occurring) in a given time period were deaths of people above that age and half were deaths below that age. Care should also be exercised when analysing Indigenous median age at death, as differences in identification by age may lead to biased summary indicators such as median age at death.

Table 27: The incompleteness of Indigenous identification means that the number of deaths registered as Indigenous is an underestimate of the actual number of deaths which occur in the Aboriginal and Torres Strait Islander population. Variations in median age at death by Indigenous status, sex and jurisdiction should be interpreted with care as they are sensitive to differential data quality. Data exclude registered deaths where Indigenous status was not stated.

Figures 51 and 52: Data presented in this table may differ from data presented in the 2006 edition of this report for comparable years because of a change from using year of occurrence of death to year of registration of death for mortality analyses.

1.19 Infant mortality rate

Refer to notes for measure 1.16 regarding mortality data. Rates are per 1,000 live births.

Figure 53: Rates presented in this table may differ from those presented in the 2006 edition of this report for comparable years because of a change from using year of occurrence of death to year of registration of death for mortality analyses. The average of births over 1993–95 in Western Australia was used for births in Western Australia in 1991 and 1992 as there were errors in the number of births recorded in these years. Figure 54: Data exclude 34 registered infant deaths where Indigenous status was not stated over the period 2007–08 in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined.

Tables 28 and 29: Data exclude 104 registered infant deaths where Indigenous status was not stated over the period 2004–08 in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined.

Table 29: 'Infant' includes persons with an age at death of under 1 year. Different causes of death may have levels of completeness of identification of Indigenous deaths that differ from the all-cause under-identification (coverage) estimates. Data presented for SIDS are a subset of data presented for signs, symptoms and ill-defined conditions presented in this table. ‘Other conditions’ include: neoplasms, diseases of blood and blood-forming organs, endocrine, nutritional and metabolic diseases, mental and behavioural disorders, diseases of the nervous system, diseases of the eye and adnexa, diseases of the ear and mastoid process, diseases of the digestive system, diseases of the musculoskeletal system and connective tissues, diseases of the genitourinary system, and diseases of the skin and subcutaneous tissue. ICD codes are: Certain conditions originating in the perinatal period (P00–P96), Signs, symptoms & ill-defined conditions (R00-R99), SIDS (R95), Congenital malformations (Q00–Q99), Diseases of the respiratory system (J00–J99), Injury & poisoning (V01–Y99), Infectious and parasitic diseases (A00–B99), and Diseases of the circulatory system (I00–I99).

1.20 Perinatal mortality

Data for this measure come from the ABS Deaths Registration Database. The ABS Deaths Registration Database contains details of all deaths registered in Australia including information on fetal (stillbirths) and neonatal deaths (deaths occurring in live births up to 28 days of age) by age of the baby, sex, state/territory of birth, Indigenous status and cause of death (ICD-10). Also refer to notes for measure 1.16 regarding mortality data.

Perinatal deaths are all fetal deaths (at least 20 weeks gestation or at least 400 grams birthweight) plus all neonatal deaths (death of a live-born baby within 28 days of birth). Perinatal death rates are calculated per 1,000 all births for the calendar year.

Table 30: Includes all fetuses and babies delivered weighing at least 400 grams or, if birthweight is unavailable, at gestational age of 20 weeks or more. Data based on state of usual residence of mother. Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. It is important to note that cells with a zero value have not been affected by confidentialisation. ‘Other conditions’ includes all other causes of death not already included in the table.

1.21 Sudden infant death syndrome

Refer to notes for measure 1.16 regarding mortality data. SIDS—Sudden Infant Death Syndrome, ICD-10 code: R95. SIDS data in this table is for deaths under 1 year of age. Rates are per 1,000 live births.

Figure 57: The completeness of identification of Indigenous deaths can vary by age. Deaths and rates presented in this table may differ from those presented in the 2006 edition of this report for comparable years because of a change from using year of occurrence of death to year of registration of death for mortality analyses.

Figure 58 and Table 31: Data exclude 10 registered infant deaths where Indigenous status was not stated over the period 2004–2008 in NSW, Queensland, Western Australia, South Australia and the Northern Territory combined. Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. It is important to note that cells with a zero value have not been affected by confidentialisation.

Figure 58: Rates are crude rates per 1,000 live births.

Table 31: Rates per 1,000 live births have been directly age–standardised using the 2001 Australian standard population

1.22 All-causes age-standardised deaths rates

Refer to notes for measure 1.16 regarding mortality data. These data exclude 5,756 registered deaths where the Indigenous status is not stated.

Figures 59, 60, and Table 32: Rates have been directly age-standardised using the 2001 Australian population.

Figure 59: Rates presented in this table may differ from those presented in the 2006 edition of this report for comparable years because of a change from using year of occurrence of death to year of registration of death for mortality analyses. Non-Indigenous estimates are available for census years only for the WA, SA and NT data for 1998–2008. In the intervening years, Indigenous population figures are derived from assumptions about past and future levels of fertility, mortality and migration. In the absence of non-Indigenous population figures for these years, it is possible to derive denominators for calculating non-Indigenous rates by subtracting the Indigenous population from the total population. Such figures have a degree of uncertainty and should be used with caution, particularly as the time from the base year of the projection series increases. Preliminary 2007 and 2008 mortality data from ABS used.

1.23 Leading causes of mortality

Refer to notes for measure 1.16 regarding mortality data.

Tables 33 and 34: Data for lung cancer, cervical cancer and digestive organ cancers are a subset of the data presented for all cancers; data for diabetes are a subset of data presented for all endocrine, metabolic and nutritional disorders in this table. Data for cervical cancer are for females only. ‘Other causes’ includes: diseases of the blood and blood-forming organs and certain disorders involving the immune system, mental & behavioural disorders, diseases of the eye and adnexa, diseases of the ear and mastoid process, diseases of the skin & subcutaneous tissue, diseases of the musculoskeletal system and connective tissue, diseases of the genitourinary system (excluding kidney diseases), pregnancy, childbirth & the puerperium, congenital malformations, deformations and chromosomal abnormalities, symptoms, signs and abnormal clinical findings not elsewhere classified. ICD codes are: Circulatory diseases (I00–I99), External causes (V01–Y98), Cancer (C00– D48), Lung cancer (C34), Cervical cancer (C53), Digestive organ cancers (C15–C26), Endocrine, metabolic & nutritional disorders (E00–E89), Diabetes (E10–E14), Respiratory diseases (J00–J99), Digestive diseases (K00–K93), Conditions originating in perinatal period (P00–P96), Nervous system diseases (G00–G99), Kidney diseases (N00–N29), and Infectious & parasitic diseases (A00–B99).

Table 33: Rates exclude 5,030 registered deaths where the Indigenous status is not stated. Data cells with small values have been randomly assigned to protect the confidentiality of individuals. As a result, some totals will not equal the sum of their components. It is important to note that cells with a zero value have not been affected by confidentialisation.

Table 34: Census year non-Indigenous and Indigenous estimates are sourced from Experimental Estimates of Aboriginal and Torres Strait Islander Australians (cat. no. 3238.0.55.001). Data based on reference year. Total deaths are number of Indigenous deaths between 2004 and 2008 inclusive. Expected deaths are calculated by applying the cause specific mortality rate for the non-Indigenous standard population to the Indigenous population of the reference period. Excess deaths are calculated by subtracting the expected deaths from the observed deaths. Percent excess is calculated as excess deaths by cause/total excess deaths *100.

Figure 62: A high proportion of the cells within this table have been randomised to ensure confidentiality of data. ABS recommends cells with small values be interpreted with caution. Other causes includes all other external causes of death not presented elsewhere in this table. ICD-codes are: Intentional self-harm (X60–X84), Transport accidents (V01–V99), Accidental poisoning by and exposure to noxious substances (X40–X49), Assault (X85–Y09), and Accidental falls (W00–W19).

Table 35: Data excludes 1,784 deaths for circulatory diseases and 973 deaths for neoplasms where the Indigenous status was not stated. Directly age-standardised using the Australian 2001 standard population. Data presented for acute myocardial infarction are a subset of data presented for ischaemic heart disease; data presented for stroke are a subset of data presented for cerebrovascular disease in this table. Data presented for bronchus & lung cancer are a subset of data presented for all respiratory and inthrathoracic organs; data presented for cervix cancer are a subset of data presented for all cancers of the female genital organs in this table.

Figure 63: Preliminary 2007 and 2008 cause of death data. Rates have been directly age-standardised using the 2001 Australian standard population. Indigenous rate used 2006 Series B Indigenous experimental population estimates as denominator. Other population for 2006 calculated by subtracting 2006 Indigenous population from 2006 Total population.

1.24 Maternal mortality

Maternal deaths of Aboriginal and Torres Strait Islander women expressed as a rate per 100,000 Indigenous confinements and rate ratio. Data for this measure come from the publications Maternal Deaths 1997–1999 and Maternal Deaths 2003–2005, published by the AIHW National Perinatal Statistics Unit Slaytor et al. 2004; Sullivan et al. 2008.

In line with international conventions, the maternal mortality rate is calculated using direct and indirect deaths, excluding incidental deaths and uses the total number of confinements of at least 20 weeks gestation or 400 gram birthweight as the denominator.

Information identifying Indigenous status has been available since 1970 but only for cases classified as direct maternal deaths. Information identifying Indigenous status for indirect and incidental deaths has been collected only since 1991. It has therefore been possible to calculate the maternal mortality rate for Aboriginal and Torres Strait Islander women since 1991.

Maternal deaths where Indigenous status was ‘unknown’ have been included in rates with non-Indigenous deaths prior to the 1997–99 triennium. All calculations of maternal mortality by Indigenous status from the 1997–99 triennium exclude deaths where Indigenous status is unknown. In 1997–99, Indigenous status was reported for 77 (89%) of the 87 maternal deaths.

Figure 64 and Table 36: Rates per 100,000 confinements calculated using direct and indirect deaths only. For 1991–93 and 1994–96, the non-Indigenous maternal mortality rate includes non-Indigenous deaths and deaths where Indigenous status is unknown. For subsequent years, deaths where Indigenous status is unknown have been excluded. Ratios are the Indigenous maternal mortality rate divided by non-Indigenous maternal mortality rate. Excludes incidental deaths.

1.25 Avoidable and preventable deaths

Refer to notes for measure 1.16 regarding mortality data.

Figure 65: Preliminary 2007 and 2008 mortality data.

Figure 66: This figure presents data for Avoidable Mortality as defined in Table A1 in Appendix 1.1 of the Australian and New Zealand Atlas of Avoidable Mortality. It presents primary, secondary and tertiary weighted data as defined in Table 3 of the Report of the New South Wales Chief Health Officer. Directly age-standardised using the Australian 2001 standard population. Primary, secondary and tertiary weightings by cause do not always add to 100%, therefore primary, secondary and tertiary death counts may not add to the number of Avoidable deaths. Unavoidable Mortality is all causes other than those specified as Avoidable Mortality.

Table 37: This table presents data for Avoidable Mortality as defined in Table A1 in Appendix 1.1 of the Australian and New Zealand Atlas of Avoidable Mortality. Directly age-standardised using the Australian 2001 standard population. Other includes all avoidable mortality not specifically detailed in the table.

Determinants of Health (Tier 2)

2.01 Access to functional housing with utilities

The data for this measure comes from the Community Housing and Infrastructure Needs Survey (CHINS). It collects information on a variety of topics from discrete Aboriginal and Torres Strait Islander communities throughout Australia and on Indigenous organisations that provide rental housing to Indigenous people. Only discrete Indigenous communities are covered. The data are collected from key personnel in Indigenous communities and housing organisations that are knowledgeable about housing and infrastructure issues.

Table 38: Victoria and Tasmania included in Australia for confidentiality reasons.

Figure 69: ‘Washing people’ comprises households lacking a working bath or shower. ‘Washing clothes/bedding’ comprises households lacking washing machine and/or laundry tub. ‘Storing/preparing food’ comprises households with working stove/oven/cooking facilities and a kitchen sink and a working refrigerator. ‘Sewerage facilities’ comprises households with a working toilet. Excludes households for which information about working facilities was not reported.

2.02 Overcrowding in housing

Data are based on the 2001 and 2006 Census. Households are considered overcrowded if one or more additional bedroom is required to satisfy the Canadian National Occupancy Standard. Proportions have been calculated on all occupied private dwellings excluding those where number of bedrooms was not stated and includes not stated state/territory if the categorisation is not based on state/territory. Persons exclude visitors.

Categorisation in the 2002 and 2008 National Aboriginal and Torres Strait Islander Social Surveys is based on the Canadian National Occupancy Standard for housing appropriateness. Denominator excludes persons in households for which housing utilisation could not be determined.

Survey of Income and Housing 2007–08 data for non-Indigenous persons excludes those in households in collection districts defined as very remote, accounting for about 23% of the population in the NT. Table 39: ‘Australia’ includes other territories. ‘Private’ renter includes dwellings being rented from a real estate agent, parent/other relative or other person, dwellings being rented through a 'Residential park (includes caravan parks and marinas)', 'Employer-government (includes Defence Housing Authority)' and 'Employer-other employer' (private). ‘Other tenure types’ includes dwellings being purchased under a rent/buy scheme, occupied rent-free, occupied under a life tenure type and other tenure type nfd. ‘Total’ includes tenure type not stated.

2.03 Environmental tobacco smoke

Table 40: ‘No’ category for ‘Whether any regular smokers smoke at home indoors’ includes households in which there were no current daily smokers.

Figure 74 and 75: Excludes households in which the smoking status of members was not stated.

2.04 Year 3, 5 and 7 literacy and numeracy

Table 41, Figures 76 and 77: Equating the 2008 NAPLAN results with the 2009 results is a complex procedure and involves some degree of statistical error. For this reason, there may be minor fluctuations in the average NAPLAN test results from year to year when, in reality, the level of student achievement has remained essentially the same. It is only when there is a meaningful change in the results from one year to the next, or when there is a consistent trend over several years, that statements about improvement or decline in levels of achievement can be made confidently. Some caution is required when interpreting changes in the performance across 2008 and 2009.

2.05 Years 10 and 12 retention and attainment

Data for this measure come from the AIHW analysis of ABS National Schools Statistics Collection. Retention rate is the Year 10 or 12 students as a proportion of the corresponding cohort from the first year of secondary schooling (Year 7/8). Attainment rate is the proportion of Year 11 students who went on to achieve a Year 12 certificate.

Figure 78 and Table 42: While most students are recorded, it is likely that some are not accurately identified as Indigenous. Therefore, these statistics are likely to underestimate the number of Aboriginal and Torres Strait Islander students. In addition, the standard Indigenous status question has not yet been implemented in some jurisdictions. The following factors have not been taken into account in these statistics: students repeating a year of education, migration and other net changes to the school population, enrolment policies (including year starting high school which contributes to different age/grade structures between states and territories), inter-sector transfer and interstate movements of students. In small jurisdictions, relatively small changes in student numbers can create apparently large movements in retention rates.

Table 42: The inclusion or exclusion of part-time students can also have a significant effect on apparent retention rates, especially in South Australia, Tasmania and the Northern Territory which have relatively large proportions of part-time students. Data for Western Australia have been affected by changes in scope and coverage over time. Some Australian Capital Territory rates exceed 100%, largely reflecting the movement of students from non-government to government schools in Years 11 and 12, and of New South Wales residents from surrounding areas enrolling in Australian Capital Territory schools. In 2009, changes to the processing of Northern Territory enrolment data will affect comparisons with previous years of all numbers drawing on student data for the Northern Territory.

2.06 Educational participation and attainment of Aboriginal and Torres Strait Islander adults

Figure 81: ‘Technical or Further Education Institution’ includes TAFE/technical college, business college, and industry skills centre.

Figure 82: ‘Completed year 9 or below’ includes persons never attended school. Excludes those still attending secondary school.

Figure 83: Qualifications are as classified to the ABS Classification of Qualifications. ‘Bachelor degree or above’ includes bachelor degree, doctorate, masters, graduate diploma, graduate certificate.

Figure 84: The data comes from the National Centre for Vocational Education Research. Non-identification rates for Indigenous students in these data are high. Care also needs to be taken when comparing data across jurisdictions for load pass rates, as average module durations vary across jurisdictions. Percentages are calculated using the Indigenous and non-Indigenous estimated resident populations for 2006. Includes statements of attainment.

2.07 Employment status including CDEP participation

Figures 85: ‘Participation rate’ is the ratio of the total of persons who are employed and unemployed, to the civilian population in the same group including those who are employed, unemployed and not in the workforce. ‘Employed as a proportion of total population’ is the total of those persons who are employed (CDEP or non-CDEP) as a proportion of the civilian population in the same group. The unemployment rate is the ratio of those persons who are employed to the total of persons who are employed and unemployed.

Figure 86 and 88: Excludes ‘Labour force status not stated’ (except in Total Age-standardised).

2.08 Income

Figure 89: Equivalised gross household income quintile boundaries for Indigenous persons are: first (0 to $435); second ($436 to $686); third ($687 to $952); fourth ($953 to $1380); and fifth ($1,381 or more). Equivalised gross household income quintile boundaries for non-Indigenous persons are: first (0 to $423); second ($424 to $666); third ($667 to $925); fourth ($926 to $1,341); and fifth ($1,342 or more). Difference between rates for Indigenous and non-Indigenous persons are not statistically significant for these categories.

Figure 90: Gross weekly equivalised cash income of household quintile boundaries are: lowest quintile less than $329.20; second quintile $554.80–$685.50; third quintile $812.10–$951.80; fourth quintile $1,131.40-$1,380.20; highest quintile $1,784.80 or more for 2008 NATSISS. Figure 92: mean weekly equivalised gross household incomes for 1994 and 2002 have been adjusted for inflation using CPI.

2.09 Housing tenure type

Table 44, 45, and Figure 93: Persons aged 18 years and over. Home owners ‘being purchased’ includes with a mortgage and participants in rent/buy schemes. Renters ‘private and other landlord types’ includes real estate agents, unrelated persons, relatives, owner/managers of caravan parks, employers and other landlords. ‘Total renters’ includes landlord type not known and boarders. ‘Other’ includes persons living under life tenure schemes, those living rent-free and participants in rent/buy schemes.

Table 45: ‘Total’ includes tenure type not stated.

2.10 Index of disadvantage

Figure 95: The population of some states/territories was unable to be split into exact quintiles based on the SEIFA index of advantage/disadvantage, in all except one of these cases the best approximate quintiles were calculated. Approximate population quintiles based on the SEIFA Index of Advantage/Disadvantage were unable to be calculated for Tasmania because of the population spread.

2.11 Dependency Ratio

Data for this measure was derived from ABS population estimates based on the 2006 Census of Population and Housing.

2.12 Single-parent families

Figures 100, 101 and 102: Number of persons for family households excludes unrelated individuals living in the family household, Visitors only and Other not classifiable households. Dependent children are children under 15 years of age and full-time dependent students aged 15–24 years.

2.13 Community safety

Refer to notes for measure 1.16 regarding mortality data for Figures 103 and 104. Causes of injury are based on the first reported external cause as ‘assault’ ICD-10-AM codes X85–Y09, where the principal diagnosis was ‘injury and poisoning’ (S00–T98).
Tables 47 and 48: In the 2008 NATSISS, Indigenous persons were asked about 24 separate stressors, and in the 2007–08 NHS, non-Indigenous persons were asked about 14 separate stressors.

2.14 Contact with the criminal justice system

Table 49: ‘Persons’ includes sex not stated. The ratio of Indigenous to non-Indigenous imprisonment is calculated by dividing the Indigenous age-standardised rate by the non-Indigenous age-standardised rate. Numbers and rates for New South Wales exclude Australian Capital Territory prisoners held in New South Wales. Rates for Australian Capital Territory include Australian Capital Territory prisoners held in New South Wales as well as Australian Capital Territory prisoners held in the Australian Capital Territory.

2.15 Child protection

Figure 107: Population estimates are based on the 2006 census, refer to Appendix table A1.26 in the 2008–09 Child Protection Australia report for the specific populations used in the calculation of rates. The rate for Indigenous and non-Indigenous children and rate ratio has not been reported for Tasmania due to the high proportion of children for whom Indigenous status was unknown. Tasmania has been excluded from the Australian total rates and rate ratio.

Table 50: South Australia can only provide the number of children in out-of-home care when the Department is making a financial contribution to the care of a child. Tasmania is not able to include children in care where a financial payment has been offered but has been declined by the carer. However, the number of carers declining payment is likely to be very low. Population estimates are based on the 2006 census, refer to Appendix table A1.26 in the 2008–09 Child Protection Australia report for the specific populations used in the calculation of rates. Rate ratios are calculated by dividing the un-rounded rate of Indigenous children who were in out-of-home care by the un-rounded rate of non-Indigenous children who were in out-of-home care. The resulting number shows a comparative representation per 1,000 children.

Table 51: In Western Australia and Victoria, a small number of children are placed with externally managed foster carers who are also their relative and have been recorded in the foster care category. South Australia can only provide the number of children in out-of-home care where the Department is making a financial contribution to the care of a child. Tasmania is not able to adhere to the AIHW definition of OOHC for 2008–09 to include children in care where a financial payment has been offered but has been declined by the carer. However, the number of carers declining a financial payment is likely to be very low. In the Northern Territory, children placed with family members have all been included in the ‘Indigenous relative/kin’ category. This table does not include Indigenous children who were living independently or whose living arrangements were unknown. Percentages in tables may not add to 100 due to rounding. Children in family group homes are reported as in residential care.

2.16 Transport

Table 52: ‘Total’ for use of public transport in last 2 weeks includes persons who were housebound. Main reason for not using public transport were asked of people who had not used public transport in last 2 weeks but who had access to public transport in their area. ‘No suitable services’ includes no services available at night/convenient and available for destination. ‘Personal reasons’ includes concerns about personal safety, treated badly/discrimination and health reasons. ‘Total’ for main reason for not using public transport excludes not known responses.

2.17 Indigenous people with access to their traditional lands

2.18 Tobacco Use

Figure 114: Smokers comprises current daily smokers and persons who smoked less than daily. Difference between 1994 and 2008 is statistically significant. Difference between 2002 and 2008 is statistically significant.

2.19 Tobacco smoking during pregnancy

Refer to notes for measure 1.01 regarding perinatal data.

Figure 116: State-level data are based on place where birth occurred, not place of usual residence. Cross-border issues need to be considered here, e.g. a high proportion of births in Australian Capital Territory hospitals are for mothers resident in New South Wales. For South Australia, 'smoked' includes women who quit before the first antenatal visit. For Northern Territory, smoking status was recorded at the first antenatal visit. Proportions are directly age-standardised using the Australian female population aged 15–44 years who gave birth in 2007. Data are not available for Victoria. Because of differences in definitions and methods used for data collection, care must be taken when comparing across jurisdictions. Mother’s tobacco smoking status during pregnancy is self-reported.

Figure 117: Age-standardised data based on directly age-standardised proportions using the population of women aged 15–44 years who gave birth in all states as the standard

Table 54: Live births only for ‘Low Birthweight’ and ‘Apgar score’, Excludes Victoria.

2.20 Risky and high risk alcohol consumption

Figures 118 to 120: Alcohol risk level based on Australian Alcohol Guidelines 2000. ‘Abstainers’ are defined as persons who consumed No alcohol in last 12 months. ‘Short-term Risk’ which includes ‘Drank at risky/high risk levels in last 12 months’ and ‘Drank at risky/high risk levels at least once a week’ is based on responses to questions in 2004–05 National Health Survey/NATSIHS about frequency of consumption of specified number of drinks in previous year. The number of drinks was based on the NHMRC guidelines for risky and high risk short-term alcohol consumption for males and females. ‘Drank at risky/high risk levels in last 12 months’ is defined as Persons who consumed alcohol at specified risky/high risk levels in the short-term on at least one occasion in the last 12 months. ‘Drank at risky/high risk levels at least once a week’ is defined as Persons who consumed alcohol at specified risky/high risk levels in the short-term at least once a week in the last 12 months. Risk level based on consumption in week prior to interview.

Figure 121: Refer to notes for measure 1.16 regarding mortality data. Excludes a total of 59 deaths for which Indigenous status was ‘not stated’. Rates are directly age-standardised using the Australian 2001 Standard population.

2.21 Drug and other substance use including inhalants

Table 55: The substance use questions in the 2008 NATSISS are comparable to those used in the 2002 NATSISS. However, when comparing between 2002 and 2008 it should be noted that there were changes in the proportion of people who did not accept the substance use form (6 per cent non-response in the 2002 NATSISS compared with 9 per cent for the 2008 NATSISS). ‘Analgesics and sedatives for non-medical use’ includes pain killers, tranquilisers and sleeping pills. ‘Total used substances in last 12 months’ includes heroin, cocaine, petrol, LSD/synthetic hallucinogens, naturally occurring hallucinogens, ecstasy/designer drugs, and other inhalants, and includes methadone in 2008. Sum of components may be more than total as persons may have reported more than one type of substance used. Used substances in the last 12 months ‘Total’ includes 'whether used in last 12 months' not known. ‘Not stated’ comprises people who accepted the substance use form but did not state if they had ever used substances.

2.22 Level of physical activity

Figure 124: ‘Age-standardised’ rates are directly age-standardised proportions.

Figure 125: ‘Total’ includes level of physical activity not stated.

2.23 Dietary behaviours

Figure 126: Recommended usual daily vegetable intake is defined as ‘5 or more serves per day’. Recommended usual daily fruit intake is defined as ‘2 or more serves of fruit per day’. Low usual daily vegetable intake is defined as ‘1 or less serves per day including not eating vegetables at all’. Low usual daily fruit intake is defined as ‘1 or less serves per day including not eating fruit at all’. Recommended usual daily vegetable intake not available for 2001 as there was no category for 5 serves or more.

Figure 127: Information for some persons aged 15–17 years was provided by a parent or guardian.

Table 56: ‘Usual type of milk consumed’ total includes ‘usual type of milk’ not known. ‘Salt added after cooking’ total includes ‘frequency salt is added after cooking’ not known.

2.24 Breastfeeding practices

Table 57: ‘Ever breastfed’ includes not known if child currently breastfed. ‘Total’ excludes children for whom breast feeding status was not known.

2.25 Unsafe sexual practices

Figure 130: Refer to notes in measure 1.04 for notes on the National Notifiable Disease Surveillance System. Rates have been directly age-standardised using the 2001 Australian population.

Figures 131 and 132: Refer to notes for measure 1.01 regarding perinatal data.

Figure 132: Excludes not stated Indigenous status.

2.26 Prevalence of overweight and obesity

Figures 133, 134 and 135: Proportions exclude those for whom BMI was unknown or not stated (39,583 or 15% for Indigenous and 1,175,132 or 8% for non-Indigenous).

Figure 135: Directly age-standardised proportions to the Australian 2001 standard population.

Health System Performance (Tier 3)

3.01: Antenatal care

Data for this measure come from the state/territory-based Perinatal Collections (‘Midwives Collections’).

It collects data on women who gave birth in the period, whether resulting in a live or still birth, if the birthweight is at least 400 grams or the gestational age was 20 weeks or more. Indigenous and non-Indigenous data exclude births where the mother’s Indigenous status is not stated. Jurisdiction-level data are based on place where birth occurred, not place of usual residence. Cross-border issues need to be considered here, e.g. a high proportion of births in Australian Capital Territory hospitals are for New South Wales mothers. Data not available from the Australian Capital Territory, Victoria, Western Australia and Tasmania. Note that WA has revised its midwives notification form and data should be available from 2010.

Figure 136: Rate is for NSW, Queensland and South Australia combined. In 2007 NSW collected data for a new variable ‘was antenatal care received’, which provides a more accurate picture of the use of antenatal sessions. Prior to 2007 data for the number of women attending antenatal sessions in NSW was restricted to those whose 'duration of pregnancy at first antenatal session was recorded’. In order to maintain consistency in the time series data using the pre-2007 definition is used. South Australia data excludes women where number of antenatal care sessions attended is unknown.

Figure 137: Data for New South Wales and Northern Territory only. Data not collected in Queensland or South Australia.

Figure 139: Data for Queensland, South Australia and Northern Territory only. Data not collected in New South Wales.

3.02 Immunisation

Figure 140 and Table 58 is based on the Australian Childhood Immunisation Register (ACIR) which is managed by Medicare Australia and holds information on childhood immunisation coverage. All children under seven years of age who are enrolled in Medicare, are automatically included on the ACIR. Children who are not eligible to enrol in Medicare can be added to the ACIR when details of a vaccination are received from a doctor or immunisation provider. Coverage estimates for Aboriginal and Torres Strait Islander children include only those who identify as such and are registered on the ACIR. Children identified as Indigenous on the ACIR may not be representative of all Aboriginal and Torres Strait Islander children, and thus coverage estimates should be interpreted with caution. Children for whom Indigenous status was not stated are included with the ‘non-Indigenous’ under the ‘other’ category. Vaccination coverage is a measure of the proportion of people in a target population who have received the recommended course of vaccinations at a particular age. Vaccination coverage data from the ACIR and the NATSIHS are not directly comparable because of the differences in the cohort used, population coverage, data collection method, method of calculating ‘fully immunised’ and vaccines included.

Figure 140: Three-month cohort used—cohort for ‘aged one year’ is born between 1 July and 30 September 2008, cohort for ‘aged two years’ is born between 1 July and 30 September 2007, and cohort for ‘aged five years’ is born between 1 July and 30 September 2004.

3.03 Early detection and early treatment

Figure 142: Child health checks commenced in May 2006. Data provided are for the period 1 July 2008 to 30 June 2009. Rates are calculated using the average of 2008 and 2009 Indigenous population projections for those aged 0–14 years. The adult health checks were introduced in May 2004 as a biennial assessment. Data provided are for the period 1 July 2008 to 30 June 2009. Rates are calculated using the average of 2008 and 2009 Indigenous population projections for those aged15–54 years.

Figure 143: Data provided are for the period 1 July 2008 to 30 June 2009. Rates are calculated using the average of 2008 and 2009 Indigenous population projections for those aged 55 years and over and the total Australian population estimates for those aged 75 years and over.

Figure 144: The data is from BreastScreen Australia for women who attend for a screening mammogram at a BreastScreen Australia service. Indigenous status data are only available at the national level as numbers are too small to provide meaningful comparison between jurisdictions.

Figure 145: Should exclude data from women who have had a hysterectomy, however this data was not collected in the NATSIHS.

3.04 Chronic disease management

Figure 147: The data comes from the Service Activity Reporting Data Collection. The SAR collects data from approximately 150 Australian Government-funded Aboriginal and Torres Strait Islander primary health-care services and is held at the Department of Health and Ageing (DoHA). It is estimated that these services provide GP services to around 40% of the Indigenous population. From 2006–07 the SAR response category 'Management of chronic illness' was replaced by the three categories 'Management of diabetes', 'Management of cardiovascular disease' and 'Management of other chronic illness'. 'Management of chronic illness' represents the percentage of services that provided or facilitated access to any one of those three categories. 2008–09 OSR data counts all auspice services individually when calculating rates, therefore caution should be exercised when comparing rates with earlier data collection periods.

Figure 148: Indigenous adults aged 15 years and over who are regular clients of the HFL service. Data for clients with Type 2 diabetes were provided by 68 services (11 urban services, 33 regional services and 24 remote services) and data for clients with coronary heart disease were provided by 68 services (12 urban services, 32 regional services and 24 remote services). Services used their own definition of regular client. Finalised data from one service for clients with coronary heart disease was excluded on the basis that the numbers were inconsistent with other data provided and for this indicator the service wrote ‘Recording paper-based notes not always accurate.’

3.05 Differential access to key hospital procedures

Tables 59 and 60 and Figure 150: Refer to notes for measure 1.02 regarding hospitalisation data.

Table 59: Proportions are directly age-standardised using the age and cause specific rates of other Australians.

Table 60: Includes procedures where the category was not stated. Figure 150: Per cent refers to the proportion of hospitalisations with coronary heart disease as the principal diagnosis receiving either coronary angiography or coronary revascularisation.

3.06 Ambulatory care sensitive hospital admissions

Refer to notes for measure 1.02 regarding hospitalisation data.

Figure 152: Directly age-standardised using the Australian 2001 standard population.

Figure 153: ICD-10-AM codes J10 J11 J13 J14 J153 J154 J157 J159 J168 J181 J188 A35 A36 A37 A80 B05 B06 B161 B169 B180 B181 B26 G000 M014 J45 J46 I50 I110 J81 E101 E102 E103 E104 E105 E106 E107 E108 E110 E111 E112 E113 E114 E115 E116 E117 E118 E130 E131 E132 E133 E134 E135 E136 E137 E138 E140 E141 E142 E143 E144 E145 E146 E147 E148 J20 J41 J42 J43 J44 J47 I20 I240 I248 I249 D501 D508 D509 I10 I119 E40 E41 E42 E43 E550 E643 E86 K522 K528 K529 N390 N10 N12 N11 N136 K250 K251 K252 K254 K255 K256 K260 K261 K262 K264 K265 K266 K270 K271 K272 K274 K275 K276 K280 K281 K282 K284 K285 K286 L03 L04 L08 L980 L88 L983 N70 N73 N74 H66 H67 J02 J03 J06 J312 K02 K03 K04 K05 K06 K08 K098 K099 K12 K13 K35 K36 K37 O15 G40 G41 R56 R02. Note some of these codes are for principal diagnosis only, some are for principal or additional diagnosis, and some are principal diagnosis with the exclusion of some procedure codes. For more information on coding used, refer to AIHW and National Health Performance Committee 2004, The national report on health sector performance indicators 2003.

3.07 Health promotion

Table 61: Data for this measure comes from the Health expenditure data. Estimates of the level of Indigenous under-identification were used to adjust some reported expenditure. In some states and territories, a single state wide average under-identification adjustment factor was applied. In others, differential under-identification factors were used, depending on the region in which the particular service(s) were located. In some jurisdictions, no Indigenous under-identification adjustment was considered necessary.

Table 62: Refer to notes in Figure 147 in 3.04 for notes on the Service Activity Reporting Data Collection. Two hundred and one of the 205 respondent Aboriginal and Torres Strait Islander primary health-care services provided valid data about health-related activities provided by the service. The percentages in the table are calculated as a proportion of these 201 services.

Figure 155: Data from five combined BEACH years April 2004–March 2005 to April 2008–March 2009 inclusive. Directly age-standardised rate using the total number of encounters for the period as the standard. Other includes non-Indigenous patients and patients for whom Indigenous status was not stated. IPCP-2 codes defining Advice/education codes A45002, B45002, D45002, F45002, H45002, K45002, L45002, N45002, P45002, R45001, S45002, T45002, U45002, W45004, X45002, Y45002, Z45002. IPCP-2 codes defining Counselling/advice treatment A45016, A45019, A45020, A45021, A45030, A48004, L45004, R45004, T45004, T45009. IPCP-2 codes defining Counselling/advice nutrition/weight T45005, T45007, T58002, A45006. IPCP-2 codes defining Counselling/advice smoking P58008, P45005. IPCP-2 codes defining counselling/ advice alcohol P45005, P58009. IPCP-2 codes defining counselling/ advice exercise A45004, A58005. IPCP-2 codes defining counselling/ advice lifestyle P45008, P58012. IPCP-2 codes defining family planning A98002, A98003, W14002, W45006, W45007, W45008,W58001, W58005, W58007, W58012, W58013,Y14001, Y45006, Y45007, Y58005, Y58006. IPCP-2 codes defining counselling/ advice relaxation P45007, P58011, P58017.

Figure 156: Communities with a population of 50 or more, or a reported usual population of fewer than 50 but which were not linked to a parent community or resource agency. The total communities includes ‘whether selected health promotion program conducted’ not stated and excludes communities where distance to nearest hospital not stated.

3.08 Discharge against medical advice

Refer to notes for measure 1.02 regarding hospitalisation data.

Figures 157 and 160: Percentage of hospital separations (excluding mental and behavioural disorders) in the period 2006–07 to 2007–08.

Figure 158: Proportions are age-standardised.

Figure 159: Proportions are age-standardised. Excludes private hospitals in Tasmania, the Northern Territory and the Australian Capital Territory. Data are based on state/territory of usual residence.

Figure 160: ICD-10-AM codes are: Injury, poisoning and certain other consequences of external causes (S00–Y98), Diseases of the respiratory system (J00–J99), Symptom, signs and abnormal clinical and laboratory findings, n.e.c. (R00–R99), Diseases of the digestive system (K00-K93), Complications of pregnancy, childbirth and the puerperium (O00–O99), Diseases of the skin and subcutaneous tissue (L00-L99), Diseases of the circulatory system (I00–I99), Endocrine, nutritional and metabolic diseases (E00-E90), Factors influencing health status and contact with health services (Z00–Z99), Certain infectious and parasitic diseases (A00–B99), and Diseases of the nervous system (G00–G99). ‘Other’ includes: neoplasms, certain conditions originating in the perinatal period, diseases of the ear and mastoid process, diseases of the eye and adnexa, diseases of the genitourinary system, diseases of the musculoskeletal system, diseases of the blood and blood-forming organs and certain disorders involving the immune system, and congenital malformations and deformations and chromosomal abnormalities. ‘Total’ includes hospitalisations for which no principal diagnosis was recorded and excludes mental and behavioural disorders (F00–F99).

3.09 Access to mental health services

Figure 160: These survey results are likely to undercount the number of Indigenous Australians visiting doctors. Combined financial year data for five years. Data for Indigenous and other Australians have not been weighted. Rates were directly age-standardised per 100. ‘Other’ includes non-indigenous patients and patients for whom Indigenous status was not stated. ICPC–2 codes: P01–P13, P15–P20, P22-P25, P27–P29, P70–P82, P85–P86, P98–P99.

Figure 161: The data for this figure comes from the AIHW National Community Mental Health Care Database (NCMHCD). The quality of the Indigenous identification in this database varies by jurisdiction and should be interpreted with caution. Rates were directly age-standardised using the Australian 2001 standard population. ‘Other Australians’ includes service contacts for non-Indigenous clients and those for whom Indigenous status was not stated (around 7% of all contacts).

Figures 162 and 163: Refer to notes for measure 1.02 regarding hospitalisation data.

Figure 163: ICD-10-AM codes F00–F99, G30, G47.0, G47.1, G47.2, G47.8, G47,9, 099.3, R44, R45.0, R45.1, R45.4, R48, Z00.4, Z03.2, Z04.6, Z09.3, Z13.3, Z50.2, Z50.3, Z54.3, Z61.9, Z63.1, Z63.8, Z63.9, Z65.8, Z65.9, Z71.4, Z71.5, Z76.0. Directly age-standardised using the Australian 2001 standard population. Australian hospitalisation numbers and rates have been adjusted for Indigenous under-identification using a national adjustment factor of 0.89. This factor was derived from a study undertaken by the AIHW in 2007 which assessed the level of Indigenous under-identification in hospital data in all states and territories by comparing information gathered from face-to-face interviews in public hospitals with results from hospital records. By applying this factor, the number of Indigenous hospitalisations was increased by 11% and these additional hospitalisations then subtracted from the number of hospitalisations for Other Australians. Rates include hospitalisations for which sex was not stated.

3.10 Aboriginal and Torres Strait Islander people in the health workforce

‘n.p.’ refers to not published (data cannot be released due to quality issues and confidentiality). Numbers less than 10 are considered too unreliable for general use due to the impact of randomisation of small cell values to avoid the release of confidential data. Occupation classification is based on 2006 Australian and New Zealand Standard Classification of Occupations (ANZSCO) codes. Classification codes for 1996 and 2006 were mapped to fit that of 2006. Table 11 includes a detailed breakdown of occupations. Average period change determined using regression analysis. Per cent change between the reporting periods 1996 and 2006 based on the average annual change over the period. Rate per 10,000 measures the health workforce available (numerator) to service the population (denominator). Denominator used in rates is the 2006 total population by Indigenous status minus those where occupation is not stated. Rate difference is non-Indigenous rate minus the Indigenous rate. Both 2001 and 2006 figures for ‘Registered Nurses’ include Midwifery and Nursing Professionals nfd. ‘Other medical practitioners’ includes specialists and surgeons. Health Promotion Officers could not be identified separately in 2001 and 1996 due to different occupation classifications. These were included in Community Workers in 2001 and 1996 and not included in the table. For some occupations, such as Nurses, Medical Practitioners, and Pharmacists, there are slight differences between the 2006 figures in this table and those in the Health and Community Services Labour Force 2006, and the Aboriginal and Torres Strait Islander Health Labour Force Statistics and Data Quality Assessment reports. These discrepancies are due to the impact of aggregating randomised data from data sets with different small cell distributions and the use of different occupation classifications (in the case of the second report).

3.11: Competent governance

Table 65: The data for this table comes from the Office of the Registrar of Indigenous Corporations. In 2008–09, compliance analysis was able to be completed for 84 companies incorporated under the ACA Act and registered with ORIC. This table excludes 2 deregistered companies and 4 companies unable to be matched for compliance analysis. Table 66: Refer to notes in Figure 147 in 3.04 for notes on the Divisions of Service Activity Reporting Data Collection.

3.12 Access to services by types of service compared to need

Figures 165 and 166: Indigenous rates should be interpreted with caution due to small population numbers in some jurisdictions. This also impacts on comparisons between jurisdictions and over time. Medicare data presented by Indigenous status have been adjusted for under-identification in the Medicare Australia Voluntary Indigenous Identifier (VII) database. The methodology for this adjustment was developed and verified by the AIHW and the Department of Health and Ageing for assessment of MBS and PBS service use and expenditure for Indigenous Australians. For an explanation of the methodology, see Expenditure on health for Aboriginal and Torres Strait Islander people 2006-07. Rates are age standardised to the Australian population as at 30 June 2001.

Figures 167, 168 and 170. Data are age-standardised.

Figures 167 and 170: Total who took at least one health-related action—those who were admitted to hospital in last 12 months, doctor consultation in last 2 weeks, visited casualty/outpatient in last 2 weeks or consulted with other health professional in last 2 weeks. Some estimates have a relative standard error of between 25% and 50% and should be used with caution.

Table 67: ‘Needed to go to dentist in last 12 months’ are for persons aged 2 years and over.

Figure 169: Refer to notes for measure 1.02 regarding hospitalisation data. Directly age-standardised using the Australian 2001 standard population. ‘Outer regional’ includes remote Victoria. ‘Remote’ excludes remote Victoria.

3.13 Access to prescription medicines

Figure 171: ‘Benefit-paid pharmaceuticals’ includes the Repatriation Pharmaceutical Benefits Scheme (RPBS) as well as the PBS.

Figure 172: ‘PBS’ does not include RPBS benefits for Veterans.

3.14 Access to after-hours primary care

Figure 175 and Table 68: The data comes from the National Non-Admitted Patient Emergency Department Care Database. The Non-admitted Patient Emergency Department Care data are required to be reported for hospitals categorised as peer group A or B in the previous year's Australian hospital statistics. In addition, data are provided for some smaller hospitals by some states and territories. The coverage of the National Non-admitted Patient Emergency Department Care Database is estimated at about 76% of records for 2006–07 and 78% for 2007–08. Therefore these data will only cover a sub-set of after-hours emergency episodes of care. The identification of Indigenous patients is not considered complete and varies among jurisdictions. It is considered acceptable only for Western Australia and the Northern Territory.

Table 68: After hours is defined by the MBS definition (excluding consideration of public holidays): on Sunday, before 8am or after 1pm on a Saturday, or at any time other than 8am to 8pm on a weekday. Excludes patients who were admitted or arrived at the hospital by ambulance.

3.15 Regular GP or health service

Table 69: ‘Total’ includes persons aged 18 years and over and includes refusal to answer and ‘not stated’.

3.16 Care planning for clients with chronic diseases

Table 70: Clients are Indigenous adults aged 15 years and over who are regular clients of the HFL service. In a small number of services there is likely to be double counting of clients, as clients are reported to have had both an MBS and Alternative GPMP. Valid data for this indicator were provided by 59 services (11 urban services, 27 regional services and 21 remote services). Services used their own definition of regular client.

Table 70: Clients are Indigenous adults aged 15 years and over who are regular clients of the HFL service. Chronic diseases include Type 2 Diabetes and Coronary Heart Disease. For Type II diabetes, valid data were provided by 49, 50 and 56 services, for the reporting periods ending in June 2007, June 2008 and June 2009 respectively. For coronary heart disease, valid data were provided by 49, 49 and 56 services, for the reporting periods ending in June 2007, June 2008 and June 2009 respectively.

3.17 Accreditation

Figure 179: Data are from public hospitals only. Data are reported for New South Wales, Victoria, Queensland, Western Australia, South Australia and Northern Territory only. These 6 jurisdictions are considered to have adequate levels of Indigenous identification, although the level of accuracy varies by jurisdiction and hospital. Hospitalisation data for these jurisdictions should not be assumed to represent the hospitalisation experience in the other jurisdictions. ‘Other patient episodes’ includes hospitalisations for non-Indigenous people and those for whom Indigenous status was ‘not stated’. Remoteness category based on residence of patient.

Figure 180: Aboriginal and Torres Strait Islander proportions are based on ABS population estimates used in the Annual Survey of Divisions of General Practice. There is double counting of some services where general practices reside on the border of two divisions. In that case two divisions may service the same practice. GPA+ data is for the period 2009-2010. AGPAL data is as of February 2010.

3.18 Aboriginal and Torres Strait Islander people training for health-related disciplines

The data for Table 72 and Figure 181 comes from the DEST Higher Education Schools Statistics Collection. Approximately 3% of students in this data collection have a ‘not stated’ Indigenous status. At the moment these are recorded as non-Indigenous, although plans are under way to separately record the ‘not stated’ responses.

Table 73: Classification based on ABS narrow fields of education. The ‘total’ data take into account the coding of Combined Courses to two fields of education. As a consequence, counting both fields of education for Combined Courses means that the totals may be less than the sum of all fields of education. Health-related courses includes Medical studies, nursing, pharmacy, dental studies, optical science, public health, radiography, rehabilitation therapies. Rate is calculated using 2008 Australian population aged 15–64. 2008 data are preliminary.

Table 73: Classification based on qualification field of education classification. The number of qualifications completed in 2008 are based on preliminary data and will be revised upwards in the next collection.

3.19 Expenditure on Aboriginal and Torres Strait Islander health compared to need

Refer to note in measure 3.07 for notes on the Health Expenditure Data.

Figure 182: Constant prices were calculated using the health price indexes from AIHW 2004a, p68. There were substantial changes in estimating methods between the first (1995–96) and second (1998–99) reports.

Figure 183: Includes ‘Other health services, n.e.c.’

Figure 184: By ASGC remoteness area of patient residence.

Figure 186: ‘Other’ excludes expenditure on research, health administration and other health services n.e.c.

3.20 Recruitment and retention of clinical and management staff (including GPs)

Figures 187 and 188: Refer to notes in Figure 147 in 3.04 for notes on the Divisions of Service Activity Reporting Data Collection.

Figure 187: Number of funded FTE vacancies divided by the total FTE positions multiplied by 100.

Figure 189: Uses the RRMA categorization: rural, remote and metropolitan areas.

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