Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Deaths—1.23 Leading causes of mortality

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Why is it important?:

Mortality rates are a useful measure of the overall health status of a population, particularly to compare one population with another or to measure improvements over time. The gap between the Aboriginal and Torres Strait Islander population and the rest of the Australian population for particular causes of death provides an indication of the prevention, prevalence and management of particular diseases for Aboriginal and Torres Strait Islander peoples, relative to the rest of the population. This provides a useful indication of the diseases that have a greater impact on Aboriginal and Torres Strait Islander peoples. However, some significant health problems will not be reflected in mortality statistics; many conditions that cause serious health problems may not be fatal (such as depression, arthritis and intellectual disability) and so do not appear as common causes of death. As health status and health services improve for Aboriginal and Torres Strait Islander peoples, it is anticipated premature mortality will reduce over time.

Findings:

During the period 2006–10, in the five jurisdictions with adequate quality data (NSW, Qld, WA, SA and the NT), the most common cause of death among Aboriginal and Torres Strait Islander peoples was circulatory diseases (26% of all deaths), followed by neoplasm (including cancer) (19%) and external causes (15%). Circulatory diseases were also the most common cause of death for other Australians followed by cancer. After adjusting for age, circulatory disease accounted for the largest gap in death rates (27% of the gap) followed by endocrine metabolic and nutritional disorders (including diabetes) (17%); neoplasms (including cancer) (12%); and respiratory diseases (12%). Deaths due to diabetes were seven times higher for Indigenous Australians than non-Indigenous Australians.

For Indigenous Australians, the leading causes of death due to external causes were suicide (30%), transport accidents (28%), accidental poisoning (10%), assault (9%) and accidental drowning (4%). Around 61% of these deaths occurred between 15 and 39 years of age.

Mortality rates for circulatory disease showed the largest decline in deaths for both Indigenous Australians and non-Indigenous Australians. Over the period 1997–2010, in WA, SA and the NT combined, there was a significant reduction in the gap with non-Indigenous Australians. Current trends (2001–10) in the five jurisdictions with adequate data (NSW, Qld, WA, SA, and the NT) show a decline in death rates due to circulatory disease for both Indigenous and non-Indigenous Australians and a significant closing of the gap. A study in the NT found an increase in incidence of acute myocardial infarction between 1992 and 2004 for Aboriginal and Torres Strait Islander peoples and at the same time an improvement in survival due to reductions in death both pre-hospital and after-hospital admission (You et al. 2009).

Mortality rates for respiratory disease have declined significantly for Indigenous Australians and other Australians in both the short term and long term. There has been a significant closing of the gap over the long term but not the short term.

For kidney disease mortality there was a significant increase in recent years (2001–10) in both the Aboriginal and Torres Strait Islander mortality rate and the gap. There has been a significant increase in the mortality gap due to cancer in long- and short-term trends, mainly reflecting that mortal­ity rates for other Australians have fallen. For injury deaths, there was no significant reduction in short-term trends, or in the longer term). No significant changes were detected for diabetes mortality rates or the gap in diabetes mortality between Aboriginal and Torres Strait Islander peoples and other Australians.

Implications:

Four groups of chronic conditions account for approximately 70% of the gap in mortality between Indigenous and non-Indigenous Australians: circulatory disease, endocrine/ metabolic/ nutritional disorders (including diabetes), cancer, and respiratory diseases. External causes such as suicide and transport accidents are also important contributors to the gap in mortality.Top of page

The health system can contribute to sustained improvements, in partnership with Aboriginal and Torres Strait Islander peoples, through identification of Indigenous clients, health promotion, early detection, chronic disease management and specialist and acute care to treat the more severe outcomes. Improved management of chronic disease can prevent the development of life-threatening complications but cannot cure these diseases. For example, a study of incidence and survival of acute myocardial infarction found improvements in survival for the NT Indigenous population associated with pre-hospital management of conditions and also within hospital specialised coronary care services and greater emphasis on post-hospital management (You et al. 2009). Another study in the NT found the largest gains for the Indigenous population in avoidable mortality were for conditions amenable to medical care with only marginal change in conditions responsive to health policy interventions such as campaigns to reduce smoking and improve diet (Li et al. 2009a).

The 15–29 year age group had the highest rate of deaths from suicide while deaths due to transport accidents were highest in the 15–39 year age group. Acute care services can save the lives of seriously injured people, and there is scope for improvements in timely access to life-saving emergency care for Indigenous Australians. High levels of intentional self-harm highlight the need for cross-sectoral approaches to healing, self-esteem and social and emotional wellbeing (see measure 1.18).

In December 2007, COAG committed to closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation. The $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (COAG 2008c), sets priorities for a broad range of health measures, which are discussed in more detail elsewhere in this report. Other national partnerships and agreements have been established to provide support across a range of social, economic and environmental dimensions.

The Mental health: Taking Action to Tackle Suicide package includes $30.2 million that targets groups and communities at high risk of suicide, including Indigenous Australians. The Australian Government also committed to the development of Australia's first national Aboriginal and Torres Strait Islander Suicide Prevention Strategy and the establishment of the Indigenous Suicide Prevention Advisory Group which is guiding the development of the Strategy.Top of page
Table 24—Causes of death, by Indigenous status, NSW, Qld, WA, SA and the NT, 2006–10

 

Underlying cause of death

Per cent of deaths—Indigenous
Per cent of deaths—
non-Indigenous
Rate per 100,000 persons—Indigenous
Rate
per 100,000
persons—
non-Indigenous
Rate ratio
Rate difference
Per cent of total gap
Circulatory diseases
26.3
33.9
351.0
201.0
1.7
150.0
27.1
Neoplasms
18.9
29.9
244.6
178.0
1.4
66.6
12.0
  • Digestive organs
5.3
8.0
67.9
47.7
1.4
20.2
3.6
  • Lung cancer
4.5
5.6
59.6
33.4
1.8
26.1
4.7
  • Cervical cancer
0.5
0.2
4.8
1.0
4.8
3.8
0.7
External causes
15.0
5.9
84.3
37.1
2.3
47.2
8.5
Endocrine, metabolic & nutritional disorders
8.8
3.7
117.7
21.8
5.4
95.8
17.3
  • Diabetes
7.6
2.6
101.8
15.2
6.7
86.6
15.6
Respiratory diseases
7.7
8.2
112.3
48.7
2.3
63.6
11.5
Digestive diseases
5.9
3.4
57.8
20.3
2.8
37.5
6.8
Kidney diseases
2.9
1.9
40.3
11.4
3.5
28.9
5.2
Conditions originating in perinatal period
2.4
0.4
6.0
2.8
2.2
3.2
0.6
Nervous system diseases
2.5
4.0
6
24.0
1.1
2.5
0.4
Infectious & parasitic diseases
2.3
1.5
25.4
8.7
2.9
16.7
3.0
Other causes
7.2
7.2
85.1
43.1
2.0
42.0
7.6
All causes
100.0
100.0
1,151.1
597.0
1.9
554.0
100.0
Note: rates are age standardised
Source: ABS analysis of National Mortality Database
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Figure 76—Deaths of Indigenous Australians from external causes of injury and poisoning, by age, NSW, Qld, WA, SA and NT, 2006–10
Figure 76—Deaths of Indigenous Australians from external causes of injury and poisoning, by age, NSW, Qld, WA, SA and NT, 2006–10
Source: ABS analysis of National Mortality Database
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Table 25—Detailed causes of death for circulatory disease, cancers and respiratory disease, Aboriginal and Torres Strait Islander peoples, NSW, Qld, WA, SA and the NT, 2006–10
Circulatory Disease

Underlying cause of death
Males—
number of deaths
Males—
% of deaths
Females—
number of deaths
Females—
% of deaths
Total—
number of deaths
Total—
% of deaths
Ischaemic heart disease
978
60.7
589
44.8
1,567
53.6
  • Acute myocardial infarction
385
23.9
253
19.3
638
21.8
Other heart disease
261
16.2
254
19.3
515
17.6
Cerebrovascular disease
237
14.7
282
21.5
519
17.7
  • Stroke
189
11.7
225
17.1
414
14.2
Hypertension disease
49
3.0
69
5.3
118
4.0
Rheumatic heart disease
29
1.8
61
4.6
90
3.1
Other
57
3.5
59
4.5
116
4.0
Total circulatory diseases
1,611
100.0
1,314
100.0
2,925
100.0
Neoplasms (includes cancer, by site of neoplasm)Top of page

Underlying cause of death
Males—
number of deaths
Males—
% of deaths
Females—
number of deaths
Females—
% of deaths
Total—
number of deaths
Total—
% of deaths
Digestive organs
334
31.0
260
25.3
594
28.2
  • Bowel
69
6.4
59
5.7
128
6.
Respiratory and inthrathoracic organs
326
30.2
221
21.5
547
26.0
Breast
-
-
134
13.0
134
6.4
Lymphoid, haematopoietic and related tissue
54
5.0
74
7.2
128
6.1
Lip, oral cavity and pharynx
98
9.1
30
2.9
128
6.1
Female genital organs
-
-
123
12.0
123
5.8
  • Cervix
-
-
58
5.6
58
2.8
Male genital organs
70
6.5
-
-
70
3.3
Non-malignant neoplasms
14
1.3
17
1.7
31
1.5
Other
65
6.0
63
6.1
128
6.1
Total neoplasms
1,078
100.0
1,029
100.0
2,107
100.0
Respiratory diseases

Underlying cause of death
Males—
number of deaths
Males—
% of deaths
Females—
number of deaths
Females—
% of deaths
Total—
number of deaths
Total—
% of deaths
Chronic lower respiratory diseases
270
59.0
263
65.8
533
62.1
  • COPD
223
48.7
212
53.0
435
55.0
  • Asthma
16
3.5
30
7.5
46
5.7
Pneumonia and influenza
103
22.5
80
20.0
183
21.3
Other
85
18.6
57
14.3
142
16.6
Total respiratory diseases
458
100.0
400
100.0
858
100.0
Source: AIHW analysis of National Mortality Database
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Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status(a)(b)
Circulatory disease
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Circulatory disease
Cancer
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Cancer
Respiratory diseaseTop of page
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Respiratory disease
Injury and poisoning
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Injury and poisoning
DiabetesTop of page
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Diabetes
Kidney disease(c)
Figure 77—Age-standardised mortality rates for selected causes of death, by Indigenous status—Kidney disease
Indigenous rates are not available between 1991–96 because of small numbers
(a)Prior to 1998, 'not stated' was included as non-Indigenous deaths. Rates for the longer-term trends (from 1991 to 2010) for WA, SA and NT, have therefore been calculated for 'Other Australians', which included deaths where Indigenous status is 'not stated'.
(b)For 1991–2010 data, causes of death were classified and coded in ICD–9 up until 1996 and ICD–10 from 1997 onwards. The change in classification/ coding scheme affects the comparability of rates calculated for 1996 and prior years with rates calculated for 1997 onwards.
(c)Data for Indigenous Australians not available for 1991–97 due to small numbers.
Source: AIHW analysis of National Mortality Database
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