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

Tier 1—Deaths—1.24 Avoidable and preventable deaths

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Avoidable and preventable mortality refers to deaths from conditions that are considered avoidable given timely and effective health care (including disease prevention and population health initiatives) (Page et al. 2006). Avoidable deaths have been used in various studies to measure the quality, effectiveness and/or accessibility of the health system. Deaths from most conditions are influenced by a range of factors in addition to health system performance, including the underlying prevalence of conditions in the community, environmental and social factors and health behaviours.

Causes of avoidable mortality can be sub-divided into 'preventable' conditions for which there are effective means to prevent the condition occurring (e.g., conditions caused by smoking) and 'amenable' conditions for which death may be averted even after the condition has developed through early detection and effective treatment (e.g., cervical cancer).

Potentially avoidable deaths can sometimes be further assigned to categories reflecting whether they could be avoided through primary interventions (prevention), secondary (early intervention) and tertiary interventions (medical treatment) (National Health Performance Committee 2004).

Findings:

In the period 2006–10, there were 6,777 deaths of Aboriginal and Torres Strait Islander people aged 0–74 years from avoidable causes in NSW, Qld, WA, SA and the NT combined. This represented 74% of deaths of Aboriginal and Torres Strait Islander peoples aged 0–74 years in these five jurisdictions. In contrast, deaths from avoidable causes for non-Indigenous people represented 66% of deaths of other Australians aged 0–74 years in these four jurisdictions.

Amenable mortality accounted for 2,578 Indigenous deaths in the five jurisdictions, or 28% of deaths of Indigenous Australians aged 0–74 years. For non-Indigenous Australians aged 0–74 years, amenable mortality accounted for 26% of deaths. Potential years of life lost due to amenable mortality were highest in the 45–64 year age group for both Indigenous and non-Indigenous Australians. However, potential years of life lost were higher in the 25–44 year group for Indigenous Australians (27%) compared with non-Indigenous Australians (16%) and lower in the 65–74 year age group (4% and 13% respectively).

After adjusting for differences in age structure, Aboriginal and Torres Strait Islander peoples died from all avoidable causes at 3.5 times the rate of non-Indigenous Australians. The avoidable mortality rate of Aboriginal and Torres Strait Islander peoples was higher than that of non-Indigenous Australians in all age groups, and particularly high (4–5 times that of other Australians) in the middle adult age groups (25–64 years). Avoidable mortality rates were lowest in NSW (382 per 100,000) and highest in the NT (787 per 100,000).

Reliable data on time-trends in avoidable mortality are available since 1991 for WA, SA and the NT. There was a significant decline in the avoidable mortality rate for Aboriginal and Torres Strait Islander peoples in the period 1991 to 1996 in these jurisdictions combined. This decline con­tinued over the period 1997 to 2010, with Aboriginal and Torres Strait Islander rates dropping by 24%. The difference in rates between Indigenous and other Australians has narrowed significantly over this period. This rate of decline was faster than for all-cause mortality. A study in the NT found a rapid fall in avoidable mortality between 1985 and 2004 in the Indigenous population for conditions amenable to medical care. This suggests that improvements in health care have made a major contribution to the fall in death rates and is consistent with observed improvements in perinatal survival, congenital malformations, stroke and hypertensive conditions, pneumonia and asthma, and infectious diseases (Li et al. 2009a).Top of page

Short-term trend data for the period 2001–10 in NSW, Qld, WA, SA and the NT also show a significant decline in Indigenous avoidable mortality, however, this decline was greater for males (25%) than for females (16%). There was also a significant narrowing of the gap.

Among Aboriginal and Torres Strait Islander peoples, the most common conditions or events causing avoidable mortality were ischemic heart disease (19%) cancer (17%, in particular lung cancer), diabetes (10%), suicide (9%) and road traffic injuries (6%). After adjusting for difference in age structure the conditions contributing the most to the avoidable mortality gap between Indigenous and non-Indigenous Australians were ischemic heart disease (22% of the gap), diabetes (16% of the gap) and cancer (14% of the gap).

Within potentially avoidable deaths, the greatest opportunities to reduce mortality for Aboriginal and Torres Strait Islander peoples relate to primary prevention (52% of avoidable deaths). However, there are also significant opportunities in terms of secondary (24%) and tertiary interventions (24%).

Implications:

Death rates for avoidable mortality among Aboriginal and Torres Strait Islander peoples are declining and the gap is closing. Mortality rates for avoidable mortality are declining at a faster rate than for all-cause mortality. Chronic disease and injury are causing the greatest proportion of avoidable deaths for Aboriginal and Torres Strait Islander peoples and are amenable to both prevention and treatment. A study in the NT found that this decline has been greatest for conditions amenable to medical care, for example neonatal and pediatric care, antibiotics, immunisation, drug therapies, improved intensive care and surgical procedures. Only marginal change was found for conditions responsive to public health (Li et al. 2009a).

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes comprises a package of health reforms that include a focus on preventive health and primary health care. Through this agreement a range of initiatives are being implemented which address prevention, early detection and management of chronic disease.Top of page
Figure 78—Age-standardised mortality rates for avoidable causes of death, Indigenous and other Australians aged 0–74 years
Figure 78—Age-standardised mortality rates for avoidable causes of death, Indigenous and other Australians aged 0–74 years
Source: AIHW analysis of National Mortality Database
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Figure 79—Avoidable mortality (by subcategory) and unavoidable mortality, by Indigenous status, persons aged 0-74 years, NSW, Qld, SA and the NT, 2006-10
Figure 79—Avoidable mortality (by subcategory) and unavoidable mortality, by Indigenous status, persons aged 0-74 years, NSW, Qld, SA and the NT, 2006-10
Source: AIHW analysis of National Mortality DatabaseTop of page
Table 26—Avoidable mortality, by cause of death and Indigenous status, persons aged 0–74 years, NSW, Qld, WA, SA and the NT, 2006–10
Cause of death
Indigenous
(%)
Non-Indigenous
(%)
Indigenous—
rate per 100,000
Non-Indigenous—
rate per 100,000
Rate ratio
Rate difference
Rate difference
(%)
Ischaemic heart disease
18.6
17.6
107.5
25.9
4.1
81.6
22.0
Cancer
16.7
38.3
105.8
56.0
1.9
49.8
13.5
  • Digestive organ cancers
5.0
12.0
31.6
17.5
1.8
14.2
3.8
  • Lung cancer
6.2
13.6
42.1
19.7
2.1
22.4
6.1
  • Cervical cancer
0.8
0.5
4.3
0.7
6.1
3.6
1.0
Diabetes
10.0
3.2
64.2
4.8
13.5
59.4
16.0
Suicide
8.5
7.5
25.7
11.8
2.2
13.9
3.8
Road traffic injuries
6.4
4.1
20.8
6.4
3.2
14.3
3.9
Alcohol related disease
5.4
2.7
25.6
3.9
6.6
21.7
5.9
Cerebrovascular disease
4.7
5.8
29.6
8.7
3.4
20.9
5.6
COPD
4.1
4.5
31.3
6.7
4.7
24.6
6.6
Nephritis and nephrosis
3.7
1.4
23.3
2.0
11.4
21.2
5.7
Selected infections
3.6
2.2
18.4
3.3
5.7
15.2
4.1
Violence
2.6
0.6
9.1
1.0
9.2
8.1
2.2
Birth defects
2.3
1.7
4.9
2.8
1.8
2.1
0.6
Complications of perinatal period
2.1
0.9
3.4
1.5
2.2
1.8
0.5
Rheumatic and other valvular heart disease
1.3
0.3
5.2
0.4
13.3
4.8
1.3
Other
9.9
9.2
44.7
14.0
3.2
30.6
8.3
Total
100.0
100.0
519.4
149.2
3.5
370.2
100.0
Total avoidable deaths
6,777
110,183
Total deaths people 0-74 years
9,144
166,122
Total deaths
11,132
479,933
Note: rates are age-standardised
Source: AIHW and ABS analysis of National Mortality Database
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