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1.22 All causes age-standardised death rate

Why is it important?

The mortality rate of a population provides a summary measure of the overall health status of that population. However, it has some well-known limitations. There may be delays for many years before improvements in health status lead to reductions in mortality, and mortality statistics do not reflect the burden of illness in a population for diseases that do not necessarily result in death, such as arthritis and depression. Despite these limitations, mortality rates are a useful measure with which to compare the overall health status of different populations and to monitor changes in overall health status of populations over time. The all-causes mortality rate for Aboriginal and Torres Strait Islander peoples is 1.7 times that for non-Indigenous Australians, indicating that the overall health status of Aboriginal and Torres Strait Islander peoples is worse than that of non-Indigenous Australians.

Findings

During the period 2009–13, in those jurisdictions with adequate quality data (NSW, Qld, WA, SA, and the NT), 12,327 deaths were identified as those of Aboriginal and Torres Strait Islander peoples. After adjusting for age differences between the two populations, the all-cause mortality rate was 1.7 times as high for Aboriginal and Torres Strait Islander peoples as the rate for non-Indigenous Australians (985 versus 585 deaths per 100,000 population). There was a 16% reduction in all-cause mortality rates for Aboriginal and Torres Strait Islander peoples in the time period 1998 to 2013 (in NSW, Qld, WA, SA, and the NT). There was also a significant narrowing of the gap (by 15%) in mortality rates between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians over this period.

Most deaths for Aboriginal and Torres Strait Islander peoples occur in the middle age groups. Most deaths for the non-Indigenous population occur in the older age groups. This partly reflects the younger age profile of the Indigenous population. In 2008–12, 64% of Aboriginal and Torres Strait Islander deaths occurred before the age of 65 years. The largest gaps were in the 35–59 year age group (based on the sum of years of life lost due to premature mortality). In the 35–44 year age group the Indigenous mortality rate was 4 times the non-Indigenous rate. Within the Indigenous population males and females had different patterns of mortality by age. Indigenous males aged 15–34 years had mortality rates twice that of Indigenous females. For males, deaths were highest in the 45–64 years age group, while for females deaths were highest in the 55–74 years age group. In the period 2009–13, Indigenous mortality rates ranged from 804 deaths per 100,000 in NSW to 1,461 in the NT. Between 2001 and 2012 there has been a significant decrease in mortality rates in remote areas (remote and very remote combined) for young children and middle age groups and an increase in the 75 years and over group.

Mortality rates are also available for other countries where Indigenous peoples share a similar history of relatively recent European colonisation, such as New Zealand and the United States. In New Zealand, the age-standardised all-cause mortality rate for the Maori population was 922 per 100,000 in 2012, compared with 615 per 100,000 for other New Zealanders. In the United States, the mortality rate for American Indians/Alaska Natives was 50% higher than the rate for non-Hispanic whites during the period 1999–2009 (Espey et al. 2014). Caution must be used in comparing Australian data with data for other countries due to variations in data quality, methods applied for addressing data quality issues and definitions for identifying indigenous peoples.

Implications

The very high mortality rates for Aboriginal and Torres Strait Islander peoples, particularly in early childhood and the middle adult years, are an indication of the relatively poor overall health status of Aboriginal and Torres Strait Islander peoples and reflect the high rates of chronic disease and injury. There has been significant improvement in mortality rates for Aboriginal and Torres Strait Islander peoples in the past 15 years in the jurisdictions with adequate data for long term analysis (NSW, Qld, WA, SA and the NT). There has also been a significant narrowing of the gap. The fact that improvements have occurred demonstrates that the severe health problems of Aboriginal and Torres Strait Islander peoples have been reduced to some extent and can be reduced further, and faster, with sustained and improved effort. Closing the gap in life expectancy between Aboriginal and Torres Strait Islander peoples and other Australians within a generation has been adopted as a target by COAG. In the five years since the target was set there has been limited time for investments to impact on population level death rates. For example, reductions in population level smoking rates take five years to impact on heart disease and up to twenty years for cancer. Improvements in educational attainment will take 20 to 30 years to impact on early deaths from chronic disease in the middle years.

Figure 1.22-1 Age-standardised all-cause mortality rates, by Indigenous status, 1998–2013
chart showing age-standardised mortality rates

Figure 1.22-1 shows age-standardised mortality rates (deaths per 100,000 population) by Indigenous status over the period 1998 to 2013 in NSW, Qld, WA, SA and the NT. There was a 16% reduction in all-cause mortality rates for Aboriginal and Torres Strait Islander peoples. There was also a significant narrowing of the gap (by 15%) in mortality rates between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians over this period.

Source: ABS and AIHW analysis of National Mortality Database

Table 1.22-1 Age-standardised all-cause mortality rates, by Indigenous status, NSW, Qld, WA, SA and the NT, 2009–13
Jurisdiction Number of deaths
Indig.
Number of deaths
Non-Indig.
Deaths per 100,000
Indig.
Deaths per 100,000
Non-Indig.
Rate
ratio
Rate
difference
NSW 3,327 240,265 804 585 1.4 219
Qld 3,652 130,702 964 590 1.6 375
WA 2,229 61,941 1,323 552 2.2 680
SA 776 63,088 818 611 1.3 207
NT 2,343 2,676 1,461 612 2.4 850
Total NSW, Qld, WA, SA, NT 12,327 498,672 985 585 1.7 400

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.22-2 Selected age-specific mortality rates, Indigenous Australians, remote areas, 2001 to 2012
chart showing age-specific mortality rates

Figure 1.22-2 shows age-specific mortality rates (rate per 100,000) for Aboriginal and Torres Strait Islander peoples in remote areas over the period 2001 to 2012. Rates are presented over time for Indigenous Australians aged 0-4 years, 35-44 years and 75 years and over. Between 2001 and 2012 there has been a significant decrease in mortality rates in remote areas (remote and very remote combined) for children and middle age groups and an increase in the 75 years and over group.

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.22-3 The gap in potential years of life lost before age 75 years (PYLL) per 1,000 population between Indigenous and non-Indigenous Australians, by age and sex 2008–12
chart showing gap in potential years of life lost before age 75 years

Figure 1.22-3 shows the gap in potential years of life lost before age 75 years (PYLL) per 1,000 population between Indigenous and non-Indigenous Australians, by age and sex for the period 2008–12. PYLL is the number of additional years a person would have lived had thye not died before age 75 years. The gap is the difference bewteen the PYLL rate per 1,000 for Indigenous and non-Indigenous populations. Approximately 64% of Aboriginal and Torres Strait Islander deaths occur before the age of 65 years. The largest gaps were in the 35-59 year age group (based on the sum of years of life lost due to premature mortality). In the 35-44 year age group the Indigenous mortality rate was 4 times the non-Indigenous rate.

Source: ABS and AIHW analysis of National Mortality Database

Note: PYLL is the number of additional years a person would have lived had they not died before age 75 years. The gap is the difference between the PYLL rate per 1,000 for Indigenous and non-Indigenous Australian populations.

Figure 1.22-4 Age distribution of proportion of deaths, by sex and Indigenous status, NSW, Qld, SA and the NT, 2008–12
chart showing the proportion of deaths

Figure 1.22-4 shows the proportion of deaths distributed across different age groups among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Qld, WA, SA and NT for the period 2008–2012. Data is presented separately for males and females. Most deaths for Aboriginal and Torres Strait Islander peoples occur in the middle age groups. Most deaths for the non-Indigenous population occur in the older age groups. This partly reflects the younger age profile of the Indigenous population. Approximately 64% of Aboriginal and Torres Strait Islander deaths occur before the age of 65 years.

Source: ABS and AIHW analysis of National Mortality Database