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1.24 Avoidable and preventable deaths

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) (AIHW 2010e; 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 subdivided 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) (NHPC 2004).

Findings

In the period 2008–12, there were 7,079 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 75% of all deaths of Aboriginal and Torres Strait Islander peoples aged 0–74 years. In contrast, deaths from avoidable causes for non-Indigenous Australians represented 66% of all non-Indigenous deaths in this age group.

Amenable mortality accounted for 2,607 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 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 times that of non-Indigenous Australians) in the middle adult age groups (35–54 years). Indigenous avoidable mortality rates were lowest in NSW (304 per 100,000) and highest in the NT (789 per 100,000).

There was a 27% decline in the avoidable mortality rate for Aboriginal and Torres Strait Islander peoples in the period 1998 to 2012, and a significant narrowing of the gap. 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. 2009).

Among Aboriginal and Torres Strait Islander peoples, the most common conditions or events causing avoidable mortality were ischaemic heart disease (19%), cancer (18%), diabetes (10%), suicide (9%) and road traffic injuries (6%). After adjusting for the difference in age structure the conditions contributing the most to the avoidable mortality gap between Indigenous and non-Indigenous Australians were ischaemic heart disease (22% of the gap), diabetes (17% 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 (53% of avoidable deaths). However, there are also significant opportunities in terms of secondary (24%) and tertiary interventions (23%).

Implications

Death rates for avoidable mortality among Aboriginal and Torres Strait Islander peoples are declining and the gap is closing. 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 paediatric care, antibiotics, immunisation, drug therapies, and improved intensive care and surgical procedures. Only marginal change was found for conditions responsive to public health (Li et al. 2009). The Indigenous Australians' Health Programme commenced from 1 July 2014, consolidating four existing funding streams (primary health care base funding, child and maternal health programmes, Stronger Futures in the Northern Territory and the Aboriginal and Torres Strait Islander Chronic Disease Fund), to improve the focus on local health needs, deliver the most effective outcomes, and better support efforts to achieve health equality between Aboriginal and Torres Strait Islander and non-Indigenous Australians (see Policies and Strategies section). The National Suicide Prevention Programme and Taking Action to Tackle Suicide package include Indigenous specific initiatives (see measure 1.18).

Figure 1.24-1 Age-standardised mortality rates for avoidable causes of death, Indigenous and non-Indigenous Australians aged 0–74 years, NSW, Qld, WA, SA and the NT, 1998-2012
chart showing age-standardised mortality rates

Figure 1.24-1 shows age-standardised mortality rates (rate per 100,000 population) for avoidable causes of death among Indigenous and non-Indigenous Australians in NSW, Qld, WA, SA and NT over the period 1998 to 2012. Data is presented for persons aged 0–74 years. There was a 27% decline in the avoidable mortality rate for Aboriginal and Torres Strait Islander peoples in the period 1998 to 2012, and a significant narrowing of the gap.

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.24-2 Avoidable mortality (by subcategory) and unavoidable mortality, by Indigenous status, persons aged 0–74 years, NSW, Qld, WA, SA and the NT, 2008–2012
chart showing avoidable and unavoidable mortality rates

Figure 1.24-2 shows avoidable and unavoidable mortality rates (deaths per 100,000 population) among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Queensland, WA, SA and NT for the period 2008–2012. Data is presented separately for primary, secondary and tertiary avoidable mortality rates. The rate ratio for each age group is also shown. Within potentially avoidable deaths, the greatest opportunities to reduce mortality for Aboriginal and Torres Strait Islander peoples relate to primary prevention (53% of avoidable deaths). However, there are also significant opportunities in terms of secondary (24%) and tertiary interventions (23%). Numbers and rates of deaths are higher for Indigenous Australians in each category of avoidable deaths nad also for unavoidable deaths.

Source: ABS and AIHW analysis of National Mortality Database

Table 1.24-1 Avoidable mortality, by cause of death and Indigenous status, persons aged 0–74 years, NSW, Qld, WA, SA, and the NT, 2008–12
Cause of death Per cent
Indigenous
Per cent
Non Indig.
Age standardised rate per 100,000
Indigenous
Age standardised rate per 100,000
Non Indig.
Rate ratio Rate difference Rate difference %
Ischaemic heart disease 18.5 16.4 89.2 23.3 3.8 65.9 22.1
Cancer 18.0 39.2 96.9 55.4 1.7 41.4 13.9
Digestive organ cancers 5.7 12.1 30.9 17.1 1.8 13.8 4.6
Lung cancer 6.5 13.9 37.3 19.5 1.9 17.9 6.0
Cervical cancer 0.7 0.5 3.3 0.7 4.5 2.5 0.9
Diabetes 10.4 3.3 56.4 4.7 12.0 51.7 17.4
Suicide 8.9 7.5 23.4 11.6 2.0 11.7 3.9
Road traffic injuries 6.1 3.8 16.6 5.9 2.8 10.6 3.6
Alcohol related disease 5.0 2.7 20.3 3.9 5.2 16.4 5.5
Cerebrovascular disease 4.2 5.6 21.6 8.1 2.7 13.6 4.6
COPD 4.4 4.9 321.0 109.6 2.9 211.4 na
Nephritis and nephrosis 3.4 1.3 18.4 1.9 9.5 16.4 5.5
Selected infections 3.3 2.1 14.3 3.1 4.7 11.2 3.8
Violence 2.7 0.7 8.0 1.0 7.8 7.0 2.4
Birth defects 1.9 1.7 3.3 2.7 1.2 0.6 0.2
Complications of perinatal period 1.8 0.8 2.4 1.3 1.8 1.0 0.3
Rheumatic and other valvular heart disease 1.3 0.3 5.3 0.4 12.4 4.8 1.6
Other 10.3 9.9 38.6 14.9 2.6 23.7 8.0
Total 100.0 100.0 442.7 145.3 3.0 297.4 100.0
Total number
Total avoidable deaths 0-74 years 7,079 112,076
Total deaths people 0-74 years 9,438 169,111
Total deaths 11,612 495,782

Note: The avoidable mortality classification includes some causes for specific age groups: childhood vaccine-preventable diseases (0–14 years), asthma (0–44 years) and chronic obstructive pulmonary disease (COPD, 45–74). Age-standardised rates cannot be calculated for these causes. Rates for COPD are age-specific death rates. Childhood-vaccine-preventable deaths and asthmas have been excluded from the 'other' category, and all three causes are excluded from the total.

Source: ABS unpublished 2014 special tables