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Aboriginal and Torres Strait Islander Health Performance Framework - Summary report

Leading causes of disease burden and mortality

Burden of disease

In 2018, Indigenous Australians lost 239,942 years due to premature death or living with disease or injury, which equates to around 289 DALY for every 1,000 Indigenous Australians

The rate of disease burden among Aboriginal and Torres Strait Islander people was more than double (2.3 times) that of non-Indigenous Australians in 2018. After adjusting for differences in population size and age structure:

  • 400 years were lost to disease burden for every 1,000 Indigenous Australians
  • 177 years were lost to disease burden for every 1,000 non-Indigenous Australians.

With regard to the fatal burden of disease among Indigenous Australians aged under 75, almost two-thirds (64%) was due to potentially avoidable deaths (AIHW 2023 forthcoming). 

After adjusting for population growth and ageing, there was a 15% decline in total burden for Indigenous Australians from 2003 to 2018 – this decrease was driven by a 27% decline in fatal burden. Over the same period there was no substantial change in non-fatal burden.

These results come from Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 (AIHW 2022c), the latest available burden of disease information for Indigenous and non-Indigenous Australians.

What is the burden of disease and how is it measured?

‘Burden of disease’ refers to the impact of disease and injury on a population. It is measured in ‘disability adjusted life years’ (DALY), which comprises:

  • years lost from dying prematurely (YLL), also known as fatal disease burden.
  • years lost due to living with disease or injury (YLD), also known as non-fatal disease burden.

Among Indigenous Australians, 23% of total disease burden in 2018 was due to mental and substance use disorders (54,263 DALY). The other leading causes were:

  • injuries (12% or 29,769)
  • cardiovascular disease (10% or 24,612)
  • cancer (9.9% or 23,742)
  • musculoskeletal conditions (8.0% or 19,168) (Figure 4.4).

Indigenous Australians in Very remote (492 DALY per 1,000 population) and Remote (486 DALY per 1,000 population) areas experienced higher rates of total burden than those living in Major cities (393 DALY per 1,000 population). Mental & substance use disorders was the leading contributor to burden in all remoteness areas, ranging from 17% to 27% of total burden.

Indigenous Australians living in the most disadvantaged areas experienced more than 3 times the total burden of Indigenous Australians in the least disadvantaged areas (591 and 164 DALY per 1,000 population, respectively).alians living in the most disadvantaged areas experienced more than 3 times the total burden of Indigenous Australians in the least disadvantaged areas (591 and 164 DALY per 1,000 population, respectively).

Figure 4.4: Leading causes of disease burden among Indigenous Australians, by sex, 2018

This cumulative bar chart shows that for Indigenous males, the leading 4 causes of disease burden were: mental and substance use disorders (23%), injuries (including suicide) (16%), and cardiovascular diseases (11%) and cancer (10%). For Indigenous females, the leading 4 causes were: mental and substance use disorders (22%), cancer (10%), musculoskeletal disorders (10%), and cardiovascular disease (9%).

Source: adapted from Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018.

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Avoidable deaths

Avoidable deaths

Avoidable deaths are premature deaths – among those aged under 75 – from health conditions and injuries that could be avoided with disease prevention and population health initiatives or access to timely and effective health care.

Avoidable deaths, as a measure, is often used as an indicator of the quality, effectiveness, and accessibility of the health system.

There were 7,400 avoidable deaths among Indigenous Australians over the 5-year period 2015–2019, accounting for 60% of all deaths of Indigenous Australians aged 0–74 (data from NSW, Qld, WA, SA and NT combined). The rate of avoidable deaths among Indigenous Australians was 208 deaths per 100,000 population, with a higher rate in more remote areas, ranging from 142 deaths per 100,000 population in Major cities to 329 deaths per 100,000 population in Remote and Very remote areas combined.

There were no significant changes in the rate of avoidable deaths over the decade from 2010 to 2019. Over a longer period, from 2006 to 2019, the age-standardised rate of avoidable deaths among Indigenous Australians declined from 374 to 323 per 100,000 population (Figure 4.5).

Figure 4.5: Avoidable deaths by Indigenous status (age-standardised rate) (2006–2019), and remoteness area (crude rate) (2015–2019)

The line chart which shows that the rate of avoidable deaths declined between 2006 and 2019, from 374 per 100,000 to 323 per 100,000 for Indigenous Australians. The column chart shows that for Indigenous Australians, the rate of avoidable deaths increased with increasing remoteness, from 142 per 100,000 in Major cities to 329 per 100,000 in Remote areas.

Notes: Data from NSW, Qld, WA, SA and NT combined.

Sources: Measure 1.24, Table D1.24.2 and D1.24.6 – AIHW National Mortality Database.

In 2015–2019, the leading five causes of avoidable deaths among Indigenous Australians were:

  • coronary heart disease (21%; 1,560 deaths)
  • diabetes (12%; 868)
  • suicide and self-inflicted injuries (11%; 843)
  • chronic obstructive pulmonary disease (8.8%; 651)
  • cancer (8.0%; 587).

The age-standardised death rate due to these leading causes was consistently higher for Indigenous Australians than non-Indigenous Australians with coronary heart disease (26% of the gap in avoidable mortality), diabetes (18% of the gap) and chronic obstructive pulmonary disease (13% of the gap) showing the largest differences (Figure 4.6).

Figure 4.6: Rate of avoidable deaths, top 5 causes, by Indigenous status, 2015–2019 (age-standardised)

This column chart presents death rates for the five top causes of avoidable deaths for Indigenous Australians, as well as the equivalent avoidable death rate for non-Indigenous Australians. The leading causes of avoidable deaths for Indigenous Australians were coronary heart disease, diabetes, COPD, cancer and suicide and self-inflicted injuries. Rates were higher for Indigenous than non-Indigenous Australians for all 5 of these causes.

Notes

1. Data from NSW, Qld, WA, SA and NT combined.

2. Data are shown for the top 5 causes of avoidable death for Indigenous Australians.

Source: Measure 1.24, Table D1.24.5 – AIHW and ABS analysis of National Hospital Mortality Database.

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Mortality rate and leading causes of death

In the 5-year period 2015–2019, there were 15,439 deaths of Indigenous Australians, corresponding to 430 deaths per 100,000 population. From 2006 to 2019, the age-standardised death rate for Indigenous Australians declined by 8.3%. However, over the most recent decade to 2019 there was no significant reduction in the age-standardised death rate among Indigenous Australians.

In 2015–2019, cancer (as a broad disease group) was the leading broad cause of death among Indigenous Australians accounting for 23% (3,612 deaths) of all deaths in this period. After cancer, the leading broad leading causes of death for Indigenous Australians were:

  • cardiovascular disease (23%; 3,471 deaths)
  • Injury and poisoning (15%; 2,240)
  • respiratory disease (9.7%; 1,498)
  • endocrine, nutritional and metabolic diseases (8.6%; 1,333)

Death rates for Indigenous males were higher than for Indigenous females across most leading causes, except for kidney diseases (6.5 compared with 9.1 per 100,000 population) and diabetes (29 compared with 34 per 100,000), where rates were higher for Indigenous females. Death rates from all the leading causes of death were higher for Indigenous Australians in remote than in non-remote areas.

The age-standardised death rate for endocrine, nutritional and metabolic diseases for Indigenous Australians was 3.7 times as high as for non-Indigenous Australians (86 compared with 23 deaths per 100,000 population).

For both injury and poisoning, and respiratory disease, were twice as high for Indigenous Australians compared with non-Indigenous Australians (79 compared with 40 per 100,000 population; and 106 compared with 52 per 100,000 population, respectively).

For chronic obstructive pulmonary disease, the age-standardised death rate for Indigenous Australians was almost 3 times as high as for non-Indigenous Australians (70 compared with 24 deaths per 100,000 population).

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Perinatal, infant, and child mortality

Perinatal deaths include stillbirths (deaths prior to or during labour and/or birth) and neonatal deaths (within 28 days following birth).

Over the decade from 2010 to 2019, there were no significant changes in the rates of perinatal, neonatal or stillbirth deaths among babies born to Indigenous women (Figure 4.7).

Over a longer period, from 2006 to 2019, the perinatal death rate for babies born to Indigenous women declined by 25% from 19 to 15 per 1,000 births. This was predominatly driven by the significant declines (by 38% from 7.2 to 4.4 per 1,000 births) in the neonatal death rate as the rate of stillbirth deaths has not changed significantly over this period.

Similarly, death rates of Indigenous infants (aged under 1) did not change significantly over the decade from 2010 to 2019, though there was a decline over the longer period between 2006 and 2019 (by 34%, from 9.4 to 5.8 per 1,000 live births). The death rate among Indigenous children (aged 0–4) did not change significantly in either analysis period (Figure 4.7).

Figure 4.7: Rate of perinatal and child deaths, 2006–2019

The first line chart shows that for Indigenous Australians, the rate of perinatal deaths declined from 19 per 1,000 births in 2006 to 15 per 1,000 births in 2019. The second line shows no clear trend in the rate of Indigenous child deaths among Indigenous Australians.

Note: Child deaths data from NSW, Qld, WA, SA and NT combined. Child deaths includes children aged 0–4.

Sources: Measure 1.21, Table D1.21.2 – AIHW analysis of the National Perinatal Data collection; and Measure 1.20, Table D1.20.3 – AIHW National Mortality Database.

Note that data pertaining to perinatal deaths are from the AIHW’s National Perinatal Mortality Data Collection (NPMDC). These data sourced are from midwives and other birth attendants, who collect information from mothers, perinatal administrative and clinical record systems. This differs to the source used for reporting on infant and child deaths (the National Mortality Database), which is based on death registrations. The two collections are not directly comparable.

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