NACCHO Aboriginal Health #closethegap Report: ABS Cause of deaths statistics

 

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Aboriginal and Torres Strait Islander Causes of Death

The top three WHO leading causes of death for Aboriginal and Torres Strait Islander Australians in 2014 were Ischaemic heart diseases (I20-I25), Diabetes (E10-E14) and Chronic lower respiratory diseases (J40-J47).

Compared to the non-Indigenous population, death rates were 1.7 times higher for Ischaemic heart diseases (I20-I25), 5.9 times higher for Diabetes (E10-E14) and 3.0 times higher for Chronic lower respiratory diseases (J40-J47) for Aboriginal and Torres Strait Islander Australians.

Further information can be found in the Deaths of Aboriginal and Torres Strait Islander section of this publication.

There were 2,914 deaths registered across Australia in 2014 where the deceased person was identified as being of Aboriginal and Torres Strait Islander origin. This represents 1.9% of all deaths registered.

The remainder of this chapter is focussed on the 2,730 deaths recorded in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory. Data for Victoria, Tasmania and the Australian Capital Territory have been excluded in line with national reporting guidelines (for information on issues with Aboriginal and Torres Strait Islander identification, see Explanatory Notes 57-66). When considering these five jurisdictions, the age-standardised death rate for Aboriginal and Torres Strait Islander Australians was 982.4 per 100,000.

Closing the Gap

The Council of Australian Governments’ (COAG) National Indigenous Reform Agreement is a partnership between all levels of government to work with Aboriginal and Torres Strait Islander communities to achieve the target of closing the gap in Indigenous disadvantage. One of the targets is to ‘close the gap in life expectancy within a generation’. The ABS provides COAG with mortality data that supports measurement of progress towards this.

This chapter provides death counts, age-standardised death rates (SDRs), and comparisons in numbers and rates between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians by cause of death. Data on infant mortality is also included.

Data Quality Issues

A variety of measures of mortality (including age-specific death rates, median age at death, and infant mortality rates) indicate that the mortality level of Aboriginal and Torres Strait Islander persons is substantially higher than that of the non-Indigenous population.

The exact scale of difference between the mortality of Aboriginal and Torres Strait Islander persons and non-Indigenous persons is difficult to establish conclusively. Some of the issues affecting the reporting of Aboriginal and Torres Strait Islander mortality include mis-identification of Aboriginal and Torres Strait Islander deaths, unexplained changes in the number of people recorded as being Aboriginal and Torres Strait Islander Australians in different data collections and over time, the incorrect use of a standard Aboriginal and Torres Strait Islander status question, changes in administrative processes, and not stated Aboriginal and Torres Strait Islander status. As a result, changes in numbers of registered Aboriginal and Torres Strait Islander deaths over time may not accurately reflect changes in the numbers of Aboriginal and Torres Strait Islander deaths. For more information on this and other issues to consider when undertaking analysis of Aboriginal and Torres Strait Islander deaths see Explanatory Notes 57-66.

The ABS works collaboratively with the Registrars of Births, Deaths and Marriages through the National Civil Registration and Statistics Improvement Committee. This Committee is in the process of developing an Aboriginal and Torres Strait Islander Data and Statistics Improvement Strategy for births and deaths. This strategy will identify key initiatives to be progressed by the Committee with the support of other stakeholders (government and non-government) to improve the quality and coverage of civil registration and vital statistics in Australia as it relates to Aboriginal and Torres Strait Islander people.

Further care should also be taken when interpreting deaths of Aboriginal and Torres Strait Islander persons for Queensland for 2010. An initiative undertaken by the Queensland Registry of Births, Deaths and Marriages resulted in the registration of 374 outstanding deaths from 1992-2006. Of these, approximately 76% were deaths of Aboriginal and Torres Strait Islander persons. For further information see Technical Note: Retrospective Deaths by Causes of Death, Queensland, 2010 and the Deaths, Australia, 2010 Technical Note: Registration of Outstanding Deaths, Queensland, 2010.

About cause of death statistics

Causes of death data are a significant and important input to health and social policy formulation and planning as well as health related research and analysis. For example, causes of death data provide an insight into the diseases and factors contributing to life expectancy, potentially avoidable deaths, years of life lost and leading causes of death. Causes of death statistics, together with statistics pertaining to births and deaths, make up the ’vital statistics’ component of Australia’s civil registration system, providing an important foundation for both population statistics as well as health statistics. Australia, as a member state of the World Health Organization (WHO), supplies data annually to the WHO on deaths by age, sex and cause of death, as compiled from the civil registration system by the Australian Bureau of Statistics.

In Australia, causes of death statistics are recorded as both underlying causes and multiple causes of death. The underlying cause is the single disease or injury which began the sequence of conditions that resulted in death. Unless stated otherwise, causes of death statistics presented by the ABS refer to the underlying cause. For further information on the way causes of death are compiled, see the Explanatory Notes in this publication.

Deaths

There were 153,580 deaths registered in Australia in 2014, 5,902 more than the number registered in 2013 (147,678). There were more male deaths (78,341) registered in 2014 than female deaths (75,239), resulting in a sex ratio of 104.1 male deaths for every 100 female deaths.

Leading causes of death

The leading causes of death were Ischaemic heart diseases (I20-I25), Dementia, including Alzheimer’s disease (F01, F03, G30), Cerebrovascular diseases (including strokes) (I60-I69), Cancer of the trachea, bronchus and lung (C33, C34), and Chronic lower respiratory diseases (J40-J47). These accounted for over one-third of all deaths.

Although the five leading causes of death were the same for males as females in 2014, there were also key differences between the sexes.

          • More males than females died from Ischaemic heart diseases (I20-I25) (11,082 males; 9,091 females) and from Cancer of the trachea, bronchus and lung (C33, C34) (4,947 males; 3,304 females).

 

        • More females than males died from Dementia, including Alzheimer’s disease (F01, F03, G30) (7,859 females; 4,106 males) and Cerebrovascular diseases (I60-I69) (6,486 females; 4,279 males).

The diagram below shows, in order, the five leading causes of death for the total population. Each leading cause is shown to account for a proportion of all deaths calculated separately for males and females. The leading cause of death for all people, Ischaemic heart diseases (I20-I25), accounted for one in seven male deaths and one in eight female deaths. The second leading cause, Dementia, including Alzheimer’s disease (F01, F03, G30) accounted for one in 19 male deaths and one in 10 female deaths. Dementia, including Alzheimer’s disease (F01, F03, G30) was the second leading cause for females, and the fifth leading cause for males. Cancer of the trachea, bronchus and lung (C33, C34) was the second leading cause for males accounting for one in 16 deaths, and was the fifth leading cause for females accounting for one in 23 deaths. Further information can be found in the Leading Causes of Death section in this publication.

Leading causes as a proportion of all male and female deaths, 2014Diagram: Leading causes as a proportion of all male and female deaths, 2014.

Causes of death by age

Leading causes of death vary across age groups.

        • Among those aged 15 to 44, the leading causes of death were Intentional self-harm (suicide) (X60-X84), Accidental poisonings (including drug overdoses) (X40-X49) and Land transport accidents (V01-V89).
        • Among those aged 45 to 74, the most common causes of death were Ischaemic heart diseases (I20-I25), Cancer of the trachea, bronchus and lung (C33, C34) and Chronic lower respiratory diseases (J40-J47).
        • Among those aged 75 and over, the most common causes of death were Ischaemic heart diseases (I20-I25), Dementia, including Alzheimer’s disease (F01, F03, G30), and Cerebrovascular diseases (I60-I69).

Further information can be found in the Leading Causes of Death section in this publication.

Years of Potential Life Lost

Years of Potential Life Lost measures the extent of ‘premature’ mortality. While a cause of death may have a lower incidence than that of another, its impact when measured in terms of premature death may be greater, as a result of that cause affecting a younger demographic.

Intentional self-harm (X60-X84) deaths accounted for 97,066 years of potential life lost, the highest of all leading causes in 2014. Deaths from Dementia, including Alzheimer’s disease (F01, F03, G30) accounted for only 6,710 years of potential life lost. A key reason for this difference is that the median age at death for Intentional self-harm (X60-X84) in 2014 was 44.2 years. In comparison, the median age at death for Dementia, including Alzheimer’s disease (X60-X84) was 88.4 years. The median age at deaths for all causes in 2014 was 81.8 years.

Potentially Avoidable Mortality

Potentially avoidable deaths comprise deaths from certain conditions that are considered avoidable given timely and effective health care. In 2014, 26,283 Australians died from potentially avoidable causes of death.

Among people who died between 15 and 44 years of age, 69.8% of deaths were considered to be potentially avoidable in 2014. Some of the leading potentially avoidable causes included Intentional self-harm (X60-X84), Accidental poisonings (X40-X49) and Land transport accidents (V01-V89).

Approximately half (46.9%) of those who died aged 45-74, died of causes considered to be potentially avoidable. The most common potentially avoidable causes for this age group were Ischaemic heart diseases (I20-I25), Chronic obstructive pulmonary disease (J40-J44) and Colon, sigmoid, rectum and anus cancer (C18-C21).

Further information can be found in the Potentially Avoidable Mortality section in this publication.

Multiple Causes of Death

Multiple causes are all causes and conditions reported on the death certificate that contributed to, were associated with, or were the underlying cause of the death (see the Glossary for further details). Looking at these multiple causes gives a more complete picture of the diseases and conditions affecting the health of the Australian population. In 2014 there was an average of 3.3 causes for each death.

As the population ages, deaths are likely to feature chronic conditions with multiple comorbidities. Approximately two-thirds of deaths (65.9%) in people aged over 75 years in 2014 had three or more conditions certified by a doctor or coroner. For people under 45 years of age, 53.0% of deaths were reported with three or more conditions.

Deaths where the underlying cause is considered to be chronic, are generally more likely to have a greater number of conditions reported on the death certificate than deaths due to other causes. In 2014, for deaths with an underlying cause of Type 2 diabetes (E11), there was an average of 5.5 conditions reported with each death, the most common of these being Diseases of the circulatory system (I00-I99).

Further information can be found in the Multiple Causes of Death section in this publication.

Aboriginal and Torres Strait Islander Causes of Death

The top three WHO leading causes of death for Aboriginal and Torres Strait Islander Australians in 2014 were Ischaemic heart diseases (I20-I25), Diabetes (E10-E14) and Chronic lower respiratory diseases (J40-J47).

Compared to the non-Indigenous population, death rates were 1.7 times higher for Ischaemic heart diseases (I20-I25), 5.9 times higher for Diabetes (E10-E14) and 3.0 times higher for Chronic lower respiratory diseases (J40-J47) for Aboriginal and Torres Strait Islander Australians.

Further information can be found in the Deaths of Aboriginal and Torres Strait Islander section of this publication.

Perinatal deaths

Changes were made to the coding of Perinatal deaths in 2013 which resulted in neonatal deaths being assigned only a ‘main condition in infant’ rather than an underlying cause of death. In the past year the ABS has led a process, working with coding specialists both internationally and nationally, to derive a supported method for coding an underlying cause for deaths certified using the Medical Certificate of Cause of Perinatal Death (MCCPD). This has resulted in a new coding method for neonatal deaths which has been implemented by the ABS.

Further information on changes to the Perinatal dataset can be found in Technical Note 2, Changes to Perinatal Death Coding.

ACKNOWLEDGEMENT

This publication draws extensively on information provided freely by the state and territory Registrars of Births, Deaths and Marriages, and the Victorian Department of Justice who manage the National Coronial Information System (NCIS). Their continued cooperation is very much appreciated: without it, the wide range of vitals statistics published by the ABS would not be available.

INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 0701300 135 070.

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