Australian Indigenous

Overview of Indigenous health 2004

This overview is also available as a downloadable PDF using Adobe Acrobat.

Mortality

• Standardised death rates
• Expectation of life
• Age at death
• Infant mortality
• Causes of death
• Maternal mortality

Major impediments to producing a complete picture of Indigenous mortality in Australia are the incomplete identification of Indigenous status in death records, and the experimental nature of the population estimates [12]. As a result, the 2,140 deaths registered in 2002 where the deceased person was identified as Indigenous is certainly an underestimate of the actual number of Indigenous deaths [21].

Assessment by the ABS of the completeness of recording of Indigenous deaths is based on a comparison of registered Indigenous deaths with an estimate of the expected number of Indigenous deaths for the particular jurisdiction. The estimated completeness of identification of Indigenous people in death registrations has improved generally in recent years, but was still only 55% overall in 2001 [22]. WA, SA and the NT have been the jurisdictions with the most complete identification, but, except for the NT, identification in 2001 was generally quite poor (see footnote in 'Limitations of the sources of Indigenous health information' for proportions of Indigenous deaths identified correctly). Reflecting this, the ABS provided in 2001 detailed breakdown of Indigenous deaths only for NSW, Victoria , Queensland , WA, SA and the NT [22]. The poor coverage, coupled with the need to update the procedures for estimating coverage based on population figures derived from the 2001 census, meant that the ABS publication for 2002 did not include detailed tables of Indigenous deaths, nor information about overall death rates. As a result, there is no consistency about the extent of information available for recent years. Reflecting this, readers should be aware that the following sections vary in terms of the years to which they relate.

Standardised death rates

After adjusting for the differences in the age structures of the Indigenous and non-Indigenous populations, death rates for Indigenous people were between two and four times those of non-Indigenous people in Australia in 2001 (rates and ratios for the projected numbers of deaths should be interpreted with caution for two reasons: (1) the numbers are based on the estimated completeness of Indigenous identification in death registration systems for each jurisdiction; and (2) the population figures may under-estimate the actual numbers of Indigenous people. It is likely, however, that the true rates will be closer to those based on the projected numbers than to those based solely on death registrations.) (Table 6) [22] .

Table 6 Indigenous and non-Indigenous indirectly standardised death rates (ISDRs) and ISDR ratios, by jurisdiction, 2001

Source: Derived from ABS, 2002 [22]

Notes:

1. The projected numbers of deaths are based on the estimated completeness of Indigenous identification in death registration systems for each jurisdiction

2. Rates are per 1,000 population; rate ratio is the Indigenous rate divided by the non-Indigenous rate

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Expectation of life

After adjustment for the underestimate of the number of deaths identified as Indigenous (using the 1996 Census-based estimates and projections), Indigenous males born in 1999-2001 could be expected to live to 56.3 years, almost 21 years less than the 77.0 years expected for all males (Table 7) [22] . The expectation of life at birth of 62.8 years for Indigenous females was almost 20 years less than the expectation of 82.4 years for all Australian females.

Table 7 Expectation of life at birth for Indigenous people and the total population, Australia and selected States, 1999-2001

Source: ABS, 2002 [22]

Note: The Australian Indigenous estimates are based on the adjusted numbers of deaths for NSW, Victoria, Queensland, WA, SA and the NT, and do not include deaths for the ACT and Tasmania.

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Age at death

For those jurisdictions with reasonable information about Indigenous deaths, the median age at death for Indigenous males in 2002 ranged from 47.1 years for the NT to 56.3 years for NSW [21]. (The median age at death is the age below which 50% of people die. Because the measure partly reflects the age structures of the respective populations, it is a less precise measure than age-specific death rates, which are summarised below.) These levels are around 20 years less than those for non-Indigenous males, which were generally around 76-77 years. The median age at death for Indigenous females in 2002 ranged from 50.0 years for the NT to 61.9 years for NSW. These levels are more than 20 years less than those for non-Indigenous females, which were generally between 82 and 83 years.

Age-specific death rates are higher for Indigenous people than for the total population across all age groups, but the rate ratios are particularly high in the young and middle adult years (Table 8) [21]. (These ratios, being based on the numbers of deaths registered, are likely to underestimate the true differences between death rates for Indigenous people and the total population by up to 30%.)

Table 8 Indigenous and total population age-specific death rates (registered deaths) and Indigenous:total population rate ratios, by sex, New South Wales , Queensland , Western Australia , South Australia , and the Northern Territory , 2002

Source: Derived from ABS, 2003 [21]

Notes

1. Indigenous and total population rates are for NSW, Qld , WA , SA and the NT combined

2. Rates are per 1,000 population

3. Rate ratio is the Indigenous rate divided by the total population rate

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Infant mortality

The infant mortality rate is the number of deaths of children under one year of age in a calendar year per 1,000 live births in the same calendar year. For those jurisdictions with reasonable information about Indigenous deaths in 2000-2002, the highest Indigenous infant mortality rate was in the NT (18.1) and the lowest in NSW (9.5) (Table 9) [21]. These rates are considerably higher than those for the total population in these jurisdictions, which range from the NT (11.2) to WA (4.6).

Table 9: Infant mortality rates, Indigenous and total populations and rate ratios, selected jurisdictions, 2000-2002

Source: Derived from ABS, 2003 [21]

Notes:

1. Infant mortality rate is the number of infant deaths per 1,000 live births

2. The Indigenous rates are likely to be under-estimated, due to the incomplete identification of Indigenous status on death records

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Causes of death

For deaths identified as Indigenous in 2000-2002, cardiovascular disease (also known as 'diseases of the circulatory system', which includes heart disease and stroke) was the leading cause of death for Indigenous males and females living in Queensland, WA, SA and the NT, with rates 3.2 and 2.8 times those of males and females of the total population (note: the estimates quoted here have not been adjusted for the likely under-identification of Indigenous people in death registration systems, so the numbers and SMRs could be up to 30% higher) (Table 10) [19].

For Indigenous males, the next most frequent causes of death were injuries (including transport accidents, intentional self-harm and assault) (rate 3.0 times that of the total male population), malignant neoplasms (cancers) (1.3), diseases of the respiratory system (3.9), and endocrine, nutritional and metabolic disorders (mainly diabetes) (7.3). For Indigenous females, the most frequent causes of death after cardiovascular disease were malignant neoplasms (rate 1.6 times that of the total female population), endocrine, nutritional and metabolic disorders (11.7), injuries (2.9), and disease of the respiratory system (3.6).

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Maternal mortality

In 1997-1999 (the most recent period for which detailed data are available) seven (9.3%) of the 90 maternal deaths where Indigenous status was known were of Indigenous women (Indigenous status was not reported in 17% of the deaths) [23].

Reflecting the higher rate of confinements among Indigenous women, the maternal mortality ratio for Indigenous women in 1995-1997 was 23.5 per 100,000 confinements, more than three times higher than the ratio of 7.6 per 100,000 for non-Indigenous women (Table 11). For direct maternal deaths, the ratio for Indigenous women was 13.0 compared with 5.1 for non-Indigenous women⁶.

Table 10 Numbers of Indigenous deaths, by cause and sex, and Indigenous standardised mortality ratios, Queensland , Western Australia , South Australia and the Northern Territory, 2000-2002

Source: AIHW, 2004[19]

Notes: 1 The standardised mortality ratio (SMR) is the ratio of the number of Indigenous deaths occurring to the number expected if the age, sex and cause-specific rates of the Australian total population applied to the Indigenous population.

2 Due to under-identification of Indigenous deaths, these numbers and SMRs are likely to underestimate the true differences between the Indigenous and total populations by around 30%

Table 11 Numbers of confinements, maternal deaths and maternal mortality ratios, by Indigenous status, Australia , 1997-1999

Source: Slaytor, Sullivan and King, 2004 [23]

Note:

1. Maternal mortality ratio is the number of maternal deaths divided by the number of confinements (in 100,000s). Due to some uncertainty about the numbers of Indigenous deaths and confinements, some caution must be exercised in the interpretation of the ratios.

2. The non-Indigenous numbers and ratios include deaths for which Indigenous status was not known. This probably results in a slight, unknown over-estimate, and a resultant under-estimate of the differences between Indigenous and non-Indigenous women.

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Last updated: 12 January, 2005