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4704.0 - The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples, 2008  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 29/04/2008   
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Contents >> Mortality >> CAUSE OF DEATH

CAUSE OF DEATH

In 2001-2005, the five leading causes of death for Aboriginal and Torres Strait Islander peoples resident in Queensland, Western Australia, South Australia and the Northern Territory were diseases of the circulatory system, external causes of morbidity and mortality (predominantly accidents, intentional self-harm and assault), neoplasms (cancer), endocrine, metabolic and nutritional disorders (mainly diabetes), and respiratory diseases (table 9.10). Deaths due to these causes accounted for around three-quarters of all Indigenous deaths. Circulatory diseases and neoplasms accounted for a higher proportion of all non-Indigenous deaths than Indigenous deaths (37% and 30% compared with 27% and 15% respectively). In contrast, external causes and endocrine, metabolic and nutritional disorders accounted for a higher proportion of all Indigenous deaths than non-Indigenous deaths (16% and 9% compared with 6% and 4% respectively).

Standardised mortality ratios (SMRs) have been used in this section to compare death rates between the Indigenous and non-Indigenous populations. The SMR is the ratio between the observed number of deaths in the Indigenous population and the expected number of deaths that would have occurred if the Indigenous population experienced the same age-specific death rates as the non-Indigenous population. If the SMR is greater than 1.0, there were more deaths than expected; if the ratio is less than 1.0, there were fewer deaths than expected.

While the overall undercoverage of the Indigenous deaths in the four jurisdictions used for this analysis may understate the SMRs for all causes and for all people, differential undercoverage by sex and by cause may also affect detailed analysis of SMRs.

In 2001-2005, for both Indigenous males and females, there were almost three times as many deaths from all causes as would be expected, based on the rates for non-Indigenous Australians. The highest SMRs for Indigenous males and females were for endocrine, nutritional and metabolic diseases, caused mainly by diabetes mellitus. The rates for Indigenous males and females for these diseases were 8 and 10 times the rates for non-Indigenous males and females (table 9.10). There were also large disparities between Indigenous and non-Indigenous mortality rates for diseases of the digestive system, diseases of the genitourinary system, symptoms, signs and abnormal findings and certain infectious and parasitic diseases (SMRs of between 5 and 6 for males and females). Indigenous males were six times as likely, and Indigenous females three times as likely, to die from mental and behavioural disorders as non-Indigenous males and females respectively.

9.10 INDIGENOUS DEATHS(a), main causes - 2001-2005

Males
Females
Percentage of total deaths
Observed deaths
Expected deaths
SMR(b)
Observed deaths
Expected deaths
SMR(b)
Indigenous
Non-Indigenous

Diseases of the circulatory system (I00-I99)
1 150
360
3.2
856
320
2.7
26.6
36.8
External causes (V01-Y98)
851
292
2.9
369
105
3.5
16.2
6.3
Neoplasms (C00-D48)
592
406
1.5
547
351
1.6
15.1
29.7
Endocrine, nutritional and metabolic diseases (E00-E90)
315
42
7.5
367
36
10.1
9.0
3.5
Diabetes (E10-E14)
281
26
10.8
319
22
14.5
8.0
2.4
Diseases of the respiratory system (J00-J99)
378
88
4.3
281
77
3.6
8.7
8.7
Diseases of the digestive system (K00-K93)
251
43
5.8
182
36
5.1
5.7
3.3
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
169
28
6.0
85
19
4.6
3.4
0.7
Certain conditions originating in the perinatal period (P00-P96)
126
44
2.9
82
36
2.3
2.8
0.4
Diseases of the genitourinary system (N00-N99)
79
16
4.8
119
20
6.0
2.6
2.2
Diseases of the nervous system (G00-G99)
122
42
2.9
69
44
1.6
2.5
3.3
Certain infectious and parasitic diseases (A00-B99)
102
20
5.1
72
14
5.0
2.3
1.2
Mental and behavioural disorders (F00-F99)
101
17
5.8
72
23
3.1
2.3
2.3
All causes
4 329
1 438
3.0
3 215
1 123
2.9
100.0
100.0

(a) Data for Qld, WA, SA and NT combined. Deaths are based on year of registration of death. Disease groupings are based on ICD-10 chapter.
(b) Standardised mortality ratio is the observed Indigenous deaths divided by expected Indigenous deaths, based on the age, sex and cause-specific rates for non-Indigenous persons.
Source: AIHW National Mortality Database


In the age groups in which differences in death rates between Indigenous and non-Indigenous populations are greatest (35-54 years), ischaemic heart disease, diseases of the liver (i.e. alcoholic liver disease and cirrhosis of the liver), diabetes and other forms of heart disease are major causes of death (table 9.11). Indigenous males and females aged 35-54 years died from diabetes at 23 and 37 times the rates, and from influenza and pneumonia at 18 and 27 times the rates, of non-Indigenous males and females of the same age for these conditions. There were also large discrepancies between Indigenous and non-Indigenous mortality rates for assault (ratios of 16 and 12 for males and females respectively); chronic lower respiratory diseases (ratios of 14 and 12); mental and behavioural disorders due to psychoactive substance use (ratios of 12 and 19) and pedestrian injured in transport accident (ratios of 18 and 67). While some of these rates have been derived from a relatively small number of deaths - for example assault and pedestrian injured in transport accident among Indigenous women (17 and 23 deaths respectively) - differences between the two population groups are still striking.

9.11 AGE-SPECIFIC DEATH RATES, main causes(a), Persons aged 35-54 years - 2001-2005

Indigenous(b)
Non-Indigenous(b)
Rate ratio(c)
Males
Females
Males
Females
Males
Females

Ischaemic heart disease (I20-I25)
227.7
87.1
32.3
6.1
7.0
14.2
Disease of the liver (K70-K77)
75.4
50.8
8.8
3.6
8.6
14.0
Diabetes (E10-E14)
74.7
51.5
3.2
1.4
23.1
37.2
Other selected forms of heart disease (I30-I52)
45.7
21.8
5.6
2.0
8.1
10.8
Malignant neoplasm of the digestive organs (C15-C26)
40.6
19.1
20.1
12.3
2.0
1.6
Chronic lower respiratory disease (J40-J47)
32.6
25.1
2.4
2.1
13.6
11.7
Intentional self harm (X60-X84)
46.4
9.9
26.1
7.1
1.8
1.4
Malignant neoplasm of the respiratory and intrathoracic organs (C30-C39)
31.9
21.1
12.2
8.1
2.6
2.6
Cerebrovascular disease (I60-I69)
28.3
24.4
5.5
4.7
5.1
5.2
Influenza and pneumonia (J10-J18)
30.5
21.1
1.7
0.8
18.4
26.5
Pedestrian injured in a transport accident (V01-V09)
23.9
15.2
1.4
0.2
17.7
(d)66.7
Ill-defined and unknown causes of mortality (R95-R99)
30.5
8.6
4.0
2.2
7.6
3.8
Car occupant injured in a transport accident (V40-V49)
23.2
11.9
5.7
2.9
4.1
4.0
Mental and behavioural disorders due to psychoactive substance use (F10-F19)
24.7
9.9
2.1
0.5
11.8
19.3
Assault (X85-Y09)
23.2
11.2
1.5
0.9
15.6
12.3

(a) Data for Qld, WA, SA and NT combined. Deaths are based on year of year of registration of death. Disease groupings are based on 3-digit groupings of ICD-10.
(b) Age-specific rate per 100,000 population aged 35-54 years.
(c) Rate for Indigenous persons divided by the rate for non-Indigenous persons.
(d) The confidence intervals for this ratio are quite large (46.2-96.3) due to the small number of deaths recorded.
Source: AIHW National Mortality Database



Excess deaths

Deaths higher than the expected number are referred to as 'excess deaths'. Excess deaths are calculated by subtracting the number of expected Indigenous deaths based on the age, sex and cause-specific rates of non-Indigenous Australians, from the number of actual deaths in the Indigenous population.

Over the period 2001-2005 there were 2,891 excess deaths among Indigenous males and 2,092 excess deaths among Indigenous females in Queensland, Western Australia, South Australia and the Northern Territory. Diseases of the circulatory system accounted for the highest proportion of excess deaths (2,006 deaths in total, 1,326 of which were excess deaths). Other major causes of excess deaths were external causes, endocrine, nutritional and metabolic diseases and diseases of the respiratory system. Deaths due to these causes were responsible for around two-thirds of excess deaths among Indigenous males and females (2,561 deaths in total, 1,921 of which were excess deaths) (table 9.12).

9.12 MAIN CAUSES OF EXCESS INDIGENOUS DEATHS(a)(b) - 2001-2005

Number
Proportion (%)
Indigenous males
Indigenous females
Indigenous males
Indigenous females

Diseases of the circulatory system (I00-I99)
790
536
27.3
25.6
External causes (V01-Y98)
559
264
19.3
12.6
Endocrine, nutritional and metabolic diseases (E00-E90)
273
331
9.5
15.8
Diseases of the respiratory system (J00-J99)
290
204
10.0
9.7
Neoplasms (C00-D48)
186
196
6.4
9.4
Diseases of the digestive system (K00-K93)
208
146
7.2
7.0
Symptoms, signs and abnormal clinical and laboratory findings, n.e.c. (R00-R99)
141
66
4.9
3.2
Diseases of the genitourinary system (N00-N99)
63
99
2.2
4.7
Certain infectious and parasitic diseases (A00-B99)
82
58
2.8
2.8
Mental and behavioural disorders (F00-F99)
84
49
2.9
2.3
Certain conditions originating in the perinatal period (P00-P96)
82
46
2.8
2.2
All other causes
134
97
4.6
4.6
All causes
2 891
2 092
100.0
100.0

(a) Excess deaths are equal to the observed Indigenous deaths minus expected Indigenous deaths (based on the 1999-2003 age, sex and cause-specific rates for non-Indigenous persons).
(b) Data for Qld, WA, SA and NT combined. Deaths are based on year of registration of death. Disease groupings are based on ICD-10 chapter.
Source: AIHW National Mortality Database



Diseases of the circulatory system

Diseases of the circulatory system were responsible for around 27% of total Indigenous male and female deaths for the period 2001-2005. In comparison, these diseases accounted for 34% of all male deaths and 40% of all female deaths for non-Indigenous Australians. Within circulatory system diseases, ischaemic heart diseases (heart attack, angina) were responsible for 64% of Indigenous male deaths and 49% of Indigenous female deaths, while cerebrovascular disease (stroke) accounted for 14% of male deaths and 19% of female deaths.

Compared with non-Indigenous Australians, Indigenous males and females experienced higher rates of mortality from diseases of the circulatory system in every age group. The greatest differences in age-specific death rates for males occurred in the age groups 25-34 and 35-44 years, with Indigenous males recording a rate 9 to 11 times the rate for non-Indigenous males (rates of around 69 and 251 per 100,000 for Indigenous males compared with 7 and 23 per 100,000 for non-Indigenous males). Indigenous females recorded rates of around 12 times the rates for non-Indigenous females for the 35-44 and 45-54 year age groups (rates of 32 and 122 per 100,000 for Indigenous females compared with 4 and 10 per 100,000 for non-Indigenous females) (graphs 9.13 and 9.14).

9.13 MALE DEATH RATES(a), CIRCULATORY DISEASES(b), by Indigenous status and age - 2001-2005
Graph: 9.13 Male death rates, circulatory diseases, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.14 FEMALE DEATH RATES(a), CIRCULATORY DISEASES(b), by Indigenous status and age - 2001-2005
Graph: 9.14 Female death rates, circulatory diseases, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005



Diabetes

The major cause of Indigenous deaths within the endocrine disease category is diabetes. Diabetes has a far greater impact on mortality for the Indigenous population than for the non-Indigenous population. For the period 2001-2005, diabetes was responsible for 8% of total Indigenous deaths compared with 2% of non-Indigenous deaths. For non-Indigenous Australians, the proportion of total deaths caused by diabetes was 1% to 3% for all age groups from 25-34 years and over. For Indigenous Australians, diabetes was responsible for 10% of deaths in the 45-54 years age group and for 14% of total Indigenous deaths in the 55-64 year age group (graph 9.15).

9.15 DIABETES DEATHS(a) AS A PROPORTION OF TOTAL DEATHS(b)(c), by Indigenous status and age - 2001-2005
Graph: 9.15 Diabetes deaths as a proportion of total deaths, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


The earlier onset of diabetes experienced by the Indigenous population is reflected in the differences in age-specific death rates. For the period 2001-2005, Indigenous males in the 35-44 and 45-54 years age groups experienced age-specific death rates 16 and 31 times, respectively, the corresponding rates for non-Indigenous males (rates of 31 and 144 per 100,000 for Indigenous males compared with 2 and 5 per 100,000 for non-Indigenous males) (graph 9.16). For the same age groups, the rates experienced by Indigenous females were 32 and 46 times the corresponding non-Indigenous female rates (graph 9.17) (rates of 29 and 87 per 100,000 for Indigenous females compared with 1 and 2 per 100,000 for non-Indigenous females). The markedly higher death rates from diabetes in the Indigenous population are partly a reflection of the earlier onset of diabetes in this population compared with the non-Indigenous population combined with a high prevalence of some of the risk factors associated with diabetes such as smoking, hypertension and obesity. Higher death rates from diabetes may also reflect poorer management of diabetes among Indigenous people, in particular those living in rural and remote areas (Wood & Patterson 1999).

9.16 MALE DEATH RATES(a), DIABETES(b), by Indigenous status and age - 2001-2005
Graph: 9.16 Male death rates, diabetes, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.17 FEMALE DEATH RATES(a), DIABETES(b), by Indigenous status and age - 2001-2005
Graph: 9.17 Female death rates, diabetes, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005



Chronic kidney disease

Chronic kidney disease includes diabetic nephropathy, hypertensive renal disease, glomerular disease and chronic renal failure and end-stage renal disease (ESRD). ESRD results when the kidneys cease functioning almost entirely, leading to a build up of waste products and excess water in the body causing progressively worse illness (AHMAC 2006). This is the last and most debilitating stage of chronic kidney disease in which dialysis or kidney transplantation is necessary to maintain life.

Chronic kidney disease was responsible for 2% and 5% of Indigenous male and female deaths respectively for the period 2001-2005. The overall death rates from chronic kidney disease were 7 and 9 times as high as the rates for non-Indigenous males and females respectively. Among Indigenous deaths from chronic kidney diseases, chronic renal failure accounted for 43% of male deaths and 37% of female deaths, while diabetic nephropathy accounted for 23% (males) and 25% (females) respectively.

Both Indigenous males and females experienced markedly higher rates of mortality from chronic kidney disease after the age of 25 years. The greatest differences in age-specific death rates for males occurred in the 45-54 year age group with Indigenous males recording a rate 31 times the rate for non-Indigenous males (50 compared with 2 deaths per 100,000) (graph 9.18). For females, the greatest difference in age-specific death rates also occurred in the 45-54 year age group with Indigenous females recording a rate 51 times that for non-Indigenous females (56 compared with 1 per 100,000) (graph 9.19).

9.18 MALE DEATH RATES(a), CHRONIC KIDNEY DISEASE(b), by Indigenous status and age - 2001-2005
Graph: 9.18 Male death rates, chronic kidney disease, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.19 FEMALE DEATH RATES(a), CHRONIC KIDNEY DISEASE(b), by Indigenous status and age - 2001-2005
Graph: 9.19 Female death rates, chronic kidney disease, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005



External causes of mortality

The quality of external causes of death data is affected by differences in the way that coronial deaths are reported across the various jurisdictions and in procedures around reportable deaths (i.e. deaths reported to a coroner). In addition, statistics on suicide deaths are dependent on coronial processes to determine the intent of a death (whether intentional self-harm, accidental, homicide or undetermined intent) as this information is required for the correct ICD-10 coding of cause of death. The timing of data compilation can therefore be affected by the length of coronial processes. For more information on data quality issues pertaining to external causes of death data, see ABS Information Paper: External Causes of Death, Data Quality, 2005 (ABS 2007e).

For the period 2001-2005, deaths due to external causes, such as accidents, intentional self-harm (suicide) and assault accounted for 16% of all Indigenous deaths, compared with 6% of all deaths among non-Indigenous Australians. For both populations, males accounted for around 70% of the total deaths due to external causes. For Indigenous males, the leading causes of death from external causes were intentional self-harm (35%), transport accidents (27%) and assault (8%), while for Indigenous females the leading causes of death were transport accidents (30%), intentional self-harm (18%) and assault (16%).

Over the period 2001-2005, for most age groups the age-specific death rates for Indigenous males were two to three times the corresponding rates for non-Indigenous males (graph 9.20). Indigenous females experienced higher age-specific death rates than non-Indigenous females in every age group, with the greatest difference occurring in the 35-44 year age group. In this age group, Indigenous females recorded a rate almost five times that of non-Indigenous females (87 deaths per 100,000 compared with 18 per 100,000) (graph 9.21).

9.20 MALE DEATH RATES(a), EXTERNAL CAUSES OF MORBIDITY AND MORTALITY(b), by Indigenous status and age - 2001-2005
Graph: 9.20 Male death rates, external causes of morbidity and mortality, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.21 FEMALE DEATH RATES(a), EXTERNAL CAUSES OF MORBIDITY AND MORTALITY(b), by Indigenous status and age - 2001-2005
Graph: 9.21 Female death rates, external causes of morbidity and mortality, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


Intentional self-harm (suicide)

Intentional self-harm was the leading cause of death from external causes for Indigenous males for the 2001-2005 year period. The suicide rate was almost three times that for non-Indigenous males, with the major differences occurring in younger age groups. For Indigenous males aged 0-24 years and 25-34 years, the age-specific rates were three and four times the corresponding age-specific rates for non-Indigenous males respectively (graph 9.22).

9.22 MALE DEATH RATES(a), INTENTIONAL SELF-HARM(b), by Indigenous status and age - 2001-2005
Graph: 9.22 Male death rates, intentional self harm, by Indigenous status and age, Qld, Wa, SA and NT combined, 2001-2005


The suicide rate for Indigenous females aged 0-24 years was five times the corresponding age-specific rates for non-Indigenous females. For age groups 45-54 years and over, age-specific rates for Indigenous females were similar to, or lower than the corresponding rates for non-Indigenous females (graph 9.23).

9.23 FEMALE DEATH RATES(a), INTENTIONAL SELF-HARM(b), by Indigenous status and age - 2001-2005
Graph: 9.23 Female death rates, intentional self harm, by Indigenous status and age, Qld, Wa, SA and NT combined, 2001-2005


Assault

Assault is a significant cause of death for both Indigenous males and females. Over the period 2001-2005, the Indigenous male age-specific death rates for ten year age groups from 25 through to 54 were between 11 and 17 times the corresponding age-specific rate for non-Indigenous males, while for females the rates ranged between 9 and 23 times the equivalent age-specific rates for non-Indigenous females (graphs 9.24 and 9.25).

9.24 MALE DEATH RATES(a), ASSAULT(b), by Indigenous status and age - 2001-2005
Graph: 9.24 Male death rates, assualt, by Indigenous status and age, Qld, WA, SA and NTcombined, 2001-2005


9.25 FEMALE DEATH RATES(a), ASSAULT(b), by Indigenous status and age - 2001-2005
Graph: 9.25 Female death rates, assualt, by Indigenous status and age, Qld, WA, SA and NTcombined, 2001-2005



Neoplasms (cancer)

Neoplasms were responsible for 15% of total Indigenous deaths compared with 30% of total non-Indigenous deaths for the period 2001-2005. Nevertheless, Indigenous people are over-represented in deaths from cancer compared with non-Indigenous Australians (the SMR for males and females is 1.4 and 1.5 respectively). This apparent contradiction is due to high numbers of deaths for other causes in the Indigenous population as well as high mortality rates from neoplasms for Indigenous Australians in the middle age groups. The major causes of cancer deaths for Indigenous males were malignant neoplasms of the digestive organs (30% of total), malignant neoplasms of the respiratory and intrathoracic organs (30%), and malignant neoplasms of lip, oral cavity and pharynx (9%). For Indigenous females the major causes were malignant neoplasms of the respiratory and intrathoracic organs (21% of total), malignant neoplasms of the digestive organs (21%), and malignant neoplasms of the female genital organs (14%).

Indigenous people were over-represented in a number of cancer groups, including malignant neoplasms of the lip, oral cavity and pharynx (7% of total Indigenous cancer deaths compared with 2% of non-Indigenous cancer deaths), malignant neoplasms of the respiratory and intrathoracic organs (26% Indigenous, 20% non-Indigenous) and malignant neoplasms of the female genital organs, which includes cervical cancer (14% total Indigenous females, 9% non-Indigenous females). Most of these cancers are smoking-related which is a reflection of the higher prevalence of smoking among the Indigenous population. Cervical cancer is also preventable through Pap Smear screening.

Indigenous people were under-represented in other cancer groups, including melanoma and other malignant neoplasms of skin (1% of total Indigenous cancer deaths compared with 4% of non-Indigenous cancer deaths), and malignant neoplasms of male genital organs, which includes prostate cancer (4% of total Indigenous males, 13% of non-Indigenous males).

The 2001-2005 age-specific death rates for neoplasms indicate that for age groups 0-24 years and 65 years and over, the rates for Indigenous males and females were similar to those for non-Indigenous males and females. For the age groups 35-44, 45-54 and 55-64 years, the rates for Indigenous males and females were about twice the non-Indigenous rates (graphs 9.26 and 9.27).

9.26 MALE DEATH RATES(a), NEOPLASMS(b), by Indigenous status and age - 2001-2005
Graph: 9.26 Male death rates, neoplasms, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.27 FEMALE DEATH RATES(a), NEOPLASMS(b), by Indigenous status and age - 2001-2005
Graph: 9.27 Female death rates, neoplasms, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


Cancer mortality of the Northern Territory Indigenous population has been compared with that of the Australian population for 1977-2000 (Condon et al 2004). The cancer mortality rate among Indigenous people was higher than the total Australian rate for cancers of the liver, lungs, uterus, cervix and thyroid, and, in younger people only, for cancers of the oropharynx, oesophagus and pancreas. Northern Territory cancer mortality rates for Indigenous Australians were lower than the total Australian rates for renal cancers and melanoma, and, in older people only, for cancers of the prostate and bowel. Over the period 1977-2000, there were increases in death rates for cancers of the oropharynx, pancreas and lung; all three are smoking-related cancers.

A study by Condon et al (2005) compared people diagnosed with cancer in Western Australia and Tasmania with Indigenous people diagnosed with cancer in the Northern Territory over the period 1991-2001. The study found that Northern Territory Indigenous patients had poorer survival rates for most cancers and the relative risk of death was higher for cancers of the oropharynx, colon and rectum, pancreas, lung, uterus, cervix, vulva, lymphoma, breast and leukaemia. Survival rates are the proportion of all cancer patients alive at the beginning of the period who are still alive at the end of the period. It was concluded that for cancers of the liver, lung and oesophagus, higher Northern Territory Indigenous mortality rates were due mostly to higher cancer incidence rates. For other cancers that have better survival rates in all Australians, such as cancer of the thyroid and cervix, high Indigenous mortality rates were due to both higher incidence and lower survival.


Respiratory diseases

Respiratory diseases, which include 'influenza' and 'pneumonia' and 'chronic lower respiratory diseases' (including asthma, bronchitis and emphysema), were responsible for 9% of total Indigenous deaths for the period 2001-2005. Like diabetes, respiratory diseases affect the Indigenous population at younger age groups than is the case for the non-Indigenous population, and this is reflected in the differences in age-specific death rates from these diseases. For the period 2001-2005, Indigenous males in the 35-44 years age group experienced age-specific death rates 22 times higher than the corresponding rate for non-Indigenous males (63 per 100,000 compared with 3 per 100,000), while the rate for Indigenous females in this age group was 20 times higher than that for the corresponding rate for non-Indigenous females (37 per 100,000 compared with 2 per 100,000) (graphs 9.28 and 9.29).

9.28 MALE DEATH RATES(a), RESPIRATORY DISEASES(b), by Indigenous status and age - 2001-2005
Graph: 9.28 Male death rates, respiratory diseases, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005


9.29 FEMALE DEATH RATES(a), RESPIRATORY DISEASES(b), by Indigenous status and age - 2001-2005
Graph: 9.29 Female death rates, respiratory diseases, by Indigenous status and age, Qld, WA, SA and NT combined, 2001-2005



Multiple causes of death

Multiple causes of death include all causes and conditions reported on the death certificate. Since 1997, the ABS has coded all causes of death reported on each death certificate, including the underlying, immediate and other associated causes of death. While only one cause can be recorded as the underlying cause of death, many deaths due to chronic diseases, such as heart disease, kidney disease and diabetes often occur with concurrent or co-existing conditions. It is useful, therefore, to describe the extent to which any or all of these conditions have been reported. For deaths where the underlying cause was identified as an external cause, multiple causes include circumstances of injury, the nature of injury as well as any other conditions reported on the death certificate.

For the 7,544 Indigenous deaths in 2001-2005 in Queensland, Western Australia, South Australia and the Northern Territory, there was a total of 23,977 causes reported, an average of three causes per death. Deaths where only a single cause was reported occurred in 15% of total Indigenous male deaths and 12% of total Indigenous female deaths, less than for non-Indigenous males (22%) and females (24%) (table 9.30). Correspondingly, deaths where multiple causes were reported were more common among Indigenous people. For example, 27% of deaths among Indigenous males and 29% of deaths among Indigenous females recorded five or more causes of death, compared with 15% of non-Indigenous male and female deaths.

9.30 DEATHS(a), by number of causes reported, Indigenous status and sex - 2001-2005

Number of deaths
Proportion of deaths (%)(b)
Males
Females
Males
Females
no.
no.
%
%

Indigenous
1
732
496
15.1
12.0
2
1 217
751
22.0
21.4
3
920
685
24.5
25.7
4
613
546
18.8
21.1
5 or more
847
737
26.9
28.6
Total(c)
4 329
3 215
100.0
100.0
Non-Indigenous
1
26 681
25 558
22.4
23.6
2
31 596
27 499
26.5
25.4
3
25 727
23 838
21.6
22.0
4
17 087
15 526
14.3
14.4
5 or more
18 120
15 764
15.2
14.6
Total(c)
119 211
108 185
100.0
100.0

(a) Data for Qld, WA, SA and NT combined. Deaths are based on year of registration of death.
(b) Proportions have been indirectly age standardised using the age and sex specific proportions for non-Indigenous Australians. Components may not add to total when indirect age standardisation is used.
(c) Includes deaths for which no cause of death was recorded.
Source: AIHW National Mortality Database


Table 9.31 shows the relationships between a number of underlying causes of death and associated causes for Indigenous and non-Indigenous Australians. For deaths from ischaemic heart disease, diabetes was reported as an associated cause of death among Indigenous males and females at two to three times the rates of non-Indigenous males and females. For deaths from diabetes, renal failure was reported as an associated cause of death among Indigenous males and females at almost twice the rates of non-Indigenous males and females.

9.31 UNDERLYING CAUSES OF DEATH(a)(b)(c), by selected associated causes and Indigenous status - 2001-2005

Indigenous
Non-Indigenous
Males
Females
Males
Females
%
%
%
%

Neoplasms (C00-D48)
Reported alone
26.5
27.4
39.4
43.7
Reported with
Septicaemia
4.5
5.6
3.6
3.3
Diabetes mellitus
11.9
20.2
4.7
3.9
Ischaemic heart disease
10.2
12.8
8.5
5.8
Cerebrovascular diseases
4.8
3.2
3.7
3.6
Influenza and pneumonia
10.6
9.4
7.8
5.9
Renal failure
11.2
11.2
5.9
4.5
Chronic lower respiratory diseases
15.8
8.2
7.0
4.2
Diabetes mellitus (E10-D14)
Reported alone
0.1
0.6
1.5
1.6
Reported with
Septicaemia
13.5
9.9
7.2
7.7
Ischaemic heart disease
48.6
45.5
58.5
50.7
Cerebrovascular diseases
23.9
26.9
21.0
24.3
Influenza and pneumonia
11.6
12.0
8.8
7.5
Renal failure
37.5
39.1
24.0
23.3
Chronic lower respiratory diseases
6.0
3.8
7.5
4.9
Ischaemic heart disease (I20-I25)
Reported alone
9.1
6.5
15.5
12.4
Reported with
Diabetes mellitus
19.2
22.0
10.2
9.0
Cerebrovascular diseases
10.1
12.0
7.9
10.1
Influenza and pneumonia
9.1
5.6
4.8
5.2
Renal failure
14.9
26.0
10.8
9.6
Chronic lower respiratory diseases
19.9
12.7
11.5
7.6
Neoplasms
8.4
5.5
7.8
5.0
Renal failure (N17-N19)
Reported alone
12.8
8.7
8.6
13.4
Reported with
Septicaemia
21.3
18.4
13.0
10.1
Diabetes mellitus
10.9
12.5
9.1
9.3
Ischaemic heart disease
45.7
17.9
37.2
29.8
Cerebrovascular diseases
17.5
2.5
9.5
8.0
Influenza and pneumonia
11.7
11.0
15.1
14.2
Chronic lower respiratory diseases
11.5
7.9
10.5
5.4

(a) Data are for Qld, WA, SA and NT combined. Deaths based on year of occurrence of death for 1999-2002 and year of registration of death for 2003.
(b) Proportions have been indirectly age standardised using the age, sex and cause-specific proportions of non-Indigenous persons.
(c) Totals may add to more than 100% as more than one associated cause can be recorded for each death.
Source: AIHW National Mortality Database


Table 9.32 uses the recording of multiple causes of death to associate the category of external cause of death with the nature of the injury sustained by Indigenous people. For the period 2001-2005, of all deaths from transport accidents, 42% involved injuries to multiple body parts, 38% involved injuries to the head and 17% involved injuries to the chest. For deaths from accidents other than transport accidents, 33% were for 'other and unspecified effect', while injuries to the head involved 15% of deaths and poisoning involved 13% of deaths from these accidents. Most deaths from intentional self-harm were for 'other and unspecified effects' (which includes suffocation and drowning) (85%), while deaths from assault most commonly involved injuries to the head (27%) or to the chest (32%).

9.32 INDIGENOUS DEATHS DUE TO EXTERNAL CAUSES(a), by nature of injury - 2001-2005

Nature of injury
Transport accidents
Other accidents
Intentional self-harm
Assault
Total

Injuries to the head
37.6
15.4
3.6
26.9
18.7
Injuries to the neck
7.7
3.6
6.0
11.9
6.3
Injuries to the thorax (chest)
17.2
1.8
1.9
32.1
9.6
Injuries to the abdomen, lower back, lumbar spine, pelvis, hip and thigh
10.9
11.1
1.4
20.1
8.9
Injuries involving multiple body parts
42.3
1.8
0.8
8.2
13.5
Injuries to unspecified part of trunk, limb or body region
10.4
4.8
0.5
13.4
5.8
Effects of foreign body entering through natural orifice
1.2
6.6
0.5
3.0
2.6
Burns and corrosions
0.9
5.7
0.8
-
2.0
Poisoning by drugs, medicaments and biological substances
-
13.3
3.6
-
4.8
Toxic effects of substances chiefly non-medicinal as to source
3.0
13.3
9.0
4.5
7.8
Other and unspecified effects of external causes
3.3
32.8
85.0
4.5
36.2
Other
4.1
7.8
1.4
8.2
6.9
Total deaths (V01-Y98)(b)
338
332
366
134
1 220

- nil or rounded to zero (including null cells)
(a) Data for Qld, WA, SA and NT combined. Deaths are based on year of registration of death.
(b) Components add to more than 100% as more than one injury can be recorded for each death from external causes.
Source: AIHW National Mortality Database






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