3303.0 - Causes of Death, Australia, 2017 Quality Declaration 
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Leading causes of death in Aboriginal and Torres Strait Islander People

This article provides analysis of leading causes of death for Aboriginal and Torres Strait Islander people residing in New South Wales, Queensland, South Australia, Western 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 61-73).

Measures of mortality relating to Aboriginal and Torres Strait Islander people are key inputs into the Closing the Gap strategy, led by the Council Of Australian Governments (COAG). This is a government partnership where work is undertaken with Aboriginal and Torres Strait Islander communities to close the gap in Indigenous disadvantage. Mortality data enables measurement of progress towards key Closing the Gap targets.

In 2017, there were 2,988 deaths of Aboriginal and Torres Strait Islander people (1,631 males and 1,357 females). The standardised death rate was 976.3 per 100,000 persons, a 2.3% decline from 2016 which recorded a death rate of 999.7. Trends in the mortality rate from all causes for Aboriginal and Torres Strait Islander males and females (and persons combined) from 2008 to 2017 are presented in the graph below. Although year to year fluctuations have occurred, for persons overall, the all cause death rate has decreased by 2.2% over the past decade going from 998.0 per 100,000 to 976.3 per 100,000. The median age of death for Aboriginal and Torres Strait Islander people over this period increased from 56.2 in 2008 to 60.0 in 2017, which aligns with increased life expectancy for Aboriginal and Torres Strait Islander people over a similar period (ABS, 2013). The overall reduction in the death rate has been driven by a decline in the death rate for males, which decreased by 5.2% (1129.4 per 100,000 to 1070.3 per 100,000). In contrast, the female death rate increased slightly over this period (an increase of 0.1%) going from 886.3 to 887.4 per 100,000 persons.

Graph Image for SDRs, Aboriginal and Torres Strait Islander People, 2008-2017(a)(b)(c)(d)(e)

Footnote(s): (a) Standardised death rate. Death rate per 100,000 estimated resident population as at 30 June (mid year). See Explanatory Notes 44-47 for further information. (b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data. (c) The age standardised death rates for Aboriginal and Torres Strait Islander people presented in this table use Aboriginal and Torres Strait Islander population projections based on the 2011 Census. See Explanatory Note 69 for further information. (d) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60. (e) Data are reported by jurisdiction of usual residence for NSW, Qld, WA, SA and the NT only. 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 61-73.

Source(s): SDRs, Aboriginal and Torres Strait Islander People, 2008-2017(a)(b)(c)(d)(e)-SDRs, Aboriginal and Torres Strait Islander People, 2008-2017(a)(b)(c)(d)(e)



The leading cause of death for Aboriginal and Torres Strait Islander people in 2017 was Ischaemic heart disease (344 deaths), accounting for 11.5% of all deaths. Diabetes was the second leading cause (226 deaths). Compared to 2016, the death rate from both Ischaemic heart disease and Diabetes in Aboriginal and Torres Strait Islander people has decreased (heart disease mortality decreased from 122.7 to 114.7 per 100,000 persons, and diabetes decreased from 88.2 per 100,000 to 83.3). This reduction was consistent for both men and women (both causes showed a much larger decrease for males than females). The third to fifth leading causes for Aboriginal and Torres Strait Islander people in 2017 were Chronic lower respiratory diseases (202 deaths), Malignant neoplasms of the trachea, bronchus and lung (184 deaths) and Intentional self-harm (165 deaths). Suicide was the only one of the top five causes of death to see an increased rate from last year for both genders, with the male suicide rate increasing from 39.0 to 39.6 and the female rate increasing from 11.8 to 11.9.

Decade long trends in the mortality rate for the top five leading causes of death for Aboriginal and Torres Strait Islander people are outlined in the table below. Longer term trends of diseases can be seen, although annual fluctuations in data should be considered. The rate of Ischaemic heart disease deaths has decreased by 20.6% since 2008 (from 144.5 per 100,000 persons to 114.7), while the rate for Diabetes has declined by 16.4% (from 99.6 to 83.3 deaths per 100,000 persons). These reductions have been primarily driven by males (23.9% reduction in the rate of heart disease deaths, 23.6% reduction in the rate from diabetes deaths), although the corresponding death rates for females for these causes also declined (17.3% decrease in the death rate for heart disease, 10.9% decrease in the death rate for diabetes).

The death rate from the remaining three leading causes increased from 2008 to 2017, though remaining comparable with death rates for 2016. Chronic lower respiratory diseases have fluctuated over the decade, ranging from 57.9 in 2008 to a peak of 85.2 in 2014. The mortality rate for chronic lower respiratory diseases remains high in 2017 at 81.5 per 100,000 persons. Although males have a higher rate of death due to chronic lower respiratory disease (85.6 per 100,000 persons in 2017), females accounted for a larger share of this increase over the decade, growing by 78.8% from 43.8 per 100,000 persons in 2008 to 78.3 in 2017. Death rates from malignant neoplasms of the trachea, bronchus and lung, commonly known as lung cancer, have also increased within the period, ranging from 50.6 per 100,000 persons in 2008, to 63.3 in 2012 and recording a mortality rate of 60.5 in 2017.

Both chronic lower respiratory diseases and lung cancer are smoking related diseases. In 2014 to 2015 it was estimated that 45% of the Aboriginal and Torres Strait Islander population were current smokers, with the prevalence being as high as 56% in remote areas (ABS, 2017) . Although smoking rates have decreased over time for Aboriginal and Torres Strait Islander people, the development of smoking related illnesses can have delayed onset from smoking initiation (ABS, 2017).

The mortality rate from intentional self-harm has also increased in Aboriginal and Torres Strait Islander persons over the last decade, going from 17.8 per 100,000 persons in 2008 to 25.5 per 100,000. This increase was observed for both men and women.

Top 5 leading causes of death, Standardised Death Rates, NSW, Qld, SA, WA and NT, Aboriginal and Torres Strait Islander People, 2008-2017 (a)(b)(c)(d)(e)(f)

Cause of Death and ICD Code2008200920102011201220132014201520162017

Ischaemic heart disease (I20-I25)144.5160.8137.1142.9143.5127.3131.9145.2122.7114.7
Diabetes mellitus (E10-E14)99.688.680.685.892.790.490.177.488.283.3
Chronic lower respiratory diseases (J40-J47)57.962.359.766.364.665.085.272.582.481.5
Malignant neoplasm of trachea, bronchus and lung (C33, C34)50.651.852.760.463.355.756.056.067.960.5
Intentional self-harm [suicide] (X60-X84, Y87.0)(e)17.817.721.123.920.024.023.825.925.125.5
All causes998.0971.2977.2977.0982.6995.7982.4999.9999.7976.3

Footnote(s):
(a) Causes listed are the top 5 leading causes of death for all Aboriginal and Torres Strait Islander deaths registered in 2017, based on WHO recommended tabulation of leading causes. See Explanatory Notes 36-39 for further information.
(b) Standardised death rate. Death rate per 100,000 estimated resident population as at 30 June (mid year). See Explanatory Notes 44-47 for further information.
(c) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data.
(d) The age standardised death rates for Aboriginal and Torres Strait Islander people presented in this table use Aboriginal and Torres Strait Islander population projections based on the 2011 Census. See Explanatory Note 69 for further information.
(e) The data presented for intentional self-harm includes ICD-10 codes X60-X84 and Y87.0. Care needs to be taken in interpreting figures relating to intentional self-harm. See Explanatory Notes 91-100 in this publication.
(f) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.


The table below shows the number and rate of the top 20 leading causes of death in Aboriginal and Torres Strait Islander people and Non-Indigenous people in 2017. As can be seen, there are systematic differences between the death rates for leading causes, which are consistently higher in Aboriginal and Torres Strait Islander people. The largest rate ratios are seen for deaths from Diabetes (Aboriginal and Torres Strait Islander rate 5.2 times higher than the Non-Indigenous population), Cirrhosis and other diseases of the liver (Aboriginal and Torres Strait Islander rate 3.7 times higher than the Non-Indigenous population), and Chronic lower respiratory diseases (Aboriginal and Torres Strait Islander rate 2.9 times higher than the Non-Indigenous population). The death rate from intentional self-harm is 2.0 times higher in Aboriginal and Torres Strait Islander people, with a death rate of 25.5 per 100,000 persons for Aboriginal and Torres Strait Islander people compared to 12.7 per 100,000 for Non-Indigenous persons.


Top 20 leading causes of death, NSW, Qld, SA, WA and NT, Aboriginal and Torres Strait Islander Status, 2017 (a)(b)(c)(d)(e)(f)(g)(h)

Cause of Death and ICD Code
Aboriginal and Torres Strait Islander
no.
SDR
rate
Non-Indigenous
no.
SDR
rate
Rate Ratio
Rate Difference

All causes
2,988
976.3
110,217
556.8
1.8
419.5
Ischaemic heart diseases (I20-I25)
344
114.7
12,732
63.7
1.8
50.9
Diabetes (E10-E14)
226
83.3
3,218
16.0
5.2
67.3
Chronic lower respiratory diseases (J40-J47)
202
81.5
5,661
28.0
2.9
53.5
Malignant neoplasm of trachea, bronchus and lung (C33, C34)
184
60.5
5,678
27.8
2.2
32.6
Intentional self-harm [suicide] (X60-X84, Y87.0)(c)
165
25.5
2,165
12.7
2.0
12.8
Cirrhosis and other diseases of liver (K70-K76)
98
24.1
1,281
6.6
3.7
17.5
Dementia, including Alzheimer disease (F01, F03, G30)
97
60.4
9,520
47.6
1.3
12.8
Cerebrovascular diseases (I60-I69)
96
42.5
7,179
36.0
1.2
6.5
Accidental poisoning (X40-X49)
78
14.5
833
5.1
2.8
9.4
Land transport accidents (V01-V89, Y85)(d)
77
12.6
904
5.2
2.4
7.3
Certain conditions originating in the perinatal period (P00-P96)
66
5.5
329
2.1
2.6
3.4
Symptoms, signs and ill-defined conditions (R00-R99)
64
12.5
1,542
8.2
1.5
4.4
Malignant neoplasm of pancreas (C25)
60
19.9
2,014
9.9
2.0
10.0
Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81-C96)
57
19.8
3,068
15.3
1.3
4.5
Influenza and pneumonia (J09-J18)
53
18.2
2,850
6.5
2.8
11.7
Malignant neoplasm of liver and intrahepatic bile ducts (C22)
53
21.0
1,316
14.3
1.5
6.6
Diseases of the urinary system (N00-N39)
52
18.7
2,396
12.0
1.6
6.8
Malignant neoplasm of colon, sigmoid, rectum and anus (C18-C21, C26.0)(e)
50
19.4
3,665
18.3
1.1
1.1
Malignant neoplasms of breast (C50)
35
10.8
1,970
10.1
1.1
0.8
Cardiomyopathy (I42)
32
9.1
703
3.6
2.5
5.5

Footnote(s):
(a) Causes listed are the top 20 leading causes of Aboriginal and Torres Strait Islander deaths for 2017, based on the WHO recommended tabulation of leading causes. See Explanatory Notes 36-39 in this publication for further information. Groupings of deaths coded to Chapter XVIII: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) are not included in analysis, due to the unspecific nature of these causes. Furthermore, many deaths coded to this chapter are likely to be affected by revisions, and hence recoded to more specific causes of death as they progress through the revisions process.
(b) Standardised death rate. Death rate per 100,000 estimated resident population as at 30 June (mid year). See Explanatory Notes 44-47 for further information.
(c) The data presented for intentional self-harm includes ICD-10 codes X60-X84 and Y87.0. Care needs to be taken in interpreting figures relating to intentional self-harm. See Explanatory Notes 39 and 91-100 in this publication.
(d) The data presented for Land transport accidents includes ICD-10 codes V01-V89 and Y85. See Explanatory Note 39 in this publication.
(e) The data presented for Malignant neoplasm of the colon, sigmoid, rectum and anus (C18-C21) includes deaths due to Malignant neoplasm of the intestinal tract, part unspecified (C26.0). Comparisons with data for this leading cause, and associated leading cause rankings, should therefore be made with caution. See Explanatory Note 38 in this publication for further details.
(f) The age standardised death rates for Aboriginal and Torres Strait Islander people presented in this table use Aboriginal and Torres Strait Islander population projections based on the 2011 Census. See Explanatory Note 69 for further information.
(g) The rate ratio is the rate for Aboriginal and Torres Strait Islander persons divided by the Non-Indigenous rate.
(h) The rate difference is the rate Aboriginal and Torres Strait Islander persons less the Non-Indigenous rate.


Deaths from Non-Communicable Diseases in Aboriginal and Torres Strait Islander People

More than half of the top 20 leading causes of death in Aboriginal and Torres Strait Island people in Australia in 2017 can be characterised as non-communicable diseases (NCDs). NCDs refer to diseases and conditions which develop over a long period of time and are not caused by infectious agents, but are instead the outcome of various genetic, physiological, environmental and life-style factors (WHO 2018). NCDs cannot be spread from person to person, and include well-known health problems like cardiovascular disease (such as heart disease and stroke), cancers, diabetes, and chronic lung diseases (including asthma and chronic obstructive pulmonary disease). The World Health Organization (2018) estimates that NCDs account for approximately 70% of all deaths globally each year.

Many NCDs share common and preventable risk factors such as a lack of physical exercise, harmful levels of alcohol consumption, smoking and an unhealthy diet, which can result in more serious risk factors like obesity, high cholesterol, high blood glucose levels, and high blood pressure (WHO 2018). NCDs disproportionately affect certain population groups in Australia, including Aboriginal and Torres Strait Islander people (Moodie, Tolhurst and Martin, 2016). As a result, there are differences in NCD related mortality for Aboriginal and Torres Strait Islander people compared to Non-Indigenous people.

One way of measuring the impact of NCDs is to measure 'premature' mortality. Premature mortality is defined as any death that occurs between the ages of 1-78 years and can be calculated by estimating the average number of years people died from a certain disease before reaching 79 years of age. This measure is known as the average Years of Potential Life Lost (YPLL) (see Explanatory Notes 40-43)

Using this method, the graph below provides the average YPLL for Aboriginal and Torres Strait Islander people and Non-Indigenous people across four selected NCDs in 2017. On average, Aboriginal and Torres Strait Islander people lose 29.1 years of life across the selected NCDs. The largest number of years lost was for cardiovascular diseases with an average of 31.5 years, followed by cancers with an average of 28.2 years of life lost. For the Non-Indigenous population, the average number of life years lost per death for selected NCDs is 10.6 years, with cancer accounting for the highest number of years lost for this group at an average of 11.2 years.

Graph Image for Average YPLL, NCDs, Aboriginal and Torres Strait Islander Status, 2017(a)(b)(c)(d)

Footnote(s): (a) Causes listed are for selected NCDs and include Cancers (C00-C97, D45-D46, D47.1, D47.3-D47.5), Diabetes (E10-E14), Cardiovascular diseases (I00-I99) and Chronic lung diseases (J30-J98). (b) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60. (c) Years of Potential Life lost. See Explanatory Notes 44-47 for further information. (d) Data are reported by jurisdiction of usual residence for NSW, Qld, WA, SA and the NT only. 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 61-73.

Source(s): Average YPLL, NCDs, Aboriginal and Torres Strait Islander Status, 2017(a)(b)(c)(d)-Average YPLL, NCDs, Aboriginal and Torres Strait Islander Status, 2017(a)(b)(c)(d)



An additional measure of premature mortality from NCDs focuses on deaths within the specific age bracket of 30 to 69 year olds. This age group is suggested by the WHO in their Global Monitoring Framework (2014) on NCDs, and is used to generate internationally comparable measures of NCD burden and also account for lower life expectancies around the world. This measure can also be used in an Australian context to further measure NCD-related mortality in Aboriginal and Torres Strait Islander people.

The table below presents the average age specific death rates for two time periods, 2008 to 2012 and 2013 to 2017, for four selected NCDs combined (cardiovascular disease, cancer, diabetes, and chronic lung disease). It focuses on ten year age groups between 30 to 69 years for Aboriginal and Torres Strait Islander people. A mixed picture of change over the last decade from NCDs emerges for these age groups, with reductions for some age groups and increases for others. NCD-related mortality has decreased by the largest percentage in 30-39 year olds, which saw a 13.1% decrease from 2008-2012 to 2013-2017, going from an average of 104.2 deaths per 100,000 people to 90.5 per 100,000. The average death rate from NCDs for Aboriginal and Torres Strait Islander people in the 50-59 year age bracket also declined by 2.9% from 2008-2012 to 2013-2017 (going from 706.8 per 100,000 people to 686.6 per 100,000). An increase was observed in the 60 to 69 year age group, increasing by 1.6%, while the death rate for 40 to 49 year olds moved by the smallest margin of any of these age groups over the past decade, increasing by 0.5% (from 291.7 per 100,000 people to 293.2 per 100,000).

Average Age-Specific Death Rates, Selected Non-Communicable Diseases Combined, NSW, Qld, SA, WA and NT, Aboriginal and Torres Strait Islander People, 2008-2012 and 2013-2017 (a)(b)(c)(d)


Selected Age Group
2008-2012
2013-2017

30 Years - 39 Years
104.2
90.5
40 Years - 49 Years
291.7
293.2
50 Years - 59 Years
706.8
686.6
60 Years - 69 Years
1,518.0
1,542.4

Footnote(s):
(a) Selected NCDs include Cancers (C00-C97, D45-D46, D47.1, D47.3-D47.5), Diabetes (E10-E14), Cardiovascular diseases (I00-I99) and Chronic lung diseases (J30-J98).
(b) See Explanatory Notes 75-106 for further information on specific issues related to interpreting time-series and 2017 data.
(c) Causes of death data for 2017 are preliminary and subject to a revisions process. See Explanatory Notes 57-60.
(d) Age-specific death rates. Deaths per 100,000 of estimated resident population as at 30 June (mid year). See Explanatory Notes 69 further information.

REFERENCES

1. Australian Bureau of Statistics (ABS) 2013, Life Tables for Aboriginal and Torres Strait Islander Australians, 2010-2012. Cat no. 3302.0.55.003. Viewed September 7th 2018
https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3302.0.55.0032010-2012?OpenDocument

2. Australian Bureau of Statistics (ABS) 2017, Aboriginal and Torres Strait Islander Peoples: Smoking Trends, Australia, 1994 to 2014-2015. Cat no. 4737.0. Viewed September 10th 2018.https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4737.0Main+Features11994%20to%202014-15?OpenDocument

3. World Health Organization (WHO) 2018, Noncommunicable Diseases. Viewed 5th September 2018.
http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

4. Moodie, A.R., Tolhurst, P., Martin, J.E., (2016). Australia's health: being accountable for prevention. Medical Journal of Australia. Volume 204, Issue 6.
https://www.mja.com.au/journal/2016/204/6/australias-health-being-accountable-prevention

5. World Health Organization (WHO) 2014, Noncommunicable Diseases Global Monitoring Framework: Indicator Definitions and Specifications. Viewed September 3rd 2018.
http://www.who.int/nmh/ncd-tools/indicators/GMF_Indicator_Definitions_Version_NOV2014.pdf