Causes of inequality in life expectancy between Indigenous and non‐Indigenous people in the Northern Territory, 1981–2000: a decomposition analysis

Zhao, Yuejen; Dempsey, Karen

doi:10.5694/j.1326-5377.2006.tb00340.x

Cited by 77 publications

(76 citation statements)

References 16 publications

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“…Estimated gaps in LE between the Australian Aboriginal population and the total population of Australia overall have varied between 10.6 and 21 years, depending on sex, time periods chosen, the jurisdiction investigated and, most of all, the method of calculation [3,9-19]. Many earlier published estimates have been based on relatively small, predominantly remote populations and shed little light on Aboriginal LE in urban and regional areas where most of the Aboriginal population of Australia resides [11,12,17-20].…”

Section: Introductionmentioning

confidence: 99%

A review of life expectancy and infant mortality estimations for Australian Aboriginal people

et al. 2014

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BackgroundSignificant variation exists in published Aboriginal mortality and life expectancy (LE) estimates due to differing and evolving methodologies required to correct for inadequate recording of Aboriginality in death data, under-counting of Aboriginal people in population censuses, and unexplained growth in the Aboriginal population attributed to changes in the propensity of individuals to identify as Aboriginal at population censuses.The objective of this paper is to analyse variation in reported Australian Aboriginal mortality in terms of LE and infant mortality rates (IMR), compared with all Australians.MethodsPublished data for Aboriginal LE and IMR were obtained and analysed for data quality and method of estimation. Trends in reported LE and IMR estimates were assessed and compared with those in the entire Australian population.ResultsLE estimates derived from different methodologies vary by as much as 7.2 years for the same comparison period. Indirect methods for estimating Aboriginal LE have produced LE estimates sensitive to small changes in underlying assumptions, some of which are subject to circular reasoning. Most indirect methods appear to under-estimate Aboriginal LE. Estimated LE gaps between Aboriginal people and the overall Australian population have varied between 11 and 20 years.Latest mortality estimates, based on linking census and death data, are likely to over-estimate Aboriginal LE.Temporal LE changes by each methodology indicate that Aboriginal LE has improved at rates similar to the Australian population overall. Consequently the gap in LE between Aboriginal people and the total Australian population appears to be unchanged since the early 1980s, and at the end of the first decade of the 21st century remains at least 11–12 years.In contrast, focussing on the 1990–2010 period Aboriginal IMR declined steeply over 2001–08, from more than 12 to around 8 deaths per 1,000 live births, the same level as Australia overall in 1993–95. The IMR gap between Aboriginal people and the total Australian population, while still unacceptable, has declined considerably, from over 8 before 2000 to around 4 per 1,000 live births by 2008.ConclusionsRegardless of estimation method used, mortality and LE gaps between Aboriginal and non-Aboriginal people are substantial, but remain difficult to estimate accurately.

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Section: Introductionmentioning

confidence: 99%

A review of life expectancy and infant mortality estimations for Australian Aboriginal people

et al. 2014

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“…Indigenous people living within developed countries continue to live in poverty and experience a ‘protracted’ epidemiological transition4 that is associated with a double burden of communicable diseases and NCDs,7 8 similar to that of many developing countries 2. In central Australia, for example, diabetes and other NCDs are the major contributors to racial disparities in mortality8 and to a life expectancy that remains 14 years less for Indigenous Australian men relative to their non-Indigenous peers 9. A high burden of infectious diseases persists in this Indigenous population.…”

Section: Introductionmentioning

confidence: 99%

Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in central Australia

et al. 2013

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ObjectivesWe hypothesise that rising prevalence rates of non-communicable diseases (NCDs) increase infection risk and worsen outcomes among socially disadvantaged Indigenous Australians undergoing a rapid epidemiological transition.DesignAvailable pathology, imaging and discharge morbidity codes were retrospectively reviewed for a period of 5 years prior to admission with a bloodstream infection (BSI), 1 January 2003 to 30 June 2007.Participants558 Indigenous and 55 non-Indigenous community residents of central Australia.Outcome measuresThe effects of NCDs on risk of infection and death were determined after stratifying by ethnicity.ResultsThe mean annual BSI incidence rates were far higher among Indigenous residents (Indigenous, 937/100 000; non-Indigenous, 64/100 000 person-years; IRR=14.6; 95% CI 14.61 to 14.65, p<0.001). Indigenous patients were also more likely to have previous bacterial infections (68.7% vs 34.6%; respectively, p<0.001), diabetes (44.3% vs 20%; p<0.001), harmful alcohol consumption (37% vs 12.7%; p<0.001) and other communicable diseases (human T-lymphotropic virus type 1, 45.2%; strongyloidiasis, 36.1%; hepatitis B virus, 12.9%). Among Indigenous patients, diabetes increased the odds of current Staphylococcus aureus BSI (OR=1.6, 95% CI 1.0 to 2.5) and prior skin infections (adjusted OR=2.1, 95% CI 1.4 to 3.3). Harmful alcohol consumption increased the odds of current Streptococcus pneumoniae BSI (OR=1.57, 95% CI 1.02 to 2.40) and of previous BSI (OR=1.7, 95% CI 1.1 to 2.5), skin infection (OR=1.7, 95% CI 1.1 to 2.6) or pneumonia (OR=4.3, 95% CI 2.8 to 6.7). Twenty-six per cent of Indigenous patients died at a mean (SD) age of 47±15 years. Complications of diabetes and harmful alcohol consumption predicted 28-day mortality (non-rheumatic heart disease, HR=2.9; 95% CI 1.4 to 6.2; chronic renal failure, HR=2.6, 95%CI 1.0 to 6.5; chronic liver disease, HR=3.3, 95% CI 1.6 to 6.7).ConclusionsIn a socially disadvantaged population undergoing a rapid epidemiological transition, NCDs are associated with an increased risk of infection and BSI-related mortality. Complex interactions between communicable diseases and NCDs demand an integrated approach to management, which must include the empowerment of affected populations to promote behavioural change.

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“…Although there was clear improvement in LE for NT Indigenous females over recent decades, the improvement in LE among males was slow, and the changes in LE gap between Indigenous and non-Indigenous males stagnated [4-6]. Previous research indicates that cardiovascular disease, genitourinary disease, diabetes, and respiratory disease are the leading contributors to the excess Indigenous mortality [5]. Australian governments have stated their determination to close the Indigenous LE gap within a generation, and halve the education and employment gap within a decade [1].…”

Section: Introductionmentioning

confidence: 99%

Decomposing Indigenous life expectancy gap by risk factors: a life table analysis

Zhao

Wright

Begg

et al. 2013

Popul Health Metrics

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Background: The estimated gap in life expectancy (LE) between Indigenous and non-Indigenous Australians was 12 years for men and 10 years for women, whereas the Northern Territory Indigenous LE gap was at least 50% greater than the national figures. This study aims to explain the Indigenous LE gap by common modifiable risk factors.Methods: This study covered the period from 1986 to 2005. Unit record death data from the Northern Territory were used to assess the differences in LE at birth between the Indigenous and non-Indigenous populations by socioeconomic disadvantage, smoking, alcohol abuse, obesity, pollution, and intimate partner violence. The population attributable fractions were applied to estimate the numbers of deaths associated with the selected risks. The standard life table and cause decomposition technique was used to examine the individual and joint effects on health inequality. Results:The findings from this study indicate that among the selected risk factors, socioeconomic disadvantage was the leading health risk and accounted for one-third to one-half of the Indigenous LE gap. A combination of all six selected risks explained over 60% of the Indigenous LE gap.Conclusions: Improving socioeconomic status, smoking cessation, and overweight reduction are critical to closing the Indigenous LE gap. This paper presents a useful way to explain the impact of risk factors of health inequalities, and suggests that reducing poverty should be placed squarely at the centre of the strategies to close the Indigenous LE gap.

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Causes of inequality in life expectancy between Indigenous and non‐Indigenous people in the Northern Territory, 1981–2000: a decomposition analysis

Cited by 77 publications

References 16 publications

A review of life expectancy and infant mortality estimations for Australian Aboriginal people

A review of life expectancy and infant mortality estimations for Australian Aboriginal people

Non-communicable diseases, infection and survival in a retrospective cohort of Indigenous and non-Indigenous adults in central Australia

Decomposing Indigenous life expectancy gap by risk factors: a life table analysis

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