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Abstract
Introduction: Mortality and life expectancy (LE) gaps between Indigenous and all Australians are of public concern. Past measurements relied on Australian jurisdictions where Aboriginal designation is considered reasonably complete, and mostly outer regional and remote. However, most Aboriginal people reside in metropolitan and inner regional areas. Little data is available on adult Aboriginal mortality trends, and no reliable data from New South Wales (NSW). Accurate mortality measurements are necessary to measure health outcome changes, which reflect health service provision, and economic and social conditions affecting Aboriginal people.
Aims: This thesis investigates, for the first time, age-, sex- and cause-specific mortality calculated for a large urban Aboriginal Community-Controlled Health Service (ACCHS) cohort in inner-city Sydney, NSW, and compares with other Indigenous mortality estimates in Australia and elsewhere.
Methods: Probabilistic death-matching was performed with demographic data from the ACCHS cohort and National Death Index. Life tables were constructed from accepted death matches, age-specific mortality rates and LE extracted for the 1995-2009 period. Cumulative age-standardised adult mortality was calculated for comparison with other Indigenous and national populations from routine death recording and census denominators. Age-specific contributions of mortality to LE gaps were calculated using a decomposition method from constructed and published life tables. ACCHS cohort cause-specific mortality was calculated and compared with other populations. External causes of mortality were analysed comprehensively as an example of a major cause of death category.
Results: ACCHS cohort all-cause mortality rates decreased, and LE estimates increased over time. However, relative differences compared with all Australians showed no improvement and relative adult mortality increased over time due to contemporaneous non-Indigenous mortality improvement. Cause-specific ACCHS mortality was similar to recorded Australian Indigenous mortality and significantly greater for external causes and cardiovascular diseases. Accidental drug poisoning was the major contributor to the external causes differential. When compared with New Zealand Māori, ACCHS cohort and Indigenous Australians had greater LE gaps (compared with non-indigenous LE) and premature adult mortality at younger age intervals.
Conclusion: An urban Aboriginal cohort showed mortality rates and LE estimates similar to national Indigenous population data from routine death recording and census denominators, although some cause-specific differences.