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The Queensland Government acknowledges and respects Traditional Owners and Aboriginal and Torres Strait Islander Elders past, present and emerging, on whose land we work to support the provision of safe and quality healthcare. Indigenous artwork is by Riki Salam of Gilimbaa Indigenous Creative Agency. Indigenous Queenslander is used in this document to describe a person of Aboriginal and/or Torres Strait Islander descent who identifies as an Aboriginal person or a Torres Strait Islander, is accepted as such by the community in which he or she lives, and who resides in Queensland. Closing the gap performance report 2018 Published by the State of Queensland (Queensland Health), March 2019

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Queensland Health) 2019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health). For more information contact: Aboriginal and Torres Strait Islander Health Branch, Department of Health, GPO Box 48, Brisbane QLD 4001, phone (07) 3708 5557,

An electronic version of this document is available at www.health.qld.gov.au/atsihealth

Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

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Queensland Health | Closing the Gap Performance Report 2018 3

Foreword

This report provides an opportunity for all Queenslanders to celebrate significant gains and improvements

in life expectancy for Aboriginal and Torres Strait Islander Queenslanders. Latest estimates suggest that

Aboriginal and Torres Strait Islander Queenslanders have the highest life expectancy of any jurisdiction and

the smallest gap in life expectancy. This provides tangible evidence that positive health outcomes can be

affected with effort, investment and resolve.

It is important that we reflect on the outcomes achieved and take comfort in the fact that change is not only

possible, but is real and evident in Queensland today. For too long the Aboriginal and Torres Strait Islander

health agenda has been mired in negativity and adversely affected by racism and exclusion. The discourse

has focussed on the population and not the drivers of poor health outcomes and how we can collaboratively

affect change.

We can now come together as a state to celebrate the improved life expectancy estimates and to reflect on

the importance of these achievements. However, we must always contextualise progress and understand

clearly the challenges that lie ahead. Closing the gap in life expectancy within a generation remains

ambitious, but also necessary.

While there has been a 14 per cent improvement in child mortality rates since the Closing the Gap targets

were agreed to, the gap remains unchanged. This is the challenge of setting relative targets— parallel

improvements in mortality among other Queensland children mean we need to see even greater gains in

Aboriginal and Torres Strait Islander health outcomes. Our efforts therefore need to be greater to accelerate

progress. Evidence based programs which work in partnership with Aboriginal and Torres Strait Islander

people would go a long way towards this.

We must acknowledge that life expectancy for Aboriginal and Torres Strait Islander people is influenced by

where they live. There is a substantial life expectancy gap between Aboriginal and Torres Strait Islander

populations in major cities and remote locations in Australia. While ensuring the health of Aboriginal and

Torres Strait Islander people living in major cities remains important, we must embed appropriate policy

settings to ensure effort is prioritised for remote Aboriginal and Torres Strait Islander populations.

Finally, and most importantly, there is still a great deal of work to be done on the reconciliation journey. While

the Close the Gap refresh has not yet been endorsed by the Council of Australian Governments (COAG),

the Queensland Government remains committed to a refreshed agenda. Engagement mechanisms to truly

work with Aboriginal and Torres Strait Islander people and to build sustained and lasting collaborations to

close the gap are necessary.

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Queensland Health | Closing the Gap Performance Report 2018 4

Ministerial Aboriginal and Torres Strait Islander health workshop 2018

Aboriginal and Torres Strait Islander leaders gathered in Cairns on 22 November 2018 to tackle the question

“how can we work together to improve health and healthcare for Aboriginal and Torres Strait Islander

people?”

Facilitated by Professor Cindy Shannon, and including a keynote address by Mick Gooda, key themes

emerging from the workshop included:

• Racism in the health system: institutional racism and individual racism must be addressed as a key

barrier to Aboriginal and Torres Strait Islander people’s access to services and the impact on health

outcomes.

• Partnerships: formalised partnerships and relationships with Aboriginal and Torres Strait Islander

people, communities and the community controlled health sector must be strengthened to improve

outcomes and to tackle discrimination.

• Workforce: the need to develop education and employment pathways to increase the Aboriginal and

Torres Strait Islander health workforce and make the health workforce more culturally capable.

At the workshop, the Minister announced his intention to establish a Chief Aboriginal and Torres Strait

Islander Health Officer position to drive strategy and policy direction for improving Aboriginal and Torres

Strait Islander health outcomes across the Queensland health system.

Being established as a Deputy Director-General position, the Chief Aboriginal and Torres Strait Islander

Health Officer will be a key leadership role in Queensland Health, focussing on increasing the visibility and

importance of Aboriginal and Torres Strait Islander health across the health system, and leading the change

agenda to ensure that all areas of the health system are contributing to the Closing the Gap agenda.

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Queensland Health | Closing the Gap Performance Report 2018 5

Contents _Toc3994558

This report ........................................................................................................................................................ 7

Moving towards a strengths-based approach .............................................................................................. 9

Holistic view of health ................................................................................................................................. 10

Recent system responses ............................................................................................................................. 11

Closing the gap health plans ...................................................................................................................... 11

Making Tracks Investment Strategy 2018–2021 ....................................................................................... 11

Quality Improvement Payment (QIP) ......................................................................................................... 12

Thriving communities reform agenda ........................................................................................................ 12

Target: Close the gap in life expectancy within a generation (by 2031) ....................................................... 14

Life expectancy .......................................................................................................................................... 15

The life expectancy gap.......................................................................................................................... 15

By jurisdiction.......................................................................................................................................... 17

Trends ..................................................................................................................................................... 18

Life expectancy projections .................................................................................................................... 19

Understanding the changes ................................................................................................................... 19

Age and cause decomposition analysis ................................................................................................. 20

Regional variation ................................................................................................................................... 25

Mortality ...................................................................................................................................................... 26

Leading causes for mortality .................................................................................................................. 26

Mortality rate trends ................................................................................................................................ 27

Leading contributors to mortality rate difference .................................................................................... 28

Regional variation in mortality rates ....................................................................................................... 30

Target: Halve the gap in child mortality within a decade (by 2018) .............................................................. 31

Child mortality ............................................................................................................................................. 32

The child mortality gap ........................................................................................................................... 33

By jurisdiction.......................................................................................................................................... 33

Age distribution ....................................................................................................................................... 34

Supporting indicators ................................................................................................................................. 35

Antenatal visits ....................................................................................................................................... 35

Smoking during pregnancy ..................................................................................................................... 37

Premature birth ....................................................................................................................................... 38

Birthweight .............................................................................................................................................. 39

Immunisation .......................................................................................................................................... 41

Conclusion .................................................................................................................................................. 42

Appendices .................................................................................................................................................... 43

Methods ...................................................................................................................................................... 43

Adjustment of deaths registered in 2010 ................................................................................................ 43

Change to identification of Aboriginal and Torres Strait Islander deaths............................................... 43

Life expectancy gap decomposition ....................................................................................................... 43

Abbreviations .............................................................................................................................................. 47

Glossary ..................................................................................................................................................... 48

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Queensland Health | Closing the Gap Performance Report 2018 6

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Queensland Health | Closing the Gap Performance Report 2018 7

This report This report is the 6th Queensland Health Closing the Gap Performance Report and marks the 11th year of

the Closing the Gap Strategy launched by then Prime Minister Kevin Rudd in 2008.

Since the inception of the Closing the Gap strategy there has been significant effort and investment into

Aboriginal and Torres Strait Islander health across both State and Federal Governments. Investments and

effort are specifically focussed on improving the two Aboriginal and Torres Strait Islander health targets:

closing the gap in life expectancy by 2031 and halving mortality for Aboriginal and Torres Strait Islander

children aged under 5 years by 2018.

The primary purpose of this report is to detail Queensland’s progress towards the two closing the gap health

targets.

This report differs from previous years by further expanding on the breakdown (decomposition) of life

expectancy improvements and identifying areas that require additional focus moving forward to close the

gap in life expectancy.

Previous reports have emphasised individual programs funded to provide services to Aboriginal and Torres

Strait Islander Queenslanders, however this report highlights system-wide responses, specific enablers

within the health system and a focus on contributors to the life expectancy gap to drive renewed effort to

close the gap in health outcomes for Aboriginal and Torres Strait Islander Queenslanders. Previous reports

are available at https://www.health.qld.gov.au/atsihealth/close_gap and provide more detailed information

on specific funded services and initiatives.

Previous reports addressed the issue of lag time between the launch of the Closing the Gap strategy in 2008

and when we are likely to see impacts from investment and the resourcing of policies. The 2010–2012

estimates illustrated incremental improvement with small increases in life expectancy and subsequently

smaller reductions in the life expectancy gap. It was clear that while there was significant policy effort and

investment, it was too early to see the outcome impact of these efforts.

In 2015–2017 in Queensland, the Aboriginal and Torres Strait Islander life expectancy estimates show an

improved picture to those released previously. There have been substantial increases in life expectancy and

reductions in the life expectancy gap for both males and females. Queensland is now leading the way

nationally with the highest life expectancy for both Aboriginal and Torres Strait Islander males and females

and lowest life expectancy gap of any jurisdiction.

This provides evidence that the gap is closing and that the sustained effort and investment is yielding

substantial health outcomes for Aboriginal and Torres Strait Islander people regarding life expectancy.

There has also been a tangible improvement in child mortality, with a 14 per cent improvement in child

mortality rates since the Closing the Gap targets were agreed to. However, halving the gap in child mortality

within a decade has proved challenging. Parallel improvements in child mortality among other Queensland

children mean the gap remains unchanged.

It is important to note that there is volatility in the child mortality measures due to small numbers, with rates

fluctuating from year to year. While the child mortality rate has increased from a historic low in 2012–2016,

it is important to consider the overall gains that have been made in the last decade. Nonetheless, with the

target now expiring, we need a renewed focus on child and maternal health and more strategic targeting to

address these differentials if we are to impact upon child mortality.

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Queensland Health | Closing the Gap Performance Report 2018 8

In addition, there are substantial life expectancy gaps between Aboriginal and Torres Strait Islander people

who live in major cities and those living in remote areas. Nationally, the life expectancy difference between

Aboriginal and Torres Strait Islander people living in remote areas compared to those living in major cities

is comparable to the gap between Aboriginal and Torres Strait Islander and other Queenslanders.

Further analysis is required however this highlights the ongoing challenges facing the system as we continue

to drive change and improve health outcomes for Aboriginal and Torres Strait Islander people both nationally

and in Queensland across all geographies.

There is a policy requirement to ensure that as we affect improvements in Aboriginal and Torres Strait

Islander health outcomes, we do not create disparities within the population and entrench disadvantage in

remote populations. Sustained improvements in major city populations are to be celebrated, however, they

cannot come at the expense of remote and very remote populations.

We must use the evidence provided in this report to modify our policy settings appropriately to ensure that

future effort and investment is targeted at those populations most at risk of premature mortality and reduced

access to services.

This report provides detail and supporting indicators which will provide context on progress towards closing

the gap in life expectancy and halving the gap in child mortality.

This report also provides context and focus on what Queensland Health and the Queensland Government

are doing to positively engage with Aboriginal and Torres Strait Islander people to address the legacy of

colonisation and racism and to ensure that Queensland Government services are working with Aboriginal

and Torres Strait Islander people, and are staffed and led by Aboriginal and Torres Strait Islander people.

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Queensland Health | Closing the Gap Performance Report 2018 9

Moving towards a strengths-based approach

There have been many conversations at all levels (academic, policy, health workforce, community) around

the negative framing of Aboriginal and Torres Strait Islander discourse, also called the deficit discourse. This

discourse shifts the focus from the disparity to the people. It is this framing than can perpetuate negative

stereotypes, and in itself lead to a lack of empowerment over one’s own health. It can lead to a perpetuation

of disadvantage within populations and can become a significant impediment to not only health outcomes

but also educational, employment and housing outcomes.

Over the last two decades there has been a substantial move towards the celebration of Aboriginal and

Torres Strait Islander Australians as the oldest living culture in the world. This has been driven by Aboriginal

and Torres Strait Islander people and is part of the broader movement to nurture pride and cultural identity.

However, governments at all levels have been slow to learn from this approach and continue to negatively

frame and message within policy and performance documents. Priorities and policies are largely drafted and

endorsed independent of Aboriginal and Torres Strait Islander people. Too often we are guilty of doing to,

not with; of excluding and not listening. It is timely that we reflect principally on how the government works

collectively and collaboratively with Aboriginal and Torres Strait Islander people to change this discourse.

Throughout this report we do refer to ‘gaps’ as that was the measure or target that was set 11 years ago.

However, we are also explicitly trying to message around the gains that are being made by Queensland

Aboriginal and Torres Strait Islander people irrespective of what is happening with other Queenslanders.

We need to continue to work to identify out what is causing improvements, and harness the strengths within

culture, family and environment that can help promote health within Aboriginal and Torres Strait Islander

people and reflect this in our reporting and documents.

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Queensland Health | Closing the Gap Performance Report 2018 10

Holistic view of health

Health is traditionally a holistic concept for Aboriginal and Torres Strait Islander people. It encompasses the

physical, social, emotional, spiritual and cultural wellbeing of the individual and of the whole community. This

is a whole-of-life view and includes the concept of life-death-life. Many Aboriginal and Torres Strait Islander

people still retain this belief system, however, traditional cultures and beliefs have been challenged and

influenced by many factors, including Christianity, since colonisation.

Aspects of Aboriginal and Torres Islander cultures must be considered in the patient’s clinical care to ensure

their holistic health and individual needs are met. Each patient will have their own beliefs and individual

needs, so a ‘one size fits all’ approach will not work. Healthcare staff should also be aware that urban, rural

and remote, and discrete Aboriginal and Torres Strait Islander communities will each have differing needs.

Differences also extend to certain cultural practices and beliefs between clans/language groups.

Kinship, family obligations and responsibilities tend to be of greater importance than personal health needs.

These factors frequently contribute to patients discharging themselves against medical advice with obvious

detrimental impact on their health. Communication difficulties due to language differences (both verbal and

non-verbal), lower health literacy and cultural differences are commonly known as barriers to improving

health outcomes for Aboriginal and Torres Strait Islander people.

The segregated practice of Men’s and Women’s Business is still a very real and fundamental part of cultural

practice today.

“Everything is so inter-related, you can’t dissect it. Where in Western culture there tends to be

individualism…we don’t see ourselves like that. We’re very much part of a wider community, a wider family.

So when an individual comes to a health facility, you’re not just treating that individual, you’re treating the

whole family, because of those family kinship structures and those obligations and responsibilities.”

Julie Rogers, Cultural Advisor

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Queensland Health | Closing the Gap Performance Report 2018 11

Recent system responses Queensland Health and the Queensland Government have prioritised closing the gap in health outcomes

for Aboriginal and Torres Strait Islander Queenslanders. Investment through the Making Tracks Policy and

Accountability Framework has been instrumental in driving change in health outcomes for Aboriginal and

Torres Strait Islander Queenslanders.

However, investment in targeted health services and programs is only a part of the closing the gap journey.

To close the gap there is a requirement for the entire system to work in concert to achieve Aboriginal and

Torres Strait Islander health gains. To focus the efforts of Hospital and Health Services (HHSs) in delivering

culturally safe and secure services for Aboriginal and Torres Strait Islander people, the following initiatives

have been implemented:

Closing the gap health plans

Following the launch of the Statement of Action towards closing the gap in health outcomes in December

2017, all HHSs have developed Closing the Gap Health Plans. HHSs have been asked to identify system-

level initiatives to improve health outcomes for Aboriginal and Torres Strait Islander Queenslanders, focusing

on the three key themes of the Statement of Action:

1. Embedding Aboriginal and Torres Strait Islander representation in Queensland Health leadership,

governance and workforce;

2. Improving local engagement and partnerships between Queensland Health and Aboriginal and

Torres Strait Islander people, communities and organisations.

3. Improving transparency, reporting and accountability in Closing the Gap progress.

Since the launch of the Statement of Action, new Aboriginal and Torres Strait Islander senior management

and leadership positions (Directors and Executive Directors) have been established in several HHSs, and

positions are now established in Metro North, Cairns, Townsville, Central Queensland, Torres and Cape,

and Darling Downs, while other HHSs are considering establishing similar roles.

All HHSs have identified building their Aboriginal and Torres Strait Islander workforce, and developing an

Indigenous workforce strategy to support this growth. Strengthening the cultural capability of the broader

workforce is also a key activity across most HHSs. Most HHSs have prioritised establishing or strengthening

partnerships with Aboriginal and Torres Strait Islander Community Controlled Health Services in their

regions to support better integration of health services across health providers.

These system-level initiatives will support increased access to culturally capable health services for all

Aboriginal and Torres Strait Islander Queenslanders, wherever they may live in the state.

Making Tracks Investment Strategy 2018–2021

Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033:

Investment Strategy 2018–2021 is the fourth triennial plan developed under the Making Tracks Policy and

Accountability Framework since its launch in 2010.

The Investment Strategy seeks to operationalise the priorities set out in the Making Tracks Framework,

building on the progress made over recent years and recognising that change takes time and sustained

effort. The Investment Strategy identifies key priority areas across the life course and the health system, and

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Queensland Health | Closing the Gap Performance Report 2018 12

targets both existing and emerging health priorities. Targeted Queensland Government investment in

Aboriginal and Torres Strait Islander health is more than $270 million over the life of the Investment Strategy.

The key themes in the Investment Strategy are:

• Cultural capability across the health system: Investing in the community controlled primary health

care sector; increasing the Indigenous workforce in Queensland Health; and improving cultural

capability of the workforce and organisation as a whole.

• Partnerships: Building partnerships between government and non-government service providers,

particularly the Aboriginal and Torres Strait Islander community controlled primary health care

sector.

• Prevention and health promotion: Supporting people to make positive decisions in relation to their

health, including an investment to expand the Deadly Choices healthy lifestyle program.

• The Investment Strategy sets an agenda for leveraging mainstream services to contribute to close

the gap, as well as supporting and providing funding to Aboriginal and Torres Strait Islander

Community Controlled Health Services and Non-Government Organisations. This ensures that

across the health system, Aboriginal and Torres Strait Islander Queenslanders can access culturally

safe and appropriate care.

• These system-level initiatives will support increased access to culturally capable health services for

all Aboriginal and Torres Strait Islander Queenslanders, wherever they may live in the state.

Quality Improvement Payment (QIP)

In line with intent of closing the gap in health outcomes for Aboriginal and Torres Strait Islander

Queenslanders the objective of the QIP is to increase:

• the proportion of Aboriginal and Torres Strait Islander mothers attending at least five antenatal visits

with the first antenatal visit occurring during the first trimester, and

• the proportion of Aboriginal and Torres Strait Islander mothers who stopped smoking by 20 weeks

gestation.

A total of $5 million for 2018–19 has been made available across the HHSs to improve on established

baseline performance. The reward funding has been allocated according to the number of additional mothers

that need to be targeted to achieve parity between the service levels delivered for Indigenous and other

Queenslander women.

Thriving communities reform agenda

In December 2016, the Queensland Productivity Commission (QPC) commenced its inquiry into

Government investment in remote and discrete Aboriginal and Torres Strait Islander communities to

consider how available resources can best be used to support Aboriginal and Torres Strait Islander people

to live healthy, safe and fulfilling lives.

Whilst the QPC Final Report, provided to the Queensland Government on 22 December 2017, noted some

examples of good service delivery, it identified significant opportunities to improve how programs and

services are designed, funded and delivered to better meet the needs of remote and discrete Aboriginal and

Torres Strait Islander communities across Queensland. The Report made 22 recommendations to deliver a

long-term reform proposal that provides incentives for community development, puts communities at the

centre of service delivery reform, and focuses on monitoring and evaluating performance for improved

outcomes.

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Queensland Health | Closing the Gap Performance Report 2018 13

Following extensive consultation with Aboriginal and Torres Strait Islander communities and community

controlled organisations, the Queensland Government delivered a Response to the QPC’s Final Report,

which has formed the basis of the newly developed Thriving Communities reform agenda. This overarching

reform agenda is built on three key pillars:

• Structural reform which aims to transfer accountability and decision-making to regions and

communities, reform funding and resourcing arrangements, and introduce mechanisms to monitor

progress through independent oversight.

• Service delivery reform to enable the needs of individuals to be placed at the core of service delivery

models tailored to the local circumstances.

• Economic reform to enable the implementation of mechanisms that foster greater economic activity

and community development, therefore making communities more sustainable.

The Thriving Communities reform agenda rests on key principles of collaboration and co-design with and

long-term commitment to work in partnership with individual communities, their leaders and Mayors along

with other stakeholders to implement its intent. This strategic focus will not only enhance leadership and

governance outcomes, which are key enablers for embedding community control and place-based service

models, but also directly impacts on social and economic development outcomes for Aboriginal and Torres

Strait Islander people in Queensland.

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Queensland Health | Closing the Gap Performance Report 2018 14

Target: Close the gap in life expectancy within

a generation (by 2031)

An Aboriginal and/or Torres Strait Islander baby born in Queensland in 2015–

2017 can expect to live 4.3 years longer on average than in 2005–2007.

Key points

• The most recent life expectancy results show that Queensland Aboriginal and Torres Strait

Islander people have had positive-growth in life expectancy at birth and a reduction in the life

expectancy gap with other Queenslanders.

• 10 years into the 25-year target of closing the gap in life expectancy by 2031, the gap in life

expectancy has reduced by 33 per cent for females and 34 per cent for males. Based on this

trend the target is not on track to being met, but may be within sight of a 30-year rather than 25-

year goal.

• Immediate, prioritised targeting of premature mortality from cardiovascular diseases, cancers,

and endocrine disorders (including diabetes) in those aged over 40 years will return the greatest

gains towards closing the gap in life expectancy. These three conditions in this age group cause

55 per cent of the life expectancy gap.

• At the national level, area level remoteness has an important influence on life expectancy at birth.

The gap between Aboriginal and Torres Strait Islander people in major cities and in remote and

very remote areas is similar to the gap between Aboriginal and Torres Strait Islander people and

other Australians more generally. Further analysis is required to understand the remoteness gap

among Aboriginal and Torres Strait Islander Queenslanders, however there is no evidence to

suggest the story would be much different for Queensland.

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Queensland Health | Closing the Gap Performance Report 2018 15

Queensland Aboriginal and Torres Strait Islander people have seen a substantial increase in life expectancy

at birth. This increase surpasses that of any other jurisdiction over the past five years. Queensland Aboriginal

and Torres Strait Islander males and females now have the longest life expectancy, the smallest gap in life

expectancy, and the largest gains in life expectancy over the last five years of all Aboriginal and Torres Strait

Islander Australians.

Growth in life expectancy from 2010–2012 to 2015–2017 was largely driven by reductions in mortality in the

50–74 year age group. Change in mortality rates from cardiovascular diseases and endocrine disorders

(including diabetes) were the biggest contributors to the increase in life expectancy.

Cardiovascular disease, cancers, and endocrine disorders (including diabetes) in people aged 40–84 years

account for over half the gap in life expectancy in 2015–2017—these are the disease and population

priorities for closing the gap in the short term.

Focussing on the acute end of the disease spectrum is however unsustainable in the long-term. Taking a

life course approach to health, disease prevention, illness management in partnership with Aboriginal and

Torres Strait Islander people will positively influence health and wellbeing, as well as life expectancy, into

the future.

This section presents life expectancy estimates calculated by the Australian Bureau of Statistics (ABS) and

released in November 2018.1 Changes in the propensity to identify as Aboriginal and Torres Strait Islander

between the 2011 and 2016 Census means that there have been compositional changes to the population

which are likely to impact on the life expectancy estimates, with the most likely net change being an increase

in life expectancy. Reported improvements should therefore be interpreted with caution.

Life expectancy • An Aboriginal and Torres Strait Islander boy born in Queensland in 2015–2017 had an average life

expectancy of 72.0 years. For girls, the average life expectancy at birth was 76.4 years. This was 3.3

and 2.0 years longer respectively than the previous estimate for 2010–2012.

Figure 1: Aboriginal and Torres Strait Islander life expectancy, 2015–2017

The life expectancy gap

• The life expectancy gap between Aboriginal and Torres Strait Islander and other Queenslanders has

reduced over successive measurement periods.

1 ABS. 2018. Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, cat no. 3302.0.55.003, viewed 21/02/2019.

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

An Aboriginal and Torres Strait Islander baby boy born in

Queensland in 2015–2017 will on average live to:

An Aboriginal and Torres Strait Islander baby girl born in

Queensland in 2015–2017 will on average live to:

Males Females

3.3 years longer

than previous

estimates (2010–2012)

2.0 years longer

than previous

estimates (2010–2012)

76.4 years

72.0 years

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Queensland Health | Closing the Gap Performance Report 2018 16

• The gap has reduced by a third since 2005–2007.

• The 2015–2017 gap in life expectancy for males was 7.8 years, and for females 6.7 years (Figure 2).

Figure 2: Queensland life expectancy by Indigenous status, 2005–2007 to 2015–2017

Males Females

Estimates may not sum due to rounding.

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

67.168.7

72.0

78.8 79.4 79.8

2005–2007 2010–2012 2015–2017

Indigenous Males Non-Indigenous Males

11.810.8

7.8

72.774.4

76.4

82.7 83.0 83.2

2005–2007 2010–2012 2015–2017

Indigenous Females Non-Indigenous Females

10.0 8.66.7

GapGap

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Queensland Health | Closing the Gap Performance Report 2018 17

By jurisdiction

• There is substantial variation in Aboriginal and Torres Strait Islander life expectancy at birth between

jurisdictions. The Northern Territory had significantly lower life expectancy compared to Queensland, 5.4

and 6.5 years lower for males and females respectively (Figure 3).

• The most recent estimates of life expectancy at birth show that compared with other jurisdictions and

Australia, Queensland Aboriginal and Torres Strait Islander people had the:

o Longest life expectancy for both males and females (72.0 and 76.4 years respectively).

o Smallest gap in life expectancy with other Queenslanders for both males and females (7.8 and

6.7 years respectively).

o Largest gains in life expectancy over five years (2010–2012 to 2015–2017) for males and

females (3.3 and 2.0 years respectively).

Figure 3: Life expectancy and life expectancy gap by Indigenous status and jurisdiction, 2015–2017

Males Females

Queensland

New South Wales

Australia*

Estimates may not sum due to rounding.

* Australian estimates displayed are different to the headline Australian estimates. Those shown allow direct comparison with available state and territory estimates as they do not take age-

specific identification rates into account. Australian estimates include all states and territories.

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

Western Australia

Northern Territory

Queensland

New South Wales

Australia*

Western Australia

Northern Territory

72.0

70.9

70.0

66.9

66.6

79.8

80.2

80.2

80.3

78.1

Indigenous Non-Indigenous

7.8

9.4

10.3

13.4

11.5

Gap

76.4

75.9

74.4

71.8

69.9

83.2

83.5

83.5

83.8

82.7

Indigenous Non-Indigenous

6.7

7.6

9.0

12.0

12.8

Gap

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Queensland Health | Closing the Gap Performance Report 2018 18

Trends

• Aboriginal and Torres Strait Islander life expectancy for females has increased more in Queensland than

in any other jurisdiction, and for males the increase was the second biggest (Figure 4).

• Queensland Aboriginal and Torres Strait Islander life expectancy was ranked second below New South

Wales in 2005–2007, but it is now the highest among jurisdictions with available estimates.

Figure 4: Aboriginal and Torres Strait Islander life expectancy at birth by jurisdiction, 2005–2007 to 2015–2017

Males Females

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

NSW 68.3

70.9 ↑2.6 years

Qld 67.1

72.0 ↑4.9 years

WA 64.5

66.9 ↑2.4 years

NT 61.5

66.6 ↑5.1 years

60

65

70

75

80

2005-2007 2010-2012 2015-2017

NSW 74.0

75.9 ↑1.9years

QLD 72.7

76.4 ↑3.7years

WA 70.0

71.8 ↑1.8years

NT 69.4 69.9 ↑0.5years

60

65

70

75

80

2005-2007 2010-2012 2015-2017

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Queensland Health | Closing the Gap Performance Report 2018 19

Life expectancy projections

Predicting life expectancy fifteen years into the future for two population groups is a complex and uncertain

exercise. We can however project what life expectancy would be based on a simple model that assumes

the last 10 years of growth in life expectancy (at three-time points) will continue in a linear trend until 2030–

2032. Based on this projection, while the gap would be greatly reduced by 2030–2032 (approximately a 2-

year gap for males and females) (Figure 5), closing the gap would not occur for another six years 2036–

2038.

Figure 5: Estimated and projected life expectancy by Indigenous status, Queensland 2005–2007 to 2030–2032

Figure 6: Estimated and projected life expectancy gap, Queensland 2005–2007 to 2030–2032

Understanding the changes

Identifying and understanding the drivers of the improvement in life expectancy and the reduction of the gap

is important. However, there are large unknowns in terms of the total and specific impact of each driver.

Males Females

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

Projections based on linear trend of the three time points extrpolated out to 2030–2032

67.168.7

72.0

78.8 79.4 79.8

60

70

80

90

2005–2007

2010–2012

2015–2017

2020–2022

2025–2027

2030–2032

Indigenous estimated Non-Indigenous estimated

Indigenous projected Non-Indigenous projected

72.774.4

76.4

82.7 83.0 83.2

60

70

80

90

2005–2007

2010–2012

2015–2017

2020–2022

2025–2027

2030–2032

Indigenous estimated Non-Indigenous estimated

Indigenous projected Non-Indigenous projected

Males Females

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

Projections based on linear trend of the three time points extrpolated out to 2030–2032

11.810.8

7.8

0

5

10

15

20

2005–2007

2010–2012

2015–2017

2020–2022

2025–2027

2030–2032

Gap estimated Gap projected

108.6

6.7

0

5

10

15

20

2005–2007

2010–2012

2015–2017

2020–2022

2025–2027

2030–2032

Gap Gap projected

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Queensland Health | Closing the Gap Performance Report 2018 20

• The improvement in life expectancy and reduction in the gap have come after a decade of sustained

investment in Aboriginal and Torres Strait Islander health and building capacity within the health system.

• Beyond the health system, the environment of increased awareness and understanding of the health

needs of Aboriginal and Torres Strait Islander people and improvements in other social determinants of

health such as education and employment will have had a positive impact on life expectancy.

• Some of the change observed may be an artefact of the methods used by the ABS, and quality of the

deaths and population data that feed into the estimates.

• Also, the changing propensity to identify as Aboriginal and Torres Strait Islander, particularly among

Aboriginal and Torres Strait Islander people that live in major city areas (where life expectancy is longer)

means that the cohort of people included in the 2015–2017 life expectancy calculations has a slightly

different, and perhaps healthier, composition compared to that of earlier estimates. This means that the

increase in life expectancy may be in part due to the changing propensity to identify as Aboriginal and

Torres Strait Islander people.

Age and cause decomposition analysis

At a more proximal level, decomposition techniques allow identification of age and cause-specific

contributions to differences in life expectancy. For a description of the methods and more detailed results

see Appendix Life expectancy gap decomposition. Using these methods over the next three pages we

examine:

• What caused the increase in life expectancy from 2010–2012 to 2015–2017?

• What caused the reduction in the life expectancy gap?

• What are the current priority areas for closing the current gap in life expectancy?

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Queensland Health | Closing the Gap Performance Report 2018 21

What caused the increase in life expectancy from 2010–2012 to 2015–2017?

Life expectancy at birth for Queensland Aboriginal and Torres Strait Islander males and females increased

by 3.3 years and 2.0 years respectively.

Figure 7: Increase in Aboriginal and Torres Strait Islander life expectancy by age and cause, Queensland 2010–2012 to 2015–2017

Numbers may not sum due to rounding.

• The main cause of death contributing to the increase in life expectancy came from reduced mortality

rates from cardiovascular disease (primarily coronary heart disease and stroke); this contributed 36

per cent (1.2 years) and 48 per cent (1.0 years) to the males and female life expectancy increase

respectively. Among other Queenslanders, females gained 0.3 years and males 0.4 years of life

expectancy over the same period due to reductions in cardiovascular disease mortality (Figure 7).

• Reduction in diabetes mortality contributed 0.5 and 0.3 years to increased life expectancy of males

and females respectively.

• In both males and females over half of the gain in life expectancy came from a reduction in mortality

in 50–74 year olds.

Males

Other: 1.0 yrs

Cancers: 0.4 yrs

Endocrine (including diabetes): 0.8 yrs

Cardiovascular disease: 1.2 yrs

Increase by cause of death

Age 0-24: 0.3 yrs

Age 25-49: 0.7 yrs

Age 50-74: 1.9 yrs

Age 75+: 0.5 yrs

68.7 in 2010–2012

72.0 in 2015–2017

3.3 year increase in life

expectancy

Increase by age group

.Source: A&TSIHB analysis of ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003; ABS, Customised report, 2019; and Cause of Death

Unit Record File (COD URF), Australian Coordinating Registry

Females

Other: 0.3 yrs

External causes: 0.3 yrs

Endocrine (incl. diabetes): 0.4 yrs

Cardiovascular disease: 1.0 yrs

Increase by cause of death

Age 0-24: 0.1 yrsAge 25-49: 0.5 yrs

Age 50-74: 1.2 yrs

Age 75+: 0.3 yrs

74.4 in 2010–2012

76.4 in 2015–2017

2.0 year increase in life

expectancy

Increase by age group

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Queensland Health | Closing the Gap Performance Report 2018 22

What caused the reduction in the life expectancy gap?

The gap between Queensland Aboriginal and Torres Strait Islander people and other Queenslanders

reduced from 10.8 to 7.8 years for males and 8.6 to 6.7 years for females.

Figure 8: Reduction in the life expectancy gap by age and cause, Queensland 2010–2012 to 2015–2017

Numbers may not sum due to rounding.

• For males the gap in life expectancy reduced by 3.0 years between 2010–2012 and 2015–2017.

Cardiovascular diseases caused one third of this reduction (0.7 years due to coronary heart disease,

and 0.2 years for stroke), with other ill-defined conditions, and digestive system diseases together

responsible for another one-third (Figure 8).

• For females the gap in life expectancy reduced by 1.9 years over the same period. Over this time the

contribution to the gap from cardiovascular disease, endocrine disorders (including diabetes), and

external causes together reduced by 1.6 years.

• Most for the reduction in the gap was due to the reduction in mortality rates among the middle aged

50–74 years.

Males

Other: 0.9 yrs

Digestive system diseases: 0.4 yrs

Other ill-defined causes: 0.5 yrs

Cardiovascular disease: 1.1 yrs

Gap decrease by cause of death

Age 0-24: 0.2 yrs

Age 25-49: 0.6 yrs

Age 50-74: 1.7 yrs

Age 75+: 0.6 yrs

7.8 in 2015–2017

10.8 in 2010–2012

3.0 year decrease in life expectancy gap

Gap decrease by age group

Females

Source: A&TSIHB analysis of ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003 and Cause of Death Unit Record File (COD URF),

Australian Coordinating Registry

Other: 0.3 yrs

External causes: 0.3 yrs

Endocrine (including diabetes): 0.4 yrs

Cardiovascular disease: 0.8 yrs

Gap decrease by cause of death

Age 25-49: 0.5 yrs

Age 50-74: 1.1 yrs

Age 75+: 0.3 yrs

6.7 in 2015–2017

8.6 in 2010–2012

1.9 year decrease in life expectancy gap

Gap decrease by age group

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Queensland Health | Closing the Gap Performance Report 2018 23

What are the current priority areas are for closing the current gap in life expectancy?

While life expectancy has been increasing, there has been a shift in cause contribution to the gap in life

expectancy. Cancer is now approaching cardiovascular disease as the major contributor to the life

expectancy gap for Aboriginal and Torres Strait Islander Queenslanders.

Epidemiologically the efforts targeted at cardiovascular disease must be maintained and strengthened,

they must also be accompanied by renewed strategic policy focus on cancer to ensure that gains made

in cardiovascular disease are not offset in the future by increases in cancer mortality and morbidity.

Figure 9: Life expectancy gap by age and cause, Queensland 2015–2017

Numbers may not sum due to rounding.

• Reducing mortality among adults aged 50–74 years has the biggest potential to impact the life

expectancy gap; almost half the gap is driven by differences in mortality in this age group (Figure 9).

• While cardiovascular disease remains the most significant cause of the life expectancy gap for males

and females, its influence over the gap has decreased due to improvement in cardiovascular disease

mortality rates. Cancers and endocrine disorders (including diabetes) are now approaching almost

equal importance as contributors to the gap.

• When looking at more specific causes, for females diabetes (1.2 years), coronary heart disease (0.8

years), chronic lower respiratory disease (0.7 years) and cancer of trachea, bronchus and lung (0.6

years) were large contributors to the life expectancy gap.

Males

Other: 3.3 yrs

Endocrine (incl. diabetes): 1.3 yrs

Cancers: 1.5 yrs

Cardiovascular disease: 1.7 yrs

Gap by cause of death

Age 0-24: 0.5 yrs

Age 25-49: 2.0 yrs

Age 50-74: 3.7 yrs

Age 75+: 1.6 yrs

72 yrs Indigenous

79.8 yrs non-Indigenous

7.8 year gap in life expectancy

Gap by age group

Females

Source: A&TSIHB analysis of ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003 and Cause of Death Unit Record File (COD URF),

Australian Coordinating Registry

Other: 2.9 yrs

Endocrine (incl. diabetes): 1.2 yrs

Cancers: 1.2 yrs

Cardiovascular disease: 1.4 yrs

Gap by cause of death

Age 0-24: 0.5 yrs

Age 25-49: 1.2 yrs

Age 50-74: 3.3 yrs

Age 75+: 1.7 yrs

76.4 yrs Indigenous

83.2 yrs non-Indigenous

6.7 year gap in life

expectancy

Gap by age group

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Queensland Health | Closing the Gap Performance Report 2018 24

• Coronary heart disease (1.2 years), diabetes (1.0 years), cancer of trachea, bronchus and lung (0.6

years) and chronic lower respiratory disease (0.5 years) were substantial contributors to the life

expectancy gap for males.

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Queensland Health | Closing the Gap Performance Report 2018 25

Regional variation

Queensland’s Aboriginal and Torres Strait Islander population is spread across the state with significant

numbers living in remote (almost 36,500), regional (109,500) and major city areas (75,000) based on 2016

Census. Historically there have been notable mortality differentials by remoteness for Aboriginal and Torres

Strait Islander people. This is also evident in the calculations of life expectancy by remoteness (major cities,

regional, remote) released by the ABS in November 2018. Due to completeness of death data across

jurisdictions and volatility in small numbers at a sub state level, the ABS released remoteness estimates

nationally and not by jurisdiction.

Life expectancy estimates revealed large variations between Aboriginal and Torres Strait Islander people

living in various regions, and large variation in the life expectancy gaps with other Australians. Comparatively

there is very little variation by remoteness for non-Indigenous Australians.

Further exploration of the regional variations within Queensland will give a richer understanding of the

Queensland context and enable better prioritisation of resources.

Figure 10: Life expectancy at birth and gap by remoteness areas, Australia 2015–2017

• Aboriginal and Torres Strait Islander Australian males that lived in major city areas had a life expectancy

at birth 6.2 years longer than those that lived in remote and very remote areas; for females the difference

was 6.8 years (Figure 10).

• The gap in life expectancy in major cities was almost 40 per cent lower for males and 50 per cent lower

for females compared to the gap in remote and very remote areas.

Source: ABS, Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, Cat. No. 3302.0.55.003

Males Females

72.170.0

65.9

80.779.1 79.7

Major cities Inner and outerregional

Remote and veryremote

Indigenous Males Non-Indigenous Males

8.69.1

13.8

Gap

76.574.8

69.6

83.7 82.8 83.6

Major cities Inner and outerregional

Remote and veryremote

Indigenous Females Non-Indigenous Females

7.2 8.014.0

Gap

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Queensland Health | Closing the Gap Performance Report 2018 26

Mortality

Leading causes for mortality

Understanding patterns in mortality for Aboriginal and Torres Strait Islander people helps to identify current

and emerging causes of death in the population. Shifting composition of mortality within a population and

variations in cause of death compared to another population can provide an indication of areas of greater

need from the health system.

Figure 11: Leading causes of Indigenous mortality, Queensland 2002 to 2017

• The change in leading causes of death for Aboriginal and Torres Strait Islander Queenslanders between

2002 and 2017 represents a shift in mortality distribution within the population (Figure 11).

• There have been sustained improvements in mortality from cardiovascular disease leading to a

lessening of the effect that cardiovascular disease has on overall mortality. In 2017 cardiovascular

disease accounted for 18.6 per cent of all deaths – the lowest contribution to total deaths in at least 16

years – down from 27.7 per cent in 2002. Once adjusted for changes to age structure over time, the rate

of mortality from cardiovascular disease is at its lowest in at least 16 years. This reflects substantial

improvements in the prevention of deaths due to cardiovascular disease.

• Cancer was the leading cause of death in 2017, accounting for 25.0 per cent of total deaths for Aboriginal

and Torres Strait Islander Queenslanders. Cancer was previously the third leading cause of death in

2002, accounting for 14.4 per cent of deaths. The increasing contribution of cancer to overall mortality

is driven by both the increased number of deaths caused by cancer, but also the declining impact of

other causes, particularly cardiovascular disease.

Source: Queensland Deaths Register

Other

5. Respiratory

4. Endocrine

3. Cancer

2. External causes

1. CVD

0%

50%

100%

2002

Other

4. Respiratory

4. Endocrine

3. External causes

2. CVD

1. Cancer

2017

Totalnumber of deaths

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Queensland Health | Closing the Gap Performance Report 2018 27

Mortality rate trends

Mortality rates (age standardised) can be used to monitor the health status of a population over time and

allows for comparisons with other population groups to provide contextual comparisons. Although useful in

regular monitoring and a crude proxy indicator for life expectancy, mortality rates alone do not

comprehensively adjust for confounding factors, such as under-identification of data.

Figure 12: Mortality rate by Indigenous status, Queensland 2002 to 2017

• The mortality rate for Aboriginal and Torres Strait Islander Queenslanders has declined since 2002, with

the most substantial improvement occurring between 2002 (1,087 deaths per 100,000) and 2008 (824

deaths per 100,000) (Figure 12). Early improvements were largely driven by decreased mortality from

cardiovascular disease, which accounted for more than 50 per cent of the improvement.

• Declines in the mortality rate for Aboriginal and Torres Strait Islander people have been less constant

between the launch of the Closing the Gap Strategy in 2008 and 2017. The trend in mortality appears to

be declining slightly from 2008 to 2017 (802 per 100,000), however annual variation in age standardised

mortality yields an unstable trend due to data quality and demographic factors. Under-identification of

Aboriginal and Torres Strait Islander people in population and mortality data, as well an increasing

propensity to identify, particularly in major cities, also impacts results.

• The mortality rate difference with other Queenslanders was 296 deaths per 100,000 population in 2017,

decreasing from 412 deaths per 100,000 in 2002. However, despite long term improvements, the

mortality rate difference has increased since 2008 due to sustained falls in mortality among other

Queenslanders.

Notes:

Directly age standardised to the 2001 Australian population

2016 and 2017 are prelimary data and subject to change

2017 population is from ABS projections based to 2011

Source: Queensland Deaths Register

Mortality recorded by year of death

676 625

507

1,087

824 802

Rate

pe

r 100,0

00 Indigenous

Non-Indigenous

Rate difference

296199

412

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Queensland Health | Closing the Gap Performance Report 2018 28

Methodological considerations

The mortality rate trend in Figure 12 delivers a contrasting message to the most recent life expectancy

estimates, showing a widening mortality rate difference while the life expectancy gap is narrowing. The

methodology used to calculate life expectancy utilises several additional variables that are not accounted

for in age standardised mortality rates. These methodological differences as well as differences in

underlying data sources contribute to this variation and are detailed below:

The ABS adjust mortality data for under and over identification of Aboriginal and Torres Strait Islander

people to calculate life expectancy. In 2005–2007 and 2010–2012 estimates there was an under-

identification of Aboriginal and Torres Strait Islander deaths resulting in a substantial positive adjustment

to mortality, however in the 2015–2017 estimates there was a very slight negative adjustment to mortality

due to a minor over-identification. This contrasts to age standardised mortality rates, which use unadjusted

mortality, therefore would have underestimated mortality in previous years but not latter years.

The life expectancy method utilised population estimates based on the 2016 Census, which showed a

substantial increase in identification of Aboriginal and Torres Strait Islander people, whereas the age

standardised mortality rate used estimates based on 2011 Census.

Leading contributors to mortality rate difference

Figure 13: Mortality rate difference by cause (Indigenous and non-Indigenous)

• Cancer, cardiovascular disease and endocrine disorders accounted for approximately 61.7 per cent of

the difference in mortality rate between Aboriginal and Torres Strait Islander and other Queenslanders

in 2015–2017.

• Cancer was the leading contributor (78 deaths per 100,000) to the mortality rate difference between

Aboriginal and Torres Strait Islander and other Queenslanders in 2015–2017, overtaking endocrine

disorders as the leading contributor to the rate difference (Figure 13).

• This marks a substantial increase in the contribution of cancer to the mortality rate difference since

2002–2004 where it accounted for 22 deaths per 100,000 (5.5 per cent) of the rate difference.

Directly age standardised to the 2001 Australian population

Source: Queensland Deaths Register

405

250

323

Rate

pe

r 1

00

,00

0

Endocrine

Cancer

CVD

Other

All cause

Ratedifference

22

80

38

30

69

78100

53

121

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Queensland Health | Closing the Gap Performance Report 2018 29

• The widening of this rate difference is due to an increase in the mortality rate from cancers for Aboriginal

and Torres Strait Islander Queenslanders and a simultaneous decline in the mortality rate among other

Queenslanders.

• Contributing factors to the higher rate of cancer related mortality for Aboriginal and Torres Strait Islander

Queenslanders include:

o Prevalence of risk factors, such as smoking.

o Screening program participation.

o Access to health services, and

o Timing of presentation to services. 2

• Since 2002–2004 the mortality rate difference for cardiovascular disease almost halved from 100 per

100,000 to 53 per 100,000 in 2015–2017. This was due to sustained, substantial improvement in

mortality from cardiovascular disease for Aboriginal and Torres Strait Islander Queenslanders, which

was greater than in other Queenslanders in the 2002–2004 to 2015–2017 period.

• The mortality rate difference for endocrine, nutritional and metabolic disorders, such as type 2 diabetes,

declined by 43.3 per cent between 2002–2004 and 2015–2017. This has been driven by a large

improvement in endocrine mortality for Aboriginal and Torres Strait Islander Queenslanders.

2 AHIW. 2018. Cancer in Aboriginal & Torres Strait Islander people of Australia, cat no. CAN 109, viewed 21/02/2019.

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Queensland Health | Closing the Gap Performance Report 2018 30

Regional variation in mortality rates

Where one lives has a bigger impact on mortality rates for Aboriginal and Torres Strait Islander people than

other Queenslanders.

Figure 14: Mortality rate by remoteness area and Indigenous status, Queensland 2013–2015

• For Queensland Aboriginal and Torres Strait Islander people in outer regional and remote areas, the

mortality rate was at least 30 percent higher than the rate in major city and inner regional areas in 2013–

2015 (Figure 14).

• This supports the national remoteness life expectancy results discussed earlier. It also reveals that

combining inner and outer regional populations (as was done in the life expectancy estimates), may

obscure some of the heterogeneity in health outcomes for this group. That is the mortality risk in inner

regional areas may be more like that of major city areas, and outer regional more like remote.

Directly age standardised to the 2001 Australian population

Source: Queensland Deaths Register

723670

939 983

547 545 533 540

Major City Inner Regional Outer Regional Remote/Veryremote

Rate

pe

r 1

00

,00

0

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 31

Target: Halve the gap in child mortality within a

decade (by 2018)

34 more Queensland Aboriginal and Torres Strait Islander children lived in 2013–

2017, than would have if rates remined unchanged since 2004–2008

The difference in the child (0–4 years) mortality rate between Queensland’s Aboriginal and Torres Strait

Islander children and other Queensland children highlights that inequalities in health outcomes begin at the

earliest stages of life. The life course approach to health tells us that babies that are born strong and healthy

have the best chance of progressing to adulthood in good health, and avoiding chronic conditions that have

been associated with low birth weight and preterm births.

Key points

• The Aboriginal and Torres Strait Islander child (0–4 years) mortality rate has reduced by 14 per

cent from 2004–2008 to 2013–2017.

• The gap in child mortality has fluctuated over time however the gap in 2013–2017 is comparable

to that in 2004–2008.

• Data for reporting against 2018 will not be available until 2019.

• Based on recent trends in child mortality, the target to halve the gap in mortality rates is unlikely

to be achieved by 2018.

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Queensland Health | Closing the Gap Performance Report 2018 32

Child mortality

Figure 15. Child mortality rates and projected trends by Indigenous status, Queensland 2001–2005 to 2004–2018

• At the time the COAG targets were agreed to in 2008, the Aboriginal and Torres Strait Islander child

mortality rate was 187 deaths per 100,000 population in 2004-08. Latest estimates (2013–2017) indicate

that the child mortality rate has reduced by approximately 14 per cent, to 161 child deaths per 100,000

population (Figure 15).

• Compared to the previous estimate (2012–2016), the child mortality rate has increased (from 151 to 161

deaths per 100,000 population).

• As more information becomes available, further analysis can be undertaken to fully understand the

factors contributing to the increase in the child mortality rate.

• The mortality rate is sensitive to small changes in the numerator. This is evidenced by fluctuations in the

rate over time despite pooling five years of data. However, overall from 2001–2005 to 2014–2018 there

has been a reduction and the rate trends downward.

9068

69

207

187

161

117 119

92Rate

per

100,0

00

Indigenous rate

Non-Indigenous rate

Estimated target***

Notes: * 2010 deaths based on adjusted registrations

** Trendline based on linear trend of 2004–2008 to 2013–2017 data (trend since targets agreed to)

*** Estimated target based on the projected non-Indigenous estimate for 2014–2018 plus half the measured gap (Indigenous rate minus non-Indigenous rate) in 2004–2008

Source: Australian Bureau of Statistics (2018), Deaths, Year of registration, Indigenous status, Age at death, Sex, Five State/Territory.ABS.Stat. Findings based on use of ABS.Stat data.

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Queensland Health | Closing the Gap Performance Report 2018 33

The child mortality gap

Figure 16: Child mortality gap, Queensland 2001–2005 to 2014–2018

• At baseline (2004–2008), the gap in child mortality rates between Aboriginal and Torres Strait Islander

and other Queenslanders was 68 child deaths per 100,000. In 2013–2017, the gap was 69.4 child deaths

per 100,000 (Figure 16).

• A fluctuating Aboriginal and Torres Strait Islander child mortality rate combined with simultaneous

reductions in the rate among other Queenslander children means that while there have been

improvements, the gap is comparable to that when the COAG targets were agreed upon. Overall, the

gap trends downwards.

By jurisdiction

Figure 17: Child mortality by Indigenous status and jurisdiction, 2013–2017

68 69

0

20

40

60

80

100

Gap (

death

s p

er

100,0

00)

Measured gap

Target

Notes: The gap is the Indigenous minus the non-Indigenous child mortality rates

* 2010 deaths based on adjusted registrations

** Trendline based on linear trend of 2004–2008 to 2013–20167gap (trend since targets agreed to)

Source: Australian Bureau of Statistics (2018), Deaths, Year of registration, Indigenous status, Age at death, Sex, Five State/Territory.ABS.Stat. Findings based on use of ABS.Stat data.

NSW

SA

Qld

WA

NT

5 State/Territory

72

67

92

53

97

75

116

149

161

198

305

163

0 100 200 300 400

Rate per 100,000

Non-Indigenous Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 34

• Compared to other jurisdictions with high quality Aboriginal and Torres Strait Islander mortality data,

Queensland has the third lowest Indigenous child mortality rate (Figure 17).

Age distribution

Figure 18: Distribution of child deaths by age at death, Aboriginal and Torres Strait Islander Queenslanders, 2013–2017

• The vast majority of child deaths (88 per cent; Figure 18) occur in infancy. To have the greatest impact

on the child mortality gap, the focus must therefore be on preventing Aboriginal and Torres Strait Islander

infant deaths.

• With 43 per cent of child deaths occurring on the day of birth, the prevention of infant deaths begins prior

to and during pregnancy.

• Programs that focus on optimising the health of Aboriginal and Torres Strait Islander women in the years

leading up to pregnancy, and programs that focus on providing culturally appropriate evidence-based

antenatal care are vital.

• The mortality rate for Aboriginal and Torres Strait Islander children was around 70 per cent higher than

the rate among other Queenslanders (Figure 19). This is largely driven by infant mortality, with 187 of

the 213 child deaths in 2013–17 occurring in the first year of life.

Figure 19: Age specific mortality rate by Indigenous status, 2013–2017

43% 18% 26% 12%

Day of birth43% of child deaths*

Neonate <28 days62% of child deaths

Infant <1 year88% of child deaths

Child 0–4 years100% of child deaths

* Based on the per cent of total child deaths that occur on day one

Number Rate* Deaths Rate*

<1 year 187 676.6 1,125 394.5 1.72

1–4 years 29 27.7 213 18.2 1.52

0–4 years 213 161.1 1,338 91.9 1.75

* Mortality rate per 100,000

Age at deathIndigenous Non-Indigenous

Rate ratio

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Queensland Health | Closing the Gap Performance Report 2018 35

Supporting indicators

Antenatal visits

Antenatal care is vital for screening the health of expectant mothers and preventing early complications such

as hypertension and gestational diabetes, which are known to affect the health of the unborn baby. Culturally

safe antenatal care also presents an opportunity for primary prevention initiatives, and to raise awareness

and counsel expectant mothers about risk factors during pregnancy.

Figure 20: Attendance at antenatal visits, Queensland

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• There has been an increase in the number of Aboriginal and Torres Strait Islander women attending

regular antenatal care. Almost 9 in 10 Aboriginal and Torres Strait Islander women that gave birth in

2017–18 attended five or more antenatal visits (Figure 20).

• While the gap has reduced, Queensland needed 266 (6.7 per cent) more Aboriginal and Torres Strait

Islander women to attend 5 or more antenatal visits to have closed the gap with other Queenslanders in

2017–18.

• While regular attendance at antenatal care is important, ideally it also commences early in pregnancy.

The proportion of Aboriginal and Torres Strait Islander pregnant women that had an antenatal visit in the

first trimester increased substantially, from 36.3 per cent in 2009–10 to 60.0 per cent in 2017–18.

• Queensland needed 709 (17.6 per cent) more Aboriginal and Torres Strait Islander women to attend

their first antenatal visit in the first trimester to have closed the gap with other Queenslanders in 2017–

18.

5+ Antenatal visits Antenatal visit in first trimester

Indicator: Aboriginal and Torres Strait Islander women who attended 5 or

more antenatal visits during pregnancy

Indicator: Aboriginal and Torres Strait Islander women who attended an

antenatal visit during the first trimester

76.7 77.6

89.693.5 94.1

96.3

0

20

40

60

80

100

2002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Indigenous Non-Indigenous

36.3

60.060.5

77.6

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 36

Figure 21: Distribution of the number of antenatal visits by Indigenous status, Queensland, 2015–16 to 2017–18

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• For the three-year period 2015–16 to 2017–18, the number of mothers attending eight or more antenatal

visits was 65.8 per cent for Aboriginal and Torres Strait Islander Queenslanders (Figure 21).

Indigenous

Non-Indigenous

1.9% 9.1% 23.2% 65.8%

Fewer than 2 2 to 4 5 to 7 8+

0.3% 3.3% 14.3% 82.0%

Fewer than 2 2 to 4 5 to 7 8+

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Queensland Health | Closing the Gap Performance Report 2018 37

Smoking during pregnancy

Smoking during pregnancy is one of the most preventable cause of adverse outcomes in pregnancy.

Smoking causes complications of pregnancy and harm to the unborn baby, which extends to childhood and

even adulthood. The Queensland Aboriginal and Torres Strait Islander Burden of Disease and Injury Study

found that in 2011, 28 per cent of low birth weight burden was attributable to smoking during pregnancy.7

Pregnancy provides a window of opportunity for health professionals to help smokers quit, reducing the risk

of complications and protecting the baby’s health.

Figure 22: Proportion of women smoking during pregnancy, Queensland

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• There has been a considerable reduction in the proportion of Aboriginal and Torres Strait Islander

women that smoked at any time during pregnancy, with rates reducing from 53.6 per cent in 2007–08 to

41.9 per cent in 2017–18 (Figure 22).

• Parallel declines in the rate among other Queenslanders means the gap remains relatively unchanged,

at 32.5 per cent in 2017–18.

• Queensland needed 1,324 (32.5 per cent) fewer Aboriginal and Torres Strait Islander women smoking

during pregnancy to close the gap with other Queenslanders 2017–18.

• The impact of smoking on both the mother’s and child’s health, and the large remaining gap mean that

there are still large opportunities for gain in this area.

• A number of women quit smoking during pregnancy, with the percentage of women smoking after 20

weeks gestation slightly lower. In 2017–18, the rate of smoking after 20 weeks gestation was 37.0 per

cent among Aboriginal and Torres Strait Islander women and 7.4 per cent for other Queenslander

women.

• Queensland needed 1,200 (29.6 per cent) fewer Aboriginal and Torres Strait Islander women smoking

after 20 weeks gestation to close the gap with other Queenslanders 2017–18.

Smoked at any stage Smoked after 20 weeks gestationIndicator: Aboriginal and Torres Strait Islander women who smoked at

any stage during pregnancy

Indicator: Aboriginal and Torres Strait Islander women who smoked

after 20 weeks gestation

54.6 53.6

41.9

19.0 17.7

9.4

0

20

40

60

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Indigenous Non-Indigenous

51.848.8

37.0

17.414.7

7.4

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 38

Premature birth

A premature birth is when a baby is born before 37 weeks gestational age. A substantial majority of

premature babies, especially those born late in the pre-term period, will go on to develop normally without

serious long-term health problems. However, some premature babies, particularly if born very premature,

have lower rates of survival and can have long term health problems.

While the cause of premature birth is often unknown, the prevention of premature birth begins with a healthy

pregnancy and culturally safe and effective antenatal care.

Figure 23: Proportion of babies born preterm (<37 weeks), Queensland

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• The percentage of preterm babies has remained relatively static for both population groups, at 10.4 per

cent for Aboriginal and Torres Strait Islander women and 6.7 per cent for other Queenslander women in

2017–18 (Figure 23).

• The gap in preterm births between Aboriginal and Torres Strait Islander and other Queenslander women

was 4.2 per cent in 2007–08 and 3.7 per cent in 2017–18.

• Queensland needed 149 (3.7 per cent) fewer preterm babies born to Aboriginal and Torres Strait Islander

women to close the gap with other Queenslanders in 2017–18.

Preterm babiesIndicator: Proportion of preterm babies (born at < 37 weeks gestation) to

Aboriginal and Torres Strait Islander women

11.210.3 10.4

6.06.1 6.7

0

5

10

15

20

2002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 39

Birthweight

Low birthweight

Babies who are born of low birthweight are at a greater risk of poor health, disability and death than other

babies. Infants born with low birth weight are at increased risk of developing diabetes, renal disease and

cardiovascular disease in later life and are at greater risk of mortality than adults that were not classified as

low birthweight. Reducing the rates of low birthweight among Aboriginal and Torres Strait Islander babies is

therefore essential to reduce infant mortality and improving morbidity and mortality in adult life.

A baby may be born small due to being born early (preterm) or they may be small because of intrauterine

growth restriction. There are a number of factors contributing to low birthweight, including illness during

pregnancy, multiple pregnancy, harmful behaviours such as smoking or excessive alcohol consumption, and

poor antenatal care.

Culturally appropriate antenatal care that can engage with Aboriginal and Torres Strait Islander expectant

mothers early on in their pregnancy, and retain that engagement throughout pregnancy will be instrumental

in being able to help lower the percentage of low birthweight babies.

Figure 24: Proportion of babies born of low birthweight (less than 2,500g), Queensland 2002–03 to 2017–18

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• The proportion of babies born with low birthweight at any gestational age (including preterm births) has

remained stable between 2007–08 and 2017–18. (Figure 24).

• Queensland needed 191 (4.8 per cent) fewer low birthweight babies born (at any gestational age) to

Aboriginal and Torres Strait Islander women to close the gap with other Queenslanders in 2017–18.

• The proportion of babies born with low birthweight born at term (37+ weeks gestational age) to Aboriginal

and Torres Strait Islander women was 3.7 per cent in 2017–18. This rate has remained stable between

2007–08 and 2017–18.

• Queensland needed 68 (1.9 per cent) fewer babies with low birthweight born at term Aboriginal and

Torres Strait Islander women to close the gap with other Queenslanders in 2017–18.

• This highlights that a large proportion of low birthweight babies are pre-term. Reducing the proportion of

births that are pre-term is therefore vital to substantially increase the proportion of babies born in the

healthy birthweight range.

Low birthweight Low birthweight at 37+ weeks gestation

Indicator: Proportion of babies born of low birthweight (<2500g) to

Aboriginal and Torres Strait Islander women

Indicator: Proportion of babies born of low birthweight (<2500g) at 37+

weeks gestation to Aboriginal and Torres Strait Islander women

10.89.4 9.8

4.5 4.45.0

0

5

10

15

20

2002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Indigenous Non-Indigenous

4.63.5 3.7

1.4 1.4 1.8

2002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 40

Babies born in the healthy birthweight range

Birthweight is a key indicator of infant health. A low birthweight is a known risk factor for neurological and

physical disabilities, and too high a birthweight can be associated with gestational diabetes and difficult

delivery.

The definition of ‘healthy birthweight’ varies according to the literature. While Our Future State defines

healthy birthweights in the range of 2,000 to 4,000 grams, an alternative upper cut off from the literature is

4,500 grams. The proportion of babies born in the healthy birthweight range varies depending on the chosen

cut-off point, so an analysis with both options is presented.

Figure 25: Proportion of babies born with healthy birthweight, Queensland 2002–03 to 2017–18

Source: Perinatal data collection, preliminary data extracted 24 January 2019

• Overall, the majority of babies born to Aboriginal and Torres Strait Islander women are born in the healthy

birthweight range (Figure 25).

• Using a cut off of 3,999 grams:

o In 2017–18, 80.8 per cent of babies born to Aboriginal and Torres Strait Islander women were

born in the healthy birthweight range.

o Queensland needed 160 (4.0 per cent) more babies in the healthy weight range born to

Aboriginal and Torres Strait Islander women to close the gap with other Queenslanders in 2017–

18.

• Using a cut-off of 4,499 grams:

o In 2017–18, 89.0 per cent of babies born to Aboriginal and Torres Strait Islander women were

born in the healthy birthweight range.

o Queensland needed 191 (4.8 per cent) more babies in the healthy weight range born to

Aboriginal and Torres Strait Islander women to close the gap with other Queenslanders in 2017–

18.

Indicator: Proportion of healthy birthweight babies (2500-3999g) born to

Aboriginal and Torres Strait Islander women

Indicator: Proportion of healthy birthweight babies (2500-4499g) born to

Aboriginal and Torres Strait Islander women

Healthy birthweight babies (2500-3999 grams) Healthy birthweight babies (2500-4499 grams)

81.9 82.3 84.8

79.882.4 80.8

40

60

80

100

2002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Non-Indigenous Indigenous

87.3 89.2 89.0

93.5 93.6 93.82002–03

2003–04

2004–05

2005–06

2006–07

2007–08

2008–09

2009–10

2010–11

2011–12

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Indigenous Non-Indigenous

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Queensland Health | Closing the Gap Performance Report 2018 41

Immunisation

Immunisation is an important protective factor for children’s health. This is a message that is that is clearly

being heard and is reflected in the high immunisation rates among Aboriginal and Torres Strait Islander

children.

Figure 26: Trends in fully immunised coverage rates by Indigenous status and age group, Queensland 2012–13 to 2017–18

• By the age of five, 96.9 per cent of Queensland Aboriginal and Torres Strait Islander children were fully

immunised (for other Queenslanders, the 5-year-olds the rate was 94.0 per cent) in 2017–18 (Figure

26).

• Emphasising the importance of early and timely immunisation will help increase the immunisation rates

at 1 and 2 years of age which, although high, were 2.5 and 2.8 percentage points below other

Queenslander rates in 2017–18.

1 year old cohort 2 year old cohort* 5 year old cohort

86.0

91.8

93.0

89.0

92.796.9

92.5 94.3

92.5

91.8

91.494.0

40

50

60

70

80

90

100

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

2012–13

2013–14

2014–15

2015–16

2016–17

2017–18

Per

cent

Indigenous Queensland Non-Indigenous Queensland

Source: Australian Immunisation Register* The fall in vaccination rates in 2014-15 was due to a change in the national definition of fully immunised at two years

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Queensland Health | Closing the Gap Performance Report 2018 42

Conclusion

This report highlights substantial health gains for Aboriginal and Torres Strait Islander Queenslanders.

These gains should be celebrated. However, it is also important to acknowledge the gap in health outcomes

between Aboriginal and Torres Strait Islander and other Queenslanders remains. While gains can be made

through technology, access to services, and preventive health care, reconciliation and a future without

prejudice, exclusion and racism will provide the best chance of truly closing the health gap.

The social determinants of health for Aboriginal and Torres Strait Islander Queenslanders, while improving,

are lagging behind that of other Queenslanders. The impacts of racism, colonisation and dispossession

impact on the health of Aboriginal and Torres Strait Islander Australians on a daily basis.

Australia is on the journey to achieve equality of health outcomes with Aboriginal and Torres Strait Islander

people. If we can work together to reconcile the last 230 years of colonisation, address reconciliation and

the pervading racism in contemporary Australia, equity of health outcomes can be a reality.

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Queensland Health | Closing the Gap Performance Report 2018 43

Appendices

Methods

Adjustment of deaths registered in 2010

In 2010, the Queensland Register of Births, Deaths and Marriages undertook a deaths registration initiative

which resulted in the registration of 374 previously unregistered deaths that occurred between 1992 and

2006.3 Most of these were deaths Aboriginal and Torres Strait Islander people (284). Child mortality data in

this report are based on year of registration to align with the national Closing the Gap reporting. To enable

more meaningful interpretation of the trend in child mortality rates we adjust the number of deaths registered

in 2010 based on data supplied by the ABS.4

Change to identification of Aboriginal and Torres Strait Islander deaths

Prior to 2015, Indigenous status of deaths registered in Queensland was ascertained from the Death

Registration Form (DRF) and, where this field was left blank, from the Medical Certificate Cause of Death

(MCCD). From 2015, Indigenous status has been derived from both the DRF and the MCCD. This

administrative change has led to a subsequent increase in the number of deaths that were identified as

Aboriginal and Torres Strait Islander and decrease in the number of deaths for which the Indigenous status

was 'not stated'.5 Approximately 4 per cent of deaths registered in Queensland that were identified as

Aboriginal and Torres Strait Islander in 2015 and 2016 were ascertained using the new methods—that is,

approximately 35 deaths annually were identified as Aboriginal and Torres Strait Islander where previously

they would have been classified as “not stated” or “non-Indigenous” (ABS, personal communication, 17

November 2017) . While this apparent increase in deaths should be kept in mind when interpreting trends in

mortality, at this stage the change has not been large enough to affect the overall interpretation of trends.

Life expectancy gap decomposition

The improvement in life expectancy of Queensland Aboriginal and Torres Strait Islander people over the five

years 2010–2012 to 2015–2017, reduction of the gap with other Queenslanders, and the current 2015–2017

gap in life expectancy were all partitioned into cause and age-specific contributions using the Arriaga

method.6 Using data from Australian Bureau of Statistics life tables for Aboriginal and Torres Strait Islander

people7 and other Queenslanders8, deaths were proportionately distributed by cause based on cause of

death data9. An implicit assumption in this analysis was that there is no difference in the identification rate

for Aboriginal and Torres Strait Islander deaths by underlying cause.

3 ABS. Deaths, Australia, 2010. Australian Bureau of Statistics; 2011. 4 ABS. Adjusted mortality numbers and rates for selected states and territories by Indigenous status for 2006-2010: Australian Bureau of Statistics; 2017. 5 ABS. Deaths, Australia, 2016. Australian Bureau of Statistics; 2017. 6 Auger N, Feuillet P, Martel S, Lo E, Barry AD, Harper S.2014. Mortality inequality in populations with equal life expectancy: A practical decomposition method in SAS and Excel. Annals of Epidemiology 2014. 7 ABS. 2018. Life Tables for Aboriginal and Torres Strait Islander Australians, 2015-2017, cat no. 3302.0.55.003, viewed 21/02/2019. 8 ABS. Customised report. 2019. 9 Cause of Death Unit Record File (COD URF), Australian Coordinating Registry. Extract provided by Statistical Analysis and Linkage Unit, Statistical Services Branch, Queensland Health.

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Queensland Health | Closing the Gap Performance Report 2018 44

Table 1: Male increase in life expectancy decomposed by age and cause, Queensland 2010–2012 to 2015–2017

Table 2: Female increase in life expectancy decomposed by age and cause, Queensland 2010–2012 to 2015–2017

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic d

isea

ses

(A0

0-B

99

)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-D

48

)

Ch

apte

r 0

4 -

En

do

crin

e, n

utr

itio

nal

&

met

abo

lic d

isea

ses

(E0

0-E

89

)

Ch

apte

r 0

5 -

Men

tal,

beh

avio

ura

l

dis

ord

ers

(F0

0-F

99

)

Ch

apte

r 0

6 -

Dis

ease

s o

f th

e n

ervo

us

syst

em (

G0

0-G

99

)

Ch

apte

r 0

9 -

Dis

ease

s o

f th

e

circ

ula

tory

sys

tem

(I0

0-I

99

)

Ch

apte

r 1

0 -

Dis

ease

s o

f th

e

resp

irat

ory

sys

tem

(J0

0-J

99

)

Ch

apte

r 1

1 -

Dis

ease

s o

f th

e d

iges

tive

syst

em (

K0

0-K

93

)

Ch

apte

r 1

3 -

Dis

ease

s o

f th

e

mu

scu

losk

elet

al s

yste

m &

co

nn

ecti

ve

tiss

ue

(M0

0-M

99

)

Ch

apte

r 1

4 -

Dis

ease

s o

f th

e

gen

ito

uri

nar

y sy

stem

(N

00

-N9

9)

Ch

apte

r 1

6 -

Cer

tain

co

nd

itio

ns

ori

gin

atin

g in

th

e p

erin

atal

per

iod

(P0

0-P

96

)

Ch

apte

r 1

8 -

Sym

pto

ms,

sig

ns

&

abn

orm

al c

linic

al &

lab

fin

din

gs, n

ec

(R0

0-R

99

)

Ch

apte

r 2

0 -

Ext

ern

al c

ause

s o

f

mo

rtal

ity

and

mo

rbid

ity

(U5

0-Y

98

)

Oth

er

All

cau

se

<1 0.00 0.01 0.00 0.00 0.00 0.04 0.01 0.01 0.00 0.00 -0.01 0.09 0.00 0.03 0.181-4 0.01 0.00 0.00 0.00 -0.02 0.01 0.01 0.00 0.00 0.00 0.00 0.00 -0.01 0.00 -0.015-9 0.00 0.00 0.00 0.00 0.01 -0.01 -0.02 0.00 0.00 0.00 0.00 0.00 -0.05 0.00 -0.05

10-14 0.00 0.00 0.00 0.00 0.00 0.00 -0.01 0.00 0.00 0.00 0.00 0.00 0.02 -0.01 0.0115-19 0.00 0.02 0.00 0.00 -0.02 0.02 0.00 0.00 0.02 0.00 0.00 0.00 0.03 0.02 0.0820-24 -0.02 0.02 0.00 0.00 -0.01 0.06 0.00 0.00 0.00 0.00 0.00 0.00 0.01 -0.02 0.05

25-29 0.00 0.01 0.02 0.00 0.02 -0.03 -0.01 0.01 0.00 0.00 0.00 0.02 0.04 0.05 0.13

30-34 -0.02 0.05 0.01 -0.01 0.06 0.06 0.03 0.01 0.00 0.00 0.00 0.01 -0.18 0.02 0.0435-39 0.03 0.10 -0.01 0.00 0.02 0.02 -0.02 0.09 0.01 0.01 0.00 0.00 0.00 0.00 0.2440-44 0.01 0.02 0.00 0.01 0.02 0.09 0.00 0.00 0.03 -0.01 0.00 -0.03 -0.09 0.01 0.0745-49 -0.02 -0.01 0.22 0.01 -0.02 0.18 -0.04 -0.05 0.02 0.03 0.00 -0.01 -0.07 -0.02 0.2350-54 -0.01 0.06 0.06 0.00 0.00 0.12 0.06 0.05 0.03 0.02 0.00 0.02 -0.04 -0.01 0.3655-59 0.03 0.04 0.12 0.02 0.00 -0.09 0.05 0.02 0.01 0.07 0.00 0.06 0.03 -0.01 0.3660-64 0.02 0.12 0.12 0.02 -0.03 0.04 0.02 0.00 0.01 0.02 0.00 0.01 -0.02 -0.01 0.3265-69 -0.01 0.13 0.18 -0.01 -0.02 0.08 -0.02 -0.01 0.00 0.03 0.00 0.01 0.01 0.01 0.3770-74 0.02 -0.07 -0.03 0.04 0.00 0.26 0.13 -0.01 0.03 0.05 0.00 0.08 0.00 0.00 0.5075-79 0.06 -0.02 0.07 -0.01 0.01 0.15 -0.03 -0.01 0.00 0.06 0.00 -0.01 0.02 0.01 0.3080-84 0.00 -0.02 0.04 -0.03 0.03 0.12 0.03 -0.03 -0.01 -0.02 0.00 0.02 -0.01 0.00 0.1385+ 0.01 -0.06 -0.02 -0.01 -0.01 0.07 -0.02 0.03 0.00 0.04 0.00 -0.01 0.01 0.00 0.03

All ages 0.10 0.40 0.78 0.02 0.04 1.19 0.18 0.12 0.16 0.30 -0.01 0.26 -0.30 0.09 3.33

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic d

isea

ses

(A0

0-B

99

)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-D

48

)

Ch

apte

r 0

4 -

En

do

crin

e, n

utr

itio

nal

&

met

abo

lic d

isea

ses

(E0

0-E

89

)

Ch

apte

r 0

5 -

Men

tal,

beh

avio

ura

l

dis

ord

ers

(F0

0-F

99

)

Ch

apte

r 0

6 -

Dis

ease

s o

f th

e n

ervo

us

syst

em (

G0

0-G

99

)

Ch

apte

r 0

9 -

Dis

ease

s o

f th

e

circ

ula

tory

sys

tem

(I0

0-I

99

)

Ch

apte

r 1

0 -

Dis

ease

s o

f th

e

resp

irat

ory

sys

tem

(J0

0-J

99

)

Ch

apte

r 1

1 -

Dis

ease

s o

f th

e d

iges

tive

syst

em (

K0

0-K

93

)

Ch

apte

r 1

3 -

Dis

ease

s o

f th

e

mu

scu

losk

elet

al s

yste

m &

co

nn

ecti

ve

tiss

ue

(M0

0-M

99

)

Ch

apte

r 1

4 -

Dis

ease

s o

f th

e

gen

ito

uri

nar

y sy

stem

(N

00

-N9

9)

Ch

apte

r 1

6 -

Cer

tain

co

nd

itio

ns

ori

gin

atin

g in

th

e p

erin

atal

per

iod

(P0

0-P

96

)

Ch

apte

r 1

8 -

Sym

pto

ms,

sig

ns

&

abn

orm

al c

linic

al &

lab

fin

din

gs, n

ec

(R0

0-R

99

)

Ch

apte

r 2

0 -

Ext

ern

al c

ause

s o

f

mo

rtal

ity

and

mo

rbid

ity

(U5

0-Y

98

)

Oth

er

All

cau

se

<1 -0.01 0.01 -0.01 0.00 -0.01 0.04 -0.03 0.01 0.00 0.00 -0.07 0.05 0.00 0.06 0.051-4 0.02 0.00 0.00 0.00 -0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.01 -0.01 0.025-9 0.00 0.00 0.00 0.00 0.02 -0.01 0.00 -0.01 0.00 0.00 0.00 -0.01 -0.03 0.00 -0.04

10-14 0.00 -0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.01 0.01 -0.01 -0.0215-19 0.00 0.01 0.00 0.00 -0.01 0.01 -0.02 0.00 0.01 0.00 0.00 -0.01 0.01 0.01 0.0220-24 0.00 0.00 -0.01 0.00 -0.02 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.05 -0.02 0.04

25-29 0.00 0.00 0.00 0.00 0.00 -0.01 -0.01 0.01 -0.01 -0.01 0.00 0.01 0.14 0.02 0.16

30-34 -0.02 0.01 0.00 0.00 0.02 0.00 0.03 0.03 -0.01 -0.01 0.00 0.01 0.04 0.00 0.0935-39 0.02 0.07 0.00 0.01 -0.01 0.01 -0.02 0.07 0.01 0.01 0.00 0.01 0.07 -0.01 0.2640-44 -0.02 0.02 0.01 -0.01 0.01 0.09 -0.03 0.00 0.02 0.00 0.00 -0.01 -0.02 0.00 0.0645-49 0.00 -0.15 0.12 0.01 0.00 0.10 -0.03 -0.02 0.01 -0.01 0.00 -0.03 -0.04 -0.01 -0.0650-54 0.00 -0.06 0.03 0.04 0.00 0.07 -0.01 0.03 0.01 -0.01 0.00 0.01 -0.02 0.00 0.1055-59 0.05 0.11 0.09 0.03 0.02 -0.01 0.09 -0.04 0.00 0.06 0.00 0.08 0.07 0.01 0.5760-64 0.01 0.04 0.05 0.01 -0.01 0.10 -0.04 0.01 0.00 0.00 0.00 0.00 -0.01 0.00 0.1665-69 -0.03 -0.04 0.10 0.00 -0.02 0.02 -0.07 0.01 0.00 0.02 0.00 0.01 0.00 0.01 0.0070-74 0.04 -0.02 -0.01 0.02 -0.01 0.28 -0.01 -0.05 0.01 0.05 0.00 0.08 -0.01 0.00 0.3675-79 -0.02 -0.01 0.05 -0.02 -0.02 0.15 -0.01 -0.03 -0.02 0.04 0.00 0.00 0.01 0.00 0.1280-84 0.01 0.03 0.03 -0.07 0.03 0.05 0.05 -0.05 0.00 0.01 0.00 0.04 0.00 -0.01 0.1285+ 0.01 -0.03 0.00 -0.02 0.00 0.05 -0.04 0.06 -0.06 0.05 0.00 -0.02 0.03 0.00 0.02

All ages 0.06 -0.03 0.44 0.01 0.00 0.97 -0.15 0.02 -0.01 0.21 -0.07 0.22 0.32 0.06 2.03

Page 45: Indigenous artwork is by Riki Salam of Gilimbaa Indigenous ... · Indigenous artwork is by Riki Salam of Gilimbaa Indigenous Creative Agency. Indigenous Queenslander is used in this

Queensland Health | Closing the Gap Performance Report 2018 45

Table 3: Male change in the life expectancy gap decomposed by age and cause, Queensland 2010–2012 to 2015–2017

Table 4: Female change in the life expectancy gap decomposed by age and cause, Queensland 2010–2012 to 2015–2017

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic

dis

ease

s (A

00

-B9

9)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-

D4

8)

Ch

apte

r 0

4 -

En

do

crin

e,

nu

trit

ion

al &

met

abo

lic

dis

ease

s (E

00

-E8

9)

Ch

apte

r 0

5 -

Men

tal,

beh

avio

ura

l dis

ord

ers

(F0

0-

F99

)

Ch

apte

r 0

6 -

Dis

ease

s o

f th

e

ner

vou

s sy

stem

(G

00

-G9

9)

Ch

apte

r 0

9 -

Dis

ease

s o

f th

e

circ

ula

tory

sys

tem

(I0

0-I

99

)

Ch

apte

r 1

0 -

Dis

ease

s o

f th

e

resp

irat

ory

sys

tem

(J0

0-J

99

)

Ch

apte

r 1

1 -

Dis

ease

s o

f th

e

dig

esti

ve s

yste

m (

K0

0-K

93

)

Ch

apte

r 1

3 -

Dis

ease

s o

f th

e

mu

scu

losk

elet

al s

yste

m &

con

nec

tive

tis

sue

(M0

0-M

99

)

Ch

apte

r 1

4 -

Dis

ease

s o

f th

e

gen

ito

uri

nar

y sy

stem

(N

00

-

N9

9)

Ch

apte

r 1

6 -

Cer

tain

con

dit

ion

s o

rigi

nat

ing

in t

he

per

inat

al p

erio

d (

P0

0-P

96

)

Ch

apte

r 1

8 -

Sym

pto

ms,

sig

ns

& a

bn

orm

al c

linic

al &

lab

fin

din

gs, n

ec (

R0

0-R

99

)

Ch

apte

r 2

0 -

Ext

ern

al c

ause

s

of

mo

rtal

ity

and

mo

rbid

ity

(U5

0-Y

98

)

Oth

er

All

cau

se

<1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1

1-4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5-9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -0.1

10-14 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15-19 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

20-24 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1

25-29 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1

30-34 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -0.1 0.0 0.035-39 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.240-44 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.145-49 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.250-54 0.0 0.0 0.0 -0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.355-59 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.360-64 0.0 0.1 0.2 0.0 0.0 -0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.265-69 0.0 0.0 -0.1 0.0 0.0 0.2 -0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.370-74 0.0 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.575-79 0.0 -0.1 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.380-84 0.0 0.0 0.0 0.0 0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.0 -0.1 0.0 0.185+ 0.0 0.1 -0.1 -0.1 -0.1 0.0 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.0 0.1

All ages 0.0 0.3 0.2 -0.2 0.1 1.1 0.2 0.4 0.1 0.2 0.0 0.5 -0.1 0.1 3.0

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic

dis

ease

s (A

00

-B9

9)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-

D4

8)

Ch

apte

r 0

4 -

En

do

crin

e,

nu

trit

ion

al &

met

abo

lic

dis

ease

s (E

00

-E8

9)

Ch

apte

r 0

5 -

Men

tal,

beh

avio

ura

l dis

ord

ers

(F0

0-

F99

)

Ch

apte

r 0

6 -

Dis

ease

s o

f th

e

ner

vou

s sy

stem

(G

00

-G9

9)

Ch

apte

r 0

9 -

Dis

ease

s o

f th

e

circ

ula

tory

sys

tem

(I0

0-I

99

)

Ch

apte

r 1

0 -

Dis

ease

s o

f th

e

resp

irat

ory

sys

tem

(J0

0-J

99

)

Ch

apte

r 1

1 -

Dis

ease

s o

f th

e

dig

esti

ve s

yste

m (

K0

0-K

93

)

Ch

apte

r 1

3 -

Dis

ease

s o

f th

e

mu

scu

losk

elet

al s

yste

m &

con

nec

tive

tis

sue

(M0

0-M

99

)

Ch

apte

r 1

4 -

Dis

ease

s o

f th

e

gen

ito

uri

nar

y sy

stem

(N

00

-

N9

9)

Ch

apte

r 1

6 -

Cer

tain

con

dit

ion

s o

rigi

nat

ing

in t

he

per

inat

al p

erio

d (

P0

0-P

96

)

Ch

apte

r 1

8 -

Sym

pto

ms,

sig

ns

& a

bn

orm

al c

linic

al &

lab

fin

din

gs, n

ec (

R0

0-R

99

)

Ch

apte

r 2

0 -

Ext

ern

al c

ause

s

of

mo

rtal

ity

and

mo

rbid

ity

(U5

0-Y

98

)

Oth

er

All

cau

se

<1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -0.1 0.0 0.0 0.0 0.0

1-4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

5-9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

10-14 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

15-19 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

20-24 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

25-29 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.230-34 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.135-39 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.340-44 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.145-49 0.0 -0.2 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -0.150-54 0.0 -0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.155-59 0.1 0.1 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.0 0.660-64 0.0 0.0 0.0 0.0 0.0 0.1 -0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.165-69 0.0 -0.1 0.1 0.0 0.0 0.0 -0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -0.170-74 0.0 -0.1 0.0 0.0 0.0 0.3 0.0 -0.1 0.0 0.1 0.0 0.1 0.0 0.0 0.475-79 0.0 0.0 0.1 0.0 0.0 0.2 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.180-84 0.0 0.0 0.0 -0.1 0.1 0.0 0.1 -0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.185+ 0.0 0.0 0.0 0.0 0.0 0.0 -0.1 0.1 -0.1 0.1 0.0 0.0 0.1 0.0 0.0

All ages 0.1 -0.1 0.4 0.0 0.1 0.8 -0.2 0.0 -0.1 0.3 -0.1 0.3 0.3 0.1 1.9

Page 46: Indigenous artwork is by Riki Salam of Gilimbaa Indigenous ... · Indigenous artwork is by Riki Salam of Gilimbaa Indigenous Creative Agency. Indigenous Queenslander is used in this

Queensland Health | Closing the Gap Performance Report 2018 46

Table 5: Male life expectancy gap decomposed by age and cause, Queensland 2015–2017

Table 6: Female life expectancy gap decomposed by age and cause, Queensland 2015–2017

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic d

isea

ses

(A0

0-B

99

)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-D

48

)

Ch

apte

r 0

4 -

En

do

crin

e, n

utr

itio

nal

&

met

abo

lic d

isea

ses

(E0

0-E

89

)

Ch

apte

r 0

5 -

Men

tal,

beh

avio

ura

l

dis

ord

ers

(F0

0-F

99

)

Ch

apte

r 0

6 -

Dis

ease

s o

f th

e n

ervo

us

syst

em (

G0

0-G

99

)

Ch

apte

r 0

9 -

Dis

ease

s o

f th

e

circ

ula

tory

sys

tem

(I0

0-I

99

)

Ch

apte

r 1

0 -

Dis

ease

s o

f th

e

resp

irat

ory

sys

tem

(J0

0-J

99

)

Ch

apte

r 1

1 -

Dis

ease

s o

f th

e d

iges

tive

syst

em (

K0

0-K

93

)

Ch

apte

r 1

3 -

Dis

ease

s o

f th

e

mu

scu

losk

elet

al s

yste

m &

co

nn

ecti

ve

tiss

ue

(M0

0-M

99

)

Ch

apte

r 1

4 -

Dis

ease

s o

f th

e

gen

ito

uri

nar

y sy

stem

(N

00

-N9

9)

Ch

apte

r 1

6 -

Cer

tain

co

nd

itio

ns

ori

gin

atin

g in

th

e p

erin

atal

per

iod

(P0

0-P

96

)

Ch

apte

r 1

8 -

Sym

pto

ms,

sig

ns

&

abn

orm

al c

linic

al &

lab

fin

din

gs, n

ec

(R0

0-R

99

)

Ch

apte

r 2

0 -

Ext

ern

al c

ause

s o

f

mo

rtal

ity

and

mo

rbid

ity

(U5

0-Y

98

)

Oth

er

All

cau

se

<1 -0.02 -0.01 0.00 0.00 0.01 0.00 0.01 0.00 0.00 0.00 -0.15 -0.01 -0.01 -0.01 -0.191-4 -0.01 0.01 0.00 0.00 -0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.01 -0.02 0.00 -0.015-9 0.00 0.01 0.00 0.00 -0.01 -0.01 -0.01 0.00 0.00 0.00 0.00 0.00 -0.04 0.00 -0.06

10-14 0.00 0.01 0.00 0.00 0.00 0.00 -0.01 0.00 0.00 0.00 0.00 0.00 -0.02 0.00 -0.0115-19 0.00 -0.01 0.00 0.00 -0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.10 0.00 -0.1020-24 -0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.17 -0.01 -0.18

25-29 0.00 -0.01 0.00 0.00 0.01 -0.03 -0.01 -0.01 0.00 0.00 0.00 0.00 -0.19 0.00 -0.22

30-34 -0.02 0.01 -0.01 -0.01 0.01 -0.03 -0.01 -0.03 0.00 0.00 0.00 0.00 -0.22 0.00 -0.3035-39 -0.01 -0.03 -0.02 -0.02 0.01 -0.06 -0.02 -0.04 -0.01 -0.01 0.00 -0.02 -0.08 0.00 -0.3040-44 -0.01 -0.05 -0.07 0.00 -0.01 -0.18 -0.01 -0.04 0.00 -0.01 0.00 -0.05 -0.10 -0.01 -0.5445-49 -0.04 -0.06 -0.06 -0.01 -0.03 -0.18 -0.06 -0.11 0.00 -0.01 0.00 0.00 -0.07 -0.01 -0.6450-54 -0.02 -0.13 -0.11 -0.07 -0.01 -0.14 -0.02 -0.02 0.00 -0.03 0.00 0.00 -0.01 -0.01 -0.5655-59 -0.03 -0.15 -0.06 -0.01 -0.03 -0.20 -0.05 -0.02 0.00 -0.01 0.00 0.00 0.01 -0.02 -0.5760-64 -0.03 -0.23 -0.06 -0.01 -0.02 -0.33 -0.08 -0.05 -0.01 -0.01 0.00 0.00 -0.02 0.00 -0.8665-69 0.00 -0.24 -0.15 -0.01 0.00 -0.17 -0.20 -0.07 0.00 -0.01 0.00 -0.02 0.01 -0.01 -0.8570-74 -0.04 -0.34 -0.23 0.00 0.04 -0.26 0.02 0.01 0.00 -0.02 0.00 0.00 -0.01 0.01 -0.8375-79 0.01 -0.23 -0.23 -0.07 0.02 -0.12 -0.14 -0.06 0.00 0.00 0.00 -0.01 0.01 0.01 -0.8180-84 -0.03 -0.14 -0.09 -0.10 0.02 0.00 -0.11 -0.04 -0.01 -0.09 0.00 -0.02 -0.03 0.00 -0.6385+ 0.03 0.02 -0.20 -0.15 -0.02 0.05 -0.01 0.06 0.01 0.06 0.00 -0.02 0.00 0.01 -0.15

All ages -0.20 -1.54 -1.27 -0.46 -0.05 -1.66 -0.70 -0.40 0.00 -0.14 -0.15 -0.13 -1.05 -0.05 -7.8

Age

Ch

apte

r 0

1 -

Cer

tain

infe

ctio

us

and

par

asit

ic d

isea

ses

(A0

0-B

99

)

Ch

apte

r 0

2 -

Neo

pla

sms

(C0

0-D

48

)

Ch

apte

r 0

4 -

En

do

crin

e, n

utr

itio

nal

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<1 -0.02 0.00 -0.01 0.00 -0.01 0.01 -0.03 0.00 0.00 0.00 -0.21 -0.03 0.00 0.02 -0.271-4 0.00 0.01 0.00 0.00 -0.01 0.00 -0.01 0.00 0.00 0.00 0.00 0.01 -0.01 0.00 -0.015-9 0.00 0.00 0.00 0.00 0.00 -0.01 0.00 -0.01 0.00 0.00 0.00 -0.01 -0.03 0.00 -0.05

10-14 0.00 -0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.01 -0.02 -0.01 -0.0315-19 0.00 0.00 0.00 0.00 0.00 0.00 -0.02 0.00 0.00 0.00 0.00 -0.01 -0.06 0.00 -0.0820-24 0.00 0.00 -0.01 0.00 -0.01 0.01 0.00 0.00 0.00 0.00 0.00 0.00 -0.08 -0.02 -0.10

25-29 0.00 0.01 -0.01 0.00 -0.01 -0.01 -0.01 0.00 -0.01 -0.01 0.00 0.00 -0.03 -0.01 -0.07

30-34 -0.02 0.00 -0.01 0.00 -0.02 -0.05 0.00 0.00 -0.01 -0.01 0.00 0.00 -0.04 -0.01 -0.1535-39 0.00 0.00 -0.01 0.00 -0.02 -0.05 -0.02 -0.02 0.00 0.00 0.00 0.00 -0.03 -0.01 -0.1440-44 -0.03 0.00 -0.03 -0.02 0.00 -0.08 -0.04 -0.03 0.00 0.00 0.00 -0.01 -0.07 -0.01 -0.3245-49 0.00 -0.14 -0.04 0.00 -0.01 -0.10 -0.03 -0.05 0.00 -0.03 0.00 -0.03 -0.05 -0.01 -0.4950-54 -0.01 -0.11 -0.08 -0.01 0.00 -0.12 -0.06 -0.01 0.00 -0.04 0.00 0.01 -0.01 0.00 -0.4555-59 -0.02 -0.11 -0.12 -0.01 0.00 -0.18 -0.02 -0.10 -0.01 -0.03 0.00 0.00 0.02 0.00 -0.5760-64 -0.02 -0.23 -0.11 -0.02 0.01 -0.20 -0.12 -0.03 0.00 -0.02 0.00 -0.01 -0.02 0.01 -0.7765-69 -0.03 -0.24 -0.12 0.01 0.01 -0.15 -0.18 -0.03 0.00 -0.01 0.00 -0.01 -0.01 0.01 -0.7470-74 0.00 -0.20 -0.16 -0.03 0.02 -0.17 -0.16 -0.04 -0.02 0.00 0.00 0.00 -0.02 0.01 -0.7775-79 -0.11 -0.19 -0.23 -0.06 -0.03 -0.12 -0.07 -0.07 -0.02 -0.03 0.00 0.00 -0.01 -0.01 -0.9580-84 0.01 -0.08 -0.12 -0.13 0.02 -0.18 -0.10 -0.07 0.01 -0.01 0.00 0.00 0.01 -0.01 -0.6385+ 0.02 0.06 -0.13 -0.05 0.06 0.00 -0.07 0.07 -0.10 0.00 0.00 -0.02 0.00 0.02 -0.15

All ages -0.23 -1.23 -1.17 -0.29 0.01 -1.41 -0.92 -0.37 -0.16 -0.20 -0.21 -0.10 -0.46 -0.01 -6.7

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Queensland Health | Closing the Gap Performance Report 2018 47

Abbreviations

ABS Australian Bureau of Statistics

ACIR Australian Childhood Immunisation Register

AIHW Australian Institute of Health and Welfare

COAG Council of Australian Governments

CVD Cardiovascular disease

HHS Hospital and Health Service

PDC Perinatal Data Collection

RR Rate ratio

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Queensland Health | Closing the Gap Performance Report 2018 48

Glossary

Age standardised rates (ASR) provide an indication of the frequency of an event within a population

adjusted for the confounding effect of different age structures in the populations (or time periods) being

compared.

External causes refer to those disease groups used in International Classification of Diseases 10th

Edition Australian Modification (ICD-10-AM) classification developed in Australia by the National Centre

for Classification in Health, which was based on the World Health Organisation ICD-10. External causes

include, but are not limited to, injury, poisoning, burns and trauma.

‘Gap’ refers to the rate difference between Aboriginal and Torres Strait Islander and other Queenslanders.

For trend analyses, references to the widening or narrowing of the gap refer to changes in the age

standardised rate difference over time.

Health gap refers to the difference between the burden of disease estimates for Aboriginal and Torres

Strait Islander Queenslanders in a given calendar year and what the estimates would have been if

Aboriginal and Torres Strait Islander Queenslanders had experienced mortality and disability at the level

of the total Queensland population.

Health services include alcohol and drug services, health promotion and disease prevention services,

women’s and men’s health, child and maternal health, aged care services, service for people living with a

disability, mental health services as well as clinical and hospital services.

Hospital and Health Services are statutory agencies established and funded by the Queensland

Government to deliver a range of integrated services, including hospital inpatient, outpatient and

emergency services, community and mental health services, aged care services, public health and health

promotion programs.

Life expectancy measures the average number of additional years a person of a given age and sex might

expect to live if the age-specific death rates of the given period continued throughout their lifetime. In this

report life expectancy refers to life expectancy at birth.

Low birthweight is defined as less than 2500 grams. Low birthweight constitutes a risk factor for diseases

of early childhood and chronic disease in later life.

Mortality rate refers to the number of deaths registered in a given calendar year expressed as a

proportion of the estimated resident population at 30 June that year. Age specific death rates are the

number of deaths at a specified age as a proportion of the resident population of the same age. Higher

age specific death rates in younger age groups indicate excess of unnecessary early deaths.

Primary health care is the first point of contact between a person and the health system. Primary

healthcare in Queensland is provided through:

• general practitioners

• government operated community health services

• primary health care clinics

• the Royal Flying Doctor Service

• public and private dental health services

• Aboriginal and Torres Strait Islander community-controlled health services.

It also includes some outpatient services provided by hospitals. Primary healthcare services provide

clinical and community health care, and facilitate access to specialist health services.

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