Mortality in the Northern Territory

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1 Mortality in the Northern Territory Part 1: Key Indicators & Overview Shu Qin Li Steven Guthridge Health Gains Planning Department of Health and Community Services Northern Territory 2004

2 This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgment of the source. Reproduction for other purposes requires the written permission of the CEO of the Department of Health and Community Services, Northern Territory. The suggested citation is: Li SQ and Guthridge SL. Mortality in the Northern Territory , Part 1: Key Indicators and Overview. Department of Health and Community Services, Darwin, Acknowledgments The authors express their gratitude to the staff of the Registries of Births, Deaths and Marriages in all states and territories for providing data for the national dataset. The authors also wish to thank the Australian Bureau of Statistics for collating the national dataset and providing a copy of the dataset, which has been used in this report. This report builds on previous work of the Epidemiology Branch, especially that undertaken by Karen Dempsey and John Condon in the 1999 publication, Mortality in the Northern Territory Copyright 2004 by Department of Health and Community Services, Northern Territory Printed by the Government Printer of the Northern Territory ISBN Printed November 2004 An electronic version is available at: Enquiries or comments about this publication should be directed to: Director Health Gains Planning Department of Health and Community Services PO Box Casuarina NT

3 Table of contents EXECUTIVE SUMMARY...1 CHAPTER 1 INTRODUCTION...3 CHAPTER 2 ALL CAUSES OF DEATH...7 Number of deaths... 8 Life Expectancy at birth... 9 Median age of death Age-adjusted death rate Age-specific death rate Age-specific death rate ratio Age-adjusted death rate by health district CHAPTER 3 MOST COMMON CAUSES OF DEATH...23 Most common causes of death Most common causes of death by sex Most common causes of death (0-4 years) Most common causes of death (5-24 years) Most common causes of death (25-44 years) Most common causes of death (45-64 years) Most common causes of death (65 years or over) CHAPTER 4 MAJOR ICD CHAPTERS...37 Age-adjusted death rate (infectious diseases) Age-adjusted death rate (cancer) Age-adjusted death rate (circulatory) Age-adjusted death rate (respiratory diseases) Age-adjusted death rate (injuries) REFERENCES...48 GLOSSARY...49 APPENDIX...51 Northern Territory population Australian Estimated Resident Population ICD-9 & ICD-10 Codes SELECTED PUBLICATIONS...54

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5 Executive Summary Mortality reporting is an important source of information on the health of populations. It provides both an overview of the health status of the population and informs health service planning and prioritisation. During the twenty years from 1981 to 2000, a total of Northern Territory residents died in Australia. The number has generally increased in line with the population, from 603 deaths in 1980 to 874 in Of these deaths, there was a disproportionate number among Aboriginal people, who although making up 29 per cent of the total NT resident population (2000), accounted for approximately half of all deaths. Life expectancy For the most recent 5-year period of , the life expectancy for NT Indigenous males was 59.4 years and NT non-indigenous males, 76.1 years. The life expectancy for NT Indigenous females was 65.0 years, and for NT non-indigenous females, The life expectancy for NT non-indigenous males is slightly lower than the Australian national average, and the life expectancy of NT non-indigenous females is similar to the corresponding Australian national average The life expectancy at birth for both NT Indigenous people and NT non-indigenous people has improved over the 20-year period of this report. However the improvement for Indigenous people has not been as great as for the non-indigenous people and the gap between Indigenous people and the Australian national average has increased from approximately 15 years in to 18 years in Most common cause of deaths The most common causes of death for NT residents during the 1981 to 2000 period for each population group were; Indigenous males, circulatory disease (26.5%), injury (18.8%) and respiratory disease (15.3%), non-indigenous males, injury (25%), circulatory disease (24%) and cancer (23%), Indigenous females, circulatory disease (24%), respiratory diseases (16%) and cancer (13%), and non-indigenous females cancer (29%), followed by circulatory disease (26%) and injury (13%). The most common causes of death for both Australian males and females were circulatory disease (41.8%, 48.5%) followed by cancer (27.1%, 24.0%) and respiratory disease (8.6%, 6.8%). Comparative death rates and twenty year trends The overall health status for Territorians was worse than other Australians, largely as a result of poor Indigenous health outcomes. After adjusting for differences in age structure, the death rate for NT Indigenous males from all causes was approximately twice the rate of Australian males, and the death rate for NT Indigenous females was approximately three times the rate for Australian females. There was substantial variation in death rates ratios in different age groups, with a peak rate ratio for male NT Indigenous compared with Australian males of 8.1, and for females of 9.0, both in the 40 to 44 age group. The death rate for NT non-indigenous males was slightly higher than Australian males and the death rate for NT non-indigenous females was similar to Australian females. 1

6 Executive Summary In general, the death rate was higher for males than females. During the 20-year period, males accounted for 63% of all deaths, while comprising 53% of the total NT population. The age-adjusted death rate from all cause death for both NT Indigenous and NT non-indigenous people declined during this 20-year period, although the decline was greater for non-indigenous than the Indigenous population. During the 20-year period, the death rate for Indigenous people declined for some specific disease categories, including infectious diseases and increased for categories, including cancer. For NT non-indigenous people, there was a decline in death rates in both sexes for circulatory diseases and injury. 2

7 Chapter 1 Introduction Background This report is the first volume in the Mortality in the Northern Territory series, and provides an overview of information on Northern Territory (NT) deaths for the years 1981 to It provides detailed statistics for deaths from all causes, and for each of the major International Classification of Disease (ICD) chapters. Age-adjusted death rate, age-specific death rate and life expectancy are used to describe and compare health status within the Northern Territory population. Australian data is provided for comparison, where appropriate. The two subsequent volumes of this series provide disease specific causes of death including analysis of associated and underlying causes of death. The NT has the smallest population among the eight states and territories of Australia. In 2000, the estimated resident population for the NT was 195, Of this total 29% (56,131) identified as Indigenous compared with between 1% and 3% in other states and territories. 2 The NT also has the youngest population among the Australian states and territories, with 52% of the population, aged less than 30 years (66% of Indigenous and 46% of non-indigenous). By contrast only a small proportion of the NT population is 65 years or over (2.7% of Indigenous and 3.8% of non-indigenous). 1 These differences are highlighted in the Population Pyramids in Figure 1, and have substantial impact on the health status and disease patterns of the NT compared with the wider Australian population. Structure of the report This report has four chapters. Chapter 1 Introduction, provides background information on the Northern Territory population, data sources, methodology and limitations of the report. Chapter 2 All Causes, provides summary statistics on death from all causes, including the number of deaths, life expectancy at birth, median age at death, age-adjusted death rate, age-specific death rate and age-adjusted death rate by districts. Chapter 3 Most Common Causes, provides information on the most common causes of death by sex and by age group, and Chapter 4 Major ICD Chapters provides a summary of mortality information on the 5 major causes of death in the NT, by ICD disease chapter. These groups are infectious disease, cancer, circulatory diseases, respiratory disease and injuries. At the end of the report, there are a number of appendices, which include the population estimates, and life tables used for calculations in this report. There is also detail on calculation of summary statistics. Detailed information on each ICD chapter for specific diseases categories are available in Volume 2 and Volume 3 of the Mortality in the Northern Territory series. Sources of deaths data Deaths data for the period of 1981 to 2000 were obtained from the Australian Bureau of Statistics (ABS). The original deaths were recorded by the Registrar of Births, Deaths and Marriages in each state and territory, and then reported to ABS. ABS codes cause of death using the Ninth Revision of International Classification of Diseases (ICD-9) for the period of and Tenth Revision of the International Classification of Diseases (ICD-10) for the period Until 1996, only the underlying cause of death was recorded by the ABS. Since 1997, all associated causes of death have been recorded, which allows the investigation of the associations between common chronic diseases. Indigenous status was first included in national death data in The Northern Territory Department of Health and Community Services has previously completed a project to retrospectively identify 3

8 Chapter 1 Introduction Figure 1: Population Pyramids, NT Indigenous males NT Indigenous females 7% 6% 5% 4% 3% 2% 1% 0% 0% 1% 2% 3% 4% 5% 6% 7% NT non-indigenous males NT non-indigenous females 7% 6% 5% 4% 3% 2% 1% 0% 0% 1% 2% 3% 4% 5% 6% 7% Australian males Australian females 7% 6% 5% 4% 3% 2% 1% 0% 0% 1% 2% 3% 4% 5% 6% 7% 4

9 Chapter 1 Introduction indigenous status in NT death data, by using Aboriginal names and Aboriginal community names. This previous work has enabled the analysis of deaths by Indigenous status for the full 20-year period in this report. Sources of population data The population data used in this report brings together a number of ABS datasets to produce experimental NT population estimates by year, sex, ATSIC region, five-year age groups (up to 85+ for all years) and indigenous status. The method of deriving NT Indigenous and non-indigenous population estimates was based on John Condon s methodology, which is detailed in Demographic Characteristics and Trends of the Northern Territory Indigenous Population Statistical methods Several statistical methods have been used to produce the summary statistics in this report. Life expectancy Life expectancy is the number of years that a newborn child expected to live if the current pattern of death rate in each age group remained the same for the rest of the child s life. Although theoretical, it is a useful summary measure of current death rates. The abridged life table was used to produce the life expectancy in this report. 4 Details of the method for calculation of life expectancy are included in the Appendix to this report. Median Age at Death Nationally there has been discussion on the use of Median Age At Death (MAAD) as an alternative to life expectancy, as a summary measure of mortality for the Australian Indigenous population. This has lead to inclusion in a recent ABS mortality publication. 5 The central advantage of MAAD is that it only requires assessment of deaths and does not need a population denominator. Indigenous identification is problematic in both death data and population estimates, and the benefit of avoiding the use of population estimates is attractive. The validity of use of Median Age At Death has been assessed by Coory and Bade, 6 who highlighted the limitations of MAAD. These include firstly that the measure requires large samples sizes to distinguish real change, secondly it is insensitive to even substantial change in mortality rate and thirdly, comparisons of trends between populations are not appropriate. In part, these limitations are a result of the dependence of the median age at death on the age structure of the underlying population. Coory and Baade conclude that Median Age At Death should only be used in the absence of better measures. In the Northern Territory, indigenous identification in both death and population data has been demonstrated to be reliable. 7. The Median Age At Death is included in this report for completeness, and is not recommended as a suitable summary measure for the Northern Territory. Assessment of trends is of some limited value, however detailed comparisons between the Australian, NT non-indigenous and NT Indigenous MAAD estimates are not appropriate. 5

10 Chapter 1 Introduction Age-adjusted death rate The Northern Territory population has a much younger age structure than the Australian population and direct comparison of crude death rate between the NT population and Australian population is misleading. Therefore, the death rates were adjusted for the different age structure using the direct standardisation method. The age-specific death rates for each five-year age group were applied to the corresponding five-year age group of the 1991 Australian Estimated Resident Population (Appendix A.3) and the age-adjusted rates were calculated according to the following formula: AR = {R I x P i } P i AR = the age-adjusted death rate i = five year age groups R i = the age-specific death rate for age group i P i = the standard population in age group i Limitations of the report This report has a number of limitations. First, the data may be unstable due to the small number of deaths and small population denominator, especially for age-specific death rate for the less common causes of death. Caution need to be taken when interpreting the results of the report. Second, due to the late registration of deaths, there will be still a small number (5-15%) of deaths which are unregistered at the end of each year. 8 Delay in reporting is particularly common for unexplained or unexpected deaths such as suicide and homicide, for which registration may be delayed during coronial investigations. For the completeness of death registration data and to reduce this effect, this report only included the deaths which occurred before 31 December Third, the identification of Indigenous people in the death registration data and population data has been a problem for all states and territories in Australia and was absent prior to In the Northern Territory, there has been a previous project to identify NT indigenous status in death data by using community names, commonly used Aboriginal names and parent s names in the death registration information. 9 As a result, the quality of data on indigenous status is reasonably accurate in NT death registration data. Finally, the reporting of resident status may be inaccurate. An NT usual resident refers to any one who resides in the NT for a minimum of 6 months. Resident status misclassification may affect both the death registration data and population data and is exacerbated by the high interstate migration in the NT population. However, the misclassification in the resident s status was more likely to be non-differential misclassification, which reduces this effect in this report. The assessment of long term mortality trends in Australia is affected by two classification changes. These are the introduction of automated coding for processing deaths registered after 1 January 1997, and the introduction of the tenth revision of the International Classification of Diseases (ICD-10) for classifying deaths registered from 1 January The ABS has reduced the effect of these two changes by recoding all deaths in 1997 and 1998 to ICD 10. The data is this report includes the recoded data, and is either manually coded in ICD-9 (before 1997) or coded in ICD 10 (from 1997). The introduction of ICD-10 has lead to some artefactual variation in disease specific mortality trends. The extent of this variation has been calculated by McKenzie et al, and the most notable variations at a Chapter level, are for Diseases of the Blood and Blood Forming Organs, Mental Disorders and Ill- Defined Conditions. 10 The authors also report variations at specific disease, or code level with two significant variations being in the recording of senile dementia and bronchopneumonia. Care needs to be taken when interpreting trends for classification sensitive conditions through the period from This caution is repeated in the relevant sections of this report. 6

11 Chapter 2 All causes All causes of death 7

12 Chapter 2 Number of deaths All causes Table 2.1 All causes, number of deaths, Northern Territory, Males Females Year NT Indigenous NT non- Indigenous Total NT Indigenous NT non - ndigenous Total Total ,811 NT residents died during from all causes of death, with a range from 594 deaths in 1982 to 874 deaths in The increase is broadly consistent with population growth. Males make up 53% of the NT resident population, and 63% of the total deaths during this period, reflecting the higher death rate in males. Indigenous people make up 29% of the NT resident population 1 (2000), but more than 50% of the deaths, a result of the higher death rate for Indigenous people. 8

13 Chapter 2 All causes Life Expectancy at birth (males) Life expectancy at birth (years) 100 Indigenous non-indigenous Australia Year Fig 2.1 Life Expectancy at birth, males, Northern Territory, Table 2.2 Life expectancy at birth, males, Northern Territory, five-year periods Years NT Indigenous NT non-indigenous Australia During the period , the life expectancy for NT Indigenous males was 59.4 years, NT non-indigenous males 76.1 years, and Australian males 77.3 years. Between the early 1980s and the late 1990s, Indigenous NT male life expectancy increased by 1.5 years, non- Indigenous NT males by 5.7 years and Australian males by 5.0 years. In the gap between the life expectancy of NT Indigenous males and Australian males was 14.4 years. This gap widened to 17.9 years in the last 5-year period of 1996 to The life expectancy of NT non-indigenous males was slightly lower than that of Australian males in most years of the period. 9

14 Chapter 2 All causes Life Expectancy at birth (females) Life expectancy at birth (years) 100 Indigenous non-indigenous Australia Year Fig 2.2 Life Expectancy at birth, females, Northern Territory, Table 2.3 Life expectancy at birth, females, Northern Territory, five-year periods Years NT Indigenous NT non-indigenous Australia During the period , the life expectancy for NT Indigenous females was 65.0 years, NT non-indigenous females 84.0 years, and Australian females 83.5 years. Between the early 1980s and the late 1990s, Indigenous female life expectancy increased by 1.5 years, and non- Indigenous females by 3.8 years and Australian females by 3.8 years. In the gap between the life expectancy of NT Indigenous females and Australian females was 16.2 years. This gap widened to 18.5 years in the last 5- year period of 1996 to The life expectancy of NT non-indigenous females was slightly higher than that of Australian females for most of the years during the period. 10

15 Chapter 2 All causes Median age of death M edian age (years) 80 Males Indigenous males non-indigenous males Australian males Year Fig 2.3 Median ages (years) at death, Northern Territory, males, M edian age (years) Females Year Indigenous females non-indigenous males Australian females Fig 2.4 Median age (years) at death, Northern Territory, females, The NT population had younger median ages of death for both males and females, than that of the Australian groups. This is partly explained by the younger population structure of the NT. During the period 1981 to 2000, the median age at death increased for NT non- Indigenous people but not for NT Indigenous people. In 2000, the median age of death for NT Indigenous males was 51 years, and for Indigenous females, 55 years. The median age of death for NT non- Indigenous males and females was 62 years and 66 years respectively in The median age of death for Australian males and females was 75 years and 81 years in

16 Chapter 2 All causes Age-adjusted death rate (males) Number of deaths per 100,000 population 2500 Indigenous males non-indigenous males Australian males Year Fig 2.5 All cause death, age-adjusted death rate, males, Northern Territory, Table 2.4 All cause death, age-adjusted death rate, males, Northern Territory and Australia, five year periods Years NT Indigenous NT non-indigenous NT total Australia Rate (Ratio) Rate (Ratio) Rate (Ratio) Rate (1.8) (1.1) (1.2) (2.2) (1.1) (1.3) (2.2) (1.2) (1.4) (2.4) (1.1) (1.3) Note: The rate ratio is the ratio of the NT to Australian age-adjusted death rate. The age-adjusted death rate for NT Indigenous males was between 1.8 and 2.4 times higher than that of Australian males. There was an overall fall of 3% in the death rate for NT Indigenous males during this 20-year period. There was a steady decline in the ageadjusted death rate for NT non-indigenous males, with an overall fall of 27% during this period. The Australian male death rate also fell by 27% during this period. 12

17 Chapter 2 All causes Age-adjusted death rate (females) Number of deaths per population Indigenous females non-indigenous males Australian females Year Fig 2.6 All cause death, age-adjusted death rate, females, Northern Territory, Table 2.5 All cause death, age-adjusted death rate, females, Northern Territory and Australia, five year periods Years NT Indigenous NT non-indigenous NT total Australia Rate (Ratio) Rate (Ratio) Rate (Ratio) Rate (2.4) (1.0) (1.4) (2.6) (0.9) (1.5) (2.7) (1.0) (1.5) (2.8) (1.0) (1.5) Note: The rate ratio is the ratio of the NT to Australian age-adjusted death rate. Between the early 1980s and the late 1990s, there was a steady decline in the age-adjusted death rates for all females. The death rate for NT Indigenous females fell by just over 5%, the NT non- Indigenous females by 19% and Australian female rate fell by 21%. The death rate for NT Indigenous females was more than 2.5 times higher than that of Australian females in most of the years during this period. The death rates for NT non-indigenous females were similar to that of Australian females. 13

18 Chapter 2 All causes Age-specific death rate Number of deaths per 100,000 population Males Females NT Indigenous NT non-indigenous Australia Fig 2.7 All causes, age-specific death rate, males and females, Table 2.6 All causes, age-specific death rate per 100,000 population, Northern Territory & Australia, Males Females Age group (years) NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia or over For the 5-year period of , the NT Indigenous age-specific death rate was much higher for all age groups and for both males and females, than either the NT non-indigenous or Australian rates. For the 5-year period of 1996 to 2000, the NT non-indigenous death rate was higher in most age groups than rates for Australian males. The age-specific death rate for NT and Australian females were similar across age groups. 14

19 Chapter 2 All causes Age-specific rate ratio Age-specific death rate ratio NT Indigenous to Australia NT non-indigenous to Australia NT Indigenous to Australia NT non-indigenous to Australia Fig 2.8 All causes, ratio of the Northern Territory to Australian age-specific death rates, males & females, Table 2.7 All causes, ratio of the Northern Territory to Australian age-specific death rates, Males Females Age group (years) NT Indigenous to Australia NT non-indigenous to Australia NT Indigenous to Australia NT non-indigenous to Australia The ratio of NT Indigenous male to Australian male, age-specific death rates varied from 1.2 to 8.1 with a peak through the age groups from 30 to 54. The ratio of NT Indigenous females to Australian females varied from 1.3 to 9.0 with a peak through the age groups from 30 to 54 years. 15

20 Chapter 2 Number of deaths per 100,000 All causes Age-specific death rate (0-4 years) Males Females Indigenous non-indigenous Australia Fig 2.9 All causes, age-specific death rate, males and females, 0-4 years of age, Northern Territory and Australia, Table 2.8 All causes, age-specific death rate, males and females, 0-4 years of age, five year periods Males Females Years NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia Between 1981 and 2000, there was a steady decline in the age-specific death rate for all populations in the 0-4 years age group. NT Indigenous age specific death rates for the 0-4 age group were 2 to 3 times higher than the Australian rates during this period. Both NT Indigenous males and female age-specific death rates fell by over 25% during this period. During the same period the Australian age-specific death rates fell approximately 46%. The gap between the NT Indigenous and Australian death rates has widened through this period. The NT non-indigenous age-specific death rates was higher than the Australian rate in the early 1980s, and fell to a similar level in the late 1990s. 16

21 Chapter 2 All causes Age-specific death rate (5-24 years) Number of deaths per 100, Males Females Indigenous non-indigenous Australia Fig 2.10 All causes, age-specific death rate, males and females, 5-24 years of age, Northern Territory and Australia, Table 2.9 All causes, age-specific death rate, males and females, 5-24 years of age, five year periods Males Females Years NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia Between 1981 and 2000, there was a decline in age-specific death rates for all population groups. The NT Indigenous male death rate fell 6.5% and NT Indigenous female rate by 20.7%, compared with a fall of 25-30% in the rates for Australian males and females. The NT Indigenous age-specific death rates remained at least 2 times higher than the Australian rates throughout this period. NT non-indigenous age-specific death rates for both sexes were generally higher than the Australian rates throughout the 20-year period, though the gap is decreasing. 17

22 Chapter 2 All causes Number of deaths per 100,000 population 1500 Age-specific death rate (25-44 years) Males Females 1500 Indigenous non-indigenous Australia Fig 2.11 All causes, age-specific death rate, males and females, years of age, Northern Territory and Australia, Table 2.10 All causes, age-specific death rate, males and females, years of age, five year periods Males Females Years NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia The age-specific death rate for NT Indigenous males improved by 8.7% through the 20-year period. However, the rate was still nearly 6 times higher than that of Australian males in The age-specific death rate for NT Indigenous females remained constant during the 20-year period, and was approximately 6 times higher than the rate for Australian females. The NT non-indigenous males agespecific death rate declined during this period, but was still 20% higher than the Australian rate in The NT non-indigenous female agespecific death rate was similar to the Australian rate throughout the 20-year period. Australian age-specific death rates fell by 3.2% (males) and 10.0% (females) during this period. 18

23 Chapter 2 All causes Age-specific death rate (45-64 years) Number of deaths per 100, Males Females Indigenous non-indigenous Australia Fig 2.12 All causes, age-specific death rate, males and females, years of age, Northern Territory and Australia, Table 2.11 All causes, age-specific death rate, males and females, years of age, five year periods Males Females Years NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia There was a steady decline in age-specific death rates for all populations in this age group. The reduction in the death rate for NT Indigenous males and females was less than for the NT non-indigenous and Australian males and females. The age specific death rates for the NT Indigenous males and females were 3 to 5 times higher than that of the Australian rates. The NT non-indigenous male agespecific death rate was similar to the rate for Australian males. The age-specific death rate for NT non- Indigenous females was slightly lower than that of the Australian female rate in most years of the 20-year period. 19

24 Chapter 2 All causes Age-specific death rate (65 years and over) Number of deaths per 100, Males Females Indigenous Non Indigenous Australia Fig 2.13 All causes, age-specific death rate, males and females, 65 years of age and over, Northern Territory and Australia, Table 2.12 All causes, age-specific death rate, males and females, 65 years of age and over, five year periods, Males Females Years NT Indigenous NT non- Indigenous Australia NT Indigenous NT non- Indigenous Australia Although the age-specific death rates for NT Indigenous people were higher than that of the Australian rates, the differences in the rates was less than in the younger age groups. The age-specific death rate for NT Indigenous males increased during this period. The age-specific death rates for both NT non-indigenous males and females were lower than the Australian rate in most years of the 20-year period. The age-specific death rates in the NT Indigenous females and Australian females declined during this period. 20

25 Chapter 2 All causes Age-adjusted death rate by health district (males) Number of deaths per 100,000 population Darwin urban Darwin rural Alice Springs urban Alice Springs rural Katherine Barkly East Arnhem NT non- Indigenous Australia Fig 2.14 All causes, age-adjusted death rate, NT Indigenous males by district, NT non-indigenous & Australian males, & Table 2.25 All causes, age-adjusted male death rate per 100,000 population, by district for and NT Indigenous males NT non-indigenous males Australian males District Darwin urban Darwin rural Alice Spring urban Alice Spring rural Katherine East Arnhem Barkly Total The NT Indigenous male age-adjusted death rates were higher in all NT administrative health districts when compared with NT non-indigenous males and Australian males. Comparison of the two 5-year periods shows a decline in the death rates for NT Indigenous males in all administrative health districts, except Darwin Urban District. The death rate for Indigenous males in the East Arnhem District declined substantially between and Darwin Rural District had the highest death rate for Indigenous males among all districts in

26 Chapter 2 All causes Age-adjusted death rate by health district (females) Number of deaths per 100,000 population Darwin urban Darwin rural Alice Springs urban Alice Springs rural Katherine Barkly East Arnhem NT non- Indigenous Australian Fig All causes, age-adjusted death rate, NT Indigenous females by district, NT non- Indigenous and Australian females, & Table 2.26 All causes, age-adjusted female death rate per 100,000 population, by district for and NT Indigenous females NT non-indigenous females Australian females District Darwin urban Darwin rural Alice Spring urban Alice Spring rural Katherine East Arnhem Barkly Total The NT Indigenous female age-adjusted death rates were higher in all NT administrative health districts than the rates for the NT non-indigenous females and Australian females. Comparison of the two 5-year periods shows a decline in the death rates for NT Indigenous females in all administrative health districts, except Darwin Urban District and Alice Spring Urban District. The death rate for Indigenous females in the Darwin Rural District declined substantially between and The death rate for NT Indigenous females in Alice Springs Urban District increased between the five-year periods, and was the highest in all districts in

27 Ch apter 3 Most common causes Most common causes of death In this report, the most common causes of death were determined using the percentage distribution of deaths for each major ICD chapter. The age-adjusted death rates are also provided for comparison in this section. Throughout this report circulatory diseases and cardiovascular disease (CVD) are interchangeable. Some key features of this section are: Circulatory disease was the leading cause of death in NT Indigenous males and NT Indigenous females and the second most common cause of death in NT non-indigenous males and NT non-indigenous females. Injuries and poisoning was the leading cause of death in NT non-indigenous males and cancer was the leading cause of death in non-indigenous females. Injuries and poisoning was the second most common cause of death in NT Indigenous males and respiratory disease was the second common cause of death in NT Indigenous females. In NT non-indigenous Territorians and Australians, most circulatory disease deaths occurred in those aged 65 and over whereas among NT Indigenous people, the largest proportion of circulatory disease deaths occurred in those aged years. 23

28 Chapter 3 Most common causes Most common causes of death by sex (males) CVD Indigenous males Cancer Injury RSD Digestive Endocrine Nervous GUS M ent al Perinat al Congenit al Ill defined Infectious Blood Other non-indigenous males 30% 20% 10% 0% 0% 10% 20% 30% Fig 3.1 Most common causes of death in Northern Territory males Table 3.1 Percentage distribution by major disease categories, with age-adjusted death rate per 100,000 population, males, Cause of NT Indigenous males NT non-indigenous males Australian males death Rank Number % Rate Rank Number % Rate Rank Number % Rate CVD Cancer RSD Injury Digestive Endocrine Nervous GUS Other Mental Infectious Perinatal Congenital Ill defined Blood Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Circulatory disease was the leading cause of death in both NT Indigenous and Australian males, and the second most common cause of death in NT non- Indigenous males. Injury (and poisoning) was the leading cause of death in NT non-indigenous males, and the second most common cause of death in NT Indigenous males. 24

29 Chapter 3 Most common causes Most common causes of death by sex (females) Indigenous females CVD Cancer Injury RSD Digestive Endocrine Nervous GUS M ental Perinatal Congenital Ill defined Infectious Blood Other non-indigenous females 30% 20% 10% 0% 0% 10% 20% 30% Fig 3.2 Most common causes of death in Northern Territory females Table 3.2 Percentage distributions by major disease categories, with age-adjusted death rate per 100,000 population, females, NT Indigenous females NT non-indigenous females Australian females Rank Number % Rate Rank Number % Rate Rank Number % Rate CVD Cancer RSD Injury Digestive Endocrine Other Nervous GUS Infectious Mental Congenital Perinatal Ill defined Blood Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Circulatory disease was the leading cause of death in NT Indigenous females and Australian females. Cancer was the leading cause of death for NT non-indigenous females. 25

30 Chapter 3 Most common causes Most common causes of death (0-4 years) Perinat al Congenit al Ill defined Injury Indigenous males Nervous RSD Cancer Infectious Endocrine CVD Digestive Blood GUS non-indigenous males 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% Fig 3.3 Most common causes of death in Northern Territory males, 0-4 years of age, Table 3.3 Percentage distribution by major disease categories, with age-specific death rate per 100,000 population, males, 0-4 years of age, NT Indigenous males NT non-indigenous males Australian males Rank Number % Rate Rank Number % Rate Rank Number % Rate Perinatal Congenital Ill defined Injury Nervous RSD Cancer Infectious Endocrine CVD Digestive Blood GUS Mental Other Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Perinatal death was the leading cause of death in males in this age group, for all populations. The age-adjusted death rate from perinatal causes in NT Indigenous males was more than three times higher than for Australian males. The death rate for NT non- Indigenous males was slightly higher than that of Australian males. 26

31 Ch apter 3 Most common causes Most common causes of death (0-4 years) Perinatal Congenital Ill defined Injury Indigenous females Nervous RSD Cancer Infectious Endocrine CVD Digestive Blood GUS M ental non-indigenous females 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% Fig 3.4 Most common causes of death in Northern Territory females, 0-4 years of age, Table 3.4 Percentage distribution by major disease categories, with age-specific death rate per 100,000 population, females, 0-4 years of age, NT Indigenous females NT non-indigenous females Australian females Rank Number % Rate Rank Number % Rate Rank Number % Rate Perinatal Congenital Ill defined Injury Nervous RSD Cancer Infectious Endocrine CVD Digestive Blood GUS Mental Other Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Perinatal death was the leading cause of death in females in this age group, for all populations. The age-adjusted death rate from perinatal causes in NT Indigenous females was more than three times higher than for Australian males. The death rate for NT non-indigenous females was higher than that of Australian females. 27

32 Chapter 3 Most common causes Most common cause s of death (5-24 years) Injury Cancer Nervous CVD Indigenous males M ent al RSD Congenit al Endocrine Infectious Ill defined Digestive Blood GUS non-indigenous males 100% 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% 100% Fig 3.5 Most common causes of death in Northern Territory males, 5-24 years of age, Table 3. 5 Percentage distribution by major disease categories, with age-specific death rate per 100,000 population, males, 5-24 years of age, NT Indigenous males NT non-indigenous males Australian males Rank Number % Rate Rank Number % Rate Rank Number % Rate Injury Cancer Nervous Mental CVD RSD Congenital Endocrine Infectious Ill defined Digestive Blood GUS Perinatal Other Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Injury was the leading cause of death in males in all populations, in this age group. The age-specific death rate from injury in NT Indigenous males was almost twice the rate for Australian males. The death rate from mental health conditions in NT Indigenous males was nearly 10 times the rate for both NT non- Indigenous and Australian males. 28

33 Ch apter 3 Most common causes Most com mon causes of death (5-24 years) Injury Cancer Nervous CVD Indigenous females M ental RSD Congenital Endocrine Infectious Ill defined Digestive Blood GUS non-indigenous females 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% Fig 3.6 Most common causes of death in Northern Territory females, 5-24 years of age, Table 3.6 Percentage distribution by major disease categories, with age-specific death rate per 100,000 population, females, 5-24 years of age, NT Indigenous females NT non-indigenous females Australian females Rank Number % Rate Rank Number % Rate Rank Number % Rate Injury Cancer Nervous CVD Congenital RSD Mental Endocrine Infectious Other Ill defined Digestive Blood GUS Perinatal Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Injury was the leading cause of death in females in all populations, in this age group. The age-specific death rate from injury among NT Indigenous females was nearly twice the rate of Australian females. Circulatory disease was the second leading cause of death for NT Indigenous females with a rate nearly ten times the rate for Australian females. 29

34 Chapter 3 Most common causes Most common causes of death (25-44 years) Injury CVD Cancer Endo crine Indigenous males M ental Digestive RSD Nervous Infectious Congenital GUS Blood Other non-indigenous males 80% 60% 40% 20% 0% 0% 20% 40% 60% 80% Fig 3.7 Most common causes of death in Northern Territory males, years of age, Table 3.8 Percentage distribution by major disease categories, with age-specific death rate per 100,000 population, males, years of age, NT Indigenous males NT non-indigenous males Australian males Rank Number % Rate Rank Number % Rate Rank Number % Rate Injury Cancer CVD Mental Endocrine Digestive Nervous RSD Infectious Ill defined Congenital GUS Blood Other Perinatal Note: Causes of death ranked by percentage distribution, and in the order of Australian cause of death. Injury was the leading cause of death in males in all populations, in this age group. The death rate from injury in NT Indigenous males was 4 times higher than for Australian males. The rate for NT non- Indigenous males was nearly 2 times higher than the rate for Australian males. The death rate from CVD among NT Indigenous males was nearly 10 times higher than the rate for Australian males. 30

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