First Nations Australians burden of disease

Introduction

The Australian Institute of Health and Welfare (AIHW) produced Aboriginal and Torres Strait Islander burden of disease estimates for 2018 as part of the Australian Burden of Disease Study (ABDS).¹ While state-level data were limited, it did include critical information to assist in policy and planning within Queensland to improve the health of First Nations peoples.

Burden of disease is a complex analytical method to measure the gap between the ideal of everyone living to old age in good health and people’s experience of illness and early death. The methods are summarised on the Burden of Disease section of this report with detailed information available from the AIHW.¹

This section uses age-standardised rates (ASRs or standardised rates) of health burden to adjust for differences in the age distributions between First Nations peoples and others.

Burden of disease

Health loss due to premature death

The leading causes of fatal burden for First Nations Queenslanders in 2018 were injury (23.6% of total), cancer and other neoplasms (21.2%), cardiovascular diseases (17.2%) and infant and congenital conditions (10.6%). Standardised fatal burden rates have diminished in recent years, by 26.8% nationally since 2003 and by 20.3% in Queensland since 2011.¹

The standardised fatal burden rate for First Nations peoples was 2.2 times the rate for other Queenslanders. The leading contributors to the fatal burden gap in 2018 were cardiovascular diseases, accounting for 22.7% of the gap, cancer and other neoplasms (18.9%), injury (15.0%) and kidney and urinary diseases (9.1%).¹

Health loss due to disability

The leading causes of disability burden for First Nations Queenslanders in 2018 were mental and substance use disorders (42.7% of total), musculoskeletal disorders (13.8%), respiratory diseases (8.8%), neurological conditions (5.3%), hearing and vision disorders (4.8%) and oral disorders (4.0%).¹

The standardised disability burden rate for First Nations peoples was 2.0 times the rate for other Queenslanders in 2018. The leading contributors to the disability burden gap for First Nations Queenslanders in 2018 were mental and substance use disorders (42.6% of the disability gap), musculoskeletal disorders (10.6%), respiratory diseases (10.3%) and hearing and vision disorders (8.5%).¹

Total burden

Mental and substance use disorders were the leading total burden disease group for First Nations Queenslanders in 2018 (23.9%) for both males and females (Table 1). This is consistent with the 2011 results. However, the rank of other disease groups differed, with injury ranked 2nd for males and cancers for females.²

Health loss by select specific causes

Due to small numbers of cases and other limitations, jurisdictional estimates are not available for specific conditions. Nationally, the five leading specific causes for health loss (DALYs) in 2018 for First Nations peoples were coronary heart disease (5.8%), anxiety disorders (5.3%), suicide and self-inflicted injuries (4.6%), alcohol use disorders (4.4%) and depressive disorders (4.3%).¹

National comparisons

In 2018, the standardised burden rate for First Nations Queenslanders was 4.4% lower than the First Nations peoples national rate. It was the lowest among the four jurisdictions with reportable data primarily due to lower rates of fatal health loss (Figure 1).¹

This shows some improvement over the seven years since 2011, when the Queensland rate was 2.8% higher than the national rate, and second lowest after New South Wales.¹

Remoteness and sociodemographic differences

For First Nations Australians in 2018, the standardised rate of health loss for those living in remote and very remote areas was 23.8% to 25.2% higher, respectively, than those living in major cities. Most of the health loss was associated with premature death, with negligible difference in disability burden rates. In 2011, the standardised burden rate in remote/very remote areas was about double that in major cities (2.2 times higher in remote areas and 1.6 times higher in very remote areas). This indicates that inequities for First Nations peoples due to remoteness may be diminishing although greater effort to reduce burden from premature death is needed.¹

In contrast, the socioeconomic difference in burden rate for First Nations Australians increased between 2011 and 2018. Standardised burden rates in areas of greatest socioeconomic disadvantage were 3.6 times those in least disadvantaged areas in 2018, while in 2011 there was a 2.5-fold difference.²

One-in-four First Nations Australians (26.6%) lived in areas of greater socioeconomic disadvantage while nearly half (48.9%) live in areas of less disadvantage.¹ Concerted effort is required improve health outcomes in areas of socioeconomic disadvantage, in all areas including major cities, remote and regional areas.

The gap in health loss

The standardised burden rate for First Nations Queenslanders was 2.1 times that of other Queenslanders, having reduced slightly from 2.2 times in 2011. The gap in health outcomes between First Nations Queenslanders and others can be measured using rate ratios. Nationally this gap narrowed by 15.6%, a small but significant improvement.¹

This gap changes over the life course and is generally better for children and older people than the young and early middle-aged adults, even though gaps were observed in the fatal burden (years of life lost, YLL) for young females and disability burden (years lived with a disability, YLD) for 0-4 year old (Figure 2). The greatest difference in overall burden (disability adjusted life years, DALY) was among those aged about 35 to 55 years indicating substantial effort is needed to address the health needs of First Nations peoples in these age groups for both males and females.¹

The leading contributors to the health gap between First Nations Queenslanders and others were mental (accounting for 22.0% of the gap), cardiovascular (12.6%), cancer (10.0%), respiratory (9.4%) and injuries (8.1%).¹

Risk factors

The joint effect of 19 modifiable risk factors accounted for 49.1% of the total health burden for First Nations Australians in 2018 (data for Queensland is not available) (Table 2). The attributable health loss (DALYs) by risk factor was:

• tobacco use, 11.9%
• alcohol use, 10.5%
• overweight (including obesity), 9.7%
• illicit drug use, 6.9%
• dietary factors, 6.2%.²

Combined, risk factors accounted for 66.1% of the health gap between First Nations peoples and other Australians, with tobacco use a leading individual contributor explaining 20.3% of the gap (Table 2). Strategies to reduce exposure to tobacco and address alcohol-related problems are therefore critical to closing the health gap including the life expectancy difference.¹

In 2018, the joint effect of these risk factors accounted for 97.8% of the burden of endocrine disorders, 94.8% of burden due to kidney and urinary diseases, 77.3% of the cardiovascular disease burden, 59.7% of the injury burden and 55.9% of cancer burden. This illustrates the importance of continuing to focus on prevention to improve health outcomes for First Nations peoples.¹

Living life in full health

Health adjusted life expectancy (HALE) provides the time an individual at a specified age (typically at birth or at age 65 years) could expect to live in full health without disease or injury.

On average, First Nations peoples in Queensland born in 2018 could expect to live about 80% of their life in full health. Health adjusted life expectancy for First Nations peoples in Queensland males born in 2018 was 57.2 years and for females was 60.2 years. Life expectancy was estimated at 72.0 years and 76.4 years, respectively.¹

HALE for First Nations peoples in Queensland was slightly higher than for First Nations Australians—for males by 1.2 years and for females by 1.4 years and compared favourably with the three other jurisdictions with reported data and ranked 2nd after New South Wales. First Nations peoples in Queensland had the highest life expectancy among the four jurisdictions for both males and females—–2.0 years higher than First Nations peoples nationally for both males and females.¹

First Nations peoples living in remote and very remote areas of Australia on average lived shorter lives than those in major cities—life expectancy was 6.2 years lower for males with a 4.0-year difference for HALE, and for females a 6.2-year difference in life expectancy and 4.0 years for HALE.¹

Additional information

Data and statistics

Where available, ratios were calculated using higher precision estimates than those that are displayed within the report. Reported results may vary slightly from those calculated using the 1-digit precision in this report.

Visit the AIHW website for:

• Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018
• interactive data visualisations from the Australian Burden of Disease Study 2018: Interactive data on disease burden among Aboriginal and Torres Strait Islander people

Section technical notes

Refer to the Australian Burden of Disease Study: impact and cause of illness and death in Aboriginal and Torres Strait Islander people report for technical details of the results presented.

Results presented in this section are not comparable to the most recently released Australian Burden of Disease Study 2023.

Queensland Health has engaged with the AIHW, La Trobe University, and the University of Queensland Poche Centre for Indigenous Health in a project that aims to establish burden of disease estimates by Hospital and Health Service for 2011 and 2018. That study uses a greater amount of Queensland specific data, and has been modeled separately to the AIHW ABDS. When released, there may be difference in state level results between the two studies.

References

1. Australian Institute of Health and Welfare. 2022. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018, Canberra, https://www.aihw.gov.au/reports/burden-of-disease/illness-death-indigenous-2018/summary, accessed 28 April 2022.
2. Australian Institute of Health and Welfare. 2022. Australian Burden of Disease Study 2018: Interactive data on risk factor burden among Aboriginal and Torres Strait Islander people, https://www.aihw.gov.au/reports/burden-of-disease/abds-2018-interactive-risk-factor-indigenous/contents/about, accessed 23 August 2022.