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Indigenous Better Cardiac Care measure: 6.2-Mortality due to cardiac conditions, 2016

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this term6.2-Mortality due to cardiac conditions
METeOR identifier:Help on this term657115
Registration status:Help on this termHealth, Standard 17/08/2017
Description:Help on this term

Rates of:

  • cardiac mortality, by Indigenous status (measure 6.2.1)
  • in-hospital mortality for patients admitted with cardiac conditions, by Indigenous status (measure 6.2.2).
Rationale:Help on this term

In addition to the 5 priority areas, the Better Cardiac Care project also includes 2 summary measures designed to monitor hospitalisations from cardiac conditions (measure 6.1) and mortality from cardiac conditions (measure 6.2—that is, this measure).

These measures, which provide a population-wide perspective on the impact of cardiac conditions over time, are broad indicators of the effectiveness of early risk assessment and preventative care.

Indicator set:Help on this termBetter Cardiac Care measures for Aboriginal and Torres Strait Islander people (2016) Health, Standard 17/08/2017

Collection and usage attributes

Computation description:Help on this term

Measure 6.2.1:

The number of deaths due to cardiac conditions, divided by the estimated population, and multiplied by 100,000.

Data are presented as deaths per 100,000 population.

Crude rates are calculated for Indigenous Australians.

Age-standardised rates are calculated for comparisons between Indigenous and non-Indigenous Australians, and for analysis of change over time.

Data are based on calendar years.

Measure 6.2.2:

The number of hospitalisations for cardiac conditions where the person died in hospital, divided by the estimated population, and multiplied by 100,000.

Data are presented as in-hospital deaths per 100,000 population.

Crude rates are calculated for Indigenous Australians.

Age-standardised rates are calculated for comparisons between Indigenous and non-Indigenous Australians, and for analysis of change over time.

Data are based on financial years.

Definitions:

Hospitalisation (separation)—an episode of care for an admitted patient that can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of care type (for example, from acute care to palliative care).

Cardiac condition (measure 6.2.1)—identified as those deaths with an underlying cause of death of ICD-10 (2013 version) codes I00–I52, which includes acute rheumatic fever, chronic rheumatic heart diseases, hypertensive diseases, ischaemic heart diseases, pulmonary heart disease and diseases of pulmonary circulation, and other forms of heart disease.

Cardiac condition (measure 6.2.2)—identified as those separations with a principal diagnosis of ICD-10-AM (8th edn.) codes I00–I52, which includes acute rheumatic fever, chronic rheumatic heart diseases, hypertensive diseases, ischaemic heart diseases, pulmonary heart disease and diseases of pulmonary circulation, and other forms of heart disease.

Computation:Help on this term

Crude rate: (Numerator ÷ Denominator) x 100,000

Age-standardised rate: calculated using the direct method, and the Australian standard population as at 30 June 2001.

Numerator:Help on this term

Measure 6.2.1:

Number of deaths in the calendar year where a cardiac condition is the underlying cause of death (based on reference year).

Measure 6.2.2:

Number of admitted patient separations in the financial year with a principal diagnosis of a cardiac condition and a care type not equal to ‘newborn—unqualified days only’ and a separation mode equal to 'died'.

Numerator data elements:Help on this term
Data Element / Data SetEpisode of care—principal diagnosis, code (ICD-10-AM 8th edn) ANN{.N[N]}
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetHospital service—care type, code N[N]
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

 Person—underlying cause of death (ICD-10)


Data Source
AIHW National Mortality Database
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetEpisode of admitted patient care—separation mode, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data.


Denominator:Help on this term

Measure 6.2.1:

Estimated population at the middle of the reference period. Where numerator data pertain to a single calendar year, the denominator is the estimated population as at 30 June. Where numerator data are summed across multiple years, the denominator is calculated by summing the mid-point population data for the relevant years.

Measure 6.2.2:

Estimated population at the middle of the reference period. Where numerator data pertain to a single financial year, the denominator is the estimated population at 31 December, calculated as the average of the populations at 30 June at the beginning and end of the financial year. Where numerator data are summed across multiple years, the denominator is calculated by summing the mid-point population data for the relevant years.

Denominator data elements:Help on this term
Data Element / Data SetData Element

Person—estimated and projected Indigenous resident population


Data Source
ABS Indigenous estimates and projections (2011 Census-based)
Guide for use

Data source type: Census-based plus administrative by-product data


Data Element / Data SetData Element

Person—estimated resident population of Australia


Data Source
ABS Estimated resident population (2011 Census-based)
Guide for use

Used to derive population estimates for the non-Indigenous population, by subtracting estimates for the Indigenous population from the total Australian estimated resident population (ERP).

Data source type: Census-based plus administrative by-product data


Disaggregation:Help on this term

Measure 6.2.1:

Current period (2009–2013), New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined, by:

  • Indigenous status
  • Indigenous status, sex and age group (0–34, 35–44, 45–54, 55–64,  65+)
  • Indigenous status and state/territory.

Time series (1998 to 2013), New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined, by:

  • Indigenous status.

Measure 6.2.2:

Current period (2009–14), New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, by:

  • Indigenous status
  • Indigenous status, sex and age group (0–34, 35–44, 45–54, 55–64, 65+).

Time series (2005–08, 2008–11 and 2011–14), New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined by:

  • Indigenous status.
Disaggregation data elements:Help on this term
Data Element / Data SetPerson—date of birth, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Used together with date of admission for calculation of age.

Data source type: Administrative by-product data


Data Element / Data SetPerson—Indigenous status, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetData Element

Person—age group


Data Source
AIHW National Mortality Database
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetData Element

Person—sex


Data Source
AIHW National Mortality Database
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—area of usual residence, statistical area level 2 (SA2) code (ASGS 2011) N(9)
Data Source
AIHW National Mortality Database
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetData Element

Person—Indigenous status


Data Source
AIHW National Mortality Database
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—sex, code N
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetPerson—area of usual residence, statistical area level 2 (SA2) code (ASGS 2011) N(9)
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Used for disaggregation by state/territory.

Data source type: Administrative by-product data.


Data Element / Data SetEpisode of admitted patient care—admission date, DDMMYYYY
Data Source
National Hospital Morbidity Database (NHMD)
NMDS / DSS
Admitted patient care NMDS 2013-14
Guide for use

Data source type: Administrative by-product data.


Comments:Help on this term

Measure 6.2.1:

General

The numerator data for this measure are drawn from the Australian Institute of Health and Welfare (AIHW) National Mortality Database (NMD). The cause of death data in the NMD are sourced from the Registrars of Births, Deaths and Marriages in each state and territory, as well as the National Coronial Information System, and compiled and coded by the Australian Bureau of Statistics (ABS).

For 2016 reporting, the most recent data are for 2013. Due to the relatively small number of Indigenous deaths from cardiac conditions each year, mortality data for the current period are reported for the 5-year period 2009–2013 to enable disaggregation of the data by the variables of interest. Single-year data are reported for the time trend analysis.

For this measure, deaths are based on year of registration of death (referred to as ‘reference year' from 2007 onwards).

For this measure, data on deaths registered in:

  • 2011 and earlier are based on the final version of cause of death data
  • 2012 and 2013 are based on revised and preliminary versions, respectively, and are subject to further revision by the ABS.

Data for 2010 have been adjusted for the additional deaths arising from outstanding registrations of deaths in Queensland in 2010—see ABS 2012 for further details.

The NMD includes information about both the underlying and associated causes of death—however, only the underlying causes were used for this measure.

The denominator data used in the calculation of rates for the Indigenous population are ABS estimates and projections (Series B) based on the 2011 Census. Estimates for the non-Indigenous population were derived by subtracting the Indigenous estimated population from the total Australian ERP.

Indigenous identification

The Indigenous status of a deceased person is identified through the death registration process. There is some degree of under-identification of Indigenous Australians in mortality data because some deceased Indigenous Australians are not reported as Indigenous by the family, health worker or funeral director during the death registration process. Mortality data presented for this measure have not been adjusted for under-identification, so are likely to underestimate the true level of Indigenous mortality.

Data for this measure are reported for 5 jurisdictions—New South Wales, Queensland, Western Australia, South Australia and the Northern Territory—based on the state or territory of usual residence. Although the identification of Indigenous Australians in deaths data is incomplete to varying degrees in all state and territory registration systems, these 5 jurisdictions have been assessed by the ABS and the AIHW as having adequate identification. The AIHW considers the quality of Indigenous identification in mortality data for the 5 jurisdictions to be adequate from 1998, so trend data are presented for that year onwards.

Measure 6.2.2:

General

The numerator data for this measure are drawn from the AIHW National Hospital Morbidity Database (NHMD). For 2016 reporting, the most recent data available are for 2013–14. With the exception of time trends, data are reported for the 5-year period 2009–14 to enable disaggregation of the data by the variables of interest. For the time trend analysis, data are reported for three 3-year periods (that is, 2005–08, 2008–11 and 2011–14).  For 2016 reporting, data are presented for 6 jurisdictions for which the quality of Indigenous identification is considered adequate for the years reported —for details, see the ‘Indigenous identification’ section that follows.

A principal diagnosis is reported for each hospitalisation and recorded in the NHMD. For measure 6.2.2, data are based on principal diagnosis only. The principal diagnosis recorded is not necessarily the cause of death—that is, some patients with a principal diagnosis of a cardiac condition might have died as the result of another cause.

The denominator data used in the calculation of rates for the Indigenous population are ABS estimates and projections (Series B) based on the 2011 Census. Estimates for the non-Indigenous population were derived by subtracting the estimated Indigenous population from the total Australian ERP.

In-hospital death rates might be affected by different approaches to pre- and post-hospital care (for example, more deaths occurring before reaching the hospital, or more deaths following discharge from hospital); thus the findings should be interpreted in the context of overall cardiac mortality.

Indigenous identification

While there is some under-identification of Indigenous Australians in the NHMD, data for all states and territories are considered to have adequate Indigenous identification from 2010–11 onwards (AIHW 2013). For 2016 reporting, the analysis for measure 6.2.2 includes data for years before 2010–11. As such, analysis for this measure is limited to the 6 jurisdictions that were assessed by the AIHW as having adequate identification of Indigenous Australians from 2004–05 onwards—namely, New South Wales, Victoria, Queensland, Western Australia, South Australia and public hospitals in the Northern Territory (AIHW 2010). About 95% of the Australian Indigenous population live in these 6 jurisdictions (AIHW 2015b).

With the exception of data from hospitals in Western Australia, hospitalisations where the person’s Indigenous status was not stated were excluded from analyses that compare Indigenous and non-Indigenous rates. For hospitals in Western Australia, records with an unknown Indigenous status are reported as non-Indigenous, so are included in the ‘non-Indigenous’ data in these analyses.

Comparisons by jurisdiction

No comparison by state and territory is provided. Data on in-hospital deaths by state and territory are not comparable due to different practices of recording deaths in admitted patient data; some jurisdictions record deaths in emergency departments as in-hospital deaths for admitted patients, while others do not. As well, as mentioned above, in-hospital death rates may be affected by different approaches to pre- and post-hospital care.

Representational attributes

Representation class:Help on this termRate
Data type:Help on this termReal
Unit of measure:Help on this termPerson
Format:Help on this term

N[NNN].N

Data source attributes

Data sources:Help on this term
Data SourceNational Hospital Morbidity Database (NHMD)
Frequency
Annual
Quality statement
Data quality statement: National Hospital Morbidity Database 2013–14
Data custodian

Australian Institute of Health and Welfare



Data SourceAIHW National Mortality Database
Frequency
Annual
Data custodian

Australian Institute of Health and Welfare



Data SourceABS Indigenous estimates and projections (2011 Census-based)
Frequency
Periodic
Data custodian
Australian Bureau of Statistics

Data SourceABS Estimated resident population (2011 Census-based)
Frequency
Quarterly
Data custodian
Australian Bureau of Statistics

Accountability attributes

Reporting requirements:Help on this term

Annual reporting by the Australian Institute of Health and Welfare (AIHW 2015a, 2016).

Organisation responsible for providing data:Help on this term

Australian Institute of Health and Welfare

Source and reference attributes

Submitting organisation:Help on this term

Australian Institute of Health and Welfare

Origin:Help on this term

AIHW 2016. Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: second national report 2016. Cat. no. IHW 169. Canberra: AIHW.

Reference documents:Help on this term

ABS (Australian Bureau of Statistics) 2012. Causes of death, Australia, 2010. Technical note 3: retrospective deaths by causes of death, Queensland, 2010. ABS cat. no. 3303.0. Canberra: ABS. Viewed 28 January 2016, http://www.abs.gov.au/AUSSTATS/abs@.nsf
/Previousproducts /3303.0/ Technical%20Note32010?
opendocument &tabname=Notes&/ prodno=3303.0/ &issue=2010&num=&view
.

ACCD (Australian Consortium for Classification Development) 2013. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian modification (ICD-10-AM). 10th edn. Adelaide: Independent Hospital Pricing Authority, Lane Publishing.

AIHW (Australian Institute of Health and Welfare) 2010. Indigenous identification in hospital separations data: quality report. Health services series no. 35. Cat. no. HSE 85. Canberra: AIHW.

AIHW 2013. Indigenous identification in hospital separations data: quality report. Cat. no. IHW 90. Canberra: AIHW.

AIHW 2015a. Better Cardiac Care measures for Aboriginal and Torres Strait Islander people: first national report 2015. Cat. no. IHW 156. Canberra: AIHW.

AIHW 2015b. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.

Relational attributes

Related metadata references:Help on this term

See also Indigenous Better Cardiac Care measure: 6.1-Rates of hospitalisation for cardiac conditions, 2016 Health, Standard 17/08/2017

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