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National Indigenous Reform Agreement: PI 02-Mortality rate by leading causes, 2019

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termPI 02-Mortality rate by leading causes, 2019
METeOR identifier:Help on this term697096
Registration status:Help on this termIndigenous, Endorsed 31/07/2018
Description:Help on this term

Mortality rates for Australians by leading causes of death (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) (2016 version) chapter level), by Indigenous status.

Rationale:Help on this term

Achieving the Closing the Gap target of closing the life expectancy gap within a generation requires monitoring mortality rates for different diseases, so that it is understood which diseases are major contributors to mortality among Indigenous Australians, and where programs are succeeding and where they are not.

Indicator set:Help on this termNational Indigenous Reform Agreement (2019) Indigenous, Endorsed 31/07/2018
Outcome area:Help on this termIndigenous Australians achieve health outcomes comparable to the broader population Indigenous, Endorsed 21/07/2010
Quality statement:Help on this termNational Indigenous Reform Agreement: PI 02-Mortality rate by leading causes, 2018; Quality Statement Indigenous, Endorsed 07/02/2018

Collection and usage attributes

Computation description:Help on this term

Mortality rates for Australians by the leading causes of death, by Indigenous status.

Crude rates are calculated for Indigenous Australians.

Age-standardised rates are calculated for Indigenous and non-Indigenous Australians.

Rate ratios and rate differences are calculated for comparisons between Indigenous and non-Indigenous Australians (using age-standardised rates).

Note: Causes of death to be listed from highest to lowest Indigenous percentage for the most recent period (5 years combined).

Variability bands are to be calculated for rates (single year data and national data for 5 years combined) using the standard method (see 'Definitions' below).

Reporting is only for those jurisdictions which have adequate levels of Indigenous identification (New South Wales, Queensland, Western Australia, South Australia and the Northern Territory from 1998).

For trends: Percentage change and statistical significance of change are to be calculated (required for assessment of progress over time as an annual proxy measure against life expectancy target).

Excludes deaths where Indigenous status was not stated.

Where age is not stated, pro-rating should be applied.

Presentation:

Number, percentage, rate per 100,000 persons; rate ratios, rate differences, variability bands; and causes of death (as per list contained in ‘Definitions’ below) listed from highest to lowest Indigenous percentage.

Definitions:

This measure refers to ‘leading causes of death’. Data are provided for ‘selected causes of death’ according to the ICD-10 codes used for ‘leading causes of death’ in the Aboriginal and Torres Strait Islander Health Performance Framework (AIHW 2017):

  • Infectious and parasitic diseases (A00–B99)
  • Neoplasms (C00–D48)
    • Malignant neoplasms of digestive organs (C15–C26)
    • Malignant neoplasm of bronchus and lung (C34)
    • Malignant neoplasm of cervix uteri (C53)
    • Breast cancer (C50)
    • Lip, oral cavity and pharynx (C00–C14)
  • Endocrine, metabolic and nutritional disorders (E00–E89)
    • Diabetes mellitus (E10–E14)
  • Nervous system diseases (G00–G99)
  • Circulatory diseases (I00–I99)
  • Respiratory diseases (J00–J99)
  • Digestive diseases (K00–K93)
  • Kidney diseases (N00–N29)
  • Conditions originating in the perinatal period (P00–P96)
  • External causes of morbidity and mortality (V01–Y98)
  • Other causes (that is, causes not listed above)
  • Total (all causes)

For single year data, the following top 5 causes of death are to be reported:

  • Neoplasms (C00–D48)
  • Endocrine, metabolic and nutritional disorders (E00–E89)
  • Circulatory diseases (I00–I99)
  • Respiratory diseases (J00–J99)
  • External causes of morbidity and mortality (V01–Y98)
  • Total (top 5 causes)
  • Other causes (that is, causes other than the top 5)
  • Total (all causes)

The top 5 causes of death need to be re-assessed each reporting period. If a change is identified, data may need to be backcast to the baseline year for the most recent set of top 5 causes to ensure a consistent time series.

Standard method for variability band computation:

Rates derived from administrative data counts are not subject to sampling error but may still be subject to natural random variation, especially for small counts. A 95% confidence interval (CI) for an estimate is a range of values which is very likely (95 times out of 100) to contain the true unknown value. Where the 95% CIs of two estimates do not overlap it can be concluded that there is a statistically significant difference between the two estimates. This is the standard method used in Australian Institute of Health and Welfare (AIHW) publications for which formulas can be sourced from Breslow and Day (1987) in the publication Statistical methods in cancer research. Typically in the standard method, the observed rate is assumed to have natural variability in the numerator count (for example, deaths, hospital visits) but not in the population denominator count. Also, the rate is assumed to have been generated from a normal distribution ('Bell curve'). Random variation in the numerator count is assumed to be centred around the true value; that is, there is no systematic bias.

Computation:Help on this term

Mortality rates:

Crude percentage: number of deaths by cause divided by all deaths.

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

Age-standardised rate: calculated using the direct method using five-year age groups from 0–4 to 75 years and over, with the Australian standard population as at 30 June 2001 as the standard. Age-standardisation should be done in accordance with the National Indigenous Reform Agreement Performance Information Management Group (NIRAPIMG) agreed principles for direct age-standardisation (see the Comments section below).

Rate ratio: Indigenous age-standardised rate divided by non-Indigenous age-standardised rate

Rate difference: Indigenous age-standardised rate minus non-Indigenous age-standardised rate

Variability band: to be calculated using the standard method for estimating 95% CIs as follows:

Crude rate:

Where CI = confidence interval

CR = crude rate

d = the number of deaths

Age-standardised rate:

Where  CI = confidence interval

ASR = age-standardised rate

wi = the proportion of the standard population in age group i

di = the number of deaths in age group i

ni = the number of people in the population in age group i

Percentage change: Calculated by multiplying the average annual change over the period by the number of data points less 1. This is then divided by the rate for the first year in the series and multiplied by 100.

The average annual change in rates, rate ratios and rate differences are calculated using linear regression which uses the least squares method to calculate a straight line that best fits the data and returns an array that best describes the line. The simple linear regression line, Y = a + bX, or ‘slope’ estimate is used to determine the average annual change in the data over the period. The formula used to calculate the slope estimate and standard error of the slope in Microsoft Excel is:

LINEST: (known_y’s, known_x’s, true) entered as an array formula (Ctrl, Shift, Enter).

Statistical significance of change: The 95% CIs for the standard error of the slope estimate (average annual change) are used to determine whether the apparent increases or decreases in the data are statistically significant at the p<0.05 level. The formula used to calculate the CIs for the standard error of the slope estimate is:

95% CI(x) = x ± 1.96 x SE(x)

where x is the average annual change (slope estimate). If the upper and lower 95% CIs do not include zero, then it can be concluded that there is statistical evidence of an increasing or decreasing trend in the data over the study period.

Numerator:Help on this term

Number of deaths.

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

Person—date of birth


Data Source
ABS Causes of Death Collection
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

Person—date of death


Data Source
ABS Causes of Death Collection
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

Person—date of birth


Data Source
ABS Death Registrations Collection
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

Person—date of death


Data Source
ABS Death Registrations Collection
Guide for use

Data source type: Administrative by-product data.


Denominator:Help on this term

Total number of all people in relevant population at 30 June.

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

Person—estimated resident population of Australia


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

Data source type: Derived from Census, Census Post Enumeration Survey (PES) and estimates of fertility, mortality and net migration. Backcast population estimates and Series B projections.


Data Element / Data SetData Element

Person—estimated resident population of Australia


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

Data source type: Derived from Census, Census PES and estimates of fertility, mortality and net migration.


Disaggregation:Help on this term

Reporting is only for those jurisdictions which have adequate levels of Indigenous identification (New South Wales, Queensland, Western Australia, South Australia and the Northern Territory from 1998).

Current period - 2013–2017 (both all causes and specific causes of death).

For Indigenous Australians only (crude rates, and percentage):

  • State/territory (including total) by selected causes of death including total (ICD-10 chapter level and some sub-chapter level).
  • Total (selected states/territories) by sex by selected causes of death (ICD-10 chapter level and some sub-chapter level).
  • State/territory (including total) by Indigenous status: all causes of death.

For Indigenous and non-Indigenous Australians (age-standardised rates, rate ratios and rate differences):

  • State/territory (including total) by selected causes of death including total (ICD-10 chapter level and some sub-chapter level).
  • Total (selected states/territories) by sex by selected causes of death (ICD-10 chapter level and some sub-chapter level).
  • State/territory (including total): all causes of death.

Time series - Cause of death: 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013 (historical data available previously), 2014 (final revision), 2015 (preliminary revision) and 2016 (preliminary), 2017 (current).

All causes of death: 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 (historical data available previously), 2017 (current).

For Indigenous and non-Indigenous (age-standardised rates, rate ratios, rate differences, variability bands, percentage change and statistical significance of change):

  • Total (selected states/territories) by sex by Indigenous status: all causes of death.
  • State/territory (including total) by Indigenous status: all causes of death.
  • State/territory (including total) by selected causes of death including total (top 5 ICD-10 chapter levels as listed under ‘definitions’), by Indigenous status.
Disaggregation data elements:Help on this term
Data Element / Data SetData Element

Person—underlying cause of death, code (ICD-10) 2015 version ANN-ANN


Data Source
ABS Causes of Death Collection
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

Person—sex


Data Source
ABS Death Registrations Collection
Guide for use

Data source type: Administrative by-product data.


Data Element / Data SetData Element

Person—Indigenous status


Data Source
ABS Death Registrations Collection
Guide for use

Data source type: Administrative by-product data.


Comments:Help on this term

Most recent data available for the 2019 National Indigenous Reform Agreement Report (2017–18 reporting cycle) is 2017 for both all causes and specific causes of death. Up until the 2015-16 reporting cycle, causes of death data lagged a year behind the all causes data.

Data are based on reference year.

Aggregated data for all causes and by causes of death will be used for the current reporting period (2013–2017).

Single year data will be used for time series (2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 and 2017). Data for the years pre 2016 for all causes have been supplied previously. Data for specific cause of death pre 2016 have been supplied previously but for this cycle data are resupplied for 2014 (final revision) and 2015 (preliminary revision) (final revision for 2015, and preliminary revision for 2016 are not available for reporting until the next report cycle).

Disaggregation by Indigenous status will be based on data only from jurisdictions for which the quality of Indigenous identification is considered acceptable.

At this stage, only data from selected states/territories are considered of acceptable quality for reporting mortality of Indigenous persons (New South Wales, Queensland, Western Australia, South Australia and the Northern Territory from 1998).

National rates should include these five jurisdictions only.

Disaggregation by state/territory should be based on the usual residence of the deceased.

Due to the small number of Indigenous deaths reported each year, 5 year combined data will be reported for the current reporting period (computation for 5 year combined is average of 5 years for the numerator and use of mid-point year for the denominator). Single year data will be used for reporting time series.

To report trends, the assessment body should separately request percentage change and statistical significance testing for this indicator directly from the AIHW on data supplied by the Australian Bureau of Statistics (ABS).

Variability bands accompanying mortality data should be used for the purpose of comparisons over time, and for national estimates at a point in time for Indigenous/non-Indigenous and cause of death comparisons. They should not be used for comparing mortality rates at a single point in time between jurisdictions as the variability bands and mortality rates do not take into account differences in under-identification of Indigenous deaths between jurisdictions.

Baseline year for the Council of Australian Governments' National Indigenous Reform Agreement target (Close the life expectancy gap within a generation) is 2006 using the three-year average of 2005–2007; baseline year for this indicator is 2006; target year is 2031.

Measures are derived from estimated resident populations (ERPs) and projections based on the 2011 Census. The non-Indigenous population will be calculated based on 2011 Census-based ERP total population minus 2011 Census-based back-cast and projections. First release total population ERP is to be used until rebased. Rates may not be comparable with overall rates reported elsewhere in national reporting.

NIRAPIMG agreed Principles for reporting directly age-standardised rates for administrative data are as follows:

Overarching principle: Before undertaking age-standardisation, analysts must investigate the data being used to understand the age-specific distribution and any limitations that may impact on the results.

Principle 1: The standard population used should be the Australian estimated resident population as at 30 June 2001 from the 2001 Census.

The population used as the denominator for the calculation of Indigenous age-standardised rates should be Series B of Indigenous estimates and projections 2001 to 2026 based on the 2011 Census.

Principle 2: If the denominator is less than 30 in any one age group, then do not attempt to produce age-standardised rates.

Age groups may be collapsed to obtain a denominator of 30 or more (provided that this is in accordance with Principles 3 and 4).

Principle 3: If the total number of Indigenous events (for example, deaths, hospital separations) is less than 20, then do not attempt to produce age-standardised rates.

Combining several years of data or aggregating jurisdictions should be considered to obtain a total of 20 or more events.

If this does not meet the purpose (that is, data are required for time series or jurisdictional comparisons) or does not result in a total of 20 or more events, then other measures and contextual information should be reported instead of age-standardised rates which could include total number of events, crude rates, age-specific rates, age-specific rate ratios and median age at death.

Principle 4: Age-standardised rates should be calculated using the 5-year age groupings of 0–4 years to 75 years and over (provided Principles 2 and 3 for denominator and numerator are met).

10-year age groups may be used to overcome small numbers (20-year age groups are too wide and should not be used).

Principle 5: Additional contextual information (most importantly age-specific rates and ratios) should be provided in addition to age-standardised rates when:

a) the age-standardised rates and rate ratios lie largely outside the range of the age-specific rates and rate ratios

b) the pattern of age-specific rates of the Indigenous and non-Indigenous populations differ substantially (for example, deaths from a certain cause concentrate on younger ages for the Indigenous population while for the non-Indigenous population, they may occur at older ages)

c) the age-specific rates depart from the assumption of a uniform increase in death with age (for example, injury which peaks in the young adult to middle ages and certain cancers amenable to treatment for some age groups)

d) the condition of interest is largely confined to a specific age range (for example, sexually transmitted infections (STIs) and females who give birth). In such instances, age-standardisation could be restricted to include the age groups within this age range only.

Principle 6: For conditions restricted to a specific age group (for example, conditions originating in the perinatal period and sudden infant death syndrome (SIDS)), it is recommended to report the age-specific rate for the age group of interest instead of the age-standardised rate.

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[NN].N

Indicator conceptual framework

Framework and dimensions:Help on this termDeaths

Data source attributes

Data sources:Help on this term
Data SourceABS Causes of Death Collection
Frequency
Annual
Quality statement
ABS causes of death collection, QS
Data custodian

Australian Bureau of Statistics



Data SourceABS Death Registrations Collection
Frequency
Annual
Data custodian

Australian Bureau of Statistics



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

National Indigenous Reform Agreement.

Organisation responsible for providing data:Help on this term

Australian Bureau of Statistics

Further data development / collection required:Help on this term

Improve the quality of Indigenous identification in deaths data.

Source and reference attributes

Submitting organisation:Help on this term

Australian Institute of Health and Welfare

Steward:Help on this termNational Indigenous Reform Agreement Performance Information Management Group
Reference documents:Help on this term

AIHW (Australian Institute of Health and Welfare) 2017. Aboriginal and Torres Strait Islander Health Performance Framework data. Canberra: AIHW. Viewed 15 June 2017, http://www.aihw.gov.au/indigenous-data/health-performance-framework/

Breslow NE & Day NE (eds) 1987. Statistical methods in cancer research. Volume II: The design and analysis of cohort studies. IARC Scientific Publications No. 82. Lyon, France: International Agency for Research on Cancer. Viewed 20 June 2017, http://www.iarc.fr/en/publications/pdfs-online/stat/sp82/

Relational attributes

Related metadata references:Help on this term

Supersedes National Indigenous Reform Agreement: PI 02-Mortality rate by leading causes, 2018 Indigenous, Archived 31/07/2018

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