HEALTH CHARACTERISTICS


NEED FOR ASSISTANCE

Over half (61%) the people who identified in the 2011 Census had a core activity need for assistance with performing essential daily activities such as self-care, mobility and communication had been identified as an Aboriginal and Torres Strait Islander person in both the Census and on the death registration record. This was slightly lower than the proportion of people who did not have a need for assistance (65%). People with a need for assistance were more likely than those who didn't require assistance to have been identified on the death registration record only (14% compared with 12%).

In non-private dwellings, consistent identification was less likely among people with a need for assistance (59%) than it was among people who did not require assistance (69%). Among people aged under 70 years, the proportion who had been identified consistently was similar for those with a need for assistance (71%) and those who did not require assistance (69%). Whether people had a need for assistance or not made no difference to the level of consistent identification among people aged 70 years and over (both 51%). Identification as an Aboriginal and Torres Strait Islander person on the Census only was similar for people aged 70 years and over with a need for assistance (27%) and without a need for assistance (29%).


UNDERLYING CAUSE OF DEATH

Causes of Death data were examined for New South Wales, Queensland, South Australia, Western Australia and the Northern Territory to determine how different definitions of Indigenous status can affect reported mortality outcomes. Victoria, Tasmania and the Australian Capital Territory were excluded, as these jurisdictions do not have a sufficient level of Aboriginal and Torres Strait Islander identification or a sufficient number of death registrations for Aboriginal and Torres Strait Islander people to support mortality analysis.

Causes of Death information was available for just over one-third (35%) of linked death registrations for Aboriginal and Torres Strait Islander people (860), for deaths that occurred from 10 August to 31 December 2011. This was due to the timing of the project, as linkage between the Census and death registration records was finalised prior to the completion of causes of death coding for the 2011-12 period. Compared with the records on the complete linked dataset, people who identified consistently were slightly over-represented among the 860 records in scope (64% compared with 62% of all records), while people who identified on the Census only were slightly under-represented (20% compared with 24%).

Information from the available records suggested that Neoplasms was a more common underlying cause of death among people who identified on the Census record only (36%) than it was among people who identified consistently (22%) or people who identified on the death registration only (19%); and Endocrine, nutritional and metabolic diseases (such as diabetes) and Diseases of the digestive system (such as liver disease) were less common among people who identified on the Census only. However, the small number of death records with Causes of Death information available places limitations on interpretation and generalisation of what these results suggest regarding the relationship between underlying cause of death and reporting of Indigenous status.



UNDERLYING CAUSE OF DEATH BY ALGORITHMS TO DERIVE INDIGENOUS STATUS

Information from the available records, based on Indigenous status as originally recorded on the death registration record, produced an age standardised Neoplasms death rate of 66.8 deaths per 100,000 population for Aboriginal and Torres Strait Islander people, and 63.1 deaths per 100,000 for non-Indigenous people. This produced an Aboriginal and Torres Strait Islander/Non-Indigenous rate ratio of 1.1. The rate ratio for Neoplasms increased slightly to 1.3 when a person having been identified as Aboriginal and Torres Strait Islander on the Census was used to derive Indigenous status. The 'Ever Aboriginal and Torres Strait Islander' algorithm is a simple method for deriving Indigenous status. If a person was reported as being of Aboriginal and/or Torres Strait Islander origin in the Census or on their death registration record, the 'ever' definition considers them to be as such for the purposes of reporting their underlying cause of death, or other statistical information. When the 'Ever Aboriginal and Torres Strait Islander' definition was used, the rate ratio for Neoplasms increased to 1.5. However, the small number of records within these particular investigations places limitations on interpretation and generalisation of what they suggest regarding the relationship between underlying cause of death and reporting of Indigenous status.

The 'Ever Aboriginal and Torres Strait Islander' definition is not used by the ABS in population estimates or life tables for Aboriginal and Torres Strait Islander people. To avoid introducing further numerator-denominator bias when deriving Indigenous status to calculate mortality rates, the Aboriginal and Torres Strait Islander population in the death registrations numerator needs to align as closely as possible with the Aboriginal and Torres Strait Islander estimated resident population. The use of an 'Ever Aboriginal and Torres Strait Islander' algorithm may be appropriate when there are only two datasets to link, but is prone to over-identify. Therefore to assess whether using this algorithm is appropriate when determining the number of Aboriginal and Torres Strait Islander deaths used to calculate mortality indicators, a sensitivity analysis should be conducted to compare the results produced by this and other algorithms to derive Indigenous status (National best practice guidelines for data linkage activities relating to Aboriginal and Torres Strait Islander people). Life Tables for Aboriginal and Torres Strait Islander Australians, 2010–2012 (cat. no. 3302.0.55.003) compares the results given using different methods to determine the number of Aboriginal and Torres Strait Islander deaths.

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