MORTALITY RATES BY REMOTENESS AREAS

To better understand any potential relationship between remoteness and levels of mortality, a number of measures were calculated for each of the RAs.

These include:

• crude death rates;
• age-specific death rates;
• infant mortality rates; and
• standardised death rates.

Definitions of each of these measures can be found in the Glossary.

The majority of the population of Australia lives in urban areas. For example, in 2010, 71% of the population of Australia resided in major cities and only 0.7% resided in very remote areas. Similarly, 66% of deaths in Australia were of residents of major cities and just 0.5% of deaths were residents in very remote areas (noting that Queensland and Other Territories are excluded from this measure).

To avoid any misleading analysis of rates that are based on only a small number of deaths, in cases where there were fewer than 20 deaths in a RA, these locations were excluded from analysis of mortality rates. The RAs included in this analysis are listed in table 5.1.

5.1 Remoteness Areas included in analysis, States and territories - 2005 to 2010
	Remoteness Area
New South Wales	Major cities	Inner regional	Outer regional	Remote	(a)
Victoria	Major cities	Inner regional	Outer regional	(a)	(b)
South Australia	Major cities	Inner regional	Outer regional	Remote	Very remote
Western Australia	Major cities	Inner regional	Outer regional	Remote	Very remote
Tasmania	(b)	Inner regional	Outer regional	Remote	(a)
Northern Territory	(b)	(b)	Outer regional	Remote	Very remote
Australian Capital Territory	Major cities	(b)	(b)	(b)	(b)
Australia(c)	Major cities	Inner regional	Outer regional	Remote	Very remote
(a) Not included in analysis due to small death counts.
(b) No geographical jurisdiction coded to this remoteness area.
(c) Excludes Queensland and Other Territories.

Crude death rates

The crude death rate (CDR) is the simplest mortality indicator that can be estimated, but is limited by being unable to control for the age structure of the population. CDRs are presented in table 5.7 but not analysed further in this article.


Age-specific death rate

Age-specific death rates (ASDRs) for 2010 are presented in table 5.8. Death rates for persons aged zero use births registered in 2010 as a denominator. No data are presented for age zero separately for males and females due to small death counts. All other age groups use preliminary Estimated Resident Population (ERP) at 30 June 2010 as a denominator.

ASDRs generally increase with remoteness except for persons aged 85 years and over. However, very remote areas have the lowest ASDR of all RAs for persons aged 85 years and over. This may be because death may more commonly occur at ages younger than 80 years in remote and very remote areas and those surviving into their 80's relocate to inner regional and outer regional RAs to improve their access to aged care and health services. ASDRs are usually higher for males than for females except for the over 85 year old age group in very remote areas, where ASDRs are higher for females than for males.

Age-specific death rate ratios

ASDR ratios (table 5.9) have been calculated in order to compare ASDRs in each RA with the ADRS for the total Australian population. ASDR ratios are lower than 1.0 for all age groups in major cities and are generally higher than 1.0 in all other RAs for almost every age group. There are two exceptions. ASDR ratios are below 1.0 for infants and children aged 1-4 years in inner regional RAs and below 1.0 for age groups 80 years and over in remote and very remote areas.


Infant mortality rate

Infant mortality rates (IMRs) have been calculated as a three-year average ending in the reference year, for 2005 to 2010 (see graph below). Data are by RA for Australia (excluding Queensland).

In 2005, IMRs were highest in very remote areas (12.2 deaths per 1,000 live births) and lowest in major cities (4.4). Between major cities and remote areas, the difference in rates was 2.0 and between remote and very remote areas, the difference in rates was 5.8. This pattern is consistent for other years. An improvement in rates was observed in all RAs between 2005 and 2010: the largest decline in IMRs occurred in very remote areas (by 2.5) and the smallest decline occurred in major cities (by 0.7). This meant that, in 2010, the IMR in very remote areas was still 2.6 times the rate in major cities.


Standardised death rates

In this article, the study populations are the total, male and female populations of RAs over the period 2005 to 2010, while the standard population used was the total persons in the Australian population at 30 June 2001. The direct standardisation method has been used. Since the same standard population is used for all RAs and years, SDRs are directly comparable across RA categories and over time.

SDRs by RA for 2005 to 2010 are graphed below. As with IMRs, SDRs in 2005 were highest in very remote areas (9.8) and lowest in major cities (5.9). Between major cities and remote areas, the difference in rates was 1.7 and between remote and very remote areas, the difference in rates was 2.2. Between 2005 and 2010, SDRs declined across all RAs and the rate of decline was stronger as the level of remoteness increased.

Male and female standardised death rates

In graph 5.4, male SDRs were larger as the level of remoteness increased. In 2005, SDRs in very remote areas were 11.1 deaths per 1,000 standard population, 4.0 higher than in major cities. By 2010, this difference in SDRs had reduced to 1.5. The rates fell by 3.2 in very remote areas and by 0.6 in major cities between 2005 and 2010.

Female SDRs by RA in 2005 and 2010 are graphed below. As for male SDRs, in 2005, female SDRs were larger as the level of remoteness increased. By 2010, female SDRs had improved most in very remote areas (1.6) and remote areas (0.8) and were slightly higher in outer regional RAs (5.2) than in remote areas (5.0).

The ratio of male and female SDRs in 2005 and 2010 is illustrated in graph 5.6. In both years, all RAs had higher male SDRs than female SDRs. However, all RAs had smaller ratios in 2010 than in 2005, indicating a reduction in the excess of mortality of males over females. In 2005, the ratio was largest in remote areas (1.62) and the smallest in very remote areas (1.32). By 2010, the largest reduction in ratios was in very remote areas (0.16) and the smallest in major cities (0.04).

State and territory differences in standardised death rates

During the period 2005 to 2010, the RAs of New South Wales, South Australia and Western Australia had similar SDRs to the pattern shown at the Australia level. In 2010, the most notable differences from the SDR for Australia was found in the Northern Territory, which had a higher very remote area SDRs (9.5) than the total Australian SDR (7.4). Similarly, the remote area SDR for the Northern Territory in 2010 was 8.3 as compared with 6.4 for Australia.

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