Burden of avoidable deaths among Aboriginal and Torres Strait Islander people 2018

This report presents estimates of avoidable fatal burden (AYLL) among Aboriginal and Torres Strait Islander (First Nations) people in 2018. It is part of the Australian Burden of Disease Study (ABDS). Although burden of disease estimates for total Australia have been updated as part of the ABDS 2022 study, 2018 is the latest year for which estimates are available for First Nations people. 

An analysis of avoidable non-fatal burden was also planned, however, due to various methodological issues it was only possible to complete the analyses of avoidable fatal burden – see box (below) for further information.

Fatal burden is a measure of the years of life lost (YLL) due to dying prematurely (that is, before the expected life span); 1 YLL is 1 year of life lost. Fatal burden is based on 2 factors: the age at which a death occurs and the number of remaining years that a person would, on average, expect to live from that age.

In the ABDS, the remaining life expectancy varies at each age but starts as a life expectancy at birth of 86.0 years. This ideal life span is based on the lowest observed death rates at each age group from multiple countries (Murray, Ezzati et al. 2012).

Avoidable fatal burden is the fatal burden due to potentially avoidable deaths among people aged under 75.

Note that the AIHW uses ‘First Nations people’ to refer to Aboriginal and Torres Strait Islander people in this report.

Potentially avoidable deaths

Potentially avoidable deaths are deaths from conditions that are potentially preventable through individualised care and/or treatable through existing primary, specialist or hospital care. For example, potentially avoidable deaths include deaths from:

• some cancers, such as breast and colon cancers, which can be reduced through earlier detection and treatment
• some invasive infections, such as cellulitis, which can be reduced through early detection and appropriate antibiotic treatment
• diseases such as rheumatic heart disease and asthma, which can be reduced through appropriate treatment
• deaths from car accidents, which can be reduced through improved trauma care and emergency transport.

Potentially avoidable deaths are classified using a nationally agreed definition (and ICD-10 codes) (AIHW 2022; see Table A1 in Technical notes).

This definition of avoidable deaths includes only those deaths where direct intervention is delivered by a clinician or health worker. Such interventions may involve screening, diagnosis or rehabilitation, as well as treatment. Causes of death potentially avoidable within other elements of the health system (or other non-health sectors) are not in scope of this definition, for example, population health-initiatives, such as anti-smoking or pro-seatbelt campaigns; this is so the definition reflects access to and effectiveness of health care, rather than wider social systems.

The definition also excludes conditions whose associated mortality has fallen to very low levels in Australia – such causes of death are ‘avoided’ rather than ‘avoidable’. Examples of these conditions include measles, rubella and diphtheria, which are now rare in Australia as a result of Australia’s high immunisation rates.

The under 75 age threshold for avoidable deaths is the general criteria that is used in avoidable mortality analyses. Note that this only reflects a current definition of premature mortality and may need to be reviewed in response to any changes in life expectancy (OECD 2022). An implication of using this threshold is the likely under-estimation of the number of deaths that could potentially be avoided through better prevention or better health care for people aged 75 and over.

Mapping avoidable deaths to the Australian Burden of Disease Study (ABDS) causes

Of the 219 diseases and injuries defined by ICD-10 codes for fatal burden analysis in the 2018 ABDS, 65 included codes that are defined as potentially avoidable (Table 1) (also see Tables A2 and A3 in Technical notes):

• 45 included only avoidable death codes
• 18 included both avoidable and non-avoidable death codes (part-avoidable causes type 1)
• 2 contained only avoidable death codes with additional limitations (part-avoidable causes type 2).

For reporting purposes in the 2018 ABDS, 2 of the 20 part-avoidable causes were combined, resulting in 19 part-avoidable causes used in the avoidable mortality analysis (see Table A3 in Technical notes). Data from the National Mortality Database (NMD) were used to derive the avoidable fatal burden component for each of these 19 part-avoidable causes (see Technical notes section for more details).