First Nations Burden of Disease Study 2022

In 2022, First Nations infants and young children under 5 lost 18,328 years of healthy life (total burden, DALY) due to premature death or living with disease or injury, or 169 DALY per 1,000 people of this age (Table 1).

Infants and children under 5 accounted for 11% (or 108,192 people) of the First Nations population and 5.8% (18,328 DALY) of the total burden experienced by First Nations people in 2022.

Source: AIHW First Nations Burden of Disease Database

Disease group burden

The leading disease groups that contributed to the total burden in First Nations infants and children under 5 were:

• infant & congenital conditions (52% of total burden, or 9,444 DALY)
• injuries (12%, 2,204 DALY)
• blood & metabolic disorders (11%, 2,056 DALY)
• infectious diseases (9.6%, 1,758 DALY) (Figure 1).

Among First Nations infants and children under 5 there was substantially more fatal than non-fatal burden (70% or 12,898 YLL and 30% or 5,430 YLD respectively) (figures 2 and 5), with each death in this age group contributing up to 90 YLL. Infant & congenital conditions contributed more than two-thirds of the fatal burden in this age group (71%), followed by injuries (16%) (Figure 1).

Blood & metabolic disorders and infectious diseases were the leading disease group contributors to non-fatal burden for First Nations children under 5 (accounting for 32% and 18% of YLD, respectively). Infant & congenital conditions accounted for only 4.7% of non-fatal burden for First Nations children under 5 (Figure 1).

Among First Nations children under 5, the contribution of fatal and non-fatal burden to total burden differed for each disease group (Figure 2). Among the highest burden disease groups:

• The burden from infant & congenital conditions and injuries was almost all fatal.
• The burden from blood & metabolic disorders and infectious diseases was mostly non-fatal.

Figure 2: Fatal (YLL) and non-fatal (YLD) burden as a proportion (%) of total burden (DALY), leading 6 disease groups, First Nations children under 5, 2022

Source: AIHW First Nations Burden of Disease Database

How does burden differ by sex?

Among First Nations children under 5, males experienced a higher proportion of the total burden (56% compared with 44%), fatal burden (56% compared with 44%) and non-fatal burden (54% compared with 46%) than females.

Infant & congenital conditions was the leading disease group contributor to total and fatal burden for both First Nations males and females in this age group. Blood & metabolic disorders was the leading disease group contributor to non-fatal burden for both males and females (Figure 3).

To further explore the top disease groups and causes by age group, see the following interactive data visualisation: 

• Dashboard 7: Top disease groups across the stages of life: This visualisation shows the top 5 disease groups contributing to burden for each age group and the top specific causes contributing to those disease groups broken down by fatal and non-fatal burden.

Top specific causes of burden

The 5 leading specific causes of burden accounted for almost half (48%) of the total burden among First Nations children under 5:

• pre-term birth & low birthweight complications (15%, or 2,710 DALY)
• birth trauma & asphyxia (11%, 2,065 DALY)
• protein-energy deficiency (9.5%, 1,739 DALY)
• sudden infant death syndrome (SIDS) (7.1%, 1,297 DALY)
• other unintentional injuries (5.7%, 1,036 DALY).

The leading specific causes of burden for this age group varied by fatal and non-fatal burden, but the overall burden for all three measures was higher in males than females. See Figure 4 for more information. 

To further explore the top specific causes across all stages of life, see the following interactive data visualisation: 

• Dashboard 8: Top specific causes across the stages of life: This visualisation provides the top 5 causes contributing to burden for each age group, by sex.

Changes over time

Overall, the health of First Nations children under 5 improved over the period 2011 to 2022 (Figure 5). 

There was a 15% decline in the age-specific rate of total burden between 2011 and 2022 (from 200 to 169 DALY per 1,000 people). Most of this decline was observed between 2018 and 2022, with a smaller decline between 2011 and 2018.

The decrease in total burden was driven by a reduction (of 20%) in the rate of fatal burden between 2011 and 2022. Over the same period there was no substantial change in non-fatal burden (Figure 5).

Figure 5: Change between 2011 and 2022 in the age-specific total (DALY), non-fatal (YLD) and fatal (YLL) burden rates (per 1,000 people), First Nations children under 5

 Source: AIHW First Nations Burden of Disease Database

Changes by disease group

Over the period 2011 to 2022, for First Nations children under 5, among the highest burden disease groups there were decreases in the age-specific total burden rate from:

• infant & congenital conditions – a decrease of 17 DALY per 1,000 people, or 17%
• infectious diseases – a decrease of 5.2 DALY per 1,000, or 24%

An increase in burden was observed for blood & metabolic disorders (increase of 5.8 DALY per 1,000, or 43%).

Changes by specific causes

In both 2011 and 2022, the same 4 diseases were the leading causes of burden among First Nations children under 5, although there were changes in the rankings and age-specific burden rates among these causes (Figure 6).

There were decreases in the burden rate for:

• pre-term birth & low birthweight complications (24% decrease in rate), although it was the leading cause of burden in this age group in both 2011 and 2022
• SIDS (36% decrease in rate, and a decrease in ranking)

There were increases in the burden rate and ranking for:

• protein-energy deficiency (28% increase in rate)
• birth trauma & asphyxia (18% increase).

Figure 6: Changes in ranking and age-specific DALY rate (DALY per 1,000 people), leading specific causes of burden, First Nations children under 5, 2011 and 2022

lbw low birthweight; SIDS sudden infant death syndrome.

Notes 

1. An increase in rank over time does not always mean the disease or injury has increased in the population, and vice versa. Therefore, changes in ranking of causes of deaths and disease burden over time should be interpreted with caution.
2. Causes are presented in descending order, from highest age-specific rate to lowest age-specific rate, with arrows indicating either an increase (orange) or decrease (blue) in the age-specific rate over time.
3. Cause rankings exclude ‘other' residual conditions from each disease group; for example, ‘other musculoskeletal conditions’.
4. For information on colours used for each specific cause, see disease group colours for FNBDS 2022 colour legend.

Source: AIHW First Nations Burden of Disease Database

How big is the gap in this age group, and what causes it?

First Nations infants and children under 5 experienced disease burden at 2.1 times the rate for non-Indigenous children of this age in 2022 (169 compared with 80 per 1,000 people).

For infants and children under 5, infant & congenital conditions was the leading disease group contributor to the gap (representing 43% of the gap among children under 5). Blood & metabolic disorders, injuries, and infectious diseases were also important contributors to the gap in this age group (representing 19%, 17% and 12% of the gap, respectively) (see Figure 5 in Gap in disease burden section).