Burden of disease in First Nations people
For Aboriginal and Torres Strait Islander (First Nations) people, good health is more than the absence of disease or illness; it is a holistic concept that includes physical, social, emotional, cultural, spiritual and ecological wellbeing, for both the individual and the community. Although the health of First Nations people has improved in a number of areas over the past decade (for example, cardiovascular disease deaths), there are still areas where outcomes have not improved, or have worsened (such as potentially preventable hospitalisations, cancer and suicide rates) (AIHW 2025).
This report presents results from the First Nations Burden of Disease Study (FNBDS) 2022. The FNBDS 2022 is based on the Australian Institute of Health and Welfare’s previous burden of disease studies and provides an update of estimates for the First Nations population. The current reference year for the FNBDS is 2022 as this was the latest year of data available at the time of analysis for the majority of data sources used to produce burden of disease estimates for First Nations people. Estimates from the FNBDS 2022 supersede those produced for the Aboriginal and Torres Strait Islander component of the Australian Burden of Disease Study (ABDS) 2018. Content covering the geographic differences in burden, health-adjusted life expectancy and the burden attributable to risk factors will be added gradually during 2026.
A separate report presents the latest results for the whole Australian population – Australian Burden of Disease Study 2024.
High-quality information on the health impacts and distribution of different diseases, injuries and risk factors is important in providing an evidence base to inform both health policy and programs and service delivery. This is especially important for the Aboriginal and Torres Strait Islander population because it is known to have unacceptably high levels of mortality, illness and injury (AIHW 2025).
Burden of disease analysis measures the impact of fatal and non-fatal burden; that is, both deaths and living with poor health. More than counting deaths or disease prevalence, it also takes into account age at death and severity of disease, and allows different diseases to be compared and reported in a consistent manner. Estimates produced from a burden of disease study are the best summary measures of a population’s health.
Burden of disease analysis also allows the contribution of modifiable risk factors to be estimated. Many factors outside health have a significant impact on the health and wellbeing of the First Nations population – for example, justice issues, racism (both individual and systemic), ongoing poverty and disadvantage, and experiences of multiple and long-term stressors. Past colonisation and the colonial present have had, and continue to have, a devastating impact on First Nations communities and cultures. Violence and epidemic disease associated with past colonisation caused an immediate loss of life, while the occupation of land by settlers, restriction of First Nations people to reserves, controlled employment and the forced removal of children under Aboriginal protection policies disrupted families, communities, culture and the ability of First Nations people to support themselves. Many First Nations people suffer inter-generational trauma resulting from these past events. Although many of these factors are not able to be explicitly measured in this analysis, their impact on health is evident in the high levels of burden experienced by First Nations people.
Burden of disease analysis measures the impact of disease and injury in a population (in this report, the First Nations population of Australia) by estimating the amount of ‘disability-adjusted life years’ (DALY) experienced by that population. This measure counts the combined years of healthy life lost due to living with and dying prematurely from disease and injury. It is the difference between a population’s actual health and its ideal health, where ideal health is living to old age in good health (without disease or disability).
If a disease has a high number of DALY, it has a high burden on the population. Some diseases have high fatal burden (YLL) due to the number of premature deaths they cause (for example, cancers) or because they cause death at younger ages, while others have high non-fatal burden (YLD) due to the number of people living with the condition and/or the severity of the illness (for example, musculoskeletal conditions).
Burden of disease summary measures
Years lived with disability (YLD): A measure of the years spent in less than full health due to living with illness due to disease and injury, weighted to account for severity of disease. YLD represent non-fatal burden.
Years of life lost (YLL): A measure of the years of life lost due to premature death, defined as dying before the ideal life span. YLL represent fatal burden.
Disability-adjusted life years (DALY): A measure (in years) of healthy life lost either through living with illness due to disease and injury (YLD) or through dying prematurely (YLL). The DALY measure represents total burden (the sum of YLD and YLL) and can be referred to as health loss.
Each of these 3 measures can be expressed as the number of YLD/YLL/DALY in a population, or as a crude or age-standardised rate. See also Different types of statistics presented in this report.
Burden estimates can be reported for individual diseases or injuries, referred to as ‘causes’, most of which describe a specific health problem (for example, dementia). Reporting can also be for a disease group (for example, neurological conditions), which consists of a number of related causes. For more information on each disease group see Australian Burden of Disease Study: Methods and supplementary material 2018, Disease specific methods - morbidity. ’Residual’ causes (for example, other infections) have been excluded from rankings in this report, as these are often made up of several diverse conditions which, as a group, are difficult to interpret. There are 220 separate causes and 17 disease groups in the FNBDS.
Example of calculating disability-adjusted life years
Burden of disease analyses estimate health loss from living with or dying from disease and injury in a single year – measured as DALY.
Joe, aged 65, has angina (a chronic heart condition that causes temporary chest pain on exertion). Joe suffers health loss from living with angina; in burden of disease analyses, this impact is measured using a ‘disability weight’ that reflects the severity of the disease and its effects on a person’s life – see the ABDS methods report for more detail. Angina has a disability weight of 0.2 and, as it is a chronic condition, it would affect Joe for the entirety of that year (0.2 x 1 year = 0.2 YLD). This gives Joe a total of 0.2 YLD health loss due to coronary heart disease (the burden of disease cause that includes angina).
Sam, aged 18, has appendicitis (requiring appendectomy); they would experience short-term health loss (for about 2 weeks) with a disability weight of 0.3 (0.3 x 2/52 = 0.01 YLD). This gives Sam a total of 0.01 YLD health loss due to appendicitis.
Pat, aged 58, dies of liver cancer, and will lose a number of years by dying early. A person aged 58 would (according to the reference life table) live until 91. If Pat dies at 58, they will have lost 33 years (or 33 YLL) due to liver cancer.
Together, Joe, Sam and Pat contribute 33.21 DALY (0.21 YLD plus 33 YLL).
Note: Disability weights and the reference life table used in this report are the same for males and females, for First Nations people and non-Indigenous Australians, and for all reference years. Therefore, the burden estimates are comparable between males and females, between First Nations and non-Indigenous Australians, and over time.
About the data in this report
The results presented here for each reference year (2011, 2018 and 2022) are modelled estimates of the time people spent in less than full health because they died from, or were living with the effects of, disease or injury in that year. The data used to produce these estimates are drawn from a range of Australian sources such as hospital records, disease registers, health surveys, academic studies, and death records. While some of these sources focus on First Nations people exclusively (for example, the National Aboriginal and Torres Strait Islander Health Survey, 2022–23), most data sources include both First Nations people and non-Indigenous Australians, and generally contain information on the sex, age and broad location of cases, as well as their Indigenous status.
It is known from previous investigations that Indigenous status information in many data sources is incomplete, meaning that fewer cases are identified as First Nations people than actually occurred. There are many reasons for this, such as:
- the person (or their representative) may not have been asked about their Indigenous status
- the person may have been asked, but chosen not to identify
- a data recording error.
Responding to the question about Indigenous status is voluntary. A person’s choice to identify as an Aboriginal and/or Torres Strait Islander person may be affected by the context in which the question is asked – for example, whether other people are present, whether other information is also being collected, what the circumstances are, and how safe they feel at that time or in that place to share that information.
The National Agreement on Closing the Gap defines a culturally safe environment as one where there is no assault, challenge or denial of the person’s identity, who they are and what they need (All Australian governments & Coalition of Aboriginal and Torres Strait Islander Peak Organisations 2020). It is a place where cultural values, strengths and differences are respected, and racism and inequity are addressed (AIHW 2023). Individuals may choose to identify as Aboriginal and/or Torres Strait Islander people in some circumstances but not others, and this may change over time depending on their experiences as well as the impact of wider societal events and changes, such as the 2023 ‘Voice’ referendum or the 2025 Victorian Statewide Treaty Bill.
For this analysis, data from sources where there was evidence to quantify the extent of under-identification were adjusted to better estimate the burden of disease in First Nations people. More detailed information is provided in the Technical notes.
Where no data were available to provide a reliable First Nations prevalence estimate, indirect methods were used to derive prevalence estimates. Such methods included applying rate ratios, such as First Nations-to-non-Indigenous ratios, from proxy data sources (for example, hospitalisations) to the total population prevalence. Indirect methods were used to derive First Nations prevalence for either the whole or part of the disease for 82 diseases across 12 disease groups. For more information on these diseases see: Australian Burden of Disease Study: Methods and supplementary material 2018, Years lived with disability (YLD).
Different types of statistics presented in this report
A range of different statistics and estimates are presented in this report, which are useful for different purposes. These include:
- Numbers of DALY, YLD and YLL describe the overall (DALY), non-fatal (YLD) and fatal (YLL) disease burden in the population being analysed. They are useful for summarising the health of that population at a point in time, for assessing health-care needs and planning health services.
- Crude rates of DALY, YLL and YLD provide a measure of health loss against the size of the population, but without taking any other features of the population into account. They are useful for measuring the relative impact in one age group compared with another by describing the amount of health loss relative to the size of the age group. They are also useful for assessing health-care needs and planning health services.
- Age-standardised rates of DALY, YLL and YLD also provide a measure of the health loss against the size of the population, but take into account the age structure of the population and changes in population size and ageing over time. Age-standardised rates have little use in service provision planning, but are useful for comparing the impact of various diseases between 2 populations with different age structures (for example, First Nations people and non-Indigenous Australians) or between 2 different time points (for example, 2011 and 2022).
Age-specific rates are rates relating specifically to a certain age group. An age-specific rate is calculated as the number of events (DALY, YLD or YLL) in an age group divided by the population of that age group. The resultant rate is then multiplied by 1,000 to create a whole number for easier comparison and interpretation.
An age-specific DALY rate of 450 DALY per 1,000 people means that, for every 1,000 people, the equivalent of 450 years were lost because of injury, illness or premature deaths.
Note that a single person can contribute multiple DALYs to the total population burden. This is because the fatal burden component (YLL) measures the number of years of life lost compared with the ideal life expectancy of 90 years at birth, rather than simply counting deaths. For example, if a person dies 25 years earlier than expected, this contributes 25 YLL, even though it represents one individual. Because DALYs measure years of healthy life lost, rather than the number of people affected, the total years lost in a population can exceed the population size. As a result, age-specific DALY rates may sometimes exceed 1,000 per 1,000 people.
Two types of percentages are also used in this report:
- Percent of burden – this is a measure of the burden in a particular sex, age group, disease group or cause as a proportion of the total. For example, if the total burden was 2,000 DALY, and the burden due to diabetes was 200 DALY, then diabetes contributes 10% of the total burden (calculated as 200/2,000 x 100).
- Percent change over time – this is a measure of how much the burden has changed between one year and another, relative to the burden in the earlier year. For example, if the total burden was 2,000 in 2011 and 2,500 in 2022, then the burden has changed by 25% (calculated as (2,500 – 2,000)/2,000 x 100).
All Australian governments & Coalition of Aboriginal and Torres Strait Islander Peak Organisations (2020), National Agreement on Closing the Gap | Closing the Gap, Department of the Prime Minister and Cabinet. Accessed 13 November 2025.
AIHW (Australian Institute of Health and Welfare) (2023) Cultural safety in health care for Indigenous Australians: monitoring framework, AIHW: Australian Government, accessed 13 November 2025.
AIHW (2025). Aboriginal and Torres Strait Islander Health Performance Framework: summary report June 2025, AIHW: Australian Government, accessed 15 October 2025.