Changing mortality patterns in Kimberley Aborigines

Background/Aims: To examine the causes of officially reported deaths from several categories among Aboriginal and non-Aboriginal people in a statistical division of north-west Australia from 2002 to 2011. Methods: A cross-sectional analysis of official Death Registration data to calculate mortality rate ratios (Aboriginal against non-Aboriginal) for that decade in six major International Classification of Disease (ICD)-10 categories. The study setting was the West Kimberley Health District in the far north of Western Australia. Results: Death rates of Aborigines relative to non-Aborigines were much higher, by more than 10 times in some categories. Most of the excess deaths in these categories were due to circulatory diseases, injury and poisonings, neoplasms, diabetes, respiratory, and genitourinary conditions. Conclusion: This study has documented the heavy burden of mortality in West Kimberley Aborigines compared with the pattern found in non-Aboriginal people living in the same region

Burden of stroke in Indigenous Western Australians: A study using data linkage

Background And Purpose- Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997-2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia. Methods- Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status. Results- The total burden was 55 099 and 2134 disability-adjusted life years in non-indigenous and indigenous Western Australians, respectively. The indigenous to non-indigenous age-standardized stroke incidence rate ratio (15 years) was 2.6 in males (95% CI, 2.3-3.0) and 3.0 (95% CI, 2.6-3.5) in females, with similar rate ratios of disability-adjusted life years. The burden profile differed substantially between populations, with rate ratios being highest at younger ages. Conclusions- The differential between indigenous and non-indigenous stroke burden is considerable, highlighting the need for comprehensive intersectoral interventions to reduce indigenous stroke incidence and improve outcomes. Programs to reduce risk factors and increase access to culturally appropriate stroke services are required. The results here provide the quantitative basis for policy development and monitoring of stroke outcomes

Disability burden due to stroke in Western Australia: new insights from linked data sources

Background: The disability-adjusted life year index is used extensively to compare disease burden among diseases and locations, but difficulties remain in accurately estimating the nonfatal stroke burden in years lived with disability. Aims: To improve stroke-related years lived with disability estimates in Western Australia for 2000, by improving the accuracy of component inputs: nonfatal (28-day survivor) incidence, disease duration and disability (severity) weights. Methods: Nonfatal stroke incidence and the mortality difference between prevalent cases and the general population were estimated from linked hospital and mortality data using the Western Australian Data Linkage System. dismod software used these inputs to model disease duration. Disability weights were estimated from population-based stroke survey data, using indirect health valuation methods and adjusting for prestroke disability. Years lived with disability were calculated from the three components. Results: The annual age-standardised nonfatal incidence (n=1985) was higher in males (121/100 000) than females (96/100 000). The duration varied between 35·8 (females 15-24 years) and 3·4 years (males 85+ years). The mean pre-stroke-adjusted disability weight was higher at 4-months (0·38) than at 12-months (0·31). The age-standardised rate of nonfatal burden in males (302/100 000; 95% CI 290-314) was significantly higher than that in females (250/100 000; 95% CI 240-260). The nonfatal proportion of stroke burden (males 45%; females 37%) was higher than estimated in previous studies. Conclusion: This study illustrates that previous reports most likely underestimated disability burden as a contributor to the total stroke burden in Australia. Methodological refinements will contribute to burden of disease studies elsewhere. © 2010 The Authors. Journal compilatio