Objective: To quantify Indigenous mortality in the Northern Territory by remoteness of residence. Design, setting and participants: Australian Bureau of Statistics mortality data were used to compare rates of death from chronic disease in the NT Indigenous population with rates in the general Australian population over the period 1998–2003. Rates were evaluated by categories of remoteness based on the Accessibility/Remoteness Index of Australia: outer regional areas (ORAs), remote areas (RAs) and very remote areas (VRAs). Main outcome measures: Mortality from cardiovascular disease, diabetes and renal disease; standardised mortality ratios (SMRs); percentage change in annual death rates; changes in mortality between 1998–2000 and 2001–2003. Results: In 1998–2000, SMRs for all-cause mortality were 285% in ORAs, 875% in RAs and 214% in VRAs. In 2001–2003, corresponding SMRs were 325%, 731% and 208%. For the period 1998–2003, percentage changes in annual all-cause mortality were 4.4% (95% CI, –2.2%, 11.5%) in ORAs, –5.3% (95% CI, –9.6%, –0.8%) in RAs, and 1.1% (95% CI, –7.2%, 11.3%) in VRAs. In 2001–2003, compared with 1998–2000, changes in the number of Indigenous deaths were +35 in ORAs, –37 in RAs and +32 in VRAs. Similar patterns were observed for cardiovascular mortality. Conclusions: Compared with mortality in the general Australian population, Indigenous mortality was up to nine times higher in RAs, three times higher in ORAs and two times higher in VRAs. The fact that rates were lowest in VRAs runs contrary to claims that increasing remoteness is associated with poorer health status. Despite the high death rate in RAs, there was a downward trend in mortality in RAs over the study period. This was partly attributable to a fall in the absolute number of deaths.
Background: We examined the role of fish intake in the development of atopic disease with particular reference to the possibility of differential effects on allergen‐specific subgroups of sensitization. Methods: The exposure of interest was parental report of fish intake by children aged 8 years at the 1997 Childhood Allergy and Respiratory Health Study ( n = 499). The outcomes of interest were subgroups of atopy: house dust mite (HDM)‐pure sensitization [a positive skin‐prick test (SPT) ≥2 mm to Der p or Der f only], ryegrass‐pure sensitization (a positive SPT ≥2 mm to ryegrass only); asthma and hay fever by allergen‐specific sensitization. Results: A significant association between fish intake and ryegrass‐pure [adjusted odds ratio (AOR) 0.37 (0.15–0.90)] but not HDM‐pure sensitization [AOR 0.87 (0.36–2.13)] was found. Fish consumption significantly decreased the risk for ryegrass‐pure sensitization in comparison with HDM‐pure sensitization [AOR 0.20 (0.05–0.79)]. Conclusions: We have demonstrated a differential effect of fish intake for sensitization to different aeroallergens. This may be due to the different timing of allergen exposure during early life. Further investigation of the causes of atopic disease should take into account allergen‐specific subgroups.
Despite the well-recognised Indigenous-non-Indigenous health disparity, some reports suggest improvements in Indigenous mortality. Our aim was to quantify Indigenous mortality in Outer Regional (OR), Remote (R), and Very Remote (VR) areas in New South Wales, Queensland, South Australia, Western Australia, and the Northern Territory and changes in mortality from 1998 to 2005. We calculated rates, standardized mortality ratios (SMRs) and percentage change in annual rates of Indigenous cardiovascular, diabetes and renal mortality mentioned anywhere on the death certificate by using ICD-10 codes and the 2001 total Australian population as the reference population. In 1998-2001, Indigenous SMRs for all-cause mortality were 241%, 421% and 220% in OR, R and VR, respectively. In 2001-03, corresponding SMRs were 202%, 331% and 176%. Percentage changes (95% confidence interval) in annual all-cause mortality were -3.0% (-5.3%, -0.7%) in OR, -4.2% (-7.4%, -0.9%) in R and -0.5 (-9.1%, -0.7%) in VR. In 2002-2005, compared with 1998-2001, changes in the number of Indigenous deaths were -147, -195, and -197 in OR, R and VR, respectively. Similar patterns and trends were observed for cardiovascular mortality. Mortality was elevated about 2-fold in OR, 4-fold in R and 2-fold in VR areas. The downward trend in mortality regardless of remoteness of residence was partly attributable to a decrease in the absolute number of deaths. These patterns were observed for each of the states/territories individually.
SUMMARY: Aim: Indigenous Australians have much higher mortality than non‐Indigenous Australians. We aimed to quantify the excess of deaths with a renal causal assignment among Indigenous people aged 25 years and over in Queensland, Australia, 1997–2000 and their distribution by remoteness. Methods: Both underlying and associated causes defined by ICD, 10 th edition, were examined. Mortality rates were standardized to the concurrent non‐Indigenous population. Results: In Indigenous people, standardized mortality ratios with a renal assignment of death by remoteness of residence were 194% (Major City and Inner Regional), 439% (Outer Regional and Remote) and 782% (Very Remote). Of all these deaths with a renal assignment, only 18% had a renal assignment as the underlying cause. Diabetes and cardiovascular disease were frequent concomitant causes in deaths with a renal assignment. Conclusion: The Indigenous population in Queensland has elevated rates of renal deaths compared with the non‐Indigenous population. This disparity increases markedly with increasing remoteness of residence. Reliance on underlying causes of death alone greatly underestimates the association of renal disease with deaths in this population.
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