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Open Access Research article

Aboriginal premature mortality within South Australia 1999-2006: a cross-sectional analysis of small area results

David Banham1*, Heather Jury1, Tony Woollacott1, Robyn McDermott2 and Fran Baum3

Author Affiliations

1 Research and Ethics Policy, SA Health, 11 Hindmarsh Square, Adelaide, SA, 5000, Australia

2 SA NT DataLink and Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia

3 Southgate Institute, Faculty of Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia

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BMC Public Health 2011, 11:286  doi:10.1186/1471-2458-11-286

Published: 10 May 2011

Abstract

Background

This paper initially describes premature mortality by Aboriginality in South Australia during 1999 to 2006. It then examines how these outcomes vary across area level socio-economic disadvantage and geographic remoteness.

Methods

The retrospective, cross-sectional analysis uses estimated resident population by sex, age and small areas based on the 2006 Census, and Unit Record mortality data. Premature mortality outcomes are measured using years of life lost (YLL). Subsequent intrastate comparisons are based on indirect sex and age adjusted YLL results. A multivariate model uses area level socio-economic disadvantage rank, geographic remoteness, and an interaction between the two variables to predict premature mortality outcomes.

Results

Aboriginal people experienced 1.1% of total deaths but 2.2% of YLL and Aboriginal premature mortality rates were 2.65 times greater than the South Australian average. Premature mortality for Aboriginal and non-Aboriginal people increased significantly as area disadvantage increased. Among Aboriginal people though, a significant main effect for area remoteness was also observed, together with an interaction between disadvantage and remoteness. The synergistic effect shows the social gradient between area disadvantage and premature mortality increased as remoteness increased.

Conclusions

While confirming the gap in premature mortality rates between Aboriginal South Australians and the rest of the community, the study also found a heterogeneity of outcomes within the Aboriginal community underlie this difference. The results support the existence of relationship between area level socio-economic deprivation, remoteness and premature mortality in the midst of an affluent society. The study concludes that vertically equitable resourcing according to population need is an important response to the stark mortality gap and its exacerbation by area socio-economic position and remoteness.