Patterns of mortality in Indigenous adults in the Northern Territory, 1998-2003: are people living in more remote areas worse off?

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.