Objectives To describe trends in ages and causes of death in a remote-living Australian Aboriginal group over a recent 50-year period.
Design A retrospective observational study, from 1960 to 2010, of deaths and people starting dialysis, using data from local clinic, parish, dialysis and birthweight registers.
Setting A remote island community in the Top End of Australia’s Northern Territory, where a Catholic mission was established in 1911. The estimated Aboriginal population was about 800 in 1960 and 2260 in 2011.
Participants All Aboriginal residents of this community whose deaths had been recorded.
Outcome measures Annual frequencies and rates of terminal events (deaths and dialysis starts) by age group and cause of death.
Results Against a background of high rates of low birth weight, 223 deaths in infants and children and 934 deaths in adults (age > 15 years) were recorded; 88% were of natural causes. Most deaths in the 1960s were in infants and children. However, over time these fell dramatically, across the birthweight spectrum, while adult deaths progressively increased. The leading causes of adult natural deaths were chronic lung disease, cardiovascular disease and, more recently, renal failure, and rates were increased twofold in those of low birth weight. However, rates of natural adult deaths have been falling briskly since 1986, most markedly among people of age ≥45 years. The population is increasing and its age structure is maturing.
Conclusions The changes in death profiles, the expression of the Barker hypothesis and the ongoing increases in adult life expectancy reflect epidemiological and health transitions of astonishing rapidity. These probably flow from advances in public health policy and healthcare delivery, as well as improved inter-sectoral services, which are all to be celebrated. Other remote communities in Australia are experiencing the same phenomena, and similar events are well advanced in many developing countries.
- Australian aboriginal
- mortality transition
- demographic profile
- chronic disease
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Contributors WEH conceived and designed this work, collected data, directed data analyses, interpreted the findings and wrote the manuscript. BJML conducted field work and performed data collection and data preparation. SAM prepared data, performed analyses and contributed to interpretation, produced figures and tables and coordinated preparation and editing of the manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors reviewed, revised and approved the manuscript.
Funding This work has been supported by past grants from the National Health and Medical Research Council of Australia (NHMRC) (#511081, #921134, #951250 and #951342) and from the Colonial Foundation of Australia. It is currently supported by the NHMRC Centre of Research Excellence in Chronic Kidney Disease in Australia (#1079502). Past grants have specifically supported patient recruitment, data collection and data management of a broader study within which this study is embedded. Current support has enabled analyses and preparation of this manuscript. The funders had no role in preparation or conduct of the study or writing or submission of the manuscript.
Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare the following: authors had financial support from National Health and Medical Research Council of Australia (Centre for Research Excellence in Chronic Kidney Disease, APP1079502, and or Australia Fellowship, APP511081) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
Ethics approval Human Research Ethics Committee of the Northern Territory Department of Health and Community Services and Menzies School of Health Research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Grouped, de-identified data can be requested from the Corresponding Author, Wendy E Hoy (firstname.lastname@example.org).
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