Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967-2012.

OBJECTIVES: To compare long term changes in mortality and life expectancy at birth (LE) of Aboriginal people in the Northern Territory and of the overall Australian population; to determine the contributions of changes in mortality in specific age groups to changes in LE for each population. DESIGN, SETTING, PARTICIPANTS: Retrospective trend analysis of death and LE data for the NT Aboriginal and Australian populations, 1967-2012. MAIN OUTCOME MEASURES: LE estimates based on abridged life tables; mortality estimates (deaths per 100 000 population); and age decomposition of LE changes by sex and time period. RESULTS: Between 1967 and 2012, LE increased for both NT Aboriginal and all Australians; the difference in LE between the two populations declined by 4.6 years for females, but increased by one year for males. Between 1967-1971 and 1980-1984, LE of NT Aboriginal people increased rapidly, particularly through reduced infant mortality; from 1980-1984 to 1994-1998, there was little change; from 1994-1998 to 2008-2012, there were modest gains in older age groups. Decomposition by age group identified the persistent and substantial contribution of the 35-74-year age groups to the difference in LE between NT Aboriginal people and all Australians. CONCLUSIONS: Early gains in LE for NT Aboriginal people are consistent with improvements in nutrition, maternal and infant care, and infectious disease control. A rapid epidemiological transition followed, when LE gains in younger age groups plateaued and non-communicable diseases became more prevalent. Recent LE gains, across all adult age groups, are consistent with improved health service access and chronic disease management. If LE is to continue improving, socio-economic disadvantage and its associated risks must be reduced.

Do Indigenous Australians age prematurely? The implications of life expectancy and health conditions of older Indigenous people for health and aged care policy.

OBJECTIVE: To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. METHODS: Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. RESULTS: At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. CONCLUSION: The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people.

Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID 19 healthcare workers.

Assuring the safety of both patients and healthcare workers (HCWs) in hospitals has been the primary focus of every healthcare organization during the COVID 19 pandemic. This article discusses the NIH Clinical Center's interdisciplinary approach to deploying an organizational Asymptomatic Staff Testing System.

Northern Territory indigenous life expectancy improvements, 1967-2004.

OBJECTIVE: To assess the extent of changes in life expectancy at birth for the Indigenous population of the Northern Territory (NT) over the period 1967-2004, and to determine which age-specific mortality rates were mostly responsible for such change. METHODS: Life expectancy at birth figures were obtained via life table calculations using a high-quality and internally consistent dataset of NT Indigenous deaths and populations covering the period 1967-2004. A life expectancy at birth age decomposition technique was then applied. RESULTS: Indigenous life expectancy at birth has risen considerably in the NT, increasing from about 52 years for males and 54 years females in the late 1960s to about 60 years for males and 68 years for females in recent years. Significantly, for NT Indigenous females the gap with total Australian life expectancy has narrowed. CONCLUSIONS: In contrast to popular perception, Indigenous life expectancy in the Northern Territory has improved substantially from the late 1960s to the present. IMPLICATIONS: The widespread pessimism that surrounds Indigenous health and mortality is largely unfounded, at least for the NT. Although much remains to be done to reduce Indigenous mortality, the results in this paper demonstrate that improvements are occurring and that sustained and increased effort is worthwhile and will succeed.

Improving access to medicines among clients of remote area Aboriginal and Torres Strait Islander Health Services.

Despite unequivocally worse health, expenditure on Indigenous people through the Pharmaceutical Benefits Scheme (PBS) is considerably less than for other Australians. We report on the effectiveness of a program to supply PBS medicines to remote Aboriginal and Torres Strait Islander Health Services (ATSIHSs) under section 100 (s. 100) of the National Health Act 1953. THE PROGRAM: Under the special PBS arrangements (SPBSAs), approved ATSIHSs are able to order PBS medicine in bulk through local pharmacies and supply them as needed to patients on-site. The usual co-payment associated with PBS medicine is not charged and the pharmacist remuneration structure is different. METHODS: The project involved consultation with the evaluation reference group and other stakeholders at all stages. There were six main data collection components: public submissions; interviews with government and other key stakeholders; pharmacist survey; medicine utilisation and expenditure data; national ATSIHS minimum dataset; and case studies of ATSIHSs. RESULTS: These SPBSA potentially benefit 36% of the Aboriginal and Torres Strait Islander population. They have resulted in improved access to much-needed medicines, representing an increase of dollar 36.5 million in expenditure on Aboriginal and Torres Strait Islander people through the PBS between 2000/01 and 2002/03. They have further ensured that dollar 8.3 million of State and Territory expenditure formerly directed at medicine can be spent on prevention and primary care. CONCLUSION: Overall, the SPBSAs have been very successful and demonstrates an effective model for the development of Indigenous health policy.

Cancer incidence and survival for indigenous Australians in the Northern Territory.

OBJECTIVE: To compare cancer incidence and survival for the Northern Territory (NT) Indigenous population with that of other Australians, and to assess NT Indigenous incidence time trends. METHODS: Cancer registry data were used to calculate cancer incidence rate ratios (NT Indigenous to total Australian), the average annual change in NT Indigenous cancer incidence and the relative risk of cancer death after diagnosis of cancer (NT Indigenous to combined Western Australian and Tasmanian cases) for 1991-2001. RESULTS: For NT Indigenous people, incidence rates were high for cancers of the liver, gallbladder, cervix, vulva and thyroid and, in younger people only, for cancers of the oropharynx, oesophagus, pancreas and lung, but low for cancers of the colon and rectum, breast, ovary, prostate, bladder, kidney, melanoma and lymphoma. Incidence rate ratios ranged from 0.1 for melanoma to 7.4 for liver cancer. Incidence increased for breast and pancreatic cancers. Survival was low for almost all specific cancers examined, and for all cancers combined (relative risk of death 1.9, 95% CI 1.7-2.1). CONCLUSIONS: Compared with other Australians, NT Indigenous people have higher, and increasing, incidence for some cancers (particularly smoking-related cancers) and lower survival for most. IMPLICATIONS: Cancer has a greater impact on NT Indigenous people than other Australians. Well-established cancer risk factors should be more effectively tackled in Indigenous people and known effective screening programs more effectively implemented. Research is urgently required into the reasons why survival from cancer in NT Indigenous people is so much lower than in other Australians.

Improvements in Indigenous mortality in the Northern Territory over four decades.

OBJECTIVE: To provide the first report of long-term mortality trends over recent decades for an Indigenous Australian population. Very little information is available about improvements over time, or lack thereof, in the health status of Indigenous Australians. METHODS: Internally consistent time series of deaths and population data were produced for the Indigenous population of the Northern Territory (NT) for 1966--2001. Time trends for Indigenous mortality rates and differentials between NT Indigenous and total Australian rates were examined for 1967--2000. RESULTS: NT Indigenous mortality declined in all age groups and both sexes. The decline was greatest in age group 0-4 (85%). In those aged five years and over, NT Indigenous mortality declined by 30% in females and 19% in males. However, these declines did not keep pace with the relative decline for the total Australian population, so that mortality rate ratios (NT Indigenous to total Australian) increased for all age groups except 0-4 years. NT Indigenous mortality declined for communicable, maternal, perinatal and nutritional conditions by 62%, and for injury by 33%, but did not decline for non-communicable diseases. CONCLUSIONS: Indigenous mortality has improved in the NT in recent decades, but the relative gap between Indigenous and other Australians has increased. IMPLICATIONS: Reductions in NT Indigenous mortality reported here may provide some reassurance that improvement in Indigenous health is possible and has occurred, but even greater effort will be required to accelerate the pace of improvement.

Indigenous aged care service use and need for assistance: how well is policy matching need?

AIM: To investigate the effectiveness of the Australian Government's aged care planning framework for Indigenous Australians, particularly the use of a lower planning age of 50 years. METHODS: We analysed published data and administrative datasets relating to population demographics, aged care assessments, admissions and usage, need for assistance and expenditure, comparing the Indigenous 50-69 and 70+ age groups with the non-Indigenous 70+ age group. RESULTS: Indigenous people aged 50-69 years have much lower utilisation, and a different pattern of utilisation, of aged care services than either Indigenous or non-Indigenous people aged 70 and over. Community-based services are much more important for Indigenous than non-Indigenous people, regardless of age. CONCLUSION: The planning framework conflates the diverse needs of Indigenous people across a wide age range and does not set a meaningful target for service provision. It has not ensured the right balance of services across geographic areas and between different levels of care.

On application of the empirical Bayes shrinkage in epidemiological settings.

This paper aims to provide direct and indirect evidence on setting up rules for applications of the empirical Bayes shrinkage (EBS), and offers cautionary remarks concerning its applicability. In epidemiology, there is still a lack of relevant criteria in the application of EBS. The bias of the shrinkage estimator is investigated in terms of the sums of errors, squared errors and absolute errors, for both total and individual groups. The study reveals that assessing the underlying exchangeability assumption is important for appropriate use of EBS. The performance of EBS is indicated by a ratio statistic f of the between-group and within-group mean variances. If there are significant differences between the sample means, EBS is likely to produce erratic and even misleading information.

Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.

OBJECTIVE: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991-2000. MAIN OUTCOME MEASURES: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death. RESULTS: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%-78%) than for non-Indigenous people (51%; 95% CI, 53%-59%) with cancers of the colon and rectum, breast, cervix and non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%-65%] v non-Indigenous, 69% [95% CI, 64%-75%]). Stage-adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site. CONCLUSIONS: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia.

Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory.

OBJECTIVE: To examine long-term trends in cancer mortality in the Indigenous people of the Northern Territory (NT) of Australia. DESIGN: Comparison of cancer mortality rates of the NT Indigenous population with those of the total Australian population for 1991-2000, and examination of time trends in cancer mortality rates in the NT Indigenous population, 1977-2000. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2000. MAIN OUTCOME MEASURES: Cancer mortality rate ratios and percentage change in annual mortality rates. RESULTS: The NT Indigenous cancer mortality rate was higher than the total Australian rate for cancers of the liver, lungs, uterus, cervix and thyroid, and, in younger people only, for cancers of the oropharynx, oesophagus and pancreas. NT Indigenous mortality rates were lower than the total Australian rates for renal cancers and melanoma and, in older people only, for cancers of the prostate and bowel. Differences between Indigenous and total Australian cancer mortality rates were more pronounced among those aged under 64 years for most cancers. NT Indigenous cancer mortality rates increased over the 24-year period for cancers of the oropharynx, pancreas and lung, all of which are smoking-related cancers. CONCLUSIONS: Cancer is an important and increasing health problem for Indigenous Australians. Cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination).