Transformation of mortality in a remote Australian Aboriginal community: a retrospective observational study

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.