This report presents estimates of avoidable fatal burden (AYLL) among Aboriginal and Torres Strait Islander (First Nations) people in 2018. It is part of the Australian Burden of Disease Study (ABDS). Although burden of disease estimates for total Australia have been updated as part of the ABDS 2022 study, 2018 is the latest year for which estimates are available for First Nations people.
An analysis of avoidable non-fatal burden was also planned, however, due to various methodological issues it was only possible to complete the analyses of avoidable fatal burden – see box (below) for further information.
Fatal burden is a measure of the years of life lost (YLL) due to dying prematurely (that is, before the expected life span); 1 YLL is 1 year of life lost. Fatal burden is based on 2 factors: the age at which a death occurs and the number of remaining years that a person would, on average, expect to live from that age.
In the ABDS, the remaining life expectancy varies at each age but starts as a life expectancy at birth of 86.0 years. This ideal life span is based on the lowest observed death rates at each age group from multiple countries (Murray, Ezzati et al. 2012).
Avoidable fatal burden is the fatal burden due to potentially avoidable deaths among people aged under 75.
Note that the AIHW uses ‘First Nations people’ to refer to Aboriginal and Torres Strait Islander people in this report.
Potentially avoidable deaths
Potentially avoidable deaths are deaths from conditions that are potentially preventable through individualised care and/or treatable through existing primary, specialist or hospital care. For example, potentially avoidable deaths include deaths from:
- some cancers, such as breast and colon cancers, which can be reduced through earlier detection and treatment
- some invasive infections, such as cellulitis, which can be reduced through early detection and appropriate antibiotic treatment
- diseases such as rheumatic heart disease and asthma, which can be reduced through appropriate treatment
- deaths from car accidents, which can be reduced through improved trauma care and emergency transport.
Potentially avoidable deaths are classified using a nationally agreed definition (and ICD-10 codes) (AIHW 2022; see Table A1 in Technical notes).
This definition of avoidable deaths includes only those deaths where direct intervention is delivered by a clinician or health worker. Such interventions may involve screening, diagnosis or rehabilitation, as well as treatment. Causes of death potentially avoidable within other elements of the health system (or other non-health sectors) are not in scope of this definition, for example, population health-initiatives, such as anti-smoking or pro-seatbelt campaigns; this is so the definition reflects access to and effectiveness of health care, rather than wider social systems.
The definition also excludes conditions whose associated mortality has fallen to very low levels in Australia – such causes of death are ‘avoided’ rather than ‘avoidable’. Examples of these conditions include measles, rubella and diphtheria, which are now rare in Australia as a result of Australia’s high immunisation rates.
The under 75 age threshold for avoidable deaths is the general criteria that is used in avoidable mortality analyses. Note that this only reflects a current definition of premature mortality and may need to be reviewed in response to any changes in life expectancy (OECD 2022). An implication of using this threshold is the likely under-estimation of the number of deaths that could potentially be avoided through better prevention or better health care for people aged 75 and over.
Mapping avoidable deaths to the Australian Burden of Disease Study (ABDS) causes
Of the 219 diseases and injuries defined by ICD-10 codes for fatal burden analysis in the 2018 ABDS, 65 included codes that are defined as potentially avoidable (Table 1) (also see Tables A2 and A3 in Technical notes):
- 45 included only avoidable death codes
- 18 included both avoidable and non-avoidable death codes (part-avoidable causes type 1)
- 2 contained only avoidable death codes with additional limitations (part-avoidable causes type 2).
|Avoidable deaths ICD-10 codes||Number of ABDS causes||Notes|
|No avoidable deaths codes||154|
|Avoidable deaths codes only||45|
|Part-avoidable causes type 1: Avoidable and non-avoidable deaths codes||18||Two of these causes were combined for ABDS reporting purposes.|
|Part-avoidable causes type 2: Avoidable deaths codes only with additional limitations||2||Breast cancer, classified as avoidable for females only.|
Acute lymphoblastic leukaemia, classified as avoidable for those aged 0-44 only.
|Total ABDS causes||219|
For reporting purposes in the 2018 ABDS, 2 of the 20 part-avoidable causes were combined, resulting in 19 part-avoidable causes used in the avoidable mortality analysis (see Table A3 in Technical notes). Data from the National Mortality Database (NMD) were used to derive the avoidable fatal burden component for each of these 19 part-avoidable causes (see Technical notes section for more details).
Non-fatal burden (also called YLD or ‘years lived with disability’) is a weighted estimate of the number of years of life that are not spent in full health, because of the effects of illness or injury. For a particular disease, the number of YLD is influenced by the number of people living with the disease and the duration and severity of their symptoms.
For some conditions, the likelihood of a person developing them can be reduced through reducing or eliminating exposure to certain modifiable risk factors, for example, not smoking, moderating alcohol consumption, or maintaining blood pressure below a certain level. The burden associated with these risk factors is detailed in the main ABDS 2018 report.
For other conditions, links to specific modifiable risk factors are either difficult to quantify or have not been determined. This makes it impossible to say how much of their burden could potentially be avoided. However, one nationally agreed indicator relating to avoidable non-fatal burden is the concept of potentially preventable hospitalisations (PPH). These are conditions where it is considered that hospitalisation should be able to be avoided through timely and effective primary health care.
Although First Nations people experience higher rates of PPH than non-Indigenous Australians, the duration of these hospital stays is on average quite short, generally only a few days. This means that the non-fatal burden associated with each individual event is very small, and it is not possible to break the results up by age or location, meaning that the usefulness of these data are limited. Also, because the definitions of the types of hospitalisations that are considered to be potentially preventable do not correspond very closely to the cause definitions used in the ABDS, it is not possible to use methods like those outlined above to estimate the avoidable component for non-fatal burden. This exploration of avoidable burden therefore is limited to fatal burden only.
AIHW (Australian Institute of Health and Welfare) (2022) National Healthcare Agreement: PI 16–Potentially avoidable deaths, 2022, AIHW, accessed 9 February 2023.
OECD (Organisation for Economic Co-operation and Development) (2022) Avoidable mortality: OECD/Eurostat lists of preventable and treatable cause of death (January 2022 version) [PDF 694KB], OECD, accessed 17 February 2023.
Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C et al. 2012. GBD 2010: design, definitions, and metrics. The Lancet 380:2063–6.