Closing the Gap - performance report 2014

Closing the Gap performance report 2014 - i -

Closing the Gap performance report Aboriginal and Torres Strait Islander Health Unit

2014

Closing the Gap performance report 2014 - ii -

Authors

Daniel Williamson, Manager, Aboriginal and Torres Strait Islander Health Unit, Department of Health

Lucy Stanley, Lucy Stanley Consulting

Abdulla Suleman, Senior Health Data Analyst, Aboriginal and Torres Strait Islander Health Unit, Department of Health

Jenene Tull, Senior Policy and Planning Officer, Aboriginal and Torres Strait Islander Health Unit, Department of Health

Marianna Serghi, Executive Advisor - Aboriginal and Torres Strait Islander Health, Officer of the Deputy Director-General, Department of Health

Closing the Gap performance report 2014

Published by the State of Queensland (Queensland Health), March 2015

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au

© State of Queensland (Queensland Health) 2015

You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health).

For more information contact: Aboriginal and Torres Strait Islander Health Unit, Department of Health, GPO Box 48, Brisbane QLD 4001, phone 07 3234 0017.

An electronic version of this document is available at www.health.qld.gov.au

Disclaimer: The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

http://www.health.qld.gov.au/

Closing the Gap performance report 2014 - iii -

Contents Summary ....................................................................................................................... 1

Dashboard ..................................................................................................................... 2

Policy context ................................................................................................................ 6 Performance indicators ................................................................................................... 6 Performance context ....................................................................................................... 7 Performance challenges ................................................................................................. 8

Population ..................................................................................................................... 9

Council of Australian Governments target: life expectancy ........................................ 11 Cause specific mortality ................................................................................................ 12

Council of Australian Governments target: child mortality .......................................... 20 Child mortality ............................................................................................................... 23

Performance indicators ............................................................................................... 27 Child and maternal health indicators ............................................................................. 27 Aboriginal and Torres Strait Islander HHS service agreement key performance indicators – traffic light report ........................................................................................ 29 National elective surgery targets (NEST) ...................................................................... 31 National emergency access targets (NEAT) .................................................................. 36 Excess cost of purchases ............................................................................................. 38 Immunisation ................................................................................................................ 42 Morbidity – hospital separations, priority areas for action .............................................. 43

Priority conditions ........................................................................................................ 49 Rheumatic heart disease .............................................................................................. 49 Renal dialysis ................................................................................................................ 50 Cancer - incidence and mortality ................................................................................... 53 Hospital separations – condition specific analysis ......................................................... 56

Appendix ..................................................................................................................... 62 Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, Queensland .................................................................................................................. 62

Data sources ............................................................................................................... 74

Abbreviations .............................................................................................................. 75

Closing the Gap performance report 2014 - iv -

Figures Figure 1 Estimated resident population, 2013 - Queensland Indigenous and non-

Indigenous population pyramid ............................................................................ 10 Figure 2 Mortality – 2002 to 2010: all cause, circulatory, ischaemic heart disease ............ 12 Figure 3 Mortality – 2002 to 2010: stroke, respiratory, chronic lower respiratory ................ 14 Figure 4 Mortality – 2002 to 2010: endocrine, type 2 diabetes, external causes................ 16 Figure 5 Mortality – 2002 to 2010: suicide ......................................................................... 18 Figure 6 Infant mortality rates, Queensland, 2002 to 2010 and trajectory to 2025 .............. 21 Figure 7 Child mortality rates, Queensland, 2002 to 2010 and trajectory to 2025............... 21 Figure 8 Perinatal mortality, Queensland rolling five year rates, 2002 to 2010 ................... 21 Figure 9 Distribution of child deaths by cause and age at death, 2006 to 2010 .................. 22 Figure 10 Child mortality – 2002 to 2011: neonatal, infant and child mortality .................... 23 Figure 11 Child mortality – 2002 to 2011: perinatal, stillborn and post-neonatal

mortality ............................................................................................................... 25 Figure 12 Child and maternal health indicators – 2007−08 to 2013−14: antenatal

visits, low birth weight, smoking during pregnancy ............................................... 27 Figure 13 Queensland median waiting times (days) for elective surgery in public

hospitals by procedure ......................................................................................... 31 Figure 14 Percentage of patients treated within benchmarks for emergency

department waiting time, 2010−11 to 2013−14 .................................................... 36 Figure 15 Cumulative percentage of excess cost of purchases, 2011−12 to 2013−14 ......... 38 Figure 16 Excess cost of purchases by SRGs - Queensland (all Hospital and Health

Services), 2011−12 to 2013−14 ........................................................................... 39 Figure 17 Distribution of purchases by age group, 2011−12 to 2013−14 ............................. 40 Figure 18 Renal dialysis - proportion of total Indigenous separations for usual

residents of Hospital and Health Services ............................................................ 50 Figure 19 Excess cost of purchases of renal dialysis by age group ..................................... 51 Figure 20 New cancer cases and deaths, Aboriginal and Torres Strait Islander

people, 2007−2011 .............................................................................................. 52 Figure 21 Age specific cancer rates, Queensland, 2007−2011, new cases .......................... 52 Figure 22 Age specific cancer rates, Queensland, 2007−2011, deaths ................................ 52 Figure 23 Cancer trends in Queensland - new cases, 2000−2004 to 2007−2011 ................ 53 Figure 24 Cancer trends in Queensland - deaths, 2000−2004 to 2007−2011 ...................... 53 Figure 25 Cancer trends in Queensland – survival, 2001−2010 (by Kaplan-Meier

method) ............................................................................................................... 54 Figure 26 Cancer trends in Queensland – survival, 2001−2010 (crude survival rates) ......... 54 Figure 27 Age standardised cancer rates, Hospital and Health Services and

Queensland, 2007–2011 ...................................................................................... 54 Figure 28 Hospital separations, 2009−10 to 2013−14: diseases of the circulatory

system, ischaemic heart disease, stroke, hypertensive diseases, chronic rheumatic heart diseases, acute rheumatic fever ................................................. 56

Figure 29 Hospital separations, 2009−10 to 2013−14: respiratory, chronic lower respiratory disease, other diseases of upper respiratory tract, endocrine, type 2 diabetes, type 1 diabetes........................................................................... 58

Figure 30 Hospital separations, 2009−10 to 2013−14: neoplasms, external causes of morbidity and mortality, self-harm, injury and poisoning, chronic kidney disease ................................................................................................................ 60

Figure 31 Self-assessed health status by jurisdiction, AATSIHS 2012–13 ........................... 63 Figure 32 Diabetes/high blood sugar by jurisdiction, AATSIHS 2012–13 ............................. 65 Figure 33 Heart and circulatory problems/diseases by jurisdiction, AATSIHS 2012–13 ....... 65 Figure 34 Overweight/obese by jurisdiction, AATSIHS 2012–13 .......................................... 67 Figure 35 Current daily smoker by jurisdiction, AATSIHS 2012–13 ...................................... 68 Figure 36 High total cholesterol, AATSIHS 2012–13 ............................................................ 70 Figure 37 Dyslipidaemia, AATSIHS 2012–13 ....................................................................... 70 Figure 38 Diabetes prevalence based on fasting plasma glucose, AATSIHS 2012–13 ........ 71

Closing the Gap performance report 2014 - v -

Figure 39 Indicators of chronic kidney disease present, AATSIHS 2012–13 ........................ 71 Figure 40 Total in the labour force by jurisdiction, AATSIHS 2012–13 ................................. 72 Figure 41 Unemployment status by jurisdiction, AATSIHS 2013–12 .................................... 72 Figure 42 Year 12 or Certificate III or above by jurisdiction, AATSIHS 2012–13 .................. 73

Tables Table 1 Estimated resident population, 2013 ...................................................................... 9 Table 2 Estimated resident population, 2013 – by age, sex and Indigenous status ............. 9 Table 3 Life expectancy at birth (years), 2005−07 to 2010−12 .......................................... 11 Table 4 Child, infant and perinatal mortality indicators by Indigenous status,

Queensland, 2008–2012 ...................................................................................... 20 Table 5 DAMA and PPH quarterly rates by Hospital and Health Service .......................... 29 Table 6 Queensland median waiting times (days) for elective surgery in public

hospitals by procedure, 2010–11 to 2013–14....................................................... 32 Table 7 Days waiting for elective surgery by National Procedure Indicator (NPI) .............. 34 Table 8 Days waiting for elective surgery by Hospital and Health Service ........................ 34 Table 9 Trend in days waiting per count ........................................................................... 35 Table 10 Median waiting times (minutes) for emergency presentations in

Queensland public hospitals, 2012–13 and 2013–14 ........................................... 37 Table 11 Crude rates for emergency presentations in Queensland public hospitals,

2010–11 to 2013–14 ............................................................................................ 37 Table 12 Excess cost of purchases by service related group (SRG), 2011−12 to

2013−14 .............................................................................................................. 38 Table 13 Separations, WAUs and purchases - 2011−12, 2012−13, 2013−14 ..................... 40 Table 14 Indigenous vaccination coverage rates by Hospital and Health Service,

2013−14 .............................................................................................................. 42 Table 15 Age standardised hospital separations per 100,000 (2001 Australian

population): 2009−10 to 2013−14, condition heat map - Hospital and Health Service comparison .................................................................................. 44

Table 16 Age standardised hospital separations per 100,000 (2001 Australian population): 2009−10 to 2013−14, Hospital and Health Service heat map - chapter comparison ............................................................................................. 45

Table 17 Age standardised hospital separations per 100,000 (2001 Australian population): 2009−10 to 2013−14, heat map for specific conditions within some chapters ..................................................................................................... 46

Table 18 Age standardised hospital separations – rate ratio Indigenous Hospital and Health Service to Queensland non-Indigenous: 2009−10 to 2013−14 (2001 Australian population), chapter heat map - HHS comparison ............................... 47

Table 19 Age standardised hospital separations – rate ratio Indigenous Hospital and Health Service to Queensland non-Indigenous: 2009−10 to 2013−14 (2001 Australian population), heat map for specific conditions within some chapters ............................................................................................................... 48

Table 20 Number of children and compliance rates with scheduled ARF/RHD medication, by Hospital and Health Service ......................................................... 49

Table 21 Indigenous renal dialysis by Hospital and Health Service, 2011−12 to 2013−14 .............................................................................................................. 51

Table 22 Number of observed and expected new cancer cases and deaths, Aboriginal and Torres Strait Islander people, Queensland, 2007−2011 ................ 55

Table 23 Self-assessed general health status, AATSIHS 2012–13 ..................................... 63 Table 24 Long-term health conditions, AATSIHS 2012–13 ................................................. 64 Table 25 Lifestyle risk factors, AATSIHS 2012–13 .............................................................. 66 Table 26 Smoker status, AATSIHS 2012–13 ...................................................................... 67 Table 27 Health related actions, AATSIHS 2012–13 .......................................................... 68 Table 28 Chronic disease biomarkers, AATSIHS 2012–13 ................................................. 69 Table 29 Labour force status, AATSIHS 2012–13 .............................................................. 72 Table 30 Highest level of educational attainment, AATSIHS 2012–13 ................................ 73

Closing the Gap performance report 2014 - 1 -

Summary Closing the gap in life expectancy between Aboriginal and Torres Strait Islander people and other Queenslanders by 2033 and halving the Indigenous child mortality gap by 2018 are priority areas under the National Indigenous Reform Agreement (NIRA) and Making Tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033: policy and accountability framework.

Progress towards closing the health gap is monitored and reported through closing the gap performance reports developed and published annually by the Queensland Department of Health’s Aboriginal and Torres Strait Islander Health Unit. The Closing the Gap performance report 2014 charts progress in achieving health gains for Indigenous Queenslanders against a comprehensive suite of key performance indicators, targets and trajectories. The data contained in the report is used to set priorities, to inform investment decisions, and to plan service delivery at a statewide and Hospital and Health Service (HHS) level.

At a statewide level, progress has been achieved in the following areas:

mortality indicators—there have been gains against all mortality indicators. As a result, there has been a reduction in the life expectancy gap in Queensland from 11.8 years for males and 10 years for females in 2005–07 to 10.8 years for males and 8.6 years for females. The mortality rate trajectories for selected conditions indicate that Queensland is on track to achieve parity between Indigenous and non-Indigenous Queenslanders by 2033.

child mortality rates—Queensland is on track to achieve the NIRA target relating to child mortality rates.

antenatal visits—the rates of Indigenous women attending five or more antenatal visits increased from 77.8% in 2008–09 to 85.8% in 2013–14, resulting in a decrease of the gap from 16.5% to 9.7%.

surgical wait times—the number of days waiting per count decreased from 147.2 in December 2013 to 92.5 in September 2014.

Notwithstanding some HHS-specific improvement and modest statewide gains against certain indicators, areas of ongoing concern include:

obesity smoking rates smoking during pregnancy discharge against medical advice potentially preventable hospitalisations.

The dashboard on page two provides a snapshot of key findings against headline indicators.


Dashboard

Average life expectancy at birth 2010–12 Average life expectancy at birth 2010–12

68.7 74.4years years

up from 67.1 in 2005–07 up from 72.7 in 2005–07

dow n from 11.8 in 2005–07 dow n from 10 in 2005–07

Gap GapNSW

10.5 2005-2007 8.69.3 2010-2012 8.5

Qld11.8 2005-2007 10.010.8 2010-2012 8.6

WA14.7 2005-2007 12.915.1 2010-2012 13.5

NT14.0 2005-2007 11.614.4 2010-2012 14.4

10.8 year gap with non-Indigenous 8.6 year gap with non-Indigenous

68.370.5

67.168.7

64.565

61.563.4

78.879.8

78.879.4

79.280.1

75.577.8

Indigenous Non-Indigenous

7474.6

72.774.4

7070.2

69.468.7

82.683.1

82.783

82.983.7

8183.1

MalesLife expectancy

Females

Jurisdiction

2009–2013NSW

SA

dow n from 31.0 in 2005–2009 Qld

WA

NT

unchanged from 2005–2009

24.0

44.1

33.6

61.2

79.3

53.844.1

22.8 18.60

102030405060

2005–2009 2006–2010 2007–2011 2008–2012 2009–2013

Per 1

,000


Gap of 25.5deaths per 1,000

RR 2.4

Gap Trend JurisdictionChild mortality

Number of deaths per 1,000, 2009–2013

2011–2013NSW

WA

dow n from 7.1 in 1997–1999 SA

Qld

NT

dow n from 2.3 in 1997–1999

3.9

7.6

7.0

5.8

13.1

12.6

7.6 6.5

5.5 4.7 4.20.0

5.0

10.0

15.0

Per 1

,000


Gap of 2.3 deaths per 1,000

RR 1.5

Gap Trend JurisdictionInfant mortality

Number of deaths per 1,000, 2009–2013


TS-NP2013–14 Cape York

MackaySunshine Coast

Metro NorthDarling Downs

dow n from 16.8 in 2002-03 Central WestSouth West

Central QueenslandNorth West

Metro SouthWest Moreton

up from 0.82 in 2002-03 Cairns and HinterlandTownsville

Gold CoastWide Bay

Mackay2013–14 Sunshine Coast

TS-NPCentral WestMetro NorthMetro South

dow n from 6.3 in 2002-03 Cairns and HinterlandDarling Downs

Wide BayWest Moreton

Gold CoastCentral Queensland

dow n from 2.42 in 2002-03 TownsvilleCape York

North WestSouth West

Mackay2013–14 Townsville

Sunshine CoastMetro NorthGold Coast

Metro Southdow n from 35.2 in 2005-06 West Moreton

TS-NPNorth West

Cairns and HinterlandCentral Queensland

Wide Bayup from 2.86 in 2005-06 Central West

Darling DownsCape York

South West

Mackay2013–14 Sunshine Coast

Gold CoastTownsville

TS-NPWest Moreton

dow n from 32.9 in 2005-06 Metro NorthMetro South

Cairns and HinterlandNorth West

Central QueenslandCentral West

up from 2.91 in 2005-06 Wide BayCape York

Darling DownsSouth West

76.7 77.885.8

93.5 94.3 95.5

0

20

40

60

80

100

2002

-03

2003

-04

2004

-05

2005

-06

2006

-07

2007

-08

2008

-09

2009

-10

2010

-11

2011

-12

2012

-13

2013

-14

Per c

ent


Gap of 9.7per cent

RR 0.90

Antenatal visits

Child and maternal health

10.89.8 9.3

4.5 4.6 4.20

5

10

15

20

2002

-03

2003

-04

2004

-05

2005

-06

2006

-07

2007

-08

2008

-09

2009

-10

2010

-11

2011

-12

2012

-13

2013

-14

Per c

ent


Gap of 5.1per cent

RR 2.20

Low birth weight

9.2 (57)

11.3 (19)

10.8 (29)

6.7 (1)

9.3 (30)

10.5 (6)

3.5 (4)

6.7 (20)9.1 (32)

12.8 (24)13.3 (8)

5.5 (6)6.6 (14)

11.1 (47)

9.7 (18)9.3 (14)

Per cent (number), 2013–14

Bubble size represents number of low birth weight babies

54.2 53.7

46.4

18.9 17.811.7

0

10

20

30

40

50

60

2005

-06

2006

-07

2007

-08

2008

-09

2009

-10

2010

-11

2011

-12

2012

-13

2013

-14

Per c

ent


Gap of 34.8per cent

RR 3.98

Smoked during pregnancy

48.4 (306)

57.9 (99)

51.1 (140)

53.3 (8)55.2 (180)

42.4 (25)

36.0 (41)

42.2 (129)

43.8 (158)

47.9 (91)

65.0 (39)

37.8 (42)

44.4 (96)

36.4 (158)

44.1 (83)

53.2 (82)


Bubble size represents number of smokers during pregnancy

Gap Trend Jurisdiction

50.147.2

41.0

17.213.6

9.20

10

20

30

40

50

60

2005

-06

2006

-07

2007

-08

2008

-09

2009

-10

2010

-11

2011

-12

2012

-13

2013

-14

Per c

ent


Gap of 31.8per cent

RR 4.44

Smoked after 20 weeks gestation

41.3 (261)

50.3 (86)

46.4 (127)46.7 (7)

50.6 (165)

32.2 (19)

30.7 (35)

38.6 (118)38.8 (140)

45.8 (87)

63.3 (38)

31.5 (35)

34.7 (75)33.2 (144)

36.7 (69)

48.7 (75)


Bubble size represents number of smokers after 20weeks gestation

82.4 (501)

97.0 (159)

84.1 (222)

86.7 (13)88.8 (284)

79.3 (46)

95.6 (108)

91.6 (274)

83.2 (287)83.4 (156)

84.5 (49)

91.8 (101)

97.1 (200)

79.6 (336)

83.2 (153)

78.1 (118)


Bubble size represents number of women that attended five or more antenatal visits


2013–14NSW

Vicup from 358.8 in 2001-02 Qld

WA

SAup from 2.0 in 2001-02 NT

Gold CoastSunshine Coast

TS-NPCentral WestSouth West

West MoretonMetro South

MackayMetro North

Cape YorkWide Bay

Central QueenslandDarling Downs

Cairns and HinterlandNorth West

Townsville* Much of the "Factors influencing health status & contact with health servces (Z00-Z99)" chapter excess is from excess dialysis separations

703.0 779.1970.9

344.2 364.0 425.80

500

1,000

1,500

200

1-02

200

2-03

200

3-04

200

4-05

200

5-06

200

6-07

200

7-08

200

8-09

200

9-10

201

0-11

201

1-12

201

2-13

201

3-14

ASR

per

100

,000

Indigenous ASR Non-Indigenous ASR

678.3 (78,647)

778.5 (19,280)

917.2 (94,505)

1,613.6 (77,938)

1,233.1 (24,092)

1,911. (83,122)

ASR per 1,000 (number of separations), 2012–13

Bubble size represents number of Indigenous separations

1,055.5 (17,889)

781.8 (4,602)

841.2 (5,455)

487.5 (384)

893.9 (6,418)

365.8 (1,537)

644.4 (2,841)678.5 (5,737)

634.5 (7,729)

1,367.9 (7,572)

587.8 (1,460)

373.2 (1,633)385.0 (2,698)

1,801.5 (14,866)

613.6 (2,802)

804.9 (3,380)

Bubble size represents number of Indigenous separations

ASR per 1,000 (average number of separations per year),2009–10 to 2013–14

66%10%

7%

6%5%

6%

2009–10 to 2013–14

Factors influencing health status & contact with health servces (Z00-Z99)*External causes of Morbidity & Mortality (V00-Y89)Injury, poisoning & certain other consequences of external causes (S00-T98)Pregnancy, childbir th & the puerperium (O00-O99)Diseases of the respiratory system (J00-J99)Other

Gap of 545.1 separations per

1,000

RR 2.3

Gap Trend JurisdictionAll cause hospital separations

Hospital and Health Service Excess separations

2010NSW

SAdow n from 536.2 in 2002 Qld

WA

NTdow n from 1.8 in 2002

Sunshine CoastWide Bay

Metro NorthGold Coast

TS-NPCentral Queensland

Central WestMetro South

Cape YorkMackay

West MoretonSouth West

Darling DownsCairns and Hinterland

Townsville

North West

1,192.4

913.5 896.5

656.2 609.0 577.7

0

500

1,000

1,500

2002

2003

2004

2005

2006

2007

2008

2009

2010

ASR

per

100

,000

Indigenous ASR actuals Non-Indigenous ASR Actuals

962 (2,903)

1,089 (3,031)

1,431 (2,230)

1,060 (710)

1,541 (2,258)

Bubble size represents number of deaths

ASR per 100,000 (number of deaths), 2006–2010

528.2 (49)570.2 (81)

707. (169)770.4 (73)

789.9 (175)801.9 (156)811.8 (20)

852.8 (291)862.9 (152)

929.2 (118)950.9 (107)

1,024.1 (77)1,043.4 (176)

1,060.2 (540)1,218.6 (357)

1,504.1 (307)

ASR per 100,000 (number of deaths), 2006–2010ASR per 100,000

Bubble size represents number of deaths

CVD caused26% of deaths

Respiratory diseases caused 15% of deaths

Endocrine diseases caused10% of deaths

External causescaused13% of deaths

Other36%

2006–10

Gap of 318.8 deaths per

100,000

RR 1.6

Gap Trend JurisdictionAll cause mortality

Hospital and Health Service Major causes


`

Psychiatry - AcuteRenal Dialysis

Non Subspecialty MedicineRespiratory Medicine

Qualified NeonateNon Subspecialty Surgery

OrthopaedicsTracheostomy

NeurologyCardiology

RehabilitationImmunology & Infections

Upper GIT SurgeryVascular SurgeryCardiac Surgery

2013–14

$245.6 million

is the estimated cost to the public inpatient

hospital system of the gap in health status betw een Aboriginal and Torres Strait Islander and non-

Indigenous Queenslanders.

$216.1 million

$225.6 million

$245.6 million

$324.3 million

$337.7 million

$361.0 million

$108.3 million

$112.1 million

$115.4 million

201

1-12

201

2-13

201

3-14

Growth 2011–12 to 2013–14Purchase cost growth - 11%Excess cost growth - 14%Expected cost growth - 7%

Purchase

Excess

Expected

Excess cost of purchases

$22.3 (2,123)

$21.6 (36,337)

$17.7 (5,677)

$17.0 (4,496)

$14.2 (4,574)

$12.7 (5,655)

$12.1 (3,383)

$12.0 (131)

$11.7 (2,660)

$10.4 (4,086)

$9.8 (631)

$9.7 (2,710)

$6.0 (1,297)

$6.0 (527)

$5.5 (168)

$million (number of separations), 2013–14

Bubble size represents number of separations

Excess cost Trend Major SRG contributors


Policy context Progress towards closing the health gap for Aboriginal and Torres Strait Islander Queenslanders is reported on an annual basis to the Minister for Health and Minister for Ambulance Services, and Health Service Chief Executives (HSCEs).

Progress in closing the health gap for Indigenous Queenslanders is monitored through a number of indicator frameworks which operate at a national, state and a HHS level. These are:

1. The National Indigenous Reform Agreement (NIRA), which commits all jurisdictions to closing the health gap through the achievement of two Council of Australian Government’s (COAG) health targets—to close the life expectancy gap within a generation (by 2033) and to halve the gap in mortality rates for Indigenous children under five years of age within a decade (by 2018).

2. Aboriginal and Torres Strait Islander Health Performance Framework Report (HPF) has been published nationally every two years from 2006. Jurisdictional reports are also provided every two years. Data included in this report is sourced from the 2012 Queensland HPF Report (the most recent available).

3. The Making Tracks toward closing the gap in health outcomes for Indigenous Queenslanders by 2033: policy and accountability framework.

4. Individual HHS service agreement Aboriginal and Torres Strait Islander key performance indicators (KPIs): a) discharge against medical advice (DAMA) b) potentially preventable hospitalisations (PPH).

5. The Queensland Health Aboriginal and Torres Strait Islander health KPIs and trajectories reported annually at a HHS level.

Performance indicators

This performance report underpins and informs the Queensland Government’s Aboriginal and Torres Strait Islander health investment strategy and incorporates:

the two key COAG NIRA targets: – close the life expectancy gap within a generation – halve the gap in mortality rates for Indigenous children under five years of age within

a decade mortality trajectories to track progress against key drivers of Indigenous mortality,

particularly those conditions which contribute to the life expectancy gap: – circulatory disease (ischaemic heart disease, stroke) – respiratory disease (chronic lower respiratory disease) – endocrine disease (diabetes) – accident and injury (stroke) – suicide – avoidable mortality (mortality due to preventable conditions)

child mortality rates: – neonatal mortality

http://www.federalfinancialrelations.gov.au/content/npa/healthcare/national-agreement.pdf

http://www.health.gov.au/internet/main/Publishing.nsf/Content/F766FC3D8A697685CA257BF0001C96E8/$File/hpf-2012.pdf

http://www.health.qld.gov.au/atsihealth/documents/makingtracks/making_tracks_pol.pdf

http://www.health.qld.gov.au/atsihealth/documents/makingtracks/making_tracks_pol.pdf


– infant mortality – child mortality (0-4 years) – child mortality (1-4 years) – perinatal mortality (neonatal mortality and stillbirths) – stillbirths – post-neonatal mortality

child and maternal health data: – rate of more than five antenatal visits – low birth weight babies – smoking rates for women who are pregnant – smoking rates at 20 weeks for women who are pregnant

Aboriginal and Torres Strait Islander KPIs in the 2013−14 HHS service agreements: – DAMA – PPH

equity of access to health services: – national elective surgery targets (NEST) – national emergency access targets (NEAT)

weighted activity units (WAUs): – excess costs of purchases

immunisation rates: – 12 - <15 months – 24 - <27 months – 60 - <63 months

hospital separations: – priority heat maps – priority conditions – condition specific analysis

2012–13 Australian Aboriginal and Torres Strait Islander Health Survey results.

Performance context While the main purpose of this report is to report performance against these KPIs at a system wide (state) level, this report also includes a comparative ranking of HHS regions against a number of the indicators identified above. The purpose of this is to provide some indication of relative health needs across HHS regions1, thereby allowing for more targeted and effective use of resources, and to allow for a comparative assessment of individual HHS performance against selected KPIs.

1 Although the Cape York and Torres Strait and Northern Peninsula Area HHSs merged at 1 July 2014, data for these two regions continue to be reported separately in Indigenous health performance reports in order to aid planning and priority setting within the HHS.


The presentation of performance data across a comprehensive set of indicators at both a state and HHS level allows for a more detailed monitoring of activity within Queensland towards closing the health gap and achieving sustainable health gains for Indigenous Queenslanders. Improved performance against any of the indicators is expected to have a positive contribution to the higher level outcome indicators of life expectancy at birth and child mortality rates.

Performance challenges The majority of indicators are derived from existing administrative morbidity (Queensland Hospital Admitted Patients Data Collection [QHAPDC]), mortality (Registrar General of Births, Deaths and Marriages in each jurisdiction) and perinatal data collections (PDC). Consequently, many of the indicators provide a report against activity, (particularly the morbidity and perinatal indicators) rather than a picture of the true incidence and prevalence of disease within the Aboriginal and Torres Strait Islander population of Queensland.

To address the absence of incidence and prevalence data to monitor Aboriginal and Torres Strait Islander health in Queensland, the Queensland Department of Health has undertaken a Queensland-based refresh of the Burden of Disease and Injury in Aboriginal and Torres Strait Islander People report (undertaken by the University of Queensland and released in 2007).

The work is being undertaken in partnership between the Aboriginal and Torres Strait Islander Health Unit, the Health Statistics Unit and La Trobe University. A refresh of this study will allow for the development of Queensland and remoteness estimates of prevalence, incidence, fatal and non-fatal cause-specific contribution to the burden of disease and health adjusted life expectancy for Aboriginal and Torres Strait Islander people.

Burden of disease methodology is a World Health Organization internationally accepted way of quantifying the health status of populations. It provides a richer picture of the health of a population than individual health measures, such as mortality and morbidity. It also allows for more comprehensive monitoring of disease and changes in patterns of disease at whole-of-population and sub-group levels.

The first report on the Burden of disease and injury in Queensland's Aboriginal and Torres Strait Islander people was published in 2014 and a revised report will be published in 2015.

http://www.health.qld.gov.au/atsihealth/documents/burden_of_disease.pdf

http://www.health.qld.gov.au/atsihealth/documents/burden_of_disease.pdf


Population As a result of the 2011 census, the estimated resident populations of Queensland were revised.

Table 1 Estimated resident population, 2013

Status 2001 2006 2011 2012 2013 Indigenous 143,545 166,304 188,952 193,506 198,206 Non-Indigenous 3,427,924 3,841,688 4,287,826 4,374,699 4,458,597 Total 3,571,469 4,007,992 4,476,778 4,568,205 4,656,803 Indigenous % of total 4.00% 4.10% 4.20% 4.20% 4.30%

Source: Government Statistician, Queensland Treasury and Trade, October 2013

In 2013 the estimated resident Queensland Indigenous population was 198,206, and the non-Indigenous population was 4,458,597. In 2013, 4.3% of the Queensland population was Indigenous.

Table 2 Estimated resident population, 2013 – by age, sex and Indigenous status Indigenous Non-Indigenous Indigenous % Non-Indigenous % Age group Female Male Female Male Female Male Female Male 0-4 12,408 13,020 141,625 148,977 12.50% 13.20% 6.30% 6.70% 5-9 11,852 12,167 138,548 147,380 11.90% 12.30% 6.20% 6.60% 10-14 11,214 11,549 133,999 141,613 11.30% 11.70% 6.00% 6.40% 15-19 10,637 11,219 139,868 146,605 10.70% 11.40% 6.30% 6.60% 20-24 9,029 9,493 156,529 158,911 9.10% 9.60% 7.00% 7.10% 25-29 7,332 7,200 161,773 163,761 7.40% 7.30% 7.20% 7.40% 30-34 6,280 6,144 155,281 155,410 6.30% 6.20% 6.90% 7.00% 35-39 5,720 5,485 151,132 148,694 5.70% 5.60% 6.80% 6.70% 40-44 6,227 5,624 165,045 162,318 6.30% 5.70% 7.40% 7.30% 45-49 4,959 4,806 150,754 148,038 5.00% 4.90% 6.70% 6.70% 50-54 4,409 3,942 153,065 149,531 4.40% 4.00% 6.80% 6.70% 55-59 3,281 3,107 135,610 133,044 3.30% 3.10% 6.10% 6.00% 60-64 2,464 2,105 121,611 122,029 2.50% 2.10% 5.40% 5.50% 65-69 1,614 1,399 106,334 107,610 1.60% 1.40% 4.80% 4.80% 70-74 978 741 75,885 75,649 1.00% 0.80% 3.40% 3.40% 75-79 545 393 55,830 51,734 0.50% 0.40% 2.50% 2.30% 80-84 338 210 44,055 34,782 0.30% 0.20% 2.00% 1.60% 85+ 212 103 48,237 27,330 0.20% 0.10% 2.20% 1.20%

Total 99,499 98,707 2,235,181 2,223,416 100.00%

100.00% 100.00% 100.00%

Source: Government Statistician, Queensland Treasury and Trade, October 2013


Figure 1 Estimated resident population, 2013 – Queensland Indigenous and non-Indigenous population pyramid

The age distribution shows a much younger Indigenous population compared to the non-Indigenous population. The Indigenous age distribution follows that of a developing country distribution, with high fertility and mortality rates, whereas the non-Indigenous population distribution follows a developed country distribution, with low fertility and mortality rates.

In 2013, the under-15 age groups made up 36.4% and 19.1% of the Indigenous and non-Indigenous populations respectively. The 15 to 64 age groups comprised 60.3% of the Indigenous population and 66.8% of the non-Indigenous population. The over 65 year age group comprised 3.3% of the Indigenous population and 14.1% of the non-Indigenous population.

15 10 5 0 5 10 15

00-0405-0910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Male percentage Female precentage

Age

Gro

ups

non-Indigenous Indigenous


Council of Australian Governments target: life expectancy Table 3 Life expectancy at birth (years), 2005−07 to 2010−12

Key points There is a significant gap in life expectancy between Indigenous and non-Indigenous

people in Queensland. For the 2010–12 period the life expectancy gap for Indigenous Queenslanders was 10.8

years for males and 8.6 years for females. This was a reduction from 2005–07, where the gap in life expectancy was 11.8 years for

males and 10 years for females, a gain of 1 year for males and 1.4 years for females. This trend suggests that the impact of significant investments under the COAG

Indigenous health national partnership agreements is starting to take effect and Queensland is making progress towards closing the gap in life expectancy for Aboriginal and Torres Strait Islander people.

2005-2007 2010-2012Change 2005-2007 to 2010-

2012Indigenous Non-Indigenous Gap Indigenous Non-Indigenous Gap Indigenous Non-Indigenous Gap

MalesQld 67.1 78.8 11.8 68.7 79.4 10.8 1.6 0.6 -1.0

NSW 68.3 78.8 10.5 70.5 79.8 9.3 2.2 1.0 -1.2WA 64.5 79.2 14.7 65.0 80.1 15.1 0.5 0.9 0.4NT 61.5 75.5 14.0 63.4 77.8 14.4 1.9 2.3 0.4

Aust 65.7 78.9 13.1 67.4 79.8 12.4 1.7 0.9 -0.7

FemalesQld 72.7 82.7 10.0 74.4 83.0 8.6 1.7 0.3 -1.4

NSW 74.0 82.6 8.6 74.6 83.1 8.5 0.6 0.5 -0.1WA 70.0 82.9 12.9 70.2 83.7 13.5 0.2 0.8 0.6NT 69.4 81.0 11.6 68.7 83.1 14.4 -0.7 2.1 2.8

Aust 71.7 82.7 11.0 72.3 83.2 10.9 0.6 0.5 -0.1


Cause specific mortality Figure 2 Mortality – 2002 to 2010: all cause, circulatory, ischaemic heart disease

All cause Circulatory Ischaemic Heart Disease(I00-I99) (I20-I25)

Year 2002 2010 2002 2010 2002 2010Indigenous Deaths 604 615 164 147 94 86

100% 100% 27% 24% 16% 14% Age standardised rates per 100,000

Indigenous

Rate Ratio (I:NI) 1.8 1.6 1.5 1.3 1.5 1.5Gap (I-NI) 536 319 126 57 74 49

Non-Indigenous

Age specific rates per 100,000, 2008-2010

2001-2003 2008-2010 2001-2003 2008-2010 2001-2003 2008-2010

% of Indigenous deaths

Indigenous

% Deaths aged under 50 years

Non-Indigenous

0

200

400

600

800

1,000

1,200

1,400

1,600

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

Indigenous ASR actualsIndigenous TrajectoryNon-Indigenous Trajectory

1,192896

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

00-0

4

10-1

4

20-2

4

30-3

4

40-4

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50-5

4

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4

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4

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4

IndigenousNon-indigenous

379 244

0

100

200

300

400

500

600

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

214 141

0

50

100

150

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250

300

350

400

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

656 578253 187 139 92

42.6% 37.4%

9.1% 8.0%

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

00-0

4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4


0

500

1,000

1,500

2,000

2,500

3,000

00-0

4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4


28.0% 29.7%

2.6% 2.8%

26.9% 30.0%

2.4% 2.6%


Key points

All-cause mortality All-cause mortality has declined from 1,192 deaths per 100,000 people in 2002 to 896

deaths per 100,000 people in 2010. There has been a subsequent narrowing of the gap from 536 to 319 deaths per 100,000

people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 1.8 to 1.6. The trajectory indicates the reduction in all-cause mortality is on target to achieve parity

with the non-Indigenous population by 2033. In 2001–2003, 42.6% of deaths occurred in people aged less than 50 years (compared to

9.1% for non-Indigenous people). This figure reduced to 37.4% in 2008–2010.

Circulatory mortality Circulatory mortality has declined from 379 deaths per 100,000 people in 2002 to 244


people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 1.5 to 1.3. The trajectory indicates the reduction in circulatory mortality is on target to achieve parity

with the non-Indigenous population by 2033. In 2001–2003, 28.0% of deaths occurred in people aged less than 50 years (compared to

2.6% for non-Indigenous people). This figure increased to 29.7% in 2008–2010.

Ischaemic heart disease mortality Ischaemic heart disease mortality has declined from 214 deaths per 100,000 people in

2002 to 141 deaths per 100,000 people in 2010. There has been a subsequent narrowing of the gap from 74 to 49 deaths per 100,000

people. The rate ratio of Indigenous to non-Indigenous deaths has remained stable at 1.5. The trajectory indicates the reduction in ischaemic heart disease mortality is on target to

achieve parity with the non-Indigenous population by 2033. In 2001–2003, 26.9% of deaths occurred in people aged less than 50 years (compared to



Figure 3 Mortality – 2002 to 2010: stroke, respiratory, chronic lower respiratory

Stroke Respiratory Chronic lower respiratory(I60-I69) (J00-J99) (J40-J47)



Indigenous

Rate Ratio (I:NI) 0.9 0.9 2.3 1.7 3.2 2.1Gap (I-NI) -5 -7 73 31 71 30

Non-Indigenous


2001-2003 2008-2010 2001-2003 2008-2010 2001-2003 2008-2010

Non-Indigenous


Indigenous


0

30

60

90

120

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

Indigenous ASR actualsIndigenous Trajectory

0

50

100

150

200

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

0

40

80

120

160

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

5941

129

79104

57

6448 56 48 33 27

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

00-0

4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4


0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

00-0

4

10-1

4

20-2

4

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4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4


0

200

400

600

800

1,000

1,200

1,400

00-0

4

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4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4


14.5%20.3%

1.9% 2.1%

27.0% 20.4%

2.5% 2.7%

15.6%6.2%

2.0% 2.1%


Key points

Stroke mortality Stroke mortality has declined from 59 deaths per 100,000 people in 2002 to 41 deaths

per 100,000 people in 2010. There is no gap in stroke mortality between Indigenous and non-Indigenous

Queenslanders. The rate ratio of Indigenous to non-Indigenous deaths is 0.9, suggesting slightly fewer

stroke related deaths for Indigenous Queenslanders. Currently, there is parity for stroke mortality with the non-Indigenous population. In 2001–2003, 14.5% of deaths occurred in people aged less than 50 years (compared to


Respiratory disease mortality Respiratory disease mortality has declined from 129 deaths per 100,000 people in 2002

to 79 deaths per 100,000 people in 2010. There has been a subsequent narrowing of the gap from 73 to 31 deaths per 100,000

people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 2.3 to 1.7. The trajectory indicates the reduction in respiratory disease mortality is on target to



Chronic lower respiratory disease mortality Chronic lower respiratory disease mortality has declined from 104 deaths per 100,000

people in 2002 to 57 deaths per 100,000 people in 2010. There has been a subsequent narrowing of the gap from 71 to 30 deaths per 100,000

people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 3.2 to 2.1. The trajectory indicates the reduction in chronic lower respiratory disease mortality is on

target to achieve parity with the non-Indigenous population by 2033. In 2001–2003, 15.6% of deaths occurred in people aged less than 50 years (compared to



Figure 4 Mortality – 2002 to 2010: endocrine, type 2 diabetes, external causes

Endocrine Type 2 Diabetes External causes(E00-E89) (E11) (V00-Y89)



Indigenous

Rate Ratio (I:NI) 7.9 4.8 13.2 6.7 2.1 1.3Gap (I-NI) 145 80 68 36 46 12

Non-Indigenous


2001-2003 2008-2010 2001-2003 2008-2010 2001-2003 2008-2010

Non-Indigenous


Indigenous


0

50

100

150

200

250

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032


0

30

60

90

120

150

2002

2005

2008

2011

2014

2017

2020

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2026

2029

2032

0

40

80

120

160

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032

166

10173

42

8651

21 21 6 640 39

0

500

1,000

1,500

2,000

2,500

00-0

4

10-1

4

20-2

4

30-3

4

40-4

4

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4

60-6

4

70-7

4

80-8

4

Indigenous

Non-indigenous

0

100

200

300

400

500

600

700

800

00-0

4

10-1

4

20-2

4

30-3

4

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4

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4

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4

80-8

4

Indigenous

Non-indigenous

0

100

200

300

400

500

600

00-0

4

10-1

4

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4

30-3

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4

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4

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4

80-8

4

Indigenous

Non-indigenous

88.8% 87.3%

56.1%46.7%

14.9% 11.3%

0.7% 0.4%

16.2% 16.8%

5.8% 3.7%


Key points

Endocrine mortality Endocrine mortality has declined from 166 deaths per 100,000 people in 2002 to 101


people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 7.9 to 4.8. The trajectory indicates the reduction in endocrine disease mortality is on target to



Type 2 diabetes mortality Type 2 diabetes mortality has declined from 73 deaths per 100,000 people in 2002 to 42


people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 13.2 to 6.7. The trajectory indicates the reduction in type 2 diabetes mortality is on target to achieve

parity with the non-Indigenous population by 2033. In 2001–2003, 14.9% of deaths occurred in people aged less than 50 years (compared to


External cause mortality External cause mortality has declined from 86 deaths per 100,000 people in 2002 to 51


people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 2.1 to 1.3. The trajectory indicates the reduction in external cause mortality is on target to achieve

parity with the non-Indigenous population by 2033. In 2001–2003, 88.8% of deaths occurred in people aged less than 50 years (compared to



Figure 5 Mortality – 2002 to 2010: suicide

Suicide(X60-X84 or Y87.0)

Year 2002 2010Indigenous Deaths 37 22

6% 4% Age standardised rates per 100,000

Indigenous

Rate Ratio (I:NI) 2.3 1.5Gap (I-NI) 17 7

Non-Indigenous


2001-2003 2008-2010

Non-Indigenous


Indigenous


0

10

20

30

40

50

2002

2005

2008

2011

2014

2017

2020

2023

2026

2029

2032


30 19

13 12

92.7% 96.4%

70.4% 62.4%

0

20

40

60

80

100

120

140

160

00-0

4

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4

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4

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4

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4

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4

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4

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4

80-8

4

Indigenous

Non-indigenous


Key points

Suicide Suicide has declined from 30 deaths per 100,000 people in 2002 to 19 deaths per

100,000 people in 2010. There has been a subsequent narrowing of the gap from 17 to 7 deaths per 100,000

people. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 2.3 to 1.5. In 2001–2003, 92.7% of deaths occurred in people aged less than 50 years (compared to



Council of Australian Governments target: child mortality Table 4 Child, infant and perinatal mortality indicators by Indigenous status,

Queensland, 2008–2012

Indigenous count

Indigenous rate

Non- Indigenous

count

Non- Indigenous

rate Rate ratio

Child 0-4 mortality (rate per 100,000)

217 211 1537 106.1 2 (43/year) (307/year)

Child 1-4 mortality 35 NFP 217 NFP NFP (7/year) (43/year) Infant 0-1 mortality (rate per 1,000 live births)

182 6.9 1320 4.5 1.5 (36/year) (264/year) Neonatal deaths – first 28 days of life (rate per 1,000 live births)

122 4.7

972 3.3 1.4 (24/year) (194/year)

Post-neonatal deaths 60 NFP 348 NFP NFP (12/year) (70/year)

Perinatal deaths 288 11.1 2914 9.8 1.1 (58/year) (583/year)

Still birth 166 6.4 1942 6.5 1 (39/year) (388/year)

Source: all figures are sourced from the 2015 Report of Government Services (ROGS) over the 2008–12 timeframe. Infant/child mortality statistics sourced from table EA.55. Neonatal/perinatal/fetal statistics sourced from table 11A.123. Note: the table above has been updated for the period 2008–2012, however, please note the disaggregated single year detailed analysis below has not been released at time of publishing.

Key points In Queensland, the Indigenous mortality rate for children under five years of age is twice

the non-Indigenous (two times the rate for the period 2008–2012). The bulk of child mortality occurs during the first year of life, and in particular within the

first 28 days, where Indigenous mortality is over 1.4 times the non-Indigenous rate. Maternal factors and complications of pregnancy, labour and delivery as well as disorders

related to length of gestation affecting the growth of the foetus and new born babies have been identified as leading causes of infant mortality.

External causes become by far the leading causes of mortality once a baby reaches one year of age.

Currently Queensland is on target to achieve a halving of the rate in Indigenous mortality for children aged 0-4 years by 2018. However, it is important that effort to sustain these improvements is maintained.

From the period 2004–08 to 2008–12, there have been reductions in Indigenous perinatal mortality from 14.1 per 1,000 births to 11.1 per 1,000 births. This was largely due to reductions in fetal mortality (8.2 to 6.4) and neonatal mortality (6 to 4.7).


Figure 6 Infant mortality rates, Queensland, 2002 to 2010 and trajectory to 2025

Figure 7 Child mortality rates, Queensland, 2002 to 2010 and trajectory to 2025

Figure 8 Perinatal mortality, Queensland rolling five year rates, 2002 to 2010

COAG Target

0

2

4

6

8

10

12

14

Rate

per

1,0

00

Indigenous observed Non-Indigenous Trajectory Indigenous Trajectory

COAG Target

0

50

100

150

200

250

300

350

Rate

per

100

,000

Indigenous Actuals Indigenous Trajectory Non-Indigenous Trajectory

0.0

4.0

8.0

12.0

16.0

Rate

per

1,0

00

Fetal Indigenous Fetal Non-IndigenousNeonatal Indigenous Neonatal Non-IndigenousPerinatal Indigenous Perinatal Non-Indigenous


Figure 9 Distribution of child deaths by cause and age at death, 2006 to 2010

0 10 20 30 40 50 60

Perinatal period

Congenital malformations

Signs, symptoms & ill-defined

Injury & poisoning

Respiratory system

Circulatory system

Infectious and parasitic diseases

Other conditions

Percentage

Infant <1year Child 1-4 years


Child mortality Figure 10 Child mortality – 2002 to 2011: neonatal, infant and child mortality

Neonatal mortality Infant mortality (<28 days of age) (<1 years of age)

Crude rate per 1,000Year 2002 2011 2002 2010

Indigenous

Rate Ratio (I:NI) 2.4 2.6 1.9 1.8Gap (I-NI) 4.6 4.5 4.3 3.8

Non-Indigenous

Child mortality Child mortality(1-4 years of age) (0-4 years of age)

Crude rate per 1,000Year 2002 2011 2002 2010

Indigenous


Non-Indigenous

0

5

10

15

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011


7.8 7.4

3.2 2.9

9.2 8.7

4.9 4.9

0.3 0.2

0.3 0.1

0

5

10

15

20

2002

2003

2004

2005

2006

2007

2008

2009

2010


0.0

0.5

1.0

1.5

2.0

2002

2003

2004

2005

2006

2007

2008

2009

2010


2.1 2.0

1.2 1.1

0.0

1.0

2.0

3.0

4.0

5.0

2002

2003

2004

2005

2006

2007

2008

2009

2010



Key points

Neonatal mortality Neonatal mortality has had a very slight decline from 7.8 deaths per 1,000 live births in

2002 to 7.4 deaths per 1000 live births in 2010. There has been a very slight narrowing of the gap from 4.6 to 4.5 deaths per 1,000 live

births. The rate ratio of Indigenous to non-Indigenous deaths has increased slightly from 2.4 to

2.6.

Infant mortality Infant mortality has had a very slight decline from 9.2 deaths per 1,000 infants in 2002 to

8.7 deaths per 1000 infants in 2010. There has been a subsequent narrowing of the gap from 4.3 to 3.8 deaths per 1,000

infants. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 1.9 to 1.8.

Child mortality (1-4 years of age) Child mortality (1-4 years of age) has declined from 0.3 deaths per 1,000 people aged 1-4

years in 2002 to 0.2 deaths per 1,000 people aged 1-4 years in 2010. The gap changed from 0.0 to 0.1. The rate ratio for Indigenous to non-Indigenous has increased from 1.0 to 1.7

Child mortality (0-4 years of age) Child mortality has declined slightly from 2.1 deaths per 1,000 people aged 0-4 years in

2002 to 2.0 deaths per 1,000 people in 2010. The gap changed from 0.9 to 1.0. The rate ratio of Indigenous to non-Indigenous deaths changed from 1.8 to 1.9.


Figure 11 Child mortality – 2002 to 2011: perinatal, stillborn and post-neonatal mortality

Perinatal mortality Stillborn (<28 days of age and stillbirths)Crude rate per 1,000

Year 2002 2011 2002 2010

Indigenous


Non-Indigenous

Post-Neonatal mortality(≥28 days of age)

Crude rate per 1,000Year 2002 2011

Indigenous

Rate Ratio (I:NI) 3.8 2.8Gap (I-NI) 4.4 2.4

Non-Indigenous

0.0

5.0

10.0

15.0

20.0

25.0

30.0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011


19.1 17.2

9.5 9.2

11.4 9.0

6.3 6.2

0.0

5.0

10.0

15.0

20.0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011


6.0 3.7

1.6 1.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

2002

2003

2004

2005

2006

2007

2008

2009

2010



Key points

Perinatal mortality Perinatal mortality has had a very slight decline from 19.1 deaths per 1,000 births in 2002

to 17.2 deaths per 1,000 births in 2010. There has been a very slight narrowing of the gap from 9.6 to 8.0 deaths per 1,000 births. The rate ratio of Indigenous to non-Indigenous deaths has decreased slightly from 2.0 to

1.9.

Fetal death (stillbirth) Fetal death has had a decline from 11.4 deaths per 1,000 births in 2002 to 9.0 deaths per

1,000 births in 2010. There has been a subsequent narrowing of the gap from 5.1 to 2.8 deaths per 1,000

births. The rate ratio of Indigenous to non-Indigenous deaths has reduced from 1.8 to 1.4.

Post neo-natal mortality (>28 days of age) Post neonatal mortality (>28 days of age) has declined from 6.0 deaths per 1,000 infants

aged 1 month to 1 year in 2002 to 3.7 deaths per 1,000 infants aged 1 month to 1 year in 2010.

There has been a subsequent narrowing of the gap from 4.4 to 2.4 deaths per 1,000 infants aged 1 month to 1 year.

The rate ratio for Indigenous to non-Indigenous deaths has decreased from 3.8 to 2.8.


Performance indicators

Child and maternal health indicators Figure 12 Child and maternal health indicators – 2007−08 to 2013−14: antenatal visits,

low birth weight, smoking during pregnancy

Antenatal visits Low Birthweight

2007-08 2013-14Absolute

differenceRR (13-14:

07-08)2007-08 2013-14

Absolute difference

RR (13-14: 07-08)

Indigenous 77.6 85.8 8.2 1.11 Indigenous 9.4 9.3 -0.1 0.99Non-Indigenous 94.1 95.5 1.5 1.02 Non-Indigenous 4.4 4.2 -0.2 0.96

Gap (NI-I) 16.4 9.7 Gap (I-NI) 5.0 5.1RR (I:NI) 0.83 0.90 RR (I:NI) 2.13 2.20

2013-14 2013-143,504 women gave birth 3,547 babies born

3,007 (85.8%) women attended 5 or more antenatal visits 329 (9.3%) babies were of low birth weight

Needed 27 extra women attending to be on track Needed 19 fewer low birthweight babies to be on track

Smoked at any stage Smoked after 20 weeks gestation

2007-08 2013-14Absolute

differenceRR (13-14:

07-08)2007-08 2013-14

Absolute difference

RR (13-14: 07-08)

Indigenous 53.4 46.4 -6.9 0.87 Indigenous 47.2 41.0 -6.2 0.87Non-Indigenous 17.6 11.7 -5.9 0.66 Non-Indigenous 14.6 9.2 -5.3 0.63

Gap (I-NI) 35.8 34.8 Gap (I-NI) 32.6 31.8RR (I:NI) 3.04 3.98 RR (I:NI) 3.24 4.44

2013-14 2013-143,611 women gave birth 3,611 women gave birth

1,677 (46.4%) women smoked during pregnancy 1,481 (41%) women smoked after 20 weeks gestation

Needed 108 fewer women smoking to be on track Needed 58 fewer women smoking to be on track

Proportions, gaps, and rate ratios Proportions, gaps, and rate ratios

Indicator: Aboriginal and Torres Strait Islander women who attended 5 or more antenatal visits during pregnancy

Indicator: Proportion of babies born of low birthweight to Aboriginal and Torres Strait Islander women (<2500g at birth)

Proportions, gaps, and rate ratios Proportions, gaps, and rate ratios

Indicator: Aboriginal and Torres Strait Islander women who smoked at any stage during pregnancy

Indicator: Aboriginal and Torres Strait Islander women who were smoking after 20 weeks gestation

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Key points

Antenatal visits Rates of women who attended more than five antenatal visits have increased from 77.6%

in 2007–08 to 85.8% in 2013–14, an absolute increase of 8.2%. The non-Indigenous to Indigenous gap has decreased from 16.4% to 9.7%. The rate ratio of Indigenous to non-Indigenous rates has increased from 0.83 to 0.90.

Low birth weight babies There was a change in the rate of low birth weight babies from 2007–08 (9.4%) to 2013–

14 (9.3%). The Indigenous to non-Indigenous rate difference changed from 5.0% to 5.1%. The rate ratio of Indigenous to non-Indigenous rates has increased from 2.13 to 2.20.

Smoking at any stage during pregnancy Rates of women who were pregnant and smoking at any stage of their pregnancy

decreased from 53.4% in 2007–08 to 46.4% in 2013–14, an absolute decrease of 6.9%. The Indigenous to non-Indigenous gap has remained constant at approximately 35%. The rate ratio of Indigenous to non-Indigenous rates has increased from 3.04 to 3.98.

Smoking after 20 weeks gestation Rates of women who were pregnant and smoking after 20 weeks gestation decreased

from 47.2% in 2007–08 to 41% in 2013–14, an absolute decrease of 6.2%. The Indigenous to non-Indigenous gap has remained constant at approximately 32%. The rate ratio of Indigenous to non-Indigenous rates has increased from 3.24 to 4.44.


Aboriginal and Torres Strait Islander HHS service agreement key performance indicators – traffic light report Table 5 DAMA and PPH quarterly rates by Hospital and Health Service

DAMA HHS Sep-13 Target Dec-13 Target Mar-14 Target Jun-14 Target Cairns and Hinterland 2.63% 2.60% 2.70% 2.20% 2.78% 1.80% 3.08% 1.40% Cape York 0.97% 2.00% 3.20% 1.70% 1.23% 1.40% 1.78% 1.10% Central Queensland 3.87% 3.10% 2.30% 2.80% 5.01% 2.40% 3.19% 2.10% Central West 3.70% 1.40% 4.30% 1.30% 0.00% 1.20% 3.33% 1.10% Darling Downs 4.52% 3.50% 5.00% 2.90% 4.18% 2.40% 4.08% 1.80% Gold Coast 1.98% 1.60% 2.20% 1.30% 0.77% 1.10% 2.50% 0.90% Mackay 1.08% 1.40% 2.50% 1.40% 1.82% 1.40% 1.41% 1.40% Metro North 3.38% 3.70% 4.30% 3.20% 4.37% 2.60% 4.17% 2.10% Metro South 3.89% 2.80% 3.10% 2.40% 3.59% 2.00% 3.04% 1.60% North West 4.53% 5.20% 4.40% 4.40% 4.15% 3.50% 3.99% 2.70% South West 2.86% 4.60% 5.70% 3.60% 2.67% 2.60% 8.33% 1.60% Sunshine Coast 1.88% 1.70% 2.50% 1.50% 1.41% 1.40% 2.03% 1.20% Torres Strait-Northern Peninsula 0.47% 0.80% 1.20% 0.80% 0.34% 0.80% 0.00% 0.80%

Townsville 4.88% 4.10% 4.60% 3.40% 6.42% 2.70% 5.29% 2.00% West Moreton 3.35% 2.50% 6.00% 2.20% 4.51% 1.80% 3.72% 1.50% Wide Bay 2.60% 2.30% 4.60% 2.00% 2.56% 1.70% 3.65% 1.40%

PPH

HHS Sep-13 Target Dec-13 Target Mar-14 Target Jun-14 Target Cairns and Hinterland 19.80% 17.70% 16.70% 17.70% 19.10% 17.70% 16.80% 17.70% Cape York 20.10% 17.70% 16.10% 17.70% 18.00% 17.70% 24.60% 17.70% Central Queensland 16.50% 17.70% 17.60% 17.70% 19.80% 17.70% 20.30% 17.70% Central West 20.40% 17.70% 15.90% 17.70% 24.70% 17.70% 24.70% 17.70% Darling Downs 19.30% 17.70% 19.10% 17.70% 16.50% 17.70% 16.60% 17.70% Gold Coast 14.10% 17.70% 8.70% 17.70% 10.60% 17.70% 10.40% 17.70% Mackay 14.10% 17.70% 13.80% 17.70% 12.70% 17.70% 10.90% 17.70% Metro North 13.80% 17.70% 14.70% 17.70% 13.30% 17.70% 14.70% 17.70% Metro South 14.40% 17.70% 14.00% 17.70% 14.70% 17.70% 15.20% 17.70% North West 20.10% 17.70% 17.90% 17.70% 20.30% 17.70% 19.60% 17.70% South West 20.70% 17.70% 23.20% 17.70% 15.40% 17.70% 24.50% 17.70% Sunshine Coast 16.20% 17.70% 13.30% 17.70% 11.10% 17.70% 12.00% 17.70% Torres Strait-Northern Peninsula 18.50% 17.70% 21.20% 17.70% 19.50% 17.70% 17.50% 17.70%

Townsville 18.50% 17.70% 19.90% 17.70% 19.20% 17.70% 19.00% 17.70% West Moreton 16.70% 17.70% 13.30% 17.70% 12.70% 17.70% 16.70% 17.70% Wide Bay 15.40% 17.70% 15.40% 17.70% 14.50% 17.70% 19.20% 17.70% Data is preliminary at time of reporting and subject to change.

DAMA PPH Less than or equal to target Less than or equal to target Less than or equal to (target + 0.5%) Less than or equal to (target + 1%)

Greater than (target + 0.5%) Greater than (target + 1%)


Key points There are two Aboriginal and Torres Strait Islander quarterly KPIs in the HHSs’ service agreements. These two KPIs report on:

the rate of Aboriginal and Torres Strait Islander people who discharge against medical advice

the rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people.

Discharge against medical advice (DAMA) In 2013−14, the Queensland DAMA rate was 3.4%, no change from 2012−13. While there has been no change at a statewide level, certain HHSs have maintained relatively low rates of DAMA:

Cape York Gold Coast Mackay Sunshine Coast Torres Strait-Northern Peninsula.

However, a number of HHSs have persistently high DAMA rates with little or no change throughout the year, these include:

Townsville Darling Downs West Moreton Metro South.

Eradicating the DAMA gap for Aboriginal and Torres Strait Islander people continues to be a priority.

Potentially preventable hospitalisations (PPH) PPH is a new KPI in the 2013−14 HHS service agreement for Aboriginal and Torres Strait Islander people.

There is a significant gap in PPH between Indigenous and non-Indigenous Queenslanders. In 2013–14, 16.4% of all separations are identified as potentially preventable for Aboriginal and Torres Strait Islander people, compared to 8.4% for non-Indigenous Queenslanders—almost twice the rate. Encouragingly, the Indigenous PPH rate has decreased from 17.7% in 2012–13 to 16.4% in 2013−14.

Table 5 illustrates there are significant challenges that exist in managing PPH for rural and remote HHSs, where access to primary and preventative care is not as great as in urban areas. However even HHSs such as Mackay and Gold Coast which have comparatively low PPH rates still have significant Indigenous to non-Indigenous PPH differentials.


National elective surgery targets (NEST) Figure 13 Queensland median waiting times (days) for elective surgery in public hospitals

by procedure

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Cataract extraction Cholecystectomy Coronary artery bypass graft Cystoscopy Haemorrhoidectomy

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Septoplasty Tonsillectomy Total hip replacement Total knee replacement Total

Days

Indigenous non-Indigenous


Table 6 Queensland median waiting times (days) for elective surgery in public hospitals by procedure, 2010–11 to 2013–14

Indicator Procedure Ratio: Difference in median times:

Indigenous to non-Indigenous Indigenous to non-Indigenous 2010-11 2011-12 2012-13 2013-14 2010-11 2011-12 2012-13 2013-14

Cataract extraction 1.45 1.37 1.86 1.35 21 19 37 18

Cholecystectomy 1.22 1.36 0.85 0.98 11 16 -7 -1

Coronary artery bypass graft 2.86 2.56 1.44 13 13 4 Cystoscopy 1.11 1 1.1 1.04 3 0 3 1

Haemorrhoidectomy 0.61 0.9 -24 -5 np Hysterectomy 0.91 0.93 1.04 1.14 -4 -4 2 8

Inguinal herniorrhaphy 0.88 1.07 0.69 -7 4 -20 Myringoplasty 1.13 1.06 1.1 9 5 8 Myringotomy 1.45 1.91 1.51 1.63 15 27 18 27

Prostatectomy 1.71 0.99 0.99 32 -1 -1 Septoplasty 1.64 2.72 1.91 36 98 68 Tonsillectomy 1.49 1.47 1.55 1.47 27 28 28 26

Total hip replacement 0.77 2.2 2.67 -18 96 130 Total knee replacement 1.01 1.1 1.37 1 12 56 TOTAL 1.17 1.04 1.04 1.07 5 1 1 2

Key points There were significant variations in the median wait times by condition for Aboriginal and

Torres Strait Islander people compared to the non-Indigenous population and from year to year.

In 2012−13, Aboriginal and Torres Strait Islander people had longer median waiting times compared to the non-Indigenous population for the following procedures: – cataract extraction (37 days longer) – myringotomy (18 days) – septoplasty (68 days longer) – tonsillectomy (28 days longer) – total hip replacement (130 days longer) – total knee replacement (56 days to longer).

However in 2012−13, Aboriginal and Torres Strait Islander people had shorter waiting times compared to the non-Indigenous population for the following procedures: – cholecystectomy (7 days less) – inguinal herniorrhaphy (20 days less).

In 2012−13, the ratio of the median wait times of Aboriginal and Torres Strait Islander people compared to the non-Indigenous population was much greater for: – cataract extraction (1.86) – coronary artery bypass graft (1.44) – myringotomy (1.51) – septoplasty (1.91) – tonsillectomy (1.55) – total hip replacement (2.67)


– total knee replacement (1.37). Two of the conditions had a ratio of less than one:

– cholecystectomy (0.85) – inguinal herniorrhaphy (0.69).

In 2013−14, Aboriginal and Torres Strait Islander people had longer median waiting times compared to the non-Indigenous population for the following procedures: – cataract extraction (18 days longer) – myringotomy (27 days) – tonsillectomy (26 days longer).

In 2013−14, the median wait time for Aboriginal and Torres Strait Islander people was 30 days compared to 28 days in 2012–13. The non-Indigenous values were 28 and 27 respectively.

In 2013−14, the ratio of the median wait times of the Aboriginal and Torres Strait Islander people compared to the non-Indigenous population was greater than one for all the reported conditions except for cholecystectomy (0.98).

The number of Indigenous admissions for elective surgery was 5,079 in 2012–13 and 5,631 in 2013−14.

The percentage of Indigenous patients waiting more than 365 days was 2.8% and 3.5% in 2012−13 and 2013−14 respectively compared to the non-Indigenous values of 2.5% and 3.2%.

In 2012−13, the median wait time was 40 days for Indigenous Queenslanders and 36 days for non-Indigenous Queenslanders.


Table 7 Days waiting for elective surgery by National Procedure Indicator (NPI)

Indigenous Non-Indigenous Days per count

difference, Ind – non-Ind

National Procedure Indicator Count Days

waiting

Days waiting

per count

Count Days waiting

Days waiting

per count

Myringoplasty 29 3,800 131 198 24,222 122 9 Total knee replacement 43 5,578 130 1,725 202,361 117 12

Total hip replacement 16 2,051 128 723 71,064 98 30

Tonsillectomy 111 11,139 100 1,074 131,940 123 -22

Cataract extraction 119 11,527 97 2,468 227,173 92 5

Hysterectomy 41 3,945 96 599 48,729 81 15

Myringotomy 39 3,539 91 327 35,085 107 -17

Haemorrhoidectomy 8 668 84 198 12,914 65 18

Septoplasty 10 826 83 303 38,564 127 -45

Coronary artery bypass graft 9 506 56 77 1,243 16 40

Cholecystectomy 62 3,379 55 784 41,836 53 1 Inguinal herniorrhaphy 14 741 53 605 46,805 77 -24

Cystoscopy 31 1,568 51 872 24,750 28 22

Prostatectomy 7 308 44 252 10,738 43 1

Varicose veinsa 2 491 246 86 5,672 66 180 Total 541 50,066 93 10,291 923,096 90 3

As at 30 September 2014 a not heat shaded due to very high Indigenous days waiting per count

Table 8 Days waiting for elective surgery by Hospital and Health Service

Indigenous Non-Indigenous Days per count

difference, Ind – non-Ind HHS Count Days

waiting

Days waiting

per count

Count Days waiting

Days waiting

per count

Townsville 96 11,156 116 859 104,636 122 -6

West Moreton 45 4,785 106 803 94,742 118 -12

Gold Coast 25 2,594 104 1,982 165,881 84 20

Metro North 39 3,641 93 1,615 119,137 74 20

Cairns and Hinterland 65 5,800 89 372 42,313 114 -25

North West 22 1,834 83 58 4,513 78 6

Mackay 6 492 82 143 9,980 70 12

Sunshine Coast 15 1,214 81 528 27,171 51 29

Metro South 50 3,542 71 1,798 152,586 85 -14

Central Queensland 56 3,814 68 632 41,402 66 3

Wide Bay 13 667 51 364 27,000 74 -23

Darling Downs 41 1,989 49 533 48,354 91 -42

Total 473 41,528 88 9,687 837,715 86 1

As at 30 September 2014.


Table 9 Trend in days waiting per count

Increasing trend Decreasing trend

For all the procedures the number of days waiting per count decreased from 147.2 in December 2013 to 92.5 in September 2014—for most procedures there was a decreasing trend.

Days waiting by category Category 1: a condition that could get worse quickly to the point that it may become an

emergency. Patient should have surgery within 30 days of being added to the waiting list. Category 2: a condition causing some pain, dysfunction or disability, but is not likely to

get worse quickly or become an emergency. Patient should have surgery within 90 days of being added to the waiting list.

Category 3: a condition causing minimal or no pain, dysfunction or disability, which is unlikely to get worse quickly and which does not have the potential to become an emergency. Patient should have surgery within 365 days of being added to the waiting list.

All patients waiting for procedures as at 30 September 2014 were within the above limits.

Indigenous

NPI Dec-13 Feb-14 May-14 Sep-14Line chart Dec-13 Feb-14 May-14 Sep-14 Dec-13 Feb-14 May-14 Sep-14

Line chart

Cataract extraction 127 111 106 119 21,424 16,898 14,021 11,527 168.7 152.2 132.3 96.9Cholecystectomy 56 52 45 62 4,130 3,314 3,443 3,379 73.8 63.7 76.5 54.5Coronary artery bypass graft

17 11 10 9 567 374 492 506 33.4 34.0 49.2 56.2

Cystoscopy 47 21 24 31 3,545 2,387 1,532 1,568 75.4 113.7 63.8 50.6Haemorrhoidectomy 6 2 4 8 561 127 330 668 93.5 63.5 82.5 83.5Hysterectomy 45 41 35 41 3,278 3,602 4,185 3,945 72.8 87.9 119.6 96.2

Inguinal herniorrhaphy 21 16 12 14 2,433 1,546 1,408 741 115.9 96.6 117.3 52.9

Myringoplasty 63 63 56 29 15,175 16,727 11,527 3,800 240.9 265.5 205.8 131.0Myringotomy 68 53 43 39 11,745 8,727 5,035 3,539 172.7 164.7 117.1 90.7Prostatectomy 6 5 6 7 638 442 540 308 106.3 88.4 90.0 44.0Septoplasty 10 10 10 10 2,601 2,135 1,971 826 260.1 213.5 197.1 82.6Tonsillectomy 125 112 112 111 17,255 16,100 15,033 11,139 138.0 143.8 134.2 100.4Total hip replacement 16 14 14 16 3,487 2,952 2,341 2,051 217.9 210.9 167.2 128.2Total knee replacement

33 32 36 43 7,541 4,851 5,136 5,578 228.5 151.6 142.7 129.7

Varicose Veins 5 4 5 2 538 562 771 491 107.6 140.5 154.2 245.5Total 645 547 518 541 94,918 80,744 67,765 50,066 147.2 147.6 130.8 92.5

Waiting DaysCount Days Waiting per Count


National emergency access targets (NEAT) The Australasian Triage Scale has five categories—as defined in the National Health Data Dictionary Version 16 2012 (Australian Institute of Health and Welfare)—that incorporates the time by which the patient should receive care:

Category 1: resuscitation—immediate (within seconds) Category 2: emergency—within 10 minutes Category 3: urgent—within 30 minutes Category 4: semi-urgent—within 60 minutes Category 5: non-urgent—within 120 minutes.

Figure 14 shows no significant difference between Indigenous and non-Indigenous percentage of patients treated within benchmarks (as defined above) for emergency department waiting times.

Figure 14 Percentage of patients treated within benchmarks for emergency department waiting time, 2010−11 to 2013−14

The average percentages for Indigenous patients treated within the benchmarks for categories 2, 4 and 5 were 83%, 72% and 90% respectively. The corresponding non-Indigenous percentages were 81%, 71% and 91% respectively. The category 3 percentage had the largest difference between Indigenous (69%) and non-Indigenous (64%).

Table 10 shows the median waiting time (minutes) for emergency presentations for Queensland public hospitals.

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-13

2013

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Category 1 Category 2 Category 3 Category 4 Category 5 Total

Per c

ent



Table 10 Median waiting times (minutes) for emergency presentations in Queensland public hospitals, 2012–13 and 2013–14

2012–13 2013–14

Category Indigenous Non-Indigenous


Resuscitation 0 0

0 0

Emergency 5 5

6 6

Urgent 17 19

17 20

Semi-urgent 29 29

27 29

Non-urgent 24 23

26 25 Total 18 18

18 19

There were no major differences in median waiting times between the two population groups.

The crude rate is the number of presentations divided by the population.

Table 11 Crude rates for emergency presentations in Queensland public hospitals, 2010–11 to 2013–14

Year Number of emergency presentations Population Crude rate Indigenous 2010–11 56,129 188,954 29.70% 2011–12 62,162 193,506 32.10% 2012–13 71,872 198,206 36.30% 2013–14 74,709 198,206 37.70% 4 YEAR TOTAL 264,872 778,872 34.00% Non-Indigenous 2010–11 948,290 4,287,824 22.10% 2011–12 988,249 4,374,699 22.60% 2012–13 1,085,110 4,458,597 24.30% 2013–14 1,078,083 4,458,597 24.20% 4 YEAR TOTAL 4,099,732 17,579,717 23.30%

For the four year period, the Indigenous emergency presentation rate was higher—1 in 2.9 persons (34.0%) compared to the non-Indigenous rate of 1 in 4.3 persons (23.3%).


Excess cost of purchases Public hospitalisation rates for Indigenous patients are higher than for non-Indigenous patients. If the hospitalisation rate for the Indigenous population was the same as the non-Indigenous rate, the expected separations would be less than the observed separations. The excess separations (actual separations minus the number of expected separations) carry a significant and ultimately unnecessary cost, both to the population and financially.

The additional cost to the public inpatient hospital system from the gap in health status between Aboriginal and Torres Strait Islander people of Queensland and the non-Indigenous people of Queensland for the three years, 2011−12 to 2013−14, was estimated at $687.3 million. This analysis is based on place of usual residence of the patients and the activity based funding model, phase 16 with a base price of $4,660.00 per weighted activity unit (WAU).

Table 12 Excess cost of purchases by service related group (SRG), 2011−12 to 2013−14

SRG Total for three year period Cumulative Cumulative % Renal dialysis $62,209,847 $62,209,847 9.10% Psychiatry - acute $59,667,052 $121,876,898 17.70% Respiratory medicine $48,257,582 $170,134,481 24.80% Neurology $41,154,908 $211,289,389 30.70% Rehabilitation $39,857,103 $251,146,492 36.50% Non-subspecialty medicine $37,667,896 $288,814,388 42.00% Qualified neonate $36,517,221 $325,331,609 47.30% Non subspecialty surgery $35,693,128 $361,024,736 52.50% Tracheostomy $35,495,605 $396,520,342 57.70% Orthopaedics $32,771,953 $429,292,295 62.50% Cardiology $29,117,291 $458,409,586 66.70% Immunology and infections $25,681,806 $484,091,392 70.40%

In the three years from 2011−12 to 2013−14, 12 of the 42 SRGs contributed 70.4% of the excess cost of purchases.

Figure 15 Cumulative percentage of excess cost of purchases, 2011−12 to 2013−14

0%

20%

40%

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100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

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Number of SRGs

70.4% of the excess cost of purchases was from 12 of the 42 SRGs


Figure 16 Excess cost of purchases by SRGs – Queensland (all Hospital and Health Services), 2011−12 to 2013−14

$0 $10 $20 $30 $40 $50 $60 $70

Renal Dialysis

Psychiatry - Acute

Respiratory Medicine

Neurology

Rehabilitation

Non Subspecialty Medicine

Qualified Neonate

Non Subspecialty Surgery

Tracheostomy

Orthopaedics

Cardiology

Immunology & Infections

Vascular Surgery

Upper GIT Surgery

Endocrinology

Cardiac Surgery

Interventional Cardiology

Drug & Alcohol

Renal Medicine

Gastroenterology

Ear, Nose & Throat

Gynaecology

Urology

Medical Oncology

Neurosurgery

Plastic & Reconstructive Surgery

Dentistry

Ophthalmology

Haematology

Diagnostic GI Endoscopy

Rheumatology

Haematological Surgery

Dental Surgery

Colorectal Surgery

Thoracic Surgery

Extensive Burns

Dermatology

Head & Neck Surgery

Breast Surgery

Transplantation

Chemotherapy & Radiotherapy

Unallocated

Millions


Table 13 Separations, WAUs and purchases - 2011−12, 2012−13, 2013−14

Measures 2011−12 2012−13 2013−14 Total

Separations 82,370 88,055 92,924 263,349

Actual WAUs 69,599 72,461 77,475 219,535

WAU per separation 0.84 0.82 0.83 0.83

Expected WAUs 23,234 24,046 24,762 72,042

Excess WAUs 46,364 48,416 52,713 147,493

Actual to expected WAU ratio 3.00 3.01 3.13 3.05

Actual purchases $324,329,150 $337,669,751 $361,032,009 $1,023,030,910

Expected purchases $108,272,154 $112,053,216 $115,389,944 $335,715,313

Excess cost of purchases $216,056,987 $225,616,521 $245,642,046 $687,315,554

Excess cost of purchases as a percentage of actual purchases 66.6% 66.8% 68.0% 67.2%

From 2011−12 to 2013−14:

separations increased by an annual growth rate of 6.2% WAUs increased by an annual growth rate of 5.5% the WAU per separation ratio remained stable at 0.83 the indirect standardised WAU ratio (observed to expected) was 3.05 – if the

hospitalisation rate for the Indigenous population was the same as the non-Indigenous rate the expected activity in terms of WAUs would be one third the actual activity

the excess cost of purchases was close to two thirds of the actual purchases – $687.3 million would have been ‘saved’ if the hospitalisation rate for the Indigenous population was the same as the non-Indigenous rate.

Figure 17 Distribution of purchases by age group, 2011−12 to 2013−14

The age distribution of the purchase of services in Aboriginal and Torres Strait Islander people was considerably younger than the non-Indigenous population with 48.8% of the total purchase cost being for services to people aged below 40 years. In contrast to 27.5% of purchases for non-Indigenous people for those aged below 40 years.

0%

2%

4%

6%

8%

10%

12%

14%

Per c

ent

Indigenous Expected Purchases Indigenous Excess Cost of Purchases non-Indigenous Purchases


The cost of services purchased for 0-4 year olds was the highest for Aboriginal and Torres Strait Islander people ($135.4 million), and $71.8 million (53.0%) more than would have been expected had the WAU rate been the same as the non-Indigenous population.

The excess cost of purchases was more than 70% of the actual purchases for each of the age groups from 15 to 34 years.


Immunisation Table 14 Indigenous vaccination coverage rates by Hospital and Health Service, 2013−14

Source: Australian Childhood Immunisation Register

Indigenous vaccination coverage rates for Aboriginal and Torres Strait Islander children are relatively high for vaccination coverage at 24 and 60 months, with all but one HHS (Susnhine Coast) registering vaccination coverage of greater than 90%. For many HHSs vaccination coverage at 24 and 60 months is higher for Aboriginal and Torres Strait Islander children than it is for non-Indigenous children.

However Indigenous vaccination coverage at 12 months is less than 90% for all HHSs, except for Central West and Torres and Cape, and is lower than the non-Indigenous vaccination coverage for all HHSs (except Central West).

1 year 2 years 5 years

HHS

% fully vaccinated

(# children in cohort)

Gap indicator

(I-NI)

% with MMR dose 1


Gap indicator

(I-NI)

% fully vaccinated


Gap indicator

(I-NI)

% with MMR dose 2


Gap indicator

(I-NI)

% fully vaccinated


Gap indicator

(I-NI)

Cairns and Hinterland 88.6 (856) -2.7 96.5 (804) 2.3 94.9 (804) 2.1 96.2 (850) 4.5 95.9 (850) 4.8Central Queensland 80.9 (382) -10.7 95.7 (369) 0.2 90.8 (369) -3.8 94 (319) 0.5 93.4 (319) 0.4Central West 93.5 (31) 2.3 93.9 (33) -1.8 93.9 (33) -1.2 92.3 (26) -4.6 92.3 (26) -4.6Darling Downs 86.2 (434) -6.4 94.9 (392) -0.1 90.3 (392) -3.5 92.1 (379) -1.7 91 (379) -2.4Gold Coast 88.1 (168) -1.7 95.2 (187) 2.2 94.7 (187) 3 95.7 (162) 5.4 95.7 (162) 5.6Mackay 89.6 (230) -3.8 95.6 (206) -0.1 93.2 (206) -1.4 92.5 (212) -1.9 92 (212) -1.7Metro North 86.7 (452) -6.1 96.5 (432) 1.7 93.5 (432) -0.2 96.1 (386) 3.1 95.9 (386) 3.2Metro South 86.2 (536) -5.4 95.1 (548) 0.6 92.9 (548) -0.1 93.1 (518) 0.6 92.5 (518) 0.4North West 85.6 (215) -7 97 (233) 0.9 95.7 (233) 1.2 91.2 (227) -3.2 91.2 (227) -2.9South West 79.3 (82) -15.4 96.5 (113) 1.2 96.5 (113) 1.8 93.2 (103) -4.3 91.3 (103) -6.2Sunshine Coast 86.1 (180) -2.3 94 (151) 2.7 93.4 (151) 3.1 89.9 (138) 0.5 89.1 (138) 0Torres and Cape 90.2 (327) -2.3 95.8 (353) 7 95.5 (353) 7.7 96.7 (331) 3 96.4 (331) 2.7Townsville 80.3 (588) -12.5 93.8 (562) -2.3 91.5 (562) -3.5 93.5 (527) -0.5 93 (527) -0.5West Moreton 89 (291) -3 93.9 (263) -0.7 91.3 (263) -2.2 95.2 (273) 1.6 95.2 (273) 2.2Wide Bay 87.4 (270) -5 94.6 (222) -0.9 92.8 (222) -1.3 96.5 (202) 2 94.1 (202) 0QUEENSLAND 86.2 (5042) -5.5 95.4 (4868) 1 93.2 (4868) 0 94.3 (4653) 1.8 92.7 (4504) 1.6AUSTRALIA 86.3 (15556) -4.9 94.6 (14977) 1 92.3 (14977) 0.6 93.6 (14019) 1.6 93 (14019) 1.3

< 90% I<NI < 90% I<NI < 90% I<NI < 90% I<NI < 90% I<NII>NI I>NI I>NI I>NI I>NI


Morbidity – hospital separations, priority areas for action The following section presents data on hospital separations for Aboriginal and Torres Strait Islander people in Queensland. It is important to note that the hospital separations data is used as a proxy for measuring morbidity in a population in the absence of incidence and prevalence data. In measuring the frequency of disease in a population, ideally we would examine prevalence (the number of people in a defined population who have a specified outcome [e.g. disease] at a point in time) and incidence (the number of new cases of outcome of interest [e.g. disease, injury or death] within a defined population during a specified time period).

Unfortunately, due to the lack of available quality research (and disease registry) data for Aboriginal and Torres Strait Islander people, hospital separation data is often the only available data source for many diseases. While hospital separation data does provide a rich source of data from which health differentials for many conditions can be obtained, it is important to always bear in mind that this reflects activity in the acute care system—and is not a measure of true disease prevalence and incidence. For example, only those people who are acutely unwell may be hospitalised for a psychiatric disorder, particularly depression—the bulk of which may be managed in a primary care setting with many patients never coming into contact with the acute care system. In this case, reliance on hospital separations data to indicate disease prevalence or incidence would significantly under-enumerate the true frequency of depression in the population.


Table 15 Age standardised hospital separations per 100,000 (2001 Australian population): 2009−10 to 2013−14, condition heat map - Hospital and Health Service comparison

Values are coded from red (highest) to green (lowest).

Chapters/Specific Conditions CAH CY CQ CW DD GC M MN MS NW SW SC TSNPA TSV WM WB QldAll cause 105,548 78,177 84,123 48,749 89,395 36,584 64,443 67,854 63,452 136,791 58,778 37,321 38,503 180,151 61,363 80,490 85,925Blood and blood forming organs 531 559 646 702 1,099 320 604 858 671 912 448 299 338 473 470 642 604Circulatory system 3,891 4,754 4,090 3,549 4,614 2,304 3,557 3,603 3,268 5,841 4,962 2,332 2,407 4,886 4,041 3,860 3,869

Acute rheumatic fever 48 104 9 38 16 0 3 3 4 134 11 2 46 38 0 4 28Chronic rheumatic heart diseases 37 68 17 82 20 18 4 14 8 164 30 19 44 48 8 0 33Hypertensive diseases 157 153 125 193 267 32 73 59 82 161 203 54 134 158 58 154 129Ischemic Heart Disease 1,664 2,041 2,047 1,599 1,925 984 1,645 1,488 1,366 2,286 2,364 950 773 2,155 1,872 1,800 1,661Stroke 397 515 317 706 410 167 262 244 287 537 579 210 334 285 191 393 345

Congenital anomalies 98 66 97 174 137 137 102 206 132 89 115 127 66 112 217 136 123Digestive system 3,910 3,997 3,564 4,121 5,450 2,473 4,450 4,442 4,161 5,888 5,866 3,323 2,320 4,134 3,889 3,885 4,038Ear and mastoid process 275 772 341 130 552 164 184 392 355 531 314 266 264 263 312 203 336Endocrine, nutritional and metabolic 1,627 2,395 1,441 1,628 2,038 704 1,077 1,067 1,074 2,690 1,638 812 1,617 2,687 869 999 1,584

Type 1 Diabetes 57 45 67 444 111 143 69 89 92 56 294 181 58 124 59 126 93Type 2 Diabetes 1,000 1,577 744 752 1,435 200 605 504 423 1,410 993 333 1,239 1,208 478 560 874

External causes 7,443 9,187 7,782 7,944 8,685 5,037 6,659 6,996 6,790 13,731 8,347 6,587 4,064 10,680 6,639 8,130 7,743Self harm 266 304 334 199 420 257 243 465 539 802 469 411 102 431 379 401 386

Eye and adnexa 542 1,363 966 1,264 888 1,206 1,140 998 965 1,429 824 823 1,071 981 631 500 909Genitourinary system 2,471 2,843 2,726 1,704 3,207 1,809 2,299 2,224 2,452 3,709 2,417 1,984 1,741 3,004 2,323 2,441 2,523

Chronic kidney disease 224 587 239 224 237 17 60 76 139 472 104 32 143 480 127 92 220Health status and health services 63,232 28,349 44,823 10,501 36,855 10,103 29,510 25,597 26,694 72,120 10,099 7,028 10,713 133,089 25,567 41,457 44,784

Care involving dialysis 59,673 24,024 40,611 8,350 31,630 7,139 24,799 19,800 22,704 68,266 7,047 4,014 8,626 131,372 21,598 36,209 41,027Infectious and parasitic diseases 1,426 1,718 979 1,531 1,275 721 655 963 829 2,369 1,559 795 835 1,419 806 898 1,168Injury poisoning and external causes 4,918 6,953 4,583 5,181 5,299 2,874 3,751 3,835 3,819 9,515 5,864 3,429 2,390 5,969 3,996 5,038 4,752Mental and behavioural disorders 2,647 1,877 2,111 2,297 3,456 1,211 1,827 5,626 2,293 3,231 2,797 1,862 749 2,443 1,744 2,184 2,526

Adult personality and behaviour 35 21 45 135 40 27 41 281 96 17 53 44 43 19 74 56 67Mood (affective) 257 165 308 494 651 214 375 2,029 351 199 579 393 124 293 228 510 447Psychoactive substance use 1,306 849 696 746 1,102 346 441 1,408 714 1,879 1,268 691 110 1,024 558 666 925Schizophrenia, schizotypal and delusion 595 475 534 532 1,121 338 566 863 677 564 346 356 241 626 405 478 592

Musculoskeletal system and connective tiss 1,355 1,630 1,360 1,245 2,221 1,990 1,440 1,850 1,748 2,610 2,029 1,916 1,186 1,813 1,506 2,064 1,702Neoplasms - benign 397 365 326 289 579 483 453 945 929 446 516 681 354 308 1,077 731 550Neoplasms - malignant 994 1,371 1,214 513 1,612 1,214 1,380 1,837 1,725 1,182 1,050 1,041 819 1,517 1,460 1,374 1,306Nervous system 1,041 822 1,602 1,778 1,597 1,422 1,170 1,467 1,034 1,339 1,314 808 419 956 976 955 1,098Perinatal 381 410 293 158 302 270 292 327 226 502 235 383 284 342 227 305 319Pregnancy, childbirth 5,163 4,509 3,332 2,845 5,346 1,720 2,783 2,633 2,444 4,694 4,056 3,206 5,065 3,564 3,155 3,508 3,698

Gestational diabetes 602 770 37 45 67 3 28 24 20 348 61 21 1,188 56 38 41 241Respiratory system 4,940 5,013 3,699 3,562 5,915 1,532 2,559 3,099 3,224 7,829 6,626 2,192 2,066 5,209 2,918 3,863 4,115

Chronic Lower Respiratory Disease 1,916 1,529 1,462 1,491 2,208 535 1,068 1,269 1,376 2,061 3,220 916 563 2,325 1,172 1,880 1,593Upper respiratory tract 116 149 348 219 366 170 202 231 293 163 135 279 122 150 352 128 212

Skin and subcutaneous tissue 1,723 2,367 1,369 1,270 1,770 538 972 1,073 1,126 3,423 1,499 711 2,001 2,101 1,476 1,379 1,600Symptoms, signs and abnormal findings 3,984 6,049 4,562 4,306 5,182 3,390 4,240 4,809 4,285 6,444 4,550 3,304 1,798 4,882 3,706 4,067 4,322


Table 16 Age standardised hospital separations per 100,000 (2001 Australian population): 2009−10 to 2013−14, Hospital and Health Service heat map – chapter comparison


Based on the hospital separations condition heat map, priority HHSs for enhanced monitoring and investment include Cape York, Darling Downs, Metro North, North West, South West and Townsville. Gold Coast, Sunshine Coast, Torres StraitNorthern Peninsula area and West Moreton HHSs had comparatively lower hospital separation rates.

Based on the hospital separations HHS heat map, priority conditions included diseases of the digestive system, circulatory disease, external causes, injury poisoning and external causes, pregnancy, childbirth and respiratory disease. Conditions of lower rates included diseases of blood and blood forming organs, benign neoplasms, conditions originating in the perinatal period, congenital anomalies, and ear and mastoid disease.

Chapters/Specific Conditions CAH CY CQ CW DD GC M MN MS NW SW SC TSNPA TSV WM WB QldBlood and blood forming organs 531 559 646 702 1,099 320 604 858 671 912 448 299 338 473 470 642 604

Circulatory system 3,891 4,754 4,090 3,549 4,614 2,304 3,557 3,603 3,268 5,841 4,962 2,332 2,407 4,886 4,041 3,860 3,869

Congenital anomalies 98 66 97 174 137 137 102 206 132 89 115 127 66 112 217 136 123

Digestive system 3,910 3,997 3,564 4,121 5,450 2,473 4,450 4,442 4,161 5,888 5,866 3,323 2,320 4,134 3,889 3,885 4,038

Ear and mastoid process 275 772 341 130 552 164 184 392 355 531 314 266 264 263 312 203 336

Endocrine, nutritional and metabolic 1,627 2,395 1,441 1,628 2,038 704 1,077 1,067 1,074 2,690 1,638 812 1,617 2,687 869 999 1,584

External causes 7,443 9,187 7,782 7,944 8,685 5,037 6,659 6,996 6,790 13,731 8,347 6,587 4,064 10,680 6,639 8,130 7,743

Eye and adnexa 542 1,363 966 1,264 888 1,206 1,140 998 965 1,429 824 823 1,071 981 631 500 909

Genitourinary system 2,471 2,843 2,726 1,704 3,207 1,809 2,299 2,224 2,452 3,709 2,417 1,984 1,741 3,004 2,323 2,441 2,523

Infectious and parasitic diseases 1,426 1,718 979 1,531 1,275 721 655 963 829 2,369 1,559 795 835 1,419 806 898 1,168

Injury poisoning and external causes 4,918 6,953 4,583 5,181 5,299 2,874 3,751 3,835 3,819 9,515 5,864 3,429 2,390 5,969 3,996 5,038 4,752

Mental and behavioural disorders 2,647 1,877 2,111 2,297 3,456 1,211 1,827 5,626 2,293 3,231 2,797 1,862 749 2,443 1,744 2,184 2,526Musculoskeletal system and connective ti 1,355 1,630 1,360 1,245 2,221 1,990 1,440 1,850 1,748 2,610 2,029 1,916 1,186 1,813 1,506 2,064 1,702

Neoplasms - benign 397 365 326 289 579 483 453 945 929 446 516 681 354 308 1,077 731 550

Neoplasms - malignant 994 1,371 1,214 513 1,612 1,214 1,380 1,837 1,725 1,182 1,050 1,041 819 1,517 1,460 1,374 1,306

Nervous system 1,041 822 1,602 1,778 1,597 1,422 1,170 1,467 1,034 1,339 1,314 808 419 956 976 955 1,098

Perinatal 381 410 293 158 302 270 292 327 226 502 235 383 284 342 227 305 319

Pregnancy, childbirth 5,163 4,509 3,332 2,845 5,346 1,720 2,783 2,633 2,444 4,694 4,056 3,206 5,065 3,564 3,155 3,508 3,698

Respiratory system 4,940 5,013 3,699 3,562 5,915 1,532 2,559 3,099 3,224 7,829 6,626 2,192 2,066 5,209 2,918 3,863 4,115

Skin and subcutaneous tissue 1,723 2,367 1,369 1,270 1,770 538 972 1,073 1,126 3,423 1,499 711 2,001 2,101 1,476 1,379 1,600

Symptoms, signs and abnormal findings 3,984 6,049 4,562 4,306 5,182 3,390 4,240 4,809 4,285 6,444 4,550 3,304 1,798 4,882 3,706 4,067 4,322


Table 17 Age standardised hospital separations per 100,000 (2001 Australian population): 2009−10 to 2013−14, heat map for specific conditions within some chapters


Within the circulatory chapter, ischaemic heart disease had the highest standardised rate compared to the other four conditions.

Type 2 diabetes had a much higher rate than type 1.

Within the mental health chapter, psychoactive substance use and schizophrenia, schizotypal and delusional disorders had the higher rates.

CAH CY CQ CW DD GC M MN MS NW SW SC TSNPA TSV WM WB Qld

Acute rheumatic fever 48 104 9 38 16 0 3 3 4 134 11 2 46 38 0 4 28Chronic rheumatic heart diseases 37 68 17 82 20 18 4 14 8 164 30 19 44 48 8 0 33Hypertensive diseases 157 153 125 193 267 32 73 59 82 161 203 54 134 158 58 154 129Ischemic Heart Disease 1,664 2,041 2,047 1,599 1,925 984 1,645 1,488 1,366 2,286 2,364 950 773 2,155 1,872 1,800 1,661Stroke 397 515 317 706 410 167 262 244 287 537 579 210 334 285 191 393 345

Type 1 Diabetes 57 45 67 444 111 143 69 89 92 56 294 181 58 124 59 126 93Type 2 Diabetes 1,000 1,577 744 752 1,435 200 605 504 423 1,410 993 333 1,239 1,208 478 560 874

Self harm 266 304 334 199 420 257 243 465 539 802 469 411 102 431 379 401 386

Chronic kidney disease 224 587 239 224 237 17 60 76 139 472 104 32 143 480 127 92 220

Adult personality and behaviour 35 21 45 135 40 27 41 281 96 17 53 44 43 19 74 56 67Mood (affective) 257 165 308 494 651 214 375 2,029 351 199 579 393 124 293 228 510 447Psychoactive substance use 1,306 849 696 746 1,102 346 441 1,408 714 1,879 1,268 691 110 1,024 558 666 925Schizophrenia, schizotypal and delusional 595 475 534 532 1,121 338 566 863 677 564 346 356 241 626 405 478 592

Gestational diabetes 602 770 37 45 67 3 28 24 20 348 61 21 1,188 56 38 41 241

Chronic Lower Respiratory Disease 1,916 1,529 1,462 1,491 2,208 535 1,068 1,269 1,376 2,061 3,220 916 563 2,325 1,172 1,880 1,593Upper respiratory tract 116 149 348 219 366 170 202 231 293 163 135 279 122 150 352 128 212

Respiratory system

Circulatory system

Endocrine, nutritional and metabolic

External causes

Genitourinary system

Mental and behavioural disorders

Pregnancy, childbirth


Table 18 Age standardised hospital separations – rate ratio Indigenous Hospital and Health Service to Queensland non-Indigenous: 2009−10 to 2013−14 (2001 Australian population), chapter heat map - HHS comparison


A rate ratio of less than one (green in the table above) means that the Indigenous rate was less than the non-Indigenous rate. Torres Strait-Northern Peninsula, Gold Coast and Sunshine Coast HHSs have several rate ratios less than one.

Central West HHS Indigenous hospital separations for benign neoplasms were 0.28 times that of the Queensland non-Indigenous population—approximately one quarter the rate.

North West HHS Indigenous hospital separations for endocrine, nutritional and metabolic diseases, and diabetes were 4.58 times that of the Queensland non-Indigenous population.

North West and Townsville HHSs had higher rate ratios than other HHSs.

CAH CY CQ CW DD GC M MN MS NW SW SC TSNPA TSV WM WB QldAll Causes 2.66 1.97 2.12 1.23 2.25 0.92 1.62 1.71 1.60 3.44 1.48 0.94 0.97 4.53 1.54 2.03 2.16Blood and blood forming organs 0.85 0.90 1.04 1.13 1.76 0.51 0.97 1.38 1.08 1.46 0.72 0.48 0.54 0.76 0.75 1.03 0.97Circulatory system 1.82 2.22 1.91 1.66 2.15 1.07 1.66 1.68 1.52 2.73 2.32 1.09 1.12 2.28 1.89 1.80 1.81Congenital anomalies 0.67 0.45 0.67 1.19 0.94 0.94 0.70 1.41 0.90 0.61 0.79 0.87 0.46 0.77 1.48 0.93 0.84Digestive system 0.95 0.98 0.87 1.01 1.33 0.60 1.09 1.08 1.02 1.44 1.43 0.81 0.57 1.01 0.95 0.95 0.99Ear and mastoid process 1.02 2.87 1.27 0.48 2.05 0.61 0.68 1.46 1.32 1.97 1.17 0.99 0.98 0.98 1.16 0.75 1.25Endocrine, nutritional and metabolic 2.77 4.07 2.45 2.77 3.47 1.20 1.83 1.81 1.83 4.58 2.79 1.38 2.75 4.57 1.48 1.70 2.69External causes 1.58 1.95 1.66 1.69 1.85 1.07 1.42 1.49 1.44 2.92 1.78 1.40 0.86 2.27 1.41 1.73 1.65Eye and adnexa 0.41 1.04 0.74 0.96 0.68 0.92 0.87 0.76 0.74 1.09 0.63 0.63 0.82 0.75 0.48 0.38 0.69Genitourinary system 1.31 1.50 1.44 0.90 1.70 0.96 1.22 1.18 1.30 1.96 1.28 1.05 0.92 1.59 1.23 1.29 1.33Infectious and parasitic diseases 2.22 2.68 1.53 2.39 1.99 1.12 1.02 1.50 1.29 3.69 2.43 1.24 1.30 2.21 1.25 1.40 1.82Injury poisoning and external causes 1.83 2.59 1.70 1.93 1.97 1.07 1.40 1.43 1.42 3.54 2.18 1.28 0.89 2.22 1.49 1.87 1.77Mental and behavioural disorders 1.54 1.09 1.23 1.34 2.01 0.71 1.07 3.28 1.34 1.88 1.63 1.09 0.44 1.42 1.02 1.27 1.47Musculoskeletal system and connective tissue 0.68 0.82 0.69 0.63 1.12 1.00 0.73 0.93 0.88 1.32 1.02 0.97 0.60 0.91 0.76 1.04 0.86Neoplasms - benign 0.39 0.36 0.32 0.28 0.57 0.47 0.44 0.93 0.91 0.44 0.51 0.67 0.35 0.30 1.06 0.72 0.54Neoplasms - malignant 0.53 0.74 0.65 0.28 0.87 0.65 0.74 0.99 0.93 0.64 0.56 0.56 0.44 0.82 0.78 0.74 0.70Nervous system 0.91 0.72 1.40 1.55 1.39 1.24 1.02 1.28 0.90 1.17 1.14 0.70 0.37 0.83 0.85 0.83 0.96Perinatal 1.53 1.64 1.18 0.63 1.21 1.08 1.17 1.31 0.91 2.01 0.94 1.54 1.14 1.37 0.91 1.22 1.28Pregnancy, childbirth 2.16 1.88 1.39 1.19 2.23 0.72 1.16 1.10 1.02 1.96 1.69 1.34 2.11 1.49 1.32 1.46 1.54Respiratory system 2.84 2.89 2.13 2.05 3.41 0.88 1.47 1.78 1.86 4.51 3.82 1.26 1.19 3.00 1.68 2.22 2.37Skin and subcutaneous tissue 2.59 3.55 2.05 1.91 2.66 0.81 1.46 1.61 1.69 5.13 2.25 1.07 3.00 3.15 2.21 2.07 2.40Symptoms, signs and abnormal findings 1.42 2.16 1.63 1.54 1.85 1.21 1.51 1.72 1.53 2.30 1.63 1.18 0.64 1.74 1.32 1.45 1.54


Table 19 Age standardised hospital separations – rate ratio Indigenous Hospital and Health Service to Queensland non-Indigenous: 2009−10 to 2013−14 (2001 Australian population), heat map for specific conditions within some chapters


A rate ratio of less than one (green in the table above) means that the Indigenous rate was less than the non-Indigenous rate. Gold Coast and Sunshine Coast HHSs had several rate ratios of less than one.

Cape York, North West and Townsville HHSs had higher rate ratios than other HHSs.

CAH CY CQ CW DD GC M MN MS NW SW SC TSNPA TSV WM WB QldCirculatory system

Acute rheumatic fever 43.55 94.82 8.09 34.36 14.82 0.00 2.82 2.27 3.91 121.45 9.73 1.73 41.36 34.18 0.00 4.00 25.27Chronic rheumatic heart diseases 3.23 5.88 1.44 7.09 1.72 1.58 0.31 1.25 0.70 14.25 2.63 1.65 3.83 4.13 0.67 0.00 2.85Hypertensive diseases 3.03 2.95 2.40 3.71 5.15 0.61 1.41 1.14 1.59 3.10 3.90 1.04 2.58 3.05 1.11 2.97 2.48Ischemic Heart Disease 2.48 3.04 3.05 2.38 2.87 1.46 2.45 2.22 2.03 3.40 3.52 1.41 1.15 3.21 2.79 2.68 2.47Stroke 2.34 3.03 1.87 4.15 2.41 0.98 1.54 1.44 1.69 3.16 3.40 1.24 1.96 1.68 1.12 2.31 2.03

Endocrine, nutritional and metabolicType 1 Diabetes 0.79 0.63 0.94 6.22 1.56 2.01 0.96 1.24 1.28 0.78 4.12 2.53 0.81 1.73 0.83 1.76 1.30Type 2 Diabetes 7.38 11.64 5.49 5.55 10.59 1.48 4.46 3.72 3.12 10.40 7.33 2.46 9.14 8.92 3.53 4.13 6.45

External causesSelf harm 1.51 1.73 1.90 1.13 2.39 1.46 1.38 2.64 3.06 4.56 2.67 2.33 0.58 2.45 2.16 2.28 2.19

Genitourinary systemChronic kidney disease 8.42 22.07 8.97 8.41 8.92 0.63 2.25 2.85 5.23 17.73 3.89 1.21 5.39 18.05 4.77 3.44 8.28

Health status and health servicesCare involving dialysis 14.76 5.94 10.04 2.07 7.82 1.77 6.13 4.90 5.61 16.88 1.74 0.99 2.13 32.49 5.34 8.95 10.15

Mental and behavioural disordersAdult personality and behaviour 0.79 0.49 1.03 3.09 0.92 0.62 0.93 6.45 2.19 0.38 1.22 1.01 0.98 0.44 1.70 1.29 1.53Mood (affective) 0.40 0.26 0.48 0.78 1.02 0.34 0.59 3.18 0.55 0.31 0.91 0.62 0.19 0.46 0.36 0.80 0.70Psychoactive substance use 4.53 2.95 2.42 2.59 3.83 1.20 1.53 4.88 2.48 6.52 4.40 2.40 0.38 3.55 1.94 2.31 3.21Schizophrenia, schizotypal and delusion 2.61 2.08 2.34 2.33 4.92 1.48 2.48 3.78 2.97 2.47 1.52 1.56 1.06 2.75 1.78 2.09 2.59

Pregnancy, childbirthGestational diabetes 23.52 30.06 1.46 1.74 2.62 0.10 1.09 0.95 0.79 13.58 2.38 0.83 46.41 2.20 1.47 1.59 9.39

Respiratory systemChronic Lower Respiratory Disease 4.12 3.28 3.14 3.20 4.74 1.15 2.29 2.73 2.96 4.43 6.92 1.97 1.21 5.00 2.52 4.04 3.42Upper respiratory tract 0.29 0.37 0.87 0.55 0.92 0.43 0.51 0.58 0.73 0.41 0.34 0.70 0.31 0.38 0.88 0.32 0.53


Priority conditions

Rheumatic heart disease Table 20 shows the number of children aged 0 to 15 years of age with acute rheumatic fever or rheumatic heart disease (ARF/RHD) on the Queensland RHD register who received <50%, 50-79%, and >80% of scheduled benzathine penicillin G (BPG) injections (secondary prophylaxis) in the previous 12 month period (noting Cape and Torres separated at time of reporting). If a person with ARF/RHD receives <80% of scheduled BPG injections, this is regarded as poor delivery.

Table 20 Number of children and compliance rates with scheduled ARF/RHD medication, by Hospital and Health Service

HHS 0-49% 50-79% 80%+ TOTAL

Cairns and Hinterland 60 22 9 91 Cape York 12 16 20 48 Central Queensland 3 0 1 4 Central West 1 0 0 1 Darling Downs 3 0 0 3 Mackay 3 0 1 4 Metro North 3 0 3 Metro South 13 1 0 14 North West 6 11 15 32 Torres Strait and Northern Peninsula 14 23 17 54 Townsville 10 11 18 39 West Moreton 2 0 0 2 Wide Bay 3 0 0 3 Non-Queensland residents / visitors 7 2 0 9 Unknown 6 0 0 6 TOTAL 146 86 81 313

As at 14 July 2014

The effectiveness of secondary prophylaxis is reduced by non-compliance to scheduled antibiotic injections. Available evidence indicates that secondary prevention is the most cost-effective RHD mitigation strategy. Improvements in service delivery require a broad range of measures to increase client awareness and access to routine healthcare, such as provision of education and active recall for missed injections (RHD Australia 2012). The end effect of non-compliance is heart valve repair and/or heart valve replacement or subsequent mortality later in life.

Queensland has one of the largest ARF/RHD registries in Australia with currently 1,922 clients, second only to the Northern Territory (2,240). ARF and RHD are diseases which now principally impact Aboriginal and Torres Strait Islander people who represent 87.5% of the total number of people on the Queensland registry. The people on this registry range from three to 87 years old.


Renal dialysis Figure 18 Renal dialysis – proportion of total Indigenous separations for usual residents

of Hospital and Health Services

For the three year period, 2011−12 to 2013−14, the excess cost of purchases for renal dialysis was estimated to be $62.2 million. Cairns and Hinterland and Townsville HHSs made up 55.4% of the total excess cost of purchases.

104,86840%

158,48160%

Queensland

Renal DialysisIndigenousSeparations

All OtherIndigenousSeparations

28,32752%

26,59548%

Cairns and Hinterland

4,42231%

9,83469%

Cape York

5,70636%

9,94364%

Central Queensland

22016%

1,12284%

Central West

6,67134%

12,88966%

Darling Downs

1,22425%

3,66275%

Gold Coast

2,78235%

5,20165%

Mackay

3,66523%

12,54377%

Metro North

6,81930%

15,77670%

Metro South

8,93238%

14,61962%

North West

57213%

3,90887%

South West

56311%

4,45289%

Sunshine Coast

1,41619%

5,92181%

Torres Strait-Northern Peninsula

28,14260%

18,79940%

Townsville

1,77622%

6,40578%

West Moreton

3,63135%

6,81265%

Wide Bay

For the three years, 2011-12 to 2013-14 the total number of Indigenous separations was 263,349. Of these 104,868 were for renal dialysis - that is 40%. For the usual residents of the HHSs, the percentage varied between 11% (Sunshine Coast) to 60% (Townsville). For the non-Indigenous population the percentage of separations was 15% (4015,013/2,713,894) with a variation between 0% (Torres Strait-Northern Peninsula) to 23% (Wide Bay).The corresponding total Indigenous WAU percentage for renal dialysis was 6.4%

(14,151/219,536) with a variation between 1.3% (Sunshine Coast) to 11.2% (Townsville).The corresponding total non-Indigenous WAU percentage for renal dialysis was 1.8% (49,836/2,783,450) with a variation between 0% (Torres Strait-Northern Peninsula) to 3% (Wide Bay).


Table 21 Indigenous renal dialysis by Hospital and Health Service, 2011−12 to 2013−14

HHS Actual WAUs Expected WAUs

Excess WAUs



% of Queensland

Cairns and Hinterland 3,810 134 3,676 $17,130,129 27.5%

Cape York 647 42 605 $2,819,027 4.5%

Central Queensland 739 53 687 $3,199,733 5.1%

Central West 38 6 32 $149,698 0.2%

Darling Downs 860 50 810 $3,774,753 6.1%

Gold Coast 154 30 124 $578,728 0.9%

Mackay 350 36 314 $1,461,937 2.4%

Metro North 462 66 396 $1,844,591 3.0%

Metro South 899 92 807 $3,759,205 6.0%

North West 1,330 44 1,285 $5,989,017 9.6%

South West 84 18 66 $308,646 0.5%

Sunshine Coast 71 28 43 $198,934 0.3%

Torres Strait-Northern Peninsula 220 51 168 $785,180 1.3%

Townsville 3,808 78 3,730 $17,382,622 27.9%

West Moreton 226 33 192 $895,289 1.4%

Wide Bay 454 40 415 $1,932,358 3.1%

Queensland 14,151 801 13,350 $62,209,845 -

If the Indigenous renal dialysis rate was the same as that of the non-Indigenous population then the expected number of WAUs would have been 801 compared to an actual of 14,151 WAUs, that is 13,350 more than expected. If the health gap was closed, 94.3% of renal dialysis activity could have been prevented.

Figure 19 Excess cost of purchases of renal dialysis by age group

The distribution over the age groups shows that the 40 to 69 year olds make up 84% of the excess cost of purchases with an excess to observed ratio of 95%+.

0%

25%

50%

75%

100%

$0

$3

$6

$9

$12

Exce

ss W

AUs a

s a %

of O

bser

ved

Exce

ss C

ost o

f Pur

chas

esM

illio

ns

Excess cost of purchases Excess / Observed


Cancer – incidence and mortality Figure 20 New cancer cases and deaths, Aboriginal and Torres Strait Islander people,

2007−2011

Source: Oncology Analysis System (OASys), Queensland Cancer Control Analysis Team

There were on average 295 new cases of cancer per year in Aboriginal and Torres Strait Islander people of Queensland between 2007 and 2011. Cancer of the trachea, bronchus and lung was the site of cancer the most frequently diagnosed (15% of newly diagnosed cases 2007–2011). Breast, colorectal and prostate cancers were the next three most frequent sites.

Of the approximately 137 cancer related deaths per year in Aboriginal and Torres Strait Islander people of Queensland, 27% were from cancer of the trachea, bronchus and lung.

Figure 21 Age specific cancer rates, Queensland, 2007−2011, new cases

Figure 22 Age specific cancer rates, Queensland, 2007−2011, deaths

15%

27%

12%

7%

10%

9%

8%

5%

8%

5%

46%

48%

Approx. 295 new cases p.a.

Approx. 137 deaths p.a.

Trachea, bronchus, lungBreast (female)ColorectalProstateLymphomas and leukaemiasOther

0

500

1000

1500

2000

2500

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Rate

per

100

,000

Age at diagnosisQueensland Indigenous Queensland total persons

0

500

1000

1500

2000

2500

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Rate

per

100

,000

Age at death

Queensland Indigenous Queensland total persons


There was little difference in the age specific rates for new cases between Indigenous and non-Indigenous Queenslanders, however there was significant premature mortality for Indigenous Queenslanders compared to non-Indigenous Queenslanders.

Figure 23 Cancer trends in Queensland - new cases, 2000−2004 to 2007−2011

Figure 24 Cancer trends in Queensland - deaths, 2000−2004 to 2007−2011

There is an annual increase in new cases for both Indigenous and non-Indigenous people. However, while there is a small increase in deaths over time for Indigenous people, there is a small decrease in deaths over time for non-Indigenous people in Queensland.

0

100

200

300

400

500

600

2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011

ASR

per 1

00,0

00

Year of diagnosisQueensland Indigenous Queensland total persons

0

100

200

300

2000-2004 2001-2005 2002-2006 2003-2007 2004-2008 2005-2009 2006-2010 2007-2011

ASR

per 1

00,0

00

Year of diagnosisQueensland Indigenous Queensland total persons


Figure 25 Cancer trends in Queensland – survival, 2001−2010 (by Kaplan-Meier method)

Figure 26 Cancer trends in Queensland – survival, 2001−2010 (crude survival rates)

Figures 25 and 26 show signficantly lower survival rates for Indigneous Queenslanders compared to non-Indigenous Queenslanders.

Figure 27 Age standardised cancer rates, Hospital and Health Services and Queensland, 2007–2011

0%

20%

40%

60%

80%

100%

0 10 20 30 40 50 60

Per c

ent s

urvi

ving

Months from diagnosis

Queensland Indigenous Queensland total persons

0%

20%

40%

60%

80%

100%

1 year 2 years 5 years

Per c

ent s

urvi

ving

Queensland Indigenous Queensland non-Indigenous

N* ASR per 100,000 N* ASR per 100,000Central Queensland 17 7

Torres Strait-Northern Peninsula 17 12Sunshine Coast and Wide Bay 20 9

Cairns and Hinterland 49 23Central Queensland and Mackay 31 14

South East Corner (Gold Coast and Metro South) 43 19Darling Downs 17 6

Darling Downs and West Moreton 29 11West Queensland (Central, North and South West) 28 15

Metro South 36 15North West 19 11

Metro North 24 8Cape York 18 8

Townsville 34 17

* Average number of cases or deaths per year 2007-2011

New cases Deaths

0 200 400 600 800

Indigenous Total personsIndigenous Qld Total persons Qld

0 200 400 600 800


Table 22 Number of observed and expected new cancer cases and deaths, Aboriginal and Torres Strait Islander people, Queensland, 2007−2011

Observed Expected ExcessIncident cases 1476 1715 -239 0.86

Deaths 687 446 241 1.54Incident cases 92 59 33 1.55




Deaths 20 14 6 1.44Incident cases 149 177 -28 0.84







Deaths 9 23 -14 0.38Incident cases 15 14 1 1.04









Deaths 18 20 -2 0.88Incident cases 21 24 -3 0.87







Deaths 34 35 -1 0.98*SIR Standardised incident ratio; SMR Standardised mortality ratioSource: Oncology Analysis System (OASys), Queensland Cancer Control Analysis Team

Thyroid (C73)

Unspecified site (C26, C39,C76-C80, M905, M914, M973, M974-M976)Lymphomas and leukaemias (C42, C81-C85, C91-C96, M959-M972, M980-M994, M995-M996,

ALL CANCERS

Urinary tract (C64-C68)

Bladder (C67)

Eye, brain and other CNS (C69-C72)

Brain and CNS (C70-C72)

Thyroid and other endocrine (C73-C75)

Cervix (C53)

Corpus uteri (C54)

Overy (C56)

Male genital organs (C60-C63)

Prostate (C61)

Bone and Cartilage (C40, C41)

Melanoma (C44, M872-M879)

Female genital organs (C51-C58)

Colorectal (C18-C20)

Liver and biliary tract (C22-C24

Pancreas (C25)

Respiratory (C30-C38)

Trachea, bronchus, lung (C33, C34)

Stomach (C16)

Mesothelial and soft tissue (C45-C49)

Breast (C50)

SIR/SMR*

Head and neck (C0-C14)

Digestive (C15-C25)

Oesophageal (C15)


Diseases of the circulatory system

Ischeamic Heart Disease Stroke

Hypertensive diseases

Chronic rheumatic heart diseases

Acute rheumatic fever

(I00-I99) (I20-I25) (I60-I69) (I10-I15) (I05-I09) (I00-I02) Age standardised rates per 1,000

Indigenous

Rate Ratio (I:NI) 1.8 2.5 2.0 2.5 2.9 25.3Gap (I-NI) 17.3 9.9 1.8 0.8 0.2 0.3

Non-Indigenous

Age-specific rates per 1,000

Number of hospital separationsObserved 15,167 6,561 1,160 535 215 333Expected 7,448 2,145 513 181 44 29

Excess 7,719 4,416 647 354 171 304SMR 2.0 3.1 2.3 3.0 4.9 11.6

38.7

21.4

0

50

100

150

200

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+

IndigenousNon-Indigenous

16.6

6.7

0

10

20

30

40

50

60

00-0

405

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10-1

415

-19

20-2

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-29

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60-6

465

+

3.5

1.7

0

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20

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00-0

405

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10-1

415

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-59

60-6

465

+

1.3

0.5

0

2

4

6

8

00-0

405

-09

10-1

415

-19

20-2

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30-3

435

-39

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-49

50-5

455

-59

60-6

465

+

0.3

0.1

0.0

0.2

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0.8

00-0

405

-09

10-1

415

-19

20-2

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-29

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435

-39

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445

-49

50-5

455

-59

60-6

465

+

0.0

0.0

0.4

0.8

1.2

1.6

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+

0.3

Hospital separations – condition specific analysis Figure 28 Hospital separations, 2009−10 to 2013−14: diseases of the circulatory system, ischaemic heart disease, stroke, hypertensive

diseases, chronic rheumatic heart diseases, acute rheumatic fever


Circulatory disease, respiratory disease, diabetes and endocrine disease, and external causes including injury and poisoning are leading causes of hospitalisation and major contributors to the burden of disease for Aboriginal and Torres Strait Islander people.

Ischaemic heart disease and stroke are the most common reasons for hospitalisation for Indigenous Queenslanders with circulatory disease.

For the period 2009−10 to 2013−14 there were 7,719 excess circulatory disease separations for Indgenous Queenslanders.

Indigenous Queenslanders were hospitalised at much younger ages for all forms of circulatory disease compared to non-Indgenous Queenslanders.


Figure 29 Hospital separations, 2009−10 to 2013−14: respiratory, chronic lower respiratory disease, other diseases of upper respiratory tract, endocrine, type 2 diabetes, type 1 diabetes

Respiratory

Chronic Lower Respiratory

Disease

Other diseases of upper respiratory

tract Endocrine Type 2 Diabetes Type 1 Diabetes (J00-J99) (J40-J47) (J30-J39) (E00-E89) (E11) (E10)

Age standardised rates per 1,000

Indigenous

Rate Ratio (I:NI) 2.4 3.4 0.5 2.7 6.5 1.3Gap (I-NI) 23.8 11.3 -1.9 10.0 7.4 0.2

Non-Indigenous


Number of hospital separationsObserved 25,051 6,934 2,057 7,475 3,488 788Expected 13,827 2,701 3,841 3,357 483 652

Excess 11,224 4,233 -1,784 4,118 3,005 136SMR 1.8 2.6 0.5 2.2 7.2 1.2

41.2

17.4

0

50

100

150

200

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+

IndigenousNon-Indigenous

15.9

4.7

0

20

40

60

80

100

00-0

405

-09

10-1

415

-19

20-2

425

-29

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60-6

465

+

2.1

4.0

0

1

2

3

4

5

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

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-49

50-5

455

-59

60-6

465

+

15.8

5.9

0

10

20

30

40

50

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+

8.7

1.4

0

10

20

30

40

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+

0.9

0.7

0

1

1

2

2

3

00-0

405

-09

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

+


Chronic lower respiratory disease (including chronic obstructive pulmonary disease and asthma) and upper respiratory tract disease are the most common reasons for hospitalisation for Indigenous Queenslanders with respiratory disease.

For the period 2009−10 to 2013−14 there were 11,224 excess respiratory disease separations for Indigenous Queenslanders.

Type 2 diabetes is the most common reason for hospitalisation for Indigenous Queenslanders with endocrine disease.

For the period 2009–10 to 2013–14 there were 4,118 excess endocrine disease separations for Indigenous Queenslanders.

Indigenous Queenslanders were hospitalised at much younger ages for all forms of respiratory and endocrine disease compared to non-Indigenous Queenslanders.


Neoplasms

External causes of Morbidity and

Mortality Self harmInjury and Poisoning

Chronic kidney disease

(C00-C97) (V00-Y89) (X60-X84 or Y87.0) (S00-T98) (N18) Age standardised rates per 1,000

Indigenous

Rate Ratio (I:NI) 0.7 1.6 2.2 1.4 8.3Gap (I-NI) -5.5 30.4 2.1 20.2 1.9

Non-Indigenous


Number of hospital separationsObserved 4,672 48,843 2,984 33,876 990Expected 6,443 28,368 1,484 19,505 131

Excess -1,771 20,475 1,500 14,371 859SMR 0.7 1.7 2.0 1.7 7.6

13.1

18.6

0

10

20

30

40

50

60

70

80

90

00-0

405

-09

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415

-19

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425

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435

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-49

50-5

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+

77.4

47.0

0

20

40

60

80

100

120

140

160

00-0

405

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415

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425

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+

3.9

1.8

0

1

2

3

4

5

6

7

8

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405

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415

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+

67.7

47.5

0

10

20

30

40

50

60

70

00-0

405

-09

10-1

415

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2.2

0.3

0

2

4

6

8

00-0

405

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415

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20-2

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30-3

435

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40-4

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50-5

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-59

60-6

465

+

Figure 30 Hospital separations, 2009−10 to 2013−14: neoplasms, external causes of morbidity and mortality, self-harm, injury and poisoning, chronic kidney disease


The gap in age at hospitalisation was slightly lower for neoplasms, however there were 1,771 fewer separations observed for neoplasms for Indigenous Queenslanders compared to non-Indigenous Queenslanders.

External causes of morbidity and mortality had the highest number of excess separations of any condition for the period (20,475 excess separations).

Injury and poisoning (14,371 excess separations) was the largest contributor to external cause morbidity for Indigenous Queenslanders.


Appendix

Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, Queensland

Background A part of the Australian Health Survey (AHS), the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) was a nationally representative survey of close to 13,000 Australian Aboriginal and Torres Strait Islander people. The survey comprised of the existing National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), together with two new elements: the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSIPAS) and the National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS). Respondents completed either the NATSIHS or the NATSIPAS (of which there is a core set of questions common to both surveys). All Aboriginal and Torres Strait Islander people aged 18 years or older that responded to either survey were asked to participate in the NATSIHMS.

The final sample for Queensland was 3,190 persons (1,823 NATSIHS; 1,467 NATSIPAS) representing an overall response rate of 81.8% (ABS 2013b). Of the respondents aged 18 years and older, 829 (41% of eligible participants) also participated in the NATSIHMS. This makes it the largest recent survey of the health and wellbeing of Queensland’s Aboriginal and Torres Strait Islander people and therefore an important source of data for Queensland’s Aboriginal and Torres Strait Islander people.

Results of the AATSIHS are being released progressively. The first results released in November 2013 were from the NATSIHS and included information on health risk factors, long-term health conditions, measured blood pressure and use of health services (ABS 2013a). The updated results, released in June 2014, presented information on health risk factors, long-term health conditions, measured blood pressure from the core content of the NATSIHS and the NATSIPAS (ABS 2014a). More recently biomedical health measures were released. Further results will be released by the ABS in the first half of 2015, this will include further information on physical activity and detailed information on dietary intake (ABS 2014b).

This report gives an overview of the publicly released Queensland-specific data. Where the same data item was released for Queensland in both the first and updated results, we report the updated. Estimates from NATSIHS 2004–05 (ABS 2006) and AHS 2012–13 (ABS 2012, ABS 2013c) are also given, but note that these are not age standardised. This means that the difference in age structure may explain differences observed between the two population groups. Some age standardised AHS and AATSIHS results are published on the ABS website to enable comparison of the national Aboriginal and Torres Strait Islander and total Australian populations.


Results

Self-assessed health Self-assessed health status is a simple and commonly used measure of general health. It reflects a person’s perception of their own health. In the survey, respondents were asked whether in general they felt their health was excellent, very good, good, fair or poor.

Table 23 Self-assessed general health status, AATSIHS 2012–13

In 2012–13, just over a third of Aboriginal and Torres Strait Islander people in Queensland aged 15 years or older assessed their health as excellent or very good (36.5%). Almost one-quarter of people assessed their health as fair or poor. In comparison, over half of the Queensland respondents in the AHS conducted in 2011–12 rated their health as excellent or very good (53.4%), and 15.2% as fair or poor. In the previous NATSIHS of 2004–05, 42% of Queensland Aboriginal and Torres Strait Islander people assessed their health as excellent or very good and 23% as fair or poor.

Figure 31 Self-assessed health status by jurisdiction, AATSIHS 2012–13

As highlighted in Figure 31 the proportion of Aboriginal and Torres Strait Islander people in Queensland who reported excellent or very good health was not statistically significantly different from other jurisdictions.

Psychological distress

Respondents aged 18 years and older were asked a series of five questions relating to their feelings and frequency of those feelings over the past four weeks. The answers are compiled into the modified Kessler Psychological Distress Scale (K5) which gives an indication of non-specific psychological distress.

General Health % (95% CI)Self-assessed health status(a)*

Excellent 12.2 (10.4-14)Very good 24.3 (21.7-26.9)Excellent/very good 36.5 (33.7-39.3)Good 39.5 (36.8-42.2)Fair 18.3 (16.2-20.4)Poor 5.7 (4.2-7.2)Fair/poor 24 (21.6-26.4)

High/very high psychological distress(b)(c) ^ 31.1 (27.1-35.1)(a) Persons aged 15 years and over.(b) A score in the range 12–25 on the modified Kessler Psychological Distress Scale (K5). Excludes people 18+ who were not present at interview.(c) Persons aged 18 years and over.* Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13^ Source: 4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13

40.2 41.8 36.5 37.7 40.1 40.9 40.9 43.8 39.30.0

20.0

40.0

60.0

NSW Vic. Qld SA WA Tas NT ACT Australia

Per c

ent

(a) Persons aged 15 years and over.Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13


Almost one third of Queensland Aboriginal and Torres Strait Islander people had high or very high levels of psychological distress in the four weeks leading up to the survey. This compares to 10.7% of Queenslanders in the AHS 2011–12.

Long-term health conditions The survey collected data on a range of health conditions focussing on current long-term conditions. This information helps health service planning and prevention efforts. The data below is for Aboriginal and Torres Strait Islander people that reported having been told by a doctor or nurse that they had any of a range of conditions.

Number of long-term conditions Table 24 Long-term health conditions, AATSIHS 2012–13

In 2012–13, over one third of Aboriginal and Torres Strait Islander people in Queensland reported having no long-term health conditions (34.9%), while almost another third had three or more conditions (29.4%). In the AHS 2011–12, 40.5% of respondents had three or more conditions. This higher proportion in the total population is likely due to the older age structure of the total population compared to the Aboriginal and Torres Strait Islander population.

Long-term health conditions(a)(b) % (95% CI)Number of long-term health conditions^

No current long-term health condition 34.9 (32-37.8)One 22.1 (19.8-24.4)Two 13.6 (11.4-15.8)Three or more 29.4 (27-31.8)

Selected current long-term conditions(a)(b)(c)Arthritis^ 8.5 (7-10)Asthma^ 14.3 (11.8-16.8)Back pain/problem, disc disorder^ 10.6 (8.9-12.3)Diabetes mellitus* 7.7 (6.7-8.7)High sugar levels* 0.6 (0.3-0.9)Total diabetes/high sugar levels* 8.3 (7.2-9.4)Ear/hearing problems^ 11.2 (9.4-13)Eye/sight problems^ 33.2 (31.1-35.3)Heart and circulatory problems/diseases* 11.9 (10.5-13.3) Hypertensive disease* 5.7 (4.8-6.6) Heart, stroke and vascular diseases* 3.9 (2.9-4.9)Kidney disease* 1.8 (1.3-2.3)Malignant neoplasm (cancer)^ 0.7 (0.1-1.3)Osteoporosis^ 1.2 (0.5-1.9)

(b) Persons aged 2 years and over.(c) See relevant source for long-term condition inclusions and exclusions

^ Source: 4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13

* Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13

(a) Persons who reported they had a diagnosed current medical condition which had lasted, or was expected to last, for 6 months or more.


Diabetes and high blood sugar

In 2012–13, 8.3% of Queensland Aboriginal and Torres Strait Islander people reported having ever been told that they have diabetes or high blood sugar in their blood or urine, and that this condition was current. The proportion of Aboriginal and Torres Strait Islander people with diabetes or high blood sugar in Queensland was not different from that for Australia. The previous NATSIHS of 2004–05 found 6% of Queensland Aboriginal and Torres Strait Islander people reported having diabetes or high blood sugar.

Figure 32 Diabetes/high blood sugar by jurisdiction, AATSIHS 2012–13

Heart and circulatory problems/diseases

More than 1 in 10 (11.9%) Aboriginal and Torres Strait Islander people in Queensland aged two years or older reported having ever been told by a doctor or nurse that they have a heart or circulatory disease that was current and had or was expected to last six months or more. In the NATSIHS 2004–05, 10% of Queensland Aboriginal and Torres Strait Islander people reported heart and circulatory conditions. The rate in Queensland was not statistically significantly different from other jurisdictions.

Figure 33 Heart and circulatory problems/diseases by jurisdiction, AATSIHS 2012–13

8.1 7.1 8.3 8.9 10.0 3.8 12.0 7.6 8.60.0

5.0

10.0

15.0

20.0


Per c

ent

(a) Persons aged 2 years and over.Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13

13.3 10.0 11.9 12.5 12.2 15.2 14.7 8.8 12.70.0

5.0

10.0

15.0

20.0


Per c

ent

(a) Persons aged 2 years and over.Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13 (a) Persons aged 2 years and over.Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13


Lifestyle risk factors

Alcohol consumption

Participants in the AATSIHS 2012–13 were asked how long ago they last drank alcohol and a series of questions relating to the type, size and number of alcoholic drinks consumed on the three most recent days of the previous fortnight. Based on these and other answers, respondent’s drinking behaviour against National Health and Medical Research Council (NHMRC) guidelines was categorised.

Table 25 Lifestyle risk factors, AATSIHS 2012–13

In 2012–13, just over half (54.6%) of Queensland Aboriginal and Torres Strait Islander people aged 15 years and over had exceeded the single occasion risk guidelines (more than four standard drinks on a single occasion). In the AHS 2011–12, 46.8% of Queensland respondents exceeded the single occasion risk guidelines.

The 2009 NHMRC guidelines for lifetime risk of harm from alcohol stipulate no more than two drinks per day. In the AATSIHS 2012–13, 17.7% Aboriginal and Torres Strait Islander people aged 15 years and older in Queensland had on average drank more than two standard drinks per day. In the AHS 2011–12, 20.2% of Queensland respondents exceeded the lifetime risk guidelines.

Lifestyle risk factors(a) % (95% CI)Alcohol consumption^2001 NHMRC guidelines

Long term risk - Risky/high risk consumption 11.8 (9.1-14.5)Short term risk - Risky/high risk consumption 50.3 (46.3-54.3)

2009 NHMRC guidelinesExceeded lifetime risk guidelines 17.7 (14.1-21.3)Exceeded single occasion risk guidelines 54.6 (50.7-58.5)

BMI (measured)Overweight 29.1 (26.3-31.9)Obese 37.3 (34.2-40.4)Overweight/obese 66.4 (63.2-69.6)

Fruit and vegetable consumption*2003 NHMRC Guidelines

Inadequate daily fruit intake 60.7 (57.5-63.9)Inadequate daily vegetable intake\ 94 (92.4-95.6)

2013 NHMRC GuidelinesInadequate daily fruit intake 57.7 (54.4-61)Inadequate daily vegetable intake (2013 NHMRC Guidelines) 95.6 (94.3-96.9)

(a) Persons aged 15 years and over.* Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13 ^ Source: 4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13


Fruit and vegetable intake

With the help of a pictorial prompt card displaying serving size, respondents were asked their usual number of serves of fruit and vegetables consumed each day.

Only around 1 in 20 of Queensland’s Aboriginal and Torres Strait Islander people aged 15 years and older consumed adequate amounts of vegetables. This was similar to the result for all Queensland people in the AHS 2011–12. The majority of Queensland Aboriginal and Torres Strait Islander people aged over 15 years did not consume an adequate amount of fruit on a daily basis (57.7%).

Overweight/obese

Unlike previous NATSIHSs, the AATSIHS collected measured height and weight thereby giving a much more accurate estimate of the proportion of the population that is overweight or obese.

Figure 34 Overweight/obese by jurisdiction, AATSIHS 2012–13

Two thirds (66.4%) of Queensland’s Aboriginal and Torres Strait Islander people aged 15 years and older were overweight or obese in 2012–13. This was similar to other jurisdictions except the Northern Territory where 55.5% of Aboriginal and Torres Strait Islander people were overweight or obese. The proportion of the total Queensland population that was overweight or obese was 64.9%.

Smoker status

The prevalence of smoking remains high in the Aboriginal and Torres Strait Islander population of Queensland.

Table 26 Smoker status, AATSIHS 2012–13

As shown in Table 26, 41.5% of persons aged 15 years and older smoked daily. In 2004–05, half of the population were current daily smokers. The AHS 2011–12 estimates for the

69.9 65.8 66.4 64.8 66.7 63.2 55.5 59.7 66.00.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 15 years and over.Source: 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey

Smoker Status (a)* Males Females PersonsCurrent smoker

Daily 43.7 (39.2-48.2) 39.4 (35.8-43) 41.5 (38.4-44.6)Other(c) 1.4 (0.4-2.4) 1.7 (0.9-2.5) 1.6 (0.9-2.3)Total current smoker 45.1 (40.7-49.5) 41.1 (37.3-44.9) 43.1 (40-46.2)

Ex-smoker 20 (16.7-23.3) 22 (18.6-25.4) 21 (18.4-23.6)Never smoked 34.9 (30.1-39.7) 36.9 (33.2-40.6) 35.9 (32.6-39.2)

(a) Persons aged 15 years and over.

% (95% CI)



Queensland population was less than half the Aboriginal and Torres Strait Islander rate at 17.2%.

Figure 35 Current daily smoker by jurisdiction, AATSIHS 2012–13

The rate in Queensland is lower than the Northern Territory estimate of 50.8% but higher than the Australian Capital Territory (ACT) which was 28.4%.

Health related actions Participants in the survey were asked whether they had recently visited a number of health services.

Table 27 Health related actions, AATSIHS 2012–13

Almost 1 in 5 Aboriginal and Torres Strait Islander persons had visited a general practitioner (GP) or specialist in the last two weeks, and around 1 in 20 had visited a dental professional. The results were very similar to those found in the 2004–05 survey.

Chronic disease biomarkers The NATSIHMS is the largest biomedical survey ever conducted for Aboriginal and Torres Strait Islander Australians. Around 3,300 (829 in Queensland) Aboriginal and Torres Strait Islander adults (aged 18 years and over) across Australia took part and voluntarily provided blood and/or urine samples, which were tested for a range of chronic disease and nutrient biomarkers.

40.5 40.8 41.5 40.3 40.0 37.6 50.8 28.4 41.60.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 15 years and over.Source: 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey

Health-related actions^ % (95% CI)Consulted GP/specialist in last 2 weeks 19.2 (16.8-21.6)Consulted other health professional in last 2 weeks 15.8 (15.8-15.8)Visited casualty/outpatients/day clinic in last 2 weeks 6.2 (6.2-6.2)Consulted dental professional in last 2 weeks(a) 4.3 (4.3-4.3)Admitted to hospital in last 12 months 16.7 (16.7-16.7)

^ Source: 4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13

(a) Persons aged 2 years and over.


Table 28 Chronic disease biomarkers, AATSIHS 2012–13

Cardiovascular disease biomarkers

The indicators of cardiovascular disease published by jurisdiction were total cholesterol, high density lipoprotein (HDL) (good) cholesterol, triglycerides and dyslipidaemia.

Cholesterol is a fat-like substance that is found in all cells of the body. Within the blood, cholesterol travels in lipoproteins. HDL assists in removing cholesterol from the body, while high levels of low-density lipoproteins (LDLs)can lead to a build-up of cholesterol in the arteries. Total cholesterol is a measure of HDL, LDL and other fats in the blood. Triglycerides are a type of fat that is found in the blood, and stored in fat cells and used by the body for energy. Dyslipidaemia is an abnormal amount of lipids in the blood, and refers to a number of different lipid disorders. The ABS measure of dyslipidaemia can be used to estimate the proportion of people that have at least one lipid disorder, and are therefore at increased risk of heart disease.

Just over 1 in five Aboriginal and Torres Strait Islander adults in Queensland had high total cholesterol (23.1%). The National Health Measurement Survey (NHMS) found 30.8% of the total Queensland adult population had high total cholesterol. Given cholesterol is associated with age, and the younger age distribution of the Aboriginal and Torres Strait Islander population, these two estimates should not be directly compared. Some national age standardised results are available on the ABS website.

The proportion of Aboriginal and Torres Strait Islander adults in Queensland with high total cholesterol did not differ significantly from the other jurisdictions.

Selected chronic disease biomarkers (a) % (95% CI)Cardiovascular disease biomarkersAbnormal total cholesterol (≥5.5 mmol/L) 23.1 (16.9-29.3)Abnormal HDL (good) cholesterol (b) 40.6 (33.1-48.1)Abnormal triglycerides (≥2.0 mmol/L) 19.5 (13.4-25.6)Has dyslipidaemia (c) 63.1 (55.8-70.4)Diabetes (d)Has diabetes based on fasting plasma glucose (e) 8.2 (4.3-12.1)Has diabetes according to HbA1c 10 (6.6-13.4)Chronic Kidney DiseaseHas indicators of Chronic Kidney Disease (f) 18.4 (13.4-23.4)(a) Persons aged 18 years and over

(d) Diabetes prevalence is derived using a combination of biomarker test results and self-reported information on diabetes diagnosis and medication use. See Source for more information. (e) Fasting test. Only people who fasted for 8 hours or more prior to their blood test were applicable. For Australia in 2012–13, approximately 77.6% of Aboriginal and Torres Strait Islander people aged 18 years and over who participated in the biomedical component had fasted.

(c) See 4364.0.55.005 for definition.

(f) Derived using a combination of participants' estimated glomerular filtration rate (eGFR) results with their albumin creatinine ratio (ACR) results. See Source for more information.

(b) ≤1.0mmol/L males; ≤1.3mmol/L females

* Source: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia


Figure 36 High total cholesterol, AATSIHS 2012–13

Overall, 63.1% of Aboriginal and Torres Strait Islander adults in Queensland had at least one lipid disorder (dyslipidaemia)—a result not statistically significantly different from other jurisdictions.

Figure 37 Dyslipidaemia, AATSIHS 2012–13

Diabetes biomarkers

The survey included two tests to measure diabetes. Fasting plasma glucose is the standard test for diabetes in Australia. After fasting for eight hours, the test measures the amount of sugar in the blood at the time of testing. The glycated haemoglobin test (HbA1c) was also performed, this is a measure of the average blood glucose level over the preceding 12 weeks.

Based on the fasting plasma glucose test, 8.2% of the Queensland adult Aboriginal and Torres Strait Islander population had diabetes. The estimate according to HbA1c was slightly higher at 10.0%. While it is expected that there would be some difference in prevalence of diabetes estimated by the two tests, at least part of this difference may be due to restriction of fasting plasma glucose testing to those that had fasted for at least eight hours prior to test. For the whole of Australia, this excluded approximately 22.4% of adults that participated in NATSIHMS. In comparison, results from the NHMS found 5.0% of the total Queensland adult population had diabetes according to both tests.

Of the five jurisdictions with available data, the recorded prevalence of diabetes was lowest in Queensland. The prevalence was statistically significantly higher in the Northern Territory with almost 1 in 5 Aboriginal and Torres Strait Islander adults having diabetes according to the fasting blood glucose test.

24.3 23.1 #26.1 27.6 20.9 25.00.0

20.0

40.0

60.0

80.0

100.0

NSW Qld SA WA NT Australia

Per c

ent

(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia# Users should give the margin of error particular consideration when using this proportion.

65.5 63.1 #63.4 67.7 76.1 65.30.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia


Figure 38 Diabetes prevalence based on fasting plasma glucose, AATSIHS 2012–13

Chronic kidney disease biomarkers

Estimated glomerular filtration rate (eGFR) and the presence of albuminuria were the two indicators of kidney function measured in the NATSIHMS to determine stage of chronic kidney disease. Note that further testing would be required for diagnosis.

In 2012–13, 18.4% of Queensland Aboriginal and Torres Strait Islander people 18 years and older had indicators of chronic kidney disease. This was statistically significantly higher than the prevalence in the Northern Territory (32.4%).

Figure 39 Indicators of chronic kidney disease present, AATSIHS 2012–13

Socio-economic characteristics

Social and economic factors are well recognised as having an important impact on health and wellbeing.

Labour force status

Participants were asked a series of questions relating to employment.

11.6 8.2 11.1 17.7 19.0 11.1

0.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia

14.6 18.4 17.522.8

32.4

17.9

0.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia(a) Persons aged 18 years and olderSource: 4727.0.55.003 Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012–13 — Australia


Table 29 Labour force status, AATSIHS 2012–13

In 2012–13, 65.4% of Queensland Aboriginal and Torres Strait Islander people aged 15 to 64 years were in the labour force. The proportion of persons in the labour force was not statistically significantly different from the other jurisdictions.

Figure 40 Total in the labour force by jurisdiction, AATSIHS 2012–13

Figure 41 Unemployment status by jurisdiction, AATSIHS 2013–12

A total of 21.3% of Queensland Aboriginal and Torres Strait Islander participants aged 15 to 64 years were unemployed at the time of the survey. Only the ACT had an unemployment rate that was lower than the other jurisdictions.

Labour Force Status (a)* Males Females PersonsEmployed 57 (51.7-62.3) 46 (41.6-50.4) 51.4 (47.5-55.3)

Full-time 41.7 (36.7-46.7) 21.6 (18.4-24.8) 31.6 (28.5-34.7)Part-time 15.3 (11.1-19.5) 24.3 (20.1-28.5) 19.9 (16.7-23.1)

Unemployed 16 (12.8-19.2) 11.9 (9.4-14.4) 14 (12-16)Total in the labour force 73 (68.6-77.4) 57.9 (54-61.8) 65.4 (62.1-68.7)Not in the labour force 27 (22.6-31.4) 42.1 (38.2-46) 34.6 (31.3-37.9)Total 100 (100-100) 100 (100-100) 100 (100-100)

Unemployment rate(b) 21.9 (17.4-26.4) 20.6 (16.2-25) 21.3 (18-24.6)

% (95% CI)


(a) Persons aged 15–64 years.(b) For any group, the number of unemployed persons expressed as a percentage of the labour force in the same group.

57.3 59.9 65.4 59.0 58.9 62.1 54.5 74.7 60.10.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 15-64 years.Source: 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey

22.0 18.6 21.3 23.4 21.2 18.4 18.7 6.8 20.90.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 15-64 years.(b) For any group, the number of unemployed persons expressed as a percentage of the labour force in the same group. Source: 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey


Highest level of educational attainment Table 30 Highest level of educational attainment, AATSIHS 2012–13

In 2012–13, almost half of Queensland Aboriginal and Torres Strait Islander people aged 20 years and older had gained year 12 or Certificate III or above (47.6%).

Figure 42 Year 12 or Certificate III or above by jurisdiction, AATSIHS 2012–13

The percentage of Queensland respondents holding a Certificate III or above was lower than the ACT and Victoria, but higher than Western Australia and the Northern Territory.

Highest level of educational attainment (a)(b)* % (95% CI)Bachelor Degree or above 4.3 (4.3-4.3)Advanced Diploma or Diploma 6.9 (6.9-6.9)Certificate III or IV 22 (22-22)Year 12 or equivalent 14.4 (14.4-14.4) Year 12 or Certificate III or above 47.6 (47.6-47.6)Year 11 or equivalent 8.1 (8.1-8.1)Year 10 or equivalent 20.5 (20.5-20.5)Below Year 10 20.7 (20.7-20.7)(a) Persons aged 20 years and over.

(b) Includes students currently studying full-time or part-time.* Source: 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13

47.6 57.1 47.6 50.3 38.7 49.0 30.6 71.1 45.70.0

20.0

40.0

60.0

80.0

100.0


Per c

ent

(a) Persons aged 20 years and over.(b) Includes students currently studying full-time or part-time.Source: 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey


Data sources Australian Bureau of Statistics, 2006, National Aboriginal and Torres Strait Islander

Health Survey, 2004–05, cat no. 4715.0, viewed 9 September 2014 Australian Bureau of Statistics, 2012, Australian Health Survey: First Results, 2011–12,

cat no. 4364.0.55.001, viewed 9 September 2014 Australian Bureau of Statistics, 2013a, Australian Aboriginal and Torres Strait Islander

Health Survey: First Results, Australia, 2012–13, cat no. 4727.0.55.001, viewed 9 September 2014

Australian Bureau of Statistics, 2013b, Australian Aboriginal and Torres Strait Islander Health Survey: Users' Guide, 2012–13, cat no. 4727.0.55.002, viewed 9 September 2014

Australian Bureau of Statistics, 2013c, Australian Health Survey: Updated Results, 2011–2012, cat no. 4364.0.55.003, viewed 9 September 2014

Australian Bureau of Statistics, 2014a, Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13, Australia, 2012–13, cat no. 4727.0.55.006, viewed 9 September 2014

Australian Bureau of Statistics, 2014b, Topics @ a Glance - Aboriginal and Torres Strait Islander Peoples Health: 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey: Release Schedule, viewed 9 September 2014

Australian Bureau of Statistics. 33020DO018_2012 - Deaths, Australia, 2012. Australian Bureau of Statistics. 3302.0.55.003 – Life Tables for Aboriginal and Torres

Strait Islander Australians, 2010–2012. Australian Institute of Health and Welfare 2013. Aboriginal and Torres Strait Islander

Health Performance Framework 2012 report: Queensland. Canberra: AIHW. Australian Institute of Health and Welfare 2012. Australian Hospital Statistics: national

emergency access and elective surgery targets 2012. Health services series no. 48 Cat. No. HSE 131. Canberra: AIHW.

Australian Institute of Health and Welfare 2012. Health expenditure Australia 2010–11. Health and welfare expenditure series no.47.Cat no. HWE 56. Canberra: AIHW.

Activity Based Funding Operating Manual 2012–13 available at http://www.ihpa.gov.au Queensland Department of Health, Decision Support System/Panorama.

Queensland Hospital Admitted Patient Data Collection (QHAPDC), Department of Health Statistical Analysis and Linkage Team, Queensland Health.

Synthetic Population Estimates by Indigenous Status, Statistical Local Area and Health Service Districts, Age, Sex, 2000–2011 (2011 Australian Standard Geographical Classification), Government Statistician, Queensland Treasury and Trade, October 2011. Prepared by: Statistical Reporting and Coordination, Health Statistics Unit, Queensland Department of Health

Australian Childhood Immunisation Register (ACIR), Department of Human Services Oncology Analysis System (OASys), Queensland Cancer Control Analysis Team,

Queensland Health RHD Australia 2012, The Australian guideline for prevention, diagnosis and management

of acute rheumatic fever and rheumatic heart disease (2nd edition) available at http://www.rhdaustralia.org.au/sites/default/files/guideline_0.pdf

http://www.ihpa.gov.au/

http://www.rhdaustralia.org.au/sites/default/files/guideline_0.pdf


Abbreviations Abbreviation Full title AATSIHS Australian Aboriginal and Torres Strait Islander Health Survey

ABS Australian Bureau of Statistics

AHS Australian Health Survey

ARF/RHD Acute rheumatic fever and rheumatic heart disease

COAG Council of Australian Governments

DAMA Discharge against medical advice

HHSs Hospital and Health Services

HPF Health Performance Framework

HSCEs Health Service Chief Executives

KPI Key performance indicator

NATSIHS National Aboriginal and Torres Strait Islander Health Survey

NEAT National emergency access targets

NEST National elective surgery targets

NHMRC National Health and Medical Research Council

NIRA National Indigenous Reform Agreement

NPI National procedure indicator

PDC Perinatal Data Collection

PPH Potentially preventable hospitalisations

QHAPDC Queensland Hospital Admitted Patients Data Collection

WAU Weighted activity unit

Documents

Closing the Gap - performance report 2014