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PubMed2005

Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach.

OBJECTIVES: To estimate the effect of waiting time for surgery and volume of surgical activity on mortality in patients with hip fracture and to compare risk-adjusted outcomes between hospitals providing surgery for such patients. DESIGN: Retrospective cohort study. SETTING: Friuli Venezia Giulia, Italy. PARTICIPANTS: A total of 6,629 elderly people who underwent surgery for hip fracture between 1st January 1996 and 31th December 2000. MAIN OUTCOME MEASURES: In-hospital, 6-month and 1-year mortality rate. RESULTS: In-hospital mortality rate was 5.4%. At six months, the mortality rate was 20.0%, and at 1 year 25.3%. Age, male sex, and comorbidity were significant predictors of mortality. Logistic regression analysis indicated that, after controlling for main patients risk factors and taking into account the hospital level variability, there was no significant association between increase in mortality rate and more than 1 day of waiting time for surgery (OR 0.90; 95% CI 0.58-1.40 for in-hospital mortality). One hospital had a significantly higher mortality rate than the others; high hospital volume for hip fracture surgery was associated with worse outcomes (OR 1.57; 95% CI 1.38-1.78 for in-hospital mortality). Mortality after hip fracture decreased significantly from 1996 to 2000 (OR 0.85; 95% CI 0.80-0.90). CONCLUSIONS: Longer waiting time for surgery was not associated with mortality after adjusting for patient risk factors, and taking into account hospital level variability. Hospital level variability was statistically significant, and was partially explained by the total volume of hospital surgical activity. The decrease in mortality between 1996 and 2000 was confirmed by multivariate models.

Age Factors↗
PubMed1985

Changes in mortality among the elderly Finnish population 1951-1979.

Morbidity and mortality cannot be explained by biological factors alone; socio-economic factors, environment, life-style and health care delivery system also affect mortality rates. Many changes have taken place in socio-economic factors and environment among the elderly, and the health care system has expanded over the last few decades in Finland. However, the social changes have not only been for the better; and the changes in different causes of death among the elderly may have been different. Overall mortality among elderly Finnish males and females decreased in the 1950s, but increased at the beginning of the 1960s. From the later half of the 1960s overall mortality decreased. The decrease in female death rates began earlier and was more rapid than among males. Over one-half of the decrease from 1960-1969 to 1970-1979 among elderly males was due to the decrease in cardiovascular and cerebrovascular mortality; one-fifth was due to the decrease in genitourinary mortality. The male death rates in neoplasms and in violent causes increased during the period under study. Over one-half of the decrease from 1960-1969 to 1970-1979 among elderly females was attributable to the decrease in cardiovascular and cerebrovascular mortality. Lessening genitourinary mortality, gastrointestinal mortality, respiratory mortality, mortality from neoplasms and from violent causes accounted for less than 5% decrease in overall mortality.

Aged↗
PubMed2006

Comparison of three measurements of cardiac surgery mortality for the Northern New England Cardiovascular Disease Study Group.

BACKGROUND: There is no consensus on the optimal period during which to assess death after coronary artery bypass graft (CABG) surgery. Three measures are commonly used: in-hospital, 30-day, and procedural (either in-hospital or 30-day) mortality. We used a regional database to calculate the CABG mortality rate using each of these mortality measures. METHODS: Data were collected prospectively on 31,592 consecutive isolated CABG surgeries in northern New England between January 1992 and December 2001. These data were linked to the National Death Index to obtain vital status through December 2001, and used to calculate 30-day and procedural mortality rates. Procedural mortality was defined as death occurring either within the hospital setting or within 30 days of the index procedure. Regional registry data were used to calculate in-hospital mortality rates. RESULTS: Mortality rates and their 95% confidence intervals were calculated. In all but one medical center, the in-hospital mortality was the lowest rate, while in all centers the procedural mortality rate was the highest. There were 1,082 deaths captured by the procedural mortality measure. Of these, 927 were included in the in-hospital mortality measure; 956 occurred within 30 days of surgery. CONCLUSIONS: Each of the measures studied has its advantages and may be used to assess the mortality outcomes of cardiac surgery. The more important issue other than the specific measure used is our ability to measure and validate it conveniently and accurately in actual practice.

Coronary Artery Bypass↗
PubMed2006

Does the level of infant mortality affect the rate of decline? Time series data from 21 countries.

Some scholars have suggested that an inverse care law holds for infant mortality--that infant mortality reductions are more rapid in regions with lower infant mortality. This theory has not been subjected to proper quantitative analysis. This paper examines time series data on infant mortality from 21 countries to test whether percentage reductions in infant mortality are larger when infant mortality is lower. We apply the Dickey-Fuller generalized least squares (DFGLS) unit root test to infant mortality rate (IMR) time series data from 21 mostly European nations for 1870-1988 to test the statistical significance of beta in a regression analysis of Deltaln IMR(t)=alpha+beta ln IMR(t-1)+epsilon(t). Evidence that beta is significant and negative would support the claim that infant mortality declines more rapidly when substantial mortality reductions have already been achieved. With the preferred specification, the DFGLS unit root test rejected the inverse benefit hypothesis in all countries except the Netherlands at the 5% and 10% cutoffs and Australia at the 10% cutoff. The rejection of the inverse benefit hypothesis was robust to alternative specifications of the lag structure of IMR and to transformations of IMR other than logarithmic. Based on late 19th and 20th century data from countries in Europe and Latin America, there is scarce evidence that percentage reductions in infant mortality are generally smaller in higher mortality countries. These findings suggest that large percentage reductions in infant mortality are possible for countries at any stage in economic development and are reflective of durable advances in human knowledge, social institutions and physical capital.

History, 19th Century↗
PubMed2004

Recessions lower (some) mortality rates: evidence from Germany.

In his article with the provocative title "Are Recessions Good for Your Health?", Ruhm (J. Health Econ. 21(4) (2000) 659) has found robust and consistent evidence that the total mortality rate, age-specific mortality rates as well as most specific mortality causes are pro-cyclical. His finding that high unemployment rates are associated with lower mortality and vice versa stands in stark contrast to Brenner's earlier work, who found the opposite effect, possibly after a time lag. Ruhm controls for state-specific effects in a panel of US states over the period 1972-1991, whereas Brenner's work is based on time-series analysis. Extending and improving upon Ruhm's original analysis, we analyse the effect of state unemployment and economic growth rates on mortality in the states of Germany over the period 1980-2000, both in a static and a dynamic econometric model. Controlling for state-specific effects, we find evidence that aggregate mortality rates for all age groups taken together as well as most specific age groups are lower in recessions. The same is true for mortality from cardiovascular diseases, pneumonia and influenza, motor vehicle accidents and suicides, but not for necessarily for other specific mortality causes. In particular, there is never a statistically significant effect on homicides, other external effects and malignant neoplasms. There are also few differences apparent between the effect on male and female mortality. If we do not control for state-specific effects, then we often arrive at the opposite result with higher unemployment being associated with higher mortality. This suggests that a failure to control for time-invariant state-specific effects leads to omitted variable bias, which would erroneously suggest that mortality rates move counter-cyclically. Overall, we can confirm Ruhm's main finding for another country: recessions lower some, but not all, mortality rates in the case of Germany.

Adult↗
PubMed2001

Age period cohort analysis of time trends in regional mortality rates in England, Wales and Scotland.

Previous studies have demonstrated regional variation in mortality rates, this reducing for younger but not older individuals. However, it has not been clear from such studies whether or not the overall findings can or cannot be attributed to particular regions that may have abnormal patterns of change over time. We analyse mortality rates by region using data from the census years from 1931 until 1991 for adults. Age period cohort models, based on the local 'curvatures', are used to describe the changes in the rates. We also use estimable contrasts to compare the later periods with the earlier periods and to compare pre- and post-war cohorts. There is strong evidence that the changes in the mortality rates are associated with non-linear period and cohort effects. There is no evidence that these curvatures vary over regions. There is evidence that the curvatures are not the same among men and women. Among women there is evidence that there is a change in trend in the periods from 1961 to 1991 compared with the trend in the earlier periods from 1931 to 1951, such that the reduction in the mortality rates with time are slowing down for women. Among men who had higher mortality rates, there is not so much evidence of a slowing down of the reduction. Post-war cohorts of women from 1941 onwards are enjoying a reduction in mortality compared with the cohorts from 1901 to 31, while among men there is no evidence of a change in mortality trends among younger cohorts. Changes in the mortality rates over regions have come about from different long-term temporal trends in the regions rather than abrupt changes taking place at different times in different regions. The general convergence of mortality rates over regions over time with a consequent reduction in regional variance is masked by two regions, Scotland and East Anglia. These regions appear to differ from the regions as a whole in the relationship of mortality to age at a given period and in the reduction of mortality over time (drift), Scotland having a higher mortality, especially at younger ages, and lower downward trend, and East Anglia vice versa.

Adolescent↗
PubMed1983

Mortality in premature mice at birth and during neonatal development.

This paper reports a statistical study of mortality in about 2 500 premature mice at birth and during neonatal development. The premature mice were removed by caesarean section and reanimated for 30 min.; surviving mice as well as newborns delivered vaginally on day 20 of pregnancy (control mice) were raised from birth to day 20 by nursing mothers spontaneously delivered at the same time. The mortality rate in the premature mice and control newborns was estimated immediately after birth by caesarean section and 30 min. after reanimation or parturition, 6 h after birth and at 9 h every day from neonatal days 2 to 20. The caesarean section did not cause mortality. The chances of the survival of premature mice at birth depended on both gestational age and birth weight. Premature mice could not survive if their gestational age was less than 19 days and their birth weight less than 33% of that of newborn mice at term. There was no relationship between mortality and the number of newborns per litter. Two types of mortality were observed in premature mice, mortality at reanimation and breeding mortality. Mortality at reanimation was about 13%; breeding mortality, occurring only during the first 3 neonatal days, was of two types: primary neonatal mortality (10.9%), occurring from the end of reanimation up to 6 h after birth, and secondary neonatal mortality (6.9%) which appeared from days 2 to 3. The role of some factors causing mortality has been discussed.

Animals↗
PubMed2002

Evolution of all-causes and cardiovascular mortality in the age-group 75-84 years in Europe during the period 1970-1996; a comparison with worldwide changes.

BACKGROUND: In spite of the increase in longevity in the past century, studies of mortality patterns in elderly populations are scarce. We investigated cardiovascular and all-cause mortality patterns in age-group 75-84 years in Europe in the period 1970-1996. Methods Mortality data for the age-group 75-84 years were obtained from WHO and standardized according to the old European population standard. Tables were produced showing mortality rates per country around the year 1995 and trends were calculated over the period 1970-1996 using linear regression analysis. Results In both men and women aged 75-84 all-cause and cardiovascular mortality rates were higher in Central and Eastern Europe compared with Western Europe. For the last 3 available years, all-cause mortality rates differed by a factor 2/2.5 (men, women) when comparing the country with the highest with that of the lowest rate. For total cardiovascular mortality this factor was about 4/5 (men, women). During the period 1970-1996, all-cause and total cardiovascular mortality rates declined in most European countries. The decline in all causes of mortality was almost exclusively due to a decline in total cardiovascular disease mortality, especially stroke. Increases in total cardiovascular mortality were observed in some central European countries and Greece. CONCLUSION: Major changes, mainly a decline, occurred in all-cause and cardiovascular mortality in subjects aged 75-84 in Europe. Therefore a passive attitude to health problems in the elderly is not warranted.

Aged↗
PubMed2006

Endocarditis at a tertiary hospital: reduced acute mortality but poor long term prognosis.

The outcome in 132 patients with infective endocarditis diagnosed in accordance with the Duke criteria at a tertiary hospital in Denmark in the period 1998-2000 is reported. The total in-hospital mortality was 15%. Indications are that in-hospital mortality over the last decade has been reduced by around a quarter. Mortality after 3 months was 17% (CI 29%), after 3 years 32% (CI 16-47%) and after 5 years 39% (CI 22-55%). This 5-years mortality was 5 times that of an age and gender matched background population. After follow-up for 5-8 y, mortality was highest for prosthetic valve endocarditis (63% vs. 39%, p = 0.05). Heart surgery was performed in 51% of the cases. Patients who underwent surgery had a lower mortality at follow-up (36% vs. 52%, p = 0.04). The 5-year mortality was 30% (CI 9-52%) for patients treated with surgery and 48% (CI 23-72%) for patients treated without surgery. In multivariable analysis surgery was not an independent predictor for lower long-term mortality. Surgery was however an independent predictor for lower intermediate-term mortality. It is concluded that surgery may be associated with lower short- and intermediate-term mortality, while the effect might decline in the long-term. High age, prosthetic valve endocarditis, and Staphylococcus aureus endocarditis were independent predictors for high mortality. Although improvements have occurred over recent years, infective endocarditis is still a high mortality disease.

Adult↗
PubMed2001

Ethnic differences in cancer mortality trends in the US, 1950-1992.

OBJECTIVE: To describe long-term mortality trends by ethnicity, sex, and age for selected cancers and to assess the effect of age-adjustment using different standard populations on rate ratios and rate differences comparing black to white cancer mortality. DESIGN: Mortality rates for selected cancers were obtained from published reports of the Vital Statistics of the United States (1950-1992). All ethnic- and sex-specific cancer rates were directly age-adjusted to the total 1970 US standard population and to a subset of the 1970 US standard population 40 years and older. RESULTS: Over a 42-year period, lung cancer mortality increased in all population subgroups. Colorectal cancer mortality declined in whites, but increased in blacks. Prostate cancer mortality increased slightly in white men, but dramatically increased in black men. Breast cancer mortality stabilized in white women, but increased markedly in black women. Uterine cancer mortality declined for both ethnicities, while ovarian cancer mortality rates increased for both ethnicities. As expected, the ratios of the age-adjusted cancer mortality rates comparing blacks to whites were the same regardless of the age structure used as the standard population. In contrast, the differences in the age-adjusted rates between blacks and whites were greater when the age-truncated standard population was used. CONCLUSIONS: There are unexplained ethnic differences in the long-term mortality trends of selected cancers. Of particular concern are the increasing death rates in black individuals from colorectal, prostate, breast, and ovarian cancers. Since almost all deaths from these cancers occur in persons over 40, age-adjustment using an age-truncated standard population that includes only those age groups at risk should be considered, particularly when the question to be addressed is one dealing with the impact of a characteristic, such as ethnicity or sex, on mortality risk.

Adult↗
PubMed2004

Social determinants for infant mortality in the Nordic countries, 1980-2001.

AIM: Social equity in health is an important goal of public health policies in the Nordic countries. Infant mortality is often used as an indicator of the health of societies, and has decreased substantially in the Nordic welfare states over the past 20 years. To identify social patterns in infant mortality in this context the authors set out to review the existing epidemiological literature on associations between social indicators and infant mortality in Denmark, Finland, Norway, and Sweden during the period 1980-2000. METHODS: Nordic epidemiological studies in the databases ISI Web of Science, PubMed, and OVID, published between 1980 and 2000 focusing on social indicators of infant, neonatal, and postneonatal mortality, were identified. The selected keywords on social indicators were: education, income, occupation, social factors, socioeconomic status, social position, and social class. RESULTS: Social inequality in infant mortality was reported from Denmark, Finland, Norway, and Sweden, and it was found that these increased during the study period. Post-neonatal mortality showed a stronger association with social indicators than neonatal mortality. Some studies showed that neonatal mortality was associated with social indicators in a non-linear fashion, with high rates of mortality in both the lowest and highest social strata. The pattern differed, however, between countries with Finland and Sweden showing consistently less social inequalities than Denmark and Norway. While the increased inequality shown in most studies was an increase in relative risk, a single study from Denmark demonstrated an absolute increase in infant mortality among children born to less educated women. CONCLUSIONS: Social inequalities in infant mortality are observed in all four countries, irrespective of social indicators used in the studies. It is, however, difficult to draw inferences from the comparisons between countries, since different measures of social position and different inclusion criteria are used in the studies. Nordic collaborative analyses of social gradients in infant death are needed, taking advantage of the population-covering registers in longitudinal designs, to explore the mechanisms behind the social patterns in infant mortality.

Female↗
PubMed2000

Heterogeneity in Individual Mortality Risk and Its Importance for Evolutionary Studies of Senescence.

Mortality was simulated under the assumption of heterogeneity in individual age-specific mortality risk. Heterogeneity was modeled by assigning each individual its own Gompertz mortality function. Means and variances of the Gompertz intercept and slope parameters were based on published data for Drosophila melanogaster. Simulations of large cohorts reproduced mortality plateaus similar to those observed for actual cohorts of flies. Catastrophic late-age mortality was not observed except when heterogeneity was very low and rates of senescence were very high. A second set of simulations was designed to mimic experiments that have investigated age-specific patterns of genetic variance in mortality rates. Within-genotype heterogeneity in mortality risk resulted in a decline in genetic variance of mortality rates at old ages. That result suggests that the decline in genetic variance at old ages that has been observed in some experiments is an artifact of heterogeneity. Mortality rate plateaus, decrease in genetic variance of mortality rates at old ages, and absence of catastrophic late-age mortality all appear to contradict predictions of the evolutionary theory of senescence. Heterogeneity in mortality risk may explain those contradictions.

Gompertz function↗
PubMed2001

Social differentials in the decline of child mortality in nineteenth century Stockholm.

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.

Child, Preschool↗
PubMed2005

Social inequalities in perinatal and infant mortality in the northern region of Belgium (the Flanders).

BACKGROUND: The study was intended to analyse the independent effect of some facets of the socio-economic status of both parents on perinatal, neonatal and post-neonatal mortality in the northern region of Belgium (the Flanders). METHOD: Perinatal data collected by the Study Centre for Perinatal Epidemiology were linked with socio-economic data collected by the district council. Mothers aged > or =25 years are included in the study. RESULTS: 50796 births were analysed. 452 infants died either before birth or during the first year of life. 52% of the foeto-infantile mortality occurred before birth and 57% of the infant mortality in the first week of life. The educational level was strongly related to foetal (p<0.001) and, to a lesser degree, to early-neonatal mortality (p=0.001). Employment did not correlate with any mortality item. Except for foetal mortality, the strongest correlation was always observed for maternal rather than paternal social items. In a logistic regression model, foetal mortality, perinatal mortality and infantile mortality remained strongly correlated with the educational level of the mother. Infant mortality beyond the first week of life was not correlated with any aspect of the social status of the parents. CONCLUSIONS: The educational level of the mother is the single most important determinant of infantile mortality in the Flanders representing the totality of hospital births by mothers aged > or =25 years in 1999 in the Flanders. KEY POINTS STUDY QUESTION: Does education, profession and actual employment of both parents, independently operates discrimination in the outcome of pregnancy up to one year? Results: Maternal education is the only significant and independent determinant of foetal as well as neonatal and foeto-infantile mortality. Results: The status of the mother is by far more important than that of the father in determining the outcome of pregnancy.

Belgium↗
PubMed1985

The relationship of dietary fat and cholesterol to mortality in 10 years: the Honolulu Heart Program.

This report examines the relationship of dietary fat and dietary cholesterol to mortality during a 10-year surveillance of a cohort of men of Japanese descent residing in Hawaii. The consumption of dietary fat (measured in grams) is related inversely and significantly to total mortality. No significant relationships exist between grams of dietary fat and any of the specific causes of death examined. No significant relationships are found between dietary saturated fatty acids (SFA, measured in grams) or dietary cholesterol (measured in milligrams) and any of the specific causes of death examined. In contrast, percentage of calories as fat is related inversely not only to total mortality, but to cancer mortality and to stroke mortality; and it is related directly to coronary heart disease (CHD) mortality. Percentage of calories as SFA is related inversely to cancer mortality and to stroke mortality, and it is related directly to CHD mortality. Only the relationship to stroke mortality remains significant in multivariate analysis if calories from alcohol are excluded from the computation. Dietary cholesterol per 1000 calories is related directly to CHD mortality. While these data provide support for the diet-heart hypothesis, they also suggest that men with low fat intakes have a higher total mortality rate than men with higher fat intakes. This increased risk, due to an excess risk of death from stroke and cancer, indicates that there is no overall beneficial effect from a low fat diet in this cohort.

Aged↗
PubMed1995

Relationship between weather temperature and mortality: a time series analysis approach in Barcelona.

BACKGROUND: Many studies have reported that heatwaves increase mortality. However, it is not certain whether less pronounced rises in temperature also increase it. Such information might be important for predicting the impact of potential weather changes on mortality. We have assessed the relationship between daily mortality and moderate increases in weather temperature in Barcelona, Spain, following a time series approach. METHODS: The study included the period from 1 January 1985 to 30 December 1989. For all the population resident in Barcelona, Spain, we considered the following daily data: total mortality, mortality of those > 65 years, and cardiovascular and respiratory mortality. The meterological variables were: minimum temperature, maximum temperature, dew point temperature and relative humidity. Several transfer function (ARIMA) models were estimated for the entire period and for both winters and summers separately. RESULTS: We found that unusual periods of at least three consecutive days of increased weather temperature increased mortality, independently of the V-shaped relationship also found. The occurrence of an unusual period increased total daily mortality by 2% on average (1.7% on summers) and by 2.6% in those over 65 (2% on summers). Cardiovascular mortality rose by 4.6% (4.2% on summers) and respiratory mortality by 21.6% (13.2% on summers). However, only those unusual periods with an excess temperature and humidity were associated with mortality increases. CONCLUSIONS: The unusual periods observed in the present study cannot be classified as heatwaves because the weather temperature never reached high values and most of them occurred during the winter. The association of unusual periods with mortality was stronger during winters than in summers, maybe because unusual winter periods showed a temperature deviation from the average twice that in summer or because humidity during unusual winter periods was higher than in summer.

Aged↗
PubMed1997

The influence of country of birth on mortality from all causes and cardiovascular disease in Sweden 1979-1993.

BACKGROUND: Epidemiological data on ethnicity and health in Sweden have mostly been derived from small populations and focused on morbidity. The present study highlights the relation between country of birth, adjusted for other social variables, and total mortality and mortality from circulatory diseases and coronary heart disease (CHD). METHODS: The interviews with 21,420 males and 21,977 females aged 20-74 were conducted during a 7-year period, 1979-1985. The data consist of seven independent samples of the Swedish population. The present investigation was designed as a longitudinal follow-up study ranging from the day of the interview to 31 December 1993. Mortality data were obtained from the Cause of Death Register based on the Swedish national registration number. Person-years at risk were calculated from the date of the interview until death, or for those who survived, until the end of the follow-up period. The data were analysed by sex, using a proportional hazard model. RESULTS: Men born in Finland had an increased mortality from all causes of death. Women born in Finland had an increased mortality risk for circulatory diseases with a relative risk (RR) of 2.15 (95% confidence interval [CI] : 1.45-3.20) when adjusted for age, marital status, form of housing tenure and years of education. The relationship between being a woman born in Finland or Eastern Europe and mortality for coronary heart disease (CHD) was significant with an RR of 2.18 (95% CI : 1.24-3.81) and 3.02 (95% CI : 1.24-7.34) respectively. The form of housing tenure was significantly associated with mortality in all models. Education showed a graded relation to total mortality and to mortality from circulatory diseases and CHD. CONCLUSIONS: The increased mortality risk for Finnish males and females and, in addition the increased circulatory disease mortality risk for Finnish females and the strongly increased risk for CHD mortality for females born in Finland and Eastern Europe could not be explained by confounding by age, marital status or socioeconomic position.

Adult↗
PubMed2001

Variation in mortality rates in Australia: correlation with Indigenous status, remoteness and socio-economic deprivation.

BACKGROUND: The aim of this study was to study ecological correlations between age-adjusted all-cause mortality rates in Australian statistical divisions and (1) the proportion of residents that self-identify as Indigenous, (2) remoteness, and (3) socio-economic deprivation. METHODS: All-cause mortality rates for 57 statistical divisions were calculated and directly standardized to the 1997 Australian population in 5-year age groups using Australian Bureau of Statistics (ABS) data. The proportion of residents who self-identified as Indigenous was obtained from the 1996 Census. Remoteness was measured using ARIA (Accessibility and Remoteness Index for Australia) values. Socioeconomic deprivation was measured using SEIFA (Socio-Economic Index for Australia) values from the ABS. RESULTS: Age-standardized all-cause mortality varies two-fold from 5.7 to 11.3 per 1,000 across Australian statistical divisions. Strongest correlation was between Indigenous status and mortality (r = 0.69, p < 0.001). Correlation between remoteness and mortality was modest (r = 0.39, p = 0.002) as was correlation between socio-economic deprivation and mortality (r = -0.42, p = 0.001). Excluding the three divisions with the highest mortality, a multiple regression model using the logarithm of the adjusted mortality rate as the dependent variable showed that the partial correlation (and hence proportion of the variance explained) for Indigenous status was 0.03 (9 per cent; p = 0.03), for SEIFA score was -0.17 (3 per cent; p = 0.22); and for remoteness was -0.22 (5 per cent; p = 0.13). Collectively, the three variables studied explain 13 per cent of the variability in mortality. CONCLUSIONS: Ecological correlation exists between all-cause mortality, Indigenous status, remoteness and disadvantage across Australia. The strongest correlation is with Indigenous status, and correlation with all three characteristics is weak when the three statistical divisions with the highest mortality rates are excluded. Intervention targeted at these three statistical divisions could reduce much of the variability in mortality in Australia.

Australia↗