Key points

• In 2015–2017, life expectancy at birth was 71.6 years for Indigenous males (8.6 years less than non-Indigenous males) and 75.6 years for Indigenous females (7.8 years less than non-Indigenous females).
• Over the period 2006 to 2018, there was an improvement of almost 10 per cent in Indigenous age‑standardised mortality rates. However, non‑Indigenous mortality rates improved at a similar rate, so the gap has not narrowed.
• Since 2006, there has been an improvement in Indigenous mortality rates from circulatory disease (heart disease, stroke and hypertension). However, this has coincided with an increase in cancer mortality rates, where the gap is widening.

What the data tells us

National

The target to close the life expectancy gap by 2031 is not on track. The life expectancy target is measured using the Australian Bureau of Statistics (ABS) estimates of life expectancy at birth, which are available every five years.¹

In 2015–2017, life expectancy at birth was 71.6 years for Indigenous males and 75.6 years for Indigenous females. In comparison, the non-Indigenous life expectancy at birth was 80.2 years for males and 83.4 years for females (Figure 7.1). This is a gap of 8.6 years for males and 7.8 years for females.

Life expectancy is an overarching target, which is dependent not only on health, but the social determinants (such as education, employment status, housing and income). Social determinants are estimated to be responsible for at least 34 per cent of the health gap between Indigenous and non‑Indigenous Australians. Behavioural risk factors, such as smoking, obesity, alcohol use and diet, accounted for around 19 per cent of the gap (AHMAC 2017).

Source: Australian Bureau of Statistics 2018, Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017, Cat. no. 3302.0.55.003, ABS: Canberra.

View the text alternative for Figure 7.1.

States and territories

As reported last year, New South Wales, Queensland and the Northern Territory—the three jurisdictions with agreed trajectories for the life expectancy target—are not on track to meet the target.

In 2015–2017, Indigenous life expectancy was highest in Queensland (72.0 years for males, 76.4 years for females) and lowest in the Northern Territory (66.6 years for males, 69.9 years for females) (Figure 7.2).

The gap in life expectancy was the largest for males in Western Australia (13.4 years) and for females in the Northern Territory (12.8 years).

Source: Australian Bureau of Statistics 2018, Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017, Cat. no. 3302.0.55.003, ABS: Canberra.

View the text alternative for Figure 7.2.

Life expectancy by remoteness

Life expectancy for Indigenous Australians living in remote Australia was lower than for those living in urban areas. In 2015–2017, life expectancy for Indigenous males living in Remote and Very Remote areas combined was estimated to be 6.2 years lower than that of Indigenous males living in Major Cities (65.9 years compared with 72.1 years). The equivalent comparison for Indigenous females was 6.9 years lower (69.6 years compared with 76.5 years).

While life expectancy for Indigenous males and females decreases with remoteness, life expectancy for non-Indigenous males and females is similar across all remoteness categories. This means that the gap is widest in Remote and Very Remote areas.

Mortality

Age‑standardised mortality rates² are used as a proxy to track progress against the life expectancy target annually. This is because the ABS Indigenous life expectancy estimates are only available every five years, while mortality data are available annually.

In 2018, there were 3,218 Indigenous deaths (1,780 males and 1,438 females).³ This was equivalent to an age-standardised mortality rate of 927 per 100,000—around 1.7 times the non-Indigenous rate (539 per 100,000). The Indigenous rate was not within the range required to meet the target (Figure 7.3).

Between 2006 to 2018, Indigenous age‑standardised mortality rates improved by almost 10 per cent.⁴ However, non‑Indigenous rates improved at a similar rate, so the gap has not narrowed. As such, the Indigenous mortality rate has not been on track to meet the target since 2011. The rate of improvement of Indigenous mortality rates has not been as strong as prior to the 2006 baseline.

Further research (including data linkage) is required to understand the reasons why the rate of progress has slowed despite improvements in the detection and management of chronic disease. This is discussed in more detail at Causes of death.

Sources: Australian Bureau of Statistics and Australian Institute of Health and Welfare analysis of the National Mortality Database, unpublished and National Indigenous Reform Agreement Performance Information Management Group, unpublished.

Notes:

a. The Indigenous mortality rates over the period 1998 to 2006 may be less reliable than rates since 2006 as the reliability of population estimates lessens the further away the time series moves from the 2016 Census upon which they are based.

b. The Indigenous trajectory indicates the level of change required to meet the target. The trajectory has been revised to include the 2016 Census-based backcast population estimates. For more information see the Technical Appendix.

View the text alternative for Figure 7.3.

States and territories

Although there is year on year volatility in jurisdictional specific mortality data, New South Wales, Queensland, South Australia and the Northern Territory showed little or no improvement since the 2006 baseline. They are not on track to meet the target.⁵

However, in Western Australia Indigenous mortality rates improved by 27 per cent between 2006 and 2018, which has contributed to a narrowing of the gap.

Causes of death

Improvements in the mortality rate from circulatory disease (heart disease, stroke and hypertension) have primarily driven improvements in the Indigenous age‑standardised mortality rate. However, since 2006, this has coincided with a worsening of Indigenous cancer mortality rates. In 2017, for the first time, the Indigenous mortality rate from cancer was higher than for circulatory disease. Furthermore, the gap with non‑Indigenous cancer mortality rates is widening.

Further research is required to understand the reasons for changes in the trends in circulatory disease and cancer mortality—the two leading causes of death among Indigenous Australians. The Aboriginal and Torres Strait Islander Health Performance Framework Report provides greater detail about the trends in the other leading causes of death and the factors that drive them (AHMAC 2017).

Reductions in smoking, and improved early detection and management of chronic disease, are playing a vital role in driving gradual improvements in health outcomes impacting on life expectancy. However, later diagnoses of cancer, comorbidities and the types of cancer affecting Indigenous Australians are likely to be contributing to lower cancer survival (AHMAC 2017). It is important to note that population health interventions, such as smoking reduction, have a long lead time before measurable impacts can be seen.

Daily smoking among Indigenous Australians aged 15 years and over has decreased from 41 per cent in 2012–13 to 37 per cent in 2018–19 (ABS 2019b). While this is encouraging, there can be a long lag time for lung cancer to emerge (up to 30 years). This means that smoking related deaths may continue to rise over the next decade before declining, when the longer term impact of smoking reduction may be realised (Lovett et al. 2017).

Between 2003 and 2011, the decrease in the burden from Indigenous smoking-related circulatory disease has coincided with an increase in the burden of smoking-related cancer and respiratory disease (AIHW 2016 as cited by Lovett et al. 2017).⁶

Data notes

New Indigenous population estimates based on the 2016 Census have been used to rebase the denominator for calculating mortality rates and the trajectory to the target. This potentially makes the Indigenous mortality rates over the period 1998 to 2006 less reliable than rates since 2006.

For more information see the Technical Appendix.