Causes of premature and potentially avoidable death; identifying hotspots of inequality

A Geographic and Temporal Analysis

Published: 2021

Purpose of the project

The number of deaths in general and by specific cause are indicators of a population’s health and safety. As a population health measure, areas with consistently higher death rates demonstrate areas of inequality and this phenomenon can be deeply entrenched over time. The availability of a long-term archive of death records and the consistent recording of the residential location within these files has meant that the degree of geographic and temporal variation in the causes of death can now be examined at the small area level across Australia.

Reporting on the variation over time is usually done by direct age-standardisation to calculate age-standardised death rates. However, when calculating age-standardised rates, the occurrence of small numbers, both in terms of the number of deaths and populations within each age-group in a small area, means that the rates can be erroneously inflated. This approach becomes problematic when we want to identify small areas that consistently have high death rates as areas that warrant intervention. To overcome this issue, we implemented the Empirical Bayes estimation method, within the age-standardisation process, to estimate death rates at the small area level from 2009 to 2018, across Australia. This approach minimises the effects of statistical issues in the calculation of the age-standardised death rates by weighing the death rate of a small area together with the death rates from all areas under investigation.

Hotspot analysis was then undertaken on this multi-dimensional dataset highlighting the heat of each area, from "Cold" to "Hot", in relation to the area’s annual death rate compared to the annual Australian average. We have focused on the premature and potentially avoidable death categories from which a total of 26 cause of death indicators were investigated.

We hope that this new analysis, and its presentation in geographical maps, heat map graphs and data sheets, will provide information that is useful to the various levels of the health system, from state and territory health agencies, local and regional health networks and boards, PHN and primary care practitioners, with an aim to work together to reduce the level of premature and potentially avoidable deaths in Australia. The interpretation of the data and its presentation is complex, and we encourage users to read the detailed notes below, and, to take note of the document on Using the Atlas.

Further information can be obtained by contacting the Public Health Information Development Unit.

Authored by PHIDU