At a glance

  • In 2018, the standardised total burden rate was double (2.1 times higher) for First Nations Queenslanders that of other Queenslanders. This difference was slightly greater nationally (2.3 times).
  • Mental health and substance use disorders were the leading cause of health burden.
  • Health loss due to disability was greater than health loss due to premature death for First Nations Queenslanders due to reductions in fatal outcomes over a number of years.
  • Nationally, the age-adjusted gap in total burden narrowed between First Nations peoples and other Australians by 15.6% in the 15 years up to 2018. It was similar in Queensland, with 15.7% in the same time period.

Introduction

Estimates of burden of disease for the Aboriginal and Torres Strait Islander population in Australia for 2018 were produced as part of the Australian Burden of Disease Study (ABDS) released by Australian Institute of Health and Welfare (AIHW).1 While state-level data were limited, it did include critical information to assist in policy and planning within Queensland to improve the health of First Nations peoples.

Burden of disease is a complex analytical method to measure the gap between the ideal of everyone living to old age in good health and people’s experience of illness and early death. The methods are summarised on the Burden of Disease section of this report with detailed information available from the AIHW.1

This section uses age-standardised rates (ASRs or standardised rates) of health burden to adjust for differences in the age distributions between First Nations peoples and others.

Burden of disease

Health loss due to premature death

The leading causes of fatal burden for First Nations Queenslanders in 2018 were injuries (23.6% of total), cancer (21.2%), cardiovascular disease (17.2%) and infant/congenital conditions (10.6%). Standardised fatal burden rates have diminished in recent years, by 26.8% nationally since 2003 and by 20.3% in Queensland since 2011.1

The standardised fatal burden rate for First Nations peoples was 2.2 times the rate for other Queenslanders. The leading contributors to the fatal burden gap in 2018 were cardiovascular disease, accounting for 22.7% of the gap, cancers (18.9%), injuries (15.0%) and kidney and urinary diseases (9.1%).1

Health loss due to disability

The leading causes of disability burden for First Nations Queenslanders in 2018 were mental and substance use disorders (42.7% of total), musculoskeletal conditions (13.8%), respiratory (8.8%), neurological (5.3%), hearing and vision loss (4.8%) and oral health (4.0%).1

The standardised disability burden rate for First Nations peoples was 2.0 times the rate for other Queenslanders in 2018. The leading contributors to the disability burden gap for First Nations Queenslanders in 2018 were mental and substance use disorders (42.6% of the disability gap), musculoskeletal (10.6%), respiratory (10.3%) and hearing and vision loss (8.5%).1

Total burden

Mental and substance use disorders were the leading broad cause of total burden for First Nations Queenslanders in 2018 (23.9%) for both males and females (Table 1). This is consistent with the 2011 results. The ranking of other causes however differed, with injury ranked 2nd for males and cancers for females.2

Table 1: Health burden by disease group for First Nations Queenslanders, 2018

Table 1a: Health burden by disease group for First Nations Queenslanders, 2018 (persons)Ordered by DALY
Disease groupDALYs% of total
Mental14,55823.9
Injuries7,29212.0
Cancer6,22710.2
Cardiovascular5,6499.3
Musculoskeletal4,7697.8
Respiratory4,4627.3
Infant/congenital3,3365.5
Neurological2,5884.2
Endocrine1,9683.2
Gastrointestinal1,6722.7
Kidney/urinary1,6582.7
Hearing/vision1,6252.7
Infections1,6092.6
Oral1,3452.2
Skin9101.5
Blood/metabolic8881.5
Reproductive/maternal4150.7
Total60,971100.0
Table 1b: Health burden by disease group for First Nations Queenslanders, 2018 (males)Ordered by DALY
Disease groupDALYs % of total
Mental 7,874 24.0
Injuries 5,226 16.0
Cardiovascular 3,393 10.4
Cancer 3,233 9.9
Musculoskeletal 2,084 6.4
Respiratory 1,983 6.1
Infant/congenital 1,870 5.7
Neurological 1,215 3.7
Endocrine 1,017 3.1
Gastrointestinal 966 2.9
Infections 813 2.5
Hearing/vision 798 2.4
Oral 710 2.2
Kidney/urinary 693 2.1
Skin 445 1.4
Blood/metabolic 428 1.3
Reproductive/maternal 16 0.0
Total 32,764 100.0
Table 1c: Health burden by disease group for First Nations Queenslanders, 2018 (females)Ordered by DALY
Disease groupDALYs% of total
Mental6,68523.7
Cancer2,99310.6
Musculoskeletal2,6859.5
Respiratory2,4798.8
Cardiovascular2,2568.0
Injuries2,0667.3
Infant/congenital1,4675.2
Neurological1,3734.9
Kidney/urinary9653.4
Endocrine9513.4
Hearing/vision8272.9
Infections7962.8
Gastrointestinal7062.5
Oral6342.2
Skin4641.6
Blood/metabolic4591.6
Reproductive/maternal3991.4
Total28,205100.0

Health loss by select specific causes

Due to small numbers and other limitations, jurisdictional estimates are not available for specific conditions. Nationally, the five leading specific causes for health loss (DALY) in 2018 for First Nations peoples were coronary heart disease (5.8%), anxiety disorders (5.3%), suicide and self-inflicted injuries (4.6%), alcohol use disorders (4.4%) and depressive disorders (4.3%).1

National comparisons

In 2018, the standardised burden rate for First Nations Queenslanders was 4.4% lower than the First Nations peoples national rate and was the lowest among the four jurisdictions with reportable data primarily due to lower rates of fatal health loss (Figure 1).1

Figure 1: Standardised burden rate for First Nations peoples by selected jurisdictions, 2018

Figure 1a: Standardised burden rate for First Nations peoples by selected jurisdictions, 2018 (DALY)
Bar chart for standardised DALY rates for four reportable jurisdiction and Australia for First Nations people, showing Queensland having the lowest rate
Figure 1b: Standardised burden rate for First Nations peoples by selected jurisdictions, 2018 (YLL)
Bar chart for standardised YLL rates for four reportable jurisdiction and Australia for First Nations people, showing Queensland having the lowest rate
Figure 1c: Standardised burden rate for First Nations peoples by selected jurisdictions, 2018 (YLD)
Bar chart for standardised YLD rates for four reportable jurisdiction and Australia for First Nations people, showing Queensland having similar rate as Australia
Figure 1d: Standardised burden rate for First Nations peoples by selected jurisdictions, 2018 (table) Ordered by state and measure
YearStateSexMeasure Rate per 1,000
2018 NSW Persons DALY 397.2
2018 NSW Persons YLL 206.0
2018 NSW Persons YLD 191.2
2018 QLD Persons DALY 382.6
2018 QLD Persons YLL 184.7
2018 QLD Persons YLD 197.9
2018 WA Persons DALY 467.9
2018 WA Persons YLL 263.7
2018 WA Persons YLD 204.2
2018 NT Persons DALY 479.4
2018 NT Persons YLL 292.4
2018 NT Persons YLD 187.0
2018 Australia Persons DALY 399.6
2018 Australia Persons YLL 201.1
2018 Australia Persons YLD 198.5

There has been some improvement over the seven years since 2011, when the Queensland rate was 2.8% higher than the national rate, and second lowest after New South Wales.1

Remoteness and sociodemographic differences

For First Nations Australians in 2018, the standardised rate of health loss for those living in remote and very remote areas was 23.8% to 25.2% higher (respectively) than those living in major cities. Most of the health loss was associated with premature death, with negligible difference in disability burden rates. In 2011, the standardised burden rate in remote/very remote areas was about double that in major cities (2.2 times higher in remote areas and 1.6 times higher in very remote areas). This indicates that inequities for First Nations peoples due to remoteness may be diminishing although greater effort to reduce burden from premature death is needed.1

In contrast, the socioeconomic difference in burden rate for First Nations Australians increased between 2011 and 2018. Standardised burden rates in areas of greatest socioeconomic disadvantage were 3.6 times those in least disadvantaged areas in 2018, while in 2011 there was a 2.5-fold difference.2

One-in-four First Nations Australians (26.6%) lived in areas of greater socioeconomic disadvantage while nearly half (48.9%) live in areas of less disadvantage.1 Concerted effort is required improve health outcomes in areas of socioeconomic disadvantage, in all areas including major cities, remote and regional areas.

The gap in health loss

The standardised burden rate for First Nations Queenslanders was 2.1 times that of other Queenslanders, having reduced slightly from 2.2 times in 2011.

The gap in health outcomes between First Nations Queenslanders and others can be measured using rate ratios. Nationally this gap narrowed by 15.6%, a small but significant improvement.1

This gap changes over the life course and is generally better for children and older people than the young and early middle-aged adults, even though gaps were observed in the fatal burden (years of life lost, YLL) for young females and disability burden (years lived with a disability, YLD) for 0-4 year old (Figure 2). The greatest difference in overall burden (disability adjusted life years, DALY) was among those aged about 35 to 55 years indicating substantial effort is needed to address the health needs of First Nations peoples in these age groups for both males and females.1

Figure 2: Burden rate ratio of First Nations peoples compared to other Queenslanders, 2018

Figure 2a: Burden rate ratio of First Nations peoples compared to other Queenslanders, 2018 (DALY)
Lollipop chart for DALY rate ratio of First Nations peoples compared to others, by age and sex, Queensland, showing highest rate ratio among the middle aged
Figure 2b: Burden rate ratio of First Nations peoples compared to other Queenslanders, 2018 (YLL)
Lollipop chart for YLL rate ratio of First Nations peoples compared to others, by age and sex, Queensland, showing variations by age and sex.
Figure 2c: Burden rate ratio of First Nations peoples compared to other Queenslanders, 2018 (YLD)
Lollipop chart for YLD rate ratio of First Nations peoples compared to others, by age and sex, Queensland, showing variations by age and sex.
Figure 2d: Burden rate ratio of First Nations peoples compared to other Queenslanders, 2018 (table) Ordered by sex, measure and age group
YearSex Age groupMeasureRatio
2018 Males 0–4 DALY 1.7
2018 Males 5–9 DALY 1.7
2018 Males 10–14 DALY 1.6
2018 Males 15–19 DALY 1.8
2018 Males 20–24 DALY 2.2
2018 Males 25–29 DALY 2.2
2018 Males 30–34 DALY 2.6
2018 Males 35–39 DALY 2.7
2018 Males 40–44 DALY 2.8
2018 Males 45–49 DALY 2.7
2018 Males 50–54 DALY 2.4
2018 Males 55–59 DALY 2.2
2018 Males 60–64 DALY 2.2
2018 Males 65–69 DALY 1.9
2018 Males 70–74 DALY 1.8
2018 Males 75–79 DALY 1.9
2018 Males 80–84 DALY 1.7
2018 Males 85+ DALY 1.4
2018 Males 0–4 YLL 1.7
2018 Males 5–9 YLL 2.0
2018 Males 10–14 YLL 1.3
2018 Males 15–19 YLL 1.6
2018 Males 20–24 YLL 2.7
2018 Males 25–29 YLL 2.3
2018 Males 30–34 YLL 2.5
2018 Males 35–39 YLL 2.9
2018 Males 40–44 YLL 2.8
2018 Males 45–49 YLL 3.0
2018 Males 50–54 YLL 2.5
2018 Males 55–59 YLL 2.2
2018 Males 60–64 YLL 2.5
2018 Males 65–69 YLL 1.9
2018 Males 70–74 YLL 1.8
2018 Males 75–79 YLL 1.8
2018 Males 80–84 YLL 1.5
2018 Males 85+ YLL 1.3
2018 Males 0–4 YLD 1.9
2018 Males 5–9 YLD 1.6
2018 Males 10–14 YLD 1.7
2018 Males 15–19 YLD 1.9
2018 Males 20–24 YLD 1.9
2018 Males 25–29 YLD 2.1
2018 Males 30–34 YLD 2.6
2018 Males 35–39 YLD 2.5
2018 Males 40–44 YLD 2.7
2018 Males 45–49 YLD 2.4
2018 Males 50–54 YLD 2.3
2018 Males 55–59 YLD 2.1
2018 Males 60–64 YLD 1.8
2018 Males 65–69 YLD 1.9
2018 Males 70–74 YLD 2.0
2018 Males 75–79 YLD 2.0
2018 Males 80–84 YLD 2.0
2018 Males 85+ YLD 1.6
2018 Females 0–4 DALY 1.8
2018 Females 5–9 DALY 1.8
2018 Females 10–14 DALY 1.8
2018 Females 15–19 DALY 1.9
2018 Females 20–24 DALY 2.0
2018 Females 25–29 DALY 2.0
2018 Females 30–34 DALY 2.4
2018 Females 35–39 DALY 2.4
2018 Females 40–44 DALY 2.5
2018 Females 45–49 DALY 2.6
2018 Females 50–54 DALY 2.3
2018 Females 55–59 DALY 2.2
2018 Females 60–64 DALY 2.1
2018 Females 65–69 DALY 2.2
2018 Females 70–74 DALY 2.1
2018 Females 75–79 DALY 2.0
2018 Females 80–84 DALY 1.8
2018 Females 85+ DALY 1.5
2018 Females 0–4 YLL 1.7
2018 Females 5–9 YLL 3.3
2018 Females 10–14 YLL 2.9
2018 Females 15–19 YLL 2.5
2018 Females 20–24 YLL 2.9
2018 Females 25–29 YLL 2.5
2018 Females 30–34 YLL 2.5
2018 Females 35–39 YLL 2.9
2018 Females 40–44 YLL 2.9
2018 Females 45–49 YLL 3.2
2018 Females 50–54 YLL 2.6
2018 Females 55–59 YLL 2.5
2018 Females 60–64 YLL 2.5
2018 Females 65–69 YLL 2.5
2018 Females 70–74 YLL 2.4
2018 Females 75–79 YLL 2.1
2018 Females 80–84 YLL 1.8
2018 Females 85+ YLL 1.7
2018 Females 0–4 YLD 2.2
2018 Females 5–9 YLD 1.6
2018 Females 10–14 YLD 1.6
2018 Females 15–19 YLD 1.7
2018 Females 20–24 YLD 1.8
2018 Females 25–29 YLD 1.9
2018 Females 30–34 YLD 2.4
2018 Females 35–39 YLD 2.2
2018 Females 40–44 YLD 2.3
2018 Females 45–49 YLD 2.2
2018 Females 50–54 YLD 2.2
2018 Females 55–59 YLD 2.0
2018 Females 60–64 YLD 1.9
2018 Females 65–69 YLD 1.9
2018 Females 70–74 YLD 1.9
2018 Females 75–79 YLD 1.8
2018 Females 80–84 YLD 1.7
2018 Females 85+ YLD 1.4
2018 Persons 0–4 DALY 1.8
2018 Persons 5–9 DALY 1.8
2018 Persons 10–14 DALY 1.7
2018 Persons 15–19 DALY 1.8
2018 Persons 20–24 DALY 2.1
2018 Persons 25–29 DALY 2.1
2018 Persons 30–34 DALY 2.5
2018 Persons 35–39 DALY 2.5
2018 Persons 40–44 DALY 2.6
2018 Persons 45–49 DALY 2.6
2018 Persons 50–54 DALY 2.4
2018 Persons 55–59 DALY 2.2
2018 Persons 60–64 DALY 2.2
2018 Persons 65–69 DALY 2.0
2018 Persons 70–74 DALY 2.0
2018 Persons 75–79 DALY 1.9
2018 Persons 80–84 DALY 1.7
2018 Persons 85+ DALY 1.5
2018 Persons 0–4 YLL 1.7
2018 Persons 5–9 YLL 2.6
2018 Persons 10–14 YLL 1.9
2018 Persons 15–19 YLL 1.9
2018 Persons 20–24 YLL 2.7
2018 Persons 25–29 YLL 2.4
2018 Persons 30–34 YLL 2.5
2018 Persons 35–39 YLL 2.9
2018 Persons 40–44 YLL 2.8
2018 Persons 45–49 YLL 3.1
2018 Persons 50–54 YLL 2.6
2018 Persons 55–59 YLL 2.3
2018 Persons 60–64 YLL 2.5
2018 Persons 65–69 YLL 2.1
2018 Persons 70–74 YLL 2.0
2018 Persons 75–79 YLL 1.9
2018 Persons 80–84 YLL 1.6
2018 Persons 85+ YLL 1.5
2018 Persons 0–4 YLD 2.0
2018 Persons 5–9 YLD 1.6
2018 Persons 10–14 YLD 1.7
2018 Persons 15–19 YLD 1.8
2018 Persons 20–24 YLD 1.9
2018 Persons 25–29 YLD 2.0
2018 Persons 30–34 YLD 2.5
2018 Persons 35–39 YLD 2.4
2018 Persons 40–44 YLD 2.5
2018 Persons 45–49 YLD 2.3
2018 Persons 50–54 YLD 2.2
2018 Persons 55–59 YLD 2.1
2018 Persons 60–64 YLD 1.9
2018 Persons 65–69 YLD 1.9
2018 Persons 70–74 YLD 2.0
2018 Persons 75–79 YLD 1.9
2018 Persons 80–84 YLD 1.9
2018 Persons 85+ YLD 1.5

The leading contributors to the health gap between First Nations Queenslanders and others were mental and substance use disorders (accounting for 22.0% of the gap), cardiovascular diseases (12.6%), cancer (10.0%), respiratory diseases (9.4%) and injuries (8.1%).1

Risk factors

The joint effect of 19 potentially modifiable risk factors accounted for 49.1% of burden for First Nations Australians in 2018 (data for Queensland is not available) (Table 2). Tobacco use accounted for 11.9% of total health loss (DALYs), followed by alcohol use (10.4%), overweight and obesity (9.7%), illicit drug use (6.9%) and dietary factors (6.2%).2

Risk factors combined, accounted for 66.1% of the health gap between First Nations peoples and other Australians, with tobacco a leading individual contributor explaining 20.3% of the gap (Table 2). Strategies to reduce exposure to tobacco and address alcohol-related problems are therefore critical to closing the health gap including the life expectancy difference.1

Table 2: Top 5 risk factors, First Nations peoples, Australia 2018 Ordered by % of total DALY
Risk factor % of total DALY % contribution to gap in DALY
Tobacco use 11.9 20.3
Alcohol use 10.4 12.2
Overweight (including obesity) 9.7 14.9
Illicit drug use 6.9 7.4
All dietary risks 6.2 9.6
Joint effect 49.1 66.1

In 2018, the joint effect of these risk factors accounted for 97.8% of the burden of endocrine disorders, 94.8% of burden due to kidney and urinary diseases, 77.3% of the cardiovascular disease burden, 59.7% of the injury burden and 55.9% of cancer burden. This illustrates the importance of a continuing focus on prevention to improve health outcomes for First Nations peoples.1

Living life in full health

Health adjusted life expectancy (HALE) provides the time an individual at a specified age (typically at birth or at age 65 years) could expect to live in full health without disease or injury.

On average, First Nations peoples in Queensland born in 2018 could expect to live about 80% of their life in full health. Health adjusted life expectancy for First Nations peoples in Queensland males born in 2018 was 57.2 years and for females was 60.2 years. Life expectancy was estimated at 72.0 years and 76.4 years, respectively.1

HALE for First Nations peoples in Queensland was slightly higher than for First Nations Australians—for males by 1.2 years and for females by 1.4 years and compared favourably with the three other jurisdictions with reported data, ranked 2nd after New South Wales. First Nations peoples in Queensland had the highest life expectancy among the four jurisdictions for both males and females—2.0 years than First Nations peoples nationally for both males and females.1

First Nations peoples living in remote and very remote areas of Australia on average lived shorter lives than those in major cities, life expectancy was 6.2 years lower for males with a 4.0-year difference for HALE, and for females a 6.2-year difference in life expectancy and 4.0 years for HALE.1


Additional information

Data and statistics

Where presented, ratios were calculated using higher precision estimates than those that are displayed within the report.

Visit the AIHW website for:

Section technical notes

Refer to the Australian Burden of Disease Study: impact and cause of illness and death in Aboriginal and Torres Strait Islander people report for technical details of the results presented.

Results presented in this section are not comparable to the most recently released Australian Burden of Disease Study 2022.

Queensland Health has engaged with the AIHW, La Trobe University, and the University of Queensland Poche Centre for Indigenous Health in a project that aims to establish burden of disease estimates by Hospital and Health Service for 2011 and 2018. This study uses a greater amount of Queensland specific data, and has been modelled separately to the ABDS, there may therefore be some difference in the results at the state level.


Last updated: February 2024