‘Quite worrying’: Premature mortality inequality in Australia

Evelyn Lewin

27/05/2020 12:04:34 PM

The continually widening gap may be exacerbated by COVID-19.

Dr Tim Adair
Dr Tim Adair said the research highlights the need for health promotion in certain segments of the population.

People aged 35–74 who live in the lowest socioeconomic areas are twice as likely to die prematurely as those in wealthier areas. 
This gap widened by 26% for females and 14% for males from 2011 to 2016.
Furthermore, people living in outer-regional, remote and very remote areas have premature death rates about 40% higher than those in major cities, with that gap also continuing to widen.
Such were the findings from research published in Australian Population Studies.
For the study, researchers analysed the Australian death registration data from 2006–16.
Researcher Dr Tim Adair from the University of Melbourne’s Global Burden of Disease Group told newsGP he is most concerned about the widening of those gaps.
‘They’re quite worrying trends,’ he said.
Dr Adair is also concerned about the fact life expectancy is not increasing in low-socioeconomic areas.
‘Life expectancy increases in Australia have actually slowed somewhat in the last 10 or 15 years,’ he said.
‘So what we’re finding is the rates of premature mortality in the lower socioeconomic groups, which had declined for a long period of time, have actually stagnated and aren’t declining any further.
‘That’s quite a worrying trend for that segment of the population.’
The researchers embarked on their study with the knowledge that life expectancy growth had slowed.
‘But we didn’t realise that there would actually be that stagnation in mortality rates in the last few years,’ Dr Adair said.
‘That was quite surprising.’
While there has been stagnation in mortality rates in low socioeconomic areas, the highest socioeconomic areas of major cities have experienced no slowdown.
A number of factors may contribute to these differences.
‘One of the things which is noticeable from other research is that the level of smoking, the level of excessive alcohol consumption, and also the level of poor diet and obesity are higher in lower socioeconomic areas,’ Dr Adair said.
The rates of those factors are also higher in more regional and rural areas, but people in more remote areas face additional health challenges.
It’s also important to keep in mind that there are differences in accessibility of healthcare; for example, the proximity to specialist care is poorer outside of major cities,’ Dr Adair said.
The effect of COVID-19 on premature mortality rates is also a concern.
Researcher Professor Alan Lopez said lower socioeconomic groups will disproportionately experience the emotional and economic stressors of COVID-19, which may further widen the gap in mortality rates.
‘The advent of COVID-19 might well exacerbate this already unfavourable trend due to increased stress and unemployment, hitting the least well-off hardest, which could well have a flow-on effect in terms of poorer health behaviours and access to healthcare,’ Professor Lopez said.
‘This ought to be a key consideration in government policy responses to COVID-19.’
If these inequalities are not addressed, Dr Adair said future life expectancy growth in Australia might be affected. He therefore believes this new research can play a key part in highlighting the ongoing need for health promotion by GPs in both low-socioeconomic areas, as well as rural and remote regions.
‘I think it really reinforces the need for strengthened promotion of positive health behaviours in certain segments of the population,’ he said.
‘One of the longer-term issues we’re facing in Australia is the increasing levels of obesity. We’ve been very successful at lowering smoking levels, but not so much for lowering levels of obesity.
‘So what GPs can do is drive home the message of healthy behaviours which will obviously have better heath outcomes for their patients.’
According to the Australian Institute of Health and Welfare (AIHW), in 2013 approximately one in three (34%) of all deaths occurred prematurely, defined as those aged under 75.
Males accounted for 62% of premature deaths, and 85% of premature deaths were of people aged 45–74.
The leading causes of premature death in 2011–13 were coronary heart disease, lung cancer and suicide.
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