State of Our Health / Chapter 5. End of Life
Introduction

Chapter 2, Starting Well and the Early Years, focuses on South Australians’ start of life and the spectrum of factors that create the foundations on which South Australians' health is built. Chapter 5 focuses on the other end of the spectrum, death.

In previous chapters, we have considered the complex web of community, lifestyle and genetic factors that determine an individual’s potential to live a long and healthy life. The start South Australians have in life, their lifestyle choices and socioeconomic factors across the lifespan have an impact on the final years of life. Understanding patterns and trends in mortality is an important step in identifying areas for further analysis and potential opportunities to improve population health.

Chapter 5 starts with an overview of various death measures by different factors, including sex, region and Aboriginal status. It then looks at perinatal deaths and infant mortality rates, both important elements directly impacted by the health status of pregnant women and indirectly by social, economic and environmental conditions.

Next, this chapter provides an overview of the leading causes of death by age group, providing important information about conditions which may require further analysis or public health intervention. It then considers deaths by specific causes, including the leading cause of death in South Australia, circulatory disease, and the second highest cause of death in South Australia, cancer. Deaths by major, specific cancers and their trends are also provided, including lung, prostate, breast, cervical and colon cancers. Chronic respiratory diseases also have a significant mortality burden and are therefore included.

Finally, Chapter 5 provides collated information about deaths in South Australia which were premature, preventable or treatable. This information is another critical element understanding the effectiveness of the health system and whether specific areas require further attention.

Chapter 5 ends with information on suicide, a specific preventable cause of death which has an immense impact on families, communities and South Australia as a whole.

End of Life

Death Rates

  • The South Australian death rate for all age groups has been trending down since 2005. Since 2000, the male death rate has been consistently higher than the female death rate however in recent years the gap between the male and female death rate has gradually closed [5-1].

Median Age at Death

  • The median age at death for South Australians is trending up, and now stands at 79.6 years for males, and 84.9 years for females[5-2].

Age Specific Deaths

  • Age-specific death rates were equal to or higher for males than females across all age cohorts
    [5-3].
  • South Australia’s perinatal death rate at 6.2 per 1,000 births was the lowest nationally. South Australia's rate of Aboriginal perinatal deaths was also the lowest nationally [5-4].
  • The infant death rate in South Australia was 3.8 per 1000 live births and has been trending down since 2000, although it remains significantly higher for males than females [5-5].
  • There has been a nearly 30% decline in Aboriginal child mortality [5-6].

Leading Causes of Death

  • The top three causes of death in South Australia are circulatory disease, cancer, and respiratory disease. Of particular concern, intentional self-harm is now one of the main causes (either first or second leading cause) of death for South Australians aged 15 to 44 years [5-7 to 5-16].

Premature Death

  • Malignant neoplasms (i.e. cancer), cardiovascular disease, and unintentional injuries are the leading causes of premature death in South Australia. Unintentional injuries result in markedly more years of life lost prematurely amongst Country SA residents compared to their metropolitan Adelaide counterparts. Total years of expected life lost due to diabetes mellitus are also higher in Country SA than metropolitan Adelaide [5-17].

Potentially Avoidable (both Preventable and Treatable) Deaths

  • Potentially avoidable deaths are those classed as preventable (amenable to screening and primary prevention, such as immunisation), and treatable (amenable to therapeutic interventions). South Australia is ranked fourth highest out of the states and territories for potentially avoidable deaths
    [5-18].

Suicide Rate

  • Although suicide rates in South Australia are low, the rate amongst males is more than three times that of females [5-19].

End of Life Measures

5-1. Death Rate

5-1-1. Death Rate in South Australia

5-1-2. Aboriginal Death Rate

5-2. Median Age at Death

5-2-1. Median Age at Death in South Australia

5-3. Age-Specific Death Rate

5-3-1. Age-Specific Death Rate in South Australia

5-4. Perinatal Deaths

5-4-1. Perinatal Deaths

5-4.2. Aboriginal Perinatal Deaths

5-5. Infant Mortality

5-5-1. Infant Mortality in South Australia

5-5.2. Aboriginal Infant Mortality

5-6. Child Mortality – Aboriginal vs. Non-Aboriginal

5-7. Leading Causes of Death

5-7-1. Leading Causes of Death by Age Group in South Australia

5-8. Deaths from Circulatory Diseases in South Australia

5-8-1. Male Deaths from Circulatory Diseases

5-8-2. Female Deaths from Circulatory Diseases

5-8-3. Aboriginal Deaths from Diseases of the Circulatory System

5-9. Deaths from Cancer in South Australia

5-9-1. Male Deaths from Cancer

5-9-2. Female Deaths from Cancer

5-9-3. Aboriginal Deaths from Cancer

5-10. Deaths from Lung Cancer in South Australia

5-10-1. Male Deaths from Lung Cancer

5-10-2. Female Deaths from Lung Cancer

5-10-3. Aboriginal Deaths from Lung Cancer

5-11. Deaths from Prostate Cancer in South Australia

5-12. Deaths from Female Breast Cancer in South Australia

5-13. Deaths from Colon Cancer in South Australia

5-13-1. Male Deaths from Colon Cancer

5-13-2. Female Deaths from Colon Cancer

5-14. Deaths from Cervical Cancer in South Australia

5-15. Deaths from Respiratory Diseases in South Australia

5-15-1. Male Deaths from Respiratory Diseases

5-15-2. Female Deaths from Respiratory Diseases

5-15-3. Aboriginal Deaths from Respiratory Diseases

5-16. Aboriginal Deaths from External Causes

5-17. Top Causes of Premature Death (Years of Life Lost) in South Australia

5-17-1. Top Causes of Premature Death (Years of Life Lost) in South Australia

5-17-2. Top Causes of Male Premature Death (Years of Life Lost)

5-17.3. Top Causes of Female Premature Death (Years of Life Lost)

5-18. Potentially Avoidable (Preventable and Treatable) Deaths

5-18-1. Potentially Avoidable Deaths in South Australia

5-18.2. Aboriginal Potentially Avoidable Deaths

5-18.3. Potentially Preventable Deaths in South Australia

5-18-4. Aboriginal Potentially Preventable Deaths

5-18-5. Potentially Treatable Deaths in South Australia

5-18-6. Aboriginal Potentially Treatable Deaths

5.19. Suicide Rate

5-19-1. Suicide Rate in South Australia

5-19-2. Aboriginal Suicide Rate

5-1. Death Rate

5-1-1. Death Rate in South Australia

Death rate: Trend
Indirect standardised death rate per 1000 population
Latest data: 2010
Metro. Adelaide* / 5.8
Country SA* / 6.2
South Australia** / 5.9
Australia** / 5.7
International (World, 2011)*** / 7.99
SA Target
/ /
  • The South Australian indirect standardised death rate (ISDR) for all age groups has been trending down very slightly since 2005.
  • ISDR in metropolitan Adelaide down from 6.2 per 1000 population in 2005 to 5.8 in 2010.
  • ISDR in Country SA down from 6.7 in 2005 to 6.2 in 2010.
  • Overall, ISDR across South Australia down from 6.4 per 1000 population in 2005 to 5.9 in 2010.

*Source: Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302) data cubes, Table 4.1 Deaths, Summary, Statistical Divisions – 2005 to 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.
**Source: Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302.0) data cubes, Table 2: Death rates, Summary, States and Territories – 2000 – 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.
***Source: Central Intelligence Agency (CIA) The World Factbook, Death Rate.
Death rate by sex: Trend
Indirect standardised death rate per 1000 population by sex
Latest data: 2010
Males / 7.0
Females / 4.9
Persons / 5.9
/ /
  • The male death rate has been consistently higher than the female death rate since 2000.
  • The male/female gap has however gradually narrowed from 3.3 deaths per 1,000 to 2.1 deaths per 1,000.
  • The male death rate has been declining at a faster rate compared to females.

Source: Based on Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302.0) data cubes, Table 2: Death rates, Summary, States and Territories – 2000 – 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.

5-1-2. Aboriginal Death Rate

Aboriginal death rate from all causes: Trend(all ages)
Age standardised mortality rate per 1,000 population
Latest data: 2005-09
2001-05 / 11.2
2002-06 / 11.0
2003-07 / 10.5
2004-08 / 10.3
2005-09 / 10.2
/ /
  • Trend data from 2001-05 to 2005-09 of Aboriginal mortality from all cases shows a slight decline.
  • The gap in the all-cause mortality rate between Aboriginal and non-Aboriginal South Australians decreased from 4.7 per 1,000 persons in 2001-05 to 4.1 per 1,000 persons in 2005-09.

Source: Based on Australian Bureau of Statistics 2011 (and previous years), Deaths Australia, 2010, Cat. no. 3302.0, Canberra. Obtained from: Australian Government Productivity Commission: Report on Government Services 2012, Part E (Health), Health sector summary, Table EA.40.
Aboriginal death rate from all causes by state and territory(all ages)
Age standardised mortality rate per 100,000 Aboriginal population
Latest data: 2005-2009
NSW / 954.1
SA / 1,024.8
Qld / 1,064.4
NT / 1,542.1
ACT / n.p.
Tas / n.p.
Vic / n.p.
WA / n.p.
n.p. Not published / /
  • The South Australian Aboriginal mortality rate from all causes (2005-09) was 1,024.8 deaths per 100,000.
  • This was the second lowest all-cause mortality rate compared to the three other states and territories that provided data.
  • The all-cause mortality gap between Aboriginal and non-Aboriginal South Australians was 411 deaths per 100,000 population.

Source: Based on Australian Bureau of Statistics, unpublished, Causes of Death, Australia, 2009, Cat. no. 3303.0. Obtained from: Australian Government Productivity Commission: Report on Government Services 2012, Part E (Health), Health sector summary, Table EA.47.

5-2. Median Age at Death

5-2-1. Median Age at Death in South Australia

Median age at death: Trend
Median age at death (years)
Latest data: 2010
Metro. Adelaide
Country SA
South Australia / 82.4
Australia / 81.4
International
SA Target
Median age at death by sex
Median age at death (years)
Latest data: 2010
SA / Aust
Males / 79.6 / 78.1
Females / 84.9 / 84.2
Persons / 82.4 / 81.4
/
Graph does not start at the origin to show detail /
  • The last decade has seen an increasing trend in median age at death, for males and females and South Australia and nationally.
  • In 2000, the median age at death for males in South Australia was 76.1 years. This had increased to 79.6 years by 2010.
  • In 2000, the median age at death for females in South Australia was 82.2 years. This had increased to 84.9 years by 2010.
  • South Australian male and female median age at death has been consistently higher than the national figure over the last decade.

Source: Based on Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302.0) data cubes, Table 12: Median age at death, Year of occurrence, States and Territories – 2000 – 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.

Please note:Due to serious data quality concerns raised by several sources, the State of Our Health doesn't report Aboriginal Median Age at Death as a useful population health status indicator at this time.

5-3. Age-Specific Death Rate

5-3-1. Age-Specific Death Rate in South Australia

Age-specific death rate, South Australia
Deaths per 1000 population
Latest data: 2010
Age (years) / Males / Females
0 / 4.7 / 2.8
1–4 / 0.2 / 0.1
5–9 / 0.1 / 0.1
10–14 / 0.1 / 0.1
15–19 / 0.6 / 0.2
20–24 / 0.5 / 0.2
25–29 / 0.5 / 0.3
30–34 / 0.8 / 0.5
35–39 / 1.5 / 0.7
40–44 / 1.7 / 1.3
45–49 / 2.7 / 1.8
50–54 / 3.6 / 2.5
55–59 / 5.6 / 3.1
60–64 / 8.3 / 4.8
65–69 / 13.9 / 7.1
70–74 / 21.9 / 13.8
75–79 / 36.5 / 24.1
80–84 / 68.8 / 48.5
85+ / 152.2 / 131.6
/ Age specific death rate, 0-64 years

Age specific death rate, 65 years and over

N.B. 65+ years age cohort shown on a different scale to show detail
Source: Based on Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302.0) data cubes, Table 2: Death rates, Summary, States and Territories – 2000 – 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.

5-4. Perinatal Deaths

5-4-1. Perinatal Deaths

Perinatal deaths: Trend and by state and territory
Rate per 1,000 births
Latest data: 2009
Metro. Adelaide
Country SA
South Australia / 6.2
Australia / 9.0
International
SA Target
/
/
  • In 2009 the perinatal death rate in South Australia was 6.2 per 1000 births.
  • South Australia had the lowest rate of perinatal deaths across Australia.
  • Data reveals a decreasing trend in South Australia.

Source: Based on Australian Bureau of Statistics, Perinatal Deaths, 2009 (cat 3304.0) Data Cubes, Perinatal deaths (Australia) Summary tables, 2000-2009 AND 2007-2009 Released at 11.30am (AEST) 17 May 2011.
2009 data are preliminary and may be subject to revision.

5-4.2. Aboriginal Perinatal Deaths

Aboriginal perinatal deathsby state and territory
Perinatal deaths per 1,000 relevant births
Latest data: 2006-2010
Metro. Adelaide
Country SA
South Australia / 5.3
Australia
International
SA Target
/
Data for other states and territories not published /
  • The Aboriginal perinatal death rate for South Australia for 2006-10 was 5.3 per 1000 relevant births.
  • South Australia was ranked lowest overall amongst the states and territories that published data.

Source: Based on Causes of Death, Australia (cat 3303.0), Table 15.3 Perinatal deaths, by Indigenous status, NSW, Qld, SA, WA, NT, 2006-2010. Released at 11.30am (AEST) 28 June 2012.

5-5. Infant Mortality

5-5-1. Infant Mortality in South Australia

Infant mortality rate: Trend
Infant deaths per 1000 live births
Latest data: 2010
Metro. Adelaide
Country SA
South Australia* / 3.8
Australia* / 4.1
OECD Average** / 4.3
SA Target
Infant mortality rate by sex
Infant deaths per 1000 live births
Latest data: 2010
SA – males / 4.7
SA – females / 2.8
SA – all / 3.8
Aust – males / 4.8
Aust – females / 3.4
Aust – all / 4.1
/ Males

Females
/
  • The infant (defined here as being under one year of age) mortality rate in South Australia is variable (due to small numbers), between years, but overall the trend is down.
  • In 2000, there were 5.9 infant male deaths per 1000 live births. This had fallen to 4.7 in 2010.
  • Similarly, the infant female death rate has also fallen in South Australia, down from 3.2 in 2000 to 2.8 in 2010.
  • The South Australian infant death rate is roughly equivalent to the overall national rate (taking into account annual variability).

Infant mortality rate by state and territory
Infant deaths per 1000 live births
Latest data: 2010
Vic / 3.3
WA / 3.6
ACT / 3.7
SA / 3.8
NSW / 4.1
Tas / 4.1
Qld / 5.4
NT / 7.2
Australia / 4.1
/ /
  • When compared to all states and territories, South Australia was ranked with the 4th lowest rate.

*Source: Based on Australian Bureau of Statistics, Deaths, Australia (cat. no. 3302.0) data cubes, Table 2: Death rates, Summary, States and Territories – 2000 to 2010. Released at 11.30am (AEST) Thurs 10 Nov 2011.
** Source: OECD Death Data 2012, Frequently Requested Data, Health status (Mortality), Infant mortality rate 2010.

5-5.2. Aboriginal Infant Mortality

Aboriginal infant (<1 year) mortality from all causes, five year averages: Trend
Rate per 1000 Aboriginal live births
Latest data: 2006-10
2003-07 / 8.0
2004-08 / 6.9
2005-09 / 6.8
2006-10 / 5.3
/ /
  • Trend data between 2003-07 and 2006-10 reveals that the gap in infant mortality between Aboriginal and non-Aboriginal South Australians is closing.
  • The five-year moving average Aboriginal infant mortality rate has been trending down since 2003-2007.

Aboriginal infant (<1 year) mortality from all causes, five year average by state and territory
Rate per 1000 Aboriginal live births
Latest data: 2006-10
SA / 5.3
NSW / 6.4
Qld / 8.3
NT / 13.1
ACT / n.p.
Tas / n.p.
Vic / n.p.
WA / n.p.
n.p. Not published /
No published data for other states and territories /
  • The mortality rate for Aboriginal South Australian infants was 5.3 per 1,000 live births.
  • This was the lowest infant mortality rate compared to the four states and territories that published data.
  • The gap in mortality rates between Aboriginal and non-Aboriginal South Australian infants was 1.9 deaths per 1,000 live births.

Source: Based on Australian Bureau of Statistics, unpublished, Deaths, Australia, Cat. no. 3302.0; ABS unpublished, Births, Australia, Cat. no. 3301.0. Obtained from: Australian Government Productivity Commission: Report on Government Services 2012, Part E (Health), Health sector summary, Table EA.43.

5-6. Child Mortality – Aboriginal vs. Non-Aboriginal

Aboriginal child (1-4 years) mortality from all causes, five year averages: Trend
Rate per 100,000 Aboriginal population
Latest data: 2006-10
2003-07 / n.p.
2004-08 / 52.4
2005-09 / 52.7
2006-10 / 37.5
/ /
  • 2006-10 saw a nearly 30% decline in Aboriginal child mortality compared to the 2005-09 rate, falling from 52.7 per 100,000 population during the period 2005-09 to 37.5 during 2006-10 (five year averages).

Aboriginal child (1-4 years) mortality from all causes by state and territory
Rate per 100,000 Aboriginal population aged 1-4 years
Latest data: 2006-10
NSW / 34.6
SA / 37.5
Qld / 49.0
NT / 69.4
ACT / n.p.
Tas / n.p.
Vic / n.p.
WA / n.p.
n.p. Not published / /
  • The rate of Aboriginal child mortality in South Australia was 37.5 deaths per 100,000 population aged 1-4 years.
  • This was the second lowest rate when compared to the three other states and territories that provided data.
  • The gap in mortality rates between Aboriginal and non-Aboriginal South Australian children was 16.8 deaths per 100,000 aged 1-4 years.
  • South Australia had 31.9 fewer Aboriginal child deaths per 100,000 population aged 1-4 years compared to the Northern Territory.

Source: Based on Australian Bureau of Statistics, unpublished, Deaths, Australia, Cat. no. 3302.0. Obtained from: Australian Government Productivity Commission: Report on Government Services 2012, Part E (Health), Health sector summary, Table EA.44.

5-7. Leading Causes of Death

5-7-1. Leading Causes of Death by Age Group in South Australia

Top 3 underlying causes of death by age cohort, South Australia, 2010
Age specific death rate per 1,000 live births for ages under 1 year
Males / Females / Persons
Ages under 1 year all causes / 4.7 / 2.8 / 3.8
Fetus & newborn affected by maternal factors & by complications of pregnancy, labour & delivery / 0.8 / n.p. / 0.6
Ill-defined and unknown causes of mortality / 0.8 / n.p. / 0.5
Congenital malformations of the circulatory system / — / n.p. / n.p.
Age specific death rate per 100,000 population for ages 1 to 64
Males / Females / Persons
1–14 years all causes / 10.8 / 11.2 / 11.0
Accidental drowning and submersion / n.p. / n.p. / n.p.
Malignant neoplasms of eye, brain and other parts of central nervous system / – / – / –
Malignant neoplasms of lymphoid, haematopoietic and related tissue / – / – / –
Males / Females / Persons
15–24 years all causes / 52.1 / 22.0 / 37.5
Car occupant injured in transport accident / 13.9 / 7.3 / 10.7
Intentional self-harm / 16.5 / n.p. / 9.8
Event of undetermined intent / n.p. / n.p. / n.p.
Males / Females / Persons
25–34 years all causes / 63.8 / 40.8 / 52.5
Intentional self-harm / 13.9 / 5.7 / 9.8
Accidental poisoning by and exposure to noxious substances / 8.3 / n.p. / 6.1
Car occupant injured in transport accident / 7.4 / n.p. / 4.7
Males / Females / Persons
35–44 years all causes / 160.7 / 100.8 / 130.8
Intentional self-harm / 37.5 / 8.9 / 23.2
Accidental poisoning by and exposure to noxious substances / 14.3 / 8.0 / 11.2
Ischaemic heart diseases / 13.4 / n.p. / 8.0
Males / Females / Persons
45–54 years all causes / 315.2 / 215.2 / 264.7
Malignant neoplasms of digestive organs / 30.6 / 27.4 / 29.0
Ischaemic heart diseases / 44.6 / 12.0 / 28.2
Malignant neoplasms of respiratory and intrathoracic organs / 22.8 / 12.9 / 17.8
Males / Females / Persons
55–64 years all causes / 687.3 / 391.9 / 536.6
Malignant neoplasms of digestive organs / 102.2 / 42.8 / 71.9
Ischaemic heart disease / 115.4 / 22.4 / 67.9
Malignant neoplasms of respiratory and intrathoracic organs / 76.9 / 53.5 / 65.0
n.p. not available for publication due to ABS confidentiality provisions.
— nil or rounded to zero in the ABS publication due to extremely small counts.
Top 3 leading causes of death as reported above with "—" or "n.p." may be arranged in descending order by the Australian Bureau of Statistics from unpublished data.
Source: Based on Australian Bureau of Statistics, Causes of Death 2010, Australia (cat. no. 3303.0) data cubes, Underlying causes of death (South Australia), Table 5.3. Released at 11.30am (AEST) 3 May 2011.
5-7-1. (cont’d) Leading Causes of Death by Age Group In South Australia Continued
Top 3 underlying causes of death by age cohort, South Australia, 2010
Age specific death rate per 100,000 population for ages 65 and over
Males / Females / Persons
65–74 years all causes / 1,743.4 / 1,013.1 / 1,362.7
Malignant neoplasms of digestive organs / 253.6 / 109.2 / 178.3
Ischaemic heart diseases / 266.3 / 93.2 / 176.0
Malignant neoplasms of respiratory and intrathoracic organs / 202.9 / 112.1 / 155.5
Males / Females / Persons
75–84 years all causes / 5,071.8 / 3,565.0 / 4,232.1
Ischaemic heart diseases / 894.9 / 566.3 / 711.8
Malignant neoplasms of digestive organs / 430.8 / 313.7 / 365.5
Cerebrovascular diseases / 343.6 / 350.4 / 347.4
Males / Females / Persons
85–94 years all causes / 14,623.5 / 11,520.4 / 12,598.7
Ischaemic heart diseases / 3,119.2 / 1,969.2 / 2,368.8
Cerebrovascular diseases / 1,274.5 / 1,603.0 / 1,488.9
Organic, including symptomatic, mental disorders / 939.1 / 1,178.8 / 1,095.5
Males / Females / Persons
95 years and over all causes / 26,688.1 / 29,867.8 / 29,165.2
Ischaemic heart diseases / 6,270.1 / 6,429.5 / 6,394.3
Cerebrovascular disease / 1,929.3 / 4,605.6 / 4,014.2
Organic, including symptomatic, mental disorders / 1,768.5 / 4,058.4 / 3,552.4
n.p. not available for publication due to ABS confidentiality provisions
— nil or rounded to zero due to extremely small counts
Source: Based on Australian Bureau of Statistics, Causes of Death 2010, Australia (cat. no. 3303.0) data cubes, Underlying causes of death (South Australia), Table 5.3. Released at 11.30am (AEST) 3 May 2011.

5-8. Deaths from Circulatory Diseases in South Australia