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The assessment of Aboriginal and Torres Strait Islander people’s health status requires accurate information about the size of the population and the numbers of specific health conditions/occurrences. This information is required at national, regional, and local levels.
There have been improvements in recent years - both in estimates of the Indigenous population (the denominator for calculation of rates) and in the availability of data for a number of health conditions/occurrences (the numerators for calculating rates) - but there is still some uncertainty in most areas.
In relation to population estimates, the ABS has made considerable efforts to achieve accurate counts of the Aboriginal and Torres Strait Islander population in the five-yearly Australian censuses . Despite these efforts, there are impacts on data quality such as non-responses for identification.
The ABS has also worked for many years with the AIHW and state and territory authorities to improve the accuracy of Indigenous status in a number of health-related collections, including birth and death registrations, hospital administrative data, and the maternal/perinatal collection. Some attention has also been directed to the data collections related to communicable diseases, cancer, and to a number of other disease-specific collections.
A persistent problem, however, is the extent to which Aboriginal and Torres Strait Islander people are correctly identified in the various health-related data collections. In death registrations, for example, not all Aboriginal and Torres Strait Islander deaths are correctly identified as such . Due to concerns about the mortality rates of Aboriginal and Torres Strait Islander people relative to the total population, there has been ongoing data integration to investigate the quality of the data using health and death records by several state and territory government departments.
Estimating the proportions of deaths identified correctly is not simple, so it is difficult to estimate the actual number of Indigenous deaths occurring and the corresponding rates. The ABS uses estimates of the proportions of registered deaths correctly identified as Indigenous in preparing its life tables, the source of life expectancy figures.
The Indigenous Mortality Project involved linking death registrations with 2011 Census records with the aim to assess the consistency of Indigenous status across the two datasets . It was estimated that the Australia-wide rate of Indigenous identification in deaths notifications was 62%. For the jurisdictions for which results could be reported, the NT had the highest rate of consistent reporting (95%) and Vic had the lowest rate (29%). In relation to age-groups, the lowest rate of consistent identification was for people over the age of 70 years (50%). Consistent identification of Indigenous status for both the Census and death registrations was lowest in major cities (44%) and highest in remote areas (92%). The ABS has estimated that the proportion of Indigenous births identified correctly was 96% in 2002-2006, a significant improvement over the level for previous years . Completeness of identification varied across the country, with only Vic, Qld, WA, SA and the NT having levels above 90%.
The National Perinatal Data Collection provides data on pregnancy and childbirth; prior to 2011, the Indigenous status of the baby was based on the Indigenous status of the mother, since then, the Indigenous status of the baby has been based on the mother and/or father identifying as being of Aboriginal and/or Torres Strait Islander origin . This means that previously there was an underestimation of Aboriginal and/or Torres Strait Islander births. Indigenous status for around 6% of births is unknown, due to unknown status of the father.
The level of identification in hospital admissions is variable, but overall it has been estimated that 88% of Aboriginal and Torres Strait Islander patients were correctly identified in Australian public hospital admission records in 2011-12 . The accuracy of the identification of Indigenous people varied between states and territories, from 98% in the NT to 58% in the ACT. The accuracy of identification also varied with remoteness level, from 99% in very remote areas to 77% in major cities.
The levels of Aboriginal and Torres Strait Islander people’s identification in many of the other health-related data collections are generally so incomplete as to preclude reasonably accurate estimates. With these uncertainties, there must be some doubt about the precision of the various estimates of health status. The differences between Aboriginal and Torres Strait Islander people and non-Indigenous people in the levels of most of these estimates are so great, however, that the slight imprecision in some estimates is of little practical importance.
Despite the important advances that have been made in recent years in both the extent and quality of information about the health of Aboriginal and Torres Strait Islander people, there is substantial scope for further improvement. For example: