Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States.
OBJECTIVE
To compare the disease-specific mortality rates of the indigenous populations of New Zealand, Australia, Canada, and the United States with the non-indigenous populations in each country.


METHODS
For New Zealand, Australia, Canada, and the United States, we compiled and calculated (from crude data) ethnic-specific mortality rates by primary cause of death in 1999 for the indigenous and non-indigenous populations in each country. We calculated age-adjusted mortality rates, using direct standardisation and weights based on the World Health Organization world population.


RESULTS
Australia experienced the largest relative and absolute disparities in life expectancy between indigenous and non-indigenous populations. For specific causes of death, New Zealand Maori, and Australian Aboriginals and Torres Strait Islanders experienced the highest levels of disparities when compared to their respective non-indigenous population group. Large disparities exist for indigenous peoples in all four countries for diabetes mortality. CONCLUSION The indigenous peoples of New Zealand and Australia suffer from high disease-specific mortality rates. The relative size of indigenous/non-indigenous mortality disparities are highest in New Zealand and Australia. There appears to be a number of common issues that adversely affect the quality of the mortality data that is available in the four countries. Action is required to address indigenous health disparities and to improve the quality of indigenous mortality data.
Bramley
Dale
D
Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
Hebert
Paul
P
Jackson
Rod
R
Chassin
Mark
M
D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008017:Life Expectancy / Q000208:ethnology*; D008297:Male; D009026:Mortality; D009520:New Zealand / Q000453:epidemiology; D014481:United States / Q000453:epidemiology