title: Early mortality from external causes in Aboriginal mothers: a retrospective cohort study.
abstract: Maternal loss can have a deep-rooted impact on families. Whilst a disproportionate number of Aboriginal women die from potentially preventable causes, no research has investigated mortality in Aboriginal mothers. We aimed to examine the elevated mortality risk in Aboriginal mothers with a focus on external causes.
  
  
  
  We linked data from four state administrative datasets to identify all women who had a child from 1983 to 2010 in Western Australia and ascertained their Aboriginality, socio-demographic details, and their dates and causes of death prior to 2011. Comparing Aboriginal mothers with other mothers, we estimated the hazard ratios (HRs) for death by any external cause and each of the sub-categories of accident, suicide, and homicide, and the corresponding age of their youngest child.
  
  
  
  Compared to non-Aboriginal mothers and after adjustment for parity, socio-economic status and remoteness, Aboriginal mothers were more likely to die from accidents [HR = 6.43 (95 % CI: 4.9, 8.4)], suicide [HR = 3.46 (95 % CI: 2.2, 5.4)], homicide [HR = 17.46 (95 % CI: 10.4, 29.2)] or any external cause [HR = 6.61 (95 % CI: 5.4, 8.1)]. For mothers experiencing death, the median age of their youngest child was 4.8 years.
  
  
  
  During the study period, Aboriginal mothers were much more likely to die than other mothers and they usually left more and younger children. These increased rates were only partly explained by socio-demographic circumstances. Further research is required to examine the risk factors associated with these potentially preventable deaths and to enable the development of informed health promotion to increase the life chances of Aboriginal mothers and their children.
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia. JFairthorne@cfri.ca.|Department of Paediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada. JFairthorne@cfri.ca.
authors.forename: Jenny
authors.initials: J
authors.lastname: Fairthorne
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Roz
authors.initials: R
authors.lastname: Walker
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: de Klerk
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia.
authors.forename: Carrington
authors.initials: C
authors.lastname: Shepherd
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D063130:Maternal Death / Q000706:statistics & numerical data*; D010298:Parity; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
keywords: Aboriginal; Accident; Death; Homicide; Linked data; Mother; Suicide