Indigenous Mortality Research Articles

Age-specific mortality and the role of living remotely: The 1918-20 influenza pandemic in Kautokeino and Karasjok, Norway

ABSTRACT The 1918–20 pandemic influenza killed 50–100 million people worldwide, but mortality varied by ethnicity and geography. In Norway, areas dominated by Sámi experienced 3–5 times higher mortality than the country’s average. We here use data from burial registers and censuses to calculate all-cause excess mortality by age and wave in two remote Sámi areas of Norway 1918–20. We hypothesise that geographic isolation, less prior exposure to seasonal influenza, and thus less immunity led to higher Indigenous mortality and a different age distribution of mortality (higher mortality for all) than was typical for this pandemic in non-isolated majority populations (higher young adult mortality & sparing of the elderly). Our results show that in the fall of 1918 (Karasjok), winter of 1919 (Kautokeino), and winter of 1920 (Karasjok), young adults had the highest excess mortality, followed by also high excess mortality among the elderly and children. Children did not exhibit excess mortality in the second wave in Karasjok in 1920. It was not the young adults alone who produced the excess mortality in Kautokeino and Karasjok. We conclude that geographic isolation caused higher mortality among the elderly in the first and second waves, and among children in the first wave.

All-cause mortality rates for indigenous in the states of Brazil and their (non) correlation with socioeconomic and health indicators in the years 2000 and 2010

In 2010, the indigenous population represented 0.2% of the Brazilian population and was mostly located in the Legal Amazon region. In Brazil, there are laws to protect the indigenous population, in addition to a National Health Care Policy for Indigenous Peoples. However, a large part of the indigenous population is considered under social and sanitary vulnerability, which are more pronounced in certain regions of the country. Therefore, this study aimed to calculate and evaluate the all-cause mortality rate in the Brazilian indigenous population and investigate correlations with socioeconomic and health indicators. This is an ecological study based on official data (2000 and 2010). The number of deaths were extracted from the Mortality Information System. Indigenous population data were extracted from Demographic Censuses of the Brazilian Institute of Geography and Statistics. The all-cause mortality rate were calculated by states and correlated, through Pearson's correlation test, with socioeconomic and health indicators extracted from the Atlas Brazil platform. In Brazil, an increase in the overall indigenous mortality rate was observed of 15.0% between 2000 and 2010. Among the regions, the Midwest had the highest rates in 2000 and 2010 (4.54 and 5.56 deaths/1,000 indigenous people, respectively). In 2000, the state with the highest all-cause mortality rate was Piauí (9.76/1,000) and in 2010 it was Mato Grosso do Sul (6.54/1,000). All-cause mortality rate did not present a significant correlation (p-value ≤0.05) with the analyzed indicators. The findings of this study indicated that the all-cause mortality rate in Brazil increased unevenly, according to regions/states, and without any correlation with the socioeconomic and health indicators analyzed.

Taxas de mortalidade geral indígena nas unidades federativas do Brasil e sua (não) correlação com indicadores socioeconômicos e de saúde nos anos de 2000 e 2010

In 2010, the indigenous population represented 0.2% of the Brazilian population and was mostly located in the Legal Amazon region. In Brazil, there are laws to protect the indigenous population, in addition to a National Health Care Policy for Indigenous Peoples. However, a large part of the indigenous population is considered under social and sanitary vulnerability, which are more pronounced in certain regions of the country. Therefore, this study aimed to calculate and evaluate the all-cause mortality rate in the Brazilian indigenous population and investigate correlations with socioeconomic and health indicators. This is an ecological study based on official data (2000 and 2010). The number of deaths were extracted from the Mortality Information System. Indigenous population data were extracted from Demographic Censuses of the Brazilian Institute of Geography and Statistics. The all-cause mortality rate were calculated by states and correlated, through Pearson's correlation test, with socioeconomic and health indicators extracted from the Atlas Brazil platform. In Brazil, an increase in the overall indigenous mortality rate was observed of 15.0% between 2000 and 2010. Among the regions, the Midwest had the highest rates in 2000 and 2010 (4.54 and 5.56 deaths/1,000 indigenous people, respectively). In 2000, the state with the highest all-cause mortality rate was Piauí (9.76/1,000) and in 2010 it was Mato Grosso do Sul (6.54/1,000). All-cause mortality rate did not present a significant correlation (p-value ≤0.05) with the analyzed indicators. The findings of this study indicated that the all-cause mortality rate in Brazil increased unevenly, according to regions/states, and without any correlation with the socioeconomic and health indicators analyzed.

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic.

This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018–1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-01162-w.

Mortalidade infantil entre indígenas no estado do Pará

Objetivo: Analisar o perfil de mortalidade infantil indígena. Método: Estudo epidemiológico, transversal realizado com 254 óbitos em crianças indígenas menores de um ano, notificadas ao Sistema de Informação da Atenção à Saúde Indígena, no estado do Pará, no período de 2013 a 2018. Resultados: Identificou-se proporção maior de óbitos em crianças do sexo masculino (53,9%; n=137), nas etnias Kaiapó (38,2%; n=97), Munduruku (27,6%; n=70) e Xicrim (13,8%; n=35). Os óbitos ocorreram nos hospitais (53,9%; n=137), e nos domicílios (24%; n=61), e as principais causas foram: as afecções perinatais (27,2%; n=69); as doenças do aparelho respiratório (18,9%; n=48), doenças infecciosas e parasitárias (15,7%; n=40). Conclusão: A mortalidade infantil indígena é mais elevada em algumas etnias, o que favorece ações de enfrentamento naquelas mais acometidas. É necessário a valorização da cultura indígena e o reconhecimento dos problemas socioeconômicos a serem contemplados num plano de ação para redução desse indicador.

Analysis of the mortality trend in the indigenous population of Brazil, 2000–2016

ObjectivesThe objective of the study is to analyze the mortality trend in indigenous peoples in Brazil. Study designThe study design used is an ecological study. MethodsA study carried out with data from the indigenous deaths recorded on the Mortality Information System in Brazil between 2000 and 2016. The Prais Winsten regression was used to analyze the trend of overall mortality in the country and in its geopolitical regions, in addition to the trend by sex, age groups, and groups of basic causes of death. ResultsOf all deaths, 47,806 indigenous deaths were recorded between 2000 and 2016. The majority was male (56.5%) and 27.2% in children aged younger than 5 years. The major groups of causes of death were the circulatory diseases (15.8%) and external causes (14.9%). The affections of the perinatal period (23.7%) and infectious and parasitic diseases (18.5%) were the main causes in children aged younger than 5 years. The indigenous mortality rates showed an increasing trend in the country (annual percent change [APC] = 2.37%). There was growth in both sexes and in most age ranges. Mortality from external causes (APC = 4.71%), neoplasms (APC = 4.67%), and respiratory causes (APC = 4.14%) also presented growth. The infectious and parasitic causes and genitourinary causes showed a stable trend in the studied period. ConclusionsThe increasing trend of mortality in the analyzed variables showed disparities between indigenous and non-indigenous peoples in Brazil, pointing to the need for greater investment in basic social sectors, such as health, education, housing, and sanitation.

Record linkage to advance Indigenous mortality statistics in Australia – sources of error and bias

Record linkage to advance Indigenous mortality statistics in Australia – sources of error and bias

Comparing indigenous mortality across urban, rural and very remote areas: a systematic review and meta-analysis.

It remains unclear how indigenous mortality varies between residential areas. We conducted a systematic review and meta-analysis on mortality patterns in urban, rural and very remote areas for the adult and infant indigenous populations of Australia, Canada, New Zealand and the USA. A literature search was performed using major online electronic publication repositories. Studies presenting indigenous mortality or disease incidence/prevalence in urban, rural or very remote areas were included. Indigenous mortality and disease incidence/prevalence in both urban and very remote areas were compared with those in rural areas. Studies that reported number of deaths or disease incidences along with population were included in the meta-analysis. Thirty-one studies were included with data from Australia (n=19), Canada (n=3), New Zealand (n=1) and the USA (n=8). Indigenous adult all-cause mortality, cervical cancer mortality, trauma mortality and incidence of myocardial infarction were all significantly lower in urban areas compared with rural areas. Likewise, indigenous adult cardiovascular mortality and renal disease mortality were significantly lower in very remote areas compared with rural areas, while indigenous infant all-cause mortality showed no significant difference in urban, rural or very remote areas. Urban areas consistently experienced lower adult indigenous mortality compared with rural areas, as did some very remote areas. Indigenous infants, however, experience similar mortality rates across all residential areas.

International Group for Indigenous Health Measurement: Recommendations for best practice for estimation of Indigenous mortality

International Group for Indigenous Health Measurement: Recommendations for best practice for estimation of Indigenous mortality

PREDICTORS OF DEMENTIA AND MORTALITY IN INDIGENOUS AUSTRALIANS

PREDICTORS OF DEMENTIA AND MORTALITY IN INDIGENOUS AUSTRALIANS

Are Indigenous mortality gaps closing: how to tell, and when?

It is well known that the health of Australia’s Aboriginal and Torres Strait Islander people is considerably poorer than that of their non-Indigenous counterparts. Strategies, policies, programs and funding over many years have been targeted toward improving the health of Indigenous Australians and closing the gap in health status between Indigenous and non-Indigenous Australians. In this article, we review trends in key mortality rates for both populations and two complementary indices of the gap between them, both of which are essential to understanding progress or otherwise in closing the mortality gaps. Importantly, we also discuss the time required until the impact of policy changes can be assessed.​

Impact of colonialism on Māori and Aboriginal healthcare access: a discussion paper

Background: Historical socio-political processes have produced gross inequity of health resource for Aboriginal Australians and New Zealand Māori. Objectives: This paper argues that socio-political factors resulting from the entrenchment of colonialism have produced significant personal and structural barriers to the utilisation of healthcare services and directly impact the health status of these two vulnerable groups. Design: Discussion Paper. Conclusions: Understanding the actual barriers preventing the utilisation of healthcare facilities, as perceived by Indigenous people, is essential in reducing the gross disparity between Indigenous and non-Indigenous morbidity and mortality in Australia and New Zealand.

Indigenous mortality (revealed): the invisible illuminated.

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics.

Trauma consults on humanitarian surgery trips: A perspective on the Haitian trauma system and the humanitarian’s role

Ubiquitous access to surgical care, especially trauma surgery, is recognized as an essential component of public health. We present two trauma cases—an upper arm machete laceration and a penetrating chest wound—that highlight barriers facing trauma patients in Haiti and describe how it relates to humanitarian surgery trips. An Emory University student–faculty collaborative, partnering with the non-profit Project Medishare (PM) for Haiti since 2008, provides elective and urgent surgical care to the underserved population of the Haitian Central Plateau. This partnership collaborates with a main referral center known for providing quality surgical care at little or no cost. Elective urological and general surgical cases comprise the bulk of the case load but urgent trauma services have been provided when required. Future trauma system initiatives must focus on increasing access to vehicles, telecommunications, and first responders. Our recommendations are reinforced by preliminary results from a trauma needs assessment performed in the Central Plateau and surrounding departments during July 2013. Humanitarian teams can contribute by preparing for emergencies prior to departure and sharing new procedural knowledge with local providers. Supplementing the ability to intercede in emergency surgical situations furthers the goal of short-term surgical trips to diminish indigenous patient morbidity and mortality. We advocate extensive preparation for such situations and increased bidirectional knowledge sharing with local staff.

Importance to construct indigenous mortality table from crude death rate for life insurance industry in Bangladesh

This paper works on the different avenues in the crude death rates in assured lives in the demography of Bangladesh. Crude rate is studied in multi-folded ways including status of policy, sexual orientation, timeline response, monetary perspective and the overall patterns. This study is underpinned with the assumption of Uniform Death Distribution (UDD) method over time (in a single year). We demonstrate the kinetics of the contemporary crude rates along with comparative analysis with that of existing rates. Also, the level of efficacy of the existing use of mortality components that has been using for decades in every passage of life insurance instruments in Bangladesh. We point to the distinguished distortion in the existing practice to the results from the studied crude rates in the life industry and then the corresponding financial atmosphere driven by these crude rates issue. Finally, we make this instructive to the life insurance regulator in Bangladesh to pay attention to take necessary actions in life business due to notably changed demographic pattern in Bangladesh via going forward to take strong measure to construct a new indigenous mortality table based on the matrix of current crude rates instead of the existing practice of stereotype loading over extraneous tables for Bangladesh life insurance industry.

Performance of comorbidity indices in measuring outcomes after acute myocardial infarction in Australian indigenous and non‐indigenous patients

Indigenous Australians have higher prevalence of chronic diseases and worse acute care outcomes than other Australians. The extent to which higher chronic disease comorbidity levels are responsible for their worse outcomes is not clear, and the performance of comorbidity indices has not been assessed for this population with very high comorbidity levels. Using hospital separations data, the Charlson and Elixhauser comorbidity indices were used to measure chronic disease prevalence in 2035 indigenous and non-indigenous patients hospitalised after their first acute myocardial infarction (AMI) in the Northern Territory of Australia between 1992 and 2004, and to adjust for comorbidity in multivariate analysis of mortality outcomes (in-hospital and long-term deaths from coronary heart disease and all causes). Index performance was assessed by the difference between C statistic, Akaike information criterion statistic and estimate of excess indigenous mortality in models with and without comorbidity adjustment. Comorbidity index scores were higher for indigenous than non-indigenous patients and increased considerably over time, at least partly because of information bias. Indigenous patients' higher risk of in-hospital all-cause death was almost fully explained by their higher comorbidity levels. Their higher risk of long-term coronary heart disease and all-cause death was partially explained by higher comorbidity levels. Charlson and Elixhauser indices performed satisfactorily and similarly in this population. Comorbidity indices performed well in a population with very high chronic disease prevalence. After adjusting for comorbidity, short-term outcomes were similar for indigenous and non-indigenous AMI patients, but comorbidity at the time of the acute episode only partly explained the worse long-term outcomes for indigenous patients.

'Formidável contágio': epidemias, trabalho e recrutamento na Amazônia colonial (1660-1750)

The text analyzes the extent to which smallpox and measles epidemics provoked transformations in the ways in which workforces were acquired and used in colonial Amazonia from the mid-seventeenth to mid-eighteenth century, with an increase in slave raids on the indigenous population and the attempt to organize a trade route in African slaves to the region. It also explores how indigenous mortality rates at the end of the seventeenth century led to a concern with the region's defence and prompted the recruitment of soldiers from the Madeira islands.

Recent patterns in chronic disease mortality in remote living Indigenous Australians

BackgroundDespite the well-recognised Indigenous-non-Indigenous health disparity, some reports suggest improvements in Indigenous mortality. Our aim was to quantify Indigenous mortality in Outer Regional (OR), Remote (R), and Very Remote (VR) areas in New South Wales, Queensland, South Australia, Western Australia, and the Northern Territory and changes in mortality from 1998 to 2005.MethodsWe calculated rates, standardized mortality ratios (SMRs) and percentage change in annual rates of Indigenous cardiovascular, diabetes and renal mortality mentioned anywhere on the death certificate by using ICD-10 codes and the 2001 total Australian population as the reference population.ResultsIn 1998-2001, Indigenous SMRs for all-cause mortality were 241%, 421% and 220% in OR, R and VR, respectively. In 2001-03, corresponding SMRs were 202%, 331% and 176%. Percentage changes (95% confidence interval) in annual all-cause mortality were -3.0% (-5.3%, -0.7%) in OR, -4.2% (-7.4%, -0.9%) in R and -0.5 (-9.1%, -0.7%) in VR. In 2002-2005, compared with 1998-2001, changes in the number of Indigenous deaths were -147, -195, and -197 in OR, R and VR, respectively. Similar patterns and trends were observed for cardiovascular mortality.ConclusionsMortality was elevated about 2-fold in OR, 4-fold in R and 2-fold in VR areas. The downward trend in mortality regardless of remoteness of residence was partly attributable to a decrease in the absolute number of deaths. These patterns were observed for each of the states/territories individually.

Editorial

In this of the International Journal of Critical Indigenous Studies, the articles reveal how competing economies of knowledge, capital and values are operationalised through colonising power within inter-subjective relations. Writing in the Australian context, Greg Blyton demonstrates how tobacco was used by colonists as a means of control and exchange in their relations with Indigenous people. He focuses on the Hunter region of New South Wales, Australia, in the early to mid-nineteenth century to reveal how colonists exchanged tobacco for food, safe passage and Indigenous services. Blyton suggests that these colonial practices enabled tobacco addiction to spread throughout the region, passing from one generation of Indigenous people to another. He asks us to consider the link between the colonial generation of Indigenous tobacco consumption and addiction, and Indigenous mortality rates today whereby twenty percent of deaths are attributed to smoking.

What is the impact of missing Indigenous status on mortality estimates? An assessment using record linkage in Western Australia

The analysis aimed to assess the Indigenous status of an increasing number of deaths not coded with a useable Indigenous status from 1997 to 2002 and its impact on reported recent gains in Indigenous mortality. The Indigenous status of WA death records with a missing Indigenous status was determined based upon data linkage to three other data sources (Hospital Morbidity Database System, Mental Health Information System and Midwives Notification System). Overall, the majority of un-coded cases were assigned an Indigenous status, with 5.9% identified as Indigenous from the M1 series and 7.5% from the M2 series. The significant increase in Indigenous male LE of 5.4 years from 1997 to 2002 decreased to 4.0 and 3.6 years using the M1 and M2 series, respectively, but remained significant. For Indigenous females, the non-significant increase in LE of 1.8 years from 1997 to 2002 decreased to 1.0 and 0.6 years. Furthermore, annual all-cause mortality rates were higher than in the original data for both genders, but the significant decline for males remained. Through data linkage, the increasing proportion of deaths not coded with a useable Indigenous status was shown to impact on Indigenous mortality statistics in Western Australia leading to an overestimate of improvements in life expectancy. Greater attention needs to be given to better identification and recording of Indigenous identifiers if real improvements in health status are to be demonstrated. A system that captures an individual's Indigenous status once and is reflected in all health and administrative data systems needs consideration within Australia.