Lower than expected morbidity and mortality for an Australian Aboriginal population: 10-year follow-up in a decentralised community

OBJECTIVE: To examine mortality from all causes and from cardiovascular disease (CVD), and CVD hospitalisation rate for a decentralised Aboriginal community in the Northern Territory. DESIGN AND PARTICIPANTS: For a community-based cohort of 296 people aged 15 years or older screened in 1995, we reviewed hospital and primary health care records and death certificates for the period up to December 2004 (2800 person-years of follow-up). MAIN OUTCOME MEASURES: Mortality from all causes and CVD, and hospitalisation with CVD coded as a primary cause of admission; comparison with prior trends (1988 to 1995) in CVD risk factor prevalence for the community, and with NT-specific Indigenous mortality and hospitalisation rates. RESULTS: Mortality in the cohort was 964/100,000 person-years, significantly lower than that of the NT Indigenous population (standardised mortality ratio [SMR], 0.62; 95% CI, 0.42-0.89). CVD mortality was 358/100,000 person-years for people aged 25 years or older (SMR, 0.52; 95% CI, 0.23-1.02). Hospitalisation with CVD as a primary cause was 13/1000 person-years for the cohort, compared with 33/1000 person-years for the NT Indigenous population. CONCLUSION: Contributors to lower than expected morbidity and mortality are likely to include the nature of primary health care services, which provide regular outreach to outstation communities, as well as the decentralised mode of outstation living (with its attendant benefits for physical activity, diet and limited access to alcohol), and social factors, including connectedness to culture, family and land, and opportunities for self-determination.     

Long-term trends in cancer mortality for Indigenous Australians in the Northern Territory

OBJECTIVE: To examine long-term trends in cancer mortality in the Indigenous people of the Northern Territory (NT) of Australia. DESIGN: Comparison of cancer mortality rates of the NT Indigenous population with those of the total Australian population for 1991-2000, and examination of time trends in cancer mortality rates in the NT Indigenous population, 1977-2000. PARTICIPANTS: NT Indigenous and total Australian populations, 1977-2000. MAIN OUTCOME MEASURES: Cancer mortality rate ratios and percentage change in annual mortality rates. RESULTS: The NT Indigenous cancer mortality rate was higher than the total Australian rate for cancers of the liver, lungs, uterus, cervix and thyroid, and, in younger people only, for cancers of the oropharynx, oesophagus and pancreas. NT Indigenous mortality rates were lower than the total Australian rates for renal cancers and melanoma and, in older people only, for cancers of the prostate and bowel. Differences between Indigenous and total Australian cancer mortality rates were more pronounced among those aged under 64 years for most cancers. NT Indigenous cancer mortality rates increased over the 24-year period for cancers of the oropharynx, pancreas and lung, all of which are smoking-related cancers. CONCLUSIONS: Cancer is an important and increasing health problem for Indigenous Australians. Cancers that affect Indigenous Australians to a greater extent than other Australians are largely preventable (eg, through smoking cessation, Pap smear programs and hepatitis B vaccination).     

基础疾病对严重急性呼吸综合征患者预后的影响

回顾性分析宣武医院2003年5月至6月收治的212例严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的临床资料,观察患者发病前合并的基础疾病与死亡及出院时胸片吸收情况的关系。发现有基础疾病的患者,病死率(20.7%)显著高于无基础疾病患者(4.5%,P=0.000);合并2种或者2种以上基础疾病的患者,病死率明显高于合并一种基础疾病及无基础疾病的患者(P值分别为0.008、0.000);在糖尿病、高血压、冠心病、脑血管疾病、慢性阻塞性肺病、肝炎/肝硬化6种疾病中,采用Logistic回归分析,发现脑血管病、肝炎/肝硬化是SARS患者死亡的主要危险因素(P值分别为0.000、0.001),糖尿病未明显增加SARS患者的病死率。治愈的SARS患者,合并基础疾病组胸片遗留病变者(60.4%)显著高于无基础疾病组(29.9%,P=0.001)。提示SARS患者合并基础疾病者病死率明显升高,随着合并的基础疾病的增多,病死率明显上升。肝炎/肝硬化及脑血管病是死亡的危险因素;基础疾病使SARS患者肺部损伤加重、恢复慢。糖尿病未明显增加SARS患者的病死率,提示糖尿病可能对患者避免SARS引起的急性肺损伤起一定作用。     

Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study

CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years (1993-1998). SETTING AND SUBJECTS: A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992. MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD.     

Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981-2000: a decomposition analysis

OBJECTIVE: To identify the causes of the gap in life expectancy between Indigenous and non-Indigenous populations of the Northern Territory and how the causes have evolved over time. DESIGN AND SETTING: Analysis of NT death data over four 5-year periods, 1 January 1981 to 31 December 2000 inclusive. A decomposition method using discrete approximations (Vaupel and Romo) was applied to abridged life tables for the Indigenous and non-Indigenous populations of the NT. MAIN OUTCOME MEASURES: Contribution of causes of death, grouped according to global burden of disease groups and categories, to the life expectancy gap. RESULTS: The gap between the life expectancy of Indigenous and non-Indigenous people in the NT did not appear to narrow over time, but there was a marked shift in the causes of the gap. In terms of disease groups, the contribution of communicable diseases, maternal, perinatal and nutritional conditions halved during the 20 years to 2000. Meanwhile, the contribution of non-communicable diseases and conditions increased markedly. The contribution of injuries remained static. In terms of disease categories, the contribution of infectious diseases, respiratory infections and respiratory diseases declined considerably; however, these gains were offset by significantly larger increases in the contribution of cardiovascular diseases and diabetes for Indigenous women and cardiovascular diseases, cancers and digestive diseases for Indigenous men. CONCLUSIONS: The main contributors to the gap in life expectancy between the Indigenous and non-Indigenous populations were non-communicable diseases and conditions, which are more prevalent in ageing populations. With the life expectancy of Indigenous people in the NT expected to improve, it is important that public health initiatives remain focused on preventing and managing chronic diseases.     

Trends in hospital admissions and mortality from asthma and chronic obstructive pulmonary disease in Australia, 1993-2003

OBJECTIVE: To examine evolving changes in asthma and chronic obstructive pulmonary disease (COPD) in South Australia and Australia as a whole from the perspective of hospital admissions, ventilatory support and mortality data. DESIGN: Retrospective analyses, for the period 1993-2003, of hospital separations data from the Australian Institute of Health and Welfare and the Integrated South Australian Activity Collection, and mortality data from the Australian Bureau of Statistics and South Australian hospital morbidity collection. MAIN OUTCOME MEASURES: Hospital separations, ventilatory support episodes, mortality rates, burden-of-disease rankings. RESULTS: Between 1993 and 2003, in SA and nationally, hospital separations for asthma declined but separations for COPD increased significantly. Falling mortality rates from asthma in both men and women, and from COPD in men, contrast with increasing rates of COPD-related hospitalisation and mortality in women. CONCLUSIONS: Hospital admissions and mortality associated with asthma have fallen. Admission rates for COPD are declining for men, but there is no indication that admission rates for women have reached a peak. There is a need for higher prioritisation of COPD, including policies to reduce smoking in women, and medical practice initiatives to support primary and secondary prevention, pulmonary rehabilitation and appropriate drug therapies.     

2型糖尿病患者伴慢性肾脏病和外周动脉疾病对全因死亡和心血管疾病死亡的影响

目的 评价2型糖尿病（type 2 diabetes mellitus, T2DM）患者伴慢性肾脏病(chronic kidney disease, CKD)和外周动脉疾病(peripheral arterial disease, PAD)对全因和心血管疾病（cardiovascular disease, CVD）死亡的影响。方法 2004年7月—2005年1月,收集北京和上海地区8所医院的T2DM患者1559例。根据是否患有CKD或PAD,将研究对象分为不同的CKD/PAD组,对其进行5年的随访研究。使用生存分析比较各组的生存率,使用COX比例风险模型比较各组的全因和CVD死亡相对危险度（relative risk, RR）。结果 经过5年随访,共获得1343例T2DM患者的完整随访资料。随访期间,共发生全因死亡370例（27.55%）,其中CVD死亡185例（13.78%）。与非PAD非CKD组相比较,CKD合并PAD组的全因和CVD死亡率最高,其RR值分别为3.12（95%CI: 2.30~4.24）和3.47（95%CI: 2.29~5.24）。结论 T2DM患者同时伴CKD和PAD具有较高的全因和CVD死亡风险。     

Sudden death due to ischaemic heart disease in young aboriginal sportsmen in the Northern Territory, 1982-1996.

OBJECTIVE: To estimate the incidence of sport-related sudden cardiac death due to ischaemic heart disease (IHD) in competitive young Aboriginal sportsmen. SETTING: Northern Territory (NT), 1982-1996. DESIGN: Retrospective case series with cases identified from Australian Bureau of Statistics cause-of-death listings and NT coronial autopsy records. MAIN OUTCOME MEASURES: Circumstances and incidence of sport-related sudden cardiac deaths due to IHD; autopsy findings. RESULTS: Between 1982 and 1996, there were eight sudden cardiac deaths due to IHD and related to sporting activity among Aboriginal sportsmen aged 15-37 years in the NT. Six were associated with games of Australian (rules) football. All occurred in the Top End of the NT in the wet season, and all occurred after the first half, or within an hour of, a game. Four of the players had macrosopic myocardial abnormalities (hypertrophy or previous infarcts) on autopsy. The estimated incidence of IHD-related sudden cardiac death among Aboriginal Australian football players in the NT was 19-24 per 100,000 player-years, compared with 0.54 per 100,000 player-years among Australian rules footballers of similar ages in Victoria. CONCLUSIONS: Incidence of sudden cardiac death attributable to underlying IHD was extremely high among young NT Aboriginal Australian footballers. Prevention will best be achieved by funding culturally appropriate long-term strategies to reduce the incidence of IHD. However, in the short-term, community-controlled programs with education of athletes, heat-stress reduction strategies, and cardiovascular screening should reduce the incidence of sudden cardiac death in sport.     

Nutrition-related disorders in Indigenous Australians: how things have changed

Awareness of a serious Indigenous health problem in Australia did not emerge until the 1960s and 1970s. Much attention was focused at the time on poor pregnancy outcomes, high infant and young child mortality rates, and childhood malnutrition and impaired growth, often associated with high infectious disease burdens. Although that situation has improved somewhat, Indigenous infant and child health is still poor compared with that of other Australian children. Over recent decades, there has been a rapid rise among Indigenous people of nutrition-related "lifestyle" disorders such as obesity, cardiovascular disease, type 2 diabetes mellitus and chronic renal disease and their complications. This epidemic of disabling and often fatal chronic diseases in Indigenous Australians is also occurring in disadvantaged groups in many other countries. Control of this potentially disastrous epidemic must become a much higher priority in Indigenous health programs. Governments must commit to this task in cooperation and collaboration with Indigenous organisations and communities.     

An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are diseases of poverty. They occur at world-record rates in Indigenous Australians, yet individual cases are often poorly managed, and most jurisdictions with high rates of these diseases do not have formal control strategies in place. New Australian guidelines formulated in 2005 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand for diagnosis and management of ARF and RHD are a valuable resource for clinicians and policymakers. Key recommendations of the guidelines include: New diagnostic criteria for ARF in high-risk populations, including Indigenous Australians, which include echocardiographic evidence of subclinical valvular disease, and polyarthralgia or aseptic monoarthritis as major manifestations. Clear guidance about treatment of ARF. Non-steroidal anti-inflammatory drugs should be withheld until the diagnosis is confirmed, and corticosteroids may be an option in severe acute carditis. Most cases of chorea do not require medication, but use of carbamazepine or sodium valproate is recommended if medication is needed. Clear guidance about dose, dosing frequency and duration of secondary prophylaxis. Benzathine penicillin G is the preferred medication for this purpose. Establishment of a coordinated control program for all regions of Australia where there are populations with high prevalence of ARF and RHD. Key elements and indicators for evaluation are recommended. Active screening and legislated notification of ARF and RHD, where possible. Development of a structured care plan for all patients with a history of ARF or with established RHD, to be recorded in the patient's primary health care record.     

Hospitalisations due to interpersonal violence: a population-based study in Western Australia

OBJECTIVE: To quantify the impact on the Western Australian health care system of hospitalisations due to interpersonal violence, and to identify risk factors for a repeat hospital admission for interpersonal violence. DESIGN AND SETTING: A population-based, retrospective study of interpersonal violence in WA using linked data (1990--2004) from the Western Australian Mortality Database, the Hospital Morbidity Data System and the Mental Health Information System. MAIN OUTCOME MEASURES: Number of hospitalisations and associated length of stay; risk factors for repeat hospitalisation. RESULTS: Over the period 1990--2004, there were 36,934 hospital admissions due to interpersonal violence, with 11,507 of these hospitalisations due to a subsequent episode of interpersonal violence. The average length of stay was 2.6 days (SD, 4.9 days). People who were more likely to be readmitted for interpersonal violence included women (adjusted hazard ratio [AHR], 1.31; 95% CI, 1.23-1.39), Indigenous people (AHR, 1.37; 95% CI, 1.28-1.46) and patients with a mental illness (AHR, 1.46; 95% CI, 1.37-1.54). People with more affluent backgrounds tended to have a lower risk of being readmitted than people in the most disadvantaged socioeconomic group. CONCLUSION: Greater priority should be directed towards the primary prevention of violence. Groups at high risk, such as women, Indigenous people and those with a mental illness, should be targeted for special attention.     

Impact of Cardiovascular Disease Deaths on Life Expectancy in Chinese Population

Objective We aimed to analyze the impact of cardiovascular disease （CVD） deaths on life expectancy （LE） in Chinese population and estimate the percentage reduction in CVD mortality needed to increase LE by 1 year from the current level, a national target of health improvement. Methods We used life tables, cause-elimination life tables, and age decomposition of LE with corrected mortality data from the National Disease Surveillance System in 2010. Results LE at birth of Chinese people was 73.24 years in 2010. Women had a longer LE than men, and urban population had a longer LE than rural population. CVD deaths resulted in a 4.79-year LE loss and premature deaths in people aged 25 to 64 years were responsible for a substantial part of LE loss from CVD. Death from ischemic heart disease and cerebrovascular diseases accounted for 69.2% of LE loss from CVD deaths and death from cerebrovascular diseases was the largest contributor. In rural men, 51.1% LE loss from CVD deaths was caused by cerebrovascular diseases. If there were no changes in mortality rates for all other diseases, a 27.4% reduction in CVD mortality would increase LE by i year in Chinese population. Conclusion There is a considerable impact of CVD deaths on LE. A 1-year LE increase in the future requires at least a 27.4% reduction in CVD mortality from the current level. Targeting the rural population and tackling cerebrovascular diseases are important for reaching the national goal of health improvement.     

Presence and severity of COPD among patients attending cardiology OPD of a tertiary healthcare centre

Chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) are two very common entities, which often coexist due to common risk factors notably smoking. Though both are common causes of chronically poor health, only cardiovascular disease has got major health priority and government research funding. COPD is largely underdiagnosed and even unsuspected among cases of IHD. The present study wants to address this relatively unexplored area of magnitude of COPD among cases of IHD. A total of 86 (male-65, female-21) consecutive stable and ambulatory IHD patients diagnosed by cardiologist and fulfilling the criteria for inclusion, were selected from cardiology outpatient department of IPGME&R, Kolkata from January 2005 to August 2006. Associated COPD was found in 51.2% (n = 44) patients of the study group (males-36, females-8) according to GOLD criteria; 90.9% of cases of COPD had moderate to severe disease. This was much higher than the prevalence of COPD among general population. A positive correlation was found between severity of COPD and impaired left ventricular ejection fraction (EF). This study also shows that general perception about COPD is poor among patients and their physicians. Most of the COPD cases (81.8%) of IHD were newly detected in this study by spirometric evaluation. Use of inhaled bronchodilator among the previously diagnosed cases is also very low (15.9%). Awareness regarding coexistence of the two diseases may be helpful in management and reduction of mortality and morbidity of COPD in IHD.     

河南省1/10抽样人口恶性肿瘤死亡调查研究报告(1990～1992年)

目的 :调查河南省 2 0世纪 90年代初期 1/ 10抽样人口恶性肿瘤死亡率及其分布特征。方法 :收集河南省15个市县居民死亡资料 ,按《居民病伤死因统计》的统计方法 ,分析常见恶性肿瘤死亡率及其分布特征。结果 :1990～ 1992年河南 1/ 10人口恶性肿瘤普通死亡率为 117 2 5 / 10万 ,中国人口调整死亡率为 10 7 3 8/ 10万 ,占人口总死亡的 19 0 5 % ,居于各种死因的第二位。与 70年代相比 ,男性增加了 3 5 41% ,女性增加了 7 3 5 %。食管癌、胃癌、肝癌、肺癌等为最常见癌症。结论 :河南居民癌症死亡率呈上升趋势 ,对人们生命和健康危害严重 ,应加强肿瘤防治工作     

The changing face of death: recent trends in Australian mortality

The principal causes of death for persons aged between 55 and 64 years are identified from Australian mortality data for 1966 and 1977. Four conditions--ischaemic heart disease, cerebrovascular disease, bronchial carcinoma, and chronic airways disease--account for 62% of deaths in this age group, with 36% of deaths being attributed to ischaemic heart disease. Changes in age-specific mortality rates during the period from 1966 to 1977 are described for each of these four conditions. There have been substantial reductions in mortality from vascular disease in both sexes, and this trend has accelerated since 1974. A recent fall in mortality from bronchial carcinoma and chronic airways disease is indicated for males, while death rates from these disorders continue to increase rapidly for females. The introduction of beta-blockade in the treatment of vascular disease, and changes in the pattern of cigarette smoking are discussed in relation to these mortality trends.     

Intravenous contrast media: use and associated mortality

OBJECTIVE: To determine the extent of use and mortality associated with peripheral intravenous injections of radiocontrast media. DESIGN: A retrospective study of injection data was made for the three and a half year period from January 1987 to June 1990 using the Health Insurance Commission database and the records of public hospital x-ray departments. Information about deaths associated with the injections was obtained from a survey of all radiologists and from other relevant sources. SETTING AND PARTICIPANTS: The study related to the entire population of New South Wales and the Australian Capital Territory, approximately 6 million people. INTERVENTIONS: Intravenous injections of radiographic contrast medium for computed tomographic scans, intravenous pyelograms and venograms. MAIN OUTCOME: A comprehensive record of intravenous contrast usage and associated mortality in a large community. RESULTS: Between January 1987 and June 1990, 613 581 intravenous injections of radiocontrast media were administered in New South Wales and the Australian Capital Territory. The overall annual incidence of use was estimated to be 2.9% and was markedly age dependent being more than 7% in subjects over 65 years. Eight deaths were documented, representing an overall mortality of 13 per million injections (95% confidence interval [CI], 5.6-25.7). Mortality appeared to be age related being 35 per million (95% CI, 12.7-75.6) in those over 65 years compared with 4.5 per million (95% CI, 0.6-16.4) in those under 65 years. Two of the deaths involved low osmolar contrast media. CONCLUSIONS: Death after injection of intravenous contrast medium is a rare event. There was no evidence that mortality was lower with the newer, low osmolar media than with the older, high osmolar media.     

Type 2 diabetes in Indigenous and non-Indigenous children and adolescents in New South Wales

OBJECTIVE: To determine the incidence of type 2 diabetes mellitus (T2DM) in 2001-2006 in young people < 19 years and the characteristics of T2DM in the Indigenous group. DESIGN AND SETTING: Prospective population-based incidence study, New South Wales. PARTICIPANTS: Primary ascertainment was from the Australasian Paediatric Endocrine Group NSW Diabetes Register, with secondary ascertainment from the National Diabetes Register (Australian Institute of Health and Welfare). MAIN OUTCOME MEASURES: Incidence of T2DM in young people in NSW; incidence of T1DM and T2DM in Indigenous young people; characteristics at diagnosis. RESULTS: There were 128 incident cases of T2DM (62 boys, 66 girls) in the study period. The median age at diagnosis was 14.5 years (interquartile range, 13.0-16.4), and 90% were overweight or obese (body mass index > 85th percentile for age). Mean annual incidence was 2.5/100,000 person-years (95% CI, 2.1-3.0) in 10-18-year-olds. Of the ethnic groups represented, white Australian comprised 29%, Indigenous 22%, Asian 22%, North African/Middle Eastern 12% and Māori/Polynesian/Melanesian 10%. The incidence of T2DM was significantly higher in the Indigenous than the non-Indigenous group (incidence rate ratio, 6.1; 95% CI, 3.9-9.7; P<0.001), but incidence rates of T1DM were similar (15.5 v 21.4/100,000, respectively). CONCLUSIONS: T2DM accounts for 11% of incident cases of diabetes in 10-18-year-olds, and the majority are overweight or obese. The high rate among Indigenous Australian children supports screening for T2DM in this population.     

Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000--2005

OBJECTIVE: To compare infection-related mortality rates and pathogens isolated for Indigenous and non-Indigenous adult patients at Alice Springs Hospital (ASH). DESIGN, PARTICIPANTS AND SETTING: Retrospective study of inhospital deaths of adults (patients aged > or = 15 years) associated with an infection during a medical or renal admission to ASH between 1 January 2000 and 31 December 2005. MAIN OUTCOME MEASURES: Admission- and population-based infection-related mortality rates and mortality rate ratios (MRRs) for Indigenous versus non-Indigenous adults. RESULTS: There were 513 deaths, of 351 Indigenous and 162 non-Indigenous patients. For Indigenous patients, 60% of deaths were infection-related, compared with 25% for non-Indigenous patients (P < 0.001). The admission-based infection-related MRR for Indigenous versus non-Indigenous adults was 2.2 (95% CI, 1.6-3.1) (15.3 v 6.8 deaths per 1000 admissions; P < 0.001). After adjusting for age and year of death, the population-based infection-related MRR was 11.3 (95% CI, 8.0-15.8) overall (351 v 35 deaths per 100,000 population; P < 0.001) and 31.5 (95% CI, 16.1-61.8) for patients aged < 60 years. The median age of patients who died with an infection was 49 (interquartile range [IQR], 38-67) years for Indigenous and 73 (IQR, 58-80) years for non-Indigenous patients (P < 0.001). For Indigenous patients, 56% of infection-related deaths were associated with bacterial sepsis, with half of these due to enteric organisms. Other deaths followed chronic hepatitis B infection, invasive fungal infections and complications of strongyloidiasis. CONCLUSION: Indigenous patients at ASH are 11 times more likely than non-Indigenous patients to die with an infectious disease. This racial disparity reflects the ongoing socioeconomic disadvantage experienced by Indigenous Australians.