Screening for conditions of public health importance in people arriving in Australia by boat without authority

OBJECTIVE: To determine the prevalence of tuberculosis, hepatitis B carriage and markers of hepatitis C and HIV infection in people detained in immigration reception and processing centres in Australia. DESIGN AND SETTING: Eighteen-month survey of medical conditions of public health importance in people detained at the immigration reception and processing centres at Curtin and Port Hedland in Western Australia and Woomera in South Australia. PARTICIPANTS: 7000 detainees (5742 adults and 1258 children and teenagers aged < 18 years) between 1 January 2000 and 30 June 2001. MAIN OUTCOME MEASURES: People treated for active tuberculosis; issuing of health undertakings to report to a chest clinic for follow-up of inactive tuberculosis; and confirmation of hepatitis B carrier status or hepatitis C or HIV infection. RESULTS: Eleven people required treatment for tuberculosis (in nine the diagnosis was confirmed bacteriologically), representing a prevalence of 157 cases per 100,000 population. This rate is much higher than the incidence in Australia in 1998 of 4.93 cases per 100,000 population, but comparable with rates in the source countries. Health undertakings were issued to 973 people (13.9%). Of these, 682 (70.1%) were for inactive tuberculosis (26 in association with hepatitis B carriage or hepatitis C infection); and 156, 58 and two health undertakings were for hepatitis B carriage, and hepatitis C and HIV infection, respectively. CONCLUSIONS: The health-screening program at immigration reception and processing centres detects significant numbers of conditions of public health importance, enabling treatment and surveillance to the benefit of the people detained and the Australian community.     

HIV prevalence at reception into Australian prisons, 1991-1997.

OBJECTIVE: To measure the extent and outcome of HIV antibody testing at reception into Australian prisons. DESIGN: Cross-sectional survey at reception into prison. PARTICIPANTS AND SETTING: People received into Australian prisons from 1991 to 1997. MAIN OUTCOME MEASURES: Number of people tested for HIV infection and prevalence of diagnosed HIV infection. RESULTS: In 1991-1997, HIV antibody testing was carried out for 72% of prison entrants in Australia; the percentage tested declined significantly from 76% in 1991 to 67% in 1997 (P < 0.001). In New South Wales, the percentage of entrants tested at reception into prison dropped from almost 100% in 1991-1994 to 45% in 1997, whereas in the Northern Territory, South Australia and Western Australia the extent of testing increased significantly (P < 0.001). HIV prevalence was 0.2% among people received into Australian prisons in 1991-1997, and did not differ by sex. Most people with HIV infection (242/378; 64%) received into prison in 1991-1997 had been diagnosed at a previous entry; 136 people (36% of the total number of diagnoses) were newly diagnosed at reception into prison. CONCLUSIONS: A national monitoring system in place from 1991 indicates generally high rates of HIV antibody testing and a low prevalence of HIV infection among people entering Australian prisons. In each year, people not previously known to the prison health service to have HIV infection were received into prison, indicating continuing HIV infection in the population entering Australian prisons.     

Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project.

OBJECTIVE: To estimate the risk and prevalence of Mycobacterium tuberculosis (MTB) infection and tuberculosis (TB) incidence, prevalence, and mortality, including disease attributable to human immunodeficiency virus (HIV), for 212 countries in 1997. PARTICIPANTS: A panel of 86 TB experts and epidemiologists from more than 40 countries was chosen by the World Health Organization (WHO), with final agreement being reached between country experts and WHO staff. EVIDENCE: Incidence of TB and mortality in each country was determined by (1) case notification to the WHO, (2) annual risk of infection data from tuberculin surveys, and (3) data on prevalence of smear-positive pulmonary disease from prevalence surveys. Estimates derived from relatively poor data were strongly influenced by panel member opinion. Objective estimates were derived from high-quality data collected recently by approved procedures. CONSENSUS PROCESS: Agreement was reached by (1) participants reviewing methods and data and making provisional estimates in closed workshops held at WHO's 6 regional offices, (2) principal authors refining estimates using standard methods and all available data, and (3) country experts reviewing and adjusting these estimates and reaching final agreement with WHO staff. CONCLUSIONS: In 1997, new cases of TB totaled an estimated 7.96 million (range, 6.3 million-11.1 million), including 3.52 million (2.8 million-4.9 million) cases (44%) of infectious pulmonary disease (smear-positive), and there were 16.2 million (12.1 million-22.5 million) existing cases of disease. An estimated 1.87 million (1.4 million-2.8 million) people died of TB and the global case fatality rate was 23% but exceeded 50% in some African countries with high HIV rates. Global prevalence of MTB infection was 32% (1.86 billion people). Eighty percent of all incident TB cases were found in 22 countries, with more than half the cases occurring in 5 Southeast Asian countries. Nine of 10 countries with the highest incidence rates per capita were in Africa. Prevalence of MTB/HIV coinfection worldwide was 0.18% and 640000 incident TB cases (8%) had HIV infection. The global burden of tuberculosis remains enormous, mainly because of poor control in Southeast Asia, sub-Saharan Africa, and eastern Europe, and because of high rates of M tuberculosis and HIV coinfection in some African countries.     

Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?

OBJECTIVES: To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. DESIGN: Cohort study. SETTING: A remote Aboriginal community in the Northern Territory. PARTICIPANTS: 889 Aboriginal people aged 20-74 years followed up to 31 May 2003 after baseline examination in 1992-1995. MAIN OUTCOME MEASURES: Incidence rates of CHD (estimated for 123 participants with diabetes at baseline and 701 "non-diabetes" participants); rate ratios for diabetes risk (95% CI), with "non-diabetes" participants as the reference group. RESULTS: Participants with diabetes at baseline had a higher rate of CHD (37.5 per 1000 person-years) than those without diabetes (7.3 per 1000 person-years). Adjustment for multiple CHD risk factors, such as age, smoking, alcohol consumption, systolic blood pressure, body mass index, high-density lipoprotein cholesterol and total cholesterol levels, resulted in a CHD rate ratio for women of 3.7 (95% CI, 1.6-8.9) (comparing women with diabetes with those without) and a CHD rate ratio for men of 1.4 (95% CI, 0.4-4.1) (comparing men with diabetes with those without). CONCLUSIONS: Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes.     

Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote aboriginal communities on Anangu Pitjantjatjara Lands.

OBJECTIVE: To evaluate the impact of a program to improve access to, and delivery of, diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities. DESIGN: Analysis of cross-sectional data from annual age-based screening. SETTING: Six remote Aboriginal communities and three homelands on the Anangu Pitjantjatjara Lands in the far north-west of South Australia, 1996-1998. PARTICIPANTS: All Aboriginal people aged 12-40 years listed on the Nganampa Health Council population register as resident on the Anangu Pitjantjatjara Lands. MAIN OUTCOME MEASURES: Prevalence of gonorrhoea and chlamydial infection, determined by urine polymerase chain reaction tests. RESULTS: The prevalence of gonorrhoea in people aged 12-40 years almost halved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P < 0.001). The fall in prevalence of gonorrhoea was comparable and statistically significant in both men and women. Prevalence of chlamydial infection also fell, from 8.8% in men and 9.1% in women in 1996 to 7.2% in both men and women in 1998, but this decline was not statistically significant (test for trend: P = 0.174). CONCLUSION: This study documents a rapid reduction in prevalence of gonorrhoea, probably reflecting reduced duration of infectiousness due to advances in diagnosis, increased testing activity and reduced interval to treatment rather than behaviour change. These results demonstrate that, in remote communities, even with a highly mobile population, it is possible to implement effective control activities for sexually transmitted diseases.     

Congenital heart defects in Central Australia

OBJECTIVE: To determine the incidence of congenital heart defects (CHD) in Aboriginal and non-Aboriginal infants in Central Australia and to compare this with the incidence elsewhere in Australia. DESIGN AND SETTING: Data on cases were obtained from patient records of the Alice Springs Hospital, Central Australia, the sole referral centre for paediatric and initial cardiac diagnostic services for the region. PARTICIPANTS: Patients with CHD proven by echocardiography reported between 1 January 1993 and 30 June 2000. MAIN OUTCOME MEASURES: Incidence of CHD using all live births in Central Australia as the denominator. RESULTS: 108 patients with CHD were detected among 6156 live births (incidence, 17.5 per 1000; 95% CI, 14.9-21.7 per 1000); 57 of 2991 were Aboriginal (19.0 per 1000; 95% CI, 14.4-24.6 per 1000) and 51 of 3165 were non-Aboriginal (16.1 per 1000; 95% CI, 12.0-21.1 per 1000). The difference between the two groups was not statistically significant (relative risk, 1.18; 95% CI, 0.81-1.72). CHD incidence in Central Australia was significantly higher than that reported for other parts of Australia (4.3 per 1000 live births in New South Wales and the Australian Capital Territory, 1981-1984; 7.65 and 12 per 1000 total births in Western Australia, 1980-1989, and South Australia, 1993-2000, respectively). CONCLUSIONS: The high rates of CHD in Central Australia may partly reflect the high utilisation of echocardiography for assessing minor lesions. However, the incidence of both major and minor types of CHD was significantly higher than previously reported from other regions of Australia. The role of socioenvironmental factors in this high incidence should be explored.     

Trachoma in the Northern Territory of Australia, 1940-1986

All known surveys of the prevalence of trachoma in the Northern Territory from 1940 to the present were reviewed. The crude (overall) prevalence rates for trachoma were calculated from the results of those surveys which involved whole Aboriginal communities. When three-or-more surveys had been conducted in a community over a period of 10 years or more, the results were plotted against the year of the survey. In most communities in the north of the Northern Territory (the "Top End"), the prevalence of trachoma appeared to have increased dramatically between 1950 and 1955 and then to have declined substantially at a rate of 2% per annum. This fall occurred before the mass-treatment programmes of the late 1970s and its most likely explanation is the improvement in living conditions. In five- to 10-years' time, trachoma may have disappeared completely from these communities. In most Central Australian communities, the prevalence of trachoma appears to have been constant or even to have increased. If social conditions were to begin to improve in Central Australian communities this year, and if those communities were to show the same response rates as in the Top End communities, then it could be well into the next century before the prevalence of trachoma there falls to the low rates of the Top End. This should be an impetus for social change in Central Australia; however, there might be a case for medically based control programmes in Central Australia, at least in the short term.     

Aboriginal incarceration: health and social impacts

Each year up to a quarter of all young Aboriginal men have direct involvement with correctional services, and Aboriginal prisoners currently represent 22% of the total Australian prisoner population. The high rates of repeated short-term incarceration experienced by Aboriginal people in Australia have a multitude of negative health effects for Aboriginal communities and the wider society, while achieving little in terms of increased community safety. Well identified health and social priorities for Aboriginal people affected by incarceration include housing and tenancy support; mental health and wellbeing, including family violence, grief and loss support; substance misuse support; general health services, including hepatitis C management; and social inclusion, including the need for family and community integration, skills development and employment. The post-release period is a crucial time for the provision of integrated health and social services to address these priorities and to break the cycle of incarceration. To achieve significant health gains for Aboriginal people, there is a need to develop a broader collaborative approach to primary health care, incorporating social health and justice perspectives as fundamental components of health care planning. Health and human services have a critical role to play in developing community-based solutions to reduce excessive incarceration rates for Aboriginal people.     

Epidemiology of sexually transmitted infections on the Anangu Pitjantjatjara Yankunytjatjara Lands: results of a comprehensive control program

OBJECTIVE: To assess the impact of a long-term comprehensive control program for sexually transmitted infections (STIs) in remote Aboriginal communities in Central Australia, and to investigate a recent rise in gonorrhoea prevalence. DESIGN: STI prevalence was determined from annual, cross-sectional, population-wide, age-based screening, 1996-2006. During 2006, gonococcal isolates were obtained by on-site culture and tested for antimicrobial susceptibility. SETTING: Six remote clinics on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands, South Australia, which are served by Nganampa Health Council, an Aboriginal community-controlled health service. PARTICIPANTS: All resident Aboriginal people aged 14-40 years at the commencement date of each annual population-wide screen. MAIN OUTCOME MEASURES: Multivariable logistic regression models were used to compare prevalence of chlamydial infection, gonorrhoea and syphilis measured during each annual population-wide screen; antimicrobial susceptibility of gonococcal isolates obtained in 2006. RESULTS: Between 1996 and 2003, there was a significant reduction in prevalence of gonorrhoea and chlamydial infection, by 67% and 58%, respectively. Subsequently, chlamydia prevalence rate plateaued, but there was a rapid rise in prevalence of gonorrhoea. Syphilis prevalence decreased linearly over the study period (odds ratio, 0.81; P < 0.001). During the first 6 months of 2006, 89 gonococcal isolates were obtained, 39 through on-site culture during the 6-week screening period, and all were sensitive to penicillin (in the less-sensitive category). CONCLUSIONS: The decrease in STI prevalence associated with the program was maintained until 2006 for chlamydial infection and syphilis, but not for gonorrhoea, which rose in prevalence after 2003. There was no change in antimicrobial resistance to explain this rise, and gonorrhoea transmission dynamics and travel of core transmitters to regions without STI control programs might be responsible.     

The epidemiology of invasive Haemophilus influenzae infections in children under five years of age in the Northern Territory: a three-year study

A survey of all episodes of invasive Haemophilus influenzae infections that were diagnosed over a three-year period in children seen at the regional hospitals of the Northern Territory has found a significantly (P less than 0.001) higher incidence in children in Central Australia (the Alice Springs and Barkly regions, and the Anangu Pitjantjatjara Lands) than in the Top End (the Darwin, East Arnhem and Katherine regions), and a greater incidence in Aboriginal than in non-Aboriginal children. Identified risk factors for Aboriginal children were infancy (more than 70% of cases occurred before 12 months of age), sex (with a predominance in girls) and residence in Central Australia; the estimated annual incidence for Central Australian Aboriginal children was 991 cases per 100,000 children. There was a significant correlation (r = 0.62) between the total number of cases diagnosed each month in Central Australia and the mean monthly temperatures recorded in Alice Springs. Whereas virtually all cases of invasive H. influenzae infection in non-Aboriginal children were caused by type b strains, strains other than type b caused 15% of the cases in Aboriginal children. The possibilities for prevention by immunization are discussed.     

Tuberculosis in New South Wales

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.     

Ear disease in three aboriginal communities in Western Australia

Surveys of ear disease amongst Aboriginal people in two isolated bush communities (Wiluna and La Grange) and one urban community (Kwinana) in Western Australia were undertaken in 1988 or 1989. The age-adjusted prevalence odds ratio (relative risk) of perforations of the tympanic membrane for Wiluna compared with Kwinana was 5.0 (95% confidence interval [CI] 2.7-12.2) and 6.8 (95% CI 3.5-13.9) for La Grange compared with Kwinana. The relative risk of mild hearing loss, in comparison with Kwinana, was 2.5 (95% CI 1.5-4.3) for Wiluna and 3.2 (95% CI 2.0-5.0) for La Grange. There was no significant difference in the relative risk of moderate or severe hearing loss or impedance pattern B, usually interpreted as "glue ear", in any of the three communities. Overall, the urban Aboriginal community had less ear disease and hearing loss than either of the isolated bush communities, but even this community did not approach the much lower levels of prevalence in Australia as a whole.     

Hepatitis B reservoirs and attack rates in an Australian community. A basis for vaccination and crossinfection policies

Four different subpopulations in South Australia, which were expected to have high rates of hepatitis B infection (Asians, Aboriginals, homosexual men, and drug addicts) were examined for their contribution to the total reservoir of hepatitis B surface antigen (HBsAg) carriers and to the total annual incidence of acute hepatitis B infection in South Australia. Age-specific prevalence data were also examined to assess the ages at which infection is commonly acquired. It was found that the above four groups, which comprise 3% of the State's population, are likely to include about 75% of HBsAg carriers in the State, but contribute a minority of the total new infections each year; they are not likely to present a significant risk of infection to the community at large. Three different age-related patterns of acquisition of infection were recognized--among Southeast Asians and Aboriginals, homosexual men and drug addicts, and the general community, respectively. The above approach, and to some extent the general findings, should be applicable to other similar communities in the formulation of effective policies for the control and prevention of hepatitis B infection.     

Health of Aboriginal and Torres Strait Islander children in remote Far North Queensland: findings of the Paediatric Outreach Service

AIM: To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ). DESIGN, SETTING AND PARTICIPANTS: Retrospective review of the FNQ Paediatric Outreach Service's Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed. MAIN OUTCOME MEASURES: Number of children seen and common diagnoses. RESULTS: 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia. CONCLUSION: Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol-related conditions and rheumatic fever.     

Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia

OBJECTIVE: To compare trends and rates of HIV and sexually transmitted infections in Indigenous and non-Indigenous people of Western Australia. DESIGN AND SETTING: Analysis of WA notification data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and for HIV infections from 1983 to 2002. MAIN OUTCOME MEASURES: Rates of HIV and sexually transmitted infection by Indigenous status. RESULTS: In 2002, there were 3046 notifications for chlamydia, 1380 for gonorrhoea and 64 for syphilis. When information on Indigenous status was available, Indigenous people accounted for 41% of chlamydia and 76% of gonorrhoea notifications, with Indigenous:non-Indigenous age-standardised rate ratios of 16 (95% CI, 14-17) and 77 (95% CI, 67-88), respectively. Indigenous people accounted for 90.6% of syphilis notifications (age-standardised Indigenous:non-Indigenous rate ratio, 242 [95% CI, 104-561]). From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined and rates for Indigenous people increased. From 1994 to 2002, there were 421 notifications of HIV infection in WA residents, 52 (12.4%) in Indigenous people and 369 (87.6%) in non-Indigenous people. Indigenous people accounted for 39% and 6.2% of all notifications in WA females and males, respectively. The Indigenous:non-Indigenous rate ratios were 18 (95% CI, 12-29) for females and 2 (95% CI, 1-3) for males. CONCLUSIONS: Indigenous Western Australians are at greater risk of HIV transmission than non-Indigenous people. Strategies to prevent further HIV infection in Indigenous Australians should include control of sexually transmitted infections.     

Diabetes among aboriginal people in central Australia: a high prevalence based on health service attendance

The prevalence of diagnosed diabetes in Aboriginal people living in central Australia (population, 9983) was determined by collating data from the hospital, rural and urban health services, nursing homes and death registers. A total of 98 male and 183 female Aboriginal residents with diabetes attended health services in central Australia between January 1984 and December 1986. The point prevalence of diagnosed diabetes at the end of 1986 in the age group 25-34 years was 1.6% in men and 3.1% in women, and in those over 35 years, 8.8% and 14.1%, respectively. The true prevalence of diabetes (diagnosed and undetected) is likely to be at least twice this rate, and constitutes a major public health problem in central Australia. Diabetes and other disorders such as obesity, hypertension and ischaemic heart disease have common antecedents and outcomes. The control of these non-communicable diseases requires integrated and culturally appropriate educational, social and medical strategies.     

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).     

HIV and AIDS in aboriginal and Torres Strait Islander Australians: 1992-1998. The National HIV Surveillance Committee

OBJECTIVE: To describe the epidemiological pattern of newly diagnosed HIV infection and AIDS among Indigenous Australians. DESIGN AND SETTING: National surveillance for newly diagnosed HIV infection and AIDS in Australia. Information on Indigenous status was sought at HIV/AIDS notification in all State/Territory health jurisdictions, except the Australian Capital Territory, and Victoria before June 1998. MAIN OUTCOME MEASURES: Number of people with newly diagnosed HIV per year and population rate of HIV diagnosis; demographic characteristics of people with HIV and AIDS diagnoses by Indigenous status. RESULTS: From 1992 to 1998, 127 Indigenous Australians were newly diagnosed with HIV infection and 55 were diagnosed with AIDS. The population rate of HIV diagnosis among Indigenous Australians (5.23/100,000 per year) was similar to that among non-Indigenous Australians (5.51/100,000 per year). The annual number of HIV diagnoses among Indigenous people was relatively stable, but among non-Indigenous people it declined steadily over time. A higher proportion of Indigenous people diagnosed with HIV were women (26.8% v 8.9%; P < 0.001). Although male homosexual contact was the predominant source of exposure for both Indigenous (46.7%) and non-Indigenous (75.0%) people with HIV infection, exposure by heterosexual contact (36.7% v 15.3%; P < 0.001) was reported more frequently among Indigenous people. CONCLUSION: Although HIV incidence was similar among Indigenous and non-Indigenous Australians, the lack of a recent decline in incidence and the higher proportion of Indigenous people exposed to HIV by heterosexual contact indicate the need to intensify interventions to prevent HIV transmission among Indigenous people.     

Mortality rates in 14 Queensland Aboriginal reserve communities

We report the results of an age standardized comparison of the mortality rates of Queenslanders and persons living in 14 Aboriginal reserves (or communities) in Queensland. The analysis distinguishes four categories of cause of death. For all causes of death, mortality rates for people living on reserves exceeded the rates for the comparable Queensland population. On some Aboriginal reserves mortality rates were substantially higher than on others. Mortality rates from infectious diseases on some reserves were 200 (Doomadgee, Woorabinda) to 300 (Lockhart River) times those which prevailed in Queensland as a whole.