Hill Kenneth, Barker Bridget, Vos Theo
Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA 02138, USA.
Int J Epidemiol. 2007 Jun;36(3):580-9. doi: 10.1093/ije/dym011. Epub 2007 Apr 3.
International targets for reducing health inequalities, such as the Millennium Development Goals, are stated in terms of national targets. However, dramatic health differentials exist within countries, even developed ones. Studies indicate that the Indigenous population of Australia suffers a life expectancy disadvantage greater than differentials found in Indigenous populations of other developed countries. We re-examine recent national mortality levels and trends of Indigenous Australians.
Analyses of Indigenous mortality are plagued by 'numerator-denominator bias', whereby reporting of Indigenous status differs in deaths (numerators) and population (denominators). We apply demographic evaluation methods developed to address such problems to data from the 1991, 1996 and 2001 censuses of Australia and to the death registration data for the period.
The propensity of Australia's population to report Indigenous status increased between each census, particularly between 1991 and 1996, while recording of deaths as Indigenous increased sharply. Adjusted for bias, the Indigenous population had a life expectancy approximately 13 years below that of the non-Indigenous population, a 2-year greater disadvantage than recently estimated for the Maori in New Zealand. Indigenous mortality fell during the 1990s, but slightly more slowly than that of non-Indigenous Australians, leaving differentials slightly increased.
Around the world Indigenous populations are estimated to suffer a mortality disadvantage compared with non-Indigenous populations. However, establishing the magnitude of and trend in the disadvantage is difficult because of bias. Using appropriate methods to adjust for bias, the Indigenous population of Australia is estimated to suffer a life expectancy shortfall of about 13 years, greater than similar gaps in other developed countries.
诸如千年发展目标等减少健康不平等现象的国际目标是以国家目标来表述的。然而，即使在发达国家，国内也存在显著的健康差异。研究表明，澳大利亚的原住民在预期寿命方面处于劣势，且这种劣势大于其他发达国家原住民群体之间的差异。我们重新审视了澳大利亚原住民近期的全国死亡率水平及趋势。
原住民死亡率分析受到“分子分母偏差”的困扰，即原住民身份在死亡数据（分子）和人口数据（分母）中的报告方式存在差异。我们将为解决此类问题而开发的人口统计学评估方法应用于澳大利亚1991年、1996年和2001年人口普查数据以及该时期的死亡登记数据。
在每次人口普查期间，澳大利亚人口报告原住民身份的倾向都有所增加，尤其是在1991年至1996年期间，而将死亡记录为原住民的数量急剧增加。经偏差调整后，原住民的预期寿命比非原住民人口约低13岁，比最近对新西兰毛利人的估计劣势大2岁。20世纪90年代原住民死亡率有所下降，但比非原住民澳大利亚人下降得略慢，导致差异略有增加。
据估计，全世界原住民人口与非原住民人口相比在死亡率方面处于劣势。然而，由于偏差的存在，很难确定这种劣势的程度和趋势。使用适当的方法来调整偏差后，澳大利亚原住民人口的预期寿命估计短缺约13岁，比其他发达国家的类似差距更大。
