Socioeconomic inequalities in life expectancy in Australia, 2013-22: an ecological study of trends and contributions of causes of death.

BACKGROUND

Despite having one of the highest life expectancies in the world, Australia has considerable subnational variation in health. Our aim was to examine contemporary trends in area-based socioeconomic inequalities in life expectancy, including age-specific and cause-specific components.

METHODS

In this ecological study, we used individual death records and estimated resident population (ERP) to calculate life expectancy and cause-specific life-years lost for each decile of the Australian Bureau of Statistics (ABS) Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) for the whole population in Australia for 2013-22. We used the ABS Death Registrations data in the Person Linked Integrated Data Asset for individual-level records on all deaths that occurred and were registered in Australia, including year of death, age, sex, underlying cause of death, and Statistical Area Level 2 (SA2). We excluded death records in which SA2 was unknown and deaths and ERPs for people living in SA2 where IRSAD could not be defined due to small population counts. We measured inequality by the Slope Index of Inequality (SII) and the absolute gap between the most advantaged (D10) and most disadvantaged (D1) deciles.

FINDINGS

Socioeconomic inequalities in life expectancy widened before reaching a maximum in 2016-18 at SII 4·7 years (95% CI 4·4-5·0) for females and in 2017-19 for males (6·8 years [6·4-7·1]), reflecting little improvement or even deterioration in life expectancy in the more disadvantaged areas. During the COVID-19 pandemic (from 2020) inequalities continued to narrow for males (they had begun to narrow just before the pandemic) but widened for females, largely due to COVID-19 mortality. The effect of other causes of death varied over time and differed by sex, with ischaemic heart disease, lung cancer, and chronic obstructive pulmonary disease consistently being the largest contributors to life expectancy inequalities.

INTERPRETATION

Socioeconomic inequalities in life expectancy in Australia were larger in 2020-22 than in 2013-15, despite some reductions just before and during (for males only) the COVID-19 pandemic. Sustained public health efforts to prevent and manage specific chronic conditions, as well as to reduce premature mortality from injuries (particularly suicide and traffic accidents) and substance misuse among populations in the most disadvantaged areas are needed to reduce socioeconomic inequalities in life expectancy and further increase longevity in Australia FUNDING: Australian Research Council.