Alcohol-attributable deaths among indigenous and non-indigenous Australians

Introduction Alcohol abuse in Indigenous communities in Australia has been a devastating problem. The association between alcohol use and ill-health is well established but complex. The aim of this review was to assess and compare alcohol-attributable deaths and years of life lost among Indigenous Australians to the Australian population as a whole. Methods and materials Standard burden of disease and injury methodology and population attributable fractions were applied to analyse death registration data from 2003 to 2006. Alcohol use prevalence was retrieved from the 2004/5 Australian National Health Surveys and the National Aboriginal and Torres Strait Islander Health Survey. The relative risk estimates were compiled from epidemiological reviews. Results The results found that Indigenous Australians experienced 7% to 7.5% mortality burden resulting from alcohol use, and were over-represented in comparison with their population share (2.5%). At ages 15 to 74 years, the alcohol-attributable deaths and years of life lost rates among Indigenous Australians were over 2–3 times higher than in the average across all Australians. At ages 25 to 54, the alcohol-attributable mortality rates among Indigenous Australians were 4–6 times higher than the national average. Alcohol-attributable mortality risk was substantially (2–3 times) higher among males than females, regardless of ethnicity and age group. Discussion This review provides new and more reliable national data on alcohol-attributable deaths and alcohol-attributable years of life lost, comparing Indigenous Australians with the general population. Significant mortality and morbidity among Indigenous Australians is associated with excess alcohol use, which generally occurs within a historical context and socioeconomic disadvantage. The failure to address poverty in Indigenous communities is likely to undermine gains that might otherwise occur through traditional prevention activities, such as alcohol restrictions. Conclusion It was evident that the harmful use of alcohol contributed to the disproportionate mortality burden experienced by Indigenous Australians. Introduction Globally, 2.5 million (3.8% of total) deaths resulted from alcohol abuse in 2004, and harmful use of alcohol was responsible for 4.5% of the global burden of disease1. In 2010, 81% of Australians aged 14 years and over reported drinking alcohol, and 29% drank at harmful level2. The cost of alcohol use was estimated to be $15 billion annually, with an additional $1 billion due to the combined effects with illicit drugs3. In Australia, throughout 1990 to 2007 the national per capita consumption of alcohol increased steadily with some evidence of decline since 20084,5, possibly related to the international economic downturn. Vos and colleagues estimated that the burden of disease associated with alcohol use by Aboriginal and Torres Strait Islander (referred to as Indigenous hereafter) Australians is 6.2% of the overall burden of disease and injury, almost double that of the general Australian population6. Indigenous Australians constitute 2.5% of the total Australian population7. Alcohol abuse among Indigenous communities has been a devastating problem. Harmful use of alcohol is the most prevalent form of substance abuse among Indigenous Australians8. Indigenous Australians are concerned about harmful alcohol use in their communities, and actively involved in prevention. Most Indigenous people do not drink alcohol at all or drink responsibly. In 2004–05, 49% of Indigenous and 52% all Australian adults reported having consumed alcohol in the week prior to interview, and 16% of Indigenous adults reported drinking at risky level8, far exceeding the all Australian average (8%)9. By balancing the information of various sources, there appears to be a consensus that the Indigenous population is less likely to consume alcohol than nonIndigenous Australians, mainly due to higher abstention rates. However, Indigenous Australians are at least 50% more likely to drink at harmful levels, and experience adverse effects of alcohol and higher levels of mortality and morbidity than their non-Indigenous peers10,11. This summary is supported by the large-scale surveys, national hospital data collection and death registration. Alcohol misuse has negative effects on Indigenous life expectancy. * Corresponding author Email: Yuejen.Zhao@nt.gov. au 1 Health Gains Planning Branch, Northern Territory Department of Health, Australia 2 National Drug Research Institute, Curtin University, Australia