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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abstract
Background: This paper initially describes premature mortality by Aboriginality in South Australia during 1999 to
2006. It then examines how these outcomes vary across area level socio-economic disadvantage and geographic
remoteness.
Methods: The retrospective, cross-sectional analysis uses estimated resident population by sex, age and small areas
based on the 2006 Census, and Unit Record mortality data. Premature mortality outcomes are measured using
years of life lost (YLL). Subsequent intrastate comparisons are based on indirect sex and age adjusted YLL results.
A multivariate model uses area level socio-economic disadvantage rank, geographic remoteness, and an interaction
between the two variables to predict premature mortality outcomes.
Results: Aboriginal people experienced 1.1% of total deaths but 2.2% of YLL and Aboriginal premature mortality
rates were 2.65 times greater than the South Australian average. Premature mortality for Aboriginal and non-
Aboriginal people increased significantly as area disadvantage increased. Among Aboriginal people though, a
significant main effect for area remoteness was also observed, together with an interaction between disadvantage
and remoteness. The synergistic effect shows the social gradient between area disadvantage and premature
mortality increased as remoteness increased.
Conclusions: While confirming the gap in premature mortality rates between Aboriginal South Australians and the
rest of the community, the study also found a heterogeneity of outcomes within the Aboriginal community
underlie this difference. The results support the existence of relationship between area level socio-economic
deprivation, remoteness and premature mortality in the midst of an affluent society. The study concludes that
vertically equitable resourcing according to population need is an important response to the stark mortality gap
and its exacerbation by area socio-economic position and remoteness
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