Life expectancy of high-risk populations

Appleby’s recent paper in the BMJ [1] shows steadily worsening health across social care bands, with no particular step change at the lower end of the distribution. However, there are some particularly vulnerable small populations in most countries. In the UK the homeless form such a group, with an average age of death of 47 years, some 30 years less than the general population.[2] We thought it would be interesting to compare the life expectancy of particular high-risk populations with those of the host community across a range of middle- and high-risk countries. The results are shown in Table 1. The sharpest gradient applies to residents of the largest informal settlement in Kenya, who have a terrible life expectancy of about half the national mean.[3] [4] The Inuit population of Canada have a life expectancy that is 84% of the national mean,[5] while the Aboriginal and Torres Strait people of Australia have a life expectancy that is 88% of the Australian average.[6] The indigenous peoples of the Yunnan province in China,[7] the Alaska Natives of the USA,[8] the Māori people of New Zealand,[9] and the Pacific Islanders of the USA [10] all fare relatively better. Table 2 shows that excess mortality across at least one of these groups is attributed to a wide range of medical conditions.[11] As to the mechanism linking social conditions to these diseases, we would be interested in your views. In the meantime, we note that none of the above groups, save the children of Kibera slum, have an outcome as bad as that of the homeless in the UK.

Table 1. Life expectancy of indigenous populations compared to that of the country/state as a whole.

Kibera slum, Kenya – 30 year life expectancy compared to 63.5 years for country [3, 4]; Inuit people, Canada – 66.9 year life expectancy compared to 79.5 years for country [5]; Aboriginal & Torres Strait Islanders, Australia – 71.4 years life expectancy compared to 81.2 years for country [6]; Yunnan indigenous population, China – 64.5 years life expectancy compared to 71.4 years for country [7]; Alaska Natives, USA – 70.5 years life expectancy compared to 77.3 years for state [8]; Māori people, New Zealand – 74.7 years life expectancy compared to 81.2 years for country [9]; Native Hawaiians & other Pacific Islanders, USA – 74.3 years life expectancy compared to 80.5 for state.[10]

NB. All life expectancies, except for Native Hawaiians & other Pacific Islanders, are an average of the male and female life expectancies.

Table 2. Causes of excess mortality among Aboriginal and Torres Strait Islanders in Australia (2004-2008).[11]

SMR for death by diseases of circulatory system is 3.0 in males (accounting for 26.3% of excess deaths), and 1.8 in females (accounting for 24.4% of excess deaths); SMR for death by diseases of digestive system is 6.4 in males (accounting for 7.3% of excess deaths), and 4.2 in females (accounting for 9.8% of excess deaths); SMR for death by diseases of respiratory system is 3.9 in males (accounting for 8.6% of excess deaths), and 2.3 in females (accounting for 9.3% of excess deaths); SMR for death by endocrine, metabolic & nutritional disorders is 7.2 in males (accounting for 9.1% of excess deaths), and 6.4 in females (accounting for 17.6% of excess deaths); SMR for death by external causes is 3.7 in males (accounting for 20.2% of excess deaths), and 1.5 in females (accounting for 7.3% of excess deaths); SMR for death by neoplasms is 1.7 in males (accounting for 9.9% of excess deaths), and 1.3 in females (accounting for 8.8% of excess deaths).

* Standardised Mortality Ratio – observed deaths as a proportion of deaths expected based on age, gender and cause-specific rates for non-Indigenous population.
† Excess deaths (observed deaths minus expected deaths), as a percentage of total excess deaths for all causes.

— Richard Lilford, CLAHRC WM Director

— Peter Chilton, Research Associate

References:

  1. Appleby J. Health related lifestyles of children: getting better? BMJ. 2014; 348: g3025.
  2. Crisis. Homelessness: A silent killer. A research briefing on mortality among homeless people. 2011. [Online].
  3. The Kibera Law Centre. Facts. 2014. [Online].
  4. Central Intelligence Agency. The World Factbook – Kenya. 2014. [Online].
  5. Wilkins R, Uppal S, Finés P, Senéchal S, Guimond É, Dion R. Life expectancy in the Inuit-inhabited areas of Canada, 1989-2003. Statistics Canada Health Reports. 2008. [Online].
  6. Australian Bureau of Statistics. Life tables for Aboriginal and Torres Strait Islander Australians. Report No. 3302.0.55.003. Canberra: ABS; 2013.
  7. Li J, Luo C, De Klerk N. Trends in infant/child mortality and life expectancy in Indigenous populations in Yunnan Province, China. Aust NZ J Publ Heal. 2008; 32(3): 216-23.
  8. Hunsinger E. Alaska Populations Projections 2007-2030. Alaska Native Population Changes Workshop; 2008 April. [Online].
  9. Statistics New Zealand. Period life tables. 2013. [Online].
  10. Look MA, Trask-Batti MK, Agres R, Mau ML, Kaholokula JK. Assessment and Priorities for Health & Well-being in Native Hawaiians & Other Pacific Peoples. Honolulu, HI: Centre for Native and Pacific Health Disparities Research; 2013.
  11. Australian Institute of Health and Welfare. Life expectancy and mortality of Aboriginal and Torres Strait Islander people.Cat. No. IHW 51. Canberra: AIHW; 2011.
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