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. 2024 Jan 5:43:100987.
doi: 10.1016/j.lanwpc.2023.100987. eCollection 2024 Feb.

Trends and projections of cause-specific premature mortality in Australia to 2044: a statistical modelling study

Qingwei Luo  1 , Julia Steinberg  1 , Clare Kahn  1 , Michael Caruana  1 , Paul B Grogan  1 , Andrew Page  2 , Rebecca Ivers  3 , Emily Banks  4 , Dianne L O'Connell  1   5 , Karen Canfell  1
Affiliations

Trends and projections of cause-specific premature mortality in Australia to 2044: a statistical modelling study

Qingwei Luo et al. Lancet Reg Health West Pac. .

Abstract

Background: Long-term projections of premature mortality (defined as deaths age <75 years) help to inform decisions about public health priorities. This study aimed to project premature mortality rates in Australia to 2044, and to estimate numbers of deaths and potential years of life lost (PYLL) due to premature mortality overall and for 59 causes.

Methods: We examined the past trends in premature mortality rates using Australian mortality data by sex, 5-year age group and 5-year calendar period up to 2019. Cigarette smoking exposure data (1945-2019) were included to project lung cancer mortality. Age-period-cohort or generalised linear models were developed and validated for each cause to project premature mortality rates to 2044.

Findings: Over the 25-year period from 1990-1994 to 2015-2019, there was a 44.4% decrease in the overall age-standardised premature mortality rate. This decline is expected to continue, from 162.4 deaths/100,000 population in 2015-2019 to 141.7/100,000 in 2040-2044 (12.7% decrease). Despite declining rates, total numbers of premature deaths are projected to increase by 22.8%, rising from 272,815 deaths in 2015-2019 to 334,894 deaths in 2040-2044. This is expected to result in 1.58 million premature deaths over the 25-year period 2020-2044, accounting for 24.5 million PYLL. Of the high-level cause categories, cancer is projected to remain the most common cause of premature death in Australia by 2044, followed by cardiovascular disease, external causes (including injury, poisoning, and suicide), and respiratory diseases.

Interpretation: Despite continuously declining overall premature mortality rates, the total number of premature deaths in Australia is projected to remain substantial, and cancer will continue to be the leading cause. These projections can inform the targeting of public health efforts and can serve as benchmarks against which to measure the impact of future interventions. They emphasise the ongoing importance of accelerating the prevention, early detection, and treatment of key health conditions.

Funding: No funding was provided for this study.

Keywords: Age-period-cohort model; Australia; Cancer; Cardiovascular disease; Generalised linear model; Potential years of life lost; Premature mortality; Statistical projections; Suicide; Tobacco consumption.

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Conflict of interest statement

KC's research is funded by the National Health and Medical Research Council (NHMRC) of Australia (Fellowship APP1194679, Centre of Research Excellence in Cervical Cancer Control 1135172). KC is co-PI and MC is an investigator of an investigator-initiated trial of cervical screening, Compass, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity; the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, and operational support from the Australian Government. KC is also co-PI on a major investigator-initiated implementation program Elimination of Cervical Cancer in the Western Pacific (ECCWP) which will receive support from the Minderoo Foundation, the Frazer Family Foundation and equipment donations from Cepheid Inc. Neither KC and MC nor their institution on their behalf receives direct or indirect funding from industry for any project. No other conflicts of interest are declared. The remaining authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Observed and projected age-standardised rates for premature mortality due to all causes 1990–2044, Australia. All rates are age-standardised to the Segi World standard population. The shaded area represents the 95% uncertainty interval.
Fig. 2
Fig. 2
Observed and projected age-standardised premature mortality rates for 1990–2044 for all causes combined and for different cause of death categories, Australia (ranked by the total numbers of deaths observed in 2015–2019) A. High-level causes of deaths B. Detailed cause of death categories. All rates are age-standardised to the Segi World standard population. The shaded area represents the 95% uncertainty interval. COPD: Chronic obstructive pulmonary disease. SIDS: sudden infant death syndrome. Other causes includes diseases of the eye and ear (H00–H95), all pregnancy, childbirth and the puerperium (O00–O99), and all diseases not elsewhere classified excluding sudden infant death syndrome (R00–R94, R96–R99).
Fig. 2
Fig. 2
Observed and projected age-standardised premature mortality rates for 1990–2044 for all causes combined and for different cause of death categories, Australia (ranked by the total numbers of deaths observed in 2015–2019) A. High-level causes of deaths B. Detailed cause of death categories. All rates are age-standardised to the Segi World standard population. The shaded area represents the 95% uncertainty interval. COPD: Chronic obstructive pulmonary disease. SIDS: sudden infant death syndrome. Other causes includes diseases of the eye and ear (H00–H95), all pregnancy, childbirth and the puerperium (O00–O99), and all diseases not elsewhere classified excluding sudden infant death syndrome (R00–R94, R96–R99).
Fig. 3
Fig. 3
Change in rank of causes of death based on the numbers of premature deaths over the period 1990–2044, Australia. A. High-level causes of death B. Detailed cause of death categories for noncommunicable diseases. COPD: Chronic obstructive pulmonary disease. SIDS: sudden infant death syndrome.
Fig. 4
Fig. 4
Estimated annual potential years of life lost due to premature death for different cause of death categories by sex and age group, 1990–2044, Australia. Other causes includes diseases of the eye and ear (H00–H95), all pregnancy, childbirth and the puerperium (O00–O99), and all diseases not elsewhere classified excluding sudden infant death syndrome (R00–R94, R96–R99).
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