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

Qingwei Luo; Julia Steinberg; Clare Kahn; Michael Caruana; Paul B Grogan; Andrew Page; Rebecca Ivers; Emily Banks; Dianne L O'Connell; Karen Canfell

doi:10.1016/j.lanwpc.2023.100987

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

Lancet Reg Health West Pac. 2024 Jan 5:43:100987. doi: 10.1016/j.lanwpc.2023.100987. eCollection 2024 Feb.

Authors

Affiliations

¹ The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia.
² Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
³ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.

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.