The real divide: the use of algorithm‐derived Indigenous status to measure disparities in sudden unexpected deaths in infancy in Queensland

• Main Authors: Rebecca A. Shipstone, Jeanine Young, John M.D. Thompson
• Format: Article
• Language: English
• Published: Wiley 2019-12-01
• Series: Australian and New Zealand Journal of Public Health
• Subjects: Aboriginal; data linkage; Indigenous; mortality; sudden infant death syndrome (SIDS)
• Online Access: https://doi.org/10.1111/1753-6405.12951
• ISSN: 1326-0200; 1753-6405

Abstract Objective: To investigate the under‐identification of Indigenous∗ infants in death records and examine the impact of a multi‐stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). Methods: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. Results: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. Conclusions: Applying an algorithm to both numerator and denominator data reduced numerator‐denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under‐identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.