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

• Published in: Australian and New Zealand journal of public health 2019-12, Vol.43 (6), p.570-576
• Main Authors: Shipstone, Rebecca A., Young, Jeanine, Thompson, John M.D.
• Format: Article
• Language: English
• Subjects: Aboriginal; Algorithms; Archives & records; Babies; Cause of Death; Child welfare; Data; Data collection; data linkage; Death; Death & dying; Death Certificates; Documentation - standards; Emergency medical care; Estimation; Fatalities; Female; Hospitalization; Humans; Incompatibility; Indigenous; Infant; Infant mortality; Infant Mortality - ethnology; Infant, Newborn; Infants; Information Storage and Retrieval; Linked Data; Male; Mortality; Mortality rates; Native peoples; Public health; Queensland - epidemiology; Registration; Risk Factors; Statistical analysis; Sudden Infant Death - epidemiology; Sudden Infant Death - ethnology; sudden infant death syndrome (SIDS)
• ISSN: 1326-0200; 1753-6405; 1753-6405
• DOI: 10.1111/1753-6405.12951

To investigate the under‐identification of Indigenous∗∗Due to repeated use throughout this paper the term Indigenous people will be respectfully used when referring to individuals who identify as Aboriginal and/or Torres Strait Islander. infants in death records and examine the impact of a multi‐stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). 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. 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. 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. 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.