Cardiac pathology and adult Aboriginal mortality: A coronial study of sudden and external cause deaths in the Top End of the Northern Territory in 1990

A retrospective review of coronial records was performed for 179 adult decedents who came to coronial autopsy in 1990 and who had been living in the Top End of the Northern Territory at the time of death. The directly standardized rate of autopsy-examined sudden death was 7.4 times higher for Aboriginal people than for non-Aboriginal people. Coronary atherosclerosis was the cause of 37% (14/38) of the Aboriginal sudden deaths and 52% (16/31) of the non-Aboriginal sudden deaths. Evidence of coronary atherosclerosis rose with age and was seen more frequently in those dying suddenly compared to those dying of external causes. When directly standardized, the rate of autopsy-examined sudden death attributable to ischemic heart disease was 5.5 times higher for Aboriginal people than for non-Aboriginal people. Contrary to a previously published statement, there is considerable overlap between Aboriginal and non-Aboriginal heart weights, with 75% (55/73) of Aboriginal decedents and 84% (89/106) of non-Aboriginal decedents having heart weights between 250 and 500 g. We concluded that the rate of autopsy-examined sudden death from all causes, and specifically from ischemic heart disease, was much higher in Aboriginal people. However in a case of sudden death a presumptive clinical diagnosis of ischemic heart disease prior to autopsy is not justified in either Aboriginal or non-Aboriginal people, due to the high prevalence of other fatal conditions. The diagnosis of pathologically increased heart weight, which is critical in the assessment of sudden death, should be made on the same basis in both Aboriginal and non-Aboriginal people.