Explaining ethnic disparities and recent plateau and decline in Fiji life expectancy: cardiovascular disease, cancer, infection, external causes and COVID-19 — The Association Specialists
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Explaining ethnic disparities and recent plateau and decline in Fiji life expectancy: cardiovascular disease, cancer, infection, external causes and COVID-19 (23800)

Christine Linhart 1 , Serene Shrestha 1 , Vineet V Chand 2 , Meli Nadakuca 3 , Joana Lesuma 2 , Arishma A Bali 2 , Richard Taylor 1 , Stephen Morrell 1
  1. University of New South Wales, Sydney, RANDWICK, NSW, Australia
  2. Data Analysis and Management Unit, Fiji Ministry of Health and Medical Services, Suva, Fiji
  3. Social Statistics Division, Fiji Bureau of Statistics, Suva, Fiji

Background: This study quantifies cause-specific mortality contributions to life expectancy (LE) differences between Indigenous iTaukei and Fijians of Indian descent, 2018–2023.

Methods: We conducted a retrospective observational analysis of unit-record mortality data (n=49,941) from the Fiji national mortality database. LE and cause-specific mortality rates were estimated by sex, ethnicity, and age group. Differences in LE were decomposed by age and cause of death.

Results: During 2018–2023, LE plateaued in both sexes and ethnic groups, with a marked decline in 2021 among iTaukei during the peak of the COVID-19 pandemic. Among males, LE was approximately one year lower in iTaukei (64–66 years) than in Fijians of Indian descent (65–67 years). Among females, the gap was larger, with LE four to five years lower in iTaukei (66–68 years) than in Fijians of Indian descent (71–73 years). The disparity widened in 2021 to 2.6 years in males and 5.5 years in females.

During 2018–2023, higher mortality from cardiovascular disease (CVD), cancer, and infectious diseases among iTaukei was the main contributor to the LE disparity. In iTaukei males, these contributed −0.22 (CVD), −0.53 (cancer), and −0.45 (infection) years; in iTaukei females, −1.88 (CVD), −1.41 (cancer), and −0.46 (infection) years. COVID-19 mortality in 2021 was substantially higher in iTaukei (140 vs 45 per 100,000 in males; 108 vs 43 in females), contributing an additional −1.0 year reduction in LE. Higher external-cause mortality in Fijians of Indian descent partially offset these gaps.

Conclusions: Throughout 2018–2023, iTaukei experienced persistently lower LE than Fijians of Indian descent, particularly among females and during the COVID-19 pandemic. Excess mortality from CVD, cancer, and infection, especially the high cancer burden in young iTaukei women, requires targeted prevention and treatment. Elevated external-cause mortality in young Fijians of Indian descent also warrants further investigation and improved surveillance.