Introduction The health of Australian Aboriginal people is worse than that of non-Aboriginal people across every conceivable indicator. Ischaemic heart disease (IHD) is a leading cause of premature death. We aimed to determine whether short- and long-term mortality after hospitalisation for IHD was higher for Aboriginal than non-Aboriginal patients, in order to guide interventions to reduce the mortality gap.

Method New South Wales hospital data (July 2000–December 2008) were linked to mortality data (July 2000–December 2009). The first IHD admission per person was selected from January 2002. We ran multilevel logistic regression models for 30-day and 365-day mortality with 131 357 patients clustered within 193 public hospitals.

Results After adjusting for age, sex and a random hospital intercept, Aboriginal IHD patients had similar odds of dying within 30 days as non-Aboriginal patients (AOR: 1.1, 0.9–1.4). Using the same adjustments, odds of dying within 365 days were significantly higher for Aboriginal than non-Aboriginal patients (AOR: 1.4, 1.2–1.7). Adding the Charlson co-morbidity index and specific IHD diagnosis reduced this 365-day AOR to 1.2 (1.0–1.4). After adding the above variables, 2.4% of the unexplained variation in 365-day mortality was attributable to hospitals.

Conclusion Aboriginal IHD patients in NSW had similar odds of dying within 30 days of admission as non-Aboriginal patients, but were more likely to die within 1 year of admission. Increased long-term mortality was partly explained by individual risk factors. Tackling the mortality gap will require major efforts to boost primary and secondary prevention, as well as improving hospital care for IHD.