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Australian Indigenous HealthBulletin
 

Respiratory health

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Respiratory disease

‘Respiratory disease’ refers to a number of conditions that affect the lungs or their components; each of these conditions is characterised by some level of impairment of the lungs in performing the essential function of gas exchange [1]. Respiratory disease, which includes chronic obstructive pulmonary disease (COPD), asthma, pneumonia and invasive pneumococcal disease, represents a significant burden of ill-health and hospitalisation among Indigenous people, particularly among the very young and older people [2].

Respiratory disease is associated with a number of contributing factors, including poor environmental conditions, socioeconomic disadvantage, risky behaviour (particularly cigarette smoking, alcohol use, and substance use) and some previous medical conditions [3][4]. Infants and children are particularly susceptible to developing respiratory conditions, due to factors like exposure to tobacco smoke, poor environmental conditions, and poor nutrition [3][5].

COPD relates to long-term lung diseases for which the symptoms are not fully reversible, and includes chronic bronchitis, emphysema, and some cases of asthma [1]. These diseases are characterised by shortness of breath. A major risk factor for COPD is smoking, but exposure to irritants like dust and fumes and recurrent childhood infections can also increase the risk of developing COPD [6][7].

The risk of developing asthma is affected by genetics (e.g. family history of allergies), environmental factors, and other influences on the immune system (e.g. tobacco smoke and medications) [8]. Asthma attacks can be triggered by exercise, viral infections, cigarette smoke, allergens (e.g. dust mites) and irritants (e.g. air pollutants). Asthma attacks cause a narrowing of airways, resulting in symptoms including wheezing and breathlessness, which may be life threatening for some people.

Among Indigenous adults, factors contributing to pneumonia include increasing age, smoking tobacco, alcohol, diabetes mellitus, environmental factors (e.g. overcrowding) and a low uptake of relevant vaccinations [9][10].

Extent of respiratory disease among Indigenous people
Prevalence

Disease of the respiratory system was reported by 31% of Indigenous people who participated in the 2012-2013 AATSIHS [11]. After age-adjustment, the overall level of respiratory disease among Indigenous people was 1.2 times higher than for non-Indigenous people. Respiratory conditions were reported more frequently by Indigenous women (34%) than Indigenous men (28%).

Asthma was the most commonly reported condition for Indigenous people (18%) and the second most commonly reported long-term condition [11]. After age-adjustment, the level of asthma among Indigenous people was 1.9 times higher than for non-Indigenous people [11]. Asthma was reported more commonly by females (20%) than by males (15%) [12] and by Indigenous people living in non-remote areas (20%) than by those living in remote areas (10%) [13]. Other respiratory conditions reported by Indigenous people included chronic sinusitis (8%) and COPD (4%) [11].

Hospitalisation

There were 20,944 hospital separations for respiratory disease among Indigenous people in 2012-13 [14]. For selected respiratory diseases, the age standardised hospitalisation rates for Indigenous people were 4.4 times higher for COPD, 3.3 times higher for influenza and pneumonia, 1.8 times higher for asthma, 1.8 times higher for acute upper respiratory infections and 1.4 times higher for whooping cough than for their non-Indigenous counterparts [15]. Indigenous young people aged 15-24 years were hospitalised for whooping cough at 5.5 times the rate of other young people.

Hospitalisation rates were higher for Indigenous adults than for non-Indigenous adults for:

The hospitalisation rate for influenza and pneumonia was particularly high for Indigenous people living in remote/very remote areas (21.2 per 1,000) compared with Indigenous people living in major cities areas (5.5 per 1,000) (rate ratio 3.9).

Mortality

In 2012, respiratory disease was responsible for the deaths of 194 Indigenous people living in NSW, Qld, SA, WA and the NT, accounting for 7.9% of Indigenous deaths [16]. After age-adjustment, the death rate for Indigenous people was 2.2 times higher than for non-Indigenous people. Chronic lower respiratory diseases (including asthma, bronchitis, emphysema, and other COPD) were responsible for 123 Indigenous deaths; the age-adjusted death rate for Indigenous people was 2.9 times higher than for non-Indigenous people.

The death rate from chronic lower respiratory diseases for Indigenous people aged 55-64 years living in NSW, Qld, SA, WA and the NT in 2008-2012 (95 per 1,000) was 5.6 times higher than for their non-Indigenous counterparts [17]. Among people aged 65-74 years, the rate of 283 per 1,000 for Indigenous people was 3.8 times higher than for their non-Indigenous counterparts. Influenza and pneumonia were responsible for 34 Indigenous deaths, with a rate 1.9 times higher for Indigenous people than for non-Indigenous people.

The most recent detailed information on specific causes of respiratory-related deaths for Indigenous males and females is for the period 2006 to 2010. The leading specific cause of death from respiratory disease for both Indigenous males and females living in NSW, Qld, WA, SA and the NT was chronic lower respiratory diseases (Table 27) [18]. Age-adjusted death rates for chronic lower respiratory diseases were around three times higher for Indigenous males and females than for their non-Indigenous counterparts. COPD accounted for 87% of the deaths of Indigenous people caused by chronic lower respiratory diseases. Death rates for pneumonia and influenza, the next most common cause of death from respiratory disease, were 2.1 times higher for Indigenous people than for non-Indigenous people.

Table 27: Age-standardised death rates for respiratory disease, Indigenous people, by sex and condition, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2006-2010
 MalesFemalesPersons
RateRate ratioRateRate ratioRateRate ratio
Source: AIHW, 2013 [18]
Notes:
  1. Chronic lower respiratory diseases include, asthma, bronchitis, emphysema and other COPD
  2. Rates, in deaths per 100,000, are directly age-standardised using the Australian 2001 estimated resident population, by 5-year age-groups to 75+
Chronic lower respiratory diseases 88 2.9 65 3.2 75 3.0
Pneumonia and influenza 24 2.4 16 1.8 19 2.1
Other respiratory disease 24 1.2 14 1.2 1.2 1.2
All respiratory disease 135 2.3 95 2.4 112 2.3

References

  1. Thomson N, Kirov E, Ali M (2003) Respiratory system disorders. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 224-246
  2. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
  3. Pierce R, Antic R, Chang A, Howard M, James A, Maguire G, Matthiesson A, Musk B, Roseby R, Simpson G, Torzillo P (2010) Respiratory and sleep health in Indigenous Australians. Sydney: Thoracic Society of Australia and New Zealand
  4. Australian Institute of Health and Welfare (2010) Asthma, chronic obstructive pulmonary disease and other respiratory diseases in Australia. Canberra: Australian Institute of Health and Welfare
  5. Janu EK, Annabattula BI, Kumariah S, Zajaczkowska M, Whitehall JS, Edwards MJ, Lujic S, Masters IB (2014) Paediatric hospitalisations for lower respiratory tract infections in Mount Isa. Medical Journal of Australia; 200(10): 591-594
  6. Australian Institute of Health and Welfare (2014) Coronary heart disease and chronic obstructive pulmonary disease in Indigenous Australians. Canberra: Australian Institute of Health and Welfare
  7. Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future trends. The Lancet; 370(9589): 765-773
  8. Australian asthma handbook (2014) National Asthma Council Australia
  9. Phung DT, Wang Z (2013) Risk of pneumonia in relation to body mass index in Australian Aboriginal people. Epidemiology and Infection; 141(12): 2497-2502
  10. Jacups SP, Cheng A (2011) The epidemiology of community acquired bacteremic pneumonia, due to streptococcus pneumoniae, in the top end of the Northern Territory, Australia - over 22 years. Vaccine; 29(33): 5386-5392
  11. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 5 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%205%20long-term%20conditions%20by%20sex%20by%20indigenous%20status,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&5C97CE7DA7059C06CA257C2F00145D5A&0&2012-13&27.11.2013&Latest
  12. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 4 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%204%20selected%20health%20characteristics,%20by%20sex%202012-13-australia.xls&4727.0.55.001&Data%20Cubes&497BBEB2AFC1B23DCA257C2F00145D2E&0&2012-13&27.11.2013&Latest
  13. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 2 [data cube]. Retrieved 26 March 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%202%20selected%20health%20characteristics,%20by%20remoteness%20area%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&9F3D9B7052520B1BCA257CA6000E31B5&0&2012-13&26.03.2014&Latest
  14. Australian Institute of Health and Welfare (2014) Australian hospital statistics 2012-13. Canberra: Australian Institute of Health and Welfare
  15. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  16. Australian Bureau of Statistics (2014) Causes of death, Australia, 2012. Canberra: Australian Bureau of Statistics
  17. Australian Bureau of Statistics (2014) Causes of death, Australia, 2012: Deaths of Aboriginal and Torres Strait Islander Australians [data cube]. Retrieved 25 March 2014 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&3303_12%20deaths%20of%20aboriginal%20and%20torres%20strait%20islander%20australians.xls&3303.0&Data%20Cubes&0585A7BA09CCB81DCA257CA5000C9072&0&2012&25.03.2014&Latest
  18. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
 

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    Last updated: 16 April 2015
     
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