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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][3].

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 [4][5]. Infants and children under the age of 5 years are particularly susceptible to developing respiratory conditions, due to factors like exposure to tobacco smoking, poor environmental conditions, and poor nutrition [4][6][7].

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 can also increase the risk of developing COPD [8].

The risk of developing asthma is affected by environmental, lifestyle (e.g. diet and tobacco use) and genetic factors (e.g. allergic tendency) [9]. Asthma attacks can be triggered by exercise, viral infections, irritants (e.g. smoking and air pollutants) and specific allergens. These attacks cause a narrowing of the airways, resulting in symptoms including wheezing and breathlessness, which may be life threatening for some people.

Among Indigenous adults, factors contributing to pneumonia include smoking tobacco, use of alcohol and other substances, diabetes mellitus, and chronic renal disease [4].

Extent of respiratory disease among Indigenous people
Prevalence

Detailed information about respiratory disease is not yet available from the 2012-2013 AATSIHS, but 27% of Indigenous people who participated in the 2004-2005 NATSIHS reported having a long-term respiratory condition [10]. Respiratory conditions were reported more frequently by Indigenous people living in non-remote areas (30%) than by those living in remote areas (17%).

Information about asthma is available from the 2012-2013 AATSIHS, in which it was reported by 18% of Indigenous people [11]. It was the most commonly reported respiratory condition among Indigenous people, and the second most commonly reported long-term condition [12]. Asthma was reported more commonly by females (20%) than by males (15%) and by Indigenous people living in non-remote areas (20%) than by those living in remote areas (10%). After age-adjustment, the level of asthma among Indigenous people was 1.9 times higher than that among non-Indigenous people.

Hospitalisation

There were 21,265 hospital separations for respiratory disease among Indigenous people in 2011-12, representing 10.5% of separations identified as Indigenous (excluding those for dialysis) [13]. After age-adjustment, the hospitalisation rate for respiratory disease was 2.7 times higher for Indigenous people than for other Australians [13].

In the two-year period July 2008 to June 2010, in NSW, Vic, Qld, WA, SA and NT, Indigenous children aged 0-4 years were hospitalised for respiratory disease at twice the rate of other children [14]. Hospitalisation rates were substantially higher for Indigenous adults than those for non-Indigenous adults: 4.3 times higher for the 35-44 years age-group, 5.5 times higher for the 45-54 years age-group, and 4.9 times higher for the 55-64 years age-group. For Indigenous people living in remote areas, the hospitalisation rate for respiratory disease was three times the rate of Indigenous people living in major cities (80 and 27 per 1,000 respectively). The most common cause of hospitalisation for respiratory disease among Indigenous people was pneumonia (23%), followed by COPD (13%), and asthma (11%) [14].

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 [15]. After age-adjustment, the death rate for Indigenous people was 2.2 times higher than that 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 that for non-Indigenous people.

The death rate from chronic lower respiratory disease 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 the rate for their non-Indigenous counterparts [16]. Among people aged 65-74 years, the rate of 283 per 1,000 for Indigenous people was 3.8 times higher than that 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 that 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 disease (Table 26) [14]. Age-adjusted death rates were around three times higher for Indigenous males and females than those for their non-Indigenous counterparts. COPD accounted for 87% of the deaths of Indigenous people caused by chronic lower respiratory disease. 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 those for non-Indigenous people.
Table 26: 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 [14]
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

Indigenous infants living in NSW, Qld, WA, SA and NT in 2006-2010 were 3.3 times more likely than their non-Indigenous counterparts to die from respiratory disease [14].

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. Australian Institute of Health and Welfare (2011) The health and welfare of Australia's Aboriginal and Torres Strait Islander people: an overview 2011. Canberra: Australian Institute of Health and Welfare
  4. Chang AB, Torzillo PJ (2008) Respiratory infection (including Bronchiectasis). In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press: 355-385
  5. 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
  6. Chang AB, Masel JP, Boyce NC, Torzillo PJ (2003) Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities. Medical Journal of Australia; 178(10): 490-494
  7. 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
  8. McKenzie DK, Abramson M, Crockett AJ, Glasgow N, Jenkins S, McDonald C, Wood-Baker R, Frith PA (2011) The COPD-X plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease: version 2.26. Bowen Hills, Qld: The Australian Lung Foundation
  9. Australian Institute of Health and Welfare (2012) Australia's health 2012. Canberra: Australian Institute of Health and Welfare
  10. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  11. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  12. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 1 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%201%20selected%20health%20characteristics,%202001%20to%202012-13-australia.xls&4727.0.55.001&Data%20Cubes&26F4FE668ABADCF4CA257C2F00145C83&0&2012-13&27.11.2013&Latest
  13. Australian Institute of Health and Welfare (2013) Australian hospital statistics 2011–12. Canberra: Australian Institute of Health and Welfare
  14. 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
  15. Australian Bureau of Statistics (2014) Causes of death, Australia, 2012. Canberra: Australian Bureau of Statistics
  16. 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
 

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