Respiratory health

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Respiratory disease

Respiratory disease, including asthma and pneumonia, represents a significant burden of ill-health and hospitalisation among Indigenous people, particularly among the very young and older people [1]. Respiratory disease is associated with a number of contributing factors, including poor environmental conditions, socioeconomic disadvantage, risky behaviour (particularly cigarette smoking), and previous medical conditions [2][3]. Infants and children under 5 years of age are particularly susceptible to developing respiratory conditions, due to factors like low levels of childhood immunisation, parental smoking, poor nutrition (including aspects related to infant-feeding and weaning practices), and poor environmental conditions [2][4][5]. Among Indigenous adults, factors contributing to respiratory disease include tobacco smoking, use of alcohol and other substances, diabetes mellitus, and chronic renal disease [2]. Factors that affect the risk of developing asthma include environmental and related factors (e.g. diet and lifestyle), which may also change the course of the disease or trigger attacks of airway narrowing and symptoms [6]. Factors that can trigger airway narrowing and symptoms in people with asthma include exercise, viral infections, irritants (e.g. smoking and air pollutants), and specific allergens.

Extent of respiratory disease among Indigenous people

Prevalence

Disease of the respiratory system was reported by 27% of Indigenous people who participated in the 2004-2005 NATSIHS [7]. Respiratory conditions were reported more frequently by Indigenous people living in non-remote areas (30%) than by those living in remote areas (17%). The proportions represent slight decreases from those reported to the 2001 NHS: 33% for people living in non-remote areas and 21% for those living in remote areas.

With 15% of Indigenous people reporting having asthma, it was the most commonly reported respiratory condition among Indigenous people, and the second most commonly reported health condition [7][2]. Asthma was reported more frequently by Indigenous people living in non-remote areas (17%) than by those living in remote areas (9%), slight decreases from the rates reported in the 2001 NHS of 19% and 11%, respectively [7].

After adjusting for differences in the age structures of the two populations, the overall levels of respiratory disease were similar for Indigenous and non-Indigenous people, but the level of asthma among Indigenous people was 1.6 times that among non-Indigenous people [7][8].

The lower overall proportion of Torres Strait Islander people (13%) than Aboriginal people (15%) reporting asthma was largely due to the low level reported by Torres Strait Islanders living in the Torres Strait area (5%) [7].

Hospitalisation

There were 18,342 hospital separations for respiratory disease among Indigenous people living in NSW, Vic, Qld, WA, SA, and the NT in 2009-10, representing 12% of separations identified as Indigenous (excluding dialysis) [9]. During 2006-2008, age-standardised hospitalisation rates for respiratory disease were 2.6 times higher for Indigenous people than for other Australians (41 compared with 16 per 1,000, respectively) ¹¹ [10]. In 2007-2009, Indigenous children aged 0-4 years experienced almost twice the rate of hospitalisation for respiratory disease than did other Australian children [1]. In the same period, Indigenous adults 25 years and older were hospitalised for respiratory disease at rates 2 to 5 times those of other Australians.

Mortality

Disease of the respiratory system was among the leading causes of death for Indigenous people, being responsible for almost 8% of all deaths of Indigenous people living in NSW, Qld, WA, SA and the NT in 2004-2008 [10]. Death rates for respiratory disease declined significantly during 2001-2008 for both Indigenous people (20% decrease) and non-Indigenous people (14% decrease), but the rate for Indigenous people in 2008 was still more than twice that for non-Indigenous people [11]. (Bearing in mind the under-identification of Indigenous people in death registration systems, this difference is likely to be higher.) Overall, respiratory disease was responsible for around 9% of the excess deaths experienced by Indigenous people in 2004-2008 [10].

The leading specific cause of death from respiratory disease for both Indigenous males and females living in NSW, Qld, WA, SA and the NT during the period 2004-2008 was chronic lower respiratory disease with the age-standardised death rate 3.1 times higher for Indigenous people than for non-Indigenous people (Table 22) [11]. The rate for pneumonia and influenza, the next most common cause of death from respiratory disease, was 2.0 times higher for Indigenous people than for non-Indigenous people.

Table 22: 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, 2004-2008

	Males		Females		Persons
	Rate	Rate ratio	Rate	Rate ratio	Rate	Rate ratio
Source: AIHW, 2011 [11]
Notes: Chronic lower respiratory diseases include asthma, bronchitis and emphysema Rates, in deaths per 100,000, are directly age-standardised using the Australian 2001 standard population, by 5-year age-group to 75+
Chronic lower respiratory diseases	95	3.0	63	3.2	76	3.1
Pneumonia and influenza	27	2.1	22	1.8	24	2.0
Other respiratory disease	22	1.2	10	0.9	15	1.1
Total respiratory disease	144	2.3	95	2.2	116	2.3

Deaths from respiratory disease were much more common among young Indigenous people than among their non-Indigenous counterparts [12]. Compared with non-Indigenous males and females aged 35-44 years living in Qld, WA, SA and the NT in 2001-2005, death rates from respiratory disease were 22 times higher for Indigenous males in that age-group (63 compared with 3 per 100,000) and 20 times higher for Indigenous females (37 compared with 2 per 100,000).

Indigenous infants were 5.2 times more likely than their non-Indigenous counterparts to die from respiratory disease in NSW, Qld, WA, SA and the NT in 2004-2008 [10].

References

1. 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
2. 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
3. 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
4. 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
5. 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
6. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
7. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
8. Australian Institute of Health and Welfare (2008) Australia's health 2008: the eleventh biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
9. Australian Institute of Health and Welfare (2011) Australian hospital statistics 2009-10. Canberra: Australian Institute of Health and Welfare
10. Australian Health Ministers’ Advisory Council (2011) Aboriginal and Torres Strait Islander health performance framework: 2010 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
11. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
12. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare

Endnote

11. Based on the under-identification of Indigenous people in the hospital inpatient collections, this ratio is probably higher.

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