Australian Indigenous

Overview of Indigenous health 2004

This overview is also available as a downloadable PDF using Adobe Acrobat.

Hospitalisation

• Separation rates
• Age-specific separation rates
• Causes of hospitalisation

Separation rates

Of the 6.65 million hospital separations recorded in Australia during 2002-03, almost 203,000 (3%) were identified as Indigenous [24]. The age-standardised separation rate of 620 separations per 1,000 for the Indigenous population was almost twice that of the non-Indigenous population (329 per 1,000). The proportions of separations involving just overnight stays in hospital were very similar for Indigenous and non-Indigenous people - 47% and 46% respectively.

The identification of Indigenous people in hospital data is considered acceptable for only WA, SA and the NT, so these Australia-wide rates under-estimate the true difference between Indigenous and non-Indigenous hospitalisation. For jurisdictions with acceptable levels of Indigenous identification, the ratios of Indigenous and non-Indigenous separation rates are higher: 2.6 for WA, 2.0 for SA and 4.3 for the NT [24]. (Overall, it is likely that the Australia-wide numbers and rates for Indigenous hospitalisation could be up to 25% higher.)

Return to top

Age-specific separation rates

Separation rates were higher for Indigenous people than for non-Indigenous people for virtually all age groups, with the highest differences in the middle adult years (Table 12) [24].

Table 12 Age-specific hospital separation rates, by Indigenous status and sex, and Indigenous:non-Indigenous rate ratios, 2002-03

Source: Derived from AIHW, 2004 [24].

Notes:

1. Numbers do not include 231,044 separations for which Indigenous status was not stated

2. Rates are expressed as separations per 1,000 population

3. Rate ratio is the Indigenous rate divided by the non-Indigenous rate

4. The rates have not been adjusted for likely under-identification of Indigenous separations, so it is likely that the Indigenous rates, and hence the rate ratios, could be 25-30% higher

Return to top

Causes of hospitalisation

In 2002-03 the most common reason of hospitalisation for Indigenous people was 'care involving dialysis' accounting for 36% of Indigenous separations (73,028 separations) [24]. Many of these separations involved repeat admissions for the same people, some on an almost daily basis. The ICD group 'Injury and other consequences of external causes' (including motor vehicle accidents, assaults, self-inflicted harm and falls) was the next most common cause of hospitalisation for Indigenous people, being responsible for 8.4% of separations (17,058 separations) (Table 13). (Unfortunately, the published data do not provide separate figures for males and females.)

Table 13 Leading causes of Indigenous separations (excluding dialysis): numbers, proportions of separations, age-standardised separation rates and Indigenous:non-Indigenous rate ratios, 2002-03

Source: AIHW, 2004 [24]

Notes:

1. The published data do not provide separate figures for males and females

2. Rates, directly standardised using the June 1991 Australian population as the reference population, are expressed as separations per 1,000 population

3. Excludes hospitalisation for dialysis

4. The numbers have not been adjusted for likely under-identification of Indigenous separations, so it is likely that the Indigenous numbers, and hence rates and ratios, could be up to 25% higher

Return to top

Selected health conditions

• Cardiovascular disease
• Cancer
• Diabetes

Cardiovascular disease

Cardiovascular disease (CVD) presents a significant burden for Indigenous people in terms of prevalence, hospitalisation, and mortality [25]. Factors contributing to the development of cardiovascular disease include age, socio-economic circumstances, family history, physical inactivity, tobacco smoking, poor nutrition, and related physiological factors (high blood pressure, high blood cholesterol, overweight and obesity, and diabetes). A combination of risk factors and rural and remote dwelling contribute to higher levels of heart, stroke, and vascular disease among Indigenous people [25]. Immediate treatment and care of cardiovascular conditions for many Indigenous people are limited because of distance to health services, the availability of transport to access services, and language and cultural differences.

Extent of cardiovascular disease among Indigenous people

According to the 2001 NHS, the age-standardised prevalence for 'circulatory problems/ diseases' was 19% among Indigenous respondents, and 17% among non-Indigenous respondents [26]⁷. Indigenous people living in remote areas were more likely to report having 'circulatory problems' than those living in non-remote areas (24% compared with 18%). Of Indigenous people aged 35-44 years, 16% reported a cardiovascular condition, the rate increasing to 31% for those aged 45 to 54 years, and to 47% for those aged 55 years or over. The most commonly reported circulatory system disorder in Indigenous people over 25 years of age was hypertension. The prevalence of hypertension increases with age and among Indigenous people prevalence increased from the age of 35 years, with onset approximately 10 years younger than for non-Indigenous people.

There were 6,920 hospital separations identified as Indigenous for 'diseases of the circulatory system' in 2002-03, representing 3.4% of separations identified as Indigenous [24]. Hospitalisation rates were 1.1 times higher than for non-Indigenous people.

Details are not available for 2002-03, but hospitalisation rates for heart failure and coronary heart disease were between 1.5 and three times higher for Indigenous people than for non-Indigenous people in 2001-02 [25]. Indigenous males were more likely to be hospitalised for heart, stroke or vascular diseases than Indigenous females. Indigenous males were three times more likely to be hospitalised for these conditions than other Australian males, and Indigenous females were 1.7 times more likely than other Australian females. For acute rheumatic fever and chronic rheumatic heart disease, hospitalisation rates for Indigenous males and females were six and eight times higher than for other Australians.

Collectively, cardiovascular disease is the leading cause of death in the Indigenous population (Table 10) [27]. I schaemic heart diseases was responsible for 16% of all Indigenous deaths in 2002, compared with 20% of non-Indigenous deaths [28]. In Queensland , WA, SA, and the NT in 2000-2002, 'heart, stroke and vascular diseases' were the leading causes of death, accounting for 26% of Indigenous deaths at a rate 2.6 times higher than for non-Indigenous people [25].

Rheumatic heart disease was responsible for relatively few deaths, but the death rate for Indigenous people was 19 times higher than the rate for other Australians [25].

Deaths of Indigenous people from cardiovascular disease occur at younger age groups than those of non-Indigenous people - 62% of Indigenous deaths occurred prior to the age of 65 years compared with 10% for other Australians [25].

Return to top

Cancer

There is uncertainty about the incidence of cancer among Indigenous people, largely due to the under-identification of Indigenous people in cancer registrations, the exact extent of which has not been quantified [12]. The NT has the most complete information about the incidence of cancer among Indigenous people, and WA is the only other jurisdiction for which reasonable incidence data are available. Information about deaths from cancer is more readily available, but, as noted in the section on mortality, the overall levels of Indigenous identification are not very high.

Many of the cancers affecting Indigenous people are preventable - for example, cancers related to tobacco use, to which Indigenous people are particularly prone due to high levels of smoking [29-31]. (See 'Tobacco smoking' in the section on health risk factors.)

Extent of cancer among Indigenous people

The evidence available suggests that the incidence rates of cancer for Indigenous people are slightly lower than those for non-Indigenous people, but that death rates are generally higher (Table 14) [12, 29-32].

Table 14 Cancer: Indigenous to non-Indigenous incidence and death rate ratios, Queensland, WA, SA and the NT

Source: ABS & AIHW, 2003 [12]; Kirov and Thomson, 2003 [31]; Zhao, Condon and Garling, 2004 [32]

Notes:

1. Queensland incidence data are for 1996-2000 and mortality data for 1999-2001; WA incidence and mortality are for 1997-2001; and the NT incidence and mortality data are for 1991-2001

2. Rate ratio is the Indigenous age-standardised rate divided by the non-Indigenous age-standardised rate

3. The age-standardised rates from which these ratios were derived have not been included in this table or in other parts of this section because they were calculated using different standard populations - the Queensland, WA and SA rates used the World Standard Population and the NT rates used the 2001 Australian Estimated Resident Population

The patterns of cancer differed somewhat between jurisdictions, but lung cancer was among the leading specific cancers for Indigenous males and females in all jurisdictions - rates for Indigenous people were higher than those for non-Indigenous people except for Indigenous males living in WA [12, 31, 32]. The incidence of breast cancer was generally substantially lower among Indigenous women than among non-Indigenous women, but that of cervical cancer was considerably higher among Indigenous women than among non-Indigenous women. Liver cancer is another specific cancer for which incidence is generally higher for Indigenous people than for non-Indigenous people. Incidence rates for pancreas cancer were higher for Indigenous people than for non-Indigenous people in WA and the NT⁸. On the other hand, colorectal cancer, which has a high incidence among non-Indigenous people, is not among the leading cancers for Indigenous people. The proportions of cancers for which the primary site was unknown were much higher for Indigenous people than for non-Indigenous people in all jurisdictions.

The ICD group 'neoplasms' (including cancers) was the third most common cause of death among Indigenous people living in Queensland, WA, SA and the NT combined in 2000-2002 [19]. The number of deaths from neoplasms among Indigenous males was 1.3 times higher than the number expected from rates for the non-Indigenous male population, and the number for Indigenous females 1.6 times higher. Overall, neoplasms were responsible for around 8% of the excess deaths experienced by Indigenous people [12].

The leading specific cause of death from cancer for Indigenous males and females living in WA and the NT was lung cancer, with other smoking-related cancers (particularly cancers of the oropharynx, oesophagus, stomach and pancreas) also being common causes of death [29-32]⁹. The death rates for these cancers were generally higher for Indigenous people than for non-Indigenous people (the exception was the death rate from lung cancer for Indigenous males living in WA, which was slightly lower than for their non-Indigenous counterparts). Breast cancer was also a common cause of death for Indigenous females living in WA and the NT, with rates slightly lower than those for their non-Indigenous counterparts.

Cervical cancer is an important cause of death for Indigenous women, with the death rate for those living in Queensland, WA, SA and the NT in 1999-2002 being more than seven times that of their non-Indigenous counterparts [33]. Except for women aged less than 30 years, rates were higher for Indigenous women than for non-Indigenous women in every age group. Cervical cancer was the second most common cause of death for Indigenous women living in the NT in 1991-2001, with a rate four times that of their non-Indigenous counterparts [32]. A separate analysis of trends in cancer death rates in the NT found that the rate for cervical cancer among Indigenous women decreased by more than 50% in 1997-2000 [30]. Similar trend data are not available for WA, but the death rate for Indigenous women in WA in 1997-2001 was much lower than the rate for Indigenous women in the NT in 1991-2001¹⁰, and only 1.5 times that of non-Indigenous women in WA [31].

The quite low cervical death rate for Indigenous women in WA in 1997-2001 and the marked reduction in the rate for Indigenous women in the NT in 1997-2000 raises the possibility that these rates may be reflecting the impact of preventive Pap test programs, leading to earlier diagnosis and treatment [30].

The analysis of trends in cancer death rates in the NT also found that death rates for smoking-related cancers, including lung cancer, more than doubled between 1977-1982 and 1997-2000 [30]. For these cancers, the higher rate ratios for younger than older Indigenous people was seen as probably related to the comparatively recent uptake of smoking by Indigenous people in the NT.

Importantly, this analysis and a recent review of cancer services for Indigenous people have highlighted the fact that the absolute differences in survival after diagnosis with cancer are greatest for cancers with the highest survival in non-Indigenous people [29, 30]. That is, for cancers that are 'amenable to early diagnosis, effective treatment and a high probability of cure' [29, p.8]. As well, some of the most common cancers among Indigenous people are preventable, such as 'through reduced tobacco consumption, increased Pap test coverage and follow-up treatment, hepatitis B immunisation, and reduced alcohol misuse' [29, p.9]¹¹.

The review concluded that 'the experience of Indigenous people and cancer provides evidence that the Australian health system is not operating as effectively for Indigenous people as for other Australians' and that there was a need for 'strengthening primary health care services, reducing barriers for access to specialist services and improving collaboration between the two' [29, pp. 16-17].

Diabetes

Diabetes is a major health problem for many Indigenous people, not only because the prevalence and hospitalisation rates are higher than those of the non-Indigenous population, but also because morbidity and mortality associated with various diabetic complications are likely to increase [34]. Diabetes also poses long-term effects on the quality of life experienced by Indigenous people [35]. Type 2 diabetes is the most common form of diabetes worldwide, and has been recognised as one of the most significant health problems facing Indigenous people in Australia [12].

Risk factors for the development and onset of type 2 diabetes are categorised as non-modifiable and modifiable [36]. Non-modifiable risk factors include family history, race/ethnicity, degree of westernisation, and increasing age. Modifiable risk factors include obesity, poor diet, inactivity, and high blood pressure [37]. Possessing any number of risk factors increases the likelihood of developing type 2 diabetes. Type 2 diabetes development in Indigenous people has consistently been linked to high levels of centrally located obesity, the 'thrifty genotype', and/or other genetic factors. Furthermore, the 'westernisation' of Indigenous communities has led to current levels of physical inactivity and poor nutrition. Social, economic, and environmental disadvantage have also contributed to higher levels of type 2 diabetes, complications, and other chronic conditions in Indigenous people [38].

Extent of diabetes among Indigenous people

In the 2001 NHS, the age-standardised prevalence for diabetes among Indigenous people was 11%, almost four times the prevalence for non-Indigenous people (3%) [26]. The age-standardised prevalence for Indigenous people was higher for people living in remote areas (16%), and lower for people living in non-remote areas (9%), but it has been estimated that the prevalence could be as high as 20% and 25%, and possibly higher than 30% in remote areas [39].

For 2001-2002, hospital separation rates for diabetes were much higher for Indigenous people (12.3 per 1,000) than for non-Indigenous people (4.9 per 1,000) (Australian Institute of Health and Welfare, 2003). Separation rates for diabetes were higher across all age groups, but they were highest for Indigenous females aged 55-64 years (40 separations per 1,000), and Indigenous males over 65 years of age (38 separations per 1,000) (Australian Bureau of Statistics, 2003).

Deaths due to diabetes accounted for 8% of all Indigenous deaths in 2002, compared with 2% of all non-Indigenous deaths (Australian Bureau of Statistics, 2003). In Queensland , WA, SA and the NT in 1998-2000, the rate for diabetes as the main cause of death among Indigenous males was seven times the rate for non-Indigenous males, and the rate for Indigenous females was 14 times higher than that for non-Indigenous females (National Centre for Monitoring Diabetes, 2002).

Return to top

Previous page | Next page

Last updated: 12 January, 2005