Cardiovascular disease
Cardiovascular disease (CVD) presents a significant burden for Indigenous people in terms of prevalence, hospitalisation, and mortality [1]. 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 [1]. 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
Heart and circulatory problems/diseases were reported by 12% of Indigenous people who participated in the 2004-2005 NATSIHS [2]. These problems were reported slightly more frequently by Indigenous people living in remote areas (14%) than by those living in non-remote areas (11%). The proportions represent a slight, but not statistically significant, increase from those reported to the 2001 NHS.
After adjusting for differences in the age structures of the two populations, heart and circulatory problems/diseases were around 1.3 times more common for Indigenous than for non-Indigenous people [2]. Hypertensive disease was 1.5 times more common for Indigenous than for non-Indigenous people, and other diseases of the heart and circulatory system 1.2 times.
Overall, a lower proportion of Torres Strait Islander (9%) than Aboriginal people (12%) reported having a heart and circulatory problem/disease, but the proportion was 11% for Torres Strait Islanders living in the Torres Strait area [2].
There were 5,367 hospital separations identified as Indigenous for ‘diseases of the circulatory system’ to public hospitals in Qld, WA. SA and the NT in 2004-05, representing 6% of separations identified as Indigenous (excluding those for renal dialysis) [3]. Hospitalisation rates were 1.8 times higher for Indigenous people than for non-Indigenous people.
Details are not available for 2004-05, but Australia-wide 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 [1]. Indigenous males were more likely to be hospitalised for heart, stroke or vascular diseases than Indigenous females. Indigenous males were 1.3 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.
Cardiovascular disease was the leading cause of death for Indigenous people living in Queensland, WA, SA and the NT in 2000-2004, with the numbers of deaths registered being 3.1 times the number expected from non-Indigenous rates for Indigenous males and 2.6 times for Indigenous females [4]. Cardiovascular disease was responsible for 27% of all of the ‘excess deaths’ experienced by Indigenous males and females (‘excess deaths’ are defined as the difference between registered and expected deaths).
Ischaemic heart disease (particularly heart attacks) was responsible for 63% of the deaths from cardiovascular disease of Indigenous males and for 50% of those of Indigenous females [4]. Cerebrovascular disease (stroke) was responsible for 15% of the deaths from cardiovascular disease of Indigenous males and for 20% of those of Indigenous females [4].
Deaths of Indigenous people from cardiovascular disease occurred at much younger ages than those of non-Indigenous people – death rates for Indigenous males were 9-10 times those of non-Indigenous males for the 25-34 years and 35-44 years age groups, and rates for Indigenous females were 12-13 times those of non-Indigenous females for the 35-44 years and 45-54 years age groups [4].
References
1 National Centre for Monitoring Cardiovascular Disease (2004) Heart, stroke and vascular diseases: Australia facts 2004. Canberra: Australian Institute of Health and Welfare
2 Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey, Australia 2004-05. (ABS Cat. no. 4715.0) Canberra: Australian Bureau of Statistics
3 Australian Institute of Health and Welfare (2006) Australian hospital statistics 2004-05. (AIHW catalogue no. HSE 41) Canberra: Australian Institute of Health and Welfare
4 Australian Bureau of Statistics, Australian Institute of Health and Welfare (2005) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2005. (ABS catalogue no. 4704.0) Canberra: Australian Institute of Health and Welfare and the Australian Bureau of Statistics
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