Respiratory disease
Respiratory diseases represent a significant burden of ill-health and hospitalisation among Indigenous people, particularly among very young and older people [1]. The development of respiratory diseases is dependent on a number of contributing factors, including poor environmental conditions, socioeconomic disadvantage, risky behaviour (particularly cigarette smoking), and previous medical conditions [2-5]. Infants and children under 5 years of age are more susceptible to developing respiratory conditions due to factors like low levels of hand and face washing, and of childhood immunisation, parental smoking, poor nutrition (including aspects related to infant-feeding and weaning practices), and poor environmental conditions [2]. Among Indigenous adults, common risk factors for respiratory diseases include tobacco smoking, use of alcohol and other substances, diabetes mellitus and chronic renal disease [4]. Factors that may affect the risk of acquiring asthma include environmental and other related factors (for example 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 (for example, smoking and air pollutants), specific allergens and some food preservatives.
Extent of respiratory disease among Indigenous people
In the 2001 NHS, 33% of Indigenous respondents reported having
a respiratory condition, compared with 30% of non-Indigenous respondents
[7]. Asthma was the second most commonly reported health condition
among Indigenous people with a prevalence of 17% compared with 12%
among non-Indigenous people.
There were 14,980 hospital separations identified as Indigenous
for respiratory disease in 2002-03, representing 7.4% of separations
identified as Indigenous (excluding those for renal dialysis) [8].
Hospitalisation rates for Indigenous people were 3.7 times higher
than those for non-Indigenous people (based on the under-identification
of Indigenous people in the hospital inpatient collections, these
ratios could be up to 25% higher). The more detailed information
available for 1999-2000 revealed that separation rates were particularly
high in infancy and early childhood [9].
Disease of the respiratory system is among the leading causes of
death for Indigenous people, being responsible for almost 9% of
all deaths of Indigenous people living in Queensland, WA, SA and
the NT in 2000-2002 (see Table 5 in the mortality section) [6].1
The numbers of deaths from respiratory disease among Indigenous
people is around four times higher than the numbers expected from
rates for the non-Indigenous population (bearing in mind the under-identification
of Indigenous people in death registration systems, this difference
could be up to 30% higher). Overall, respiratory disease is responsible
for more than 9% of the excess deaths experienced by Indigenous
people [10].
The more detailed information available for Indigenous people living
in WA, SA and the NT combined in 1999-2001 reveals that the leading
specific respiratory cause of death for both Indigenous males and
females was chronic lower respiratory disease, for which there were
around five times more deaths than expected [4]. Pneumonia and influenza
were responsible for only small numbers of deaths, but the numbers
were 12–15 times more than expected from the rates for the
non-Indigenous population.
The differences between Indigenous and non-Indigenous people in
death rates from respiratory disease were particularly high among
young adults, with rates in the 35-44 years age group being around
20 times higher for males and 10 times higher for females [10].
References
1 Kirov E, Thomson N (2004) Summary of Indigenous
health: respiratory disease. Aboriginal and Islander Health
Worker Journal;28(2):15-18
2 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
3 Currie B, Fisher D, Anstey N, Huffam S,
Lum G, et al. (2000) Melioidosis: the Top End prospective study
continues into another wet season and an update on treatment guidelines.
Northern Territory Disease Control Bulletin;7(4):4-5
4 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
5 Valery P, Purdie D, Chang A, Masters IB,
Green AC (2003) Assessment of the diagnosis and prevalence of asthma
in Australian Indigenous children. Journal of Clinical Epidemiology;56(7):629-635
6 Australian Institute of Health and Welfare
(2004) Australia's health 2004: the ninth biennial report of
the Australian Institute of Health and Welfare. Canberra: Australian
Institute of Health and Welfare
7 Australian Bureau of Statistics (2002)
National Health Survey: Aboriginal and Torres Strait Islander
results, Australia 2001. (ABS Catalogue no. 4715.0) Canberra:
Australian Bureau of Statistics
8 Australian Institute of Health and Welfare
(2004) Australian hospital statistics 2002-03. (AIHW cat.
no. HSE 32) Canberra: Australian Institute of Health and Welfare
9 Lehoczky S, Isaacs J, Grayson N, Hargreaves
J (2002) Hospital statistics. Aboriginal and Torres Strait Islander
Australians. 1999-2000. (ABS Cat. No. 4711.0 AIHW Cat. No.
IHW-9; 4711.0) Canberra: Australian Bureau of Statistics and Australian
Institute of Health and Welfare
10 Australian Bureau of Statistics, Australian
Institute of Health and Welfare (2003) The health and welfare
of Australia's Aboriginal and Torres Strait Islander peoples 2003.
(ABS Cat no.4704.0, AIHW Cat no. IHW11) Canberra: Australian Bureau
of Statistics
Endnote
1 Caution needs to be exercised in interpretation of the various death rates presented in this report, most of which are based on the numbers of deaths registered as Indigenous. These numbers underestimate the actual numbers of Indigenous deaths, with the level of underestimation varying by jurisdiction (see ‘Limitations of the sources of Indigenous health information’). The ‘projected’ death rates take into account the estimated incompleteness of Indigenous identification in each jurisdiction. It is likely that the true death rates for Indigenous people will be closer to these rates than to those based solely on death registrations.
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