» Overview of the health of Indigenous people in Western Australia 2013
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This Overview of the health of Indigenous people in Western Australia has been prepared by the Australian Indigenous HealthInfoNet as a part of our contributions to 'closing the gap' in health between Indigenous people and other Australians by making relevant, high quality knowledge and information easily accessible to policy makers, health service providers, program managers, clinicians, researchers, students and the general community. 1
Its preparation was undertaken as a part of the development within the HealthInfoNet web resource of a specific section devoted to the health of Indigenous Western Australians. Development of the section, the first of a planned series for all states and territories, has been enabled with the provision of separate funds from the Western Australian Department of Health’s Aboriginal Health Division. The HealthInfoNet is grateful for this support.
The main purpose of this Overview is to provide a comprehensive summary of the most recent indicators of the health of Indigenous people in WA. It is beyond the scope of the Overview to analyse trends in the various indicators, so it tends to draw attention to the current health status of WA’s Indigenous people. The Overview doesn't attempt to review other aspects, such as the availability and use of services (including barriers to their use) and strategies and policies related to specific health topics. Readers interested in these aspects should refer to the topic-specific reviews that are available on the HealthInfoNet's web resource.
Research for this Overview involved the collection, collation, and analysis of a wide range of relevant information, including both published and unpublished material. Sources include the full range of relevant literature, including journal articles and other relevant publications, the vast majority of which are accessible via the HealthInfoNet’s Australian Indigenous HealthBibliography. This bibliography, with more than more 20,000 entries, captures all relevant journal articles, books, book chapters and reports (including the ‘grey’ literature).
As well as the relevant journal literature, the HealthInfoNet’s overviews draw on important government reports, particularly those produced by the Australian Bureau of Statistics (ABS), the Australian Institute of Health and Welfare (AIHW), the Steering Committee for the Review of Government Service Provision (SCRGSP), and reports in the Aboriginal and Torres Strait Islander health performance framework series. These reports, prepared by the Australian Health Ministers’ Advisory Council (AHMAC) in 2006, 2008, 2011 and 2012, are accompanied by substantial detailed analyses, including analyses that are specific to WA, and accessible on the AIHW website. The HealthInfoNet’s overviews also draw on information from the main administrative data collections (such as the birth and death registration systems and the hospital inpatient collections) and national surveys. Information from these sources has been published mainly in government reports, particularly those produced by the ABS, the AIHW, and the SCRGSP.
Importantly, this Overview draws also on a wide variety of other information sources, including registers for specific diseases and other conditions, regional and local surveys, and numerous epidemiological and other studies examining particular diseases, conditions, and health determinants. Information from these sources is disseminated mainly through journals and similar periodicals, or in special reports.
A number of sections include the results of our own analyses of data obtained from a variety of sources. For example, estimates of some health conditions were made using notification data provided by the Epidemiology Branch at the WA Department of Health. The section on cancer benefitted from information provided by the WA Cancer Registry.
Despite the important advances that have been made in recent years in both the extent and quality of information about the health of Indigenous people, there is substantial scope for further improvement. First, there are deficiencies in the information available for some important areas. Second, the important special reports noted above tend to be selective rather than comprehensive in their coverage of the various health topics. Third, the time periods for which detailed information is available tend to vary substantially; this means that documents like this Overview need to draw on information from various time periods in attempting to compile a comprehensive picture. Fourth, important data sources, particularly major surveys, are generally only conducted around every five years; this is inevitable, but it means that relevant information is often quite dated. Finally, changes in aspects like methodology and levels of reporting in publications pose difficulties in the analysis and synthesis of information with a time perspective.
The initial sections of this Overview provide information about the context of Indigenous health, the Indigenous population in WA, and various measures of population health status. Most sections about specific health conditions comprise an introduction about the condition and evidence of the current burden of the condition among Indigenous people.
It should be noted that some references in this Overview to specific health conditions or groups of related health conditions follow the exact terms used by the World Health Organization (WHO) in its International Classification of Diseases (ICD). These terms are usually included in quotation marks preceded by ICD.
Further information about the aspects summarised in this Overview are included in the corresponding sections of the HealthInfoNet's web resource (www.healthinfonet.ecu.edu.au), on which updated versions of this Overview will be made available.
We welcome your comments and feedback about the Overview of the health of Indigenous people in Western Australia 2013.
Neil Thomson, Director, on behalf of the HealthInfoNet team
Particular thanks are extended to:
The Western Australian Department of Health’s Aboriginal Health Division, which has for a number of years funded the updating and maintenance of the special section of the HealthInfoNet devoted to the health of Indigenous Western Australians
The Western Australian Department of Health’s Epidemiology Branch for the provision of a variety of WA-specific data
The Western Australian Cancer Registry for information about the incidence of cancer in WA
The Office for Aboriginal and Torres Strait Islander Health (OATSIH) within the Australian Department of Health and Ageing for their ongoing support of the ‘core’ work of the HealthInfoNet.
At 30 June 2011, the estimated Western Australian Indigenous population was 88,277.
In 2011, around 96% of Indigenous people living in WA were Aboriginal, 1.9% were Torres Strait Islanders, and 1.9% of people identified as being of both Aboriginal and Torres Strait Islander descent.
The Indigenous population is much younger than the non-Indigenous population.
More than one-third (37%) of WA’s Indigenous population lived in the Perth metropolitan area, and 15% lived in the South-Western region.
Births and pregnancy outcome
In 2011, there were 2,506 births registered in WA with one or both parents identified as Indigenous (8% of all births registered).
In 2011, Indigenous mothers in WA were younger than non-Indigenous mothers; the median age was 24.2 years for Indigenous mothers and 30.3 years for all mothers.
In 2011, total fertility rates were 3,011 births per 1,000 for Indigenous women in WA and 1,953 per 1,000 for all women in WA.
In 2010, the average birthweight of babies born to Indigenous mothers living in WA was 3,139 grams compared with 3,353 grams for babies born to non-Indigenous mothers.
In 2010, the proportion of low birthweight babies born to Indigenous women in WA was twice that of non-Indigenous women (13.6% compared with 6.1%).
In 2006-2010, the age-standardised death rate for Indigenous people in WA was 2.5 times the rate for non-Indigenous people.
Between 1991 and 2010, there was a 35% reduction in the death rates for Indigenous people in WA.
For Indigenous people born 2005-2007 in WA, life expectancy was estimated to be 65.0 years for males and 70.4 years for females, around 14 and 12.5 years less than the estimates for non-Indigenous males and females, respectively.
In 2007-2011, age-specific death rates were higher for Indigenous people than for non-Indigenous people across all age-groups in WA, and were much higher in the middle adult years.
For 2009-2011, the infant mortality rate was 2.4 times higher for Indigenous infants than that for non-Indigenous infants in WA.
For 2006 to 2010, the leading causes of death among Indigenous people in WA were cardiovascular disease, injury, and neoplasms (almost entirely cancers).
In 2006-2010, the age-adjusted rate of avoidable deaths for Indigenous people was 4.8 times higher than the rate for non-Indigenous people in WA.
In 2010-11, 7.4% of all hospitalisations in WA were of Indigenous people.
In 2010-11, the age-standardised hospital separation rate for Indigenous people in WA was 3.8 times higher than that for other Western Australians.
In 2010-11, the main causes of hospitalisation for Indigenous people were for ‘care involving dialysis’ and injury.
Selected health conditions
In 2004-2005, 11% of Indigenous people in WA reported having a long-term heart or related condition.
In 2008-10, Indigenous people in WA were hospitalised for cardiovascular diseases at 1.9 times the rate of non-Indigenous people.
In 2006-2010, cardiovascular disease was the leading cause of death for Indigenous people in WA, accounting for 26% of Indigenous deaths.
In 2006-2010, the age-adjusted death rate for Indigenous people was 2.3 times the rate for non-Indigenous people in WA.
In 2007-2011, age-adjusted cancer incidence rates were similar for Indigenous people and non-Indigenous people in WA.
In 2007-2011, the most common cancers diagnosed among Indigenous people in WA were lung and breast cancer.
In 2008-10, age-standardised hospitalisation rates for cancer were lower for Indigenous people than those for non-Indigenous people in WA.
In 2006-2010, the age-standardised death rate for all cancers for Indigenous people was 1.5 times higher than that for non-Indigenous people in WA.
In 2004-2005, 8.8% of Indigenous people in WA reported having diabetes; after age-adjustment, Indigenous people were 3.7 times more likely to report having some form of diabetes than were non-Indigenous people.
In 2008-10, age-adjusted hospitalisation rates for diabetes for Indigenous males and females were 4.4 and 6.2 times the rates of other males and females in WA, respectively.
In 2006-2010, Indigenous people in WA died from diabetes at 8.7 times the rate of non-Indigenous people.
Social and emotional wellbeing
In 2008, Indigenous people in WA experienced high to very high levels of psychological distress at almost three times the rate reported by non-Indigenous people.
In 2008, 92% of Indigenous people living in WA felt happy either some, most, or all of the time.
In 2000-2001, 24% of WA Indigenous children aged 4-17 years were at high risk of clinically significant emotional or behavioural difficulties; this compares with 15% of similarly aged children in the State’s general population.
In 2008-10, after age-adjustment, the hospitalisation rate for Indigenous males and females in WA with mental health-related conditions was 3.1 and 2.1 times the rates for their non-Indigenous counterparts, respectively.
In 2005-2009, the death rate for ICD ‘Intentional self-harm’ for Indigenous people living in WA was 3.1 times the rate for non-Indigenous people.
In 2008-2010, after age-adjustment, the notification rate of end stage renal disease was 11.7 times higher for Indigenous people than that for non-Indigenous people in WA.
In 2008-10, the age-adjusted hospitalisation rate for dialysis and chronic kidney disease were 15 times higher for Indigenous people than that non-Indigenous people living in WA.
In 2006-2010, the age-standardised death rate from kidney disease was 5.4 times higher for Indigenous people than that for non-Indigenous people in WA.
In 2008-10, after age-adjustment, Indigenous people were hospitalised for injury at 2.9 times the rate for non-Indigenous people in WA.
In 2006-2010, injury was the second most common cause of death among Indigenous people in WA, accounting for 18% of Indigenous deaths.
In 2004-2005, the overall levels of respiratory disease were similar for Indigenous and non-Indigenous people in WA.
In 2008-10, the age-standardised hospitalisation rate for respiratory disease was 4.0 times higher for Indigenous people than that for non-Indigenous people in WA.
In 2006-2010, after age-adjustment, the death rate for Indigenous people was 2.9 times higher than that for non-Indigenous people in WA.
In 2004-2005, eye and sight problems were reported by 29% of Indigenous people in WA.
In 2008, WA was the jurisdiction with the highest prevalence of low vision among Indigenous adults (12%) and the second highest prevalence among Indigenous children (1.9%).
In 2008-10, hospitalisation rates for diseases of the eye and adnexa were lower for Indigenous people than those for non-Indigenous people in WA.
Ear health and hearing
In 2008, 9.0% of Indigenous children in WA aged 0-14 years had ear/hearing problems.
In 2004-2005, prevalence of diseases of the ear and mastoid was higher among Indigenous children living in remote areas of WA (16% males and 12% females) than among those living in non-remote areas (9% males and 7% females).
In 2008-10, the age-adjusted hospitalisation rate for Indigenous people for disease of the ear and mastoid process was 1.5 times higher than the non-Indigenous rate in WA.
In 2008, 28% of Indigenous children in WA had problems with their teeth or gums.
In 2004-2005, 77% of Indigenous adults in WA had lost fewer than five adult teeth.
In 2011, after age-adjustment, Indigenous people were more than twice as likely as non-Indigenous people in WA to have a profound/core activity restriction.
In 2009-2011, the age-standardised rate for hepatitis B notifications for Indigenous people in WA was almost three times, and the rate for hepatitis C notifications was more than four times, the rates reported for other people in WA.
In 1997-2007, the age-adjusted notification rate of invasive pneumococcal disease was 6.7 times higher for Indigenous people than that for non-Indigenous people in WA.
In 2011, the age-adjusted notification rate for gonorrhoea for Indigenous people living in WA was 44 times higher than the rate for non-Indigenous people.
In 2011, the age-adjusted notification rate for infectious syphilis for Indigenous people living in WA was 11 times the rate for non-Indigenous people.
In 2011, the age-adjusted notification rate for chlamydia for Indigenous people living in WA was almost four times higher than the rate for non-Indigenous people.
In 2011, there were 98 cases of newly diagnosed HIV infection in WA, of which five were identified as Indigenous.
Factors contributing to Indigenous health
In 2004-2005, the majority of Indigenous people in WA reported eating fruit (85%) and vegetables (94%) on a daily basis.
In 2008, 29% of Indigenous adults and 66% of Indigenous children living in WA took part in some type of physical activity or sport in the previous 12 months.
In 2004-2005, 71% of Indigenous adults in non-remote areas of WA reported sedentary or low levels of activity.
In 2004-2005, the age-adjusted level of obesity/overweight was 1.3 times higher for Indigenous adults than that for non-Indigenous adults in WA.
In 2011, more than 80% of Indigenous children aged 0-5 years in WA were fully immunised against the recommended vaccine-preventable diseases.
In 2004-2005, 60% of Indigenous people aged 50 years or older in WA had been vaccinated against influenza in the previous year and 35% had been vaccinated against pneumonia in the previous five years.
In 2004-2005, 81% of Indigenous babies aged 0-3 years in non-remote areas of WA had been breastfed.
In 2008, 44% of Indigenous adults in WA were current smokers.
In 2009, 51% of Indigenous mothers in WA reported smoking during pregnancy; this level was more than four times that of their non-Indigenous counterparts.
In 2008, 34% of Indigenous adults abstained from alcohol.
In 2004-2005, there were similar levels of long-term risky/high risk alcohol use for Indigenous and non-Indigenous people in WA, but Indigenous people were twice as likely to report binge drinking on a weekly basis as non-Indigenous people.
In 2008-09, the hospitalisation rate for alcoholic liver disease was 9.3 times higher for Indigenous people than that for non-Indigenous people in WA.
In 2005-2009, the age-standardised death rate for alcohol-related deaths was 11 times higher for Indigenous people than that for non-Indigenous people in WA.
Illicit drug use
In 2008, 45% of Indigenous adults reported that they had ever used an illicit substance, and 25% reported that they had used an illicit substance in the previous 12 months.
This Overview of the health of Indigenous people in Western Australia draws largely on previously published information, some of which has been re-analysed to provide clearer comparisons between Indigenous and non-Indigenous people (for more details of statistics and methods, readers should refer to the original sources). 2
Limitations of the sources of Indigenous health information
The assessment of the health status of Indigenous people in WA requires accurate information about the size of the population and the numbers of specific health conditions/occurrences. This information is required at state, regional, and local levels (for more information about the assessment of population health status, see ).
Nationally, there have been improvements in recent years - both in estimates of the Indigenous population (the denominator for calculation of rates) and in the availability of data for a number of health conditions/occurrences (the numerators for calculating rates) - but there is still some uncertainty in most areas.
In relation to population estimates, the Australian Bureau of Statistics (ABS) has made considerable efforts in recent decades to achieve accurate counts of the Indigenous population in the five-yearly Australian censuses . Despite these efforts, doubts remain about the extent to which official estimates reflect the actual size of the Indigenous population .
The ABS has also worked for many years with the Australian Institute of Health and Welfare (AIHW) and state and territory authorities to improve the accuracy of Indigenous status in a number of health-related collections, including birth and death registrations, hospital administrative data, and the maternal/perinatal collection. Some attention has also been directed to the data collections related to communicable diseases, cancer, and to a number of other disease-specific collections.
A persisting problem, however, is the extent to which Indigenous people are correctly identified in the various health-related data collections. In death registrations, for example, not all Indigenous deaths are correctly identified as such, with some identified as non-Indigenous . Estimating the proportions of deaths identified correctly is not simple, so it is difficult to estimate the actual number of Indigenous deaths occurring and the corresponding rates. The ABS uses estimates of the proportions of registered deaths correctly identified as Indigenous in preparing its life tables, the source of life expectancy figures. Details of these estimates are not available for recent years. However, it is likely that they are in line with the ABS's assessment of the completeness of recording of Indigenous deaths in 2006-2007, which was based on a comparison of deaths in those years with Indigenous status reported in the 2006 Census . Based on this comparison, the ABS estimated that the Australia-wide and WA levels of Indigenous identification in deaths notifications in 2006-2007 were 92% ; this level of identification is much higher than previous national estimates (around 56%) .
The AIHW conducted a study in 2011-2012 that investigated the quality of Indigenous identification in records of public hospital separations in Australia’s states and territories . This study found that 96% of Indigenous patients in WA’s public hospitals were correctly identified as such in 2011-12. The accuracy of the identification of Indigenous people varied slightly with remoteness level in WA: 100% in outer regional and very remote areas; 96% in major cities; 90% in inner regional and remote areas. A previous study estimated the completeness of Indigenous identification of WA’s hospital data to be 97% in 2007 .
The estimated coverage of Indigenous births in WA was 95% for the period 2002-2006 . In 2012, a study was undertaken comparing the consistency in determining the Indigenous status of children recorded in a large-scale survey (Western Australian Aboriginal child health survey (WAACHS)) and two administrative data sources (WA Register of Births and the WA Midwives’ Notification System) . This study found that there was substantial under-identification of Indigenous births when using only the two administrative data sources; applying an adjustment based on the linked survey data increased the estimated number of Indigenous births in WA by around 25%.
The need for information at a community level was identified in consultations undertaken for the development of the National Aboriginal and Torres Strait Islander information plan, but there are no reliable data routinely available at this level. Survey information, particularly that collected nationally by the ABS, (such as in the 2004-05 National Aboriginal and Torres Strait Islander health survey (NATSIHS) and the 2008 National Aboriginal and Torres Strait Islander social survey (NATSISS)), is valuable, but it is limited at a regional level by the relatively small number of Indigenous people surveyed. It is also difficult to compare survey findings because of differing sample sizes, methodologies, and seasonal variations in some health conditions. On the other hand, very good data about various aspects of the health of Indigenous children in WA are available from the WAACHS.
Statistics on hospitalisation provide some insights into ill-health in the population. They are, however, quite a poor reflection of the extent and patterns of treatable illness in the community because they represent only illness that is serious enough to require hospitalisation. Even then, hospital statistics relate to episodes of hospitalisation, with the result that each admission of an individual for a specific condition will be counted. This has a major impact on the numbers of admissions for aspects like renal dialysis, for which some people may be admitted many times in a year.
With these uncertainties, there must be some doubt about the precision of the various estimates of Indigenous health status. The differences between Indigenous and non-Indigenous people in the levels of most of these estimates are so great, however, that the slight imprecision in some estimates is of little practical importance.
The term 'Indigenous' is used in this overview to refer generally to the two Indigenous populations of Australia – Australian Aboriginal people and Torres Strait Islanders.
Thomson N (2003) The need for Indigenous health information. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 1-24
Biddle N (2012) CAEPR Indigenous population project 2011 census papers: population and age structure. Canberra: Centre for Aboriginal Economic Policy Research
Australian Bureau of Statistics (2012) Census of population and housing - counts of Aboriginal and Torres Strait Islander Australians, 2011. Canberra: Australian Bureau of Statistics
Taylor J, Biddle N (2008) Locations of Indigenous population change: what can we say?. Canberra: Centre for Aboriginal Economic Policy Research
Australian Bureau of Statistics (2012) Deaths, Australia, 2011. Canberra: Australian Bureau of Statistics
Australian Bureau of Statistics (2009) Experimental life tables for Aboriginal and Torres Strait Islander Australians: 2005-2007. Canberra: Australian Bureau of Statistics
Australian Bureau of Statistics (2006) Deaths, Australia, 2005. Canberra: Australian Bureau of Statistics
Australian Institute of Health and Welfare (2013) Indigenous identification in hospital separations data: quality report. Canberra: Australian Institute of Health and Welfare
Australian Institute of Health and Welfare (2010) National best practice guidelines for collecting Indigenous status in health data sets. Canberra: Australian Institute of Health and Welfare
Australian Bureau of Statistics (2007) Births, Australia, 2006. Canberra: Australian Bureau of Statistics
Lawrence D, Christensen D, Mitrou F, Draper G, Davis G, McKeown S, McAullay, Pearson G, Zubrick SR (2012) Adjusting for under-identification of Aboriginal and/or Torres Strait Islander births in time series produced from birth records: using record linkage of survey data and administrative data sources. BMC Medical Research Methodology; 12: 90 Retrieved 2 July 2012 from http://dx.doi.org/10.1186/1471-2288-12-90
Aboriginal and Torres Strait Islander Health and Welfare Information Unit (1997) The Aboriginal and Torres Strait Islander health information plan. Canberra: AHMAC, AIHW & ABS