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Cardiovascular disease (CVD; ICD 'Diseases of the circulatory system') includes all diseases and conditions that affect the heart and blood vessels . CVD presents a significant burden for Indigenous people in terms of prevalence, hospitalisation, and mortality . Coronary heart disease (or ischaemic heart disease), cerebrovascular disease, hypertension and rheumatic heart disease are of particular importance to Indigenous people.
Risk factors for CVD are categorised as either modifiable, which can be behavioural and biomedical, or non-modifiable (risk factors that cannot be altered) . Modifiable behavioural factors include tobacco use, physical inactivity, dietary behaviour, and excessive alcohol consumption . Modifiable biomedical factors include hypertension, high blood cholesterol, overweight and obesity, and depression. Certain related health conditions, particularly diabetes and chronic kidney disease, can also increase the risk of developing CVD. Non-modifiable risk factors, such as age, sex, family history, and ethnicity, can influence the risk of CVD.
As important as these factors may be, they should be considered within a broad social determinants of health framework, with the following aspects being important contributors to the development of CVD disease among Indigenous people:
The most recent source of population-level information about the extent of CVD among Indigenous people is the 2004-2005 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) . Around 12% of Indigenous people reported having a long-term heart or related condition, with the proportion being slightly higher for those living in remote areas (14%) than in non-remote areas (11%). The proportions represent a slight increase from those reported in 2001 (11%).
After age-adjustment, heart and circulatory problems/diseases were around 1.3 times more common for Indigenous people than for non-Indigenous people . Hypertensive disease was 1.5 times more common for Indigenous people than for non-Indigenous people, and other diseases of the heart and circulatory system were 1.2 times more common.
Overall, a lower proportion of Torres Strait Islander people (9%) than Aboriginal people (12%) reported having a heart and circulatory problem/disease, but the proportion was 11% for Torres Strait Islander people living in the Torres Strait area .
At 31 December 2009, there were 1,374 Indigenous people and 105 non-Indigenous people living in the Top End of the NT and the NT part of central Australia who were registered as having rheumatic heart disease (RHD) . Almost two-thirds (65%) of these people were females. After age-adjustment, the prevalences for Indigenous males were 38 times higher in the Top End and 14 times higher in the central Australia part of the NT than the corresponding rates for their non-Indigenous counterparts. Age-adjusted prevalences of RHD for Indigenous females were 23 times higher in the Top End and 20 times higher in central Australia part of the NT than the corresponding prevalences for their non-Indigenous counterparts. The prevalence of RHD for Indigenous people was highest in the 45-54 years age-group (3.5%). The highest Indigenous and non-Indigenous ratios were for the 0-14 years and 25-34 years age-groups - 178 and 108 respectively.
There were 9,817 hospital separations for CVD among Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2010-11 . After age-adjustment, Indigenous people were hospitalised for CVD at 1.6 times the rate for non-Indigenous people .
There were 7,212 hospital admissions of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in the two-year period July 2006 to June 2008 for coronary heart disease . Of these admissions, 2,871 were for acute myocardial infarction (heart attack). Admission rates for Indigenous males were 1.7 times higher for coronary heart disease and 2.2 times higher for acute myocardial infarction than the corresponding rates for other Australian males. Rates for Indigenous females were 2.8 times higher for coronary heart disease and 3.1 times higher for acute myocardial infarction than the corresponding rates for other Australian females.
For cerebrovascular disease (including stroke), there were 1,329 admissions to hospital of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2006-08 . Admission rates for Indigenous males were 1.6 times higher for cerebrovascular disease overall and 1.7 times higher for stroke than the corresponding rates for other males. The rates for Indigenous females were 1.9 and 2.1 times higher, respectively, than those for other females.
Hospitalisation rates for hypertension for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2006-08 were considerably higher than those for non-Indigenous people: 2.6 times higher for males and 2.5 times higher for females . The highest ratios were for the 35-44 and 45-54 years age-groups where Indigenous rates were between four and five times higher than non-Indigenous rates.
In 2007-08 in NSW, Vic, Qld, WA, SA and the NT there were 347 Indigenous people hospitalised for RHD/acute rheumatic fever (ARF) .7 The hospitalisation rate for Indigenous people was 67 per 100,000, eight times the rate for non-Indigenous people.
CVD was the leading cause of death for Indigenous people living in NSW, Qld, WA, SA and the NT in 2006-2010, being responsible for 26% of all deaths of Indigenous people . After age-adjustment, the death rate for Indigenous people was 1.7 times that for non-Indigenous people. Coronary heart disease was responsible for 61% of the CVD-related deaths among Indigenous males and for 45% of those among Indigenous females. Cerebrovascular disease was responsible for 15% of deaths from CVD among Indigenous males and for 22% of those among Indigenous females.
RHD was responsible for the deaths of 90 Indigenous people living in NSW, Qld, WA, SA and the NT in 2006-2010 . The age-adjusted death rate from RHD for Indigenous people living in NSW, Qld, WA, SA and the NT in 2004-2008, the most recent period for which details are available, was 5.8 times that of non-Indigenous people . Indigenous males were 4.1 times more likely to die from RHD than non-Indigenous males, and Indigenous females 6.8 times more likely to die from RHD than their non-Indigenous counterparts.
The striking difference between Indigenous people and non-Indigenous people in overall CVD mortality is the much greater impact among young and middle-aged Indigenous adults. In 2002-2005 in Qld, WA, SA and the NT, the death rates for all CVD were 8 to 12 times higher for Indigenous people in the 35-44 years and 45-54 years age-groups than the rates for their non-Indigenous counterparts .