Respiratory health

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Respiratory disease

The term ‘respiratory disease’ refers to a number of conditions that affect the lungs or their components; each of these conditions is characterised by some level of impairment of the lungs in performing the essential function of gas exchange [1]. Respiratory disease, which includes asthma, chronic obstructive pulmonary disease (COPD), pneumonia and invasive pneumococcal disease, represents a significant burden of ill-health and hospitalisation among Indigenous people, particularly among the very young and older people [2][3].

Respiratory disease is associated with a number of contributing factors, including poor environmental conditions, socioeconomic disadvantage, risky behaviour (particularly cigarette smoking, alcohol use, and substance use), and previous medical conditions [4][5]. Infants and children under the age of 5 years are particularly susceptible to developing respiratory conditions, due to factors like low levels of childhood immunisation, parental smoking, poor nutrition (including aspects related to infant-feeding and weaning practices), and poor environmental conditions [4][6][7][8]. Among Indigenous adults, factors contributing to respiratory disease include tobacco smoking, use of alcohol and other substances, diabetes mellitus, and chronic renal disease [4].

The risk of developing asthma is affected by environmental, lifestyle (e.g. diet and tobacco use), and genetic factors (e.g. allergies) [9]. Asthma attacks can be triggered by exercise, viral infections, irritants (e.g. smoking and air pollutants), and specific allergens. These attacks cause a narrowing of the airways, resulting in symptoms including wheezing and breathlessness. The symptoms of asthma are generally reversible.

COPD is a term for long-term lung diseases for which the symptoms are not fully reversible, and include chronic bronchitis, emphysema, and some cases of asthma [1]. These diseases are characterised by shortness of breath. A major risk factor for COPD is smoking, but exposure to irritants like dust and fumes can also increase the risk of developing COPD [10].

Extent of respiratory disease among Indigenous people

Prevalence

Disease of the respiratory system was reported by 27% of Indigenous people who participated in the 2004-2005 NATSIHS [11]. Respiratory conditions were reported more frequently by Indigenous people living in non-remote areas (30%) than by those living in remote areas (17%).

Asthma was reported by 15% of Indigenous people in the 2004-2005 NATSIHS [11]. It was the most commonly reported respiratory condition among Indigenous people, and the second most commonly reported health condition. Asthma was reported more frequently by Indigenous people living in non-remote areas (17%) than by those living in remote areas (9%).

After age-adjustment, the overall levels of respiratory disease were similar for Indigenous and non-Indigenous people, but the level of asthma among Indigenous people was 1.6 times that among non-Indigenous people [11][12].

The lower overall proportion of Torres Strait Islander people (13%) than Aboriginal people (15%) reporting asthma was largely due to the low level reported by Torres Strait Islanders living in the Torres Strait area (5%) [11].

Hospitalisation

There were 19,471 hospital separations for respiratory disease among Indigenous people living in NSW, Vic, Qld, WA, SA, and the NT in 2010-11, representing 11% of separations identified as Indigenous (excluding dialysis) [13]. During this period, the age-standardised hospitalisation rate for respiratory disease was 2.8 times higher for Indigenous people than for other Australians [14].15

In the two-year period from July 2008 to June 2010, Indigenous children aged 0-4 years were hospitalised for respiratory disease at twice the rate of other Australian children [2]. Hospitalisation rates were substantially higher for Indigenous adults than non-Indigenous adults, with rates almost six times higher for Indigenous people aged 45-54 years and more than four times higher for Indigenous people aged 35-44 years and 55-64 years.

In 2008-10, the most common cause of hospitalisation for respiratory disease among Indigenous people was pneumonia (23%), followed by COPD (13%), and asthma (11%) [2].

For Indigenous people living in remote areas, the hospitalisation rate was three times the rate of Indigenous people living in major cities (80 and 27 per 1,000 people respectively) in 2008-10 [2].

Mortality

In 2010, respiratory disease was responsible for the deaths of 194 Indigenous people living in NSW, Qld, SA, WA and the NT, accounting for 7.5% of Indigenous deaths [15]. After age-adjustment, the death rate for Indigenous people was 2.6 times that for non-Indigenous people. Chronic lower respiratory diseases (COPD and asthma) were responsible for 115 Indigenous deaths; the age-adjusted death rate for Indigenous people was 3.0 times higher than that for non-Indigenous people. Influenza and pneumonia were responsible for 44 Indigenous deaths, with a rate 2.8 times higher for Indigenous people than for non-Indigenous people [16].

The most recent detailed information on specific causes of respiratory-related deaths for Indigenous males and females is available for the period from 2004 to 2008. During this time period, the leading specific cause of death from respiratory disease for both Indigenous males and females living in NSW, Qld, WA, SA and the NT was chronic lower respiratory disease (Table 22) [17]. Age-standardised death rates were around three times higher for Indigenous males and females than those for their non-Indigenous counterparts. Death rates for pneumonia and influenza, the next most common cause of death from respiratory disease, were 2.0 times higher for Indigenous people than for non-Indigenous people.

Table 22: Age-standardised death rates for respiratory disease, Indigenous people, by sex and condition, and Indigenous:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2004-2008

	Males		Females		Persons
	Rate	Rate ratio	Rate	Rate ratio	Rate	Rate ratio
Source: AIHW, 2011 [17]
Notes: Chronic lower respiratory diseases include asthma, bronchitis and emphysema Rates, in deaths per 100,000, are directly age-standardised using the Australian 2001 standard population, by 5-year age-groups to 75+
Chronic lower respiratory diseases	95	3.0	63	3.2	76	3.1
Pneumonia and influenza	27	2.1	22	1.8	24	2.0
Other respiratory disease	22	1.2	10	0.9	15	1.1
All respiratory disease	144	2.3	95	2.2	116	2.3

More recent detailed information is not available, but the death rate from chronic lower respiratory disease for Indigenous people aged 55-64 years living in NSW, Qld, SA, WA and the NT in 2006-2010 (57 per 1,000) was 5.5 times higher than the rate for their non-Indigenous counterparts [16]. Among people aged 65-74 years, the rate of 79 per 1,000 for Indigenous people was 4.4 times higher than that for their non-Indigenous counterparts. Indigenous infants were 3.3 times more likely than their non-Indigenous counterparts to die from respiratory disease.

Death rates from respiratory disease are still considerably higher for Indigenous people than for non-Indigenous people, but the disparity has closed over recent decades, largely because of significant decreases in rates among Indigenous people since 1997 [2].

References

1. 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
2. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
3. Australian Institute of Health and Welfare (2011) The health and welfare of Australia's Aboriginal and Torres Strait Islander people: an overview 2011. Canberra: Australian Institute of Health and Welfare
4. Chang AB, Torzillo PJ (2008) Respiratory infection (including Bronchiectasis). In: Couzos S, Murray R, eds. Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press: 355-385
5. Australian Institute of Health and Welfare (2010) Asthma, chronic obstructive pulmonary disease and other respiratory diseases in Australia. Canberra: Australian Institute of Health and Welfare
6. 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
7. Pierce R, Antic R, Chang A, Howard M, James A, Maguire G, Matthiesson A, Musk B, Roseby R, Simpson G, Torzillo P (2010) Respiratory and sleep health in Indigenous Australians. Sydney: Thoracic Society of Australia and New Zealand
8. O’Grady K-AF, Taylor-Thomson DM, Chang AB, Torzillo PJ, Morris PS, Mackenzie GA, Wheaton GR, Bauert PA, De Campo MP, De Campo JF, Ruben AR (2010) Rates of radiologically confirmed pneumonia as defined by the World Health Organization in Northern Territory Indigenous children. Medical Journal of Australia; 192(10): 592-595
9. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
10. McKenzie DK, Abramson M, Crockett AJ, Glasgow N, Jenkins S, McDonald C, Wood-Baker R, Frith PA (2011) The COPD-X plan: Australian and New Zealand guidelines for the management of chronic obstructive pulmonary disease. Bowen Hills, Qld: The Australian Lung Foundation
11. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
12. Australian Institute of Health and Welfare (2008) Australia's health 2008: the eleventh biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
13. Australian Institute of Health and Welfare (2012) Australian hospital statistics 2010-11. Canberra: Australian Institute of Health and Welfare
14. Australian Institute of Health and Welfare (2012) Australian hospital statistics 2010-11 supplementary tables. Canberra: Australian Institute of Health and Welfare
15. Australian Bureau of Statistics (2012) Causes of death, Australia, 2010. Canberra: Australian Bureau of Statistics
16. Australian Bureau of Statistics (2012) Causes of death, Australia, 2010: Deaths of Aboriginal and Torres Strait Islander Australians. Retrieved 20 March 2012 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&3303.0_12%20deaths%20of%20aboriginal%20and%20torres%20strait%20islander%20australians.xls&3303.0&Data%20Cubes&0BC29ACBD5D3F0D5CA257A24001D97D6&0&2010&22.06.2012&Previous
17. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare

Endnote

15. Based on the under-identification of Indigenous people in the hospital inpatient collections, this ratio is probably higher.