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Respiratory disease

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Respiratory disease

‘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 chronic obstructive pulmonary disease (COPD)1, asthma, pneumonia and invasive pneumococcal disease, represents a significant burden of ill-health and hospitalisation among Aboriginal and Torres Strait Islander people [2], particularly among the very young [2][3] and older people [2].

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 some previous medical conditions [4][5]. Infants and children are particularly susceptible to developing respiratory conditions, due to factors like exposure to tobacco smoke, poor environmental conditions, poor nutrition, and limited access to medical care [6][7].

Extent of respiratory disease among Aboriginal and Torres Strait Islander people
Prevalence

Long-term diseases of the respiratory system2 were reported by 31% of Aboriginal and Torres Strait Islander people who participated in the 2012-2013 AATSIHS [8]. After age-adjustment, the overall level of respiratory disease among Aboriginal and Torres Strait Islander people was 1.2 times higher than for non-Indigenous people. For Aboriginal and Torres Strait Islander people respiratory conditions were more frequently reported by women (34%) than men (28%). Respiratory conditions were the most commonly reported condition for those less than 35 years of age.

Asthma was the most commonly reported long-term respiratory condition for Aboriginal and Torres Strait Islander people (18%) and the second most commonly reported long-term condition [8]. After age-adjustment, the level of asthma among Aboriginal and Torres Strait Islander people was 1.9 times higher than for non-Indigenous people. Asthma was reported more commonly by females (20%) than by males (15%) and by people living in non-remote areas (20%) than remote areas (10%) [9]. Other long-term respiratory conditions reported included chronic sinusitis (8%) and COPD (4%) [8].

Hospitalisation

There were 20,702 hospital separations for respiratory disease as a principal diagnosis among Aboriginal and Torres Strait Islander people in 2013-14 [10]. This represents 5.1% of all Aboriginal and Torres Strait Islander hospitalisations (including dialysis).

For selected respiratory diseases, the age-standardised hospitalisation rates for Aboriginal and Torres Strait Islander people in 2012-13 were 4.4 times higher for COPD, 3.3 times higher for influenza and pneumonia, 1.8 times higher for asthma, 1.8 times higher for acute upper respiratory infections and 1.4 times higher for whooping cough than for their non-Indigenous counterparts [11]. Aboriginal and Torres Strait Islander young people aged 15-24 years were hospitalised for whooping cough at 5.5 times the rate of non-Indigenous young people. Hospitalisation rates were higher for Aboriginal and Torres Strait Islander adults than for non-Indigenous adults for:

The hospitalisation rate for influenza and pneumonia in 2012-13 was particularly high for Aboriginal and Torres Strait Islander people living in remote/very remote areas (21 per 1,000) compared with those living in major cities areas (5.5 per 1,000), with a rate ratio of 3.9 [11].

Mortality

In 2013, respiratory disease was the underlying cause of death for 216 Aboriginal and Torres Strait Islander people living in NSW, Qld, SA, WA and the NT, accounting for 8.2% of Aboriginal and Torres Strait Islander deaths [12]. After age-adjustment, the death rate for Aboriginal and Torres Strait Islander people from respiratory disease was 2.0 times higher than for non-Indigenous people. Chronic lower respiratory diseases (including asthma, bronchitis, bronchiectasis, emphysema, and other COPD) were responsible for 148 Aboriginal and Torres Strait Islander deaths; the age-adjusted death rate for Aboriginal and Torres Strait Islander people was 2.4 times higher than for non-Indigenous people.

The death rate from chronic lower respiratory diseases for Aboriginal and Torres Strait people aged 45-54 years living in NSW, Qld, SA, WA and the NT in 2009-2013 (28 per 100,000) was 7.6 times higher than for their non-Indigenous counterparts [12]. Among people aged 55-64 years, the rate of 88 per 100,000 for Aboriginal and Torres Strait Islander people was 5.1 times higher than for their non-Indigenous counterparts. Influenza and pneumonia were responsible for 37 Aboriginal and Torres Strait Islander deaths: the age-adjusted death rate was 1.7 times higher than for non-Indigenous people.

The most recent detailed information on specific causes of respiratory-related deaths for Aboriginal and Torres Strait Islander males and females is for the period 2006 to 2010 [13]. The leading specific cause of death from respiratory disease for both males and females living in NSW, Qld, WA, SA and the NT was chronic lower respiratory diseases (Table 25). Age-adjusted death rates for chronic lower respiratory diseases were around three times higher for Aboriginal and Torres Strait Islander males and females than for their non-Indigenous counterparts. COPD accounted for 87% of the deaths of Aboriginal and Torres Strait Islander people caused by chronic lower respiratory diseases. Death rates for pneumonia and influenza, the next most common cause of death from respiratory disease, were 2.1 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.

Table 25. Age-standardised death rates for respiratory disease, Aboriginal and Torres Strait Islander people, by sex and condition, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, NSW, Qld, WA, SA and the NT, 2006-2010

 

Males

Females

Persons

 

Rate

Rate ratio

Rate

Rate ratio

Rate

Rate ratio

Chronic lower respiratory diseases

88

2.9

65

3.2

75

3.0

Pneumonia and influenza

24

2.4

16

1.8

19

2.1

Other respiratory disease

24

1.2

14

1.2

18

1.2

All respiratory disease

135

2.3

95

2.4

112

2.3

Notes:

  1. Chronic lower respiratory diseases include, asthma, bronchitis, bronchiectasis, emphysema and other COPD
  2. Rates, in deaths per 100,000, are directly age-standardised using the Australian 2001 ERP, by 5-year age-groups to 75+ years
  3. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate

Source: AIHW, 2013 [13]

Death rates from respiratory disease are still higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people, but the disparity has closed over recent decades, largely because of significant decreases in rates among Aboriginal and Torres Strait Islander people since 1998 [14]. Age-standardised death rates for respiratory disease in NSW, Qld, WA, SA and NT declined by 26% over the period 1998-2012 for Aboriginal and Torres Strait Islander people.

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 (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet
  3. O’Grady K-AF, Torzillo PJ, Chang AB (2010) Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life. Medical Journal of Australia; 192(10): 586-590
  4. Lim FJ, Lehmann D, McLoughlin A, Harrison C, Willis J, Giele C, Keil AD, Moore HC (2014) Risk factors and comorbidities for invasive pneumococcal disease in Western Australian Aboriginal and non-Aboriginal people. pneumonia; 4(2014): 24-34
  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. Janu EK, Annabattula BI, Kumariah S, Zajaczkowska M, Whitehall JS, Edwards MJ, Lujic S, Masters IB (2014) Paediatric hospitalisations for lower respiratory tract infections in Mount Isa. Medical Journal of Australia; 200(10): 591-594
  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. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 5 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%205%20long-term%20conditions%20by%20sex%20by%20indigenous%20status,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&5C97CE7DA7059C06CA257C2F00145D5A&0&2012-13&27.11.2013&Latest
  9. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 2 [data cube]. Retrieved 26 March 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%202%20selected%20health%20characteristics,%20by%20remoteness%20area%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&9F3D9B7052520B1BCA257CA6000E31B5&0&2012-13&26.03.2014&Latest
  10. Australian Institute of Health and Welfare (2015) Admitted patient care 2013–14: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  11. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  12. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. Canberra: Australian Bureau of Statistics
  13. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  14. Australian Institute of Health and Welfare (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: Australian Institute of Health and Welfare

Endnotes

  1. COPD relates to long-term lung diseases for which the symptoms are not fully reversible, and includes chronic bronchitis, emphysema, and some asthma [1].
  2. Individuals who reported a current respiratory condition that had lasted, or was expected to last, for 6 months or more [8].
 
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