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1.04 Respiratory disease

Why is it important?

Aboriginal and Torres Strait Islander peoples experience considerably greater mortality and morbidity from respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia and invasive pneumococcal disease than other Australians. Chronic respiratory diseases were responsible for 9% of the total disease burden among Indigenous Australians in 2003. COPD and asthma caused 43% and 38% of this burden respectively. The burden from chronic respiratory diseases in Indigenous Australians occurred at a rate 2.5 times that of the total Australian population (Vos et al. 2007).

High rates of pneumonia are associated with factors such as respiratory diseases, poor living conditions, malnutrition and smoking and alcohol misuse (Lim et al. 2014; Grau et al. 2014). Young children and those in older age groups are most at risk. Indigenous children in the NT have rates of radiologically confirmed pneumonia that are among the highest in the world (O'Grady et al. 2010).

Asthma can impact on physical functioning and attendance at school and work. It commonly coexists with other chronic conditions and is often associated with low socio-economic status and poorer quality of life. The mortality rate due to asthma in Australia is high on an international scale. Deaths due to asthma occur in all age groups, but the risk of dying from asthma increases with age. Asthma is more common among Indigenous Australians and they are at greater risk of dying from asthma than other Australians.

COPD is a serious lung disease that mainly affects older people and is associated with smoking, environmental pollutants and/or childhood infectious diseases (AIHW 2014n). Currently, 44% of Indigenous Australians aged 15 years and over smoke, 2.5 times the non-Indigenous rate. This is higher in remote areas (53%) than non-remote areas (41%) (see measure 2.15). COPD is characterised by chronic obstruction of lung airflow that interferes with breathing. Previous studies have found that among Indigenous Australians aged 55 years and over hospitalised for COPD, cancer is a commonly associated condition (AIHW 2011b).

Findings

Between 2008 and 2012, respiratory disease caused 888 deaths among Indigenous Australians in NSW, Qld, WA, SA and the NT combined (8% of Indigenous deaths). This was around twice the non-Indigenous rate. For respiratory deaths among Indigenous Australians, 53% were attributed to COPD, 4% to asthma and 19% to pneumonia and influenza.

There has been a significant decline in respiratory disease mortality rates among Indigenous Australians since 1998, and also a significant decline in the gap.

Self-reported data on respiratory diseases is available from the 2012–13 Health Survey. In 2012–13, 31% of Indigenous Australians reported long­ term respiratory diseases that had lasted 6 months or more. The most commonly reported respiratory condition was asthma (18%) followed by chronic sinusitis (8%) and COPD (4%). Asthma has increased since 2004–05 from 15% of the Indigenous population to 18% in 2012–13. Indigenous females reported higher rates of respiratory diseases (34%) than males (28%). Indigenous Australians living in non-remote areas reported higher rates (35%) than those in remote areas (18%). Rates varied by jurisdiction from 13% in the NT to 44% in the ACT. There was also an increase with age, ranging from 21% for 0–14 year olds to 43% in the 45–54 year group. After adjusting for differences in the age structure of the two populations, Indigenous Australians were 2.5 times as likely to report COPD and 1.9 times as likely to report asthma as non-Indigenous Australians.

Although hospitalisation statistics reflect separations from hospital rather than the prevalence or incidence of diseases in the community, they are a measure of the occurrence of conditions requiring acute care. Between July 2011 and June 2013, there were 42,209 hospitalisations for respiratory disease among Indigenous Australians (10% of Indigenous hospitalisations excluding dialysis). After adjusting for differences in the age structure of the two populations, the hospitalisation rate for respiratory disease was 2.4 times as high for Indigenous Australians as it was for non-Indigenous Australians. The greatest differences occurred in the older (65 years and over, and 55–64 years) age groups. Young children (0–4 years) had the second highest hospitalisation rates for Indigenous Australians (79 per 1,000), and the highest rates for non-Indigenous Australians (46 per 1,000).

Hospitalisation rates for respiratory diseases were lowest in Tasmania (13 per 1,000) and highest in the NT (67 per 1,000). Rates in remote areas were more than 3 times the rates in major cities for Indigenous Australians but rates were similar across areas for non-Indigenous Australians. Since 2004–05, there has been a 16% increase in respiratory disease hospitalisation rates in the six jurisdictions with adequate data for trend reporting (NSW, Vic, Qld, WA, SA and the NT combined). Rates for Indigenous children aged 0–4 years increased by 23% over the same period. In the period July 2011 to June 2013, COPD (29%) was the most common type of respiratory disease for which Indigenous Australians were hospitalised. this was followed by pneumonia (23%) and asthma (11%). The greatest differences between the two populations were for COPD and pneumonia.

In the period 2011–13 there were 745 notifications of invasive pneumococcal disease for Indigenous Australians, representing 14% of all cases notified that year.

Implications

While mortality rates for respiratory disease among Indigenous Australians have fallen, hospitalisation rates have increased in recent years and self- report data suggests a much higher prevalence of respiratory disease among Indigenous Australians compared with non-Indigenous Australians. Initiatives addressing smoking, immunisation, living conditions, overcrowding, chronic disease and access to health care are likely to contribute to improvements in respiratory disease. The Indigenous Australians' Health Programme, which commenced 1 July 2014, (consolidating primary health care base funding, child and maternal health programmes, Stronger Futures inthe Northern Territory and the Aboriginal and Torres Strait Islander Chronic Disease Fund) focuses on local needs to support prevention and management of diseases including respiratory disease (see Policies and Strategies section). Additionally, the Australian Government provides GP health assessments, follow- on care and incentive payments for improved chronic disease management for Indigenous Australians under the MBS, along with cheaper medicines through the PBS.

Figure 1.04-1 Age-standardised hospitalisation rates for respiratory disease by Indigenous status and remoteness, July 2011–June 2013
chart showing Age-standardised hospitalisation rates

Figure 1.04-1 shows age-standardised hospitalisation rates for a principal diagnosis of respiratory disease by Indigenous status and remoteness (rate per 1,000 population). Rates in remote areas were more than three times the rates in major cities for Indigenous Australians but rates were similar across areas for non-Indigenous Australians.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.04-2 Age-specific hospitalisation rates for respiratory disease, by Indigenous status, July 2011–June 2013
chart showing Age-specific hospitalisation rates

Figure 1.04-2 shows age-specific hospitalisation rates for a principal diagnosis of respiratory disease by Indigenous status (rate per 1,000 population). After adjusting for differences in the age structure of the two populations, the hospitalisation rate for respiratory disease was 2.4 times as high for Indigenous Australians as it was for non-Indigenous Australians. The greatest differences occurred in the older (65 years and over, and 55–64 years) age groups. Young children (0–4 years) had the second highest rates for Indigenous Australians (79 per 1,000), and the highest rates for non-Indigenous Australians (46 per 1,000).

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.04-3 Age-standardised hospitalisation rates for respiratory disease, by Indigenous status, sex, and jurisdiction, July 2011–June 2013
chart showing Age-standardised hospitalisation rates

Figure 1.04-3 shows hospitalisations for a principal diagnosis of respiratory disease, by Indigenous status and sex, from July 2011 to June 2013 (rate per 1,000 population). Hospitalisation rates were lowest in Tasmania (13 per 1,000) and highest in the NT (67 per 1,000).

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.04-4 - People reporting respiratory disease (age-standardised), by Indigenous status, 2012–13
chart showing People reporting respiratory disease

Figure 1.04-4 shows the proportion of persons reporting respiratory disease by Indigenous status for the period 2012–13. In 2012–13, 31% of Indigenous Australians reported long term respiratory diseases that had lasted 6 months or more. The most commonly reported respiratory condition was asthma (18%) followed by chronic sinusitis (8%) and COPD (4%).

Source: ABS and AIHW analysis of 2012–13 AATSIHS

Figure 1.04-5 Age-standardised mortality rates, respiratory diseases, by Indigenous status, NSW, Qld, WA, SA & NT, 1998 to 2012
chart showing Age-standardised mortality rates, respiratory diseases

Figure 1.04-5 shows age-standardised mortality rates from respiratory disease (deaths per 100,000) by Indigenous status over the period 1998 to 2012. There has been a significant decline in respiratory disease mortality rates among Indigenous Australians since 1998, and also a significant decline in the gap.

Source: ABS and AIHW analysis of National Mortality Database

Figure 1.04-6 Deaths of Indigenous Australians by type of respiratory disease and sex, NSW, Qld, WA, SA and the NT, 2008–2012
chart showing Deaths of Indigenous Australians from respiratory diseases

Figure 1.04-6 shows the rate of deaths of Aboriginal and Torres Strait Islander peoples from respiratory disease, by sex (rate per 100,000 population). Between 2008 and 2012, respiratory disease caused 888 deaths among Indigenous Australians in NSW, Qld, WA, SA and the NT combined (8% of Indigenous deaths). For respiratory deaths among Indigenous Australians, 53% were attributed to COPD, 4% to asthma, and 19% to pneumonia and influenza.

Source: ABS and AIHW analysis of National Mortality Database