Socioeconomic status and self-reported asthma in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

<p>Abstract</p> <p>Background</p> <p>Asthma is more common among Indigenous than non-Indigenous Australian adults, but little is known about socioeconomic patterning of asthma within the Indigenous population, or whether it is similar to the non-Indigenous population.</p> <p>Methods</p> <p>I analysed weighted data on self-reported current diagnosed asthma and a range of socio-economic and demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05.</p> <p>Results</p> <p>Current asthma prevalence was higher for Indigenous than non-Indigenous people in every age group. After adjusting for age and sex, main language and place of residence were significantly associated with asthma prevalence in both populations. Traditional SES variables such as education, income and employment status were significantly associated with asthma in the non-Indigenous but not the Indigenous population. For example, age-and sex-adjusted relative odds of asthma among those who did not complete Year 10 (versus those who did) was 1.2 (95% confidence interval (CI) 1.0-1.5) in the non-Indigenous population versus 1.0 (95% CI 0.8-1.3) in the Indigenous population.</p> <p>Conclusions</p> <p>The socioeconomic patterning of asthma among Indigenous Australians is much less pronounced than for other chronic diseases such as diabetes and kidney disease, and contrasts with asthma patterns in the non-Indigenous population. This may be due in part to the episodic nature of asthma, and the well-known challenges in diagnosing it, especially among people with limited health literacy and/or limited access to health care, both of which are more likely in the Indigenous population. It may also reflect the importance of exposures occurring across the socioeconomic spectrum among Indigenous Australians, such as racism, and discrimination, marginalization and dispossession, chronic stress and exposure to violence.</p

Diagnostic and therapeutic procedures among Australian hospital patients identified as Indigenous

Objectives: To determine whether hospital patients identified as Indigenous are less likely than other inpatients to have a principal procedure recorded, and the extent to which any disparity in procedure use can be explained by differences in patient, episode and hospital characteristics. Design: Retrospective analysis of routinely collected administrative data from the National Hospital Morbidity Database (NHMD). Setting: Australian public and private hospitals. Patients: All patients included in the NHMD whose episode type was recorded as acute and whose separation occurred between 1 July 1997 and 30 June 1998. Patients admitted for routine dialysis treatment were excluded. Main outcome measure: Whether a principal procedure was recorded. Results: In public hospitals, patients identified as Indigenous were significantly less likely than other patients to have a principal procedure recorded, even after adjusting for patient, episode and hospital characteristics (adjusted odds ratio [OR], 0.67; 95% CI, 0.66–0.68). This disparity was apparent for most diseases and conditions. In private hospitals, no significant difference was observed (adjusted OR, 0.94; 95% CI, 0.83–1.06). Conclusions: The disparity in procedure use after adjustment for relevant factors indicates that in Australian public hospitals there may be systematic differences in MJA 2002; 176: 58-62 the treatment of patients identified as Indigenous

Patterns and correlates of self-reported racial discrimination among Australian Aboriginal and Torres Strait Islander adults, 2008–09: analysis of national survey data

BackgroundThere is now considerable evidence that racism is a pernicious and enduring social problem with a wide range of detrimental outcomes for individuals, communities and societies. Although indigenous people worldwide are subjected to high levels of racism, there is a paucity of population-based, quantitative data about the factors associated with their reporting of racial discrimination, about the settings in which such discrimination takes place, and about the frequency with which it is experienced. Such information is essential in efforts to reduce both exposure to racism among indigenous people and the harms associated with such exposure.MethodsWeighted data on self-reported racial discrimination from over 7,000 Indigenous Australian adults participating in the 2008&ndash;09 National Aboriginal and Torres Strait Islander Survey, a nationally representative survey conducted by the Australian Bureau of Statistics, were analysed by socioeconomic, demographic and cultural factors.ResultsMore than one in four respondents (27%) reported experiencing racial discrimination in the past year. Racial discrimination was most commonly reported in public (41% of those reporting any racial discrimination), legal (40%) and work (30%) settings. Among those reporting any racial discrimination, about 40% experienced this discrimination most or all of the time (as opposed to a little or some of the time) in at least one setting. Reporting of racial discrimination peaked in the 35&ndash;44 year age group and then declined. Higher reporting of racial discrimination was associated with removal from family, low trust, unemployment, having a university degree, and indicators of cultural identity and participation. Lower reporting of racial discrimination was associated with home ownership, remote residence and having relatively few Indigenous friends.ConclusionsThese data indicate that racial discrimination is commonly experienced across a wide variety of settings, with public, legal and work settings identified as particularly salient. The observed relationships, while not necessarily causal, help to build a detailed picture of self-reported racial discrimination experienced by Indigenous people in contemporary Australia, providing important evidence to inform anti-racism policy

Consent for long-term storage of blood samples by Indigenous Australian research participants: the DRUID Study experience

Background: Little is known about the characteristics of people who do and do not agree to the long-term storage and use of their biological materials, or about potential biases that may be introduced as a result of differential consent. More specifically, concerns about tissue storage and use are especially relevant among population groups for whom blood and other biological materials are culturally significant, such as Indigenous Australians. Using data from a 2003&ndash;2005 study of 1,004 Indigenous Australians, we examined participants\u27 choices regarding long-term storage of excess blood for possible use in future studies.Results: Overall, 55% of participants agreed to long-term storage. Among 854 participants with a fasting blood sample and completed questionnaire, consent for storage was more likely among those aged 45+ years than those 15&ndash;44 (odds ratio (OR) = 1.55, 95% confidence interval (CI): 1.14, 2.11), and was similar for males and females. After adjustment for age and other covariates using logistic regression, consent was more likely for never smokers than current smokers (OR = 1.48, 95% CI: 1.04, 2.10), those reporting any non-Indigenous grandparent(s) (OR = 2.07, 95% CI: 1.50, 2.85), and those whose consent form was administered/witnessed by an Indigenous staff member (OR 1.43, 95% CI: 1.05, 1.94). Consent for long-term storage was associated with only small differences (generally less than &plusmn; 5%) in the results of assays performed on all participants\u27 blood samples as part of the baseline health examination.Conclusion: These data show that consent for blood storage among these research participants was neither rare nor universal. It was associated with some socio-demographic/cultural factors but not with blood biochemistry. Decisions about requesting or giving consent for storage and later use of tissue samples must recognize a number of important, and potentially competing, ethical and logistical considerations

Socio-demographic factors and psychological distress in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

BackgroundIndigenous Australians are known to be at greater risk of morbidity and mortality from mental health related conditions, but most available data relate to the use of mental health services, and little is known about other aspects of social and emotional wellbeing. Using the first available nationally representative data, we examined the prevalence and patterning of psychological distress among Indigenous Australian adults and compared these with corresponding data from the non-Indigenous population.MethodsThe analysis used weighted data on psychological distress, as measured by a modified Kessler Psychological Distress score (K5), and a range of socio-demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys. Very high psychological distress (VHPD) was defined as a K5 score &ge; 15 (possible range = 5-25).ResultsIndigenous adults were about three times more likely than non-Indigenous adults to be classified with VHPD: 14.5% (95% confidence interval (CI) 12.9-16.0%) versus 5.5% (95% CI 5.0-5.9%). After adjusting for age, most socio-demographic variables were significantly associated with VHPD in both populations, although the relative odds were generally larger among non-Indigenous people. Indigenous people in remote areas had a lower prevalence of VHPD than their non-remote counterparts, and only marital status, main language, and food insecurity were significantly associated with VHPD in remote areas.ConclusionsHigher absolute levels of VHPD combined with smaller socio-demographic gradients in the Indigenous population suggest the importance of risk factors such as interpersonal racism, marginalization and dispossession, chronic stress and exposure to violence that are experienced by Indigenous Australians with common and/or cross-cutting effects across the socioeconomic spectrum. The lower prevalence of VHPD and lack of association with many socio-demographic variables in remote areas suggests either that the instrument may be less valid for Indigenous people living in remote areas or that living in an Indigenous majority environment (such as exists in most remote communities) may mitigate the risk of psychological distress to some degree

SpORtI: The species originality and rarity index combines phylogenetic and functional originality with rarity metrics to provide a new perspective on species rarity

Methods used to assign rarity among species are fundamental to our ecological understanding and conservation of species that are most vulnerable to extinction or extirpation. Bees (Hymenoptera: Apoidea: Anthophila) are at the forefront of declines in pollinator diversity and a comprehensive understanding of their conservation requirements in any landscape is essential. Rarity is generally defined in terms of numerical abundance and geographical distribution, though aspects of species life history, such as degree of specialization and taxonomic relatedness, are also widely recognized as important. Incomplete information on the life histories of many taxa obliges ecologists to rely on species-level classifications of specialization provided by expert opinion or in published site- or region-specific studies. Descriptions of specialization are therefore rooted in characterization of the habitat and introduce subjectivity into rarity calculations through assumptions of how species perceive and use resources. An alternative approach that may reduce this level of subjectivity is to incorporate important life-history elements into species rarity assessments, which are traits of the organism itself and not its environment. Phylogenetic and functional originality are metrics which have been presented as useful for characterizing the uniqueness of species, and thus for developing a more informed index of species rarity. This study describes our Species Originality and Rarity Index (SpORtI) for bees that includes variables reflecting five rarity and originality metrics for each species: numeric rarity, geographic rarity, phenological rarity, phylogenetic originality, and functional originality. We compared species-specific rarity weights generated with this approach against other indices using a bee dataset collected over three years across the 520,000-km2 land area of the Great Lakes Basin and within the United States and found that rankings using our approach differed significantly from other indices. Our index represents an improvement on previous approaches since it incorporates key information identified by other researchers and avoids potential subjectivity associated with assigning habitat specialization. Importantly, SpORtI has the added advantage to incorporate updated species life-history traits reported in the literature to allow for the most comprehensive and timely rarity index. This new index will aid researchers and practitioners in determining what species to focus conservation efforts on, as well as which management treatments and environmental factors affect our most vulnerable species of bees, or other taxa, so that limited resources can be applied to focal areas of conservation concern more effectively and efficiently

Exploring the Pathways Leading from Disadvantage to End-Stage Renal Disease for Indigenous Australians

Indigenous Australians are disadvantaged, relative to other Australians, over a range of socio-economic and health measures. The age- and sex-adjusted incidence of end-stage renal disease (ESRD) - the irreversible preterminal phase of chronic renal failure - is almost nine times higher amongst Indigenous than it is amongst non-indigenous Australians. A striking gradient exists from urban to remote regions, where the standardised ESRD incidence is from 20 to more than 30 times the national incidence. We discuss the profound impact of renal disease on Indigenous Australians and their communities. We explore the linkages between disadvantage, often accompanied by geographic isolation, and both the initiation of renal disease, and its progression to ESRD. Purported explanations for the excess burden of renal disease in indigenous populations can be categorised as: (1) primary renal disease explanations; (2) genetic explanations; (3) early development explanations; and (4) socio-economic explanations. We discuss the strengths and weaknesses of these explanations and suggest a new hypothesis which integrates the existing evidence. We use this hypothesis to illuminate the pathways between disadvantage and the human biological processes which culminate in ESRD, and to propose prevention strategies across the life-course of Indigenous Australians to reduce their ESRD risk. Our hypothesis is likely to be relevant to an understanding of patterns of renal disease in other high-risk populations, particularly indigenous people in the developed world and people in developing countries. Furthermore, analogous pathways might be relevant to other chronic diseases, such as diabetes and cardiovascular disease. If we are able to confirm the various pathways from disadvantage to human biology, we will be better placed to advocate evidence-based interventions, both within and beyond the scope ofthe health-care system, to address the excess burden of renal and other chronic diseases among affected populations