Exclusion of Indigenous youth from important parts of the Australian Health Survey

[No abstract available

Association Between Diabetes And Coronary Heart Disease In Aboriginal People: Are Women Disadvantaged?

Objectives: To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. Design: Cohort study. Setting: A remote Aboriginal community in the Northern Territory. Participants: 889 Aboriginal people aged 20–74 years followed up to 31 May 2003 after baseline examination in 1992–1995. Main outcome measures: Incidence rates of CHD (estimated for 123 participants with diabetes at baseline and 701 “non-diabetes” participants); rate ratios for diabetes risk (95% CI), with “non-diabetes” participants as the reference group. Results: Participants with diabetes at baseline had a higher rate of CHD (37.5 per 1000 person-years) than those without diabetes (7.3 per 1000 person-years). Adjustment for multiple CHD risk factors, such as age, smoking, alcohol consumption, systolic blood pressure, body mass index, high-density lipoprotein cholesterol and total cholesterol levels, resulted in a CHD rate ratio for women of 3.7 (95% CI, 1.6-8.9) (comparing women with diabetes with those without) and a CHD rate ratio for men of 1.4 (95% CI, 0.4–4.1) (comparing men with diabetes with those without). Conclusions: Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes

Albuminuria and Incident Coronary Heart Disease in Australian Aboriginal people

Background. It has been suggested that albuminuria is useful in identifying persons at increased risk of coronary heart disease (CHD). Australian Aborigines have exceedingly high rates of renal failure together with increased CHD mortality. We undertook this prospective cohort study to assess the independent effect of albuminuria on CHD risk in Aboriginal people in the Northern Territory of Australia. Methods. We examined the relation between micro- and macroalbuminuria and incident CHD in a sample of 870 Aboriginal adults aged 20 to74 years old without prevalent baseline CHD. Cox proportional hazards models were used to assess the association between baseline albuminuria and CHD incidence. Results. During a median of 9.2 years of follow-up, 89 CHD events occurred during the follow-up period (1992 to 2003). The incidence of CHD increased significantly across categories of albuminuria (4.4, 10.9, and 29.8 per 1000 person-years for normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively). The multiple Cox proportional hazards regression showed the hazard ratio was 3.4 (95% CI 1.6, 7.3), adjusting for age, gender, body mass index (BMI), blood pressure, total cholesterol, diabetes status, cigarette smoking, and alcohol consumption, for macroalbuminuria group. Hazard ratio for microalbuminuria group was not significantly different from unity during the first 6 years of follow-up but significantly higher during the follow-up period 6 years with adjusted hazard ratio 9.0 (95% CI 2.0, 40.0). Conclusion. Independent of traditional cardiovascular risk factors, both microalbuminuria and macroalbuminuria may be useful in identifying persons at increased risk of CHD in Aboriginal people

Cardiovascular risk among urban Aboriginal people

A Letter to the Editor

Albuminuria as a marker of the risk of developing type 2 diabetes in non-diabetic Aboriginal Australians

Background Aboriginal Australians experience a higher risk of diabetes than the general Australian population. In this paper, we conducted a nested case-control study to determine whether the presence of microalbuminuria and macroalbuminuria is associated with the development of diabetes among diabetes-free Aboriginal people at baseline

Patterns of mortality in Indigenous adults in the Northern Territory, 1998–2003: are people living in more remote areas worse off?

Objective: ToquantifyIndigenousmortalityintheNorthernTerritorybyremotenessof residence. Design, setting and participants: Australian Bureau of Statistics mortality data were used to compare rates of death from chronic disease in the NT Indigenous population with rates in the general Australian population over the period 1998–2003. Rates were evaluated by categories of remoteness based on the Accessibility/Remoteness Index of Australia: outer regional areas (ORAs), remote areas (RAs) and very remote areas (VRAs). Main outcome measures: Mortality from cardiovascular disease, diabetes and renal disease; standardised mortality ratios (SMRs); percentage change in annual death rates; changes in mortality between 1998–2000 and 2001–2003. Results: In 1998–2000, SMRs for all-cause mortality were 285% in ORAs, 875% in RAs and 214% in VRAs. In 2001–2003, corresponding SMRs were 325%, 731% and 208%. For the period 1998–2003, percentage changes in annual all-cause mortality were 4.4% (95% CI, –2.2%, 11.5%) in ORAs, –5.3% (95% CI, –9.6%, –0.8%) in RAs, and 1.1% (95% CI, –7.2%, 11.3%) in VRAs. In 2001–2003, compared with 1998–2000, changes in the number of Indigenous deaths were +35 in ORAs, –37 in RAs and +32 in VRAs. Similar patterns were observed for cardiovascular mortality. Conclusions: ComparedwithmortalityinthegeneralAustralianpopulation,Indigenous mortality was up to nine times higher in RAs, three times higher in ORAs and two times higher in VRAs. The fact that rates were lowest in VRAs runs contrary to claims that increasing remoteness is associated with poorer health status. Despite the high death rate in RAs, there was a downward trend in mortality in RAs over the study period. This was partly attributable to a fall in the absolute number of deaths

A chronic disease outreach program for Aboriginal communities

Background. Our objective is to describe a program to improve awareness and management of hypertension, renal disease, and diabetes in 3 remote Australian Aboriginal communities. Methods. The program espouses that regular integrated checks for chronic disease and their risk factors are essential elements of regular adult health care. Programs should be run by local health workers, following algorithms for testing and treatment, with backup, usually from a distance, from nurse coordinators. Constant evaluation is essential to develop community health profiles and adapt program structure. Results. Participation ranged from 65% to 100% of adults. Forty-one percent of women and 72% of men were current smokers. Body weight varied markedly by community. Although excessive in all, rates of chronic diseases also differed markedly among communities. Rates increased with age, but the greatest numbers of people with morbidities were middle age and young adults. Multiple morbidities were common by middle age. Hypertension and renal disease were early features, whereas diabetes was a variable and later manifestation of this integrated chronic disease syndrome. Adherence to testing and treatment protocols improved markedly over time. Substantial numbers of new diagnoses were made. Blood pressure improved in people in whom antihypertensive agents were started or increased. Components of a systematic activity plan became more clearly defined with time. Treatment of people in the community with the greatest disease burden posed a large additional workload. Lack of health workers and absenteeism were major impediments to productivity. Conclusion. We cannot generalize about body habitus, and chronic disease rates among Aboriginal adults. Pilot data are needed to plan resources based on the chronic disease burden in each community. Systematic screening is useful in identifying high-risk individuals, most at an early treatable stage. Community-based health profiles provide critical information for the development of rational health policy and needs-based health services

Regional Variation in the Incidence of End-Stage Renal Disease in Indigenous Australians

Objective: To evaluate regional variation in the incidence of end-stage renal disease (ESRD) in Indigenous Australians, and to examine the proximity to ESRD treatment facilities of Indigenous patients. Design: Secondary data review, with collection of primary data regarding patients' place of residence before beginning ESRD treatment. Participants: Indigenous ESRD patients who commenced treatment in Australia during 1993-1998. Methods: We obtained data from the Australian and New Zealand Dialysis and Transplant Registry regarding 719 Indigenous patients who started ESRD treatment between 1 January 1993 and 31 December 1998. We obtained primary data from the treating renal units to determine the place of residence before beginning renal replacement therapy. We calculated the average annual incidence of ESRD for each of the 36 Aboriginal and Torres Strait Islander Commission regions using population estimates based on the 1996 Census, and calculated standardised incidence ratios with 95% confidence intervals for each region. We compared the number of cases with the treatment facilities available in each region. Main outcome measure: Regional standardised ESRD incidence for Indigenous Australians referenced to the total resident population of Australia. Results: Standardised ESRD incidence among Indigenous Australians is highest in remote regions, where it is up to 30 times the national incidence for all Australians. In urban regions the standardised incidence is much lower, but remains significantly higher than the national incidence. Forty-eight per cent of Indigenous ESRD patients come from regions without dialysis or transplant facilities and 16.3% from regions with only satellite dialysis facilities. Conclusions: There is marked regional variation in the incidence of ESRD among Indigenous Australians. Because of the location of treatment centres, there is inequitable access to ESRD treatment services for a significant proportion of Indigenous patients

Reducing Premature Death and Renal Failure in Australian Aborigines: A Community-Based Cardiovascular and Renal Program

Objective: To describe results of a systematic treatment program to modify renal and cardiovascular disease in an Aboriginal community whose rates of renal failure and cardiovascular deaths are among the highest in Australia. Design: Longitudinal survey of people during treatment, and comparison of rates of natural death and renal failure with those in a historical control group. Setting: Tiwi Islands (population, about 1800), November 1995 to December 1998. Participants: All adults with blood pressure 140/90, with diabetes and urinary albumin/creatinine ratio (ACR) 3.4 g/mol (microalbuminuria threshold), or with progressive overt albuminuria (ACR 34 g/mol) were eligible for treatment. The historical control group comprised 229 people who satisfied these criteria in the pretreatment period 1992-1995. Interventions: Perindopril, combined with calcium-channel blockers and diuretics if needed to achieve blood pressure goals; attempts to improve control of blood glucose and lipid levels; health education. Main outcome measures: Blood pressure, ACR, serum creatinine level and glomerular filtration rate (GFR) over two years of treatment; rates of renal failure and natural death compared with control group (analysed on intention-to-treat basis). Results: 258 people enrolled in the program, and 118 had complete data for two years of treatment. In these 118, blood pressures fell significantly, while ACR and GFR stabilised. Rates of the combined endpoints of renal failure and natural death per 100 person-years were 2.9 for the treatment group (95% CI, 1.7-4.6) and 4.8 for the control group (95% CI, 3.3-7.0). After adjustment for baseline ACR category, the relative risk of the treatment group versus the control group for these combined endpoints was 0.47 (95% CI, 0.25-0.86; P = 0.013). Treatment benefit was especially marked in people with overt albuminuria or hypertension and in non-diabetic people. The estimates of benefit were supported by a fall in community rates of death and renal failure. Conclusions: Aboriginal people can participate enthusiastically in chronic disease management, with rapid, dramatic improvement in clinical profiles and mortality. Similar programs should be introduced urgently into other Aboriginal communities nationwide