Presentations of Ill Health in Aboriginal Populations

The following data are summarised from the "Overview of Australian Indigenous Health 2008" (www.healthinfonet.ecu.edu.au).

Injury (including motor-vehicle accidents, assaults, self-inflicted harm, falls) and poisoning (13.9%)
Pregnancy related (12.6%)
Respiratory diseases (11.3%)
Digestive diseases (8.6%)
Symptoms, signs not elsewhere classified (7.0%)
Circulatory diseases (5.7%)
Mental & behavioural disorders (5.7%)
Diseases of the skin & subcutaneous tissue (4.5%)
Genitourinary system diseases (4.3%)
Infectious/parasitic diseases (3.9%)
Endocrine, including diabetes)(3.8%)

With the exception of digestive disorders, admission rates are higher for indigenous people.

Injury is a significant cause of ill health in the indigenous population, but most don't result in hospitalisation.
Injuries resulting from assault are the most frequent in the indigenous population, and are much higher than in the non-indigenous population.
Intentional self-harm and motor-vehicle accidents are also significant causes of death within the indigenous population.

Risk factors for respiratory disease prevalent among indigenous population include poor environmental conditions, socio-economic disadvantage, cigarette smoking, alcohol and substance abuse, diabetes mellitus and chronic renal disease.
Poor sanitation, poor nutrition, parental smoking and low levels of immunisation are the main factors causing respiratory disease in children.
The overall levels of respiratory disease were similar for indigenous and non-indigenous people, although the level of asthma was 1.6-times higher for the indigenous population.
Hospitalisations were 3.3 times higher for indigenous people than for non-indigenous people, although this may be higher due to the reduced identification of indigenous people in the hospital in-patient collections.
Chronic lower respiratory disease is the leading cause of respiratory death among indigenous people.
Influenza and pneumonia were responsible for only a small number of deaths but were still 12 to 15 times higher than in non-indigenous people.

Cardiovascular disease is the leading cause of death in the indigenous population, and is nearly three times that of the non-indigenous population.
The prevalence of heart and circulatory disease in indigenous people was about 1.3 times more common that in non-indigenous people.
Higher prevalence of risk factors such as high blood pressure, obesity and tobacco smoking combined with rural and remote living are likely to be factors in the high prevalence in the indigenous population.
Indigenous people living in rural and remote areas are a little more likely to have circulatory problems than those living in non-remote areas.
Immediate care and treatment of cardiovascular conditions for many indigenous people are limited because of the distance to health services, the availability of transport to access those services, and language and cultural differences.
Hospital-admission rates for cardiovascular disease in the indigenous population are 1.8 times larger than for non-indigenous Australians.
The higher admission rates may allude to a poorer management of chronic conditions within the indigenous population.

There is limited data about cancer prevalence in the indigenous population, but analyses do suggest that, while cancer rates may be slightly lower in the indigenous population, cancer deaths are 40% higher. However, these data may need adjustment due to the fact that cancer registrations tend to be under-reported in the indigenous population.
Lung cancer and other preventable, smoking-related cancers are the leading causes of death in the indigenous population.
The reduced cancer-survival rates in the indigenous population are likely due to the later diagnosis and treatment than occurs in the non-indigenous population, suggesting a need to improve primary health care approaches related to cancer prevention, early identification and treatment.

Type-2 diabetes is a significant health problem amongst indigenous Australians, and the incidence is likely to be much higher than in the non- indigenous population.
Diabetes is a major cause of indigenous mortality, accounting for 8% of all indigenous deaths.
Diabetes-related mortalities are 7 to 10 times greater in the indigenous population, with higher rates for people living in remote areas.
It is likely that high levels of centrally-located obesity combined with low levels of physical activity and poor nutrition are key factors in the high prevalence of diabetes in indigenous Australians.

Renal disease, particularly kidney disease, is more prevalent in the indigenous population.
Currently dialysis is the most common cause of hospitalisation for indigenous people, with admission rates up to 12 times that of non- indigenous people.
Prevalence of end-stage renal disease (ESRD) in indigenous people is nine times that of non-indigenous people and up to 30 times the national average for people in remote areas.
Of new cases starting treatment for renal disease, aboriginal people are also presenting at a much younger age, with 57% less aged less than 55 years, compared with 31% for the non-indigenous population.
The death rate from chronic kidney disease for indigenous people was up to 10 times higher the rate for non-indigenous people, with the 25-34 and 45-54 age groups being particularly enhanced (over 30 times and 50 times respectively).
The data may under-estimate the contribution of chronic kidney disease to mortality as deaths due to chronic kidney disease can occur in context with other chronic conditions.

There is limited data about the prevalence of mental illness in the indigenous population and the problem is compounded by the difficulty in defining mental health in the first place.
Indigenous people over 18 years old were almost 1½ times more likely to report experiencing at least one stressor than non indigenous people, and the stressors reported most frequently by indigenous people were death of a family member or close friend (46%), serious illness or disability (31%), and inability to get a job (27%).
Information about the hospitalisations for mental and behavioural disorders due to psychoactive substance abuse in 2003-04 was 3 (female) to 4 (male) times higher for indigenous people, and rates for schizophrenia, schizotypal and delusional disorders were more than double that for non-indigenous people.
The indigenous mortality due to suicide is 2- (female) to 5-times (male) higher than the non-indigenous population, with high rates amongst young people.

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