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Cardiovascular Health in Aboriginal Australians

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Source: AIHW National Cardiovascular Disease Database ... Health and Welfare National Cardiovascular Disease Database, http://www.aihw.gov. ... – PowerPoint PPT presentation

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Title: Cardiovascular Health in Aboriginal Australians


1
Cardiovascular Health in Aboriginal Australians
  • SAR Talk
  • Karen E. Joynt
  • October 31, 2006

2
Presentation Outline
  • Where is Australia, and is it as small as it
    looks on the map?
  • Who are the aboriginal people in Australia?
  • Disadvantaged overall health in aboriginal people
  • Cardiovascular health in aboriginal people
  • Understanding the problem of cardiovascular
    health in aboriginal people
  • The good news?

3
Australia a primer
4
Australia its really big
5
Australia a primer
6
So what about the kangaroos?
7
So what about the kangaroos?
8
Who are Australias aboriginal people?
  • aboriginal adj.
  • Having existed in a region from the beginning
    aboriginal forests.
  • Indigenous Australians Aboriginal Australians
  • They were there first!
  • 30,000-40,000 BC
  • Captain James Cook, 1770

Natives opposing the arrival of Captain James
Cook 19th century engraving
9
Indigenous Australians
  • Made up of many tribes with distinct cultures,
    languages, traditions, land
  • 492,700 people
  • 2.4 of the population of Australia
  • 30 metropolitan, 43 regional, 26 remote

Source AIH InfoNet 2005 Map www.wikipedia.com
10
Sacred ground Uluru
11
Sacred ground Uluru
12
Overall social welfare
  • Education
  • 32 higher education (57 non-indigenous)
  • 1 of higher education population
  • Employment
  • 13 unemployment (4.6 non-indigenous)
  • Mean weekly income 394 (657)
  • Housing
  • Metropolitan 34 homeowners, 32 renters, 24
    state housing
  • Remote 14 homeowners, 50 renters, 36 state
    housing
  • High proportion of temporary / improvised housing

Source AIH InfoNet 2005
13
Poor health across the lifespan
  • High burden of poor health
  • Low birth weight
  • 13 versus 6 (non-indigenous)
  • Infant mortality
  • Three times higher than non-indigenous infants
    (16 per 1000 compared with 5 per 1000)
  • Childhood disease
  • Chronic otitis media
  • Rheumatic heart disease

Source AIH InfoNet 2005
14
Life expectancy in Australia
Source Zhao and Dempsey 2006
15
International Indigenous mortality rates
(all-cause)
Source Ring and Firman 1998
16
Age-specific death rates ages 45-54 years
Source AIHW National Mortality Database 1999-2003
17
Thomas and Condon dz trends
Source Thomas et al 2006
18
Risk for any cardiovascular death, indigenous
versus nonindigenous
Source AIHW National Cardiovascular Disease
Database
19
Risk for coronary heart disease death, indigenous
versus nonindigenous
Source AIHW National Cardiovascular Disease
Database
20
Cardiovascular disease Mortality
Source Thomas et al 2006
21
Explaining the disparity
  • Rheumatic heart disease
  • Traditional risk factors
  • Diabetes
  • Hypertension
  • Smoking
  • Obesity and overweight
  • Physical inactivity
  • Psychosocial stressors
  • Lack of access to care

22
Rheumatic heart disease
  • Incidence 200 cases per 100,000 population
  • Prevalence 1.33 in children aged 5-14 (national
    prevalence 0.034)
  • Mortality indigenous men and women are 27 and 23
    times more likely, respectively, to die of RHD
    than nonindigenous persons
  • Up to 3 of excess deaths in males and 7 in
    females

AIHW 2002, Cunningham 1996
23
Traditional risk factors?
24
Risk factor burden, persons aged 15 or older
Source Australian Indigenous Health InfoNet
25
Diabetes PrevalencePercentage of adults
reporting diabetes, 2001
Ratio 5
Ratio 9
20 impaired glucose tolerance
Source Australian Indigenous Health InfoNet
26
Diabetes burden
  • Hospitalization rates 10-15x higher than
    non-indigenous
  • High rates of retinopathy, nephropathy
  • Mortality rates 11-18x higher than non-indigenous
    persons
  • High burden on females?

Source AIHW, Wang and Hoy 2004
27
Hypertension
  • By self-report 12 of indigenous males and 16
    of indigenous females (compared with 9 and 10
    of nonindigenous, respectively)
  • By direct measurement roughly 50 in one sample
    of 592 patients taken in 1993-1997
  • At well-person checks 49 of adults over the age
    of 35 were hypertensive in a sample of 2900
    patients taken in 1998-2000
  • Both studies found 17 of males aged 15-34 years
    were hypertensive (5 of females)

Source ABS 2002, Leonard 2002, Miller 2002
28
Cigarette smoking
Source CEITC 2006
29
Physical inactivity
  • 43 of Indigenous people classified as sedentary
    versus 30 of non-Indigenous
  • 30 of Indigenous people classified as low
    exercise level versus 39 of non-Indigenous
  • Little to no formal physical activity in terms of
    organized sports, gyms, etc.

30
Obesity and overweight
  • Essentially zero obesity in the Indigenous
    population until the 1960s
  • Question of the thrifty genotype
  • Impact of rapid lifestyle transition

Source McDermott 2000
31
Psychosocial stressors
  • Known to increase risk of CVD and negatively
    impact prognosis in established CVD
  • Depression
  • Loss, displacement, grief, mourning
  • Anger, frustration
  • The Stolen Generation

Caminka Art 2004
32
The Stolen Generation
  • The Aboriginal Ordinance
  • 1900-1969 (perhaps even longer)
  • 1 in 3 to 1 in 10 indigenous children were taken
    from their homes and families by government and
    religious agencies
  • Over 100,000 children
  • Placed in white families or institutionalized

33
Governmental Apology?
  • Australians of this generation should not be
    required to accept guilt and blame for past
    actions and policies. John Howard

34
Access to care
  • Only 15 of indigenous Australians in remote
    areas and 38 in urban areas have a Medicare
    number
  • Lack of acceptable identification
  • Language barriers
  • Cultural beliefs about durable images of people
  • Medicare is underutilized due to lack of access
    to centers providing MBS / PBS care
  • Aboriginal Medical Services provide
    community-based primary care
  • Often understaffed, underfunded
  • No specialist services

Source House of Representatives 2000
35
Access to care, continued
  • Distances traveled to access health care often
    long
  • Transfers from Darwin to FMC
  • Transfers from Alice Springs to Royal Adelaide
  • No family, high death rate
  • Leads to mistrust and apprehension, especially
    for transfer of children

Source House of Representatives 2000, Henry
2004, Alex Brown, personal communication
36
Access to care travel distances
37
Access to care, continued
  • Waiting time to access health care often long
  • One cardiology clinic per two week period
  • Rotating cardiologists, so little continuity
  • No way to easily contact the cardiologist
  • Cardiac rehabilitation not available
  • Monitoring, telephone access often impossible
  • Lack of holistic, culturally appropriate care

38
So whats the good news?
  • Self-determination versus mainstreaming
  • Tangentyere Council
  • CAYLUS
  • RANP
  • Rheumatic heart disease program (UNICEF)
  • Meal programs
  • Banking assistance

39
Making indigenous health a priority!
  • Offices of Aboriginal Health
  • State councils on aboriginal health
  • Aboriginal Health Australia
  • Australian Indigenous Health InfoNet
  • Menzies School of Public Health
  • Centre for Remote Health

40
Beautiful Australia
41
Thank you
  • Paddy Phillips, Chair of Medicine at Flinders
    Medical Centre
  • The Cardiovascular Outcomes Research group at
    Flinders Medical Centre Dr. Derek Chew, Carolyn
    Astley, Sue Mattschoss, Danni Molloy, Leann Cox,
    and Dr. Luan Huynh
  • Tangentyere Council
  • The Duke Global Health program and Dr. Ralph
    Corey
  • Dr. Diana McNeill and Dr. Andrew Muir

42
References
  • Australian Bureau of Statistics (2002) National
    Health Survey Aboriginal and Torres Strait
    Islander results. Canberra Australian Bureau of
    Statistics
  • Australian Indigenous Health InfoNet (2005)
    Summary of Australian Indigenous Health, February
    2005. www.healthinfonet.ecu.edu.au/html/html_keyfa
    cts_plain_lang_summary.pdf
  • Australian Institute of Health and Welfare
    National Cardiovascular Disease Database,
    http//www.aihw.gov.au/dataonline.cfm
  • Australian Institute of Health and Welfare
    National Mortality Database 1999-2003,
    http//www.aihw.gov.au/dataonline.cfm
  • Center for Excellence in Indigenous Tobacco
    Control, 2006, http//www.healthinfonet.ecu.edu.au
    /html/html_community/tobacco_community/publication
    s.htm
  • Cunningham J, Condon JR. Premature mortality in
    Aboriginal adults in the Northern Territory,
    1979-1991. Medical Journal of Australia
    1996165309-312
  • Henry B, Houston S, Mooney G. Institutional
    racism in Australian healthcare a plea for
    decency. Medical Journal of Australia
    2004180517-520
  • House of Representatives Standing Committee on
    Family and Community Affairs. Health is Life
    Report on the Inquiry into Indigenous Health.
    Canberra, 2000. Chapter 2 Improving the
    coordination, planning, and delivery of health
    services.

43
References
  • Leonard D, McDermott R, ODea K, et al. Obesity,
    diabetes, and associated cardiovascular risk
    factors among Torres Strait Islander people.
    Australian and New Zealand Journal of Public
    Health 200226(2)144-149
  • McDermott R, Rowley KG, Lee AJ, Knight S, O'Dea
    K. Increase in prevalence of obesity and diabetes
    and decrease in plasma cholesterol in a central
    Australian aboriginal community. Med J Aust. 2000
    May 15172(10)480-4.
  • Miller G, McDermott R, McCullough B, et al. The
    Well Persons Health Check a population
    screening program in Indigenous communities in
    North Queensland. Australian Health Review
    200225(6)136-147
  • Ring I, Firman D. Reducing Indigenous Mortality
    in Australia Lessons from other countries.
    Medical Journal of Australia 1998169
  • Thomas DP, Condon JR, Anderson IP, Li SQ, Halpin
    S, Cunningham J, Guthridge SL. Long-term trends
    in Indigenous deaths from chronic diseases in the
    Northern Territory a foot on the brake, a foot
    on the accelerator. Medical Journal of Australia
    2006185145-9
  • Wang Z, Hoy WE. Association between diabetes and
    coronary heart disease in Aboriginal people are
    women disadvantaged? Med J Aust. 2004 May
    17180(10)508-11.
  • Zhao Y, Guthridge S, Magnus A, Vos T. Burden of
    disease and injury in Aboriginal and
    non-Aboriginal populations in the Northern
    Territory. Medical Journal of Australia
    2004180498-502
  • Zhao Y, Dempsey K. Causes of inequality in life
    expectancy between Indigenous and non-Indigenous
    people in the Northern Territory, 1981-2000 a
    decomposition analysis. Medical Journal of
    Australia 2006184490-4
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