Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.05 Circulatory disease

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Why is it important?:

Circulatory disease is a major cause of morbidity and mortality in older Australians. In recent decades, Australian mortality rates from circulatory disease have fallen considerably, due to factors such as reduced smoking rates and improved treatment of high blood pressure and ischaemic heart disease (IHD). However, recent trends in Australian society, such as increased levels of obesity and diabetes, threaten to slow or reverse these improvements. Circulatory disease occurs much more frequently in Indigenous Australians and at much younger ages. Circulatory disease accounts for 17% of the burden of disease in Indigenous Australians (Vos et al. 2007) and 27% of mortality (see measure 1.23). Smoking levels are high among Indigenous adults (see measure 2.18) with evidence of a small reduction in the most recent period, while levels of physical inactivity and obesity, diabetes and high blood pressure are much higher than for non-Indigenous Australians. Additionally, low socioeconomic status is associated both with greater risk of developing circulatory disease and with lower chance of receiving appropriate treatment (Beard et al. 2008; Cunningham 2010).

Findings:

In 2004–05, approximately 12% of Indigenous Australians reported having a circulatory condition. After adjusting for differences in the age structure of the two populations, Indigenous Australians were 1.2 times as likely to have circulatory disease as non-Indigenous Australians—twice as likely for coronary heart disease (Penm 2008). There was no significant change in self-reported levels of circulatory disease between 2001 and 2004–05. Indigenous Australians living in remote areas reported higher rates of circulatory disease than those living in non-remote areas (14% compared with 11%). Self-reported rates of circulatory disease were also higher for Indigenous females (15%) compared with males (11%). Main conditions reported were hypertension (7%), coronary heart disease (1%), heart failure (1%) and rheumatic heart disease (0.7%) (Penm 2008).

In 2004–05, Indigenous Australians were more likely to report having circulatory disease if they were not in the labour force (30%) than if they were employed (23%). Circulatory diseases were also associated with low or sedentary exercise levels and overweight/obesity.

From July 2006 to June 2008, the circulatory disease hospitalisation rate for Indigenous Australians was just over 1.5 times that of other Australians. Hospitalisation rates were higher for Indigenous men (37 per 1,000) than Indigenous women (31 per 1,000). The difference in rates between Indigenous and other Australians is greater for women (rate ratio of 1.8) than for men (rate ratio of 1.4).

Between 2001–02 and 2007–08, the hospitalisation rate for Indigenous Australians was stable, while it decreased slightly for other Australians. IHD is the most common type of circulatory disease causing hospitalisation for Aboriginal and Torres Strait Islander peoples, accounting for 44% of all circulatory disease hospitalisations. This is twice the rate for other Australians. Hospitalisation rates vary across jurisdictions from 23 per 1,000 in Victoria to 39 per 1,000 in Western Australia.

Circulatory conditions were managed in approximately 13% of general practice attendances by Aboriginal and Torres Strait Islander peoples. Indigenous Australians have a similar attendance rate for circulatory disease to other Australians (rate ratio of 1.2). However the pattern varies for specific types of consultations, for example, hypertension and cardiac check-up rates were similar to other Australians, yet visits for IHD and heart failure were higher (2 and 3 times respectively).

Circulatory disease mortality rates for Indigenous Australians during the period 2004–08 were twice the rate for non-Indigenous Australians (see measure 1.23). Inequalities in risk factors, hospitalisations, mortality, and access to procedures for treating IHD also exist between Maori and other New Zealanders (Curtis et al. 2010). This points to the increasing burden of cardiovascular disease in Indigenous populations worldwide (Kritharides et al. 2010).

Implications:

Although the self-reported prevalence of circulatory disease for Aboriginal and Torres Strait Islander peoples is only slightly higher than for other Australians, mortality rates and hospitalisation rates are much higher. Circulatory problems were managed at general practice encounters at similar rates for Indigenous patients and other patients. High rates of hospitalisation and mortality indicate a failure in the areas of prevention, early detection, early treatment and chronic disease management.

Smoking, physical inactivity, poor diet, high alcohol consumption, obesity and diabetes all damage the circulatory system. Australian cohort studies suggest obesity rates are similar between Indigenous and non-Indigenous children. This suggests that cardiovascular health disparities manifest beyond childhood, providing opportunity for prevention (Haysom et al. 2009).

While there have been improvements in Indigenous circulatory disease mortality rates over the last decade, it is still the most common cause of death (27%). A better understanding is required of why GP attendances for hypertension and cardiac check-ups are relatively low considering the mortality rates. Improved access to and utilisation of both primary and acute care services for Aboriginal and Torres Strait Islander peoples are necessary to achieve earlier diagnosis and better management of circulatory disease.

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes includes a focus on preventive health and primary health care. Initiatives are being introduced to improve specialist care for Indigenous Australians with chronic diseases, including new programs to support primary care providers to better coordinate chronic disease management, and increase access to specialist and multidisciplinary team care.

Figure 15 – Age-standardised hospitalisation rates for a principal diagnosis of circulatory disease for Aboriginal and Torres Strait Islander and other peoples in Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08


Figure 15 – Age-standardised hospitalisation rates for a principal diagnosis of circulatory disease for Aboriginal and Torres Strait Islander and other peoples in Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 15 (TXT 1KB)

Figure 16 – Age-specific hospitalisation rates for a principal diagnosis of circulatory disease, by Indigenous status and sex, NSW, Vic., Qld, WA, SA and NT, July 2006 – June 2008


Figure 16 – Age-specific hospitalisation rates for a principal diagnosis of circulatory disease, by Indigenous status and sex, NSW, Vic., Qld, WA, SA and NT, July 2006 – June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 16 (TXT 1KB)

Table 10 – Age-standardised hospitalisations for circulatory disease by principal diagnosis for Aboriginal and Torres Strait Islander peoples by sex, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008

Principal Diagnosis
Males
Females
Persons
%
Rate
Ratio
%
Rate
Ratio
%
Rate
Ratio
Ischaemic heart disease
47.1
17.2
1.7*
39.8
12.4
2.8*
43.6
14.6
2.1*
Acute myocardial infarction
20.2
7.2
2.2*
14.3
4.6
3.1*
17.4
5.8
2.5*
Subsequent myocardial infarction
0.2
0.1
4.3*
0.3
0.1
9.9*
0.2
0.1
6.2*
Pulmonary and other heart disease
29.2
11.5
1.5*
31.3
10.2
1.9*
30.2
10.8
1.7*
Cerebrovascular disease
7.5
3.5
1.6*
8.6
3.0
1.9*
8.0
3.2
1.8*
Stroke
6.5
3.0
1.7*
7.6
2.8
2.1*
7.0
2.9
1.9*
Rheumatic fever and heart disease
3.2
0.5
5.3*
5.4
0.9
8.2*
4.2
0.7
6.9*
Hypertension disease
2.3
0.7
2.6*
3.4
1.0
2.5*
2.8
0.8
2.6*
Other diseases of the circulatory system
10.7
3.4
0.6*
11.5
3.1
0.6*
11.1
3.2
0.6*
Total
100.0
36.8
1.4*
100.0
30.5
1.8*
100.0
33.4
1.6*
Total number of hospitalisations for circulatory disease:
8,630
7,900
16,530
(a) Per 1,000 persons, directly age-standardised using the Australian 2001 standard population.
* Represents results with statistically significant differences in the Indigenous/other comparisons at the p<.05 level.

Source: AIHW analysis of National Hospital Morbidity Database

Table 11 – Age-standardised hospitalisations with a principal diagnosis of circulatory disease for Aboriginal and Torres Strait Islander peoples by sex and jurisdiction, July 2006–June 2008

Male
Female
Persons
Number
Rate
Ratio
Number
Rate
Ratio
Number
Rate
Ratio
New South Wales
2,443
32.8
1.3*
2,036
26.0
1.6*
4,479
29.2
1.4*
Victoria
385
22.9
0.8*
422
23.5
1.3*
807
23.2
1.0
Queensland
2,450
40.7
1.5*
2,405
35.8
2.1*
4,855
38.1
1.8
Western Australia
1,519
43.8
1.9*
1,319
34.6
2.4*
2,838
38.8
2.1*
South Australia
538
40.1
1.6*
518
32.7
2.0*
1,056
36.0
1.8*
Northern Territory
1,295
38.1
2.0*
1,200
29.8
2.5*
2,495
33.3
2.1*
Australia8,63036.8 1.4*
7,90030.61.8*
16,530 33.5 1.6*
(a) Per 1,000 persons, directly age-standardised using the Australian 2001 standard population.
* Represents results with statistically significant differences in the Indigenous/other comparisons at the p<.05 level.

Source: AIHW analysis of National Hospital Morbidity Database

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