Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.04 Respiratory disease

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Aboriginal and Torres Strait Islander peoples experience considerably greater mortality and morbidity from respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), pneumonia and invasive pneumococcal disease than other Australians. Chronic respiratory diseases were responsible for 9% of the total disease burden among Indigenous Australians in 2003. COPD and asthma caused 43% and 38% of this burden respectively. The burden from chronic respiratory diseases in Indigenous Australians occurred at a rate 2.5 times that of the total Australian population (Vos et al. 2007).

High rates of pneumonia are associated with factors such as respiratory diseases; poor living conditions; malnutrition; and smoking and alcohol misuse. Young children and those in older age groups are most at risk. Indigenous children in the NT have rates of radiologically confirmed pneumonia that are among the highest in the world (O'Grady et al. 2010). Although hospitalisation statistics reflect admissions to hospital rather than the prevalence or incidence of pneumonia in the community, they are a measure of the occurrence of severe pneumonia requiring acute care.

Asthma can impact on physical functioning and attendance at school and work. It commonly coexists with other chronic conditions and is often associated with low socioeconomic status and poorer quality of life. The mortality rate due to asthma in Australia is high on an international scale. Deaths due to asthma occur in all age groups, but the risk of dying from asthma increases with age. Asthma is more common among Indigenous Australians than other Australians, particularly adults, and Indigenous Australians have a higher risk of dying from asthma than other Australians (AIHW 2011b).Top of page

COPD is a serious lung disease that mainly affects older people and is often difficult to distinguish from asthma. It is characterised by chronic obstruction of lung airflow that interferes with breathing. In 2007–08, people aged 55 years and over with COPD were nearly twice as likely (20%) to be a current smoker than those without the disease (11%) (AIHW 2011b).

Findings:

Between 2006 and 2010, respiratory disease caused 8% of deaths among Indigenous Australians in NSW, Qld, WA, SA and the NT combined. This was around twice the non-Indigenous rate. For respiratory deaths among Indigenous Australians, 55% were attributed to COPD, 6% to asthma, and 21% to pneumonia and influenza. There has been a significant decline in respiratory disease mortality rates among Indigenous Australians since 1997, and also a significant decline in the gap.

Between July 2008 and June 2010, there were an estimated 35,343 hospitalisations for respiratory disease among Aboriginal and Torres Strait Islander peoples in the six jurisdictions with data of adequate quality. These episodes accounted for 6% of all hospitalisations for Indigenous Australians. After adjusting for differences in the age structure of the two populations, the hospitalisation rate for respiratory disease was 2.7 times as high for Aboriginal and Torres Strait Islander peoples as it was for non-Indigenous Australians. The greatest rate difference occurred in the younger (0–4 years) and older (55–64 and 65 years and over) age groups.

Rates of hospitalisations among Indigenous Australians for respiratory disease vary across the jurisdictions, from 26 per 1,000 in Victoria to 62 per 1,000 in the NT. Rates in remote areas were three times the rates in major cities for Indigenous Australians but rates were similar across geographic areas for non-Indigenous Australians. Over the last twelve years the hospitalisation rate for respiratory disease for Indigenous Australians fell significantly. Rates for Aboriginal and Torres Strait Islander children aged 0–4 years over the same period also declined significantly and the gap has narrowed.Top of page

In the period July 2008 to June 2010, hospitalisation for pneumonia was more common for Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians. Pneumonia (23%) was the most common type of respiratory disease for which Indigenous Australians were hospitalised. This was followed by COPD (13%) and asthma (11%). Between 2009–11 there were 683 notifications of invasive pneumococcal disease for Aboriginal and Torres Strait Islander peoples, representing 13% of all cases notified that year. Among people aged 55 years and over, hospitalisations for COPD were higher for Indigenous Australians than for other Australians, and cancer was commonly listed as an associated diagnosis (AIHW 2011b).

In 2004–05, the self-reported prevalence of asthma was higher among Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians. The rate for Aboriginal and Torres Strait Islander children was 14%, compared with 11% for non-Indigenous children. After adjusting for differences in the age structure of the two populations, Indigenous Australians aged 15 years and over were 1.6 times as likely as non-Indigenous people to have asthma. Asthma was reported almost twice as often by Indigenous people living in non-remote areas (17%) as in remote areas (9%).

Implications:

Top of pageBoth mortality rates and hospitalisation rates for respiratory disease have fallen, suggesting that the impact of respiratory disease on Aboriginal and Torres Strait Islander peoples has reduced in recent years. This finding provides encouragement that progress is being achieved, and that further improvements are possible. Rates of invasive pneumococcal disease in the general community have fallen since 2002, which appears to reflect the introduction and extension of pneumococcal vaccination since 2001 (see measure 3.02) (Roche et al. 2008). Improved influenza and pneumococcal vaccination coverage will be important in further reducing the burden of acute respiratory illness and death. However, hospitalisation for respiratory disease was 2.7 times as common for Indigenous Australians than other Australians and mortality rates were double. Therefore, respiratory disease remains an important public health issue. Initiatives addressing smoking, immunisation, living conditions, overcrowding, chronic disease and access to health care are likely to contribute to improvements in respiratory disease.
Figure 19—Age-standardised hospitalisation rates for respiratory disease by Indigenous status and remoteness, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010

Figure 19—Age-standardised hospitalisation rates for respiratory disease by Indigenous status and remoteness, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 20—Age-specific hospitalisation rates for respiratory disease, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to July 2010
Figure 20—Age-specific hospitalisation rates for respiratory disease, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to July 2010
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 21—Age-standardised hospitalisation rates for respiratory disease, by Indigenous status, sex, and jurisdiction, July 2008 to June 2010
Figure 21—Age-standardised hospitalisation rates for respiratory disease, by Indigenous status, sex, and jurisdiction, July 2008 to June 2010
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 22—Deaths of Indigenous Australians from respiratory disease, by sex, NSW, Qld, WA, SA and the NT, 2006–10
Figure 22—Deaths of Indigenous Australians from respiratory disease, by sex, NSW, Qld, WA, SA and the NT, 2006–10
Source: ABS and AIHW analysis of ABS Mortality Database
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Figure 23—Age-standardised mortality rates, respiratory diseases, by Indigenous status

Figure 23—Age-standardised mortality rates, respiratory diseases, by Indigenous status
Source: ABS and AIHW analysis of ABS Mortality Database
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