Better health and ageing for all Australians

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

Tier 1—Health conditions—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, such as increased levels of obesity and diabetes, threaten to slow or reverse these improvements. Circulatory disease is more common among Indigenous Australians and tends to occur at much younger ages. Circulatory disease accounts for 17% of the burden of disease in Indigenous Australians (Vos et al. 2007) and 26% of mortality (see measure 1.23). Smoking levels are high among Indigenous adults (see measure 2.18), although evidence shows a small reduction in the most recent period. Levels of physical inactivity, 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 2006–10, circulatory disease was the leading cause of death among Indigenous Australians, with a death rate 1.7 times that of non-Indigenous Australians (see measure 1.23). Studies have found that Indigenous Australians are more likely to experience major coronary events and are also more likely to die from them (You et al. 2009; AIHW 2006a).Top of page

There has been a 41% decline in the mortality rate for Aboriginal and Torres Strait Islander peoples between 1997 and 2010 and a significant narrowing of the gap. A study in the NT between 1992 and 2004 found an increase in incidence of acute myocardial infarction and at the same time an improvement in survival both prior to and after hospital admission (You et al. 2009).

In 2004–05, approximately 12% of Aboriginal and Torres Strait Islander peoples reported having a diagnosed circulatory condition. After adjusting for differences in the age structure of the two populations, Indigenous Australians were 1.2 times as likely to report having circulatory disease as non-Indigenous Australians and almost twice as likely to have coronary heart disease (Penm 2008). The greatest disparities were in the 25–54 year age groups. There was no 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 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, Aboriginal and Torres Strait Islanderpeoples were more likely to report having circulatory disease if they were unemployed (28%) than if they were employed (23%). Circulatory diseases were also associated with low or sedentary exercise levels, overweight/obesity and high cholesterol.

BEACH survey data collected from April 2006 to March 2011 suggest that approximately 8% of problems managed by GPs among Aboriginal and Torres Strait Islander peoples were for circulatory conditions. After adjusting for differences in the age structure of the two populations, rates for the management of hypertension and cardiac check-ups were similar to those for other Australians, yet the management rate for ischemic heart disease was twice as high.Top of page

For the two years to June 2010, after adjusting for differences in the age structure of the two populations, the circulatory disease hospitalisation rate for Aboriginal and Torres Strait Islander peoples was 1.7 times that of non-Indigenous Australians. Between 1998–99 and 2009–10, the hospitalisation rate for Indigenous Australians for circulatory disease was stable, but decreased by 13% for non-Indigenous Australians. Hospitalisation rates were higher for Indigenous males (38 per 1,000) than Indigenous females (31 per 1,000).

IHD was the most common type of circulatory disease hospitalisation for Indigenous Australians (43%). Diabetes was a common comorbidity. Among those hospitalised for coronary heart disease, Indigenous Australians were nearly half as likely to receive coronary procedures such as coronary angiography and revascularisation procedures (see measure 3.06). A study in the NT found that they were also less likely to receive in-patient cardiac rehabilitation, prescription of statins on discharge, and were more likely to die in the two years after discharge (Brown 2010). A study in NSW found that patients admitted to smaller more remote hospitals without on-site angiography had increased risk of short- and long-term mortality (Randall et al. 2012).

Implications:

Circulatory disease problems were managed by GPs at similar rates for both Indigenous Australians and other Australians. Hospitalisation rates for circulatory disease were higher among Indigenous Australians but they were less likely to receive coronary procedures when in hospital than non-Indigenous Australians. High rates of mortality due to circulatory disease indicate a failure in the areas of prevention, diagnosis and early detection, early treatment, chronic disease management, treatment and rehabilitation.

Approaches that are culturally competent, family-centred, and encourage partnerships with Aboriginal and Torres Strait Islander people to work collaboratively across the continuum of prevention and care, have been identified as key points for success (NHMRC 2005).

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes includes a focus on preventive health, primary health care and specialist care. Initiatives are being implemented to improve specialist care for Aboriginal and Torres Strait Islander peoples with chronic diseases, including programs to support primary care providers to better coordinate chronic disease management, and increase access to specialist and multidisciplinary team care.Top of page

A study in the NT of avoidable mortality for Indigenous Australians between 1985 and 2004 found significant improvement associated with conditions amenable to medical care and marginal improvement for conditions responsive to preventative measures. The study noted the reduction of mortality from stroke and hypertensive disease were consistent with improved drug therapies, improved intensive care, dedicated 'stroke units' and surgical procedures (Li et al. 2009a). Under the Health and Hospitals Fund 2011 Regional Priority Round, more than $6 million is being provided in Darwin to establish an Integrated Cardiac Network Service. This service will link Darwin, Alice Springs, Tennant Creek, Katherine and Gove, to better diagnose and manage cardiac disease in the NT Indigenous population. Also, well-equipped cardiac care outreach and rehabilitation services will be linked to diagnose and manage coronary artery disease, rheumatic heart disease, arrhythmias and heart failure.
Figure 24—Age-standardised hospitalisation rates for circulatory disease, by Indigenous status

Figure 24—Age-standardised hospitalisation rates for circulatory disease, by Indigenous status
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 25—Age-specific hospitalisation rates for circulatory disease, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010

Figure 25—Age-specific hospitalisation rates for circulatory disease, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
Source: AIHW analysis of National Hospital Morbidity Database
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Table 6—Age-standardised hospitalisations for circulatory disease by principal diagnosis for Aboriginal and Torres Strait Islander peoples by sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
Male %Male rate(a)Male ratioFemale %Female rate(a)Female ratioPersons %Persons
rate(a)
Persons
ratio
Ischaemic heart disease
47.0
17.1
1.9*
38.7
12.1
3.1*
43.0
14.4
2.3*
Pulmonary and other heart disease
29.1
11.9
1.6*
31.4
10.3
1.9*
30.2
11.0
1.7*
Cerebrovascular disease
7.6
3.5
1.8*
8.8
3.3
2.2*
8.2
3.4
2.0*
Rheumatic fever and heart disease
2.7
0.4
4.8*
5.5
0.9
8.3*
4.0
0.7
6.8*
Hypertension disease
2.1
0.6
2.7*
3.4
1.0
3.0*
2.7
0.9
2.9*
Other diseases of the circulatory system
11.5
4.0
0.7*
12.2
3.2
0.7*
11.9
3.6
0.7*
Total(b)
100.0
37.5
1.5*
100.0
30.7
1.9*
100.0
33.9
1.7*
(a)Rate 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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Table 7—Age-standardised hospitalisations for circulatory disease for Aboriginal and Torres Strait Islander peoples by sex and jurisdiction, July 2008–June 2010
Male numberMale rate(a)Male ratioMale numberMale rate(a)Male ratioPersons numberPersons
rate(a)
Persons
ratio
New South Wales
2,675
35.3
1.5*
2,300
27.5
1.8*
4,975
31.1
1.6*
Victoria
510
29.6
1.1*
415
21.1
1.2*
925
24.8
1.2*
Queensland
2,754
42.2
1.8*
2,620
36.0
2.2*
5,374
38.9
1.9*
Western Australia
1,490
37.5
1.6*
1,382
33.4
2.3*
2,872
35.5
1.9*
South Australia
506
34.3
1.5*
539
32.5
2.2*
1,045
33.4
1.8*
Northern Territory
1,427
37.3
1.9*
1,310
29.4
2.4*
2,737
33.0
2.0*
Tasmania
120
15.5
1.0
85
8.7
1.0
205
12.1
1.0
Australian Capital Territory
43
29.1
1.7*
33
16.7
1.5
76
22.3
1.6*
Total(b)
9,362
37.5
1.5*
8,566
30.7
1.9*
17,928
33.9
1.7*
(a)Rate per 1,000 persons, directly age-standardised using the Australian 2001 standard
(b)Total excludes Tasmania and the ACT
*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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