Overview
Health conditions such as cancer, kidney disease, respiratory disease, notifiable communicable diseases, circulatory system diseases, rheumatic fever and rheumatic heart disease and ear and hearing problems, contribute to the greater burden of ill-health experienced by Indigenous Australians compared to non-Indigenous.
Although the data presented here are limited in their availability and are often of uncertain quality, it is clear that Indigenous Australians suffer from a greater burden of ill health than other Australians. High rates of hospitalisation and illnesses, such as cancer, renal disease and some communicable diseases, all impact on the quality of life of Indigenous Australians. The absence of discussion of certain health conditions should not be understood to imply that Indigenous Australians experience only those described here. There is very little information about the health of people who are not hospitalised, or who are not recorded in the various registries (e.g. cancer, communicable diseases, ANZDATA), although surveys will provide new information in the near future. The high rates of illness experienced by Indigenous people are reflected in higher death rates, explained in the mortality section of this site.
On this page
Cancer
Cancer registries: Cancer is the third leading cause of death for Indigenous Australians. Information on cancer incidence comes from the state and territory cancer registries. The registries collect data on all malignant tumours except for non-melonoma skin cancers. It is believed that there is considerable under-identification of Aboriginal and Torres Strait Islander peoples in cancer registrations, although the exact extent of this has not been qualified. Indigenous cancer incidence rates have been reported to be lower than non-Indigenous rates in several states, however due to incomplete Indigenous identification in cancer registries, it appears likely that the incidence of cancer in Indigenous Australians is similar to that of other Australians.
Deaths from cancer: Mortality data from 1999-2003 show that 14.8% of deaths of Indigenous Australians were due to cancer, compared to 29.3% of deaths of non-Indigenous Australians. Although a lesser proportion overall, there were 1.5 times as many deaths from cancer among Indigenous males and females as would be expected based on the rates of non-Indigenous Australians.
Circulatory system diseases
Circulatory Disease Rates: Circulatory system diseases include coronary heart disease, stroke, peripheral vascular disease and heart failure. In 2004-05, 12% of Aboriginal and Torres Strait Islanders reported a long-term health condition associated with the circulatory system (ABS 2006). The most commonly reported condition of the circulatory system among Indigenous Australians was hypertension.
In 2004-05 hospital separation rates for circulatory diseases were 1.8 times higher for Indigenous Australians compared to non-Indigenous Australians.
Deaths from Circulatory Disease: In 1999-2003, in Western Australia, South Australia and Queensland and the Northern Territory, circulatory system diseases accounted for 27.3% of Indigenous deaths. Indigenous males and females died from circulatory diseases at 2.9 and 2.5 times the rates of non-Indigenous males and females, respectively.
Diabetes
Diabetes Rates: Diabetes is a disease of particular importance in the Indigenous population and manifests in two primary forms - Type 1 diabetes and Type 2 diabetes. Gestational diabetes is a third form that affects pregnant women.
The majority of Indigenous Australians diagnosed with diabetes have Type 2 diabetes (98-99%), often developing the disease earlier than other Australians. Although there are limited data on the national rates of gestational diabetes among Indigenous women, it is estimated that the rate could be as high as 20%.
In 2004-05 approximately 6% of Indigenous Australians reported diabetes/high sugar levels. The self-reported prevalence rate among Indigenous Australians was 3 times that among non-Indigenous Australians.
Hospitalisations for Diabetes: In 2003-04, diabetes represented 1% of all Indigenous hospitalisations. Approximately 83% of these were for Type 2 diabetes. Hospitalisation rates for diabetes for Indigenous males and females were five times those for other males and females.
Deaths from diabetes: Diabetes deaths accounted for 8% of all Indigenous deaths for the period 1999-2003 in Queensland, Western Australia, South Australia and the Northern Territory. Between 1999 and 2003, for persons aged 35-54 years, the age-standardised death rates from diabetes for Indigenous males was 73.6 per 100,000 population, and 56.7 per 100,000 population for Indigenous females. These rates were 21 and 37 times greater than for non-Indigenous males and females, respectively.
Diabetes-associated health conditions: Diabetes is associated with a number of other major health conditions. It has been associated with cardiovascular disease, and is a major cause of nephropathy (kidney disease), neuropathy (nerve damage), retinopathy resulting in blindness, and is associated with peripheral vascular disease, causing ulceration, gangrene and, ultimately, amputation. In addition, diabetes in pregnant women is associated with foetal abnormalities, and may also increase the risk of infants developing insulin resistance and other diabetes-related conditions later in life.
Risk factors for diabetes: A number of factors have been suggested as influencing the development of diabetes. Genetics, obesity, physical inactivity and poor diet and nutrition are some of these and are detailed below:
- Genetics: A family history of diabetes is a risk factor for both Type 1 and Type 2 diabetes, suggesting that genetic factors may play a role in the development of the disease. Type 1 diabetes is thought to occur after an auto-immune attack against the insulin-producing beta-cells in the pancreas, which may be caused by a genetic predisposition to the disease and exposure to environmental triggers (de Courten et al. 1998). Similarly, genetic factors play a role in the development of Type 2 diabetes, but their interaction with lifestyle and environmental factors is complex and not yet well understood (O'Dea 1992). High rates of Type 2 diabetes are often found in populations undergoing rapid changes to their lifestyle. A complex array of environmental and lifestyle factors may unmask a possible genetic susceptibility to the disease in these circumstances (O'Dea 1992).
- Nutrition: Diet plays a crucial role in the development of Type 2 diabetes. In general, the diet of Aboriginal and Torres Strait Islander people has undergone rapid change, from a low energy, low density diet to a diet high in energy derived from refined carbohydrates and saturated fats (O'Dea 1992). Evidence suggests that a diet of this kind leads to weight gain and increased insulin resistance, particularly in populations which have undergone rapid lifestyle transition. The association between diet and diabetes-related conditions was examined in a study involving a group of urban-dwelling Aborigines who spent seven weeks as "hunter-gatherers" in their homelands in the Kimberley region of northern Western Australia. Dietary changes, including the consumption of food low in saturated fat and high in complex carbohydrates, were accompanied by increased levels of physical activity. Metabolic abnormalities associated with Type 2 diabetes that were observed in the group were reported to be "greatly improved or completely normalised".
- Obesity: Type 2 diabetes is more common in people who are obese than in those who are not. Aspects of obesity that may be important in the development of Type 2 diabetes include the distribution of fat on the body, the timing of onset and the duration of obesity, and gender differences. Results from the 2004-05 NATSISS show that the percentage of Indigenous people who are overweight or obese across the age groups (from 15 years to 55 years and over) ranged from 29% to 60%. For non-Indigenous people the range was 24%-56%.
- Physical activity: Physical activity has been shown to lessen the risk of developing diabetes. From the few data available about the physical activity levels of Aboriginal and Torres Strait Islander people, it appears that Indigenous Australian adults are less likely to exercise than the rest of the adult population. Increased levels of physical activity are thought to contribute to improvements in the effectiveness of insulin, even where obesity is present.
A longitudinal study of Aboriginal people in Central Australia examining the association between body mass index (BMI) and the incidence of diabetes, found that the diabetes incidence rates for each category of BMI were among the highest in the world. Even in the lowest BMI category, the rate of diabetes was two to five times higher than the rate for the non-Aboriginal population. O'Dea (1996) and Daniel et al. (1999) have suggested that Aboriginal people may need to achieve a lower BMI than non-Aboriginal people, in order to reduce the risk of diabetes.
Ear and hearing problems
Rates of Ear and Hearing Problems: Approximately 12% of Indigenous Australians reported ear and hearing problems (2004-05 NATSIHS) compared to 13% of non-Indigenous Australians (2004-05 NHS). Indigenous people reported higher rates of hearing loss in all age groups from 0-54 years of age. In the 55+ age group non-Indigenous people reported higher rates of ear and hearing problems.
Children: Aboriginal and Torres Strait Islander children are reported as having ear and hearing problems approximately twice as often as non-Indigenous children. This is due in part to high rates of otitis media (middle ear infection) among children in many Indigenous communities (Couzos et al. 2001). Results of the 2004-05 NATSIHS show that the prevalence of hearing loss/diseases of the ear was 10% for Indigenous children aged 0-14, compared with only 3% of non-Indigenous children.
Kidney disease
Risk factors: Risk factors for kidney disease include diabetes, high blood pressure, infections, low birthweight and obesity, all of which are more common among Indigenous Australians than among other Australian people (ABS & AIHW 2005). Kidney disease affects a relatively small number of people, but has a severe impact on the quality of life of those affected and their carers. Also, the cost of treatment of kidney disease (e.g. haemodialysis) is very high.
Dialysis and Kidney Transplants: People with End Stage Renal Disease (ESRD) require dialysis or a kidney transplant for survival, as they have lost approximately 95% of their kidney function. These patients are registered with the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). In 2003, 882 (6.5%) of registrations were for patients who identified as Aboriginal and/or Torres Strait Islander, including new and continuing patients (ANZDATA). Of these, 86% were receiving dialysis treatment, and the remainder (14%) had functioning transplants. In contrast, 46% of all patients registered had a functioning transplant. Some of the reasons Indigenous patients are less likely to receive a transplant include having multiple illnesses, being less likely to find a suitable donor, lack of understanding by Indigenous patients about kidney disease and its treatments and communication issues between Indigenous patients and health professionals (ABS & AIHW 1999 and 2005).
Age and location of ESRD patients: Indigenous patients with ESRD are more likely to be younger than non-Indigenous patients with the disease. In 2003, around 63% of new and continuing Indigenous patients were under 55 years of age, compared with 46% of non-Indigenous patients (ANZDATA). Research has shown that ESRD incidence among Indigenous Australians in remote areas is 30 times higher than the total national incidence of ESRD. In urban areas, the incidence of ESRD among Indigenous Australians is much lower, but still higher than the national incidence rate (Cass et al. 2001).
Notifiable communicable diseases
Notifiable diseases surveillance: Notifiable communicable diseases include tuberculosis, various types of hepatitis, malaria, leprosy, measles, Haemophilus influenzae type b, syphilis, gonococcal infection, arbovirus infections (such as Ross River virus), chlamydial infection, meningococcal infection, mumps, pertussis, rubella, salmonellosis, and other diseases. State and territory health authorities forward information about disease notifications to the National Notifiable Diseases Surveillance System (NNDSS). The proportion of disease cases notified to the health authorities (and therefore to the NNDSS) is unknown and is likely to vary for different diseases and from one jurisdiction to another (Hargreaves et al. 1995).
Notification rates: In 2003, the notification rates for people identified as Indigenous were higher than rates for the total population in South Australia, Western Australia and the Northern Territory for chlamydial infection, donovanosis, gonococcal infection, Haemophilus influenzae type b, hepatitis A, hepatitis B, hepatitis C, meningococcal infection, salmonellosis, shigellosis, syphilis and tuberculosis, but lower or very similar for measles, pertussis (whooping cough), mumps, rubella and Ross River virus.
Because the Indigenous population has a younger age structure than the total population, diseases and infections which are more common in children and young people could be expected to have relatively higher crude rates in the Indigenous population than in the total population, even if age-specific rates were similar. However, for most of the communicable diseases, differences in the age structures of the two populations do not explain the differences in the crude rates.
HIV/AIDS
HIV/AIDS rates: Information on HIV/AIDS is published by the National Centre in HIV Epidemiology and Clinical Research (NCHECR 2000). Between 2000 and 2002, Indigenous males had similar rates of HIV infection to other males, whereas for Indigenous females rates were three times those of other females.
Mode of Infection: Between 2000 and 2002, the mode of infection with HIV was similar between Indigenous and non-Indigenous males and females. HIV was most commonly contracted through homosexual/bisexual contact for both Indigenous (53%) and non-Indigenous males (71%). The majority of Indigenous (74%) and non-Indigenous (89%) females with HIV contracted the disease through heterosexual contact. In contrast, a larger proportion of Indigenous males and females who contracted HIV were exposed to the virus through injecting drug use (24% and 21% respectively), compared to non-Indigenous males and females (3% and 4% respectively).
Rate of Decline: The rate of decline of HIV/AIDS infection among Indigenous Australians has been significantly slower than in the non-Indigenous population, since reaching a peak in 1994.
Respiratory diseases
Respiratory diseases are a leading cause of illness, disability and mortality in human populations around the world. Common respiratory diseases include influenza, pneumonia, asthma and chronic obtrusive pulmonary disease (COPD- comprising of both chronic bronchitis and emphysema).
Respiratory Disease Hospitalisations: In 2003-04, 7% of hospitalisations of Indigenous Australians were for respiratory diseases. Hospitalisations for respiratory diseases were twice as high in the Indigenous population as among other Australians.
Deaths from Respiratory Disease: In 1999-2003 there were 637 Indigenous deaths in Queensland, South Australia, Western Australia and the Northern Territory with respiratory diseases as the underlying cause of death, representing 8.6% of all Indigenous deaths in those jurisdictions. Indigenous males and females died from respiratory diseases at around 4 times the rate of non-Indigenous males and females.
Rheumatic fever and rheumatic heart disease
Acute rheumatic fever (ARF) is a bacterial infection that may lead to a weakening of the heart muscle if left untreated, leading to rheumatic heart disease (RHD). Although this disease is rare among the Australian population overall, rates among Indigenous Australians, particularly children, living in remote areas are very high. Poverty and overcrowding, poor sanitary conditions, lack of education and limited access to medical care for adequate diagnosis and treatment are recognised as contributing factors to this disease in Australia.
Incidence of ARF: In 2002, the incidence of acute rheumatic fever among Aboriginal and Torres Strait Islander children aged 5-14 years in the Top End of the Northern Territory was about 250 per 100,000 and in Central Australia it was about 350 per 100,000, accounting for about 50% of new cases in these areas. There were no reported cases of acute rheumatic fever among non-Indigenous children in the same age group.
Prevalence of RHD: In 2002, the prevalence of rheumatic heart disease was approximately 17 per 1,000 among Aboriginal and Torres Strait Islander peoples in the Top End of the Northern Territory and around 13 per 1,000 in Central Australia. The corresponding rate for other Australians was less than two per 1,000 in the Top End and 1 per 1,000 in Central Australia.
Hospitalisations for ARF and RHD: In 2003-04 Indigenous males were hospitalised at 13 times, and Indigenous females at 16 times, the rate of non-Indigenous males and females.
Deaths from ARF and RHD: Rheumatic fever and rheumatic heart disease accounted for 55 deaths in Queensland, Western Australia, South Australia and the Northern Territory in 2000-02. Indigenous Australians are far more likely to die from rheumatic fever and rheumatic heart disease than other Australians. The mortality rates for Indigenous males and females were 17 and 21 times the respective rates for non-Indigenous Australians.
Further information
For more general information on these health conditions, visit the following pages in the AIHW website:
Chronic diseases, Cancer, Cardiovascular Health, Diabetes, Population health.