Population health impacts of dementia among First Nations people
This page presents the latest data showing the population health impacts of dementia among First Nations people including:
- prevalence and incidence of dementia
- deaths due to dementia
- deaths due to dementia versus deaths with dementia.
Although there are no national-level estimates of the number of First Nations people with dementia, studies examining different communities of First Nations people have consistently found that dementia prevalence rates are about 3–5 times as high as rates for Australia overall.
High dementia prevalence (that is, all dementia cases in a given period) and incidence (that is, new dementia cases in a given period) have been documented recently for very different groups of First Nations people:
- Rates of dementia for First Nations people in remote and rural communities are among the highest in the world. For First Nations people aged 45 and over living in the remote Kimberley region of Western Australia, dementia prevalence was 12.4% (Smith et al. 2008), and when followed up 7 years later for those aged 60 and over, dementia incidence was 21 per 1,000 person years (LoGiudice et al. 2016).
- Across the Northern Territory, the age-adjusted prevalence of dementia diagnoses recorded in electronic health data systems for First Nations people aged 45 and over was 6.5%, compared with 2.6% among the non-Indigenous Australians (Li et al. 2014).
- First Nations people also had a younger age of onset of dementia, with a median age of 72 years compared with a median age of 79 years among non-Indigenous Australians. The age-adjusted incidence rate of dementia among First Nations people aged 45 and over was about 2.5 times as high as the rate among non-Indigenous Australians (27 and 11 per 1,000 person years, respectively) (Li et al. 2014).
- Among urban and regional dwelling First Nations people aged 60 and over, the prevalence of dementia was about 3 times as high as the overall Australian prevalence for the same age group (21% and 6.8%, respectively), with Alzheimer’s disease being the most common type of dementia present. Dementia prevalence rates among urban and regional dwelling First Nations people were slightly lower compared to rates among First Nations people living in remote areas (Radford et al. 2017).
- A study by Russell et al. (2020), estimated a dementia prevalence of 14.2% among Torres Strait Islanders aged between 45 and 93 years.
- The ARC Centre for Excellence in Population Ageing Research projected that by 2051, the relative growth in the number of First Nations people aged 50 years and over with dementia will be 4.5 to 5.5 times the 2016 estimated prevalence (Temple et al. 2022). The study attributes this to the Aboriginal and Torres Strait Islander population ageing, where age is a known risk factor for dementia.
Evidence of high prevalence, younger onset, and high incidence of dementia, suggests that without interventions to help moderate the impact of dementia, its burden among First Nations people will continue to grow in coming years.
Preventing dementia in First Nations people requires an understanding of the underlying medical and social risk factors for developing dementia. Some important risk factors that present at higher levels among First Nations people include: head injury, stroke, diabetes, high blood pressure, renal disease, cardiovascular disease, obesity, hearing loss, childhood stress and trauma, and lower socioeconomic status (Flicker and Holdsworth 2014; Goldberg et al. 2018; Radford et al. 2019). A key national research priority is to develop and evaluate culturally responsive programs, interventions and policies to reduce dementia risk factors across the life course and prevent or delay the onset of cognitive decline and dementia (including by targeting social determinants of health) (NHMRC 2020).
Continuing the improvement and quality of First Nations identifiers in administrative data sets would support better dementia prevalence estimates for First Nations people across Australia (AIHW 2020; Griffiths et al. 2019). Similarly, ensuring the availability and uptake of culturally sensitive and validated assessment tools to diagnose cognitive decline and dementia would lead to improved estimates of dementia prevalence as well as better diagnosis of dementia among First Nations people. The Kimberley Indigenous Cognitive Assessment (KICA) tool is an example of such a tool, which allows for the cognitive screening of older First Nations people living in urban, rural (KICA urban regional) and remote (KICA remote) areas of Australia, as well as the assessment of possible dementia. The complete resource package includes patient and carer assessments, family reports, pictures, and an instruction booklet and video. These are available from Aboriginal Ageing Well Research.
This section reports on deaths where dementia was recorded as the underlying cause of death, referred to as deaths due to dementia. It also presents death statistics aggregated over several years as a result of the small number of deaths due to dementia among First Nations people in any given year. Except for data reported by remoteness area, dementia-related deaths for First Nations people exclude data from Tasmania, Victoria and Australian Capital Territory, as these jurisdictions are considered to have inadequate levels of Indigenous identification in mortality data. Refer to Deaths due to dementia for more information on dementia-related deaths for all Australians. See the Technical notes for more information about deaths data, such as known issues with under-identification of First Nations people.
During 2019–21, about 370 First Nations people died due to dementia (230 women and 130 men). During this period, dementia was the fifth leading cause of death among First Nations people aged 65 and over (about 350 deaths, after coronary heart disease, chronic obstructive pulmonary disease, diabetes, and lung cancer), accounting for 8% of all deaths among First Nations people aged 65 and over.
To assess trends in deaths due to dementia over the past 10 years, the number of deaths due to dementia for 2012–2016 were compared to the number of deaths in the most recent 5-year period (2017–21). The number of deaths due to dementia among First Nations people increased in the most recent 5-year period (2017–21) for men and women across all ages (Figure 12.1). During 2012–2016, there were around 320 deaths due to dementia among First Nations people, while there were 580 deaths due to dementia during 2017–21. This is equivalent to an 83% increase in deaths due to dementia among First Nations people during this period, with the highest increase among people who died aged 85 and over (98% increase).
Between 2017 and 2021, most deaths due to dementia among First Nations men and women occurred among those aged 85 and over, but a larger proportion of First Nations men (70%) were aged less than 85 compared to First Nations women (52%). With an ageing First Nations population, it is expected that the number of deaths due to dementia will continue to rise in the future.
Figure 12.1: Deaths due to dementia among First Nations people during 2012–2016 and 2017–2021, by age and sex
This figure shows that the number of deaths among First Nations men and women increased by age and recency.
The majority of deaths among First Nations people due to dementia in 2019–21, were recorded as due to Unspecified dementia (around 220 or 62% of deaths due to dementia), followed by Alzheimer’s disease (23%) and Vascular dementia (10%) (Table S12.4). These dementia types were also the most common types recorded overall among Australians who died due to dementia in 2021 (see the Deaths due to dementia).
A nationwide study of mortality data between 2006–2014 showed that deaths with dementia were 57% higher among First Nations people compared to non-Indigenous Australians, with the biggest difference occurring among men and those aged less than 75 years. First Nations people were also more likely to have dementia coded as Unspecified dementia, compared to non-Indigenous Australians (Waller et al. 2021).
Due to the low number of deaths among First Nations people for particular types of dementia, and because there are known limitations with the accuracy and consistency of dementia coding on death certificates, the breakdowns by dementia subtypes presented here can only be considered indicative of the distribution of dementia types among First Nations people. For more information on these limitations, see Deaths due to dementia and Technical notes.
After accounting for population differences in different geographic areas in Australia, there are notable geographic variations in deaths due to dementia during 2019–21 (Figure 12.2). Age-standardised rates of deaths due to dementia among First Nations people were:
- lowest in New South Wales (41 per 100,000 First Nations people) and highest in the Northern Territory (131 per 100,000 First Nations people)
- lowest in Inner and Outer regional areas (49 per 100,000 First Nations people) and highest in Remote and Very remote areas (109 per 100,000 First Nations people).
This figure shows that dementia death rates of First Nations people varied by state or territory, as well as by remoteness areas.
The discussion about dementia deaths among First Nations people has so far been restricted to deaths due to dementia, that is, where dementia was recorded as the underlying cause of death (UCOD). In addition to the underlying cause of death, the National Mortality Database contains information on up to 19 associated causes of death (ACOD) – that is, other causes that were instrumental or significantly contributed to the death. Given people with dementia often have other health conditions and there can only be one underlying cause of death recorded, it is important to also account for all other cases where First Nations people died with dementia (where dementia was recorded as the underlying or an associated cause of death).
During 2019–21, about 370 First Nations people died due to dementia. In comparison, just over 780 First Nations people died with dementia (Figure 12.3). Around half (47%) of the deaths with dementia among First Nations people in 2021 were deaths due to dementia (that is, dementia was the underlying cause of death). This proportion increased by age at death, from 41% of deaths with dementia among First Nations people who died aged under 75, to 53% among First Nations people who died aged 85 or over. Across all age groups, the number of deaths involving dementia were much higher when associated cause of death information on dementia was included.
This figure shows that in all age groups, the number of deaths among First Nations people was higher when deaths with dementia were included along with deaths due to dementia.
When dementia was an associated cause of death, common underlying causes of death included: diabetes, coronary heart disease and cerebrovascular disease (Table S12.7). These conditions were also common underlying causes of death among Australians generally when dementia was an associated cause of death (Table S3.8).
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