National Aboriginal and Torres Strait Islander Health Measures Survey - Results for Very Remote Australia

Presents National Aboriginal and Torres Strait Islander Health Measures Survey 2022–24 results for people living in Very Remote Australia

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30/06/2025
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National Aboriginal and Torres Strait Islander Health Measures Survey, 2022-24

The following article presents National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) 2022–24 results for people living in Very Remote Australia.

This release has been developed in consultation with the ABS’s Aboriginal and Torres Strait Islander Health Surveys Advisory Group, a group of external stakeholders who have guided the content and release of data from this survey.

Any reference to persons/people/peoples in this product refers to Aboriginal and Torres Strait Islander persons/people/peoples.

The ABS recommends that users refer to the NATSIHMS 2022–24 methodology for important information that will help with interpreting these statistics. This includes information on response rates, coverage and sample bias. Undercoverage is higher in the NATSIHMS 2022–24 compared to other ABS surveys and caution is recommended when using these estimates.

Introduction

The National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) 2022–24 was conducted from August 2022 to April 2024. The survey measured specific biomarkers of chronic disease and nutrition in urine and/or blood samples that were voluntarily provided by Aboriginal and Torres Strait Islander participants aged 5 years and over across Australia, including very remote areas and discrete Indigenous communities. 

The margins of error presented in this article are 95% confidence intervals. Some data has been randomly adjusted to avoid the release of confidential data. This means discrepancies may occur between sums of the component items and totals. For more information, see the NATSIHMS 2022–24 methodology.

Very Remote Australia

Australia can be divided into five classes of Remoteness areas based on a measure of relative geographic access to services. The five remoteness classes are: Major Cities, Inner Regional, Outer Regional, Remote and Very Remote[1]. This article presents NATSIHMS results for people aged 5 years and over living in Very Remote Australia.

Map of ASGS Edition 3 Remoteness Areas for Australia

Map detailing the five different Remoteness Area classes which make up the Remoteness Structure. The map shows areas shaded in light to dark green colours, to demonstrate Very Remote Australia, Remote Australia, Outer Regional Australia, Inner Regional Australia and Major Cities of Australia respectively.

The Australian Institute of Health and Welfare’s report on the health of rural and remote Australians shows that people living in areas outside of Major Cities have higher rates of hospitalisations, deaths and injury and have poorer access to, and use of, primary health care services[2].

In 2021, 9.4% of all Aboriginal and Torres Strait Islander people lived in Very Remote Australia. Almost half (47.1%) of all people who lived in Very Remote Australia were Aboriginal and Torres Strait Islander people[3]. 

Biomedical results for children

Data for 12–17 year olds is not presented below for the biomarkers of cardiovascular disease, chronic kidney disease, or liver function as the cut-offs for these biomarkers used in the NATSIHMS 2022–24 only apply to persons aged 18 years and over. Results for 12–17 year olds have been presented for diabetes and nutrient biomarkers, however care should be taken when interpreting these results as they may be poorer quality than equivalent statistics for persons aged 18 years and over.

Diabetes

Diabetes is a chronic condition where the body is unable to produce or use insulin (a hormone that controls blood glucose levels). If left undiagnosed or poorly managed, diabetes can lead to coronary heart disease, stroke, kidney failure, limb amputations, and blindness[4]. For information about how diabetes is defined in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

In 2022–24, 22.5% of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia had diabetes, as defined by their blood test results, self-reported diabetes status and medication use. This comprised:

  • 18.4% who had known diabetes
  • 4.2% who had newly diagnosed diabetes.

A further 10.4% of Aboriginal and Torres Strait Islander people 18 years and over were at risk of diabetes. Only 1.3% of children aged 12–17 years old had diabetes.

Of Aboriginal and Torres Strait Islander people aged 18 years and over:

  • 20.0% of males and 25.0% of females had diabetes
  • people aged 18–34 years old (8.7%) were less likely to have diabetes than people aged 35–54 years old (26.4%) and people aged 55 years and over (45.8%).
  1. Weighted results for persons where a blood sample was collected.
  2. The proportion for 'newly diagnosed diabetes' has a high margin of error and should be used with caution.
  3. People with 'known diabetes' are those who either self-reported a diabetes diagnosis and regularly take diabetes medication, or self-reported a diabetes diagnosis and had a blood test result that was above the cut-offs for diabetes.
  4. People with 'newly diagnosed diabetes' are those who had a blood test result that was above the cut-offs for diabetes but did not self-report a diabetes diagnosis.

Cardiovascular disease

Cardiovascular disease (CVD) is an umbrella term that includes heart, stroke, and blood vessel diseases. For information about cardiovascular disease biomarkers in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

Total cholesterol

Cholesterol (a waxy, fat-like substance) is a lipid necessary to make hormones, including vitamin D, and also helps digestion[5]. Total cholesterol includes both low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol.

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia:

  • 17.9% had an abnormally high total cholesterol level (≥5.5 mmol/L)
  • 21.3% of males and 14.1% of females had an abnormally high total cholesterol level, however this difference was not statistically significant
  • there was no statistically significant difference in the proportion of people with an abnormally high total cholesterol level between age groups.
  1. Weighted results for persons where a blood sample was collected.

High-density lipoprotein (HDL) cholesterol

High density lipoprotein (HDL), also known as ‘good’ cholesterol, picks up cholesterol in the blood and transports it to the liver to be broken down. Having an abnormally low HDL cholesterol level may increase the risk of heart attack or stroke[5].

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia:

  • 62.5% had an abnormally low HDL cholesterol level (<1.0 mmol/L for males and <1.3 mmol/L for females)
  • three in four females (73.6%) and two in four males (49.1%) had an abnormally low HDL cholesterol level
  • there was no statistically significant difference in the proportion of people with an abnormally low HDL cholesterol level between age groups.
  1. Weighted results for persons where a blood sample was collected.

Chronic kidney disease

Chronic kidney disease (CKD) is characterised by a gradual loss of kidney function over time. This affects the kidney's ability to filter blood and leads to a build-up of waste and fluid inside the body[6]. For information about how CKD biomarkers are calculated and defined in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

There are five stages of CKD, ranging in severity from Stage 1 (lowest severity) to Stage 5 (highest severity)[7]. In the NATSIHMS, indicators of CKD were determined by combining estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR) results.

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia:

  • 7.6% had an abnormally low eGFR (<60 mL/min/1.73m²)
  • 31.9% had albuminuria (an ACR of ≥2.5 mg/mmol for males and ≥3.5 mg/mmol for females).

Males and females aged 18 years and over had similar rates of an abnormally low eGFR (6.9% for males and 8.9% for females) and albuminuria (30.9% for males and 32.6% for females).

In 2022–24, 33.4% of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia had indicators of CKD, comprising:

  • 19.1% with Stage 1 CKD (eGFR ≥90 mL/min/1.73 m² & albuminuria)
  • 8.6% with Stage 2 CKD (eGFR 60–89 mL/min/1.73 m² & albuminuria)
  • 2.2% with Stage 3a CKD (eGFR 45–59 mL/min/1.73 m²)
  • 0.8% with Stage 3b CKD (eGFR 30–44 mL/min/1.73 m²)
  • 2.4% with Stage 4–5 CKD (eGFR <30 mL/min/1.73 m²).

People aged 18–34 years old (18.8%) were less likely to have indicators of CKD than people aged 35–54 years old (39.1%) and people aged 55 years and over (51.9%). There was no significant difference in the proportion of males and females aged 18 years and over who had indicators of CKD (32.6% for males and 33.5% for females).

  1. Weighted results for persons where a blood sample and a urine sample were collected.
  2. Indicators of CKD are determined by combining a participants estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR) results. For more information, see the IHMHS: Concepts, Sources and Methods.

Liver function

The liver works as the body's filter, removing toxins from the blood, processing nutrients, and regulating metabolism. A range of factors, including fatty liver disease (where fat accumulates in the liver), infections and excessive alcohol consumption can lead to liver damage if left untreated[8]. While the liver function tests in the NATSIHMS 2022–24 cannot diagnose the presence of liver disease, elevated levels of either liver function biomarker may indicate liver damage. For more information, see the IHMHS: Concepts, Sources and Methods.

Alanine aminotransferase

Alanine aminotransferase (ALT) is an enzyme used to break down food into energy. An elevated ALT level indicates a degree of liver inflammation[9].

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia:

  • 26.2% had an abnormally high ALT level (>40 U/L for males and >30 U/L for females)
  • 22.8% of males and 29.0% of females had an abnormally high ALT level, however this difference was not significant
  • there was no statistically significant difference in the proportion of people with an abnormally high ALT level between age groups.
  1. Weighted results for persons where a blood sample was collected.

Gamma-glutamyl transferase

Gamma-glutamyl transferase (GGT) is a common enzyme found in many of the body’s tissues and organs, primarily in the liver. An elevated GGT level can indicate poor liver function[10].

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia:

  • 33.1% had an abnormally high GGT level (>50 U/L for males and >35 U/L for females)
  • males and females had similar rates of abnormally high GGT (35.4% and 31.1%)
  • the proportion of people with an abnormally high GGT level was steady with age, ranging from 31.3% of people aged 18–34 years old, to 36.8% of people aged 55 years and over.
  1. Weighted results for persons where a blood sample was collected.

Iron and haemoglobin

Iron is an essential mineral which is needed to produce red blood cells. Iron deficiency can lead to fatigue, tiredness, decreased immunity, and is the leading cause of anaemia worldwide[11][12]. For information about iron and haemoglobin biomarkers in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

Serum ferritin

Ferritin is a blood protein that stores iron. While normal serum ferritin levels vary by age and sex, a low serum ferritin level indicates iron depletion, and a high serum ferritin level suggests risk of iron overload. A low ferritin level is the first indicator of iron deficiency anaemia[13][14].

The World Health Organization recommends excluding individuals with elevated inflammatory markers, such as C-reactive protein (CRP), when analysing serum ferritin results because serum ferritin levels are affected by inflammation[13]. 

In the NATSIHMS 2022–24, people with a CRP level >10mg/L were excluded from serum ferritin analysis in line with WHO’s recommendation. This accounted for 20.5% of the weighted test results in Very Remote areas.

In 2022–24, the mean serum ferritin level for Aboriginal and Torres Strait Islander people in Very Remote Australia was:

  • 166 µg/L for people aged 18 years and over, which is above the population cut-off for ferritin deficiency (<15 µg/L)
  • lower for people aged 18–34 years old (101 µg/L) than for people aged 35–54 years old (183 µg/L) and people aged 55 years and over (263 µg/L)
  • higher for males 18 years and over than for females aged 18 years and over (202 µg/L compared to 135 µg/L)
  • 48 µg/L for children aged 12–17 years old.
  1. Weighted results for persons where a blood sample was collected.

Haemoglobin

Haemoglobin is a protein found in red blood cells that helps transport oxygen from the lungs to the rest of the body[13]. As iron is an essential part of the haemoglobin molecule, the haemoglobin concentration of whole blood can be used to test for iron deficiency anaemia. Along with anaemia, loss of red blood cells and problems with red cell production can result in a low haemoglobin concentration[15].

In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over in Very Remote Australia:

  • 12.9% had an abnormally low haemoglobin level (<130 g/L for males and <120 g/L for females)
  • females were more likely to have an abnormally low haemoglobin level than males (16.8% compared to 8.8%)
  • the proportion of people with an abnormally low haemoglobin level was steady with age, ranging from 11.5% of people aged 18–34 years old, to 16.4% of people aged 55 years and over.
  1. Weighted results for persons where a blood sample was collected.

Nutrient biomarkers

Iodine

Iodine is essential to make thyroid hormones that regulate normal growth and metabolism. Iodine deficiency in childhood or adulthood may lead to goitres or hypothyroidism, and impaired mental and physical development[16]. For information about iodine in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

In 2022–24, the population of Aboriginal and Torres Strait Islander people aged 18 years and over living in Very Remote Australia was iodine sufficient[17], with a median urinary iodine concentration (UIC) of 150 µg/L:

  • males and females aged 18 years and over had a similar median UIC (155 µg/L and 148 µg/L)
  • median UIC was similar among age groups for persons, males and females aged 18 years and over
  • females aged 16–44 years old had a median UIC of 150 µg/L, which is within the WHO cut-off for iodine sufficiency for the general population (100-199 µg/L) and for people who are pregnant (150-249 µg/L)
  • children aged 5–17 years old were also iodine sufficient, with a median UIC of 240 µg/L.
  1. Weighted results for persons where a urine sample was collected.

Vitamin D

Vitamin D is a hormone that is essential for the body to absorb and retain calcium and phosphorus effectively, which is important for bone health and muscle function. Vitamin D deficiency can cause inadequate bone mineralisation, leading to rickets in children and fractures and osteoporosis in adults[18]. For information about vitamin D in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

In 2022–24, for Aboriginal and Torres Strait Islander people living in Very Remote Australia:

  • the mean vitamin D level for people aged 18 years and over was 52 nmol/L
  • males and females aged 18 years and over had a similar mean vitamin D level (50 nmol/L and 55 nmol/L)
  • mean vitamin D levels did not vary significantly between any age groups for persons, males or females
  • the mean vitamin D level for children aged 12–17 years old was 57 nmol/L.
  1. Weighted results for persons where a blood sample was collected.

Vitamin D deficiency is classified as having a vitamin D level of less than 50 nmol/L. In 2022–24, of Aboriginal and Torres Strait Islander people aged 18 years and over:

  • nearly half (47.8%) were vitamin D deficient
  • the difference in the proportion of males and females who were vitamin D deficient was not significant (51.6% and 44.9%)
  • prevalence of vitamin D deficiency was similar among age groups for males and females.

One in three (34.0%) children 12–17 years old were vitamin D deficient.

  1. Weighted results for persons where a blood sample was collected.

Serum folate

Folate is a B group vitamin (B9) that the body uses to make DNA and other genetic material. It is essential for healthy growth and development, particularly for the foetus in the first 3 months of pregnancy[19][20]. Folate deficiency can lead to anaemia, and in pregnancy can increase the chance of neural tube defects of the newborn[21]. For information about folate in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

In 2022–24, for Aboriginal and Torres Strait Islander people in Very Remote Australia, the mean folate level:

  • was 25.1 nmol/L for people aged 18 years and over, which is above the population cut-off for folate deficiency (<10 nmol/L)
  • for males and females aged 18 years and over was similar (26.5 nmol/L and 23.8 nmol/L)
  • was similar amongst age groups for persons, males and females
  • was 30.0 nmol/L for children aged 12–17 years old.
  1. Weighted results for persons where a blood sample was collected.

Vitamin B12

Vitamin B12 is important for several functions in the body, including the production of red blood cells and DNA, and healthy functioning of the nervous system[22]. Vitamin B12 deficiency, if left untreated, can lead to anaemia, nerve damage and brain damage[23]. For information about vitamin B12 in the NATSIHMS 2022–24, see the IHMHS: Concepts, Sources, and Methods.

In 2022–24, for Aboriginal and Torres Strait Islander people in Very Remote Australia, the mean vitamin B12 level:

  • for people aged 18 years and over was 395 pmol/L, which is above the population cut-off for vitamin B12 deficiency (<150 pmol/L)[24]
  • was not significantly different between males and females aged 18 years and over (405 pmol/L and 387 pmol/L)
  • for children aged 12–17 years old was 446 pmol/L.
  1. Weighted results for persons where a blood sample was collected.

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National Aboriginal and Torres Strait Islander Health Measures Survey - Results for Very Remote Australia, 2022–24

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Footnotes

  1. Australian Bureau of Statistics, ‘Remoteness Structure’, https://www.abs.gov.au/statistics/standards/australian-statistical-geography-standard-asgs-edition-3/jul2021-jun2026/remoteness-structure; accessed 30/05/2025.
  2. Australian Institute of Health and Welfare, ‘Rural and remote health’, https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health; accessed 30/05/2025.
  3. Australian Bureau of Statistics, ‘Estimates of Aboriginal and Torres Strait Islander Australians’, https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoples/estimates-aboriginal-and-torres-strait-islander-australians/latest-release#remoteness-areas; accessed 30/05/2025.
  4. Australian Institute of Health and Welfare, ‘Diabetes: Australian facts – Summary', https://www.aihw.gov.au/reports/diabetes/diabetes/contents/summary; accessed 30/05/2025.
  5. The Heart Foundation, ‘Blood cholesterol’, https://www.heartfoundation.org.au/your-heart/high-blood-cholesterol; accessed 30/05/2025.
  6. Kidney Health Australia, ‘What is kidney disease: factsheet’, https://kidney.org.au/resources/factsheets-and-photosheets/what-is-chronic-kidney-disease-factsheet; accessed 30/05/2025.
  7. Kidney Health Australia, ‘Stages of kidney disease’, https://kidney.org.au/your-kidneys/what-is-kidney-disease/stages-of-kidney-disease; accessed 30/05/2025.
  8. Liver Foundation, ‘About the liver’, https://liver.org.au/your–liver/about–the–liver/; accessed 30/05/2025.
  9. Pathology Tests Explained, ‘ALT (Alanine Aminotransferase)’, https://pathologytestsexplained.org.au/ptests.php?q=ALT%20(Alanine%20aminotransferase); accessed 30/05/2025.
  10. Liver Foundation, ‘Liver tests explained’, https://liver.org.au/your–liver/treatments/liver–tests–explained/; accessed 30/05/2025.
  11. Health Direct, ‘Iron Deficiency’, https://www.healthdirect.gov.au/iron-deficiency; accessed 30/05/2025.
  12. World Health Organization, ‘Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity, Vitamin and Mineral Nutrition Information System’, https://www.who.int/publications/i/item/WHO-NMH-NHD-MNM-11.1; accessed 30/05/2025.
  13. World Health Organization, ‘WHO guideline on use of ferritin concentrations to assess iron status in individuals and population’, https://iris.who.int/handle/10665/331505; accessed 30/05/2025.
  14. Gibson, RS, & Friel, JK, ‘Principles of Nutritional Assessment: Iron’, https://nutritionalassessment.org/iron/index.html; accessed 30/05/2025.
  15. Australian Red Cross Lifeblood, ‘Anaemia’, https://www.lifeblood.com.au/patients-recipients/blood-plasma-platelets/reasons-for-a-transfusion/anaemia; accessed 30/05/2025.
  16. Eat for Health, ‘Iodine’ https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/iodine; accessed 30/05/2025.
  17. World Health Organization, ‘Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers, 3rd ed’, https://www.who.int/publications/i/item/9789241595827; accessed 30/05/2025.
  18. Eat for Health, ‘Vitamin D’, https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/vitamin-d; accessed 30/05/2025.
  19. World Health Organization, ‘Serum and red blood cell folate concentrations for assessing folate status in populations’, https://www.who.int/publications/i/item/WHO-NMH-NHD-EPG-15.01; accessed 30/05/2025.
  20. Gibson, RS, ‘Principles of Nutritional Assessment, Chapter 22: Folate and vitamin B12’, https://global.oup.com/academic/product/principles-of-nutritional-assessment-9780195171693?cc=au&lang=en&; accessed 30/05/2025.
  21. Eat for Health, ‘Folate’, https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/folate; accessed 30/05/2025.
  22. Dietitians Australia, ‘Vitamin B12’, https://dietitiansaustralia.org.au/health-advice/vitamin-b12; accessed 30/05/2025.
  23. Eat for Health, ‘Vitamin B12’, https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/vitamin-b12; accessed 30/05/2025.
  24. de Benoist B, ‘Conclusions of a WHO Technical Consultation on Folate and Vitamin B12 Deficiencies’, https://journals.sagepub.com/doi/abs/10.1177/15648265080292S129; accessed 30/05/2025.