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SPECIFIC CAUSES OF ILL-HEALTH
Indigenous people aged 55 years and over were more likely than those in the younger age groups to report feeling happy and calm/peaceful all or most of the time however the only statistically significant difference was between the rates for this older group and those aged 25-34 years. Indigenous people aged 55 years and over were least likely to report feeling full of life or having a lot of energy all or most of the time (AIHW forthcoming).
Hospitalisations for mental and behavioural disorders
Data on hospitalisations for mental and behavioural disorders provide a measure of the use of hospital services by those with problems related to mental health. In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, there were 5,504 hospitalisations of Indigenous males and 4,579 hospitalisations of Indigenous females for mental and behavioural disorders (table 7.11). This represented 5% and 3% of all hospitalisations of Indigenous males and females respectively.
There were more hospitalisations of Indigenous males and females than expected based on the rates for other Australians for most types of mental and behavioural disorders (table 7.11). In particular, hospitalisations for 'mental and behavioural disorders due to psychoactive substance use' were almost five times higher for Indigenous males and around three times higher for Indigenous females than for other males and females.
Hospitalisation rates for intentional self-harm may also be indicative of mental illness and distress. In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, Indigenous Australians were more likely to be hospitalised for intentional self-harm than other Australians (rates were three times as high for Indigenous males and twice as high for Indigenous females) (see table 7.26).
Circulatory system diseases
Circulatory system diseases include coronary heart disease, stroke, peripheral vascular disease, hypertension and heart failure. The main underlying problem in circulatory system diseases is atherosclerosis, a process that clogs blood vessels with deposits of fat, cholesterol and other substances that have built up in the inner lining of the vessels. It is most serious when it affects the blood supply to the heart (which can lead to angina, heart attack or sudden death) or to the brain (which can lead to a stroke).
Prevalence of circulatory diseases
In 2004-05, an estimated 12% of Indigenous people reported suffering from heart disease and/or other circulatory conditions (table 7.5). The reported prevalence of heart and circulatory conditions was higher among older people. For example, 54% of Indigenous people aged 55 years and over reported a heart or circulatory condition compared with 11% of those aged 25-34 years (ABS 2006c).
Hypertensive disease (high blood pressure) was the most common type of heart or other circulatory condition reported by both Indigenous and non-Indigenous Australians in 2004-05 (15% and 11% respectively). After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were one-and-a-half times as likely as non-Indigenous people to have hypertensive disease (AIHW 2007a).
Hospitalisations for circulatory diseases
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, diseases of the circulatory system were the main reason for 4,181 hospitalisations of Indigenous males, representing 4% of hospitalisations for Indigenous males. For Indigenous females, the comparative figures were 3,678 hospitalisations, representing 3% of hospitalisations for Indigenous females (table 7.13).
Indigenous Australians had higher hospitalisation rates for diseases of the circulatory system than other Australians across all age groups. The differences were most marked in relative terms among those aged 25-44 years and 45-64 years, where Indigenous hospitalisation rates were more than twice the rates for other Australians (graph 7.12).
Indigenous Australians were hospitalised at higher rates than other Australians for most types of circulatory system diseases (table 7.13). For the most common type of circulatory system disease (ischaemic heart disease), there were over twice as many hospitalisations of Indigenous males and four times as many hospitalisations of Indigenous females as for other Australian males and females. Hospitalisations for hypertensive disease were also substantially higher in the Indigenous population than among other Australians. Most notably, hospitalisations for rheumatic heart disease were 8 and 13 times higher for Indigenous males and females respectively. These large differences are to some extent determined by the very low prevalence of rheumatic heart disease in the non-Indigenous population (see section on rheumatic heart disease).
Rheumatic heart disease
Rheumatic heart disease is caused by the long-term damage done to the heart muscle or heart valves as a result of acute rheumatic fever. Acute rheumatic fever is a delayed complication of a throat or possibly skin infection caused by group A streptococcus bacterium. Both acute rheumatic fever and rheumatic heart disease are important and preventable causes of ill-health and death. They are typically associated with overcrowding, poor sanitary conditions and other aspects of socioeconomic disadvantage. Limited access to medical care for adequate diagnosis and/or appropriate treatment of these diseases contributes to their occurrence and recurrence in some population subgroups (Couzos & Carapetis 2003).
A register of persons with known or suspected rheumatic fever and rheumatic heart disease has operated in the Top End of the Northern Territory since 1997 and in Central Australia since 2002. Between 2003 and 2006 there were 250 new cases of acute rheumatic fever in the Top End and Central Australia, 246 (98%) of whom were Aboriginal and/or Torres Strait Islander people. Over this period, more than half (54%) of Indigenous people who suffered acute rheumatic fever were aged 5-14 years, with the disease creating a foundation for continuing health problems throughout their lives. Rates of rheumatic fever in the age group 5-14 years were 2.5 per 1,000 persons; considerably higher than the rates for those in younger and older age groups (table 7.14).
Diabetes mellitus (diabetes) is a significant health problem for Indigenous Australians. There are three main types of diabetes: Type 1, Type 2 and gestational diabetes. Type 1 diabetes is caused by a total lack, or near total lack of insulin, while Type 2 diabetes is marked by a reduced level of insulin or the inability of the body to use insulin properly (i.e. insulin resistance). Gestational diabetes occurs during pregnancy in about 3% to 8% of all females not previously diagnosed with diabetes and usually disappears after the baby is born (AIHW 2002b). Gestational diabetes increases the risk of subsequently developing Type 2 diabetes.
Prevalence of diabetes
The overall proportion of Indigenous Australians reporting diabetes as a long-term health condition in 2004-05 was 6% (table 7.5). Indigenous people in remote areas were more likely to report having diabetes than those in non-remote areas (9% and 5% respectively). Prevalence of diabetes was highest among Indigenous people aged 55 years and over (32%) (ABS 2006c).
After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were three times as likely as non-Indigenous people to report having diabetes in 2004-05 (table 7.5). The greatest differences in diabetes prevalence between Indigenous and non-Indigenous Australians were among those aged 35-44 years and 45-54 years where rates for Indigenous people were around five times those for non-Indigenous Australians (graph 7.15).
Hospitalisations due to diabetes
In 2005-06, diabetes was the principal diagnosis for 3,400 hospitalisations of Indigenous Australians in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, representing 1.4% of all hospitalisations in which the patient was Indigenous (53% were females). Despite a relatively low prevalence of Type 1 diabetes in the Indigenous population, 13% of hospitalisations of Indigenous people for diabetes were for Type 1 diabetes. Hospitalisation rates for diabetes for Indigenous persons ranged from around 7 per 1,000 population for those aged 25-44 years to 45 per 1,000 population for those aged 65 years and over (graph 7.16). Among people aged 25 years or over, hospitalisation rates for diabetes among Indigenous males and females were considerably higher than for other Australian males and females.
After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, hospitalisation rates for all types of diabetes for Indigenous males and females were four and five times those for other Australian males and females respectively. Hospitalisation rates for Type 2 diabetes for Indigenous males and females were 7 and 10 times those for other Australian males and females respectively.
Diabetes as an associated diagnosis
The data shown in graph 7.16 are for diabetes as a principal diagnosis only. However diabetes is more frequently reported as an additional or associated diagnosis (other diagnoses reported for a hospital episode) than as a principal diagnosis. In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, diabetes was recorded as an associated diagnosis for 37,378 hospitalisations of Indigenous Australians (excluding hospitalisations with a principal diagnosis of diabetes). It should be noted that there has been a substantial increase in the number of hospitalisations for diabetes recorded as an additional diagnosis in recent years, mainly due to a coding rule which was recently introduced in Western Australia whereby all patients hospitalised with a principal diagnosis of 'care involving dialysis' who were clinically documented as having diabetes must now have diabetes recorded as an additional diagnosis.
Among the complications of, or conditions associated with, diabetes, are coronary heart disease, stroke, peripheral vascular disease, digestive diseases, cancer of the pancreas, retinopathy and kidney disease (AIHW 2002b). In 2005-05, around 20% of hospitalisations of Indigenous Australians for care involving dialysis had diabetes as an associated diagnosis compared with 5% of hospitalisations for other Australians. Diseases of the circulatory system were the most common principal diagnosis for hospitalisations in which diabetes was an associated diagnosis (table 7.17). Approximately 58% of hospitalisations of Indigenous Australians for this disease category had diabetes recorded as an associated diagnosis, compared with 17% of other Australians.
The main function of the kidneys is 'to regulate the water content, mineral composition and acidity of the body' (Vander et al 1990:472). They are also involved in the excretion of metabolic waste products and of various chemicals. Kidney disease has a marked impact on the quality of life of those who have it as well as those who care for them. It is expensive to treat, and the rates of kidney disease are known to be high in some Indigenous communities (McDonald et al 2005; Shephard et al 2003).
The association between kidney disease and other aspects of the health of Indigenous people is extremely important. Diseases and conditions such as diabetes, high blood pressure, infections, low birthweight and obesity are risk factors for kidney disease (Catford et al 1997), and are all more common among Indigenous people than among other Australians. Socioeconomic disadvantage has also been shown to be associated with higher rates of renal disease among Indigenous Australians (Cass et al 2002; Cass et al 2004). Cass et al 2004, illustrated a number of pathways linking disadvantage and kidney disease including psychosocial factors, cultural factors, damaging health behaviours, factors related to the health care system and government/corporate policies.
The following section presents information from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), and the AIHW's National Hospital Morbidity Database.
Chronic kidney disease
Chronic kidney disease includes diabetic nephropathy, hypertensive renal disease, glomerular disease and chronic renal failure and end-stage renal disease (ESRD). ESRD results when the kidneys cease functioning almost entirely, leading to a build-up of waste products and excess water in the body causing progressively worse illness (AHMAC 2006). This is the last and most debilitating stage of chronic kidney disease in which dialysis or kidney transplantation is necessary to maintain life.
Information is available on Indigenous persons with ESRD from ANZDATA. In Australia, people who develop ESRD and undertake dialysis or kidney transplantation are registered with ANZDATA. The Registry is the most comprehensive and reliable source of information on people treated for ESRD. It compiles data on incidence and prevalence, renal complications, co-morbidities and patient deaths. Indigenous identification in the ANZDATA registry is based on self-identification in hospital records. However, because of the heightened awareness of the extent of renal disease among Indigenous Australians, and the prolonged and repeated contact with renal units in hospitals, it is believed that Indigenous identification in the ANZDATA registry is more complete than in general hospital data (Cass et al 2001). There is little information, however, on earlier chronic kidney disease, despite its importance in the Indigenous population. The main focus of this section is therefore on ESRD.
End-stage renal disease
In 2005, there were 2,654 new patients registered with ANZDATA. Of these, 207 (or 8%) identified as Aboriginal or Torres Strait Islander. This is higher than the proportion of Indigenous people in the total population (2.5%). Indigenous people commencing ESRD treatment were substantially younger, on average, than other Australians commencing ESRD treatment. This is in part because many Aboriginal and Torres Strait Islander people suffer chronic conditions such as diabetes and hypertension at younger ages than other Australians which, if left untreated, often lead to an earlier onset of ESRD (AHMAC 2006). Over half (56%) of Aboriginal and Torres Strait Islander people registered with ANZDATA were aged less than 55 years, whereas approximately one-third (31%) of other Australians registered were below this age.
The number of Indigenous patients starting ESRD treatment has more than tripled over the last decade, from 64 in 1992 to 207 in 2005 (table 7.18). Some of this increase may be due to improvements in the identification of Indigenous patients over this period. The increase in the number of Indigenous patients starting ESRD treatment, combined with a lower rate of transplantation, leads to a much higher rate of ESRD prevalence among Indigenous people (Excell & McDonald 2006).
In all states and territories, Indigenous Australians accounted for a disproportionate number of new cases of ESRD. Indigenous patients accounted for 91% of all newly registered patients in the Northern Territory, 19% in Western Australia and 10% in Queensland (Excell & McDonald 2006). Incidence rates for ESRD among Indigenous Australians were higher in remote areas of Australia than in major cities. Indigenous Australians were 26 times more likely to register for treatment of ESRD than other Australians in remote areas, 18 times more likely in outer regional areas and 12 times more likely in very remote areas. In major cities and inner regional areas, incidence rates for Indigenous Australians were four to five times those for other Australians living in these areas (AIHW 2007a).
A number of other health conditions are associated with renal disease, including cerebrovascular disease, lung disease, peripheral vascular disease, coronary artery disease, smoking and diabetes. In 2005, most of these conditions were reported in similar proportions for Aboriginal and Torres Strait Islander and other patients beginning ESRD treatment. Diabetes, however, was much more likely to be reported for Aboriginal and Torres Strait Islander patients than for other patients (78% and 38% respectively). The greater excess of diabetes among ESRD Indigenous entrants reflects the burden of this disease in the Aboriginal and Torres Strait Islander population. In 2005, diabetes was the primary cause of more than 58% of Indigenous people using dialysis compared with 22% of all other dialysis patients (Excell & McDonald 2006).
Management of kidney disease
ESRD patients require either a kidney transplant or dialysis to maintain the functions normally performed by the kidneys. Patterns of treatment for ESRD differ between Indigenous and other patients. In 2005, of all ANZDATA-registered Indigenous ESRD patients, 87% were reliant on dialysis and 13% had received a kidney transplant. In comparison, just over half (55%) of other Australians living with ESRD were reliant on dialysis and 45% had received a kidney transplant (table 7.19). This difference in treatment patterns has changed relatively little over the last several years.
Hospitalisations due to chronic kidney disease
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, there were around 101,900 hospitalisations of Indigenous Australians for chronic kidney disease and its sequelae, 44% of which were hospitalisations of Indigenous males and 56% of Indigenous females. There were around 10 times as many hospitalisations of Indigenous males and 18 times as many hospitalisations of Indigenous females as hospitalisations of other Australian males and females respectively. For care involving dialysis, Indigenous males and females were hospitalised at 10 and 19 times the rates of other males and females respectively. Rate ratios were also high for most other types of chronic kidney disease such as diabetic nephropathy (table 7.20). Of all hospitalisations for chronic kidney disease and its sequelae, the majority (100,153 or 98%) were for care involving dialysis.
Hospitalisation rates for care involving dialysis for Indigenous Australians were markedly higher in older age groups, peaking for those aged 65 years and over (graph 7.21). The rates for other Australians also peaked at ages 65 years and over, however at much lower levels. It should be noted that the rates of hospitalisation for dialysis reflect the outcome of some individuals accessing services many times, for example an individual reliant on treatment may undergo dialysis 2-3 times a week.
7.21 HOSPITALISATION RATES FOR CARE INVOLVING DIALYSIS(a)(b), by Indigenous status and age - 2005-06
Cancer includes a range of diseases in which abnormal cells proliferate and spread out of control. Normally, cells grow and multiply in an orderly way to form organs that have a specific function in the body. Occasionally, however, cells multiply in an uncontrolled way after being affected by a carcinogen, or after developing a random genetic mutation, and form a mass which is called a tumour or neoplasm. Tumours can be benign (not a cancer) or malignant (a cancer). Benign tumours do not invade other tissues or spread to other parts of the body, although they can expand to interfere with healthy structures (AIHW 2007c).
For many cancers, the causes are unknown. Some cancers occur as a direct result of smoking (in particular, lung cancer), dietary influences (especially cancers of the digestive system), infectious agents (especially cervical cancer through exposure to the human papilloma virus) or exposure to radiation (especially melanomas through excessive sun exposure), while others may be a result of an inherited genetic predisposition (for example, prostate and breast cancer are higher for persons with a family history of these cancers) (AIHW 2007c). However, the greatest risk factor for most cancers in the general population is advancing age, with the median age of first diagnosis for all cancers being 69 years for men and 65 years for women.
Incidence of cancer
Cancer incidence and survival data come from state and territory cancer registries. Identification of Aboriginal and Torres Strait Islander people is not yet included on pathology forms and the extent to which Aboriginal and Torres Strait Islander cancer patients are identified in hospital inpatient statistics varies around Australia. Nevertheless Indigenous identification in the registries has been improving. All-cancer incidence rates for New South Wales and Victoria for 2000-2004 have increased to be comparable with the rates for the Northern Territory, Queensland and Western Australia, the jurisdictions previously found to have good Indigenous identification.
Most common cancers
Across Australia, there were 3,083 cancers diagnosed among Aboriginal and Torres Strait Islander people in the period from 2000 to 2004. The most common cancers diagnosed among Indigenous males in the period were cancer of the lung, bronchus and trachea (19% of all male cancer cases reported), prostate cancer (10%), colorectal cancer (10%), cancer of unknown primary site (6%), and lymphomas (5%) (table 7.22). The most common cancers diagnosed among Indigenous females were breast cancer (25% of all female cancer cases reported), cancer of the lung, bronchus and trachea (12%), colorectal cancer (9%), cancer of the cervix (7%) and cancer of unknown primary site (6%) (table 7.22). In contrast to the non-Indigenous population, more new cases of cancer were reported among Indigenous females (1,598) than Indigenous males (1,485) in this period.
Table 7.23 presents age standardised incidence per 100,000 population for the 12 most common cancers diagnosed among Indigenous people in 2000-2004, in order of incidence. Among the most common cancers, age standardised incidence, even with under-reporting, was higher among Indigenous males and females for lung cancer, cancers of the mouth and throat and cancer of unknown primary site. The rates for cervical cancer among Indigenous females were more than double those for non-Indigenous females. Incidence was lower among Indigenous people for colorectal cancer, prostate cancer and lymphomas. High incidence of cancers of the lung, mouth and throat are caused by high rates of smoking earlier in life, while high cervical cancer incidence is preventable by early detection in Pap test screening. High incidence of cancer of unknown primary site is likely to be associated with late diagnosis.
Among the less common cancers, age standardised incidence was also higher in the period 2000-2004 for the Indigenous population than for the non-Indigenous population for cancers of the liver and gallbladder, pancreatic cancer, cancer of the oesophagus, and, in males only, thyroid cancer.
Breast cancer screening
In the BreastScreen Australia Program in 2003-2004 there were 12,459 women aged 40 years and over who identified themselves as Indigenous. Participation in the Program in the 50-69 years target age group was estimated at 35% for Indigenous women, much lower than the 56% participation for the total Australian female population in this age group (AIHW & DoHA 2007).
Hospitalisations due to cancer
In 2005-06, cancer was responsible for 1,423 hospitalisations of Indigenous males and 2,109 hospitalisations of Indigenous females, both representing just over 1% of all hospitalisations in which the patient was Indigenous. This does not include most chemotherapy and radiotherapy activity procedures. Hospitalisation rates for cancer for both Indigenous and other Australians increased from age 25 years onwards but were considerably lower for Indigenous than for other Australians in each age group (graph 7.24).
The five most common malignant cancers for which Indigenous males were hospitalised in 2005-06 were lung cancer (140 hospitalisations), skin cancer (106 hospitalisations), prostate cancer (59 hospitalisations), secondary cancer of the respiratory and digestive organs (51 hospitalisations) and secondary malignant neoplasm of other sites (45 hospitalisations). The five most common cancers for which Indigenous females were hospitalised in 2005-06 were breast cancer (140 hospitalisations), lung cancer (112 hospitalisations), skin cancer (108 hospitalisations), cervical cancer (84 hospitalisations), and secondary cancer of other sites (60 hospitalisations).
Injury and poisoning
Injury and poisoning are large contributors to Indigenous morbidity, especially for younger people. A variety of factors can affect a person's risk of being injured, including age, sex, alcohol use and socioeconomic status. Widespread hurt, loss, and suffering in Indigenous communities also leads to an increase in self-harm, making the incidence of intentional injury much more common among Aboriginal and Torres Strait Islander people than other Australians (AHMAC 2006). Injury data can be viewed in terms of the damage sustained to the body (e.g. broken bones, head injuries), or by the external cause of the injury (e.g. falls, poisoning and drowning), both of which are recorded by hospitals on admission.
Hospitalisations for injury and poisoning
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, injury or poisoning was the principal diagnosis recorded in 18,843 hospitalisations of Indigenous patients (table 7.25). Over half (57%) of these hospital episodes were for Indigenous males. Hospitalisations due to injury and poisoning represented 10% of all hospitalisations for Indigenous males and 6% of all hospitalisations for Indigenous females. Indigenous males and females were hospitalised for injury and poisoning at 1.8 times the rate of other males while for females, the corresponding rate ratio was 2.4.
Rates of hospitalisation due to injury and poisoning varied with age. For Indigenous people, rates were highest among those aged 25-44 years, while for other Australians rates were highest for those aged 65 years and over. In all age groups, Indigenous males were more likely to be hospitalised for injury and poisoning than were Indigenous females.
External causes of injury resulting in hospitalisations
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, as in previous years, the most commonly recorded external causes of injury resulting in hospitalisation among Indigenous Australians were assault (males 22%; females 31%), accidental falls (males 17%; females 17%), exposure to inanimate mechanical forces (e.g. explosion of materials, contact with glass) (males 15%; females 9%), complications of medical or surgical care (males 9%; females 12%) and transport-related injuries (males 11%; females 7%).
Indigenous males and females were hospitalised more often than other Australians for most external causes of injury (table 7.26). Hospitalisations for injury due to assault were 6 and 33 times higher for Indigenous males and females respectively.
Respiratory diseases are leading causes of illness, disability and mortality around the world. Common respiratory diseases include asthma, chronic obstructive pulmonary disease ((COPD), comprising both chronic bronchitis and emphysema), influenza and pneumonia. While all these respiratory diseases are also leading causes of illness resulting in a high use of health services, pneumonia and COPD are leading underlying causes of death (see Chapter 9 for more information).
Prevalence of respiratory diseases
In the 2004-05 NATSIHS, the proportion of Aboriginal and Torres Strait Islander people who reported some form of respiratory disease was 27%. This represents a small decrease from 29% in 2001. The most common form of respiratory disease reported by Indigenous people in 2004-05 was asthma (15%) (table 7.5).
After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous people were nearly twice as likely as non-Indigenous people to report having bronchitis, and one-and-a-half times as likely to report having asthma (ABS 2006c). The prevalence of respiratory diseases in the Indigenous population was highest among people aged 55 years and over (38%), whereas in the non-Indigenous population those in age groups 25-34 years and 35-44 years had the highest proportions of people with respiratory diseases (both 33%).
Hospitalisations for respiratory diseases
About 15,700 hospitalisations of Indigenous people with a principal diagnosis of respiratory disease occurred in 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, representing about 6% of all hospitalisations of Indigenous people in these jurisdictions. Hospitalisation rates for respiratory diseases in the Indigenous population were more than twice those in the non-Indigenous population.
For both Indigenous people and other Australians, hospitalisations for respiratory disease were most common among the very young and the old (graph 7.27). In 2005-06, the hospitalisation rates for respiratory diseases among Indigenous children aged 0-4 years were twice the rate for other Australian children. Almost half of hospitalisations among children aged 0-4 years were for infants (aged less than one year). Hospitalisation rates for Indigenous infants were more than twice the rate for other Australian infants. Indigenous Australians aged 25 years and over were hospitalised for respiratory disease at three to five times the rates of other Australians.
Indigenous Australians were hospitalised at higher rates for most types of respiratory diseases than other Australians (table 7.28). In 2005-06, Indigenous males and females were hospitalised for influenza and pneumonia (combined) at around five times the rate, for COPD at around six to eight times the rate and for asthma at up to twice the rate of other Australians.
Communicable diseases and HIV/AIDS
While much of the burden of communicable diseases comes from respiratory infections such as influenza, data presented here include notification and hospitalisation as the result of other serious communicable diseases such as sexually transmissible infections (STIs), viral hepatitis and viral infections such as mumps, measles and rubella. The evidence from these analyses reinforces the fact that the burden of communicable diseases for Indigenous Australians is far greater than for other Australians.
In Australia, communicable diseases of particular health importance are 'notifiable', and under legislation each case must be notified to state and territory health authorities. Notifications are received from hospitals, general practitioners and diagnostic laboratories. While each Australian state and territory has its own set of notifiable diseases, a set of 56 diseases and conditions are nationally notifiable. Data on all these cases are forwarded to the National Notifiable Diseases Surveillance System (NNDSS), managed by the Australian Government Department of Health and Ageing. The numbers of notifications, however, represent a variable proportion of all the actual cases of any disease. This is because for some diseases, many cases may go undetected for a long period of time and infections that are diagnosed in a laboratory test are more likely to be notified than those that are not (Menzies, McIntyre & Beard 2004).
Only data from Western Australia, South Australia and the Northern Territory on the notification rates of infectious diseases have been reported in this section. This is because the recording of Indigenous status in these jurisdictions was assessed by the NNDSS in 2004 as being adequate (more than 60% coverage) (AIHW & ABS 2005). However, recording of Indigenous status for Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) data is considered reliable by the National Centre for HIV Epidemiology and Clinical Research (NCHECR) for all states and territories, with the exception of the ACT, from 2004 onwards. Over the period 2004-2006, notification rates for Indigenous Australians were higher than for other Australians for many notifiable diseases (table 7.29).
Sexually transmitted infections
Rates of STIs were much higher in the Indigenous population than among other Australians, with the rates for syphilis and gonococcal infection among Indigenous people 61 and 86 times the rates among other Australians. Rates of Hepatitis A, B and C were also higher among Indigenous Australians (ratios of between 5 and 12) (table 7.29). The substantially higher levels of chlamydia, gonorrhoea and syphilis infection among Indigenous people compared with other persons may also facilitate HIV transmission in the Indigenous population (Grosskurth et al 1995).
Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae and can cause infection in parts of the respiratory tract (otitis media, sinusitis, pneumonia) or enter the bloodstream. For the period 2004-2006, there were 403 notifications of invasive pneumococcal disease among Indigenous people in Western Australia, South Australia and the Northern Territory combined. The notification rate for Indigenous Australians was almost 13 times the rate for other Australians.
Notifications of HIV and AIDS infections are forwarded to NCHECR and are recorded in the National AIDS Registry and the National HIV Database. Between 2004 and 2006, 58 notifications of HIV infection and 22 notifications of AIDS infection were recorded in the Indigenous population (table 7.30). The majority (80%) of these notifications were for Indigenous males. The notification rate for AIDS and HIV was similar for Indigenous males and other males however the notification rate for AIDS and HIV for Indigenous females was 60% more than that for other females.
Hospitalisations due to certain infectious and parasitic diseases
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, infectious and parasitic diseases, which include illnesses such as intestinal infectious diseases, septicaemia, viral infections and fevers, sexually transmitted infections, tuberculosis and mycoses, were responsible for 2,666 hospitalisations of Indigenous males, representing 3% of all hospitalisations of Indigenous males. For Indigenous females, the comparative figure was 2,583 hospitalisations, representing 2% of all hospitalisations of Indigenous females (table 7.32).
Indigenous males and females were hospitalised for infectious and parasitic diseases at twice the rate of other males and females. The highest rates of hospitalisation for infectious and parasitic diseases occurred among Indigenous children aged 0-4 years. Over 40% of the hospitalisations in this age group were for Indigenous infants (less than one year old) who were hospitalised at a rate of 98 per 1,000 population. Indigenous infants were hospitalised at twice the rate of other infants. The greatest difference in rates occurred among those aged 25-44 years and 45-64 years where Indigenous Australians were hospitalised at around three times the rate of other Australians (graph 7.31).
7.31 HOSPITALISATION RATES FOR INFECTIOUS AND PARASITIC DISEASES(a)(b)(c), by Indigenous status and age - 2005-06
Indigenous males and females were hospitalised for intestinal infectious diseases at twice the rate of other males and females (table 7.32).
Musculoskeletal conditions, including arthritis, are a major cause of pain and disability, especially among the elderly. Arthritis is a heterogenous group of disorders in which there may be inflammation of the joints, causing chronic pain, stiffness, functional limitations and deformity. Its two most common forms are osteoarthritis and rheumatoid arthritis (AIHW 2005a).
Diseases of the musculoskeletal system and connective tissue were reported by 22% of Indigenous people in 2004-05. In particular, 13% reported back pain/disc disorders and 9% reported arthritis (table 7.5). The proportion of Aboriginal and Torres Strait Islander people reporting musculoskeletal diseases was higher in older age groups. Higher prevalence was reported for Indigenous Australians than other Australians among people aged 25-54 years (ABS 2006c).
Hospitalisations for musculoskeletal diseases
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, diseases of the musculoskeletal system and connective tissue were the principal diagnosis for 4,205 hospitalisations of Aboriginal and Torres Strait Islander people, representing around 2% of all hospitalisations of Indigenous people. Hospitalisation rates for musculoskeletal diseases ranged from about 2 per 1,000 for Indigenous children aged 0-4 years to 31 per 1,000 population for Indigenous people aged 65 years and over. Hospitalisation rates for musculoskeletal diseases for Indigenous Australians were similar to, or lower than, rates for other Australians across all age groups.
Of all musculoskeletal diseases, arthritis was the most common cause of hospitalisation for Indigenous Australians. Indigenous Australians were hospitalised for rheumatoid arthritis and osteoarthritis at lower rates than other Australians.
Eye and vision problems
In 2004-05, 30% of the Indigenous population reported diseases of the eye and adnexa (appendages of the eyeball which include the eyelids, muscles and soft tissue) (table 7.5). One in six (16%) reported hyperopia (long-sightedness) and 10% reported myopia (short-sightedness). Within the Indigenous population, those living in non-remote areas were more likely to report eye and sight problems (32%) than those living in remote areas (25%).
While the overall age standardised prevalence of eye and vision problems was slightly lower among Indigenous Australians than among other Australians (47% compared with 51%), Indigenous people reported having cataracts and either complete or partial blindness at higher rates than non-Indigenous people. The prevalence of eye and vision problems was higher in older age groups in both the Indigenous and non-Indigenous populations (ABS 2006c).
Hospitalisations for eye and vision problems
In 2005-06, there were a total of 1,170 hospitalisations of Indigenous Australians in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, with a principal diagnosis of diseases of the eye and adnexa, representing about 0.5% of all Indigenous hospitalisations. The overall rates of hospitalisations for diseases of the eye and adnexa among Indigenous Australians were slightly less than those for other Australians. Rates of hospitalisation due to diseases of the eye were highest among those aged 65 years and over, reaching around 30 per 1,000 for Indigenous Australians and 56 per 1,000 for other Australians in this age group.
Ear and hearing problems
In 2004-05, a higher proportion of Indigenous people than non-Indigenous people reported ear and hearing problems across all age groups, except for those aged 55 years and over, among whom prevalence rates were similar.
Otitis media, a common childhood disease, is often the result of a pneumococcal invasion of the nasopharynx. Recurrence of chronic otitis media is often characterised by a perforated tympanic membrane, which can lead to hearing loss, deafness and further complications such as learning difficulties. In 2004-05, rates of otitis media were three times as high among Indigenous children aged 0-14 years as non-Indigenous children in this age group (ABS 2006c).
Hospitalisations for ear and hearing problems
In 2005-06 in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, there were 1,714 hospitalisations of Indigenous people for diseases of the ear and mastoid process (temporal bone behind the ear), representing 0.7% of all hospitalisations of Indigenous people.
Overall, hospitalisation rates for ear and hearing problems among Indigenous Australians were similar to those for other Australians. Hospitalisations were highest among children aged 0-4 years for both Indigenous and other Australians. In 2005-06, 61% of all hospitalisations of Indigenous people for ear and hearing problems were due to otitis media. Chronic ear and hearing problems are greater among Indigenous children than among other children. According to Coates (2002), Indigenous children and young adults between the ages of 2 and 20 years experience an average of 32 weeks of middle ear disease compared with 2 weeks for other children.
Oral health refers to the health of a number of tissues in the mouth, including mucous membrane, connective tissue, muscles, bone, teeth and periodontal structures or gums. It may also refer to immunological, physiological, sensory and digestive system functioning, but is most often used to refer to two specialised tissues of the mouth: the teeth and the gums. Oral health outcomes are usually measured in terms of the number of decayed, missing or filled baby (deciduous) and adult (permanent) teeth (dmft and DMFT scores) (AIHW 2007k).
The latest available data on DMFT scores for Indigenous adults come from adults seeking dental care in Australia in 2004-06. Indigenous adults had a greater average number of decayed and missing teeth and a lower average number of filled teeth than non-Indigenous adults across most age groups (table 7.33).
Hospitalisations related to oral health problems
In 2005-06 there were 2,395 hospitalisations of Indigenous people in New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory combined, for diseases of the oral cavity, salivary glands and jaw. The majority of these hospitalisations were for dental caries (54%), followed by diseases of the pulp and periapical tissues (14%). Indigenous Australians were less likely to be hospitalised for diseases of the oral cavity, salivary glands and jaw than other Australians.