National Aboriginal and Torres Strait Islander Health Measures Survey

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. People who usually lived in non-private dwellings, including hospitals and nursing homes, were not in scope of the survey. 

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 methodology.

Diabetes is a chronic condition where the body is unable to produce or effectively use insulin (a hormone that controls blood glucose levels). If left undiagnosed or poorly managed, diabetes can lead to kidney failure, stroke, limb amputations or blindness[1]. In 2023, diabetes was the fourth leading cause of death for Aboriginal and Torres Strait Islander males, and the top cause of death for Aboriginal and Torres Strait Islander females[2].

The NATSIHMS 2022–24 included two tests to measure diabetes:

• fasting plasma glucose (FPG)
• glycated haemoglobin (HbA1c).

Diabetes prevalence in the NATSIHMS was defined using a combination of blood test results, self-reported diabetes diagnosis and medication use. Using this information, participants are classified as having one of the following:

• known diabetes
• newly diagnosed diabetes
• high risk of diabetes
• no diabetes. 

Diabetes type cannot be determined using the FPG or HbA1c tests, and as such it is not possible to distinguish diabetes type for people with newly diagnosed diabetes. People with known diabetes were asked what type of diabetes they had (type 1, type 2 or other).

Results for diabetes prevalence using FPG results are presented only for people who fasted for 8 hours or more prior to their blood test. Results for diabetes prevalence using HbA1c results are presented for all people who gave a blood sample. For more information, see the IHMHS: Concepts, Sources and Methods.

In 2022–24, 15.5% of people aged 18 years and over had diabetes. This comprised:

• 12.6% who had known diabetes
• 2.8% who had newly diagnosed diabetes.

A further 4.5% of people aged 18 years and over were at high risk of diabetes. 

In 2022–24:

• prevalence of diabetes was 16.7% for males aged 18 years and over and 14.3% for females aged 18 years and over, the difference was not statistically significant
• diabetes prevalence increased with age, from 5.5% of people aged 18–34 years to 34.6% of people aged 55 years and over
• people aged 18 years and over who lived in Remote or Very Remote areas of Australia were more likely to have diabetes than people who lived in non-remote areas of Australia (21.7% compared to 14.3%).

In 2022–24, people aged 18 years and over who had:

• a measured waist circumference that put them at an increased risk of disease were more likely to have diabetes than people with a lowered risk (19.9% compared to 1.8%)
• high measured blood pressure were more likely to have diabetes than people with low or normal measured blood pressure (21.0% compared to 13.5%).

Cardiovascular disease (CVD) is an umbrella term that includes heart, stroke, and blood vessel diseases. Some types of CVD are caused by a build-up of cholesterol and other substances in the arteries, which can reduce or block blood supply to the heart (causing angina or heart attack) or to the brain (causing stroke)[8]. In 2023, ischaemic heart diseases were the leading cause of death of Aboriginal and Torres Strait Islander people[2].

The NATSIHMS 2022–24 measured the following indicators of CVD: 

• total cholesterol
• high-density lipoprotein (HDL) cholesterol
• low-density lipoprotein (LDL) cholesterol
• triglycerides. 

Results for total cholesterol and HDL cholesterol are presented below. For information on LDL cholesterol and triglycerides see Fasting blood test results.

For more information on the collection of CVD data, see the IHMHS: Concepts, Sources and Methods.

Cholesterol (a waxy, fat-like substance) is a lipid necessary to make hormones, including vitamin D, and also helps digestion[9]. Total cholesterol includes both LDL cholesterol and HDL cholesterol.

In 2022–24, of people aged 18 years and over:

• 25.7% had an abnormally high total cholesterol level (≥5.5 mmol/L)
• 12.3% had a total cholesterol level that was close to abnormal (≥5.0 to <5.5 mmol/L)
• 27.8% of males and 23.1% of females had an abnormally high total cholesterol level
• people aged 18–34 years (18.7%) were less likely to have an abnormally high total cholesterol level than people aged 35–54 years (31.3%) and people aged 55 years and over (30.2%)
• people who lived in non-remote areas of Australia were more likely to have an abnormally total high cholesterol level than people who lived in Remote or Very Remote areas of Australia (27.8% compared to 16.5%).

High cholesterol is a health condition that doesn’t always have symptoms, but if left untreated long-term, it can increase the risk of serious health complications[9]. In 2022–24, of the 25.7% of people aged 18 years and over who had an abnormally high total cholesterol level, just over one in seven (14.8%) of them reported having high cholesterol as a current long-term health condition.

In 2022–24, people aged 18 years and over who had:

• a measured waist circumference that put them at increased risk of disease were more likely to have an abnormally high total cholesterol level than people with a lowered risk (29.6% compared to 13.4%)
• high measured blood pressure were more likely to have an abnormally high total cholesterol level than people who had normal or low blood pressure (35.9% compared to 21.6%).

HDL cholesterol, 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[9].

In 2022–24, of people aged 18 years and over:

• 35.7% had an abnormally low HDL cholesterol level (<1.0 mmol/L for males and <1.3 mmol/L for females)
• almost one in two (48.3%) females had an abnormally low HDL cholesterol level, compared to one in five (21.9%) males
• males had a mean HDL cholesterol level of 1.2 mmol/L, and females had a mean HDL cholesterol level of 1.3 mmol/L
• people who lived in Remote or Very Remote areas of Australia were more likely to have an abnormally low HDL cholesterol level than people who lived in non-remote areas (58.2% compared to 30.9%).

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[10]. In 2023, diseases of the urinary system, including CKD, were the 10th leading cause of death among Aboriginal and Torres Strait Islander people[2].

The NATSIHMS 2022–24 calculated the following indicators of CKD:

• estimated glomerular filtration rate (eGFR)
• albumin/creatinine ratio (ACR).

While an abnormally low eGFR or high ACR results in the NATSIHMS may indicate impaired kidney function, CKD can only be confirmed if an abnormally low eGFR or a high ACR persists for at least three months[10]. For more information, see the IHMHS: Concepts, Sources and Methods.

eGFR measures how well the kidneys filter wastes from the blood and is a measure of kidney function. eGFR helps determine if a person has kidney damage, as a low filtration rate means that the kidneys are not working properly[11].

In 2022–24, of people aged 18 years and over: 

• 3.8% had an abnormally low eGFR (<60 mL/min/1.73m²)
• the proportion of males and females with an abnormally low eGFR was similar (3.7% and 3.9%)
• males and females had a median eGFR of 90 mL/min/1.73m²
• people aged 55 years and over were more likely to have an abnormal eGFR than people aged 18–54 years (13.1% compared to 1.0%).

In 2022–24, people aged 18 years and over who:

• had high measured blood pressure were more likely than people with normal or low blood pressure to have an abnormally low eGFR (6.6% compared to 2.5%)
• had a measured waist circumference that put them at an increased risk of disease were more likely to have an abnormally low eGFR than people with a lowered risk (4.8% compared to 0.9%)
• were obese (6.3%) were more likely to have an abnormally low eGFR than people who were overweight (2.0%) or in the underweight/normal range (1.4%).

Albuminuria occurs when excessive amounts of albumin (a protein) are present in the urine and is an indicator of CKD[10]. Albuminuria is determined by the ACR, which is measured by dividing the amount of albumin by the amount of creatinine (a metabolism by-product).

In 2022–24, of people aged 18 years and over:

• 16.5% had albuminuria (an ACR of ≥2.5 mg/mmol for males and ≥3.5 mg/mmol for females)
• more people had microalbuminuria than macroalbuminuria (14.1% compared to 2.3%)
• people aged 18–34 years (8.5%) were less likely to have albuminuria than people aged 35–54 years (19.3%) and people aged 55 years and over (27.0%)
• 18.0% of males and 15.0% of females had albuminuria
• people who lived in Remote or Very Remote areas of Australia were more likely to have albuminuria than people who lived in non-remote areas (30.5% compared to 14.0%).

In 2022–24, people aged 18 years and over who:

• were obese were more likely to have albuminuria than people who were in the underweight/normal range (20.6% compared to 12.1%)
• had a measured waist circumference that put them at an increased risk of disease were more likely to have albuminuria than people with a lowered risk (19.2% compared to 7.9%).

There are five stages of CKD, ranging in severity from Stage 1 to Stage 5[12]. In the NATSIHMS 2022–24, CKD stages are determined by combining participants’ eGFR and ACR results. 

In 2022–24, 18.5% of people aged 18 years and over had indicators of CKD, comprising:

• 9.6% with Stage 1 CKD (eGFR ≥90 mL/min/1.73 m² & albuminuria)
• 5.2% with Stage 2 CKD (eGFR 60–89 mL/min/1.73 m² & albuminuria)
• 1.7% with Stage 3a CKD (eGFR 45–59 mL/min/1.73 m²)
• 1.2% with Stage 3b CKD (eGFR 30–44 mL/min/1.73 m²)
• 0.7% with Stage 4–5 CKD (eGFR <30 mL/min/1.73 m²).

Like the patterns seen for eGFR and ACR individually, people living in Remote and Very Remote areas of Australia were more likely to have indicators of CKD than people who lived in non-remote areas of Australia (32.4% compared to 16.0%).

The proportion of males and females aged 18 years and over with indicators of CKD was similar (19.4% and 17.4%). Prevalence of indicators of CKD increased with age, from 8.7% of people aged 18–34 years to 34.9% of people aged 55 years and over.

People with CKD are likely to have one or more other chronic conditions, such as diabetes and cardiovascular disease[13]. In 2022–24, people aged 18 years and over with indicators of CKD were more likely than people without indicators of CKD to self-report having the following conditions:

• heart, stroke or vascular disease (14.6% compared to 5.7%)
• high cholesterol (20.5% compared to 10.9%)
• diabetes (40.2% compared to 9.4%).

Only 13.0% of people with indicators of CKD self-reported having the condition.

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 prevent the liver from performing these functions as it should and if left untreated, can lead to liver damage[14].

The NATSIHMS 2022–24 measured the following indicators of liver function:

• alanine aminotransferase (ALT)
• gamma-glutamyl transferase (GGT). 

While these tests cannot diagnose the presence of liver disease, elevated levels for either test may indicate liver damage. For more information, see the IHMHS: Concepts, Sources and Methods.

ALT is an enzyme used to break down food into energy. ALT is mainly found in the liver, but smaller amounts are in found in the muscles, kidneys and other organs. An elevated ALT level in the blood indicates a degree of liver inflammation[15].

In 2022–24, of persons aged 18 years and over:

• 30.6% had an abnormally high ALT level (>40 U/L for males and >30 U/L for females)
• males had a higher mean ALT level than females (39 U/L compared to 26 U/L)
• people who lived in non-remote areas of Australia were more likely to have an abnormally high ALT level than people living in Remote or Very Remote areas (31.7% compared to 23.3%).

The proportion of people with an abnormally high ALT level also differed by sex. In 2022–24:

• males aged 18 years and over were more likely than females aged 18 years and over to have an abnormally high ALT level (36.3% compared to 25.3%)
• males aged 18–34 years were more likely than females in the same age group to have an abnormally high ALT level (41.3% compared to 19.9%).

Excess fat in the liver can lead to tissue damage and affect liver function[14]. People aged 18 years and over who:

• were obese (41.7%) were more likely to have an abnormally high ALT level than people who were overweight (24.0%) and people who were in the underweight/normal weight range (17.6%)
• had a measured waist circumference that put them at an increased risk of disease were more likely to have an abnormally high ALT level than people with a lowered risk (35.3% compared to 15.7%).

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[16]. 

In 2022–24, of people aged 18 years and over:

• 21.8% had an abnormally high GGT level (>50 U/L for males and >35 U/L for females)
• people aged 18–34 years (13.1%) were less likely to have an abnormally high GGT level than people aged 35–54 years (28.5%) and people aged 55 years and over (28.2%)
• males and females had similar rates of abnormally high GGT (21.7% and 22.1%)
• people who lived in Remote or Very Remote areas of Australia were more likely to have an abnormally high GGT level than people living in non-remote areas (30.0% compared to 19.7%).

Elevated GGT was also associated with certain health risk factors. People aged 18 years and over who:

• reported being current smokers were more likely to have an abnormally high GGT level than people who were non-smokers (28.8% compared to 18.8%)
• had a measured waist circumference that put them at an increased risk of disease were more likely to have an abnormally high GGT level than people with a lowered risk (24.2% compared to 13.5%)
• were obese (27.9%) were more likely to have an abnormally high GGT level than people who were overweight (17.2%) and people who were in the underweight/normal range (14.6%).

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[17][18].

In the NATSIHMS 2022–24, the biomarkers that were used to measure the amount of iron stored in the body were:

• serum ferritin
• soluble transferrin receptor (sTfR)
• haemoglobin.

The NATSIHMS 2022–24 also measured C-reactive protein (CRP) to help understand the serum ferritin results. CRP is not reported on individually. For more information on these tests, see the IHMHS: Concepts, Sources and Methods.

Ferritin is a 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[19][20].

In 2022-24, the mean serum ferritin level for:

• people aged 18 years and over was 131 µg/L
• people aged 18–34 years (102 µg/L) was lower than for people aged 35–54 years (137 µg/L) and people aged 55 years and over (178 µg/L)
• males aged 18 years and over was higher than for females in the same age group (171 µg/L compared to 89 µg/L)
• children aged 12–17 years was 36 µg/L.

In 2022–24, of people aged 18 years and over:

• 5.5% were ferritin deficient (had a serum ferritin level under 15 µg/L)
• females were more likely to be ferritin deficient than males (8.8% compared to 2.0%).

Soluble transferrin receptor (sTfR) is an iron related protein that is important in the process of carrying iron to cells. When serum ferritin results indicate depleted iron stores, sTfR can be used to assess the severity of the iron depletion because sTfR levels increase with iron deficiency and anaemia, reflecting the body’s demand for iron[20][22]. 

In 2022–24, the mean sTfR level:

• for people aged 18 years and over was 2.9 mg/L
• was steady for all ages (2.9 mg/L)
• was similar for males and females aged 18 years and over (both 2.9 mg/L).

Haemoglobin is a protein found in red blood cells that helps transport oxygen from the lungs to the rest of the body[19]. 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[23].

In 2022–24, of people aged 18 years and over:

• 9.1% 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 (14.0% compared to 4.4%)
• people who lived in Remote or Very Remote areas of Australia were more likely to have an abnormally low haemoglobin level than people living in non-remote areas (14.1% compared to 8.1%).

Iodine is an essential part of 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[24]. In the NATSIHMS 2022–24, iodine results were obtained for persons who provided a urine sample.

In 2022–24:

• the population aged 5 years and over was iodine sufficient[25] with a median urinary iodine concentration (UIC) of 140 µg/L
• the population aged 18 years and over was also iodine sufficient[25] with a median UIC of 125 µg/L
• males and females aged 18 years and older had similar median UIC (121 µg/L compared to 126 µg/L)
• people aged 18 years and over who lived in Remote or Very Remote areas of Australia had a higher median UIC than people living in non-remote areas (148 µg/L compared to 121 µg/L)
• children aged 5–17 years old were also iodine sufficient[25], with a median UIC of 167 µg/L.

Adequate iodine intake is important during pregnancy, as iodine deficiency in pregnancy can impact foetal development[24]. In 2022–24, the median UIC for females aged 16–44 years was 125 µg/L. While this was within the range for iodine sufficiency for the general population including children (100-199 µg/L), it was below the range for people who are pregnant (150-249 µg/L)[25].

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[26]. In the NATSIHMS 2022–24, vitamin D was measured in the form of calcidiol (25(OH)D) that measured both vitamin D2 and vitamin D3. Vitamin D results were obtained for persons who provided a blood sample.

In 2022–24:

• 26.6% of people aged 18 years and over had a vitamin D deficiency
• 28.7% of males and 24.6% of females aged 18 years and over had a vitamin D deficiency
• 22.8% of children aged 12–17 years old had a vitamin D deficiency
• males and females aged 18 years and over had similar mean vitamin D levels (63 nmol/L and 64 nmol/L).

In Australia, the main source of vitamin D is exposure to sunlight. As a result, vitamin D levels vary with the amount of sunlight a person is exposed to[27]. In 2022–24, people aged 12 years and over were more likely to be vitamin D deficient in winter than in summer (36.6% compared to 17.1%).

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[28][29]. Folate deficiency can lead to anaemia, and in pregnancy can increase the chance of neural tube defects of the newborn[30]. In the NATSIHMS 2022–24, folate results were obtained for persons who provided a blood sample.

In 2022–24, the mean folate level for:

• people aged 18 years and over was 27.9 nmol/L, which is above the population cut-off for folate deficiency (<10 nmol/L)
• males and females aged 18 years and over was similar (28.5 nmol/L and 27.3 nmol/L)
• people aged 55 years and over (30.6 nmol/L) was higher than people aged 35–54 years (26.9 nmol/L) or 18–34 years (27.3 nmol/L)
• people aged 18 years and over who lived in non-remote areas was higher than people who lived in Remote and Very Remote areas of Australia (28.6 nmol/L compared to 24.6 nmol/L)
• children aged 12–17 years was 31.9 nmol/L, which is also above the population cut-off for folate deficiency.

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[31]. Vitamin B12 deficiency, if left untreated, can lead to anaemia, nerve damage and brain damage[32]. In the NATSIHMS 2022–24, vitamin B12 results were obtained for persons who provided a blood sample.

In 2022–24, the mean vitamin B12 level for:

• people aged 18 years and over was 384 pmol/L, which is above the population cut-off for vitamin B12 deficiency (<150 pmol/L)[33]
• males aged 18 years and over was 398 pmol/L
• females aged 18 years and over was 371 pmol/L
• people aged 55 years and over (348 pmol/L) was lower than people aged 35–54 years (393 pmol/L) and people aged 18–34 years (396 pmol/L)
• children aged 12–17 years was 349 pmol/L.

Almost all (98.2%) females aged 16–44 years had a vitamin B12 level of 150 pmol/L or higher.

The NATSIHMS 2022–24 included several tests that were only applicable to people who fasted prior to their blood test. These tests were LDL cholesterol, triglycerides and FPG.

Fasting rates in 2022–24 were lower than in the 2012–13 collection. The opportunity to provide a fasting blood sample was limited in remote areas. As such, the respondents who provided fasting blood samples have different characteristics to the entire population, for example, people who fasted were more likely to be older. 

The results from these tests are a valuable and important dataset; however the ABS considers them less representative of the total population than the total blood and urine test results. To enable analysis of these results, the ABS has published a series of tables in the Data downloads that provide information on biomarkers for the fasting population.

The ABS would like to acknowledge our partnership with Sonic Healthcare Australia Pathology who was the pathology provider for the NATSIHMS 2022–24. 

The ABS would also like to acknowledge the assistance and advice received from specialists in the duration of the NATSIHMS planning and dissemination, including the following peer reviewers:

• Sam Faulkner, Director, Aboriginal and Torres Strait Islander Health Advice, National Health and Medical Research Council
• Associate Professor Rosemary Wyber, general practitioner and researcher, Yardhura Walani, Australian National University.

The ABS greatly values the knowledge, expertise and contributions of the reviewers and thanks them for their time and input.

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