NACCHO #HealthElection16 : ACCHO’S Driving positive change: AIHW Report Chronic disease among Aboriginal peoples

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How one Aboriginal Community Controlled Health Organisation is driving positive change : 

Renee Blackman is a proud Gubbi Gubbi woman from the Sunshine Coast. She is a registered nurse and former Aboriginal health worker.

Her current role as Regional Services Development Manager with the Institute for Urban Indigenous Health is working with Aboriginal medical services in the south east corner of Brisbane  providing the opportunity to lead and effect positive change in primary health care service delivery in that sector.

VIEW Renee’s  ” Aboriginal Health In Aboriginal Hands  ” Interview with NACCHO TV here : Photography Wayne Quilliam Editor :Yale MacGillivray : Producer/Interviewer  Colin Cowell

NACCHO TV all current interview

“Ongoing monitoring of chronic disease in the Aboriginal and Torres Strait Islander population will help drive positive change by informing the policy frameworks and programmes which bring together chronic disease and Aboriginal and Torres Strait Islander health, including the Close the Gap initiative, the National Aboriginal and Torres Strait Islander Health Plan and the Better Cardiac Care for Aboriginal and Torres Strait Islander People project.”

This article was written by Ros Seselja and Michael de Looper for AHHA The Health Advocate’s April 2016 edition.

Chronic diseases currently cause an estimated nine out of ten deaths in Australia, and has extensive personal, social and economic impacts. The burden of chronic disease has elsewhere been characterised by the Australian Institute of Health and Welfare (AIHW) as the biggest health challenge that Australia currently faces.

Chronic disease, however, is not uniformly distributed in the population. A new report by the Australian Institute of Health and Welfare, Cardiovascular disease, diabetes and chronic kidney disease — Australian facts: Aboriginal and Torres Strait Islander people, underlines the extent to which Aboriginal and Torres Strait Islander peoples are disproportionately affected by these three largely preventable diseases.

DOWNLOAD THE REPORT HERE

The report, Cardiovascular disease, diabetes and chronic kidney disease-Australian facts: Aboriginal and Torres Strait Islander people,

The report highlights that cardiovascular disease (CVD) (including coronary heart disease and stroke), diabetes and chronic kidney disease (CKD) tend to appear earlier, progress faster, present alongside other chronic diseases and result in higher death rates in Indigenous people than in non-Indigenous people.

Using the latest available survey and administrative data, the report shows:

Higher levels of important underlying risk factors

Aboriginal and Torres Strait Islander peoples experience higher rates of selected behavioural and biomedical risk factors which influence the development and progression of chronic disease. In 2011–13, Aboriginal and Torres Strait Islander adults were 2.6 times as likely as non-Indigenous adults to smoke daily (42% and 16%, respectively), 1.2 times as likely to be overweight or obese (72% and 63%), and 1.2 times as likely to have high blood pressure (25% and 21%).

Disease rates are greater, and are higher at younger ages

Higher rates of risk factors contribute to earlier onset and higher disease rates among Aboriginal and Torres Strait Islander peoples. An estimated 27% of Aboriginal and Torres Strait Islander adults had CVD compared to 21% of non-Indigenous adults. The rate of acute coronary events (heart attacks and unstable angina) was 2.5 times as high.

The difference between Aboriginal and Torres Strait Islander and non-Indigenous Australians was even greater for diabetes and chronic kidney disease. While 5% of non-Indigenous adults had diabetes, 18% of Aboriginal and Torres Strait Islander adults had the condition. They were also twice as likely to have biomedical signs of CKD (22% and 10%).

These conditions occur at much younger ages in Aboriginal and Torres Strait Islander peoples. For example, at age 18–34, 9% of Aboriginal and Torres Strait Islander peoples had CVD compared to 4% of non-Indigenous people of the same age. Rates of both diabetes and CKD in Aboriginal and Torres Strait Islander peoples aged 35–44 were four times those of non-Indigenous people of the same age.

Hospitalisation rates are greater

Aboriginal and Torres Strait Islander adults were almost twice as likely as non-Indigenous adults to be hospitalised for CVD in 2013–14. Just over half (52%) of all Aboriginal and Torres Strait Islander hospitalisations for CVD were for people aged under 55, compared to 17% for the non-Indigenous population.

Rates of hospitalisation where dialysis was the principal diagnosis were 10 times as high as for the non-Indigenous population.

Death rates are greater, and are higher at younger ages

Higher rates of risk factors, and of disease, translate into higher mortality rates. In 2010–12, the Aboriginal and Torres Strait Islander CVD mortality rate was 1.5 times as high as the non-Indigenous rate, and Aboriginal and Torres Strait Islander peoples were 4 times and 3 times, respectively, as likely to have diabetes and CKD listed as an underlying or associated cause of death. Premature and potentially preventable CVD deaths contributed almost one-quarter (24%) to the mortality gap between Aboriginal and Torres Strait Islander and non-Indigenous people.

The gap in death rates between Aboriginal and Torres Strait Islander and non-Indigenous people was widest among younger age groups—the CVD death rate for Aboriginal and Torres Strait Islander peoples aged 35–44, for example, was 8 times as high, falling to 4 times as high for the 55–64 year old age group. For diabetes and CKD death rates at age 55–64 were 10 times as high for Aboriginal and Torres Strait Islander peoples as for nonIndigenous people.

Comorbidity is also more frequent

Shared risk factors mean that CVD, diabetes and CKD often occur concurrently, and this happens more frequently in the Aboriginal and Torres Strait Islander population. In 2011-13, 38% of Aboriginal and Torres Strait Islander adults with CVD, diabetes or CKD had 2 or more of the conditions, compared to 26% of nonIndigenous adults. More than one in 10 (11%) Aboriginal and Torres Strait Islander deaths had all three conditions listed as causes of death, compared with 3% of nonIndigenous deaths.

Comorbidity, often associated with worse health outcomes, increased with age for both populations, but was greater at each age in the Aboriginal and Torres Strait Islander population.

Changes over time

When comparable data were available over time, time trends were analysed. These show mixed results. There was a 40% fall in CVD deaths between 1998 and 2012, and a subsequent narrowing of the gap between Aboriginal and Torres Strait Islander and non-Indigenous people. Minimal change was observed in the gap in diabetes and CKD death rates.

The number of Aboriginal and Torres Strait Islander people treated for end-stage kidney disease more than doubled between 2000 and 2013—a 58% increase compared to a 35% increase for non-Indigenous people. There was little change in the disparity between Aboriginal and Torres Strait Islander and non-Indigenous people in the use of diagnostic and revascularisation procedures in CHD hospitalisations.

The importance of monitoring

As the Australian Government develops a new National Strategic Framework for Chronic Conditions, these data provide supporting evidence on the magnitude of inequalities in chronic disease within the Australian population.

Ongoing monitoring of chronic disease in the Aboriginal and Torres Strait Islander population will help drive positive change by informing the policy frameworks and programmes which bring together chronic disease and Aboriginal and Torres Strait Islander health, including the Close the Gap initiative, the National Aboriginal and Torres Strait Islander Health Plan and the Better Cardiac Care for Aboriginal and Torres Strait Islander People project.

This article was written by Ros Seselja and Michael de Looper for The Health Advocate’s April 2016 edition. To access his and previous editions, click here. The report is available for free here

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