Review of the state of knowledge of cardiovascular disease among Aboriginal and Torres Strait Islander populations
Australian Indigenous HealthInfoNet
Place of Publication
Mt Lawley, Western Australia
Australian Indigenous HealthInfoNet
This report has been prepared as part of a project which aims to review the current state of knowledge about cardiovascular disease in rural and remote settings and Aboriginal and Torres Strait Islander populations to assist the consideration of research priorities at a workshop to be held in Alice Springs in November 1999. The report aims to inform the Alice Springs workshop by providing an overview of cardiovascular disease among Indigenous people and identifying issues that arise from the overview. As such, it represents a part of the 'health intelligence' input to the 'informed opinion' process of the workshop, in which Indigenous community representatives and clinical and public health experts will identify priority areas that are amenable to research and have broad community support. The report draws on a wide range of published and unpublished information specific to Indigenous cardiovascular disease, but does not attempt to include mainstream cardiovascular clinical or public health research or research relating to the social and economic context within which cardiovascular disease occurs among Indigenous people.
This review identified almost 270 published or unpublished sources of information about cardiovascular disease among Indigenous people, but the many were of doubtful value and most of the worthwhile sources were descriptive studies of some aspect of cardiovascular disease or risk factors.
The sources confirm that the overall burden from cardiovascular disease is much greater for Indigenous people than for non-Indigenous people. For people living in Western Australia, South Australia and the Northern Territory, Indigenous people die from cardiovascular disease at a rate around twice that of other Australians. Coronary heart disease and stroke are the major specific causes of death for Indigenous people, as they are for other Australians, but in each case death rates are around twice as high. A striking aspect of Indigenous of mortality from coronary heart disease is the high death rates among young and middle-aged adults - death rates for Indigenous people aged 25-44 years were more than 10 times those of other Australians.
The review did not identify any recent research examining the mortality from cardiovascular disease for Indigenous people living in parts of Australia other than WA, SA and the NT, but there is some evidence that levels are likely to be similar, at least in New South Wales and Queensland. Similarly, little attention has been directed to specific regional differences in cardiovascular mortality among Indigenous people, but evidence from WA suggests that overall death rates are at least as high in urban areas as they are in rural and remote parts of the State.
Rheumatic fever and rheumatic heart disease are rare among the Australian population overall, but the incidence and prevalence among Indigenous people living in the Top End of the NT, in the Kimberley region of WA and possibly parts of north Queensland is very high, even by world standards. The overall death rate from these conditions for Indigenous people living in WA, SA and the NT is around 15 times that of other Australians, and the ratio would be even greater for those regions where the disease is most prevalent. There is evidence, from two nationwide surveys and a number of ad hoc studies, of much higher levels of some important biomedical cardiovascular risk factors among Indigenous people compared with other Australians. These include higher levels of cigarette smoking, obesity and harmful consumption of alcohol, and lower levels of leisure-time physical activity. As noted above, the majority of sources identified were descriptive studies, and very little attention appears to have been directed to interventions or health systems issues (with the possible exception of rheumatic fever and rheumatic heart disease). Even the descriptive studies are limited in terms of geographic coverage and specificity, attention to the conditions responsible for the most deaths (coronary heart disease and stroke) and other than biomedical risk factors (for example, psychosocial risk factors).
In view of the much greater impact of cardiovascular disease among Indigenous than non-Indigenous people, the paucity of the research into the interventions and health systems issues is striking. Given our knowledge generally about the effectiveness of primary, secondary and tertiary interventions, there appears to be an urgent need for research into how this knowledge can be applied to the benefit of the Indigenous people of Australia, and into barriers to its application.