Indigenous Australians hit by chronic disease

The prevalence of multimorbidities – the presence of two or more chronic health conditions – in Aboriginal and Torres Strait Islander Australians is 2.6 times that among non-Indigenous Australians, according to new research published online by the Medical Journal of Australia.

Researchers led by Dr Deborah Randall, from the Centre for Big Data Research in Health at the University of New South Wales, wrote that “this difference accounted for much of the difference in mortality between the two groups”.

“Life expectancy at birth of Aboriginal and Torres Strait Islander peoples is estimated to be 11.5 years lower for men and 9.7 years lower for women than for other Australians,” they wrote. “The burden of disease for Aboriginal and Torres Strait Islander Australians … is more than twice that of other Australians, and non-communicable diseases are responsible for 70% of the difference.”

Randall and colleagues examined multimorbidity among Aboriginal and non-Aboriginal people in NSW by analysing linked hospital (Admitted Patient Data Collection) and linked mortality data for 5 437 018 NSW residents with an admission to a NSW hospital between 1 March 2003 and 1 March 2013, and alive at 1 March 2013. Aboriginal Australians made up 2.2% (117 999).

“[Of the Aboriginal patients] 31.5% had at least one morbidity and 16.1% had two or more, compared with 25.0% and 12.1% of non-Aboriginal patients,” they found.

“After adjusting for age, sex, and socio-economic status, the prevalence of multimorbidity among Aboriginal people was 2.6 times that for non-Aboriginal people. The prevalence of multimorbidity was higher among Aboriginal people in all age groups; in younger age groups because of the higher prevalence of mental morbidities, and from age 60 because of physical morbidities.

“From the age of 25 years, the prevalence of multimorbidity was at least 10 percentage points higher among Aboriginal than among non-Aboriginal patients, and 20 percentage points higher between the ages of 40 and 79 years.”

Randall and colleagues wrote that the hazard of an Aboriginal Australian dying in one year was 2.4 times that of a non-Aboriginal Australian of the same age group and socioeconomic status. Once morbidity count was adjusted for, this mortality ratio reduced to 1.5, highlighting that much of higher mortality risk was associated with Aboriginal people having more morbidities.

“Providing high-quality care and evidence-based interventions, particularly interventions targeting alcohol and other substance use disorders, is crucial to reducing multimorbidity among Aboriginal and Torres Strait Islander Australians.

“The weathering and premature ageing of Indigenous Australians are as related to poverty and stress as to poor access to health care, so it is vital that the societal position of Aboriginal and Torres Strait Islander Australians be improved, that poverty and disadvantage be eliminated, and that the social determinants of health — including early development, education, employment, and income — be improved to remove the disparities in multimorbidity and mortality between Indigenous and non-Indigenous Australians,” they concluded.