Comparison of clinical manifestation among Australian Indigenous and non‐indigenous patients presenting with pleural effusion

Abstract

Background There is sparse evidence in the literature in relation to the nature and causes of pleural effusion among Australian Indigenous population. Aim To investigate the clinical and demographic characteristics of adult indigenous patients presenting with pleural effusion in the Northern Territory of Australia. Methods In this retrospective study, indigenous and non‐indigenous adults diagnosed to have pleural effusion over a 2‐year study period were included for comparative analysis. Results Of the 314 patients, 205 (65%) were non‐indigenous and 52% were male. In comparison with non‐indigenous patients, the indigenous patients were younger (50 years (interquartile range (IQR) 39–60) vs 63 years (IQR 52–72); P < 0.001), female (61% vs 41%; P = 0.001), had a higher prevalence of renal and cardiovascular disease and tended to have exudative effusion (93% vs 76%; P = 0.032). Infections were judged to be the most common cause of effusion in both groups, more so among the indigenous cohort. Effusion secondary to renal disease was higher (13% vs 1%; P < 0.001) among Australian Indigenous patients, but in contrast, malignant effusions were higher (13% vs 4%; P = 0.004) among non‐indigenous patients. Length of hospital stay was longer for indigenous patients (P = 0.001), and a greater proportion received renal dialysis (13% vs 1%; P < 0.001). Intensive care unit admission rates were higher with infective aetiology of pleural effusion (82% vs 53% indigenous and 44% vs 39% non‐indigenous respectively). Re‐presentations to hospital were higher among indigenous patients (46% vs 33%; P = 0.046) and were associated with renal and cardiac disease and malignancy in non‐indigenous patients. Conclusion There are significant differences in the way pleural effusion manifests among Australian Indigenous patients. Understanding these differences might facilitate approaches to management and to implementation of strategies to reduce morbidity and mortality in this population.

Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

“…1 2 Moreover, hospital admission rates are also reported to be significantly higher for the adult Indigenous patients and COPD is one of the potentially preventable causes of admissions in this population. 3 4 Emerging evidence in the literature suggests that Indigenous Australians not only have a higher prevalence of COPD, but also tend to exhibit other concurrent pulmonary conditions, in particular the presence of bronchiectasis, 5–11 along with significantly lower lung function parameters (LFPs) in comparison to their non-Indigenous counterparts. 12–14 …”

The Effects of Inhaled Airway Directed Pharmacotherapy on Decline in Lung Function Parameters Among Indigenous Australian Adults With and Without Underlying Airway Disease

“…Indigenous people around the world experience a higher burden of chronic health conditions, including advanced respiratory conditions. [44][45][46] Despite evidence in the literature to suggest chronic respiratory conditions along with poor LFPs are highly prevalent among Indigenous population, including in the adult Indigenous Australians, 1,4,[7][8][9][10][11][12][13][14][15][16] there is no published data examining the effects of airway directed inhaled pharmacotherapy on LFPs trajectory in this population. Hence, we believe our current study is of significant value in addressing this gap in our knowledge.…”

“…However, excessive yearly decline in FEV 1 is noted to be higher among patients using ICS containing pharmacotherapy alongside higher all-cause mortality in comparison to patients with non-ICS containing inhaled pharmacotherapy or no pharmacotherapy. In the light of this study, and the authors several years of experience in managing Indigenous patients with chronic health conditions, [7][8][9][10][11][12][13][14][15][16]54,[65][66][67][68][69][70][71][72] until and unless further prospective large scale studies are available to prove or disprove if ICS pharmacotherapy is a friend or foe in the management among Indigenous people, we sincerely recommend and advocate extreme caution in utilising…”

“…5,6 Chronic airway diseases, such as COPD and bronchiectasis are noted to be highly prevalent in the NT Indigenous population. [7][8][9][10][11] Moreover, recently published data has shown that co-occurrence of COPD and bronchiectasis along with poor lung function parameters (LFPs) are highly prevalent among Indigenous people living in the Top end health service (TEHS) region of the NT of Australia. [12][13][14][15][16] LFTs 17 play an integral role in the diagnosis, management and monitoring of several respiratory conditions.…”

“…This is despite overwhelming evidence in the literature documenting a higher burden of respiratory disease among the adult Indigenous Australian population. 4,[7][8][9][10][11][12] Furthermore, LFPs are noted to be significantly reduced among Indigenous Australians in comparison to non-Indigenous Australians. [13][14][15][16] Thus, considering these aforementioned factors together (reduced LFPs, high burden of chronic respiratory disorders along with potential higher use of airway directed pharmacotherapy), there appears to be a critical need to investigate LFPs trajectory with and without radiological evidence of chronic airway diseases and the effects of inhaled pharmacotherapy on LFPs' among the adult Indigenous Australian population.…”