Lower than expected morbidity and mortality for an Australian Aboriginal population: 10‐year follow‐up in a decentralised community

Abstract

Objective: To examine mortality from all causes and from cardiovascular disease (CVD), and CVD hospitalisation rate for a decentralised Aboriginal community in the Northern Territory. Design and participants: For a community‐based cohort of 296 people aged 15 years or older screened in 1995, we reviewed hospital and primary health care records and death certificates for the period up to December 2004 (2800 person‐years of follow‐up). Main outcome measures: Mortality from all causes and CVD, and hospitalisation with CVD coded as a primary cause of admission; comparison with prior trends (1988 to 1995) in CVD risk factor prevalence for the community, and with NT‐specific Indigenous mortality and hospitalisation rates. Results: Mortality in the cohort was 964/100 000 person‐years, significantly lower than that of the NT Indigenous population (standardised mortality ratio [SMR], 0.62; 95% CI, 0.42–0.89). CVD mortality was 358/100 000 person‐years for people aged 25 years or older (SMR, 0.52; 95% CI, 0.23–1.02). Hospitalisation with CVD as a primary cause was 13/1000 person‐years for the cohort, compared with 33/1000 person‐years for the NT Indigenous population. Conclusion: Contributors to lower than expected morbidity and mortality are likely to include the nature of primary health care services, which provide regular outreach to outstation communities, as well as the decentralised mode of outstation living (with its attendant benefits for physical activity, diet and limited access to alcohol), and social factors, including connectedness to culture, family and land, and opportunities for self‐determination.

Recent patterns in chronic disease mortality in remote living Indigenous Australians

“…A recent study by Burgess et al [26] showed that caring for country was associated with significantly more frequent physical activity, better diet, lower body mass index, less abdominal obesity, lower systolic blood pressure, less diabetes, non-elevated albumin-creatinine ratio, higher high density cholesterol lipoprotein cholesterol level, lower cardiovascular risk and reduced mortality in Indigenous Australians. In a recent study by Rowley et al [27], lower than expected cardiovascular morbidity and all-cause mortality in a decentralized Aboriginal community in the Northern Territory were attributed to regular primary health care services, better physical activity and diet, limited access to alcohol, social factors and self-determination.…”

Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines

“…The authors noted remoteness contributes to variable access to health care and is an independent predictor for poorer health outcomes [5, 6, 7, 31, 32]. Despite these significant gaps there is evidence to show that we are capable of making inroads, but this requires common sense and getting’s some basics right [33]. The bigger question is whether we can sustain such efforts for long periods, given the transitional nature of scientific funding and political sentiment.…”

“…A defining summary on traditional Indigenous views on health has been provided by Maher and is sufficiently authoritative to ensure it is essential reading for any medical context [35]. Similarly health system perspectives on Indigenous health have been summarised [14, 33-49]. What is lacking is direct information from the Indigenous clients themselves.…”

A Review of Programs That Targeted Environmental Determinants of Aboriginal and Torres Strait Islander Health

“…A Healthy Lifestyles project in north-east Arnhemland also included a family food garden program that involved staff working with families to establish backyard gardens, a community market which allowed access to fresh fruits, bush foods, fish and shell-fish, and a policy of not selling deep-fried takeaway foods until at least 11 am [16]. In an evaluation of the effects of returning to traditional Country away from an urban environment, major benefits of the associated changes in diet and lifestyle on diabetes control were identified [21] and similar benefits are likely to have accrued from other programs that included Homelands living [37,41]. In an attempt to divert spending away from tobacco and alcohol to healthier dietary choices, income management for all Aboriginal people on social security payments was made mandatory under the Northern Territory Emergency Response [43], This required change at the Federal Government level by suspending the Racial Discrimination Act 1975 to allow its implementation [51].…”