Abstract
The health of Indigenous Australians is dramatically poorer than that of the non-Indigenous population. Amelioration of these differences has proven difficult. In part, this is attributable to a conceptualisation which approaches health disparities from the perspective of individual-level health behaviours, less so the environmental conditions that shape collective health behaviours. This ecological study investigated associations between the built environment and cardiometabolic mortality and morbidity in 123 remote Indigenous communities representing 104 Indigenous locations (ILOC) as defined by the Australian Bureau of Statistics. The presence of infrastructure and/or community buildings was used to create a cumulative exposure score (CES). Records of cardiometabolic-related deaths and health service interactions for the period 2010–2015 were sourced from government department records. A quasi-Poisson regression model was used to assess the associations between built environment “healthfulness” (CES, dichotomised) and cardiometabolic-related outcomes. Low relative to high CES was associated with greater rates of cardiometabolic-related morbidity for two of three morbidity measures (relative risk (RR) 2.41–2.54). Cardiometabolic-related mortality was markedly greater (RR 4.56, 95% confidence interval (CI), 1.74–11.93) for low-CES ILOCs. A lesser extent of “healthful” building types and infrastructure is associated with greater cardiometabolic-related morbidity and mortality in remote Indigenous locations. Attention to environments stands to improve remote Indigenous health.
Highlights
Despite government policy aimed at improving health outcomes for Aboriginal and Torres StraitIslander Australians [1], Indigenous communities continue to face significant challenges that yield substantial disparities in terms of cardiometabolic disease (CMD) [2]
For the 104 Indigenous locations (ILOC) included in the study, the mean population size was 370.3 (SD 416.3) persons, the average median age of the Indigenous population corresponded to young adulthood, 23.0 years (SD 4.3), and the mean gender ratio was 1.1 females to males (SD 0.2)
Analyses of built environmental exposures expressed per the cumulative exposure score (CES) indicated a higher risk of CMD-related mortality and morbidity for ILOCs with low relative to high CES
Summary
Islander (hereafter, Indigenous) Australians [1], Indigenous communities continue to face significant challenges that yield substantial disparities in terms of cardiometabolic disease (CMD) [2]. Recent surveys indicate that Indigenous Australians are 3.3 times more likely to have diabetes compared to the non-Indigenous population [3], the age-standardised death rate for ischaemic heart disease is twice as high for the Indigenous population than for the non-Indigenous population [4], and Indigenous adults are 1.2 times more likely than non-Indigenous adults to be hypertensive [5]. The health disparity between Indigenous and non-Indigenous Australians is well documented by descriptive analyses, with studies providing information on the mechanisms linking individual risk factors to CMD in these populations [6,7], these mechanisms likely represent only a. Public Health 2020, 17, 769; doi:10.3390/ijerph17030769 www.mdpi.com/journal/ijerph
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