Disease In Indigenous Australians Research Articles

The Surgical Challenges of Rheumatic Valve Disease in Indigenous Australians

angiography at RDH between the 30th June 2011–31st July 2011 were selected and data compiled from the RDH cardiac catheter lab database. Baseline demography, risk factor profile, revascularisation procedures were determined. Basic demographic analysis were performed with further statistical analysis by 2 tailed Chi-Square test to assess statistical significance between the variables. Results: 254 patients were sampled of which 49% were Indigenous in origin. Indigenous patient were younger with nearly 60% of the population below the age of 50. Incidences of ACS among the Indigenous patients were (633 cases/ 100,000) compared to (195 cases/100,000) amongst the non-Indigenous patients. Traditional cardiovascular risk factors were more prevalent among the Indigenous population. Indigenous patients underwent more CABG procedures (12% vs. 8%) but less PCI procedures (16% vs. 20%) although this was not found to be statistically significant. Conclusions: Nearly half of ACS patients at RDH were Indigenous in origin with approximately 2/3 below the age of 50. Indigenous patients had threefold more incidence of ACS compared to non-Indigenous patients. Both populations underwent relatively similar proportions of various revascularisation procedures.

Cardiometabolic risk and disease in Indigenous Australians: The heart of the heart study

ObjectivesThis study assessed the burden and determinants of cardiovascular and metabolic risk in a community sample of high risk Indigenous Australians. BackgroundIndigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear. MethodsThe Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status. ResultsIndividuals with depression were twice as likely to have cardiovascular disease (OR 2.03; 1.07–3.88; p<0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p=0.069), but coronary artery disease did (p=0.035 for trend). Unemployed individuals were more likely to have cardiovascular disease (OR 2.32; 1.33–4.06; p<0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002; 0.01 and 0.04 respectively). ConclusionParticipants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.

The renin–angiotensin system from conception to old age: the good, the bad and the ugly

The renin-angiotensin system (RAS) plays a critical role in placentation and nephrogenesis. Failure to thrive during intrauterine life, possibly related to placental dysfunction and impaired expression of the renal RAS, as well as prematurity, results in smaller kidneys at birth and reduced nephron number. The remaining nephrons are therefore hyperfiltering from birth. Hyperfiltration, infections and Type 2 diabetes cause glomerular and tubular fibrosis, leading to further reductions in nephron number. The intrarenal RAS plays a key role in promoting tubulointerstitial fibrosis. Low birth weight and a high incidence of preterm birth program Indigenous children for early onset renal disease in adult life. Indigenous Australians have 404 000 fewer nephrons than non-Indigenous Australians. This, coupled with the high incidence of infectious diseases (particularly acute post-streptococcal glomerulonephritis) and the increasing prevalence of Type 2 diabetes, explains why end-stage renal disease is of epidemic proportions in Indigenous Australians. The existence of RAS gene polymorphisms and inflammatory cytokines may further potentiate susceptibility to renal disease in Indigenous Australians.

Kerin O'Dea: improving the health of Indigenous Australians

Kerin O'Dea: improving the health of Indigenous Australians

The Combined Burden of Diabetes and Cardiovascular Disease in Indigenous Australians

Type 2 diabetes mellitus (T2DM), cardiovascular disease, and chronic kidney disease are significant contributors to the 17-year disparity in life expectancy between Indigenous and non-Indigenous Australians. These three conditions are prevalent from a young age in Indigenous Australians and clearly contribute to their premature mortality. Risk factors that both exacerbate and promote these conditions include central obesity, dyslipidemia, cigarette smoking, albuminuria, inflammation, and poor socio-economic status. Although rates of screening for T2DM are higher in Indigenous Australians than in non-Indigenous Australians, gaps in clinical management of both T2DM and cardiovascular disease exist. To enhance survival and quality of life, prevention strategies are required at a population level and from a young age in Indigenous Australians.

Mental disorders due to substance use and cardiovascular disease risk in Aboriginal adults

TO THE EDITOR: Cardiovascular disease (CVD) and mental disorders are the top two contributors to the total burden of disease in Indigenous Australians and make a substantial contribution to the excess morbidity and mortality in this group. There is increasing evidence that mental disorders are risk factors for, or consequences of, CVD. Awareness and better understanding of the intertwined relationship between mental disorders and CVD in Indigenous populations can provide opportunities for coordinated and seamless management of these conditions in health care systems. We investigated the association between mental disorders due to substance use and CVD in a remote Indigenous community in the Northern Territ ry. A cohort of 897 Aboriginal adults aged 20–74 years (85% of the community’s total adult population) was established throu h a population-based renal disease screening program in the community between 1992 and 1995. We followed up 784 participants, who were free of CVD at baseline, to 31 May 2005, using hospital and death records. The study was approved by the Behavioural and Social Sciences Ethical Review Committee of the University of Queensland. Substance use-related mental disorders were determined from participants’ hospital records, using International Classification of Diseases, ninth revision (ICD-9) codes 192, 291 and 303–305; and 10th revision (ICD10) codes F10–F19. Cases of CVD were identified by the first CVD event recorded in participants’ hospital and death records, using ICD-9 codes 390–459 and ICD-10 codes I00–I99. We used the Kaplan–Meier method to calculate cumulative CVD incidence rates for those with and without substance use-related mental disorders. CVD hazard ratios were estimated using Cox proportional hazards models. During a median follow-up period of 10 years, 177 of the 784 participants (23%) had clinically diagnosed mental disorders due to substance use (mainly alcohol: 140 participants), and 243 (31%) developed CVD. Incidence rates of CVD were 71 (95% CI, 58–87) and 27 (95% CI, 23–32) per 1000 person-years for those with and without substance use-related mental disorders, respectively (Box). Participants with substance use-related mental disorders were 2.6 (95% CI, 2.0–3.3) times more likely to develop CVD than those without. After adjusting for CVD risk factors measured at baseline (age, sex, body mass index, smoking status, alcohol use, blood pressure, serum cholesterol level, diabetes and albuminuria status), the association remained statistically significant, with an adjusted hazard ratio of 2.6 (95% CI, 1.9–3.5). Our findings confirm an association between substance use-related mental disorders and CVD in an Indigenous population, after adjusting for potential confounders. Traditional health care systems tend to separate services and treatment for mental disorders from those for physical health problems such as CVD. This separation is even more evident in remote Indigenous settings, where primary health care practitioners are already overwhelmed in providing general medical care to community members, with mental health services being delivered infrequently by visiting psychiatrists. The observed intertwined relationship between these two common conditions calls for integration of mental health services into routine primary health care, and enhanced collaboration between primary care practitioners, cardiologists and psychiatrists, in an effort to curb the huge burden imposed by these diseases. The emerging Aboriginal mental health worker program in the NT has the potential to be an effective service model to bridge the gap between mental health care and day-today primary health care. Dedicated financial resources and ongoing support for recruitment, training and retention of Aboriginal mental health workers will be required for sustained integration of mental health care with primary care in Indigenous communities.

Some recollections about kuru in a patient at Rabaul in 1978, and subsequent experiences with prion diseases

I first heard about kuru when I was undertaking the six-month full-time Diploma in Tropical Medicine and Hygiene (DTM&H) course at Edinburgh University in 1970–1971. The Head of the Department of Infectious and Tropical Diseases, the eminent Dr Frederick J. Wright, had visited Papua New Guinea and

Correlates of preclinical cardiovascular disease in Indigenous and Non-Indigenous Australians: a case control study

BackgroundThe high frequency of premature death from cardiovascular disease in indigenous Australians is often attributed to the high prevalence of risk factors, especially type II diabetes mellitus (DM). We evaluated the relationship of ethnicity to atherosclerotic burden, as evidenced by carotid intima-media thickness (IMT), independent of risk factor status.MethodsWe studied 227 subjects (147 men; 50 ± 13 y): 119 indigenous subjects with (IDM, n = 54), and without DM (InDM, n = 65), 108 Caucasian subjects with (CDM, n = 52), and without DM (CnDM, n = 56). IMT was measured according to standard methods and compared with clinical data and cardiovascular risk factors.ResultsIn subjects both with and without DM, IMT was significantly greater in indigenous subjects. There were no significant differences in gender, body mass index (BMI), systolic blood pressure (SBP), or diastolic blood pressure (DBP) between any of the groups, and subjects with DM showed no difference in plasma HbA1c. Cardiovascular risk factors were significantly more prevalent in indigenous subjects. Nonetheless, ethnicity (β = -0.34; p < 0.0001), age (β = 0.48; p < 0.0001), and smoking (β = 0.13; p < 0.007) were independent predictors of IMT in multiple linear regression models.ConclusionEthnicity appears to be an independent correlate of preclinical cardiovascular disease, even after correction for the high prevalence of cardiovascular risk factors in indigenous Australians. Standard approaches to control currently known risk factors are vital to reduce the burden of cardiovascular disease, but in themselves may be insufficient to fully address the high prevalence in this population.

Huntington disease in indigenous Australians

Huntington disease (HD) in indigenous Australians is a poorly analysed and difficult problem. This study addresses the issue of HD in remote indigenous Australian populations in the north-west of Western Australia. Proband identification, clinical assessment, neurogenetic studies and pedigree analysis led to the discovery of HD in the 63-year-old male proband and his family. HD in remote indigenous Australian communities is a challenging diagnostic and management problem compounded by the complexity of distance.

Trends in the incidence of treated end‐stage kidney disease among Indigenous Australians and access to treatment

To determine temporal trends of incidence of treated end-stage kidney disease in Indigenous Australians and the extent to which these patients had to move from their home community to access renal replacement therapy. Data for 1993-2001, regarding place of residence before starting renal replacement therapy, were analysed to give accurate incidence for 1,194 Indigenous treated end-stage kidney disease patients. We calculated indirectly standardised incidence ratios of treated end-stage kidney disease by State and Territory. We surveyed treating renal units about which Indigenous patients relocated to access therapy from 1999 to 2001. The incidence of treated end-stage kidney disease among Indigenous Australians is high and rising; however, the rate of increase is lower than has been previously reported. The Northern Territory (NT) and Queensland have the most new Indigenous treated end-stage kidney disease cases. The highest standardised incidence ratio was in the NT (17.0), followed by Western Australia (WA) (11.9). From 1999 to 2001, half of the 476 Indigenous patients starting therapy had to relocate to access treatment. The incidence of end-stage kidney disease among Indigenous Australians continues to rise. However, significant gaps in knowledge remain about the burden of early chronic kidney disease and whether many Indigenous patients with end-stage kidney disease still choose not to receive renal replacement therapy. The need to relocate to access treatment has a strong negative impact on individuals, families and entire communities.

Carotid artery intimal medial thickness, brachial artery flow-mediated vasodilation and cardiovascular risk factors in diabetic and non-diabetic indigenous Australians

Background: Indigenous Australians are at high risk for cardiovascular disease and type 2 diabetes. Carotid artery intimal medial thickness (CIMT) and brachial artery flow-mediated vasodilation (FMD) are ultrasound imaging based surrogate markers of cardiovascular risk. This study examines the relative contributions of traditional cardiovascular risk factors on CIMT and FMD in adult Indigenous Australians with and without type 2 diabetes mellitus. Method: One hundred and nineteen Indigenous Australians were recruited. Physical and biochemical markers of cardiovascular risk, together with CIMT and FMD were meausred for all subjects. Results: Fifty-three Indigenous Australians subjects (45%) had type 2 diabetes mellitus. There was a significantly greater mean CIMT in diabetic versus non-diabetic subjects ( p = 0.049). In the non-diabetic group with non-parametric analyses, there were significant correlations between CIMT and: age ( r = 0.64, p < 0.001), systolic blood pressure ( r = 0.47, p < 0.001) and non-smokers ( r = −0.30, p = 0.018). In the diabetic group, non-parametric analysis showed correlations between CIMT, age ( r = 0.36, p = 0.009) and duration of diabetes ( r = 0.30, p = 0.035) only. Adjusting for age, sex, smoking and history of cardiovascular disease, Hb A1c became the sole significant correlate of CIMT ( r = 0.35, p = 0.01) in the diabetic group. In non-parametric analysis, age was the sole significant correlate of FMD ( r = −0.31, p = 0.013), and only in non-diabetic subjects. Linear regression analysis showed significant associations between CIMT and age ( t = 4.6, p < 0.001), systolic blood pressure ( t = 2.6, p = 0.010) and Hb A1c ( t = 2.6, p = 0.012), smoking ( t = 2.1, p = 0.04) and fasting LDL-cholesterol ( t = 2.1, p = 0.04). There were no significant associations between FMD and examined cardiovascular risk factors with linear regression analysis Conclusions: CIMT appears to be a useful surrogate marker of cardiovascular risk in this sample of Indigenous Australian subjects, correlating better than FMD with established cardiovascular risk factors. A lifestyle intervention programme may alleviate the burden of cardiovascular disease in Indigenous Australians by reducing central obesity, lowering blood pressure, correcting dyslipidaemia and improving glycaemic control. CIMT may prove to be a useful tool to assess efficacy of such an intervention programme.

Regional variation in the incidence of end-stage renal disease in Indigenous Australians.

To evaluate regional variation in the incidence of end-stage renal disease (ESRD) in Indigenous Australians, and to examine the proximity to ESRD treatment facilities of Indigenous patients. Secondary data review, with collection of primary data regarding patients' place of residence before beginning ESRD treatment. Indigenous ESRD patients who commenced treatment in Australia during 1993-1998. We obtained data from the Australian and New Zealand Dialysis and Transplant Registry regarding 719 Indigenous patients who started ESRD treatment between 1 January 1993 and 31 December 1998. We obtained primary data from the treating renal units to determine the place of residence before beginning renal replacement therapy. We calculated the average annual incidence of ESRD for each of the 36 Aboriginal and Torres Strait Islander Commission regions using population estimates based on the 1996 Census, and calculated standardised incidence ratios with 95% confidence intervals for each region. We compared the number of cases with the treatment facilities available in each region. Regional standardised ESRD incidence for Indigenous Australians referenced to the total resident population of Australia. Standardised ESRD incidence among Indigenous Australians is highest in remote regions, where it is up to 30 times the national incidence for all Australians. In urban regions the standardised incidence is much lower, but remains significantly higher than the national incidence. Forty-eight per cent of Indigenous ESRD patients come from regions without dialysis or transplant facilities and 16.3% from regions with only satellite dialysis facilities. There is marked regional variation in the incidence of ESRD among Indigenous Australians. Because of the location of treatment centres, there is inequitable access to ESRD treatment services for a significant proportion of Indigenous patients.

Public health implications of pneumococcal disease in indigenous Australians

Public health implications of pneumococcal disease in indigenous Australians