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

Kevin G Rowley, Kerin O’Dea, Ian Anderson, Robyn McDermott, Karmananda Saraswati, Ricky Tilmouth, Iris Roberts, Joseph Fitz, Zaimin Wang, Alicia Jenkins, James D Best, Zhiqiang Wang and Alex Brown
Med J Aust 2008; 188 (5): 283-287.

Summary

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.

  • Kevin G Rowley1,2
  • Kerin O’Dea2,3
  • Ian Anderson1
  • Robyn McDermott4
  • Karmananda Saraswati5
  • Ricky Tilmouth5
  • Iris Roberts3,6
  • Joseph Fitz3
  • Zaimin Wang7
  • Alicia Jenkins2
  • James D Best2,8
  • Zhiqiang Wang7
  • Alex Brown3,6

  • 1 Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, VIC.
  • 2 Department of Medicine (St Vincent’s Hospital), University of Melbourne, Melbourne, VIC.
  • 3 Menzies School of Health Research, Darwin, NT.
  • 4 University of South Australia, Adelaide, SA.
  • 5 Urapuntja Health Service, Utopia, NT.
  • 6 Centre for Indigenous Vascular and Diabetes Research, Baker Heart Research Institute, Alice Springs, NT.
  • 7 School of Population Health, University of Queensland, Brisbane, QLD.
  • 8 Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC.

Correspondence: rowleyk@unimelb.edu.au

Acknowledgements: 

We thank Elders of the Alyawarr and Anmatyerr Nations: Kumantjayi Kunoth, Hugh Heggie, and Sabina Knight. David Thomas, Dallas English, Allison Hodge, and Margaret Kelaher provided statistical advice; and Leah Johnston, Paul Rickards and Stacey Swenson provided technical assistance. This work was funded by the National Health and Medical Research Council and a VicHealth Public Health Research Fellowship to Kevin Rowley. Onemda is funded by VicHealth and the Australian Government Department of Health and Ageing.

Competing interests:

None identified.

  • 1. Gault A, O’Dea K, Rowley KG, et al. Abnormal glucose tolerance and other coronary heart disease risk factors in an isolated Aboriginal community in central Australia. Diabetes Care 1996; 19: 1269-1273.
  • 2. Indigenous Studies Program. Agreements, treaties and negotiated settlements project: Aboriginal Land Rights (Northern Territory) Act 1976 (Cth). Melbourne: University of Melbourne, 2007. http://www.atns.net.au/agreement.asp?EntityID=381 (accessed Jan 2008).
  • 3. Indigenous Studies Program. Agreements, treaties and negotiated settlements project: Pastoral Land Act 1992 (NT). Melbourne: University of Melbourne, 2007. http://www.atns.net.au/agreement.asp?EntityID=2571 (accessed Jan 2008).
  • 4. Rowley K, Gault A, McDermott R, et al. Reduced prevalence of impaired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities. Diabetes Care 2000; 23: 898-904.
  • 5. Vanstone A. Beyond conspicuous compassion: Indigenous Australians deserve more than good intentions. In: Wanna J, editor. A passion for policy: ANZOG lecture series 2005–2006. Canberra: ANU Press, 2007.
  • 6. Stafford A. Threat to cut funds for remote Aborigines. The Age (Melbourne) 2006; 6 Dec: 2.
  • 7. Daniel M, Rowley KG, McDermott R, et al. Diabetes incidence in an Australian Aboriginal population. An 8-year follow-up study. Diabetes Care 1999; 22: 1993-1998.
  • 8. Li SQ, Guthridge S. Mortality in the Northern Territory 1981–2000. Part 1: key indicators and overview. Darwin: NT Department of Health and Community Services, 2004.
  • 9. Rowley KG, Iser DM, Best JD, O’Dea K. Albuminuria in Australian Aboriginal people: prevalence and associations with components of the metabolic syndrome. Diabetologia 2000; 43: 1397-1403.
  • 10. McDermott R, O’Dea K, Rowley K, et al. Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines. Aust N Z J Public Health 1998; 22: 653-658.
  • 11. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, et al. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Circulation 1994; 90: 583-612.
  • 12. Australian Bureau of Statistics. 2006 Census data. Canberra: ABS, 2007. http://www.censusdata.abs.gov.au/ (accessed Nov 2007).
  • 13. Briganti EM, Shaw JE, Chadban SJ, et al. Untreated hypertension among Australian adults: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 2003; 179: 135-139. <MJA full text>
  • 14. Australian Bureau of Statistics. Deaths, Australia, 2004. Canberra: ABS, 2004. (ABS Catalogue No. 3302.0.)
  • 15. Australian Bureau of Statistics. Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians. Canberra: ABS, 2004. (ABS Catalogue No. 3238.0.)
  • 16. Sullivan KM, Soe MM. SMR analysis, version 4.11.19 [online calculator]. Atlanta: Rollins School of Public Health of Emory University, 2005. http://www.sph.emory.edu/~cdckms/exact-midP-SMR.html (accessed Nov 2007).
  • 17. Australian Bureau of Statistics. The health and welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005. Canberra: ABS, 2005. (ABS Catalogue No. 4704.0.)
  • 18. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander health performance framework report 2006. Canberra: AHMAC, 2006. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-oatsih-pubs-framereport (accessed Jan 2008).
  • 19. Thomas DP, Condon JR, Anderson IP, et al. Long-term trends in Indigenous deaths from chronic diseases in the Northern Territory: a foot on the brake, a foot on the accelerator. Med J Aust 2006; 185: 145-149. <MJA full text>
  • 20. O’Dea K. Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes 1984; 33: 596-603.
  • 21. Chandler M, Proulx T. Changing selves in changing worlds: youth suicide on the fault-lines of colliding cultures. Arch Suicide Res 2006; 10: 125-140.
  • 22. Pitjarra J, Kamarra OF, Ngala SR, et al. “You just can’t hold us up again!” In: Moody R, editor. The Indigenous voice: visions and realities. London: Zed Books, 1988: 383-384.
  • 23. Altman J, Buchanan G, Biddle N. Measuring the ‘real’ Indigenous economy in remote Australia using NATSISS 2002. Aust J Labour Economics 2006; 9: 17-31.
  • 24. Brough M. National emergency response to protect Aboriginal children in the NT. Media release, 21 June 2007. Canberra: Parliament of Australia, 2007. http://parlinfoweb.aph.gov.au/piweb/Repository1/Media/pressrel/8ZFN60.pdf (accessed Jan 2008).

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