Aboriginal and Torres Strait Islander health and respiratory disease

Question 1

List some common respiratory conditions among Aboriginal and Torres Strait Islander people

Answer 1

• asthma
• COPD
• bronchiectasis
• respiratory infections
• TB
• RHD
• ILD
• ELD

Question 2

Describe the burden of respiratory disease in Aboriginal and Torres Strait Islander communities

Answer 2

• Levels of respiratory disease not declining
• Level of chronic respiratory disease is 2.5 times higher than non-Indigenous Australians
• no difference between males and females

Hospitalisations
- an indication of acute conditions not prevalence
- high in over 65 and under 4s
- biggest disparity between 45-55 year olds
- exacerbated with remotemness

Question 3

Describe some of the factors contributing to high rate of respiratory disease in Aboriginal and Torres Strait Islander populations

Answer 3

Overcrowding
(or rather multigenerational families living in homes not built to match their needs) contribute to respiratory disease in several ways:
- close contact and increased expisure
- limited ventilation
- high viral load
- stress and immune function
- limited personal space
- reduced healthcare access (inter-related with low SE factors)
- increased risk of household outbreaks
- indoor air pollutants exposure e.g. old stoves

Declining but still an issue.
Associated with remoteness.

Living Conditions
- 18% of households have major structural problems and lack adequate facilities for cooking, bedding, or washing
- Do not meet standards
- Associated with remoteness

Smoking
- Smoking prevalence among Aboriginal and Torres Strait Islander peoples is high:
- 43% in 2018/19
- Leading contributor to the burden of disease and to the health gap
- Tightly tied to colonization

Question 4

Describe the burden of asthma and COPD

Answer 4

Asthma
- 6% higher in Indigenous populations
- double the risk of hospitalisations
- three times the risk of death
- top 2 of causes of hospitalisations

Chronic Obstructive Pulmonary Disease
- 1 in 25 adults report having COPD (2.5x higher than non-Indigenous)
- 1 in 10 adults over 65 hospitalized annually with respiratory disease
- 1 in 10 over 45 self-reported
- higher in females
- not associated with remoteness
- BUT associated with social determinants

Question 5

Describe the burden of disease of bronchiectasis and LRTis

Answer 5

Bronchiectasis
- Progressive disease process characterized by:
- Dilated and thick-walled bronchi
- Common among rural/remote Aboriginal children: 1.5% of all children
- children in central Australia have highest rates in the world - predisposing to poor function and susceptibility to pneumonia

Lower Respiratory Tract Infections
- Risk of lower respiratory infections is associated with:
- Number of house occupants
- Poor quality housing
- Macro- and micro-malnutrition
- Inadequate water supply
- Exposure to biomass combustion and tobacco smoke

Question 6

Describe the burden of disease of otitis media

Answer 6

• occurs at a younger age in Indigenous children
• can be acute, with effusions, or chronic suppurative with or without discharge
• Lifelong consequences of otitis media associated with hearing loss
  
  • Delayed development of speech and language: cognitive development, and auditory processing
  • Impaired learning, behavioral problems
  • Poorer education outcomes, employment opportunities and course of life
• all of this is prevetnable ^[nb recurrence due to antibiotics, affordability etc]
• A major issue is lack of statistics

Question 7

Describe the burden of disease of TB and pneumonia

Answer 7

Tuberculosis
- 1,317 cases of TB in Australia in 2013
- Overseas born (cases/100.000): 18.4
- Non-Indigenous (cases/100.000): 0.8
- Indigenous (cases/100.000): 4.6: highest rates in NT
- despite having lower rates than overseas born, higher rates of mortality
- rates historically fallen, recent uptick

**Pneumonia
- Annual incidence of pneumonia is 7% in those aged under one year
- Highest incidence in the world
- 3% in children under five

Question 8

List some measures to tackle the gap

Answer 8

• Supporting smoking cessation: must be community led, with dedicated staff, involve community in designing programs
• Enhanced immunisation programs – encouraging, promoting - usually includes more times or extra vaccines
• Enhanced access to medications - e.g. Paxlovid at younger ages, usually via prescriptions, or direct access to ACCHOs (tamiflu), also availability of vaccines at younger ages e.g. COVID
• Addressing racial disparities in care
  
  • on the rise
  • must be self-aware as HCWs
  • must be culturally aware and accepting
  • must be willing to recognise and call it out

Question 9

Describe how smoking is being tackled in Indigenous communities

Answer 9

Tackling Smoking
- Mass media designed by, and targeting Aboriginal and Torres Strait Islander peoples: success
- Additional access to nicotine replacement therapy and other pharmacotherapies: accessibility and affordability are key issues
-
- biggest improvement in under 15s (20% drop from 2002 to 2019)

Question 10

Describe some examples of enhanced access to medications

Answer 10

• Enhanced Access to Respiratory Medications
  - CSOM:
  - Ciprofloxacin ear drops on Aboriginal and Torres Strait Islander specific PBS
  - Influenza:
  - Oseltamivir (Tamiflu) provided to ACCHOs
  - COVID:
  - Lower age criteria for access to Paxlovid and Lagevrio