An Overview of Indigenous Australian Disadvantage in Terms of Ischaemic Heart Disease

Wiemers, Paul; Marney, Lucy; Yadav, Sumit; Tam, Robert

doi:10.1016/j.hlc.2018.03.003

Cited by 15 publications

(10 citation statements)

References 54 publications

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“…In Australia, attention is now focussed upon Indigenous people where CVD accounts for a substantial proportion of their life expectancy gap with the general population [32]. The reasons for this are complex and multifactorial, and they have been well described elsewhere [33,74]. The fact that Indigenous people represent a greater proportion of the population as remoteness increases is one contributing factor.…”

Section: Differences In Patient Populationsmentioning

confidence: 99%

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Thompson

Nedkoff

Katzenellenbogen

et al. 2019

IJERPH

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This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.

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Section: Differences In Patient Populationsmentioning

confidence: 99%

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Thompson

Nedkoff

Katzenellenbogen

et al. 2019

IJERPH

View full text Add to dashboard Cite

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“…In New Zealand (NZ), Māori (the indigenous population) have a considerably greater CVD burden compared to NZ Europeans ( Ministry of Health, 2019 ), and they are also overrepresented in blue-collar occupations ( Milne et al , 2019 ). The same is true for other indigenous populations ( Liebler, 2018 ; Wiemers et al , 2018 ) but, to our knowledge, no previous occupational CVD studies have focused on indigenous workers.…”

Section: Introductionmentioning

confidence: 63%

Ischaemic Heart Disease and Occupational Exposures: A Longitudinal Linkage Study in the General and Māori Populations of New Zealand

Barnes

Eng

Corbin

et al. 2021

Annals of Work Exposures and Health

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Objectives This study assessed associations between occupational exposures and ischaemic heart disease (IHD) for males and females in the general and Māori populations (indigenous people of New Zealand). Methods Two surveys of the general adult [New Zealand Workforce Survey (NZWS); 2004–2006; n = 3003] and Māori population (Māori NZWS; 2009–2010; n = 2107), with information on occupational exposures, were linked with administrative health data and followed-up until December 2018. Cox proportional hazards regression (adjusted for age, deprivation, and smoking) was used to assess associations between organizational factors, stress, and dust, chemical and physical exposures, and IHD. Results Dust [hazard ratio (HR) 1.6, 95%CI 1.1–2.4], smoke or fumes (HR 1.5, 1.0–2.3), and oils and solvents (HR 1.5, 1.0–2.3) were associated with IHD in NZWS males. A high frequency of awkward or tiring hand positions was associated with IHD in both males and females of the NZWS (HRs 1.8, 1.1–2.8 and 2.4, 1.1–5.0, respectively). Repetitive tasks and working at very high speed were associated with IHD among NZWS females (HRs 3.4, 1.1–10.4 and 2.6, 1.2–5.5, respectively). Māori NZWS females working with vibrating tools and those exposed to a high frequency of loud noise were more likely to experience IHD (HRs 2.3, 1.1–4.8 and 2.1, 1.0–4.4, respectively). Exposure to multiple dust and chemical factors was associated with IHD in the NZWS males, as was exposure to multiple physical factors in males and females of the NZWS. Conclusions Exposures associated with an elevated IHD risk included dust, smoke or fumes, oils and solvents, awkward grip or hand movements, carrying out repetitive tasks, working at very high speed, loud noise, and working with tools that vibrate. Results were not consistently observed for males and females and between the general and Māori populations.

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“…With respect to IHD, Indigenous people have been identified as being ‘disadvantaged at every stage of the disease process from excesses in risk factors to its development, premature disease onset, reduced access to diagnostic and therapeutic procedures, higher rates of adverse outcomes following both acute coronary events and revascularisation procedures and overall higher age‐standardised death rates’ 22 . It has been recognized that Multi‐disciplinary (MDT) care following a cardiac event is crucial for Indigenous peoples 23 .…”

Section: Discussionmentioning

confidence: 99%

“…20,21 With respect to IHD, Indigenous people have been identified as being 'disadvantaged at every stage of the disease process from excesses in risk factors to its development, premature disease onset, reduced access to diagnostic and therapeutic procedures, higher rates of adverse outcomes following both acute coronary events and revascularisation procedures and overall higher agestandardised death rates'. 22 It has been recognized that Multidisciplinary (MDT) care following a cardiac event is crucial for Indigenous peoples. 23 A proposed model for the delivery of secondary prevention strategies in Indigenous people may include a three-pronged approach, firstly the development of dedicated MDT clinics for Indigenous peoples, at tertiary centres such as Royal Darwin Hospital for Northern Territory patients, including cardiothoracic surgeons, cardiologists and endocrinologists.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the adoption of dedicated Indigenous health workers to act as case managers to coordinate appointments and further educate Indigenous peoples. Finally, the enhancement of support for primary care teams working together with specialists through outreach services and telehealth services, particularly for patients who are living in remote regions, 22,23 would ensure better holistic care for Indigenous peoples.…”

Section: Discussionmentioning

confidence: 99%

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The long‐term mortality of an Aboriginal and Torres Strait Islander Australian population after isolated coronary artery bypass graft surgery

Nellipudi

Baker

Prabhakaran

et al. 2022

ANZ Journal of Surgery

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Background Aboriginal and Torres Strait Islander (Indigenous) Australians have an increased prevalence of coronary artery disease and present at a younger age for coronary artery bypass graft surgery (CABG) when compared to non‐Indigenous Australians. Studies have reported postoperative outcomes in Indigenous people to be less favourable. Therefore, the aim of this study is to evaluate long term mortality between Indigenous and non‐Indigenous people post‐CABG. Methods We analysed data on all patients who underwent isolated CABG, with and without cardiopulmonary bypass, at our institution between January 1998 to September 2008. There were 33 395 person‐years of survival for analysis with a median follow‐up of 13 years (Interquartile range (IQR): 8–16 years). We analysed all‐cause mortality with the Kaplan–Meier graph and log‐rank test. Univariate and multivariate analysis was performed using a Cox proportional hazards model. Results The mean age at presentation for Indigenous people was 52 years compared to 65 yr for non‐indigenous people. There were 1431 (52.1%) deaths by the study census date, with the overall mortality for Indigenous patients at 49.8% (n = 147) and 52.4% for non‐Aboriginal patients (n = 1284). The age and comorbidities adjusted hazard ratio (HR) for all‐cause late mortality (median years) was HR = 1.712 (95% CI: 1.288–2.277, p < 0.001). Conclusion Indigenous patients present for CABG at a younger age and have a higher prevalence of comorbidities. Our study demonstrates they have a higher risk of propensity adjusted all‐cause long term mortality. Primary and secondary prevention strategies, tailored to Indigenous people, may improve health outcomes in the long‐term post‐CABG.

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An Overview of Indigenous Australian Disadvantage in Terms of Ischaemic Heart Disease

Cited by 15 publications

References 54 publications

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review

Ischaemic Heart Disease and Occupational Exposures: A Longitudinal Linkage Study in the General and Māori Populations of New Zealand

The long‐term mortality of an Aboriginal and Torres Strait Islander Australian population after isolated coronary artery bypass graft surgery

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