Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap

Vos, Theo; Barker, Bridget; Begg, Stephen; Stanley, Laura; Lopez, Alan D

doi:10.1093/ije/dyn240

Cited by 599 publications

(737 citation statements)

References 6 publications

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“…Much of the previous work using DALYs to identify health disparities within specific regions has focused on ethnic disparities. [19][20][21][22] However, DALY-gap in slum communities is different from income or indigenous health gap; it addresses disease burden of communities or neighborhoods, making it a metric easier to apply for resource allocation. Furthermore, the spatial analysis in our study showed that the TB burden differs greatly even across different slum and non-slum communities.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

et al. 2015

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To quantitatively assess disease burden due to tuberculosis between populations residing in and outside of urban informal settlements in Rio de Janeiro, Brazil, we compared disability-adjusted life years (DALYs), or BDALY-gap.^Using the 2010 Brazilian census definition of informal settlements as aglomerados subnormais (AGSN), we allocated tuberculosis (TB) DALYs to AGSN vs non-AGSN census tracts based on geocoded addresses of TB cases reported to the Brazilian Information System for Notifiable Diseases in 2005 and 2010. DALYs were calculated based on the 2010 Global Burden of Disease methodology. DALY-gap was calculated as the difference between age-adjusted DALYs/100,000 population between AGSN and non-AGSN. Total TB DALY in Rio in 2010 was 16,731 (266 DALYs/100,000). DALYs were higher in AGSN census tracts (306 vs 236 DALYs/100,000), yielding a DALY-gap of 70 DALYs/100,000. Attributable DALY fraction for living in an AGSN was 25.4 %. DALY-gap was highest for males 40-59 years of age (501 DALYs/100,000) and in census tracts with G60 % electricity (12,327 DALYs/100,000). DALY-gap comparison revealed spatial and quantitative differences in TB burden between slum vs non-slum census tracts that were not apparent using traditional measures of incidence and mortality. This metric could be applied to compare TB burden or burden for other diseases in mega-cities with large informal settlements for more targeted resource allocation and evaluation of intervention programs.

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Section: Discussionmentioning

confidence: 99%

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

et al. 2015

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“…As a lasting legacy of the trauma of colonization, systemic discrimination and racism, separation of families, removal from country, and loss of language and culture, Indigenous Australians show poorer outcomes on a range of measures. These include a 10‐plus‐year difference in life expectancy and higher rates of infant mortality, hospitalizations for chronic conditions, injury, and disability 15, 16, 17, 18. The story is similar for mental health.…”

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confidence: 99%

Risks for Mental Illness in Indigenous Australian Children: A Descriptive Study Demonstrating High Levels of Vulnerability

et al. 2017

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Policy Points: The developmental origins understanding of mental illness suggests the possibility of prevention, through addressing childhood adversities.More than 43% of Indigenous Australian children aged 6 to 10 years have 6 or more risk factors for mental illness in adulthood, and 23% are experiencing current psychological distress.Substantial risk is already present in infancy (eg, 67% exposed to 3 or more stressful family life events, and 42.5% are not living with both birth parents).An integrated service system response that can both offer high‐level therapeutic services and address associated multiple adversities, from conception to late adolescence, is urgently needed to address current psychological distress in Indigenous Australian children and to reduce the future burden of mental illness. ContextMental illness is a high source of disease burden across the globe. Mental illness is now understood as largely developmental, with its genesis at least in part in adverse childhood experiences. We sought to estimate the prevalence of childhood risks for poor mental health in Indigenous Australian children, noting that Indigenous Australians by virtue of their history of traumatic colonization and dispossession, child removal, and racism are potentially at greater risk.MethodsWe conducted a descriptive study of the modifiable risks and adversities associated with mental illness in Australian Indigenous children (infancy to 10 years), using data from the Longitudinal Study of Indigenous Children (LSIC), a cohort of 1,671 infants enrolled in 2008 and followed up annually. Risk factors of interest were identified from a comprehensive literature review of childhood determinants of adult mental illness by Fryers and Brugha (2013). The age‐category prevalence of individual risks and a multiple‐risk score were computed using data extracted from 6 waves of LSIC.FindingsThe analytic data comprised 8,378 person‐observations from the first 6 waves. Children in LSIC experience high rates of adversities. In utero, nearly 50% were exposed to smoking and 22% to alcohol. As infants, 42.5% were not living with both birth parents. Over two‐thirds of survey children were in households that had experienced, in the previous 12 months, 3 or more major life events; 22% to 26% lived in households with a drug or alcohol problem; and 18% were exposed to domestic violence (41% were ever‐exposed to age 10). At school, nearly 40% of children were bullied. Over 45% of children aged 6 to 10 years were exposed to 6 or more risks for mental illness. Few children (< 2%) were exposed to low parental warmth and, despite the high exposure to adversities, less than 5% of children report low self‐confidence. This suggests considerable resilience. More than 1 in 4 children had conduct problems in the clinical range and more than 1 in 5 were experiencing high psychological distress.ConclusionsIndigenous children in Australia face extreme levels of multiple disadvantage, exposing many to current psychological distress and high risk of developing me...

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“…23 The survey asked patients about their risk status for behavioural risk factors and screening history for blood pressure, cholesterol, diabetes and cervical cancer. These items were chosen as they contribute significantly to the burden of disease among Aboriginal and Torres Strait Islander people, 24 and there is evidence that regular screening can improve health outcomes. 2 Included survey items were based on the most recent Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Health Survey collected in 2004-05.…”

Section: Collection Of Self-report Datamentioning

confidence: 99%

“…1 Prevention activities such as regular screening are likely to produce significant health gains. 2 To achieve these gains clinicians need appropriate, valid and reliable measures of a patient's screening history.…”

mentioning

confidence: 99%

Aboriginal and Torres Strait Islander health: accuracy of patient self‐report of screening for diabetes, high cholesterol and cervical cancer

Stewart

Sanson‐Fisher

Eades

2016

Australian and New Zealand Journal of Public Health

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Objective: To determine the accuracy and clinical utility of patient self-reported screening history.Methods: Aboriginal and Torres Strait Islander patients (≥18 years; n=587) were interviewed on their screening history according to recommended time intervals; these were matched to pathology data. Results:The proportion of patients meeting screening guidelines were 32%(95%CI 26%-39%) for diabetes, 43%(95%CI 38%-47%) for cholesterol and 4.1%(95%CI 2.2%-7.3%) for cervical cancer. When patients reported having had the test, their accuracy (PPV) was low: 38%(95%CI 30%-46%) for diabetes, 47%(95%CI 42%-52%) for cholesterol, 6.5%(95%CI 3.0%-12%) for cervical cancer. However, for the minority of patients who had been screened, positive recall (sensitivity) was high: 94%(95%CI 85%-98%) for diabetes, 83%(95%CI 77%-88%) for cholesterol, 90%(95%CI 55%-98%) for cervical cancer. The accuracy of patient recall was good for those who reported not having been screened (NPV): 90%(95%CI 77%-97%) for diabetes, 70%(95%CI 61%-78%) for cholesterol, 99%(95%CI 95%-100%) for cervical cancer. Conclusions:The results indicate that reliance on self-report for patients' screening history is inappropriate due to missed opportunities for health gain. However, patients who report not being tested are sufficiently accurate to ensure that ordering the test in this group will involve only a small percentage of unnecessary assays.Implications: GPs often rely on self-report as a fast and inexpensive way to determine whether a patient requires screening. New strategies are needed to identify patients at risk.

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Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap

Cited by 599 publications

References 6 publications

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

Risks for Mental Illness in Indigenous Australian Children: A Descriptive Study Demonstrating High Levels of Vulnerability

Aboriginal and Torres Strait Islander health: accuracy of patient self‐report of screening for diabetes, high cholesterol and cervical cancer

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