Spirometry reference values in Indigenous Australians: a systematic review

Abstract

PrefaceWhile the Council of Australian Governments (COAG) has committed to improve health outcomes and wellbeing of Indigenous 1 Australians, the principal measurable targets, for both adults and children, have been based on reductions in mortality. The adult target -to close the gap in life expectancy within a generation (25 years) -requires robust estimates of life expectancy across population groups. Life tables are essential to the calculation of these estimates.The life tables provided here have been developed in order to:• Produce retrospective mortality indices and life expectancy estimates in order to reconstruct recent mortality trends and establish trajectories to guide future policy interventions;• Understand patterns of Indigenous mortality at sub-State level, particularly by remoteness, to help focus resources where they are needed most;• Measure the gaps in life expectancy between the Indigenous and non-Indigenous people in Queensland by remoteness and the recent trends; and• Examine the sources of improvements in life expectancy, in respect of age groups, gender and leading causes of deaths that have contributed to these improvements.This work will contribute significantly to the above objectives, as life tables provide the most robust summary mortality indices. For the first time, Indigenous life tables are now available to enable direct comparison between the life expectancies of Indigenous people in urban and non-urban areas of the state, as well as with those of nonIndigenous Queenslanders.

Global Lung Function Initiative‐2012 ‘other/mixed’ spirometry reference equation provides the best overall fit for Australian Aboriginal and/or Torres Strait Islander children and young adults

“…Our study is the first to provide spirometry data of healthy Aboriginal, Torres Strait Islander and both Aboriginal and Torres Strait Islander Australian children and young adults. Unlike previous studies, our cohort consisted of >300 participants (per ethnic group) who were free of both current/chronic respiratory illnesses and smoking history. In assessing the suitability of the GLI‐2012 reference equations for use by Indigenous Australians, we found that the GLI‐2012 other/mixed equations gave the best overall fit for all lung function parameters compared to Caucasian and African‐American.…”

“…As identified in our systematic review, there were several limitations in previously developed spirometry reference equations for Indigenous Australians that impeded their use in the clinical setting. These studies reported only Aboriginal lung function and no Torres Strait Islander or both data, and the differences in values compared to Caucasian data were greater than those typically observed in other non‐Caucasian ethnic groups .…”

“…Previous studies [21][22][23][24][25] have reported Australian Aboriginals to have forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) values up to 25% and 30% lower, respectively, than healthy Caucasians. However, our systematic review 26 found that in these studies, spirometry was not performed according to the current American Thoracic Society (ATS), European Respiratory Society (ERS) or GLI guidelines. 9,[26][27][28] Therefore, results obtained from these studies are unlikely to reflect a true 'healthy' population.…”

“…However, our systematic review 26 found that in these studies, spirometry was not performed according to the current American Thoracic Society (ATS), European Respiratory Society (ERS) or GLI guidelines. 9,[26][27][28] Therefore, results obtained from these studies are unlikely to reflect a true 'healthy' population.…”

Further evidence of the generalizability of the Global Lung Function Initiative reference equations for spirometry

“…summarize lung function data in a large group of healthy children and young adults from Australian aboriginal and/or Torres Strait communities in Queensland and provide guidance for the use of Global Lung Function Initiative (GLI) reference equations for this population. In previous work by this team, a systematic review of available literature highlighted the lack of good‐quality studies to appropriately define the range of normal values for indigenous populations in Australia . Thus, this comprehensive prospective study of more than 1200 participants is both necessary and timely.…”