The health of urban Aboriginal people: insufficient data to close the gap

Eades, Sandra; Taylor, Barry R.; Bailey, Sandra L.; Williamson, Anna; Craig, Jonathan C.; Redman, Sally

doi:10.5694/j.1326-5377.2010.tb04036.x

Cited by 63 publications

(62 citation statements)

References 24 publications

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“…In Australia, for example, it is estimated that the 60% of the ‘gap’ in health outcomes between the Indigenous and non-Indigenous populations is a result of the health of urban Indigenous communities [40]. The results of this review are consistent with previous studies that have pointed to a lack of studies in the area of urban Indigenous health relative to remote and rural communities [41]. Indigenous conceptions of health were rarely explicitly acknowledged in the cost-effectiveness literature.…”

Section: Discussionsupporting

confidence: 83%

Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions

et al. 2014

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BackgroundIndigenous populations around the world have consistently been shown to bear a greater burden of disease, death and disability than their non-Indigenous counterparts. Despite this, little is known about what constitutes cost-effective interventions in these groups. The objective of this paper was to assess the global cost-effectiveness literature in Indigenous health to identify characteristics of successful and unsuccessful interventions and highlight areas for further research.Methods and FindingsA systematic review of the published literature was carried out. MEDLINE, PSYCINFO, ECONLIT, EMBASE and CINAHL were searched with terms to identify cost-effectiveness evaluations of interventions in Indigenous populations around the world. The WHO definition was followed in identifying Indigenous populations. 19 studies reporting on 27 interventions were included in the review. The majority of studies came from high-income nations with only two studies of interventions in low and middle-income nations. 22 of the 27 interventions included in the analysis were found to be cost-effective or cost-saving by the respective studies. There were only two studies that focused on Indigenous communities in urban areas, neither of which was found to be cost-effective. There was little attention paid to Indigenous conceptions of health in included studies. Of the 27 included studies, 23 were interventions that specifically targeted Indigenous populations. Outreach programs were shown to be consistently cost-effective.ConclusionThe comprehensive review found only a small number of studies examining the cost-effectiveness of interventions into Indigenous communities around the world. Given the persistent disparities in health outcomes faced by these populations and commitments from governments around the world to improving these outcomes, it is an area where the health economics and public health fields can play an important role in improving the health of millions of people.

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Section: Discussionsupporting

confidence: 83%

Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions

et al. 2014

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“…The preponderance of studies undertaken in rural/remote settings was a prominent finding, typical of broader Indigenous health research [47]. Owing to the sampling method of AusDiab, which excluded districts if they were classified 100% rural [48], we could not directly compare HDL-C levels between Indigenous and non-Indigenous populations by location.…”

Section: Discussionmentioning

confidence: 99%

Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review

Lyons

O’Dea

2014

BMC Public Health

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BackgroundLow plasma high-density lipoprotein cholesterol (HDL-C) levels are a strong, independent, but poorly understood risk factor for cardiovascular disease (CVD). Although this atherogenic lipid abnormality has been widely reported in Australia’s Indigenous peoples, Aboriginal and Torres Strait Islanders, the evidence has not come under systematic review. This review therefore examines published data for Indigenous Australians reporting 1) mean HDL-C levels for both sexes and 2) factors associated with low HDL-C.MethodsPubMed, Medline and Informit ATSI Health databases were systematically searched between 1950 and 2012 for studies on Indigenous Australians reporting mean HDL-C levels in both sexes. Retrieved studies were evaluated by standard criteria. Low HDL-C was defined as: <1.0 mmol/L. Analyses of primary data associating measures of HDL-C with other CVD risk factors were also performed.ResultsFifteen of 93 retrieved studies were identified for inclusion. These provided 58 mean HDL-C levels; 29 for each sex, most obtained in rural/regional (20%) or remote settings (60%) and including 51–1641 participants. For Australian Aborigines, mean HDL-C values ranged between 0.81-1.50 mmol/L in females and 0.76-1.60 mmol/L in males. Two of 15 studies reported HDL-C levels for Torres Strait Islander populations, mean HDL-C: 1.00 or 1.11 mmol/L for females and 1.01 or 1.13 mmol/L for males. Low HDL-C was observed only in rural/regional and remote settings - not in national or urban studies (n = 3) in either gender. Diabetes prevalence, mean/median waist-to-hip ratio and circulating C-reactive protein levels were negatively associated with HDL-C levels (all P < 0.05). Thirty-four per cent of studies reported lower mean HDL-C levels in females than in males.ConclusionsVery low mean HDL-C levels are common in Australian Indigenous populations living in rural and remote communities. Inverse associations between HDL-C and central obesity, diabetes prevalence and inflammatory markers suggest a particularly adverse CVD risk factor profile. An absence of sex dichotomy in HDL-C levels warrants further investigation.

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“…15 The lack of data on urban and rural Indigenous populations has been identified as a significant barrier to 'Closing the Gap' initiatives. 21 Although over half of the Indigenous population live in urban and regional centres, most research addresses the health and social issues of remote communities and only 11% of all articles about Indigenous health during a 5-year period addressed urban populations. 21 However, preliminary data from our ongoing cohort study of ARI in young urban Indigenous children 22 suggest 20% will develop chronic cough post-ARI, principally from PBB.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

et al. 2017

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IntroductionAcute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care.Methods and analysisA multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged <15 years will be enrolled and followed weekly for 8 weeks after presenting with an ARI with cough. 214 children from this cohort with persistent cough at day 28 will be randomised to either early initiation of a cough management algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (<6 and ≥6 weeks). Demographic details, risk factors, clinical histories, examination findings, cost-of-illness data, an anterior nasal swab and parent and child exhaled carbon monoxide levels (when age appropriate) are collected at enrolment. Weekly contacts will collect cough status and cost-of-illness data. Additional nasal swabs are collected at days 28 and 56. The primary outcome is time-to-cough resolution. Secondary outcomes include direct and indirect costs of illness and the predictors of chronic cough postpresentation.Ethics and disseminationThe Children's Health Queensland (HREC/15/QRCH/15) and the Queensland University of Technology University (1500000132) Research Ethics Committees have approved the study. The study will inform best-practice management of cough in children.Trial registration numberACTRN12615000132549.

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The health of urban Aboriginal people: insufficient data to close the gap

Cited by 63 publications

References 24 publications

Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions

Global Systematic Review of the Cost-Effectiveness of Indigenous Health Interventions

Evidence for low high-density lipoprotein cholesterol levels in Australian indigenous peoples: a systematic review

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

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