Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011

Summary This report presents the results of the Indigenous component of the Australian Burden of Disease Study 2011. It provides estimates of the total, non-fatal and fatal burden of disease and injuries for the Aboriginal and Torres Strait Islander population for 2011 and 2003 using the DALY (disability-adjusted life years) measure. It also provides estimates of the burden attributable to 29 risk factors, and estimates of the gap in disease burden between Indigenous and non-Indigenous Australians. The results presented here are for the year 2011 unless otherwise stated. For any comparisons between populations or years, adjustments have been made where necessary to account for differences in population size and age structure. Indigenous Australians experience a burden of disease that is 2.3 times the rate of non-Indigenous Australians There were 284 years lost due to premature death or living with illness for every 1,000 Indigenous people in Australia in 2011, equivalent to 190,227 DALY. Indigenous Australians experienced a burden of disease that was 2.3 times the rate of non-Indigenous Australians. Rates of fatal and non-fatal burden for Indigenous Australians were 2.7 and 2.0 times those for non-Indigenous Australians, respectively. Most of the burden is from chronic diseases and injuries Chronic diseases as a group accounted for almost two-thirds (64%) of the total disease burden. The disease group causing the most burden among Indigenous Australians was mental & substance use disorders (19% of the total). This group includes conditions such as anxiety and depressive disorders, alcohol use disorders, drug use disorders and autism spectrum disorders. Other major contributors to the total burden were injuries (which includes suicide) (15%), cardiovascular diseases (12%), cancer (9%), respiratory diseases (8%) and musculoskeletal conditions (7%). Disease groups varied in their contribution to the fatal and non-fatal burden. Coronary heart disease (CHD), suicide & self-inflicted injuries, anxiety disorders, alcohol use disorders and diabetes were the leading specific diseases, together contributing 24% of the total burden. These are also the main causes of the gap in disease burden Chronic diseases were responsible for more than two-thirds (70%) of the gap in disease burden between Indigenous and non-Indigenous Australians. This group includes conditions such as cardiovascular diseases (19% of the gap), mental & substance use disorders (14%), cancer (10%), chronic kidney disease (CKD), diabetes, vision loss, hearing loss and certain respiratory, musculoskeletal, neurological and congenital disorders. Injuries were responsible for 14% of the overall gap (15% of the gap in fatal burden and 11% of the gap in non-fatal burden). Indigenous Australians experienced rates of disease burden due to injuries 3 times those for non-Indigenous Australians. Disease burden differs across state/territory, remoteness and socioeconomic groups The Northern Territory and Western Australia had higher rates of Indigenous burden of disease than New South Wales and Queensland (the 4 jurisdictions for which estimates are reported). In Western Australia, Indigenous Australians experienced rates of disease burden 2.8 times those for non-Indigenous Australians. Large inequalities were also evident across remoteness areas, with Remote and Very remote areas having higher rates of disease burden than non-remote areas. Burden of disease rates were highest in areas where the Indigenous population was most socioeconomically disadvantaged and fell with decreasing level of disadvantage. There has been a decrease in the fatal burden since 2003 There was a 5% reduction in the rate of total burden in the Indigenous population between 2003 and 2011 (equivalent to 25 DALY per 1,000 people). Most of this improvement came from decreases in the rate of fatal burden (11%), by preventing or delaying deaths from particular diseases or injuries. Large reductions were evident in rates of fatal burden due to cardiovascular diseases. There was, however, a 4% increase in the rate of non-fatal burden for Indigenous Australians between 2003 and 2011 (equivalent to 7 YLD per 1,000 people). This was mainly due to increases in people living with chronic diseases such as diabetes, anxiety and depressive disorders, and asthma; and from the non-fatal effects of injuries such as falls. A large proportion of the burden is preventable Around 37% of the burden of disease in Indigenous Australians was preventable by reducing exposure to the modifiable risk factors included in this study (which does not include the social determinants of health). The risk factors causing the most burden were tobacco use (12% of the total burden), alcohol use (8%), high body mass (8%), physical inactivity (6%), high blood pressure (5%) and high blood plasma glucose (5%). Dietary factors were also important, together accounting for almost 10% of the total burden. Together, the 29 risk factors included in the study accounted for half (51%) of the gap in disease burden between Indigenous and non-Indigenous Australians. Tobacco use was the biggest contributor to this, accounting for almost one-quarter (23%) of the overall gap