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Objective: To estimate the lifetime risk of developing hospital‐diagnosed chronic obstructive pulmonary disease (COPD) in Aboriginal people living in remote areas. Methods: A total of 1,374 participants in a remote community were followed up to 20 years. Individuals with hospital‐diagnosed COPD were identified through hospital records. The lifetime risk of hospital‐diagnosed COPD was estimated using a modified technique of survival analysis. Results: Of the 1,374 participants, 164 were identified as having incident hospital‐diagnosed COPD during 21,614 person years of follow‐up. After adjusting for the presence of competing risk of death from non‐COPD causes, the lifetime risk of COPD was 53% for the overall population, higher in women (61%) than in men (45%). Adjusting for baseline age and smoking status, women had a significantly higher risk of COPD than men with a hazard ratio (HR) = 1.55 (95%CI 1.13–2.14), while men were more likely to die from non‐COPD causes than women before being diagnosed as having COPD, HR = 2.30 (95%CI 1.64–3.23). Conclusions: These Aboriginal people have a high lifetime risk of COPD, and one in two have hospital‐diagnosed COPD during their lifetime. Our findings warrant further efforts and resources to combat this condition in remote Aboriginal communities.

Objective: To determine trends in health status over a 10‐year interval in a high‐risk remote Australian Aboriginal community. Methods: Two health surveys were performed, one between 1992 and 1997 and the other between 2004 and 2006, on people aged five years or older. Outcomes were compared across age‐matched and sex‐matched pairs. Results: There were 1,209 matched pairs. In the second survey, birthweights tended to be higher, and there were significant increases in heights of adolescents and young adults, and high density lipoprotein cholesterol (HDL‐C) levels generally. Young adult males were lighter, had lower measurements for waist circumference and blood pressure and less frequently had overt‐albuminuria, while elevated blood pressure was less common in older males. However, females ≥15 years had higher measurements for waist circumference, waist to hip ratio (WHR), body mass index (BMI) and diastolic blood pressure and a higher proportion of diabetes, notably in those aged older than 45 years. Males aged 15–24 years were less likely to be smokers while women aged less than 45 years were more often current drinkers. Conclusions: Results indicative of better nutrition among youth, better health of young adult males, stable or lower levels of albuminuria and improved HDL levels are all encouraging. The waist circumference increase in females might reflect better food access. An increase in diabetes in older subjects probably reflects recent enhanced survival of middle‐aged and older people with – and at risk for – diabetes.

To report the short-term experiences and outcomes of a program to support chronic disease management in three remote communities in Top End Northern Territory and in two Aboriginal Medical Services (AMSs) in Western Australia, and to discuss the implications of findings for health service delivery and policy.Programs were health-worker centred. They espoused regular screening of all adults for chronic disease, initiation and modification of treatment where indicated and rigorous documentation. Process measures were documented and rates of hypertension, renal disease and diabetes among adults were calculated.Rates of hypertension, proteinuria and diabetes rose throughout adult life and multiple diagnoses were common. Most people with these conditions were young or middle age adults. Rates were uniformly excessive relative to AusDiab data, but varied greatly among settings. Adherence to protocols improved, many new diagnoses were made, treatments were started or modified and blood pressures in treated hypertensive people fell. In the NT, productivity was seriously limited by lack of health workers and their absenteeism. In the WA AMSs, executive and staff support carried the programs forward to a sustainable future, despite various challenges.Integrated chronic disease testing must be repeated throughout adult life for timely diagnosis. Health workers can perform all tasks well, with appropriate supports. Blood pressure outcomes alone predict lower cardiovascular and renal mortality. The findings support incorporation of chronic disease into lifetime health care plans.

Objective: To examine the relationship between self‐reported tobacco smoking and urinary cotinine concentrations in the setting of a remote Aboriginal community. Methods: In a remote Northern Territory (NT) Aboriginal community the relationship between self‐reported tobacco smoking and urinary cotinine concentrations was examined as part of a cross‐sectional survey of cardiovascular risk factors. Current tobacco smoking was assessed as part of a questionnaire. The concentration of cotinine and cotinine/creatinine ratio (CCR) in a spot urine sample were used as a biochemical marker of nicotine exposure. Results: A total of 237 people took part in the survey, although completed questionnaires and urine results were available for 184 people. Current tobacco smoking was reported by 161 (69 [95% CI 63 to 75]%) people, with higher rates among males (84/104, 81 [95% CI 72 to 88]%) than females (77/129, 60 [95% CI 51 to 68]%, p

Objective: To assess the association between body mass index and the risk of all-eause and disease-specific mortalities In Australian Aborigines in a remote community. Design: A community based cohort study. Participants and setting: 744 Aboriginal adults aged 20 to 77 years in a remote community in Northern Territory. Eighty seven deaths occurred during the follow~up period of 5,040.8 person-years. Measures: Mortality data for the period of 1992 and June 2000 were collected. Mortality rate ratios for each body mass index quartile was determined using a Cox proportional hazards model with adjustment for age, sex, and smoking and drinking status. Results: An inverse relationship between BMI quartiles and the risk of all-cause, natural, and non-CVD mortality was found. Adjusted rate ratios (95% Cl) of all-eause mortality were 0.92 (0.54-1.59), 0.71 (0.401.26)and 0.38 (0.19-0.75) for second, third and fourth BMI quartiles, respectively, with .11", the first quartile as the reference. The fourth BMI quartile had the lowest risk of mortality with adjusted rate ratios of 0.38, 0.28, and 0.16 for deaths from all-eause, natural, and non-CVD, respectively. However, the associations between BMI and CVD and renal deaths did not reach statistical significance. Conclusions: BMI and mortality are inversely associated in Aboriginal adults in a remote community. Individuals with relatively higher BMI have a lower risk of death. (Aust N Z J Public Health 2002; 26: 305·10)

Objectives: To investigate the association between low birthweight (LBW

We conducted a brief health survey of adults in an isolated Northern Territory Aboriginal community, whose standardised mortality rates are the second highest in Australia. The screen revealed high rates of smoking and excessive drinking, of preventable infections and their sequelae, and of hypertension, insulin resistance, diabetes and renal disease. The infectious morbidities were more pronounced and the life-style morbidities almost entirely new since a health screen in 1957. Most morbidities were strongly associated with identifiable risk factors, such as overweight, smoking, excessive drinking, skin sores and scabies, all of which which are amenable to modification. Problems with food supply and pricing, poor food choices and diversion of money to cigarettes, beer and gambling all contributed to poor nutrition. Low birthweight probably compounds the risk for serious adult disease associated with these environmental influences. This profile highlights the failure of current systems to deal with health needs. Improvements in infrastructure, education and employment, and reinvigoration of preventive and primary health care programs, assumption of responsibility for health by the community and by individuals themselves, and better management of existing morbidities are essential to rectifying this shameful situation.

Objective : To examine the trends of all‐cause natural mortality for people aged 15 years and over in a remote Australian Aboriginal community between 1996 and 2010. Methods : The annual population in the community by gender and age group was obtained from the Australian Bureau of Statistics (ABS). All known deaths and all records of start of renal replacement therapy (RRT) for renal failure were recorded between 1996 and 2010. Five‐year aggregated death rates were calculated and the changes in natural mortality over the interval were evaluated. Mortality was compared with those of the Northern Territory (NT) Indigenous and non‐Indigenous people as a whole from 1998 to 2006. Results : Rates of natural deaths were lower in the third interval 2006–2010 relative to the first interval 1996–2000, with higher, but more rapidly falling rates for females than males. Reductions were prominent for both sexes in the 65 and over age groups, but death rates in females of earlier middle age also trended lower. The trends applied whether or not the starting of RRT was considered as a natural death. There was a similar trend in rates of natural death in the aggregate Indigenous population of NT. Conclusions: The downward trends probably reflect improvements in risk factor status since the 1960s, all‐of‐life health interventions, as well as better chronic disease management in the last two decades. The higher death rates in females than males in this community remain unexplained, but the rapid rate of decline of female death rates predicts that this gap will soon be minimised.

Aim: To examine chronic disease (CD)-related clinical activity and outcomes associated with introduction of a more systematic approach to chronic disease care in a remote Aboriginal community, using data from Communicare patient record management system. Methods: We examined CD process measures, outcomes and clinical profiles in adults age 15+ years from Communicare data and compared results for two intervals. Process measures were clinic visits and proportions of eligible patients with recorded CD-related procedures or diagnostic tests. Outcome measures were results of CD care items and CD morbidities. Data in the interval 2007-2009 were compared with data from 2009 to 2011, in which an intensified CD program was conducted in the clinic by its own staff. Results: About one-third of adult visits were related to CD care; CD-cycle of care encounters increased significantly in the second interval, from 3.2% to 9.1%, and proportions of adults having CD-related procedures or tests were also higher. For already commonly performed items, like blood pressure, weight and lipids, proportions of adults tested were 30-50% higher in the second interval, while proportions tested for more recently emphasised items, like waist, HbA1C, urine ACR, rose by more than 200%. Levels of SBP, DBP, HbA1c and HDL-C significantly improved in the second interval. Proportions of adults with clinical values outside normal ranges decreased for at least half of observations. Conclusions: Parameters of CD care activities and outcomes have increased significantly over the last four years in this setting, accompanied by stabilisation of or improvement in outcomes. © 2014 The Authors. ANZJPH

Objectives: We assessed the independent contribution of C-reactive protein to the risk of cardiovascular disease in Aboriginal Australians. Methods: High sensitivity CRP levels were measured in 705 Aboriginal participants aged 20–74 years free from CVD at baseline. Participants were followed for a median of 11 years. Cox proportional hazards models were used to assess the association of CRP with the risk of developing CVD events. Results: A total of 114 participants were diagnosed with CVD. Incidence rates were 5.4 and 21.4 per 1,000 person-years for the lower (

OBJECTIVE: To estimate the magnitude of excess risk for proteinuria, high blood pressure and diabetes in Australian Aboriginal adults in three remote communities by comparing them with nationwide Australian data. METHODS: Adult volunteers from three remote communities in the Northern Territory were screened for proteinuria, high blood pressure, and diabetes between 2000 and mid 2003. Rates for people age 25 to 74 years were compared with those from the AusDiab study conducted in 1999 and 2000. RESULTS: Compared with AusDiab, rates of these conditions were elevated in all Aboriginal communities, but differed among them. With adjustment for age and sex, rates of proteinuria were elevated 2.5- to 5.3-fold, rates of high blood pressure were elevated 3.1- to 8.1-fold and rates of diabetes were elevated 5.4- to 10-fold (p < 0.001 for all). The risk of having any condition ranged from 3.0- to 8.7-fold and the risk of having two or more conditions ranged from 5.8- to 14.2-fold. DISCUSSION: The data are compatible with the excess morbidity and mortality from cardiovascular disease, diabetes and renal disease in these Aboriginal groups. They reflect the multitude of risk factors operating in these environments. They dictate urgent and systematic intervention to modify outcomes of established disease and to prevent their development. However, the resources required for effective secondary intervention will differ among communities according to the disease burden.

1. Centre for Chronic Disease, School of Medicine, The University of Queensland2. RWM Consultancy, Northern Territory3. Tiwi Land Council, Tiwi Islands, Northern Territory4. Saint Vincent de Paul Society, Queensland5. Formerly Nguiu Ullintjinni Association, Tiwi Islands, Northern Territory6. Charles Darwin University, Northern Territory

Objective: To evaluate variation in the incidence of end-stage renal disease (ESRD) within Australian capital cities. To explore the relation between the incidence of ESRD and socio-economic disadvantage. Methods. We obtained data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) regarding 5,013 patients from capital cities who started ESRD treatment between 1 April 1993 and 31 December 1998. We used the postcode at the start of treatment to calculate the average annual incidence of ESRD for each of 51 capital city regions using 1996 Census counts based on place of usual residence. We calculated standardised incidence ratios with 95% confidence intervals for each region. The standardised incidence ratios were examined in relation to the SEIFA Index of Relative Socio-economic Disadvantage (IRSD), derived from the 1996 Census. Low IRSD values indicate more disadvantaged areas. Results: There is significant variation in the standardised incidence of ESRD within capital cities. There was a significant correlation (r=-0.41, p=0.003) between the standardised incidence ratio for ESRD and the SEIFA IRSD. Conclusions and implications. Capital city areas that are more disadvantaged have a higher incidence of ESRD. Socioeconomic factors may be important determinants of the risk of developing ESRD.

To describe the distribution of body mass index (BMI) and estimate the prevalence of potential chronic energy deficiency (CED) and obesity in Aborigines in remote communities (ARC) in the Top End of the Northern Territory, Australia.Centile charts were constructed for BMI from 1,631 sets of measurements from 1,138 Aborigines, aged five to 77 years, in three remote communities on the Tiwi Islands, using Cole's LMS method. These were compared with European, American white and American black reference charts. The prevalences of CED and obesity were also compared to the corresponding values from a national Indigenous sample.The BMI centiles change with age. Compared with reference populations, BMIs are lower in ARC children and adult males. Young adult females have similar BMIs to American black and higher BMIs than American white and French counterparts up to 45 years. Aborigines older than 50 years are 'thinner'. Compared with a national sample of Indigenous Australians, our sample has a higher prevalence of CED and a lower prevalence of obesity.The BMI centile curves describe the contemporary nutritional status in the remote communities. Nutritional status measured by BMI is different in ARC than in other populations.The difference in nutritional status between ARC and other populations should be considered when planning nutritional intervention strategies. The centile charts will allow health workers to determine the relative ranking of BMI for individual Aborigines in the remote communities.