A Chartbook of the Health and Wellbeing Status of Aboriginal and Torres Strait Islanders in South Australia

Transcription

1 A Chartbook of the Health and Wellbeing Status of Aboriginal and Torres Strait Islanders in South Australia 2006 Population Research & Outcome Studies Unit

2 This work is copyright. It may be reproduced with permission and the Population Research and Outcome Studies Unit (PROS) welcomes requests for permission to reproduce in the whole or in part for work, study or training purposes subject to the inclusion of an acknowledgment of the source and not for commercial use or sale. PROS will only accept responsibility for data analysis conducted by PROS staff or under PROS staff supervision. Published December 2006 by the South Australian Department of Health Population Research and Outcome Studies Unit PO Box 287 Rundle Mall 5000 South Australia, Australia In accordance with the Copyright Act 1968 a copy of each book published must be lodged with the National Library. Under relevant State or Territory Legislation a copy must also be lodged with the appropriate library or libraries in the state of publication. For information about Legal Deposit, see the website at: or contact the Legal Deposit Unit, National Library of Australia on South Australia. Dept. of Health. Population Research and Outcome Studies Unit. A chartbook of the health and wellbeing status of Aboriginal and Torres Strait Islanders in South Australia ISBN Aboriginal Australians - Health and hygiene - South Australia - Statistics. 2. Torres Strait Islanders - Health and hygiene - South Australia - Statistics. 3. Health status indicators - South Australia. I. Title This document can be found online at: Last printed Tuesday, 10 April 2007 ii

3 TABLE OF CONTENTS CHAPTER 1: INTRODUCTION... 5 CHAPTER 2: BACKGROUND AND METHODOLOGY South Australian Monitoring and Surveillance System (SAMSS) Aims and objectives Aim of this report Methodology Questions Sample Selection Introductory letter Data collection CATI Call backs Validation Data Processing Weighting Response Rates Data Analysis Average time for interview...10 CHAPTER 3: DEMOGRAPHIC PROFILE Comparison with Census data Demographic characteristics of South Australia s Aboriginal and Torres Strait Islander and non- Aboriginal and Torres Strait Islander populations from SAMSS Age and sex profile Other demographic characteristics...13 CHAPTER 4: OVERALL HEALTH STATUS CHAPTER 5: HEALTH SERVICE UTILISATION CHAPTER 6: CHRONIC CONDITIONS AND CO-MORBIDITY CHAPTER 7: HEALTH RISK FACTORS High Blood Pressure and Cholesterol Body Mass Index Smoking Alcohol Risk of Harm from Alcohol in the Long Term Risk of Harm from Alcohol in the Short Term Physical Activity...33 iii

4 7.6 Fruit and Vegetable Consumption Fruit Consumption Vegetable Consumption...36 CHAPTER 8: MENTAL HEALTH Prevalence of current self-reported diagnosed mental health condition, psychological distress and suicidal ideation...38 CHAPTER 9: PSYCHOSOCIAL EVENTS CHAPTER 10: SOCIAL CAPITAL CHAPTER 11: DAYS LOST OR LIMITED BECAUSE OF HEALTH CHAPTER 12: REFERENCES iv

5 LIST OF FIGURES Figure 4.1: Overall health status, by Aboriginal and Torres Strait Islander status, 18 years and over Figure 5.1: Health service utilisation by Aboriginal and Torres Strait Islander status, 18 years and over...20 Figure 5.2: Time since last dentist visit by Aboriginal and Torres Strait Islander status, 18 years and over...21 Figure 6.1: Prevalence of self-reported chronic conditions, by Aboriginal and Torres Strait Islander status, 18 years and over Figure 6.2: Prevalence of disability, by gender and Aboriginal and Torres Strait Islander status, 18 years and over Figure 7.1: Prevalence of high blood pressure and/or high cholesterol by Aboriginal and Torres Strait Islander status, 18 years and over Figure 7.2: Body Mass Index (WHO Definition) by Aboriginal and Torres Strait Islander status, 18 years and over Figure 7.3: Smoking status by Aboriginal and Torres Strait Islander status, 18 years and over.. 29 Figure 7.4: Risk of harm from alcohol in the long term, 18 years and over Figure 7.5: Risk of harm from alcohol in the short term, 18 years and over Figure 7.6: Physical activity (definition 1) by Aboriginal and Torres Strait Islander status, 18 years and over Figure 7.7: Physical activity (definition 2) by Aboriginal and Torres Strait Islander status, 18 years and over Figure 7.8: Serves of fruit consumed per day by Aboriginal and Torres Strait Islander status, 19 years and over Figure 7.9: Serves of vegetables per day by Aboriginal and Torres Strait Islander status, 19 years and over...37 Figure 8.1: Mental health status by Aboriginal and Torres Strait Islander status, 18 years and over Figure 9.1: Psychosocial events by Aboriginal and Torres Strait Islander status, 18 years and over Figure 10.1: Social Capital by Aboriginal and Torres Strait Islander status, 18 years and over.. 44 Figure 11.1: Days lost or limited because of health, by Aboriginal and Torres Strait Islander status, 18 years and over v

6 LIST OF TABLES Table 2.1: Response rate for period July 2002 to December Table 3.1: Proportion of Aboriginal and Torres Strait Islander respondents Table 3.2: Comparison of proportion of Aboriginal and Torres Strait Islander sample in SAMSSS with ABS 2001 Census figures, all ages Table 3.3: Comparison between proportions within age groups and sex, SAMSS and 2001 Census data, Aboriginal and Torres Strait Islander population, all ages Table 3.4: Age profile of participants by sex, all ages Table 3.5: Demographic characteristics of participants by Aboriginal and Torres Strait Islander status, 18 years and over Table 3.6: Demographic characteristics of participants by Aboriginal and Torres Strait Islander status, 18 years and over Table 4.1: Respondents overall health status, by Aboriginal and Torres Strait Islander status, 18 years and over Table 5.1: Health service utilisation by Aboriginal and Torres Strait Islander status, 18 years and over Table 5.2: Time since last dentist visit by Aboriginal and Torres Strait Islander status, 18 years and over...20 Table 6.1: Prevalence of self-reported chronic conditions and disability by Aboriginal and Torres Strait Islander status, 18 years and over Table 7.1: Prevalence of high blood pressure and/or high cholesterol by Aboriginal and Torres Strait Islander status, 18 years and over Table 7.2: WHO BMI Criteria Table 7.3: Body mass index by Aboriginal and Torres Strait Islander Status, 18 years and over 28 Table 7.4: Smoking status by Aboriginal and Torres Strait Islander Status, 18 years and over.. 29 Table 7.5: For risk of harm from alcohol in the short and long term Table 7.6: Risk of harm from alcohol (risky & high risk) in the long and short term by Aboriginal and Torres Strait Islander status, 18 years and over Table 7.7: Physical Activity Status by Aboriginal and Torres Strait Islander Status, 18 years and over Table 7.8: Fruit consumption by Aboriginal and Torres Strait Islander status, 19 years and over Table 7.9: Vegetable consumption by Aboriginal and Torres Strait Islander status, 19 years and over Table 8.1: Prevalence of mental health conditions by Aboriginal and Torres Strait Islander status, 18 years and over Table 9.1: Prevalence of Psychosocial Events by Aboriginal and Torres Strait Islander status, 18 years and over Table 10.1: Social Capital by Aboriginal and Torres Strait Islander status, 18 years and over Table 11.1: Days lost or limited because of health, by Aboriginal and Torres Strait Islander status, 18 years and over vi

7 EXECUTIVE SUMMARY Good quality data on Aboriginal and Torres Strait Islander people is needed to evaluate policies aimed at improving service delivery and health status, assess the effectiveness of programs and interventions, and to inform policy and program development. This chartbook has been prepared to provide evidence-based information on the health and wellbeing status of South Australia s Aboriginal and Torres Strait Islander people, including information on chronic conditions, risk factors, mental health and social determinants of health. This report will assist those working in the field of Aboriginal health in advocating for the health and wellbeing issues of Aboriginal and Torres Strait Islander communities. The data used in this chartbook was collected using the South Australian Monitoring and Surveillance System (SAMSS) which is a general health and wellbeing survey conducted using Computer Assisted Telephone Interviewing (CATI) technology. It is acknowledged that this survey method may preclude some population groups. The data in this report were collected in the period from July 2002 to December 2005 and presents information on the health status of the Aboriginal and Torres Strait Islander population of South Australia compared to the rest of South Australia. While differences between population groups were identified, caution should be exercised regarding comparisons between these groups because of the different age-sex structure between the Aboriginal and non-aboriginal populations. In addition, while there appeared to be significant differences in some measures of health status between Aboriginal and non-aboriginal people, these differences often did not reach statistical significance, mainly as a result of small sample sizes. However, these differences still indicate areas of concern, and the health issues examined remain important in their own right for Aboriginal and Torres Strait Islander people. The following points highlight statistically significant differences between the Aboriginal and Torres Strait Islander people and the rest of the South Australian population. Overall health status Aboriginal and Torres Strait Islander respondents were significantly more likely to report their health as poor compared to non-aboriginal and Torres Strait Islander respondents (8.5% compared to 3.9%), and were significantly less likely to report 1

8 Executive Summary their health as very good compared to non-aboriginal and Torres Strait Islander respondents (22.0% compared to 36.8%). Health services utilisation There were no significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia for health service utilisation. Chronic conditions and co-morbidity A significantly higher proportion of Aboriginal and Torres Strait Islander people reported being diagnosed with coronary vascular disease compared to non- Aboriginal and Torres Strait Islander people (15.6% compared to 8.0%); and A significantly higher proportion of Aboriginal and Torres Strait Islander people (30.6%) and Aboriginal and Torres Strait Islander males (37.0%) reported being limited in any way in any activities because of any impairment or health problem when compared to the non-aboriginal and Torres Strait Islander populations (21.7% and 22.0%, respectively). Although there were some major differences in prevalence estimates for diabetes, asthma, arthritis and osteoporosis, there were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia. Health risk factors A significantly lower proportion of Aboriginal and Torres Strait Islander people reported being a non-smoker compared to non-aboriginal and Torres Strait Islander people (29.5% vs. 41.7%), and a significantly higher proportion of Aboriginal and Torres Strait Islander people reported being a smoker compared to non-aboriginal and Torres Strait Islander people (31.4% vs. 19.7%); A significantly lower proportion of Aboriginal and Torres Strait Islander people were classified in the normal BMI category compared to non-aboriginal and Torres Strait Islander people (33.3% vs. 45.3%), and a significantly higher proportion of Aboriginal and Torres Strait Islander people were classified as obese according to BMI compared to non-aboriginal and Torres Strait Islander people (29.8% vs. 18.3%); A significantly higher proportion of Aboriginal and Torres Strait Islander people reported being non-drinkers compared to non-aboriginal and Torres Strait Islander people (28.2% vs. 17.2%), a statistically significant lower proportion of Aboriginal 2

9 Executive Summary and Torres Strait Islander people reported alcohol consumption that equates to a low risk of harm from alcohol in the long term compared to non-aboriginal and Torres Strait Islander people (60.2% vs. 78.8%), and a significantly higher proportion of Aboriginal and Torres Strait Islander people reported alcohol consumption that equates to a risky to high risk of harm from alcohol in the long term compared to non-aboriginal and Torres Strait Islander people (11.6% vs. 4.0%). There were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia for ever or currently having high blood pressure, ever or currently having high cholesterol, fruit consumption, vegetable consumption, and sufficient activity or insufficient/ no activity. Mental health A significantly higher proportion of Aboriginal and Torres Strait Islander people reported psychological distress (22.1% vs. 10.1%), and a significantly higher proportion of Aboriginal and Torres Strait Islander people reported suicidal ideation (14.6% vs. 4.5%), compared to non-aboriginal and Torres Strait Islander people. Psychosocial events A significantly higher proportion of Aboriginal and Torres Strait Islander people experienced discrimination compared to non-aboriginal and Torres Strait Islander people (16.4% vs. 3.4%); and A significantly higher proportion of Aboriginal and Torres Strait Islander people experienced a marriage or relationship breakdown compared to non-aboriginal and Torres Strait Islander people (20.0% vs. 5.5%). Social capital There were no significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia in concepts measuring social capital. Days lost or limited because of health There were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia for days lost or limited because of health. 3

10 Executive Summary Limitations When reading this chartbook it is important to take into consideration certain limitations in the data. These include: SAMSS is a telephone survey and therefore does not interview people without a telephone. Thus people living in remote Aboriginal communities or homes without telephones have not been included. There may be an underestimation of the Aboriginal and Torres Strait Islander population due to issues with identification as Aboriginal and Torres Strait Islander, and include misclassification or under-reporting of Aboriginal and Torres Strait Islander status. Small numbers in some categories need to be interpreted with caution. Caution should also be exercised regarding comparisons between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations because of the different age-sex structure. The health issues examined are important in their own right for Aboriginal and Torres Strait Islander people. Please also note that the category labels for Aboriginal and Torres Strait Islander people and non-aboriginal and Torres Strait Islander people in all graphs in this document have been abbreviated to ATSI and non-atsi. 4

11 CHAPTER 1: INTRODUCTION Health related data pertaining to Aboriginal and Torres Strait Islander people are often limited to hospital separations data, notifiable and chronic disease registries, the Australian Bureau of Statistics Census, or research centred on community dwelling respondents or specific groups. The purpose of this chartbook is to present information and data on a number of health related issues including chronic conditions, risk factors, mental health and some of the social determinants of health for the Aboriginal and Torres Strait Islander people of South Australia. Although the data in this report are limited due to small numbers and sampling issues (outlined further in the following chapter), this report provides an overview of the health and well-being status and health service utilisation of the Aboriginal and Torres Strait Islander people compared with the rest of the state. The data source used in this chartbook is the South Australian Monitoring and Surveillance System (SAMSS) operated by the Population Research and Outcome Studies Unit, South Australian Department of Health. It is an ongoing epidemiological monitoring system that aims to detect, and facilitate understanding of trends in the prevalence of chronic conditions, risk and protective factors, determinants of health and other health related issues. For the period of July 2002 to December 2005, information on a number of topics was collected from n=23773 participants including n=18907 adults (16 years and over) and n=4866 children (birth to 15 years) in South Australia. Of these, a total of n=202 interviews (0.9%) were conducted with Aboriginal and Torres Strait Islander people (n=120 aged 16 years and over and n=82 aged 15 years and under). The interviews were conducted by telephone using Computer Assisted Telephone Interviewing (CATI) technology. The following chapters present health status and health service utilisation information and highlight statistically significant differences between the Aboriginal and Torres Strait Islander people and the rest of the South Australian population. 5

12 CHAPTER 2: BACKGROUND AND METHODOLOGY 2.1 South Australian Monitoring and Surveillance System (SAMSS) Aims and objectives The main objective of SAMSS is to monitor, in a systematic way, the trends of diseases, health related problems, risk factors and other human services issues, relevant to the Department of Health, over time. As a result, the needs of the whole of the Department are addressed and key risk factor and population trends in priority chronic disease areas are monitored so that programs and policies can respond to trends in health issues. These data also monitor state and national health priority areas and will contribute to the evaluation of the effectiveness of the Department of Health programs, interventions and strategic plans. This system continuously collects data at the population level on the priority health areas and main indicators pertinent to the Department of Health policies. The risk factors included in the system are those critical to national and state health priority areas. These data will ensure that appropriate, timely and valid population health information are available to monitor health status, respond to population changes and support planning, implementation and evaluation of health services and programs. Trend and time series analyses will allow changes over time to be detected. SAMSS addresses these needs on the whole South Australian population, and interviews (or surrogate interviews) are conducted with people of all ages. Other objectives are to: Provide high quality, representative data; Characterise health problems or topics by time; Detect epidemics or changes in the topic occurrence; Identify high risk groups or risk factors associated with health problems or topics and suggest hypotheses for further investigation; Estimate the burden of health problems or topics; Evaluate health service initiatives, prevention and control programs including the effectiveness of these programs (directly or indirectly); Highlight gaps in information and services that affect South Australians general health and wellbeing; 6

13 Background and Methodology Disseminate findings to professionals and administrators within the Department of Health, and other professionals or organisations in South Australia and Australia; Project future health care needs; Set priorities for allocation of resources; and Strengthen the network for surveillance and monitoring of issues relevant to the Department of Health to improve information gathering and exchange Aim of this report This report presents key health and well-being indicators by Aboriginal and Torres Strait Islander status, using data collected by SAMSS for the period July 2002 to December Methodology Questions Issues included in the questionnaire were based on the Department of Health and national and/or state priority areas and indicators with the intention of gathering appropriate data on key indicators. Questions that are included in SAMSS were developed by the Population Research and Outcome Studies (PROS) Unit in consultation with key personnel within the Department of Health, including relevant experts. A core set of questions is asked every month with additional questions asked in alternate months. These questions are based on previous work undertaken in Australian states and territories. Where possible, questions that had previously been included in other surveys, and are perceived to ascertain reliable and valid data, were used or modified 1, 2. A question is asked specifically to identify people of Aboriginal and Torres Strait Islander origin Sample Selection All households in South Australia with a number listed in the Electronic White Pages (EWP) are eligible for selection in the sample. For the period July 2002 to December 2003, 860 South Australian residential telephone numbers per month were randomly selected. Since January 2004, 1000 South Australian residential telephone numbers per month have been randomly selected. 7

14 Background and Methodology Introductory letter A letter introducing SAMSS is sent to the household of each selected telephone number. Within each household the person who had their birthday last was selected for interview. There is no replacement for non-contactable persons. The letter informs people of the purpose of the survey and indicates that they could expect a telephone call within the time frame of the survey. During July 2002 to December 2005, 83.8% of those who participated indicated that they had received a letter Data collection Data are collected by a contracted agency and interviews were conducted in English CATI The CATI III (Computer Assisted Telephone Interview) system is used to conduct the interviews. This system allows immediate entry of data from the interviewer s questionnaire screen to the computer database. The main advantages of this system are the precise ordering and timing of call backs and correct sequencing of questions as specific answers are given. The CATI system enforces a range of checks on each response with most questions having a set of pre-determined response categories. In addition, CATI automatically rotates response categories, when required, to minimise bias. When open-ended responses are required these are transcribed exactly by the interviewer Call backs At least ten call backs are made to the telephone number selected at random from the Electronic White Pages to interview household members. Different times of the day or evening are scheduled for each call back. If a person cannot be interviewed immediately they are re-scheduled for interview at a time suitable to them. Where a refusal is encountered, another interviewer generally (at the discretion of the supervisor) calls later, in an endeavour to obtain the interview(s). Replacement interviews for persons who cannot be contacted or interviewed are not permitted. 8

15 Background and Methodology Validation Of each interviewer s work, 10% is selected at random for validation by the supervisor. The contracted agency is a member of Interviewer Quality Control Australia (IQCA) Data Processing After each occurrence of data collection, the raw data from the CATI system is imported into SPSS for analysis. Open-ended responses are saved in Excel format and the responses are either coded numerically and brought into the main SPSS database, or brought into SPSS as a string variable if necessary Weighting The data presented in this report are weighted by age, sex, area (metropolitan/ rural) and probability of selection in the household to the most recent ABS Census data or Estimated Residential Population. Probability of selection in the household was calculated on the number of adults in the household and the number of listings in the White Pages. Weighting is used to correct for the disproportional of the sample with respect to the populations of interest. The weights reflect unequal sample inclusion probabilities and compensate for differential non-response. The data are weighted using the ABS data so that the health estimates calculated would be representative of the adult populations of those areas. The weighting of the data results in occasional rounding effects for the numbers. In all instances the percentages should be the point of reference rather than the actual number of respondents. The percentages presented in this report have been processed on the figures pre-rounding Response Rates The response rate for SAMSS for the period of July 2002 to December 2005 is shown in Table 2.1. The overall response rate of SAMSS for the report period was 69.8%. Initially a sample of was drawn. Sample loss of 5537 occurred due to nonconnected numbers (4160), non-residential numbers (872), fax/modem connections (459) and not qualified (46). 9

16 Background and Methodology Table 2.1: Response rate for period July 2002 to December 2005 n % Initial eligible sample Refusals Non-contact after ten attempts Foreign language Incapacitated Terminated Respondent unavailable Completed interviews Response rate % 69.8 Participation rate % 77.0 Response rate = completed interviews / initial eligible sample. Participation rate = completed interviews / (initial eligible sample non-contact after ten attempts). There were n=13 cases deleted as a result of providing insufficient information for weighting, therefore the final sample size was n= Data Analysis Data were analysed using the Statistical Package for the Social Sciences (SPSS). The results are presented in charts as proportions (%), including error bars. Chi square (χ 2 ) tests were conducted to test for statistical significance Average time for interview The average time for a person to complete the interview was 16 minutes. 10

17 CHAPTER 3: DEMOGRAPHIC PROFILE 3.1 Comparison with Census data This chapter presents the proportion of respondents within the SAMSS sample (n=23773) describing themselves as being of Aboriginal or Torres Strait Islander descent. These figures are then compared with those obtained from the Australian Bureau of Statistics (ABS) 2001 Census data for South Australia 3,4. Table 3.1 shows the proportion of the respondents interviewed by SAMSS for the period July 2002 to December 2005 by Aboriginal and Torres Strait Islander status. Table 3.1: Proportion of Aboriginal and Torres Strait Islander respondents n % (95% CI) No ( ) Aboriginal or Torres Strait Islander ( ) Not stated ( ) Total Data source: SAMSS July December Note: The weighting of data can result in rounding discrepancies or totals not adding. Table 3.2 provides a comparison of the proportion of respondents of Aboriginal or Torres Strait Islander descent obtained from SAMSS and compared to the figures obtained for South Australia during the 2001 Australian Census 3,4. The overall Aboriginal and Torres Strait Islander population in South Australia is presented, as are the Aboriginal and Torres Strait Islander population Census figures divided into the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands and the remaining Aboriginal and Torres Strait Islander population in South Australia. Table 3.2: Comparison of proportion of Aboriginal and Torres Strait Islander sample in SAMSSS with ABS 2001 Census figures, all ages SAMSS ABS 2001 Census (SA) n % n % No Aboriginal and Torres Strait Islander Not stated Total Data source: SAMSS July December 2005 and 2001 Census data for South Australia. Note: The weighting of data can result in rounding discrepancies or totals not adding. 11

18 Demographic Profile Table 3.3 provides a comparison of the proportions of the Aboriginal and Torres Strait Islander population within each age group and sex obtained from SAMSS (n=202) compared to the 2001 Census data for South Australia 3,4. Table 3.3: Comparison between proportions within age groups and sex, SAMSS and 2001 Census data, Aboriginal and Torres Strait Islander population, all ages SAMSS Aboriginal and Torres Strait Islander population Male (%) Female (%) Total (%) 2001 Census SA Total Aboriginal and Torres Strait Islander Population Male (%) Female (%) Total population Total (%) 0 to 4 years to 14 years to 17 years to 24 years to 44 years to 64 years years and over Data source: SAMSS July December 2005 and 2001 Census data for South Australia. Note: The weighting of data can result in rounding discrepancies or totals not adding. It is recognised that the proportion of Aboriginal and Torres Strait Islander population obtained from SAMSS is lower than that obtained from the 2001 Census data 3,4. This difference should be considered when reading this report. 12

19 Demographic Profile 3.2 Demographic characteristics of South Australia s Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations from SAMSS Age and sex profile The age profile for males and females for the sample used in this report (n=23773) is shown in Table 3.4. Table 3.4: Age profile of participants by sex, all ages Mean Median Percentile 25 Percentile 75 Minimum Maximum Non-Aboriginal and Torres Strait Islander Male Female Aboriginal and Torres Strait Islander Male Female Data source: SAMSS July December Data for not stated category not presented Other demographic characteristics The demographic profile of adults aged 18 years and over (n=18212) by Aboriginal and Torres Strait Islander status is shown in Table 3.5 and Table 3.6. The measure of socio-economic status and social disadvantage as discussed in this report is the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio- Economic Disadvantage (IRSD). The SEIFA IRSD quintiles are produced by the Australian Bureau of Statistics 6,7 to measure socio-economic status by postcode. IRSD scores have been grouped into quintiles (highest, high, middle, low and lowest) for analysis where the highest quintile represents postcodes with the highest IRSD scores (most advantaged areas) and the lowest quintile represents postcodes with the lowest IRSD scores (most disadvantaged areas). It is widely recognised 8,9,10 that compared to people who are socially and economically advantaged, people who experience social and economic disadvantage also experience poorer health. 13

20 Demographic Profile As health can be affected by distance to services in remote and rural areas, this report also examines the data using the Accessibility/Remoteness Index of Australia (ARIA). This allows for comparison between major cities through to very remote regions 11. Table 3.5: Demographic characteristics of participants by Aboriginal and Torres Strait Islander status, 18 years and over Variable ATSI % non- ATSI % Sex Male Female Age group 18 to 24 years to 44 years to 64 years to 74 years years and over Marital status Married/Living with partner Separated/Divorced Widowed Never Married Refused People (aged 16 years and over) in household One person Two people Three or more people Children (under 16 years) in household No Children Children Highest educational attainment Up to Secondary School education Trade, Certificate, Diploma Degree or higher Work status Full time employed Part time employed Unemployed Economically inactive (Home duties, student, retired, unable) Data source: SAMSS July December Note: The weighting of data can result in rounding discrepancies or totals not adding. Data for not stated category not presented. 14

21 Demographic Profile Table 3.6: Demographic characteristics of participants by Aboriginal and Torres Strait Islander status, 18 years and over Variable ATSI % Annual gross household income non- ATSI % Up to $20, $20,001-$40, $40,001-$60, $60,0001-$80, $80,000 or more Not stated SEIFA 2001 Index of Relative Socio-Economic Disadvantage Quintiles Lowest quintile (most disadvantaged) Low quintile Middle quintile High quintile Highest quintile (least disadvantaged) Rural, Remote & Metropolitan Area Classifications Capital City Large Rural Centres Small Rural Centres Other Rural Areas Other Remote Areas Rural, Remote & Metropolitan Area Classifications Metropolitan area Rural Centres Other Remote Areas Area of residence (Health regions) ARIA Metropolitan Adelaide SA Country Highly accessible Accessible > Moderately accessible > Remote > Very remote > ARIA (Metro, Rural, Remote) Metropolitan (Highly accessible ARIA ) Rural (Accessible & Moderately accessible ARIA > ) Remote (Remote & Very remote ARIA > ) Total Data source: SAMSS July December Note: The weighting of data can result in rounding discrepancies or totals not adding. Data for not stated category not presented. 15

22 Demographic Profile In summary, Aboriginal and Torres Strait Islander people in South Australia have lower incomes, higher levels of unemployment and lower levels of education, are more disadvantaged according to SEIFA IRSD category, and are more likely to live in rural or remote areas than the non-aboriginal and Torres Strait Islander South Australians. For all remaining analyses, respondents who did not state their Aboriginal and Torres Strait Islander status are removed from the analysis, and unless otherwise stated analyses are undertaken on respondents aged 18 years and over (n=18202). 16

23 CHAPTER 4: OVERALL HEALTH STATUS This chapter reports on respondents overall health status. Studies 5,12 have shown that factors can influence a person s assessment of their own health. For instance language, employment status, or access to health services and information can alter how people rate their health. Respondents aged 18 years and over were asked to rate their overall health status on a scale from excellent to poor. The proportion of respondents who rated their health as excellent, very good, good, fair and poor is presented in Table 4.1 and Figure 4.1 by Aboriginal and Torres Strait Islander status. Aboriginal and Torres Strait Islander respondents were statistically significantly more likely to report their health as poor, and were statistically significantly less likely to report their health as very good, compared to non-aboriginal and Torres Strait Islander respondents. Table 4.1: Respondents overall health status, by Aboriginal and Torres Strait Islander status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) SF1 % (95% CI) % (95% CI) Excellent 16.2 ( ) 19.5 ( ) Very good 22.0 ( ) 36.8 ( ) Good 35.1 ( ) 27.7 ( ) Fair 18.2 ( ) 12.1 ( ) Poor 8.5 ( ) 3.9 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. 17

24 Overall Health Status Proportion (%) Excellent Very good Good Fair Poor Indigenous Non Indigenous Figure 4.1: Overall health status, by Aboriginal and Torres Strait Islander status, 18 years and over 18

25 CHAPTER 5: HEALTH SERVICE UTILISATION This chapter presents the utilisation of health services by respondents aged 18 years and over, by Aboriginal and Torres Strait Islander status. These services include general practitioner, specialist doctor (not in hospital), hospital use (accident and emergency, admission, clinic), and dentists. Table 5.1 and Figure 5.1 show the proportion of respondents using a general practitioner, specialist doctor (not in hospital), and hospital use (accident and emergency, admission, clinics) in the last four weeks. There were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia for health service utilisation, however visiting a general practitioner was the most common health service used by both Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander respondents. Table 5.1: Health service utilisation in the past four weeks by Aboriginal and Torres Strait Islander status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) Health Service Use % (95% CI) % (95% CI) General Practitioner 34.3 ( ) 36.1 ( ) Specialist Doctor (not in hospital) 11.3 ( ) 9.2 ( ) Hospital Services (A&E, admission clinic) 11.1 ( ) 8.6 ( ) Data source: SAMSS July 2002 December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. 19

26 Health Service Utilisation Proportion (%) General Practitioner Indigenous Specialist doctor (not in hospital) Non indigenous Hospital use - A&E, Admission, Clinics Figure 5.1: Health service utilisation by Aboriginal and Torres Strait Islander status, 18 years and over Table 5.2 and Figure 5.2 show the period of time since respondents aged 18 years and over last visited a dentist. There were no statistically significant differences in the time since the last dental check-up. Table 5.2: Time since last dentist visit by Aboriginal and Torres Strait Islander status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) Time since last dentist visit % (95% CI) % (95% CI) Less than 6 months ago 26.4 ( ) 30.8 ( ) 6 to less than 12 months ago 23.0 ( ) 22.4 ( ) 1 to less than 2 years ago 22.3 ( ) 15.2 ( ) 2 or more years ago 25.4 ( ) 22.9 ( ) Dentures or false teeth 8.6 ( ) 2.8 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. 20

27 Health Service Utilisation Proportion (%) Less than 6 months ago Between 6 and less than 12 months ago 1 to less than 2 years ago 2 or more years ago Indigenous Non Indigenous Figure 5.2: Time since last dentist visit by Aboriginal and Torres Strait Islander status, 18 years and over 21

28 CHAPTER 6: CHRONIC CONDITIONS AND CO- MORBIDITY This chapter presents self-reported chronic conditions and co-morbidity for respondents aged 18 years and over, by Aboriginal and Torres Strait Islander status. It is recognised in the literature that Aboriginal and Torres Strait Islander populations experience poorer health than non-aboriginal and Torres Strait Islander Australians 5,12. These diseases and conditions include coronary vascular disease, diabetes, asthma, arthritis, and osteoporosis. All of these conditions are recognised as National Health Priority Areas because of the significant burden that they place on the community in terms of health, social, economic and emotional costs 13. This section also reports on the prevalence of disability or impairment of any kind as a result of ill health. These results are presented in Table 6.1, and in Figure 6.1 and Figure 6.2. Statistically significant differences were observed for the following: A statistically significantly higher proportion of Aboriginal and Torres Strait Islander people who reported being diagnosed with coronary vascular disease compared to non-aboriginal and Torres Strait Islander people (15.6% compared to 8.0%); and A statistically significantly higher proportion of Aboriginal and Torres Strait Islander people (30.6%) and Aboriginal and Torres Strait Islander males (37.0%) reported being limited in any way in any activities because of any impairment or health problem when compared to the non-aboriginal and Torres Strait Islander populations (21.7% and 22.0%, respectively). Although there were some major differences in prevalence estimates for diabetes, asthma, arthritis and osteoporosis, there were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia. The lack of statistical significance between the groups is likely to be due to the small sample sizes. 24

29 Chronic Conditions and Co-Morbidity Table 6.1: Prevalence of self-reported chronic conditions and disability by Aboriginal and Torres Strait Islander status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) % (95% CI) % (95% CI) Chronic Conditions Diabetes 11.0 ( ) 6.4 ( ) Current asthma 14.2 ( ) 13.8 ( ) Coronary vascular disease 15.6 ( ) 8.0 ( ) Arthritis 16.0 ( ) 22.0 ( ) Osteoporosis 6.2 ( ) 4.2 ( ) Disability Disability (overall) 30.6 ( ) 21.7 ( ) Disability (males) 37.0 ( ) 22.0 ( ) Disability (females) 25.4 ( ) 21.4 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding Proportion (%) Diabetes Asthma CVD Arthritis Osteoporosis Indigenous Non Indigenous Figure 6.1: Prevalence of self-reported chronic conditions, by Aboriginal and Torres Strait Islander status, 18 years and over 23

30 Chronic Conditions and Co-Morbidity Respondents were asked if they are limited in any way in any activities because of any impairment or health problem. There was a statistically significant difference overall in terms of disability, and when examined further, a statistically significantly higher prevalence of Aboriginal and Torres Strait Islander males reported disability compared with non-aboriginal and Torres Strait Islander males (Figure 6.2). Proportion (%) Males Females Overall Indigenous Non Indigenous Figure 6.2: Prevalence of disability, by gender and Aboriginal and Torres Strait Islander status, 18 years and over 24

31 CHAPTER 7: HEALTH RISK FACTORS This chapter discusses health risk factors. There is a relationship between risk factors and chronic disease in that the existence of risk factors in an individual increases their chances of ill-health from chronic disease 14. The Australian Bureau of Statistics (ABS) and Australian Institute of Health and Welfare (AIHW) have reported that health risks (e.g. smoking, obesity, alcohol misuse) and other health factors (e.g. poor housing, exposure to violence) are important determinants of health among Aboriginal and Torres Strait Islander peoples 5. This section of the report covers the following health related risk factors: High blood pressure; High cholesterol; Body mass index (BMI) underweight, normal, overweight and obese; Smoking; Alcohol; Nutrition; and Physical activity. 25

32 Health Risk Factors 7.1 High Blood Pressure and Cholesterol Respondents were asked a series of questions relating to high blood pressure and high cholesterol. The proportion of respondents who reported ever having high blood pressure or high cholesterol, or currently having high blood pressure or high cholesterol, is shown in Table 7.1 and Figure 7.2 by Aboriginal and Torres Strait Islander status. Although there were no statistically significant differences observed between the Aboriginal and Torres Strait Islander and non-aboriginal and Torres Strait Islander populations of South Australia for high blood pressure or high cholesterol, the proportion of Aboriginal and Torres Strait Islander respondents reporting these conditions was higher than for the non-aboriginal and Torres Strait Islander population. Table 7.1: Prevalence of high blood pressure and/or high cholesterol by Aboriginal and Torres Strait Islander status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) % (95% CI) % (95% CI) High blood pressure Ever had high blood pressure 35.4 ( ) 28.4 ( ) Currently have high blood pressure (inc. taking medication) 21.8 ( ) 18.5 ( ) High Cholesterol Ever had high cholesterol 26.5 ( ) 23.6 ( ) Currently have high cholesterol (inc. taking medication) 18.0 ( ) 14.3 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. 26

33 Health Risk Factors Proportion (%) High blood pressure (ever) High blood pressure (current) High cholesterol (ever) High cholesterol (current) Indigenous Non Indigenous Figure 7.1: Prevalence of high blood pressure and/or high cholesterol by Aboriginal and Torres Strait Islander status, 18 years and over 7.2 Body Mass Index Respondents aged 18 years and over were asked for their height and weight. These measurements were then used to calculate body mass index (BMI). The classifications of BMI according to World Health Organization (WHO) 15 criteria are shown in Table 7.2. The formula for the calculation of BMI is as follows: weight (kg) / height (m) 2. Table 7.2: WHO BMI Criteria Category BMI Underweight <18.5 Normal weight Overweight Obese The proportion of respondents who are classified as underweight, normal weight, overweight, or obese according to the BMI categories is shown in Table 7.3 and Figure 7.2 by Aboriginal and Torres Strait Islander status. 27

34 Health Risk Factors Statistically significant differences were observed for the following: A significantly lower proportion of Aboriginal and Torres Strait Islander people were classified in the normal BMI category compared to non-aboriginal and Torres Strait Islander people (33.3% vs. 45.3%); and A significantly higher proportion of Aboriginal and Torres Strait Islander people were classified as obese according to BMI compared to non-aboriginal and Torres Strait Islander people (29.8% vs. 18.3%). Table 7.3: Body mass index by Aboriginal and Torres Strait Islander Status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) BMI % (95% CI) % (95% CI) BMI < underweight/ normal 33.3 ( ) 45.3 ( ) BMI >= 25 & < 30 overweight 36.9 ( ) 36.3 ( ) BMI >= 30 obese 29.8 ( ) 18.3 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. Proportion (%) Underweight/ normal Overweight Obese Indigenous Non Indigenous Figure 7.2: Body Mass Index (WHO Definition) by Aboriginal and Torres Strait Islander status, 18 years and over 28

35 Health Risk Factors 7.3 Smoking Respondents were asked a series of questions related to smoking. The proportion of people aged 18 years and over who reported being current smokers, ex-smokers, and non-smokers is reported in Table 7.4 and Figure 7.3 by Aboriginal and Torres Strait Islander status. Statistically significant differences were observed for the following: A significantly lower proportion of Aboriginal and Torres Strait Islander people reported being a non-smoker compared to non-aboriginal and Torres Strait Islander people (29.5% vs. 41.7%); and A significantly higher proportion of Aboriginal and Torres Strait Islander people reported being a smoker compared to non-aboriginal and Torres Strait Islander people (31.4% vs. 19.7%). Table 7.4: Smoking status by Aboriginal and Torres Strait Islander Status, 18 years and over Aboriginal and Torres Strait Islander (n=100) Non-Aboriginal and Torres Strait Islander (n=18102) Smoking Status % (95% CI) % (95% CI) Non-smoker 29.5 ( ) 41.7 ( ) Ex-smoker 39.0 ( ) 38.6 ( ) Current Smoker 31.4 ( ) 19.7 ( ) Data source: SAMSS July December Statistically significantly higher or lower (χ 2 test, p<0.05) Aboriginal and Torres Strait Islander compared to Non-Aboriginal and Torres Strait Islander. Note: The weighting of data can result in rounding discrepancies or totals not adding. Proportion (%) Non-smoker Ex-smoker Smoker Indigenous Non Indigenous Figure 7.3: Smoking status by Aboriginal and Torres Strait Islander status, 18 years and over 29