Howarth, T.P.

Jersmann, Hubertus

Majoni, Sandawana William

Mo, Lin

Ben Saad, H

Ford, L.P.

Heraganahally, Subash

2023-07-01

BACKGROUND: Aboriginal Australians are reported to have higher presence of chronic respiratory diseases. However, comprehensive evidence surrounding this is sparse. Hence, a systematic review was undertaken to appraise the current state of knowledge on respiratory health in the adult Aboriginal Australians, in particular among the three most common respiratory disorders: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD). METHODS: A systematic review of primary literature published between January 2012 and October 2022, using the databases PubMed and Scopus, was conducted. Studies were included if they reported adult Aboriginal Australian prevalence's or outcomes related to asthma, bronchiectasis or COPD, and excluded if adult data were not reported separately, if Aboriginal Australian data were not reported separately or if respiratory disorders were combined into a single group. Risk of bias was assessed by both Joanne Briggs Institute checklists and Hoys' bias assessment. Summary data pertaining to prevalence, lung function, symptoms, sputum cultures and mortality for each of asthma, bronchiectasis and COPD were extracted from the included studies. RESULTS: Thirty-seven studies were included, involving approximately 33 364 participants (71% female). Eighteen studies reported on asthma, 21 on bronchiectasis and 30 on COPD. The majority of studies (94%) involved patients from hospitals or respiratory clinics and were retrospective in nature. Across studies, the estimated prevalence of asthma was 15.4%, bronchiectasis was 9.4% and COPD was 13.7%, although there was significant geographical variation. Only a minority of studies reported on clinical manifestations (n=7) or symptoms (n=4), and studies reporting on lung function parameters (n=17) showed significant impairment, in particular among those with concurrent bronchiectasis and COPD. Airway exacerbation frequency and hospital admission rates including mortality are high. DISCUSSION: Although risk of bias globally was assessed as low, and study quality as high, there was limited diversity of studies with most reporting on referred populations, and the majority originating from two centres in the Northern Territory. The states with the greatest Aboriginal Australian population (Victoria and New South Wales) reported the lowest number of studies and patients. This limits the generalisability of results to the wider Aboriginal Australian population due to significant environmental, cultural and socioeconomic variation across the population. Regardless, Aboriginal Australians appear to display a high prevalence, alongside quite advanced and complex chronic respiratory diseases. There is however significant heterogeneity of prevalence, risk factors and outcomes geographically and by patient population. Further collaborative efforts are required to address specific diagnostic and management pathways in order to close the health gap secondary to respiratory disorders in this population.

College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.

Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia.

Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.

Department of Respiratory and sleep Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.

The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia.

Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

University of Sousse, Farhat HACHED Hospital, Heart Failure (LR12SP09) Research Laboratory, Sousse, Tunisia.

Northern Institute, Faculty of Arts & Society, Charles Darwin University, Darwin, Northern Territory, Australia.

Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia hssubhashcmc@hotmail.com.

BMJ Open Respir Res. 2023 Jul;10(1):e001738. doi: 10.1136/bmjresp-2023-001738.

0000-0003-3028-0376

0000-0003-1763-2736

0000-0003-0039-1913

0000-0003-3674-5058

0000-0002-7477-2965

0000-0003-0788-7137

https://pubmed.ncbi.nlm.nih.gov/37451702/?otool=iaurydwlib

https://hdl.handle.net/10137/12505

10

Humans

Adult

Female

Male

Australian Aboriginal and Torres Strait Islander Peoples

Retrospective Studies

Australia/epidemiology

*Pulmonary Disease, Chronic Obstructive/epidemiology

*Asthma/epidemiology

*Bronchiectasis/epidemiology

*Respiration Disorders

The 'ABC' of respiratory disorders among adult Indigenous people: asthma, bronchiectasis and COPD among Aboriginal Australians - a systematic review.

Journal Article

Publication