Blood pressure and hypertension for Australian Aboriginal and Torres Strait Islander people

Dental caries, periodontal disease and restorative dental care among Indigenous and non-Indigenous groups in Brazil: A descriptive study

OBJECTIVE

To compare patterns of dental caries, periodontal disease and dental care among Indigenous and non-Indigenous Central-West Brazilian subpopulations.

METHODS

Data were from two population-based cross-sectional studies involving 5-, 12-, 15-19- and 35-44-year-olds. The first examined were the Guarani, Kaiowá, Terena and Kadiwéu Indigenous groups from Mato Grosso do Sul Brazilian state and the second comprised a non-Indigenous population. Mean numbers of sound teeth, decayed, missing and filled teeth (dmft/DMFT), prevalence of poor oral hygiene for adults (35-44 years) and of periodontal disease were estimated. Restorative dental service utilization was measured using the Care Index.

RESULTS

The study populations comprised of 1830 Indigenous and 29 395 non-Indigenous people. The Kaiwoá ethnic group had the lowest DMFT among Indigenous groups for ages 12, 15-19 years; 0.9 (95% CI 0.7-1.1) and 2.4 (95% CI 1.9-2.9), respectively. The highest values were observed among the 12-year-old Terena ethnic group and 15- to 19-year-old Kadiwéo groups; 2.2 (95% CI 1.8-2.5) and 3.7 (95% CI 3.1-4.4), respectively. The mean DMFT values were significantly lower among Indigenous than non-Indigenous people for all age groups. The prevalence of bleeding and calculus was 70.3% (95% CI 64.5%-75.5%) and 80.1% (95% CI 74.8%-84.5%), respectively, for Indigenous people and 43.9% (95% CI 34.4%-50.7%) and 61.5% (95% CI 55.4%-67.2%), respectively, for the non-Indigenous population. Restorative services were higher among 5-year-old non-Indigenous children and adults than for Indigenous groups. Among Indigenous groups, the Terena had the highest level of restored teeth (38.0% at 12 years) and Kadiwéu the lowest level (8.8% at 12 years).

CONCLUSION

In our study, Indigenous people had a lower caries burden, but less access to restorative services than their non-Indigenous counterparts. These disparities likely reflect differences in historical, socioeconomic, cultural, environmental and political determinants that both groups have experienced differently over time.

Natural selection and local adaptation of blood pressure regulation and their perspectives on precision medicine in hypertension

Prevalence of hypertension (HTN) varies substantially across different populations. HTN is not only common - affecting at least one third of the world's adult population - but is also the most important driver for cardiovascular diseases. Yet up to a third of hypertensive patients are resistant to therapy, contributed by secondary hypertension but more commonly the hitherto inability to precisely predict response to specific antihypertensive agents. Population and individual genomics information could be useful in guiding the selection and predicting the response to treatment - an approach known as precision medicine. However this cannot be achieved without the knowledge of genetic variations that influence blood pressure (BP). A number of evolutionary factors including population demographics and forces of natural selection may be involved. This article explores some ideas on how natural selection influences BP regulation in ethnically and geographically diverse populations that could lead to them being susceptible to HTN. We explore how such evolutionary factors could impact the implementation of precision medicine in HTN. Finally, in order to ensure the success of precision medicine in HTN, we call for more initiatives to understand the genetic architecture within and between diverse populations with ancestry from different parts of the world, and to precisely classify the intermediate phenotypes of HTN.

'Work it out': evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people, with or at risk of cardiovascular disease

BACKGROUND

Chronic diseases disproportionately burden Aboriginal and Torres Strait Islander people in Australia, with cardiovascular (CV) diseases being the greatest contributor. To improve quality of life and life expectancy for people living with CV disease, secondary prevention strategies such as rehabilitation and self-management programs are critical. However, there is no published evidence examining the effect of chronic condition self-management (CCSM) group programs for Aboriginal and Torres Strait Islander people who have, or are at risk of, CV disease specifically. This study evaluates the Work It Out program for its effect on clinical outcome measures in urban Aboriginal and Torres Strait Islander participants with or at risk of CV disease.

METHODS

This study was underpinned by a conceptual framework based on Aboriginal and Torres Strait Islander community control. Participants had at least one diagnosed CV disease, or at least one CV disease risk factor. Short-term changes in clinical outcome measures over (approximately) 12 weeks were evaluated with a quasi-experimental, pre-post test design, using paired t-tests. Factors contributing to positive changes were tested using general linear models. The outcome measures included blood pressure (mmHg), weight (kg), body mass index (kg/m²), waist and hip circumference (cm), waist to hip ratio (waist cm/hip cm) and six minute walk test (6MWT).

RESULTS

Changes in several clinical outcome measures were detected, either within the entire group (n = 85) or within specific participant sub-groups. Participant's 6MWT distance improved by an average 0.053 km (95% CI: 0.01-0.07 km). The change in distance travelled was influenced by number of social and emotional wellbeing conditions participants presented with. The weight of participants classified with extreme obesity decreased on average by 1.6 kg (95% CI: 0.1-3.0 kg). Participants with high baseline systolic blood pressure demonstrated a mean decrease of 11 mmHg (95% CI: 3.2-18.8 mmHg). Change in blood pressure was influenced by the number of cardiovascular conditions participants experienced.

CONCLUSIONS

Short-term improvements seen in some measures could indicate a trend for improvement in other indicators over the longer term. These results suggest the Work It Out program could be a useful model for cardiovascular rehabilitation and prevention for other urban Aboriginal and Torres Strait Islander populations.

Obesity, albuminuria, and gamma-glutamyl transferase predict incidence of hypertension in indigenous Australians in rural and remote communities in northern Australia

OBJECTIVE

To describe the incidence of hypertension in a cohort of Australian Aboriginal and Torres Strait Islanders.

METHOD

A follow-up study conducted among 1831 indigenous population aged 15 years and over without hypertension at baseline from 19 communities in North Queensland during 1997-2008. Main measurements included baseline and follow-up weight, waist circumference, blood pressure, fasting glucose, lipids (triglycerides and cholesterol), gamma-glutamyl transferase, urinary albumin creatinine ratio, self-reported tobacco smoking, alcohol intake and physical activity.

RESULTS

Hundred cases of hypertension developed over 2633.4 person-years giving a crude incidence of hypertension of 22.6 (16.2-31.4) per 1000 person-years in females and 60.0 (47.1-76.6) per 1000 person-years for males. Age standardized overall incidence was 51.9 per 1000 person-years. Aboriginal participants were twice as likely as Torres Strait Islanders to develop hypertension, which increased with age. Obesity (BMI >30) strongly predicted incident hypertension independently of age or sex (adjusted hazard ratio 2.9, 95% confidence interval 1.9-4.8). Albuminuria and elevated gamma-glutamyl transferase increased the risk of hypertension (adjusted hazard ratio 1.4-1.7) in this population.

CONCLUSION

Incidence of hypertension in indigenous Australian adults is nearly double than that of the general Australian population. High background prevalence of obesity, diabetes and albuminuria contributes to this excess. As well as early detection and management of high blood pressure, albuminuria and diabetes in primary care settings, attention should be equally focused on community-level prevention and management of obesity.

Detection of 12.5% and 25% Salt Reduction in Bread in a Remote Indigenous Australian Community

Food reformulation is an important strategy to reduce the excess salt intake observed in remote Indigenous Australia. We aimed to examine whether 12.5% and 25% salt reduction in bread is detectable, and, if so, whether acceptability is changed, in a sample of adults living in a remote Indigenous community in the Northern Territory of Australia. Convenience samples were recruited for testing of reduced-salt (300 and 350 mg Na/100 g) versus Standard (~400 mg Na/100 g) white and wholemeal breads (n = 62 for white; n = 72 for wholemeal). Triangle testing was used to examine whether participants could detect a difference between the breads. Liking of each bread was also measured; standard consumer acceptability questionnaires were modified to maximise cultural appropriateness and understanding. Participants were unable to detect a difference between Standard and reduced-salt breads (all p values > 0.05 when analysed using binomial probability). Further, as expected, liking of the breads was not changed with salt reduction (all p values > 0.05 when analysed using ANOVA). Reducing salt in products commonly purchased in remote Indigenous communities has potential as an equitable, cost-effective and sustainable strategy to reduce population salt intake and reduce risk of chronic disease, without the barriers associated with strategies that require individual behaviour change.

Incidence and predictors of cognitive impairment and dementia in Aboriginal Australians: A follow-up study of 5 years

INTRODUCTION

Aboriginal Australians are reported to develop dementia earlier than the general population. The causes remain unknown.

METHODS

This was a longitudinal study of 363 participants aged ≥45 years. Consensus diagnoses were established for cognitive impairment or dementia.

RESULTS

At follow-up, 189 people (mean ± standard deviation age, 65.4 ± 10.3 years) participated, as 109 (30%) had died and 65 (18%) were unavailable. The incidence of cognitive impairment or dementia was 52.6 (95% confidence interval 33.9, 81.5) per 1000 person-years (380.3 total person-years) and for dementia was 21.0 (10.5, 42.1) per 1000 person-years (380.3 person-years total) over the age 60 years. Longitudinal risk factors associated with a decline from normal cognition to impairment were age and head injury. Other associations with cognitive decline were stroke, head injury, nonaspirin analgesics, lower BMI, and higher systolic BP.

DISCUSSION

Dementia incidence in Aboriginal Australians is among the highest in the world, and is associated with age and head injury.

Heart failure among Indigenous Australians: a systematic review

Background

Cardiovascular diseases contribute substantially to the poor health and reduced life expectancy of Indigenous Australians. Heart failure is a common, disabling, progressive and costly complication of these disorders. The epidemiology of heart failure and the adequacy of relevant health service provision in Indigenous Australians are not well delineated.

Methods

A systematic search of the electronic databases PubMed, Embase, Web of Science, Cinahl Plus, Informit and Google Scholar was undertaken in April 2012 for peer-reviewed journal articles relevant to the topic of heart failure in Indigenous Australians. Additionally, a website search was done to identify other pertinent publications, particularly government reports.

Results

There was a paucity of relevant peer-reviewed research, and government reports dominated the results. Ten journal articles, 1 published conference abstract and 10 reports were eligible for inclusion. Indigenous Australians reportedly have higher morbidity and mortality from heart failure than their non-Indigenous counterparts (age-standardised prevalence ratio 1.7; age-standardised hospital separation ratio ≥3; crude per capita hospital expenditure ratio 1.58; age-adjusted mortality ratio >2). Despite the evident disproportionate burden of heart failure in Indigenous Australians, the accuracy of estimation from administrative data is limited by poor indigenous identification, inadequate case ascertainment and exclusion of younger subjects from mortality statistics. A recent journal article specifically documented a high prevalence of heart failure in Central Australian Aboriginal adults (5.3%), noting frequent undiagnosed disease. One study examined barriers to health service provision for Indigenous Australians in the context of heart failure.

Conclusions

Despite the shortcomings of available published data, it is clear that Indigenous Australians have an excess burden of heart failure. Emerging data suggest that undiagnosed cases may be common in this population. In order to optimise management and to inform policy, high quality research on heart failure in Indigenous Australians is required to delineate accurate epidemiological indicators and to appraise health service provision.