5.5.3 Morbidity
Information on the general health of the Bourke Aboriginal community was obtained by asking respondents: (1) to assess their current health status and to compare it with that of other Aborigines of the same age; (2) to self-diagnose and report the presence of various disease conditions related to heart disease; and (3) to indicate if they had been in the hospital during the past year (see individual data sheets 5 and 7 to 9 in Appendix
2).
As shown in Table 5.12, respondents generally felt that they were in excellent or very good health and that they were in better health than other Aborigines the same age as themselves. Of the male respondents, 52 per cent indicated that they were in excellent or very good health, and half of these individuals (26 per cent) indicated that they were in better health than other Aborigines of the same age. On the other hand, female respondents were less likely to think of themselves as being healthy. Only 47 per cent of the female respondents implied that they were in excellent or very good health; and out of these only 18 per cent thought they were in better health than other Aborigines of the same age. Although these results seem to reflect an overall feeling of good health in the Bourke Aboriginal population, they may also reflect a bias in this non-random sample towards the opinion of younger adults.
As discussed in section 5.4.1, a series of diagnostic questions, designed by the London School of Tropical Medicine and Hygiene (Rose, 1962), were used to determine whether respondents had angina pectoris, a possible myocardial infarction, or intermittent claudication; while a series of general morbidity questions were used to determine whether respondents had ever been told by their doctor that they had any of the following conditions: high blood pressure, high blood cholesterol, diabetes, a heart attack, or a stroke.
The prevalence of these self-diagnosed and reported disease conditions tended to be underreported (see Table 5.13). Only 4 per cent of the male and 6 per cent of the
Page 165 female respondents indicated that they had diabetes, when actually about 17 per cent of men and 15 per cent of women in Bourke are known to be diabetic (Cameron et al.,
1986). Angina seems also to have been underreported, as diagnosed levels (4 or 5 per cent) were somewhat lower than those observed for Aborigines in the west Kimberley region of Western Australia with cardiac ischaemia — inadequate blood flow to the heart caused by a constriction or blockage of the coronary arteries supplying it (Bastian,
1979; Gracey and Spargo, 1987). Likewise, intermittent claudication was most likely underreported, as no respondents identified themselves as having had this condition. There was also a noticeable difference in the proportion of male respondents who reported having a possible myocardial infarction and those who reported being told by a doctor that they had had a heart attack — 5 versus 1 per cent. Although this difference is difficult to explain, it may in part be due to the fact that in some cases individuals may not be aware that they have had a heart attack. Only self-reported high blood pressure prevalence levels appear to reflect actual levels — the proportion of respondents who reported having high blood pressure is similar to the proportion observed to be hypertensive from measured systolic and diastolic blood pressure readings (26 versus 29 per cent).
Rates of hospital admission were determined by asking respondents if they had been in hospital for any reason during the past year. For all ages, the Bourke Aboriginal self- reported hospital admission rate was 298 per 1,000, or 289 per 1,000 for males (43 cases out of 149 respondents surveyed) and 313 per 1,000 for females (31 cases out of 99 respondents surveyed). These sex-specific rates compare closely with an Aboriginal statewide rate in 1978 of 312 per 1,000 for males and 365 per 1,000 for females, but are somewhat higher than recently calculated hospital admission rates for the north coast of New South Wales of 223 per 1,000 for males and 229 per 1,000 for females (Yusuf and Hamilton, 1982; Thomson et al., 1990). These apparent disparities may be due to the underlying differences in the age structure of these three populations or to the
Differences in the rates of self-reported hospital admissions by sex and age group and various risk markers and factors were compared using odds ratios2. In this case, odds ratios were constructed to measure the odds of reporting a hospital visit during the past year among respondents of a certain sex and age group or with a particular risk marker or factor, such as employment and marital status, education, and body mass index. Confidence intervals, at a 95 per cent level of confidence, were calculated around each odds ratio using Woolfs (1955) method. Differences between odds ratios among various categories were generally not significant (see Tables 5.15 and 5.16). The only exceptions appear to be with employment and smoking status. As a rule, respondents who were non-smokers or employed were significantly less likely to have been hospitalized than persons who were current or ex-smokers or who were unemployed. Although there are few significant differences in the odds ratios shown in these tables, there are many substantive differences. Among females, for example, the odds of reporting a hospital visit increases after 34 years of age; and for both sexes, education, location, body mass index, diastolic blood pressure, serum cholesterol, and vigorous exercise showed notable differences in the odds of reporting hospital visits.
Unquestionably this analysis of Aboriginal morbidity has highlighted several interesting associations between Aboriginal health status and the underlying economic,
environmental, and social conditions in Bourke. As noted above, significant and substantive differences were observed in the reporting of hospital visits by sex and age group and various risk markers and factors. This type of finding is not new to Bourke. A recent survey noted a link between certain types of illnesses, especially those in children, and housing conditions (Harris and Davies, 1984; Harris et al., 1984). For example, Staphylococcus aureus skin infections tend to occur at a much greater rate among individuals living in dwellings with no sewage or septic tanks, no bathing facilities, and/or no screens or glass on the windows; while the incidence of trachoma is
Page 167 higher among individuals living in households of six or more persons. What is new, however, is that such a wide range of factors have been implicated, and that the general perception of health in this community is so different from the actual reality.
same age for a non-random sample of Bourke Aborigines1 aged 18 years and over.
In comparison with others
Health status n2 Better
(per cent)3 Same (per cent)3 Worse (per cent)3 Total (per cent)3 Males Excellent / very good 79 26 24 1 52 Good 42 14 13 1 28 Fair / poor 31 0 18 2 20 Total 152 40 56 4 100 Females Excellent / very good 48 18 26 3 47 Good 25 13 12 0 25 Fair / poor 29 10 17 2 28 Total 102 40 55 5 100
1. Aboriginal risk factor prevalence survey conducted in April and May 1989.