Latest information and statistics on Cardiovascular health

Cardiovascular disease (CVD) is the term for diseases and conditions that affect the heart and blood vessels [41982]. Specific types of CVD include ischemic heart disease (IHD), cerebrovascular disease (including stroke), hypertension (high blood pressure), and rheumatic heart disease (RHD) [41982][38183].

Most types of CVD (excluding RHD) share a common set of risk factors. These include smoking, inadequate diet, physical inactivity, high alcohol use, high blood pressure, high cholesterol, overweight and obesity, type 2 diabetes, chronic kidney disease (CKD), depression/social isolation, sex, family history of CVD, ethnicity and age [39774][29271][24229]. Evidence shows that the risk of CVD starts relatively early for Aboriginal and Torres Strait Islander people, and a consensus statement was released in 2020 recommending that Aboriginal and Torres Strait Islander people begin having CVD risk assessments at younger ages because of early disease onset [39774].

Unlike other types of CVD, RHD occurs when acute rheumatic fever (ARF), an illness that affects the heart, joints, brain and skin, leads to permanent damage to the heart valves [41333]. ARF is caused by an untreated bacterial – group A streptococci (GAS) – infection of the throat[1]. Reducing ARF and RHD in Aboriginal and Torres Strait Islander communities requires initiatives that address poverty, overcrowded housing and poor sanitation, all of which contribute to the spread of GAS infection [41333][39666]. A comprehensive, long-term strategy was released in 2020 setting out the actions required to eliminate RHD in Australia [41333].

Extent of cardiovascular disease among Aboriginal and Torres Strait Islander people

Prevalence of cardiovascular disease

The 2021 Census measured the number of people who had a long-term health condition [45577]. Heart disease (including heart attack or angina) was reported by 3.7% of the Aboriginal and Torres Strait Islander population and stroke by 0.9%.

Around 15% of participants in the National Aboriginal and Torres Strait Islander Health Survey, 2018-19 (NATSIHS) reported having CVD [39231]. CVD was reported more frequently by females (17%) than by males (14%). The prevalence of CVD increased with age, from 1.9% among those aged 0-14 years to 56% among those aged 55 years and over (Figure 1).

Figure 1. Proportion (%) of Aboriginal and Torres Strait Islander people with self-reported CVD, by age-group (years), Australia, 2018-19

Note:        Proportions expressed as percentages.

Source:     ABS, 2019 [39231]

‘Heart, stroke and vascular disease’[2] was self-reported as a long-term condition by 5.2% of 2018-19 NATSIHS participants (5.3% of Aboriginal people and 3.0% of Torres Strait Islander people) [39231]. The prevalence of ‘heart, stroke and vascular disease’ was slightly higher among males (5.5%) than females (4.9%). Prevalence increased with age, from 0.3% among those aged 0-14 years to 26% among those aged 55 years and over. Of Australia’s states and territories, Tas and the ACT had the highest prevalence of self-reported ‘heart, stroke and vascular disease’ (6.7% and 6.5% respectively), while NSW and Vic had the lowest (both 5.0%). Prevalence was slightly higher in non-remote areas (5.4%) than remote areas (4.9%).

Hypertension[3] was self-reported by 8.3% of NATSIHS participants (8.3% of Aboriginal people and 6.6% of Torres Strait Islander people) [39231]. The prevalence of hypertension was similar for males and females (8.4% and 8.2% respectively). Prevalence increased with age, from none among those aged 0-14 years to 38% among those aged 55 years and over. Of Australia’s states and territories, Tas and the NT had the highest prevalence of self-reported hypertension (9.4% and 8.8% respectively), while Vic had the lowest (5.5%). Prevalence was higher in remote areas (10%) than non-remote areas (7.9%).

As well as being asked to self-report whether they had hypertension, participants in the 2018-19 NATSIHS aged 18 years and over were invited to voluntarily provide a blood pressure reading at the time of the interview. When measured[4], 23% of adult participants had high blood pressure[5] [39231]. Twenty-three per cent (23%) of Aboriginal adults and 26% of Torres Strait Islander adults had high blood pressure when measured. Prevalence was higher among males than females (25% and 21% respectively). For males, prevalence was highest in the 45-54 years age-group and for females it was highest at ages 55 years and over (Table 1). Prevalence was highest in SA (30%) and lowest in Vic (18%). Prevalence of high blood pressure was 22% in remote areas and 23% in non-remote areas across jurisdictions combined.

Table 1. Proportion (%) of Aboriginal and Torres Strait Islander people with measured high blood pressure, by age-group and sex, persons aged 18 years and over, 2018–19

Age-group (years)	Males	Females	Persons
18–24	9.5	7.3	8.8
25–34	19	12	16
35–44	24	22	23
45–54	40	32	36
55 years and over	39	35	37
Total 18 years and over	25	21	23

Note: Proportion expressed as percentages.

Source: ABS, 2019 [39231]

High cholesterol was reported by 4.5% of NATSIHS participants, with the prevalence being identical for males and females [39231]. The prevalence of high cholesterol increased with age, from none among those aged 0-14 years to 23% among those aged 55 years and over.

An AIHW study that used linked data to estimate the incidence[6] of stroke and acute coronary syndrome (ACS) found that among Aboriginal and Torres Strait Islander people in 2018 there were:

• about 560 new stroke events, at a crude rate of 87 per 100,000 population
• more than 1,100 new ACS events, at a crude rate of 382 per 100,000 population [46121].

Incidence and prevalence of ARF and RHD

In 2022, in NSW, Qld, WA, SA and the NT combined[7] there were 505 notifications of ARF for Aboriginal and Torres Strait Islander people [49219]. The crude notification rate was 64 per 100,000. The rate for females (80 per 100,000) was higher than the rate for males (49 per 100,000). The highest age-specific notification rates were for children aged 5-14 years (131 per 100,000) followed by young people aged 15-24 years (81 per 100,000). Rates were highest in the NT (362 per 100,000 population) and WA (70 per 100,000 population) and lowest in NSW (1.3 per 100,000). Rates were highest in remote settings (280 per 100,000) followed by major cities (11 per 100,000) and regional areas (9.3 per 100,000).

In 2017-2021, in NSW, Qld, WA, SA and the NT combined, there were 2,570 notifications of ARF for Aboriginal and Torres Strait Islander people [45046]. The crude notification rate was 69 per 100,000. The rate for females (78 per 100,000) was higher than the rate for males (59 per 100,000). The highest age-specific notification rates were for children aged 5-14 years (140 per 100,000) followed by young people aged 15-24 years (87 per 100,000). Rates were highest in the NT (371 per 100,000 population) and WA (72 per 100,000 population) and lowest in NSW (2.8 per 100,000).

In 2022, in Qld, WA, SA and the NT combined[8], there were 272 new diagnoses of RHD among Aboriginal and Torres Strait Islander people [49219]. The crude rate of new diagnoses was 55 per 100,000. The rate of new RHD diagnosis for females (75 per 100,000) was higher than the rate for males (36 per 100,000). Over half of the new diagnoses (55%) were in people aged under 25 years. Rates of new diagnoses were highest in the NT (138 per 100,000 population) followed by Qld (48 per 100,000), WA (29 per 100,000) and SA (21 per 100,000). As of 31 December 2022, there were 5,424 Aboriginal and Torres Strait Islander people living with RHD in Qld, WA, SA and the NT combined (crude rate 1,104 per 100,000).

In 2017-2021, in Qld, WA, SA and the NT combined, there were 1,750 new diagnoses of RHD among Aboriginal and Torres Strait Islander people [45046]. The crude rate of new diagnoses was 75 per 100,000. The rate of new RHD diagnosis for females (97 per 100,000) was higher than the rate for males (53 per 100,000). Over half of the new diagnoses (55%) were in people aged under 25 years. Rates of new diagnoses were highest in the NT (193 per 100,000 population) followed by Qld (57 per 100,000), WA (50 per 100,000) and SA (30 per 100,000). As of 31 December 2021, there were 5,238 Aboriginal and Torres Strait Islander people living with RHD in Qld, WA, SA and the NT combined (crude rate 1,083 per 100,000).

Several studies have used echocardiographic screening (ultrasound of the heart) to determine RHD prevalence in specific regions of Australia. A study conducted in a West Arnhem Land community in the NT in 2018 found that the total prevalence of ARF and RHD among Aboriginal and Torres Strait Islander people aged 5-20 years[9] in that community was at least 10% [40661].

Hospitalisation

There were 18,439 hospital separations for CVD^[10] among Aboriginal and Torres Strait Islander people in 2022-23 [41516], representing 5.2% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis) (Derived from [41516]).

In 2017-19, the crude CVD hospitalisation rate was 19 per 1,000 [42101]. Rates were higher for males (19 per 1,000) than females (18 per 1,000). Age-specific hospitalisation rates for CVD rose with age, from 1.8 per 1,000 for those aged 0-4 years to 110 per 1,000 for those aged over 65 years. Although rates were highest for those aged over 65 years, CVD is recognised as having a substantial impact on younger Aboriginal and Torres Strait Islander people, with the age-specific rate for those aged 35-44 years being 20 per 1,000 in 2017-19.

In 2017-19, the crude rate of CVD hospitalisation for Aboriginal and Torres Strait Islander people was highest in the NT (31 per 1,000), WA (22 per 1,000) and Qld (20 per 1,000) and lowest in Tas (9.6 per 1,000) [42101]. Other jurisdictions had rates of around 15-17 per 1,000. Rates were much higher in remote areas (30 per 1,000) than inner regional areas (16 per 1,000) and major cities (14 per 1,000).

In 2017-19, of specific CVDs, IHD was responsible for the highest number of hospitalisations of Aboriginal and Torres Strait Islander people (just over 34% of CVD hospitalisations), followed by pulmonary and other forms of heart disease (just under 34%), cerebrovascular disease (10%), hypertension (3.5%), ARF (2.7%) and RHD (1.9%)^[11] [42101].

Mortality

Of all specific causes of death, IHD was the leading cause of Aboriginal and Torres Strait Islander deaths in NSW, Qld, WA, SA and the NT combined in 2023 (488 deaths) [49929]. For males, IHD was the leading cause of death, with a crude rate of 73 per 100,000. For females, IHD was the third leading cause of death, with a crude rate of 36 per 100,000.

In 2023, cerebrovascular diseases were the seventh leading specific cause of deaths of Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT combined (161 deaths, age-standardised rate 39 per 100,000) [49929].

In 2015-2019, there were 3,471 deaths of Aboriginal and Torres Strait Islander people in NSW, Qld, WA, SA and the NT combined caused by CVD [42101]. CVD was the second leading general cause of death after neoplasms (including cancer), accounting for 23% of all deaths. The crude CVD mortality rate was 97 per 100,000. The crude CVD mortality rate for Aboriginal and Torres Strait Islander males (109 per 100,000) was higher than the rate for females (84 per 100,000). Age-specific mortality rates for overall CVD increased with age, with high rates seen among people as young as 25-34 years (23 per 100,000). Crude rates were highest in the NT (154 per 100,000) and lowest in NSW (74 per 100,000). Crude rates were higher in remote areas (152 per 100,000) than non-remote areas (78 per 100,000). Of specific CVD types, IHD caused the most deaths (56% of CVD deaths), followed by other heart disease[12] (17%), cerebrovascular disease (15%), hypertensive diseases (4.8%), other diseases of the circulatory system[13] (3.7%), and RHD (3.4%).

Burden of disease

In 2018, CVD accounted for 10% of total burden, 19% of fatal burden (premature death) and 2.6% of non-fatal burden (living with illness or disability) among Aboriginal and Torres Strait Islander people [44827]. It made the third highest contribution to total burden of all disease groups. The majority of CVD burden was caused by IHD (57%) followed by stroke (13%). Of total CVD burden, 86% was fatal and 14% was non-fatal.

In 2018, of all specific diseases and injuries, IHD was the leading cause of total burden among Aboriginal and Torres Strait Islander people, accounting for 5.8% of total burden [44827]. Of all risk factors contributing to total burden, high blood pressure was ranked ninth and contributed to 4.3% of total burden.

[1] In some settings GAS infections can also be present in the skin [41333][39666].

[2] A group of long-term health conditions which includes IHD (including heart attack and angina), cerebrovascular disease (including stroke), heart failure, oedema (fluid retention), and diseases of arteries, arterioles and capillaries [39231].

[3] Self-reported hypertension only; excludes clinically measured high blood pressure results [39231].

[4] Forty percent (40%) of adult participants in the NATSIHS did not have a blood pressure reading taken; for these participants, imputation (estimation of data) was used to obtain blood pressure [39231].

[5] Measured high blood pressure is defined as a blood pressure reading of ≥140/90 mmHg. Measured high blood pressure does not necessarily mean a person has hypertension [39231].

[6] Study did not include data from WA and the NT and therefore may underestimate true incidence [46121].

[7] The jurisdictions where there are established ARF/RHD registers.

[8] NSW data not included for RHD because NSW uses different RHD notification criteria than other jurisdictions.

[9] During the data collection period March to November 2018.

[10] ICD-10 codes I00-I99.

[11] The remainder of CVD hospitalisations (around 14%) were due to diseases of arteries, arterioles and capillaries (I70–I79); diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80–I89); and other and unspecified disorders of the circulatory system (I95–I99).

[12] ICD-10 codes I26–I52.

[13] ICD-10 codes I70–I99.