Latest information and statistics on Cardiovascular health

Cardiovascular disease (CVD) is a term used to describe all of the major diseases of the heart and circulatory system, including ischaemic heart disease (IHD), cerebrovascular disease (including stroke), heart failure, peripheral vascular disease, hypertension (high blood pressure), and rheumatic heart disease (RHD) [1][2].

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 and type 2 diabetes [1][2]. Other risk factors include socioeconomic and psychosocial factors. Evidence shows that the risk of CVD starts relatively early for Aboriginal and Torres Strait Islander people, and it is recommended that Aboriginal and Torres Strait Islander people begin having CVD risk assessments at younger ages because of early disease onset [3].

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 [4]. ARF is caused by an untreated bacterial – group A streptococci (GAS) – infection of the throat1. Reducing ARF and RHD in Aboriginal and Torres Strait Islander communities requires initiatives that address poverty, crowded housing and poor sanitation, all of which contribute to the spread of GAS infection [4][5]. A comprehensive, long-term strategy was released in 2020 setting out the actions required to eliminate RHD in Australia [4].

Extent of cardiovascular disease among Aboriginal and Torres Strait Islander people

Prevalence of cardiovascular disease

Fourteen per cent (14%) of participants in the National Aboriginal and Torres Strait Islander Health Survey, 2022-23(NATSIHS) reported having a long-term disease of the circulatory system [6]. Circulatory disease was reported by a similar proportion of males and females. The prevalence of circulatory disease increased with age, from 2.0% among those aged 0-14 years to 49% among those aged 55 years and over (Table 1). Reported circulatory disease prevalence was 1.2 times higher in remote areas (16%) than non-remote areas (13%) (Table 1) (Derived from [6]).

‘Heart, stroke and vascular disease’2 was self-reported as a long-term condition by 4.0% of 2022-23 NATSIHS participants (4.1% of Aboriginal people and 4.7% of Torres Strait Islander people) [6]. The prevalence of ‘heart, stroke and vascular disease’ was higher among males (4.3%) than females (3.7%). Lowest levels of ‘heart, stroke and vascular disease’ were reported among children and younger adults, with disease prevalence sharply increasing between the ages of 45-54 years (6.3%) and 55 years and over (19%) (Table 1). Of Australia’s states and territories, SA had the highest prevalence of self-reported ‘heart, stroke and vascular disease’ (7.0%), while the NT had the lowest (2.7%) (Table 1). Prevalence was 1.4 times higher in non-remote areas (4.2%) than remote areas (2.9%) (Table 1) (Derived from [6]).

Hypertension3 was self-reported by 8.1% of NATSIHS participants (8.1% of Aboriginal people and 5.7% of Torres Strait Islander people) [6]. The prevalence of hypertension was higher for males than females (8.3% and 7.8% respectively). Prevalence increased with age, from 0.1% among those aged 0-14 years to 35% among those aged 55 years and over (Table 1). Of Australia’s states and territories, SA had the highest prevalence of self-reported hypertension (11%), while Qld (7.4%) and WA (7.2%) had the lowest (Table 1). Prevalence was 1.4 times higher in remote areas (11%) than non-remote areas (7.6%) (Table 1) (Derived from [6]).

Table 1. Long-term circulatory diseases among Aboriginal and Torres Strait Islander people, by age-group and remoteness, all jurisdictions, 2022-23, proportion (%)

	Age-group (years)						Remoteness
	0-14	15-24	25-34	35-44	45-54	55+	Non-Remote	Remote	Total
Heart, stroke and vascular diseases	0.2*	0.0	2.0*	2.9	6.3	19	4.2	2.9	4.0
Hypertension	0.1	1.1	2.7	6.7	22	35	7.6	11	8.1
Other diseases of the circulatory system	1.7	4.6	3.2	4.4	13	12	5.1	5.6	5.1
Total circulatory system diseases	2.0	5.7	7.3	12	33	49	13	16	14

* This proportion has a high margin of error and should be used with caution.

Source:   ABS, 2024 [6]

Participants in the 2022-23 NATSIHS aged 18 years and over were invited to voluntarily provide a blood pressure reading at the time of the interview. When measured4, 25% of adult participants had high blood pressure5(Aboriginal adults: 25%; Torres Strait Islander adults: 22%) [6]. Prevalence was higher among males (27%) than females (23%). Prevalence was higher in older age groups, with the highest prevalence observed in those aged 45-54 years (37%) and 55 years and over (35%). Among the states and territories, prevalence ranged from 23% in Tas to 30% in SA (Table 2). Prevalence of measured high blood pressure varied little by remoteness (non-remote: 25%; remote: 26%).

Table 2. Selected self-reported long-term circulatory diseases and measured high blood pressure among Aboriginal and Torres Strait Islander people, by jurisdiction, 2022-23, proportion (%)

	Jurisdiction
	NSW	Vic.	Qld	WA	SA	NT	Tas	Australia
Heart, stroke and vascular diseases	3.1	4.5	5.0	3.4	7.0	2.7	5.2	4.0
Hypertension	8.0	9.5	7.4	7.2	11	9.1	9.6	8.1
Measured high blood pressure (≥140/90 mmHg)	24	28	24	26	30	26	23	25

High cholesterol was self-reported by 5.6% of NATSIHS participants, with the prevalence being slightly higher for males (5.9%) than females (5.1%) [6]. The prevalence of high cholesterol increased with age, from none among those aged 0-14 years to 27% among those aged 55 years and over (Table 3). The prevalence in non-remote areas was slightly higher than in remote areas (Table 3).

Table 3. Self-reported high cholesterol among Aboriginal and Torres Strait Islander people, by age-group and remoteness, all jurisdictions, 2022-23, proportion (%)

	Age-group (years)						Remoteness
	0-14	15-24	25-34	35-44	45-54	55+	Non-Remote	Remote	Total
Self-reported high cholesterol	0.0	0.0	1.6	4.7	12	27	5.7	4.8	5.6

 Source:  ABS, 2024 [6]

The 2021 Census measured the number of people who had a long-term health condition [7]. 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%.

In 2021, there were 2,209 acute coronary events (heart attack and unstable angina) among Aboriginal and Torres Strait Islander people aged 25 years and over in NSW, Qld, WA, SA and the NT combined [2]. The crude rate of acute coronary events was 5.9 per 1,000 (males: 7.1 per 1,000; females: 4.8 per 1,000).

Incidence and prevalence of ARF and RHD

In 2023, in NSW, Qld, WA, SA and the NT combined6 there were 545 notifications of ARF for Aboriginal and Torres Strait Islander people [8]. The crude notification rate was 68 per 100,000. The rate for females (83 per 100,000) was higher than the rate for males (53 per 100,000). Age-specific rates were high for children aged 5-14 years (232 per 100,000), young people aged 15-24 years (120 per 100,000) and adults aged 25-34 years (101 per 100,000), and comparatively low for other ages (<25 per 100,000). Rates were highest in the NT (356 per 100,000 population) and lowest in NSW (4.6 per 100,000), with rates in other jurisdictions ranging from 55 to 68 per 100,000. Rates were higher in remote areas (292 per 100,000) than in regional areas (15 per 100,000) and major cities (9.7 per 100,000).

In 2023, in Qld, WA, SA and the NT combined7, there were 282 new diagnoses of RHD among Aboriginal and Torres Strait Islander people [8]. The crude rate of new diagnoses was 56 per 100,000. The rate of new RHD diagnosis for females (73 per 100,000) was higher than for males (40 per 100,000). Nearly two-thirds of new diagnoses (64%) were in people aged under 25 years (Derived from [8]. Rates of new diagnoses were highest in the NT (156 per 100,000) followed by Qld and WA (both 38 per 100,000) and SA (33 per 100,000). As of 31 December 2023, there were 5,657 Aboriginal and Torres Strait Islander people living with RHD in Qld, WA, SA and the NT combined (crude rate 1,130 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 years8 in that community was at least 10% [9].

A recent study found that nearly half the First Nations people in the Midwest region of WA who received hospital treatment for RHD during 2012-2022 had not been notified to the WA RHD Register (10 of 21 people). Similar rates of unnotified RHD may exist in surrounding regions and need further investigation [10].

It is important for individuals with RHD to be notified to jurisdictional RHD registers to access benefits such as monitoring and case management [10].

Hospitalisation

There were 18,439 hospital separations for CVD9 among Aboriginal and Torres Strait Islander people in 2022-23 [11], representing 5.2% of all Aboriginal and Torres Strait Islander hospital separations (excluding dialysis) (Derived from [11]).

In 2017-19, the crude CVD hospitalisation rate was 19 per 1,000 [12]. 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) [12]. 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%)¹⁰ [12].

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) [13]. 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) [13].

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 [12]. 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 disease11 (17%), cerebrovascular disease (15%), hypertensive diseases (4.8%), other diseases of the circulatory system12 (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 [14]. 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 [14]. Of all risk factors contributing to total burden, high blood pressure was ranked ninth and contributed to 4.3% of total burden.

Footnotes

1 In some settings GAS infections can also be present in the skin [4][5].

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 [6].

3 Self-reported hypertension only; excludes clinically measured high blood pressure results [6].

4 Forty-six percent (46%) 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 [6].

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 [6].

6 The jurisdictions where there are established ARF/RHD registers.

7 NSW data not included for RHD because NSW uses different RHD notification criteria than other jurisdictions.

8 During the data collection period March to November 2018.

9 ICD-10 codes I00-I99.

10 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).

11 ICD-10 codes I26–I52.

12 ICD-10 codes I70–I99.