Latest information and statistics on Respiratory health

Conditions that affect the airways and other structures of the lung, and impair the process of breathing, can have an impact on a person’s respiratory health [1]. These conditions range from acute respiratory infections to chronic respiratory conditions [2].

Respiratory disease is associated with a number of risk factors, including age; genetics; inadequate nutrition and sedentary behaviour; tobacco use; environmental conditions; occupational exposures and hazards; and health conditions (such as obesity) [1]. Aboriginal and Torres Strait Islander children are particularly susceptible to developing respiratory diseases [3], which may be due to risk factors such as premature birth, exposure to tobacco smoke; poor living conditions; inadequate nutrition and limited access to medical care [4][5].

Extent of respiratory disease among Aboriginal and Torres Strait Islander people

Prevalence

Long-term diseases of the respiratory system¹ were reported by 31% of Aboriginal and Torres Strait Islander people who participated in the 2022-23 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) [6]. The proportion of reported respiratory disease among Aboriginal and Torres Strait Islander females was higher than for males (33% and 30% respectively). The proportion of Aboriginal and Torres Strait Islander people reporting respiratory diseases was lowest among those in the 0-14 years age group (19%) and highest among those in the 45-54 years age group (44%) (Table 1). Reported diseases of the respiratory system were 2.2 times as high in non-remote areas compared with remote areas (34% and 16% respectively) (Table 1).

Asthma was reported by 17% of Aboriginal and Torres Strait Islander people (Aboriginal people: 17%; Torres Strait Islander people: 19%) in the 2022-23 NATSIHS [6]. In the 2021 Census, 13% of Aboriginal and Torres Strait Islander people self-reported asthma as a long-term health condition [7]. In the 2022-23 NATSIHS, asthma was reported more commonly by females (18%) than by males (16%). It was lowest among those in the 0-14 years age group (12%) and highest among those in the 45-54 years age group (26%) (Table). For Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, SA, WA, Tas and the NT, proportions of reported asthma were lowest in the NT (7.7%) and highest in Vic (24%). Reported asthma was 2.2 times higher in non-remote areas compared with remote areas (18% and 8.1% respectively) [6] (Table 1).

Chronic obstructive pulmonary disease (COPD)2 was reported by 2.1% of Aboriginal and Torres Strait Islander people (Aboriginal people: 2.2%; Torres Strait Islander people: 1.0%) in the 2022-23 NATSIHS [6]. In the 2021 Census, 2.2% of Aboriginal and Torres Strait Islander people self-reported COPD as a long-term health condition [7]. In the 2022-23 NATSIHS, COPD was reported more commonly by males (2.4%) than females (1.9%). It was lowest among those in the 25-34 years age group (0.4%) and highest among those in the 55 years and over age-group (6.9%). For Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, SA, WA, Tas and the NT, proportions of reported COPD were lowest in SA (1.0%) and highest in Tas (4.1%). Reported COPD was 2.0 times higher in non-remote areas compared with remote areas (2.4% and 1.2% respectively) [6] (Table 1).

Hay fever and allergic rhinitis were the most prevalent respiratory conditions reported by Aboriginal and Torres Strait Islander people in the 2022-23 NATSIHS, affecting 19% of respondents [6]. The conditions were more common among females (21%) than males (17%), lowest among those in the 0-14 years age group (8.7%) and highest among those in both the 35-44 and 45-54 years age groups (26%). For Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, SA, WA, Tas and the NT, proportions of reported hay fever and allergic rhinitis were lowest in the NT (7.3%) and highest in Vic (29%). Reported hay fever and allergic rhinitis were 2.7 times higher in non-remote areas compared with remote areas (21% and 7.7% respectively) (Table 1).

Chronic sinusitis was reported among 8.5% of Aboriginal and Torres Strait Islander people in the 2022-23 NATSIHS, and was more common among females (10%) than males (6.9%) [6]. Proportions for chronic sinusitis increased with age, except for the 45-54 years age group, which had the highest proportion at 17%. Reported chronic sinusitis was 3.1 times more common in non-remote areas compared with remote areas (9.5% and 3.1% respectively) (Table 1).

Table 1. Long-term respiratory 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
COPD	1.3	1.5	0.4	1.6	3.7	6.9	2.4	1.2	2.1
Asthma	12	13	17	18	26	25	18	8.1	17
Hay fever and allergic rhinitis	8.7	25	22	26	26	21	21	7.7	19
Chronic sinusitis	3.1	7.9	8.5	12	17	13	9.5	3.1	8.5
Other diseases of the respiratory system	0.3	0.2*	0.4*	0.0	1.2*	0.4	0.5	0.5	0.5
Total respiratory system diseases	19	34	33	39	44	41	34	16	31

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

Source:    ABS, 2024 [6]

Coronavirus disease (COVID-19) incidence

For December 2021 – March 2024, there were 427,9063 4 confirmed and probable cases of COVID-19 among Aboriginal and Torres Strait Islander people [8]. Most cases occurred in NSW (140,498: 33%), followed by Qld (114,825: 27%) and WA (61,905: 14%). The ACT had the fewest reported cases (4,324: 1.0%). Confirmed and probable cases decreased by remoteness, with 3.6 times as many cases in major cities compared with remote areas (191,171 and 53,021 respectively).

Hospitalisation

For 2022-23, there were 32,501 hospital separations with a principal diagnosis of respiratory disease among Aboriginal and Torres Strait Islander people [9] representing 9.1% of all separations (excluding dialysis) among Aboriginal and Torres Strait Islander people (Derived from [9]).

Further detailed information is available for asthma. In 2021-22 there were 1,780 hospitalisations for asthma among Aboriginal and Torres Strait Islander people, with a crude rate of 2.0 per 1,000 [10]. Hospitalisations were highest among those aged 0-14 years (710: crude rate 2.5 per 1,000) and lowest among those aged 65 years and over (96: crude rate 2.0 per 1,000).

For 2018-19, the crude hospitalisation rates for Aboriginal and Torres Strait Islander people by respiratory condition were influenza and pneumonia (9.2 per 1,000), COPD (6.7 per 1,000), acute upper respiratory infection (4.6 per 1,000) and asthma (2.7 per 1,000) [11].

For 2016-18, detailed information is available regarding hospitalisation rates for specific respiratory conditions including COPD, acute upper respiratory infections, influenza and pneumonia and asthma, by age and remoteness [11]. Crude hospitalisation rates were highest for Aboriginal and Torres Strait Islander people presenting with influenza and pneumonia (8.3 per 1,000), followed by COPD (6.0 per 1,000), acute upper respiratory infections (4.4 per 1,000) and asthma (2.8 per 1,000) (Table 2). The age-specific hospitalisation rates for acute upper respiratory infections were highest in the 0-14 years age-group (8.3 per 1,000), for influenza and pneumonia in the 65 years and over age-group (31 per 1,000), followed by the 45-64 years age-group (17 per 1,000), and for asthma in the 0-14 years age-group (4.0 per 1,000).

Table 2. Hospitalisation rates for selected respiratory diseases among Aboriginal and Torres Strait Islander people, by age-group and remoteness, 2016-18

	Age-group (years)					Remoteness
	0-14	15-24	25-44	45-64	65+	Major Cities	Remote/Very Remote	Crude rate
Influenza and pneumonia	5.5	2.2	6.7	17	31	7.2	25	8.3
COPD	n/a	n/a	n/a	n/a	n/a	4.2	8.9	6.0
Acute upper respiratory infection	8.3	2.9	2.4	2.1	2.0	2.6	5.8	4.4
Asthma	4.0	1.5	2.3	2.9	2.6	2.5	3.5	2.8

For 2016-18, the age-standardised rates of hospitalisation for Aboriginal and Torres Strait Islander people with COPD, influenza and pneumonia, acute upper respiratory infections and asthma all increased with remoteness [11]. The hospitalisation rate for influenza and pneumonia was 3.4 times5 higher for Aboriginal and Torres Strait Islander people living in remote/very remote areas (25 per 1,000) compared with the rate for those living in major cities (7.2 per 1,000).

Coronavirus disease (COVID-19) hospitalisations

In 2022-23, 4.4% of hospitalisations involving a COVID-19 diagnosis (8,046 of 182,8246 total COVID-19 hospitalisations) were for Aboriginal and Torres Strait Islander people [9]. For the period January 2020 – March 2024, there were 797 admissions to an intensive care unit and/or deaths due to COVID-19 among Aboriginal and Torres Strait Islander people, with an age-standardised rate of 1.2 per 1,000 [8]. Admissions rates were highest among the 70 years and over age-group, with a rate of 9.6 per 1,000.

Mortality

In 2023, chronic lower respiratory disease (which includes asthma, bronchitis, bronchiectasis, emphysema and COPD) was the second leading cause of death overall for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT, being responsible for 342 deaths [12]. There was a 6.6% increase in the age-standardised mortality rates for chronic lower respiratory diseases in Aboriginal and Torres Strait Islander people between 2014-2018 and 2019-2023 (2014-2018: 67 per 100,000 to 2019-2023: 72 per 100,000).

The crude death rate for chronic lower respiratory disease among Aboriginal and Torres Strait Islander people in 2023 was 38 per 100,000 (males: 39 per 100,000; females: 38 per 100,000 [12]. Of the top five causes of death in 2023, by sex, chronic lower respiratory disease ranked as the second most common cause of death for females (169 deaths) and third for males (173 deaths).

Age-specific information is available for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT for 2019-2023 [12]. The rate for deaths from chronic lower respiratory diseases (as an underlying cause of death) increased with age from 35 per 100,000 in the 45-54 years age-group, 110 per 100,000 for the 55-64 years age-group, 274 per 100,000 for the 65-74 years age-group and 607 per 100,000 for the 75 years and over age-group.

In 2023, influenza and pneumonia were responsible for 84 deaths (males: 46 deaths: females: 38 deaths) among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT, at an age-standardised rate of 18 per 100,000 [12].

For 2015-2019, there were 1,498 deaths among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT due to respiratory diseases as an underlying cause of death [13]. This accounted for 9.7% of the total deaths of Aboriginal and Torres Strait Islander people. Of these deaths, 63% (937 deaths) were a result of COPD, 17% (247 deaths) due to pneumonia and influenza, and 4.9% (74 deaths) from asthma.

From 2017-21, there were 65 deaths from asthma among Aboriginal and Torres Strait Islander people [10].

Coronavirus disease (COVID-19) mortality

Nationally from January 2020 to March 2024 there were 451 reported deaths from COVID-19 among Aboriginal and Torres Strait Islander people [8]. The highest number of deaths (by percentage) were reported for NSW (32%) followed by Qld (30%), WA (14%), the NT (13%), SA (5.5%), Vic (4.2%) and the ACT and Tas (both 0.4%).

Burden of disease

In 2018, respiratory diseases accounted for 7.5% of total burden among Aboriginal and Torres Strait Islander people [14]. Of all disease groups, respiratory diseases made the sixth highest contribution to total burden. They affected all age-groups, accounting for between 3% and 13% of total burden in both males and females across the age-groups.

In 2018, COPD was the second leading specific cause of total burden with an age-standardised rate of 19 DALY per 1,000 people. Asthma was the 11^th leading specific cause of total burden with an age-standardised rate of 11 DALY per 1,000 people [14].

Footnotes

1 Includes COPD, asthma, hay fever and allergic rhinitis, chronic sinusitis and other diseases of the respiratory system [6].

2 In the 2022-23 NATSIHS, COPD includes chronic bronchitis, emphysema and chronic airflow limitation. Collection methodology may affect the number of respondents reporting emphysema [6].

3 This data are for the Omicron wave.

4 Six jurisdictions have ceased collecting and reporting data on probable COVID-19 cases, NSW, Vic, Qld, WA, ACT and the NT.

5 Rounding may lead to inconsistencies in rates reported.

6 COVID-19 hospitalisations where Indigenous status was not reported (3,757: 2.1%).