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 [45520]. These conditions range from acute respiratory infections to chronic respiratory conditions [32052].

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) [45520]. Aboriginal and Torres Strait Islander children are particularly susceptible to developing respiratory diseases [45897], 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 [27677][32998].

Extent of respiratory disease among Aboriginal and Torres Strait Islander people

Prevalence

In the 2021 Census, 13% of Aboriginal and Torres Strait Islander people self-reported asthma as a long-term health condition and 2.2% of Aboriginal and Torres Strait Islander people self-reported COPD[1]as a long-term health condition [45577]. Long-term diseases of the respiratory system[2] were reported by 29% of Aboriginal and Torres Strait Islander people who participated in the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) [39231]. The level of respiratory disease among Aboriginal and Torres Strait Islander females was approximately 1.2 times higher than for males (32% and 26% respectively). The proportion of Aboriginal and Torres Strait Islander people reporting respiratory diseases increased with age, from 19% in the 0-14 years age-group to 47% in the 55 years and over age-group (Table 1).

Asthma was reported by 16% of Aboriginal and Torres Strait Islander people (Aboriginal people: 16%; Torres Strait Islander people: 12%) in the 2018-19 NATSIHS; it was the most commonly reported long-term respiratory disease and the second most commonly reported long-term disease overall [39231]. Asthma was reported more commonly by females (18%) than by males (13%), and prevalence increased with age from 12% in the 0-14 years age-group, to 26% in the 55 years and over age-group (Table 1). Asthma was more prevalent among people living in non-remote areas (17%) than those in remote areas (8.6%).

COPD was reported by 3.4% of Aboriginal and Torres Strait Islander people in the 2018-19 NATSIHS [39231]. The proportions were higher among females (4.3%) than males (2.5%), and increased with age, apart from the 0-14 years age-group, with the highest proportion in the 55 years and over age-group (13%) (Table 1). By remoteness, reported COPD was 2.7 times higher in non-remote areas compared with remote areas (3.8% and 1.4% respectively) (Table 1).

The other specific long-term respiratory disease reported by Aboriginal and Torres Strait Islander people in the 2018-19 NATSIHS was chronic sinusitis (7.4%), with the proportion being almost twice as high in females than males (9.3% and 5.3% respectively) [39231]. Proportions for chronic sinusitis mostly increased with age (Table 1).

Table 1. Long-term respiratory diseases among Aboriginal and Torres Strait Islander people, by age-group and remoteness, all jurisdictions, 2018-19, proportion (%)

	Age-group (years)						Remoteness
	0-14	15-24	25-34	35-44	45-54	55+	Non-Remote	Remote	Total
COPD	1.7	0.8	1.3	3.6	6.4	13	3.8	1.4	3.4
Asthma	12	14	15	17	21	26	17	8.6	16
Chronic sinusitis	2.6	4.7	8.9	13	14	13	n/a	n/a	7.4
Other diseases of the respiratory system	8.6	16	20	19	19	20	n/a	n/a	15
Total respiratory system diseases	19	28	32	35	37	47	n/a	n/a	29

Notes:

• ‘Other diseases of the respiratory system’ includes hay fever and allergic rhinitis, chronic sinusitis, all other diseases of respiratory system, symptoms/signs involving respiratory systems.
• n/a – non applicable, information unavailable.

Source:    ABS, 2019 [39231]

Coronavirus disease (COVID-19) incidence

For December 2021 – March 2024, there were 427,906[3],[4] confirmed and probable cases of COVID-19 among Aboriginal and Torres Strait Islander people [49227]. 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 [41516] representing 9.1% of all separations (excluding dialysis) among Aboriginal and Torres Strait Islander people (Derived from [41516]).

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 [48186]. 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) [42032].

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 [42032]. 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

Notes:

• n/a – non applicable, information unavailable.
• Crude rate per 1,000 population.

Source: SCRGSP, 2020 (Derived from [42032])

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 [42032]. The hospitalisation rate for influenza and pneumonia was 3.4 times[5] 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 182,824[6] total COVID-19 hospitalisations) were for Aboriginal and Torres Strait Islander people [41516]. For the period January 2020-March 2024, there were 797 admissions to an intensive care unit and/or died for COVID-19 cases among Aboriginal and Torres Strait Islander people, with an age-standardised rate of 1.2 per 1,000 [49227]. 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 [49929]. 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 [49929]. 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 [49929]. 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 [49929].

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 [42101]. 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 [48186].

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 [49227]. 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 [44827]. 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 [44827].

[1] COPD relates to a progressive lung disease for which the symptoms are not fully reversible, and includes chronic bronchitis and emphysema [28156].

[2] A respiratory condition that had lasted, or was expected to last, for six months or more [39231].

[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%)