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ABSTRACT: Few studies have examined the consequences of the high prevalence of diabetes in Aboriginal communities. We aimed to determine the rates and causes of mortality in all Aboriginal central Australians with diagnosed diabetes, identified by a previous study (n =374). Cohort members were followed from 1 January 1984, or the date of diagnosis (to 31 December 1986), to 31 December 1991 or death. Death certificates, medical notes and autopsy reports were examined for cause of death. There were 130 deaths in 2280.7 person-years of follow-up. Standardised mortality ratios for Aboriginal people with diabetes, compared to the Northern Territory Aboriginal population, were 209 (95 per cent confidence interval (CI) 158 to 273) for men and 169 (CI 129 to 218) for women. The difference in ratios for men and women was not statistically significant when adjusted for age (P = 0.2). The eight-year survival rates for men and women diagnosed between 1984 and 1986 were 55.8 per cent (CI 32.6 to 73.7) for men and 80.3 per cent (CI 64.8 to 89.5) for women. Renal disease was the direct cause of death in 22.3 per cent. Infection accounted for 20.8 per cent of deaths and ischaemic heart disease for 13.8 per cent. Forty-four per cent of death certificates made no mention of diabetes. Diabetes confers an additional risk of death on a population whose mortality is already markedly worse than that of other Australians. Unlike Western diabetic populations, infections and renal disease were more common causes of death than macrovascular disease. Diabetes amplifies the effect of the community prevalence of infection and renal disease.
Australian journal of public health 11/1995; 19(5):482-6.
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ABSTRACT: Diabetes is a major public health problem for Aboriginal Australians. We wished to determine the extent and pattern of health service utilisation by Aboriginal people with diabetes in central Australia. Medical records of all Aboriginal people known to have diabetes (n = 374), identified by a previous study, were examined for attendance to health services in central Australia. All had non-insulin-dependent diabetes. Between January 1984 and December 1986, Aboriginal adults with diabetes were admitted to hospital on 694 occasions, accounting for 10.8% of adult Aboriginal admissions. The crude admission rates were 0.78 and 0.84 per diabetes-year for men and women, respectively. The age-adjusted relative risks for admission, compared with Aboriginal non-diabetic patients, were 2.93 (95% C.I., 2.62-3.26) for men and 2.46 (95% C.I., 2.28-2.66) for women. If admission for conditions associated with diabetes are excluded, the admission rates were similar for the two groups. Infection was the most common reason for attendance to a health service, representing 41.7% and 39.8% of male and female admissions, and 21.8% and 26.3% of male and female outpatient attendances. Aboriginal patients with diagnosed diabetes suffer high morbidity and contribute disproportionately to health system costs.
Diabetes Research and Clinical Practice 07/1993; 20(3):231-9. · 2.75 Impact Factor
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ABSTRACT: To determine hospital-based morbidity and mortality from bacterial infections among Aboriginal people with diabetes in central Australia.
Examination of medical records on diabetic inpatients between January 1984 and December 1986.
Alice Springs Hospital in central Australia, covering an Aboriginal population of about 12,500 people.
Subjects admitted with a bacterial infection (n = 165) were selected from the database of all Aboriginal people known to have diabetes in the region (n = 374; all had non-insulin dependent diabetes).
Number of admissions, type and site of infections, causative organisms, duration of hospital stay and cause of death.
The 281 admissions for infections accounted for 4.6% of adult Aboriginal admissions to hospital. Thirteen patients died. Eleven patients required amputation of a digit or limb. In 1986, 13/200 patients admitted with diabetes had bacteraemia compared with 14/1885 patients who did not have diabetes. One patient had Fournier's gangrene, one had malignant otitis externa, one community acquired Acinetobacter pneumonia, one pneumonia with Succinivibrio spp. found in blood cultures, and one meningitis and transverse myelopathy with Streptococcus milleri found in blood cultures.
The frequency, type and severity of infections in the relatively young patients result in high personal costs to the community and financial costs to the health care system. Standard preventive measures must be implemented to control severe bacterial infections among subjects with diabetes in this socially and economically marginalised population group.
The Medical journal of Australia 09/1991; 155(4):218-22. · 2.81 Impact Factor
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ABSTRACT: The prevalence of diagnosed diabetes in Aboriginal people living in central Australia (population, 9983) was determined by collating data from the hospital, rural and urban health services, nursing homes and death registers. A total of 98 male and 183 female Aboriginal residents with diabetes attended health services in central Australia between January 1984 and December 1986. The point prevalence of diagnosed diabetes at the end of 1986 in the age group 25-34 years was 1.6% in men and 3.1% in women, and in those over 35 years, 8.8% and 14.1%, respectively. The true prevalence of diabetes (diagnosed and undetected) is likely to be at least twice this rate, and constitutes a major public health problem in central Australia. Diabetes and other disorders such as obesity, hypertension and ischaemic heart disease have common antecedents and outcomes. The control of these non-communicable diseases requires integrated and culturally appropriate educational, social and medical strategies.
The Medical journal of Australia 10/1990; 153(6):314-8. · 2.81 Impact Factor
