Original Research

Bronchiectasis among Australian Aboriginal and non-Aboriginal patients in the regional and remote population of the Northern Territory of Australia

AUTHORS

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Sumit Mehra 1
FRACP, Respiratory and Sleep Physician

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Anne B Chang2
PhD, Divisional Head; Paediatric Respiratory and Sleep Physician

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Chor K Lam 3
MBBS, Medical Officer

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Stuart Campbell 4
MBBS, Medical Officer

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Joy J Mingi 5
GDHR, Research Officer

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Izaak Thomas6
BSc, Respiratory Aboriginal Health Worker

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Suzanne Harwood7
PGD Nsg, Respiratory Clinical Nurse Consultant

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Graeme Maguire 8
FRACP, Respiratory and Sleep Physician

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Subash Heraganahally9
FRACP, Director, Respiratory and Sleep Medicine *

AFFILIATIONS

1 Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; and Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia

2 Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia; Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, Queensland, Australia; and Center of Children’s Health Research, Australian Centre For Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia

3 Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

4 Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Department of General Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; and School of Medicine, Griffith University, Southport, Queensland, Australia

5 Department of Public Health, Charles Darwin University, Darwin, Northern Territory, Australia; and Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia

6, 7 Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia

8 Melbourne Medical School, The University of Melbourne, Victoria, Australia

9 Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; and Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia

ACCEPTED: 1 March 2021


early abstract:

Purpose: Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region, Northern Territory of Australia.  Bronchiectasis is a heterogenous disease that features among these chronic respiratory conditions in this population. However, there are sparse comparative data between Aboriginal and non-Aboriginal patients with bronchiectasis from this region.
Methods: In this retrospective study, we compared the demographics, clinical characteristics and relevant laboratory parameters among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017.
Results: A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Australian Aboriginals. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 vs 67 years), majority lived in rural and remote communities (80% vs 9 %), had higher rates of self-reported smoking (52% vs 19%), alcohol consumption (29% vs 12%) and co-occurrence of chronic obstructive pulmonary disease (65% vs 38%) and other chronic co-morbidities. Sputum microbiology was also different between the groups with <i>Haemophilus influenzae</i>, <i>Streptococcus pneumoniae</i>, and <i>Moraxella catarrhalis</i> being more common in Aboriginal patients whilst, <i>Pseudomonas aeruginosa</i>, <i>Aspergillus</i> species, non-tuberculous mycobacteria were higher in the non-Aboriginals. Further, Aboriginal patients had poorer lung function compared to non-Aboriginal patients (FEV1% predicted 33% vs 53%, FVC% predicted 49% vs 60% respectively), higher exacerbation rates (29% vs 18%) and had poorer overall outcomes (age at death 60 vs 76 years).
Conclusion: Within a single health service, Aboriginal patients with bronchiectasis have significantly poorer outcomes with differing manifestations and higher comorbidities than non-Aboriginal patients. This warrants further studies to identify feasible interventions to reduce this inequity.