Coronary Heart Disease

For the last decades, the number of fatalities from coronary heart disease (CHD) in Australia has steadily declined, however it remains one of the leading causes of all deaths and the number one cause of cardiovascular deaths among Australian population (Australian Institute of Health and Welfare [AIHW], 2011). Coronary heart disease refers to the conditions that affect the blood vessels that supply the heart muscle with nutrients and oxygen (Craft, Gordon, & Tiziani, 2011). There are two main clinical types: heart attack and angina (AIHW, 2011).

According to Johny Lee (2013), President of American Heart Association (AHA) that CHD is a preventable disease. The prevalence of CHD along with the communities affected and the impact of social determinants of health will be discussed. Prevalence Like many other countries, Australia is facing a serious health problem posed by the high prevalence of coronary heart disease. In 2007-2008 report from National Health Survey (NHS), CHD affected around 685,000 individuals or 3% of the population. Of those Australians with CHD, angina occurred in 353,000 people and 449,000 had suffered other coronary heart diseases (AIHW, 2010).

In one study conducted by University of Western Australia between 1995 and 2005 showed that Perth metropolitan area had age-standardised prevalence of CHD of 28, 373 (88%) and 14, 966 (4%) in men and women respectively (Anonymous, 2011). The prevalence of CHD varies significantly with sex and age. A male dominating prevalence of CHD exists from 35 to 85 years, moreover Australian males exhibited 2% higher prevalence than females in all age categories over than 35 (AIHW, 2011). Age is a significant factor of developing CHD.

Elderly Australians aged over 85 years experienced the highest prevalence rate at 28% and 22% for males and females respectively (AIHW, 2011). In Perth metropolis, age-specific prevalence rose sharply with age, from more than 1% in 35 to 39 age category to 42% for aged 80 to 84 in men and half that in women (Anonymous, 2011). Coronary heart disease is ranked one of the top leading causes of mortality and a retrospective review from AIHW (2007) found that it claimed 22, 729 lives and was the number one cause of cardiovascular deaths.

Between 1993 and 2008, the number of CHD hospitalisations ending in death has dropped consistently from 3. 6% to 2. 2 % (AIHW, 2007). Researchers speculate that the improved diagnostic tests and medical treatment may have affected the drop of hospital deaths. Overall, the death rates from CHD has demonstrated a constant fall over the past two decades, where it dropped more than half from 251 deaths to 98 per 100,000 (AIHW, 2007). This significant drop is likely driven by a fall of the level of tobacco use and accessibility of medical treatment (AIHW, 2011).

Furthermore, data from other countries showed that modification of risk factors, and medical advancement in diagnosis and treatment are equally important (Black & Hawks, 2005). Aboriginal and Torres Strait Islander people Coronary heart disease is a significant health problem not only in the non-Indigenous communities, but the Aboriginal and Torres Strait Islander people are even more affected who correspond around 3% (669,000) of the population (Australian Bureau of Statistics [ABS], 2011).

Based on the 2004-05 National Aboriginal and Torres Strait Islander Heath Survey (NATSIHS), the prevalence of CHD in Indigenous Australians is estimated at 1% or 5,800 people had CHD, with women being more likely to have the disease than men (AIHW & ABS, 2006) . After adjusting the age, Indigenous Australians are two times more likely to develop the disease than the non- Indigenous Australians. A further source in 2002-2003 research showed that Aboriginals were 3 times more likely to have other major coronary heart diseases (Mathur, Moon, & Leigh, 2006).

Whilst there was a fall by 20% of heart attack among non-Indigenous Australians from 1992-2004 in Western Australia (You, Condon, Zhao, & Guthridge, 2009) and the Northern Territory, the rate among Aboriginals have climbed up by 60% over the same period (Bradshaw, Alfonso, Finn, Owen, & Thompson, 2011). Interestingly, analysis from one study concluded that Aboriginal Australians living in the city and far- flung Northern Australia had equal chances of developing CHD (Bradshaw et al. , 2011).

From 2005-2007, approximately 959 Indigenous Australians have died from CHD as the underlying cause in five states except Tasmania (AIHW, 2006). After age adjustment, CHD mortality rate is 1. 4 times higher (203 per 100,000 versus 142 per 100,000) among the Indigenous people than the non- Indigenous population (AIHW, 2006). Moreover, AIHW (2006) observed that mortality due to CHD among Indigenous men and women were 1. 4 and 1. 5 times higher than non- Indigenous Australian. Fatality rate was higher in men than in women till the age of 75 and the rate is the same thereafter (AIHW, 2006).

Overall, Aboriginal and Torres Strait Islander peoples have substantially higher levels of CHD than non- Indigenous Australians. Social determinants of health: non- Indigenous Australian Coronary artery disease is attributed to a wide array of factors that increase the likelihood of developing the disease and these factors are called determinants of disease. Social determinants of health (SDOH) compose of a number of factors that influence health and wellness (Murray & Clendon, 2011). The two most significant non-modifiable determinants of CHD are age and sex.

Ageing is considered by the World Health Organisation (WHO, 2011) as the most influential factor of heart disease whilst men have higher rates of CHD than women. On the other hand, there are at least seven modifiable risk factors of coronary heart disease that applies to the general population where a majority falls into personal and behavioural health practices. First is tobacco smoking, it is the most important preventable factor of illness and death (National Heart Foundation of Australia [NHFA], 2011). A study by National Drug Strategy Household Survey (NDSHS) in 2007 showed that around 2.

9 million or 17 % Australians aged over 14 years smoked tobacco everyday (Summerill, 2008). Another crucial factor is inadequate physical activity. Data from NHS in 2007-2008 claimed that about 72% of Australians aged over 15 years were either sedentary or less active. Thirdly, poor dietary behaviour contributes to the development of CHD where in Australia dairy products which contain bad fats provide main source of nourishment. A recent study in 2007-2008 by NHS presented that around 46% of Australian population aged 5 years and above consumed whole milk.

National Health Survey (2008) also discovered that consumption of fruits and vegetables do not meet the recommended amount where 91% did not have adequate vegetables on their diet and 51% had inadequate fruit consumption. Other significant factors are high blood pressure and cholesterol. Information collected from the 1999-2000 Australian Diabetes, Obesity and Lifestyle (AusDiab) Study concluded that nearly 30% or 3. 7 million Australians aged 25 years and above were hypertensive and 51% or 6.

4 million had blood cholesterol above the recommended level. Overweight and obesity are well-established health risks contributing CHD where it is highly prevalent in Australia. Apparently, in 2007-2008 NHS study showed that around 60% of Australian adults were either obese or overweight. The last risk factor is depression. The National Survey of Mental Health and Wellness in 2007 (ABS, 2008) revealed that around 16% or nearly 2 million Australians aged 16-85 years had suffered depression at some period of their lives (ABS, 2008).

Ultimately, modifiable and non-modifiable determinants of health can have a significant impact on the prevalence of CHD in the Australian population. Social determinants of health: Indigenous Australian It has been proven that Aboriginal and Torres Strait Islander people have higher prevalence and mortality rates from CHD than non-Indigenous Australians, one reason could be the well-documented socio-economic disadvantage (Grbich, 2004).

Based on ABS (2003) survey Indigenous Australians are more likely to experience poor education, low income, inadequate housing and higher unemployment. It is an established fact the correlation between socio-economic status and state of health. One good example is the economic status, Indigenous Australians earn $100-$221 less in a week than non- Indigenous Australians and had unemployment rate of 20% compared to only 7. 5% for their Australian counterparts (ABS, 2003).

Meanwhile, educational attainment for Indigenous Australians aged over 15 years old is nearly twice as lower than non-Indigenous Australians where only 18% (32% for non- Indigenous Australian) have finished years 10 and 12 and only 18% versus 40% have vocational or higher education qualification (ABS, 2003). In addition, modifiable risk factors for CHD is more pronounced among Aboriginals as study showed in 2004-2008 by ABS and AIHW (2005) where 53% of the respondents had exposure of up to four of these risk factors.

First of these is physical inactivity, a survey by NATSIHS (2005) showed that 69% of Indigenous Australians aged over 15 years were physically inactive or less inactive compared to 40% for non-Indigenous Australians. With regards to tobacco smoking, a 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS) suggested that Aboriginals and TSI peoples smoked more than twice as non- Indigenous Australians ( 45% versus 20%). Lastly, the proportion of overweight and obese Indigenous Australians stood at 28% and 29% (NATSIHS, 2005) respectively.

The rate of overweight was lower compared to non- Indigenous Australians but the obesity rate was nearly twice as high. As discussed above, Aboriginal and Torres Strait Islander people are more exposed to risk factors which makes them more vulnerable to develop CHD. Summary In summary, there is no doubt that coronary heart disease represents a huge challenge and burden to the contemporary health and well-being of Australian population as it is mirrored by the large number of people affected by the disease.

Moreover, not all sectors of Australian society are affected equally by CHD with Aboriginal and Torres Strait Islander people often more likely to develop or to die from CHD than other members of the population which is greatly influenced by the social and economic forces that promote the development of the disease.

Health promotion program against CHD for the Aboriginal community will be provided in the next assignment. References American Heart Association. (2013). Coronary artery disease – coronary heart disease. from http://www.—The-ABCs-of-CAD_UCM_436416_Article. jsp Anonymous. (2011).

Coronary heart disease; research reports from University of Western Australia provide new insights into coronary heart disease Heart Disease Weekly, p. 1205. Retrieved from http://search. proquest. com. ezproxy. ecu. edu. au/docview/860238324 Australian Bureau of Statistics. (2011). Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. from http://www. abs. gov. au/ausstats/abs@. nsf/mf/3238. 0. 55. 001 Australian Health.

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