Risk and protective factors and selected health conditions

Mothers and babies

In 2020, 5,792 Aboriginal and Torres Strait Islander babies were born in Queensland. In the same year, approximately 7.5% of mothers that gave birth in Queensland identified as First Nations Australians (mothers).¹

Queensland had the second highest proportion of women who gave birth who identified as First Nations—the Northern Territory was highest at 30.4% and the proportion nationally was 4.9%.¹ The mean age of First Nations women that gave birth in Queensland was 26.5 years and 11.2% were under 20 years of age. In 2020:

• 90.7% of First Nations mothers attended 5 or more antenatal visits, compared to 96.9% for other Queenslander mothers
• 45.0% reported that they had smoked during pregnancy compared to 8.8% for other Queenslander mothers
• 10.5% of live born singleton babies born to First Nations mothers weighed less than 2,500g, and 11.1% were born preterm (born at less than 37 weeks gestation), compared to 4.9% and 6.2% for other Queenslander mothers, respectively
• 77.8% of babies born to First Nations mothers were a healthy weight compared to 82.8% for other Queenslander mothers.

Risk and protective factors

Dental and oral health

Oral health plays an important role in overall health and wellbeing, including self-esteem and enabling active participation in everyday activities. Adequate nutrition, speech and social interaction are affected by oral diseases which can also lead to more serious chronic diseases such as cardiovascular disease, diabetes and stroke.²

As shown in the Dental and oral health section, hospitalisations for oral and dental conditions for First Nations peoples in Queensland were highest in children from 0 to 9 years old. The National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) 2018–19 reported 58% of First Nations children 0 to 14 years had seen a dentist in the preceding 12 months and 77% had ever attended a dental practice.³

Qualitative studies in First Nations families in Brisbane identified substantial emotional, physical and financial impacts of maintaining oral health in children. Multidisciplinary approaches to oral health education and promotion that reach families before children are school-aged and continue to engage them throughout childhood are required to help reduce the burden of disease in First Nations children.⁴

Immunisations

Childhood immunisations

While the proportion of ‘fully vaccinated’ First Nations children has generally been increasing nationally, coverage was impacted by the COVID-19 pandemic with falls in rates in 2020 and 2021 in all jurisdictions which continued in 2022 (Figure 2). Declines were also seen for Queensland childhood immunisations overall (see the Immunisation section).

In 2022, 90.3% of 1-year-old First Nations children in Queensland, 89.4% of 2-year-olds and 96.0% of 5-year-olds were age-appropriately immunised. Six Australian states, including Queensland exceeded the 95% target for First Nations 5-year-olds.⁵

Immunisation timeliness, defined as children receiving vaccines on time, has been problematic for First Nations children in Australia, including Queensland, for several decades.^6-8 While the past decade has shown improvements, in 2021 on-time coverage for First Nations children nationally remained 6–13% lower than other children for the vaccines/antigens assessed.⁹

Influenza vaccine

Marked declines were observed in seasonal influenza vaccine coverage in First Nations peoples in Queensland from 2020 to 2021.

• In 2020, 35.7% received an influenza vaccine declining to 22.6% in 2021. Declines occurred in all age groups, particularly in age groups most at risk from severe influenza.
• For children 6-months to less than 5 years, coverage halved from 38.5% in 2020 to 18.9% in 2021.⁹
• For the period 1 January to 22 October 2022, 31.1% of First Nations people in Queensland had received an influenza vaccine (child data not available).

Herpes Zoster (shingles) vaccine

In 2021, 37.4% of First Nations adults 70 to less than 71-years-old in Queensland received a herpes zoster vaccine compared to 40.9% for other Queenslanders of the same age—Queensland’s coverage was second only to the Australian Capital Territory across all jurisdictions.⁹ Coverage for First Nations adults 71 to 79 years was 56.1% in 2021 marginally higher than coverage in other Queenslanders (55.3%).

Immunisations in pregnancy

The proportions of First Nations females in Queensland receiving recommended vaccines during pregnancy has been steadily improving since 2016 (Figure 3). However, a decline in both influenza and pertussis vaccine uptake was observed in 2021, similar to other Queensland females (see the Immunisation section). The reasons for this decline are not known but may be related to the COVID-19 pandemic.

COVID-19 vaccine

As at 22 February 2023, 82.4% of First Nations people 16 years of age and older in Queensland registered on the Australian Immunisation Register had received at least one dose of a COVID-19 vaccine and 78.9% had received 2 doses. The respective proportions for First Nations peoples nationally were 85.5% and 82.3%. Of those in Queensland 16 years of age and older who were eligible, 49.2% had received 3 doses (56.6% nationally), and of those 30 years of age and older and eligible, 38.7% had received four doses (35.3% nationally). Eligibility is based on meeting recommendations for further doses including completion of previous doses, age and the time-period elapsed since last dose. Data specific to First Nations children 15 years of age and younger in Queensland were not publicly available however nationally, amongst those 12 – 15 years of age, 63.9% had received at least one dose and 54.7% had received two doses.¹⁰

E-cigarette use

As highlighted in the Our Times section, the rise of e-cigarette use (vaping) poses significant threats to the health of young people and adults. Data are limited on e-cigarette use in First Nations peoples. A systematic review of cigarette and e-cigarette use by First Nations youth and adults published in 2020¹¹ analysed data in detail from the 2018–19 NATSIHS. Queensland-specific data were not reported.

• The prevalence of ever using an e-cigarette was 2.0% for proxy or youth-self report with an adult present versus 29.5% for youth self-report with no adult present.¹¹ Given the limitations with the data, and the small sample sizes (26.5% were interviewed in presence of an adult and 66.2% by a proxy), results should be interpreted cautiously. Results are not dissimilar, however, to the findings of the 2017 Australian Secondary Student’s Alcohol and Drug Survey that reported 22% of First Nations students had ever used e-cigarettes.¹²
• A multi-jurisdictional study of 1,297 First Nations smokers conducted from August 2013 to August 2014 reported 21% had ever tried an e-cigarette and, at the time, 38% had never heard of them.¹³
• In 2018–19, 1.3% of First Nations adults in the survey were currently using e-cigarettes and 8.1% had ever-used them. Males had higher use than females (1.9% and 0.8%, respectively, for current use and 9.7% and 6.5%, respectively, for ever use). The highest proportion of current use (2.0%) and ever-use (13.6%) was in 18 to 24 year olds.¹¹
• The highest proportion of reporting ever-use were those living in major cities (10.1%) compared to those in remote and very remote areas (2.6%). Current use in major cities was 1.9% but other regions were not reported.¹¹

Smoking tobacco remains a significant health concern with a standardised prevalence of 41.2% of First Nations adults 18 years and older in Queensland reporting daily smoking in 2017–19.¹⁴

Chronic diseases

There are no new data on self-reported chronic diseases in First Nations peoples in Queensland since the 2018–19 NATSIHS. The burden of chronic diseases for First Nations peoples in Queensland is detailed in the First Nations Burden of Diseases section. Given existing EndGame strategies (see Our Times section) here we present further detail on cervical cancer and rheumatic heart disease (RHD) in First Nations peoples in Queensland.

Cervical cancer

Cervical cancer is the 5th most commonly diagnosed cancer among First Nations women.¹⁵ The leading cause of disease is the human papillomavirus (HPV) and tobacco smoking is a leading risk factor.¹⁶

HPV vaccination is an established preventive factor, and cervical screening and early intervention improves survival and reduces mortality. However, data suggests cervical screening in First Nations women lags that of other women and they have poorer cervical cancer outcomes.¹⁷ Studies focusing on First Nations women in Queensland suggest access to culturally appropriate, locally-based and community-led screening initiatives can improve the uptake of cervical screening.^18,19

• The incidence of cervical cancer in First Nations women in Queensland increased from 10.8 to 17.3 per 100,000 population from 2016 to 2020.
• The highest incidence rate was for women 75 to 79 years old (Figure 4).²⁰
• Rates were highest in inner regional areas (14.2 per 100,000) followed by remote and very remote (13.9 per 100,000) and major cities (13.9 per 100,000) and outer regional areas (9.7 per 100,000).²⁰
• Just over half (55%) of all patients survived the first 5-years—survival was lowest in women 65 years and older (30%) and those living in remote and very remote regions (30%).²⁰

HPV vaccination in First Nations female adolescents in Queensland in 2021 was 83.7% for one dose and 69.9% for course completion;⁹ for adolescent males, coverage was 76.8% and 63.9% respectively.

For all Australian First Nations adolescents, coverage with one dose and course completion was 86.1% and 73.3%, respectively for females and 80.6% and 66.2% for males. Coverage in 2021 for both males and females, in Queensland and nationally, was lower than in 2020.⁹

Rheumatic heart disease

RHD, preceded by episodes of acute rheumatic fever (ARF), disproportionately affects First Nations peoples in Australia, particularly those in regional and remote areas. In Queensland, ARF has been a notifiable disease since 1999 and RHD since 2018. The diagnosis and classification of ARF and RHD is based on a specific set of criteria outlined in the Australian guidelines for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease.²¹ The progression to RHD from ARF, and worsening of RHD by recurrent ARF, is preventable via the administration of regular intramuscular injection of benzathine penicillin g (BPG) every 21 or 28 days, usually for a minimum of 10 years. This is a painful injection which is part of the reason it can be a challenge to ensure a full course of prescribed injections is administered.

While ARF is an acute condition, untreated disease and/or recurrent episodes lead to RHD. For the 5-year period 2017–2021 in Queensland, there were 767 diagnoses of ARF (including recurrent episodes) with 644 reported in First Nations peoples for a crude incidence rate of 54.4 per 100,000 First Nations population. There was a total of 2,547 First Nations people being managed for ARF or RHD who were registered in Queensland for a prevalence rate of 1,053.6 per 100,000 First Nations population.²²

The HHSs with the highest rates of ARF diagnoses among First Nations peoples in 2017–2021 were Torres and Cape (214.8 per 100,000), Northwest (188.6 per 100,000) and Cairns and Hinterland (108.7 per 100,000).²²

More detailed Queensland results were provided in the previous AIHW report. Of ARF diagnoses in First Nations peoples in Queensland for the period 2016–2020:²³

• 466 (75.8%) were first known ARF episodes and 149 (24.2%) were recurrent, 510 (82.9%) were classified as definite or probable diagnoses with the remainder classified as possible.
• The median age was 18 years and 56.1% of diagnoses were for females.
• Rates were highest in young people 5 to 24 years, switching from higher rates for male children less than 15 years old to higher rates in females 15 years of age and older (Figure 5).
• Cardiac manifestations (carditis, prolonged P-R interval, or Sydenham chorea) were present in 34.1% of cases.

At 31 December 2020, the prevalence of RHD in First Nations peoples in Queensland was 674.3 per 100,000 population and the median age was 35.5 years. Prevalence was highest in 35 to 44 year olds (Figure 6).²³

One-in-five (20.1%) First Nations persons with RHD in Queensland in 2016–2020 were classified as Priority 1 cases, defined as those:

• with severe RHD
• with high risk after valve surgery
• with three or more episodes of ARF within the last 5 years
• pregnant women with RHD
• children 5 years or younger with ARF or RHD.²³

As at 31 December 2021, there were 676 new RHD diagnoses in First Nations peoples in Queensland for a rate of 57.1 per 100,000 population. For the 5-year period 2017–2021, 16.0% of new RHD diagnoses among First Nations people in Queensland were categorised as severe while 34.4% were moderate and 45.5% were mild. Queensland had the lowest proportion of severe newly diagnosed cases of the reporting jurisdictions.²²

In Queensland, the incidence of new RHD diagnoses in First Nations peoples rose from 39.8 per 100,000 in 2016 to 57.5 per 100,000 in 2019 before falling to 38.8 per 100,000 in 2020.²³ The reasons for that decline are not clear.

About three-quarters (72.6%) of First Nations peoples in Queensland with a new diagnosis of RHD in 2017–2021 had no record of a previous ARF diagnosis—a pre-requisite of the development of RHD. This may be due to either a lack of reporting of ARF to the registers or a failure to diagnose. Because such cases cannot be prevented by secondary prophylaxis, this highlights the importance of primary prevention. A third (33.2%) of First Nations peoples in Queensland with RHD died in the 5-year period 2017–2021 and about one-quarter (27.7%) had surgery.²²

In 2021, among 1,350 First Nations peoples in Queensland prescribed BPG:²²

• 9.3% received 100% or more of their prescribed doses
• 11.0% received 80% to 99% of their prescribed doses
• 26.4% received 50% to 79% of their prescribed doses
• 38.7% received less than 50% of their prescribed doses, including 196 (14.5%) of people who received no doses
• of the 1,347 First Nations peoples in Queensland on BPG, there were 41 ARF recurrences.

Injury and poisoning

Injury and poisoning (excluding complications of medical and surgical care) are significant contributors to death and hospitalisations in First Nations peoples and the leading causes vary by age and sex. Standardised rates for injury and poisoning for First Nations peoples compared to other Queenslanders were:

• 80.6% higher for hospitalisations in 2018–19 to 2020–21 (6,267.8 and 3,469.9 per 100,000 persons, respectively)
• 74.6% higher for mortality in 2018–2020 (69.9 and 40.0 per 100,000 persons, respectively).

Road transport injuries

First Nations peoples experience a higher burden of road trauma. They are nearly three times more likely to die in road crashes than other Australians, and are disproportionately represented in passenger and pedestrian fatalities.²⁴

For the period 2016–2020, potential years of life lost due to road traffic injuries were 3.9 times higher for First Nations people living in very remote areas compared to those living in major cities.²⁵

In addition to deaths, road crashes can lead to serious and life-long disability, such as acquired brain injury or spinal cord injuries, requiring specialised care that is often not available, especially in rural and remote regions.²⁴ The factors associated with road trauma in First Nations peoples are complex²⁶ and road safety in First Nations peoples is a key objective in national road safety strategies.²⁴

For the period 2018–2020, an average of 21 deaths in First Nations peoples in Queensland per year were due to land transport accidents, a standardised rate of 9.6 per 100,000. Land transport accidents were the 8th leading cause of death in First Nations males (15.7 per 100,000) in Queensland for the period 2017–2021, 1.8 times higher than other Queensland males.²⁷ Age-specific rates are not presented given small numbers and the degree of uncertainty around estimates.

There was an average of 1,014 hospitalisations for road traffic injuries per year for 2018–19 to 2020–2021 (standardised rate: 442.0 per 100,000). Hospitalisation rates were highest for males across all age groups (Figure 7), peaking in 35 to 39 year olds.

Additional information

Data and statistics

Some additional sources of health and wellbeing statistics for First Nations peoples include:

• The Australian Bureau of Statistics National Aboriginal and Torres Strait Islander Health Survey
• The Joint Council on Closing the Gap Closing the gap
• The Productivity Commission Report on government services
• The Australian Institute of Health and Welfare report series for Indigenous Australians.

Strategies and information

Queensland Health’s First Nations health equity

More information about health services for First Nations peoples is available from:

• Queensland Health Bubba jabs immunisations for First Nations children
• Queensland Government Aboriginal and Torres Strait Islander peoples and immunisation
• Queensland Government QuitHQ for strategies and programs to quit smoking.

Section technical notes

Death data for recent periods are preliminary and subject to change. Refer to Causes of Death, Australia on the Australian Bureau of Statistics website for further information.

The mortality data presented in this section is based on the year of registration, as reported by the Australian Bureau of Statistics. Thus, any late registrations that have occurred during the reference year may not have been included. The differences in the proportion of death that are registered late between the First Nations persons and others may have impact on the measure of differences between the population groups.

For more information, refer to the Deaths of Aboriginal and Torres Strait Islander people section within the Causes of Death publication and Technical Note of the Deaths, Australia 2010 publication.

Healthy birthweight is defined as a baby weighing between 2,500 and 3,999 grams and includes all babies born of at least 20 weeks gestation and/or at least 400 grams.

E-cigarette use: For youth 15 to 17 years of age, differences in estimates were observed depending on whether or not they self-reported their e-cigarette use in the presence or not of an adult (26.5% and 7.4%, respectively) or the questions were answered by a proxy (66.2%).

The ICD coding system is maintained by the World Health Organization and provides internationally comparable mortality and morbidity statistics over time and between regions. In Australia, the ICD-10 were adapted for the Australian context from the WHO ICD system. The ICD-10-AM is now maintained by the Independent Health and Aged Care Pricing Authority (IHACPA).

Multiple factors may cause a person’s hospital admission. The principal diagnosis is the one deemed chiefly responsible for the admission.

Hospitalisation data reported in this section were sourced from the Queensland Hospital Admitted Patient Data Collection (QHAPDC). Individual record in the QHAPDC are episode based, meaning that multiple episodes from a same person will be counted multiple times in a reporting period.

Separations from interstate residents, public psychiatric hospitals, and those flagged as unqualified newborns, organ donors or boarders are excluded. Records from 47 previously declared hospitals are excluded.

Unless otherwise stated, age-standardised rates were calculated by standardising to 2001 Australian standard population for 0-65+ age groups.

For definition on selected potentially preventable hospitalisations, refer to coding standards in METEOR on the Australian Institute of Health website.

Women who attended 5 or more antenatal visits during pregnancy: Excludes interstate women who gave birth in Queensland, births with a gestational age less than 32 weeks and antenatal visits ‘not stated’. Indigenous status of mother ‘not stated’ are included within the non-Indigenous counts.

Low birthweight (<2,500g) babies: Excludes interstate women who gave birth in Queensland and babies of unknown birthweight.
Indigenous status of mother ‘not stated’ are included within the non-Indigenous counts.
Includes liveborn singleton babies.

Babies born less than 37 weeks of gestation: Excludes interstate women who gave birth in Queensland and babies of unknown gestation. Indigenous status of mother ‘not stated’ are included within the non-Indigenous counts.
Includes liveborn singleton babies.

Women who smoked at any stage during pregnancy: Excludes interstate women who gave birth in Queensland, and smoking status ‘not stated’.
Indigenous status of mother ‘not stated’ are included within the non-Indigenous counts.

References

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