Mehra Sumit, Chang Anne B, Lam Chor K, Campbell Stuart, Mingi Joy J, Thomas Izaak, Harwood Suzanne, Maguire Graeme, Heraganahally Subash
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
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
Rural Remote Health. 2021 Apr;21(2):6390. doi: 10.22605/RRH6390. Epub 2021 Apr 10.
Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region in the Northern Territory, 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.
In this retrospective study, demographics, clinical characteristics and relevant laboratory parameters were compared among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017.
A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Aboriginal. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 v 67 years), the majority lived in rural and remote communities (80% v 9 %), had higher rates of self-reported smoking (52% v 19%), alcohol consumption (29% v 12%) and co-occurrence of chronic obstructive pulmonary disease (65% v 38%) and other chronic co-morbidities. Sputum microbiology was also different between the groups with Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis being more common in Aboriginal patients, while Pseudomonas aeruginosa, Aspergillus species and non-tuberculous mycobacteria were higher in non-Aboriginal patients. Further, Aboriginal patients had poorer lung function compared to non-Aboriginal patients (forced expiratory volume after 1 second predicted 33% v 53%, forced vital capacity predicted 49% v 60% respectively), higher exacerbation rates (29% v 18%) and poorer overall outcomes (age at death 60 v 76 years).
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.
慢性呼吸系统疾病在居住于澳大利亚北领地顶端地区卫生服务区域的澳大利亚原住民中极为普遍。支气管扩张是一种异质性疾病，在该人群的这些慢性呼吸疾病中较为常见。然而，该地区原住民和非原住民支气管扩张患者之间的比较数据稀少。
在这项回顾性研究中，对2012年至2017年间被诊断为支气管扩张的成年原住民和非原住民患者的人口统计学、临床特征及相关实验室参数进行了比较。
共有388名成年人经放射学确诊为支气管扩张，其中258名（66%）为原住民。与非原住民患者相比，原住民患者明显更年轻（平均年龄54岁对67岁），大多数居住在农村和偏远社区（80%对9%），自我报告的吸烟率（52%对19%）、饮酒率（29%对12%）以及慢性阻塞性肺疾病的并发率（65%对38%）和其他慢性合并症更高。两组的痰液微生物学也有所不同，流感嗜血杆菌、肺炎链球菌和卡他莫拉菌在原住民患者中更常见，而铜绿假单胞菌、曲霉菌属和非结核分枝杆菌在非原住民患者中比例更高。此外，与非原住民患者相比，原住民患者的肺功能较差（1秒用力呼气量预测值分别为33%对53%，用力肺活量预测值为49%对60%），急性加重率更高（29%对18%），总体预后更差（死亡年龄60岁对76岁）。
在单一卫生服务机构中，患有支气管扩张的原住民患者比非原住民患者的预后明显更差，表现不同且合并症更多。这需要进一步研究以确定可行的干预措施来减少这种不平等现象。
