University Centre for Rural Health, The University of Sydney, Lismore, NSW 2480, Australia.
Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2601, Australia.
Int J Environ Res Public Health. 2022 Aug 1;19(15):9435. doi: 10.3390/ijerph19159435.
Indigenous Australians experience poorer health than non-Indigenous Australians, with cardiometabolic diseases (CMD) being the leading causes of morbidity and mortality. Built environmental (BE) features are known to shape cardiometabolic health in urban contexts, yet little research has assessed such relationships for remote-dwelling Indigenous Australians. This study assessed associations between BE features and CMD-related morbidity and mortality in a large sample of remote Indigenous Australian communities in the Northern Territory (NT). CMD-related morbidity and mortality data were extracted from NT government health databases for 120 remote Indigenous Australian communities for the period 1 January 2010 to 31 December 2015. BE features were extracted from Serviced Land Availability Programme (SLAP) maps. Associations were estimated using negative binomial regression analysis. Univariable analysis revealed on all-cause mortality for the BE features of Education, Health, Disused Buildings, and Oval, and on CMD-related emergency department admissions for the BE feature Accommodation. Incidence rate ratios (IRR's) were greater, however, for the BE features Infrastructure Transport and Infrastructure Shelter. Geographic Isolation was associated with elevated mortality-related IRR's. Multivariable regression did not yield consistent associations between BE features and CMD outcomes, other than negative relationships for Indigenous Location-level median age and Geographic Isolation. This study indicates that relationships between BE features and health outcomes in urban populations do not extend to remote Indigenous Australian communities. This may reflect an overwhelming impact of broader social inequity, limited correspondence of BE measures with remote-dwelling Indigenous contexts, or a 'tipping point' of collective BE influences affecting health more than singular BE features.
澳大利亚原住民的健康状况不如非原住民，心血管代谢疾病（CMD）是发病率和死亡率的主要原因。已知建筑环境（BE）特征可影响城市环境中的心血管代谢健康，但针对偏远地区居住的澳大利亚原住民的此类关系的研究甚少。本研究评估了北领地（NT）中大规模偏远澳大利亚原住民社区的 BE 特征与 CMD 相关发病率和死亡率之间的关联。从 NT 政府卫生数据库中提取了 2010 年 1 月 1 日至 2015 年 12 月 31 日期间 120 个偏远澳大利亚原住民社区的 CMD 相关发病率和死亡率数据。从 Serviced Land Availability Programme (SLAP) 地图中提取了 BE 特征。使用负二项式回归分析评估了关联。单变量分析显示，BE 特征中的教育、健康、废弃建筑物和椭圆形与全因死亡率相关，BE 特征中的住宿与 CMD 相关的急诊入院相关。然而，基础设施运输和基础设施庇护所的 BE 特征的发病率比更高。地理隔离与死亡率相关的 IRR 升高有关。多变量回归未得出 BE 特征与 CMD 结果之间的一致关联，除了土著位置级中位数年龄和地理隔离的负面关系外。本研究表明，城市人口中 BE 特征与健康结果之间的关系不适用于偏远的澳大利亚原住民社区。这可能反映了更广泛的社会不平等的巨大影响，BE 措施与偏远地区原住民环境的对应有限，或者是影响健康的集体 BE 影响超过单一 BE 特征的“临界点”。
