Bronchiectasis in Aboriginal and Torres Strait Islander people (see below for Mãori)
Bronchiectasis can develop in persons of any age and cultural background, however Aboriginal children living in Central Australia have among the highest published rates of bronchiectasis in the world (Chang et al 2003). The main causes include recurrent chest infections and impaired immune function.
In Aboriginal and Torres Strait Islander people, bronchiectasis is more likely to be caused by, or associated with, childhood infections. Studies have found that hospitalised pneumonia was an independent risk factor for bronchiectasis i.e. they were 15 times more likely than controls (Indigenous children hospitalised for other reasons) to develop bronchiectasis (OR 15, 95%CI 4-53) and the risk increased further in those who had severe pneumonia and those experiencing recurrent episodes of hospitalised pneumonia (Valery et al 2004). A prospective study also found that the presence of chronic cough post hospitalised bronchiolitis, was significantly associated with detection of bronchiectasis within 24 months, adjusted OR 3.0, 95%CI: 1.1, 7.0, p=0.03 (McCallum et al 2016). Using latent class analysis, the clinical profile of these children included severe bronchiolitis and detection of bacteria in their nasopharyngeal swab (Nui et al 2020).
Likewise, previous acute respiratory infections were also the most common aetiology of bronchiectasis in a combined (Australia, NZ and Alaska) study of Indigenous children. While the Indigenous children in all these regions experienced substantial disparities in poverty indices and risk factors (ETS exposure, low education levels, etc.) the children with bronchiectasis had similar rates of these factors, compared with their respective regional Indigenous populations. However, household crowding, prematurity and a high frequency and early onset of acute lower respiratory infections were significantly higher in those with bronchiectasis.
Determinants of Health
It is important for healthcare providers to understand why the rates and disease patterns of bronchiectasis are more severe in Aboriginal and Torres Strait Islander communities, to ensure that improvements are targeted in research and treatment and ensure equity. Nevertheless, it is essential to provide these children with the best possible care without becoming discouraged by factors that are generally outside the clinicians control.
Further, it should be noted that national data for Australians with bronchiectasis showed that “In 2003-24, the age-standardised hospitalisation rate due to bronchiectasis were similar across socio-economic aeras, ranging from 21 per 100,000 population in areas of least disadvantage, to 24 per 100,000 in areas of most disadvantage”. (AIHW)
Environment
It is common for extended families to live together as a way to preserve cultural traditions and maintain community strength. Overcrowding in remote communities can be exacerbated by difficult access to housing and home maintenance services. With many people living in one house, it is easier for infections to spread amongst family, particularly in areas where extreme hot and cold weather patterns occur. In remote areas of Australia severe infections are more common. Recurrent exposure to severe infections can cause destruction of lung tissue, leading to bronchiectasis.
Education on strategies to optimise healthy living environments such as hand hygiene, good nutrition, clean water, sanitation and access to necessary services are important. By engaging with families, traditional healers and health centres, health professionals can also encourage early presentation when sickness occurs to ensure effective treatment is provided. A community-based project in remote Western Australia had shown that a culture-safe education, combined with an implementation strategy to facilitate correct diagnosis and management of chronic wet cough by physicians, improved health seeking for children with chronic wet cough and their outcomes (earlier cough resolution and quality of life) (Laird et al 2021)
Socioeconomic Disadvantage
It is important for professionals to recognise that many of the barriers between traditional culture and standard healthcare service provision involve high financial costs. When living in a remote community, a trip to hospital for one person may involve costs for petrol, food and accommodation for a whole family. Medications and treatment modalities may require ongoing patient contribution, which may not be feasible when individuals carry financial responsibility for not only their immediate family, but also extended relations and community members in some cxommunities.
Aboriginal and Torres Strait Islander people are represented across all employment sectors in Australia. However, an expectation to work is disrespectful to traditional life, and poorly informed assumptions made by non-Indigenous people can be incredibly detrimental. In establishing a culture-safe healthcare environment where all Australians feel welcome, professionals must recognise and respect the lifestyle choices made by each and every person. Provision of wholistic care is of utmost importance (Chang et al 2024)
Community aspects. Responsibilities and Good Health
While good health is a focus of many traditions, there are different perspectives on how good health may be achieved. Some individuals may consider a healthy life to be one free of illness and injury, whilst others may recognise health through a strong connection to family, culture and country. In some cases health may not be the highest priority.
Even when health is a priority, some may have complex obligations e.g. during periods of cultural business, or ongoing social responsibilities to family, children or elders in the community. Professionals should take the time to understand what constitutes good health for their patients, and how individuals can be supported to achieve their personal health goals. This may include standard investigations, medications and surgical procedures, however may also include returning home – potentially during times of acute illness – to be closer to family and traditional healers.
It is important to provide patients with culture-safe education regarding their current and long-term healthcare needs. It is almost always necessary to talk with the patients’ extended family or clan to ensure that appropriate investigations are undertaken and optimal treatment provided. There is now objective evidence that culturally-safe optimal care significantly improved the lung function of Aboriginal and Torres Strait Islander children, including those with bronchiectasis (Collaro et al 2020).
Chronic Respiratory Disease
Data from the current (search data 2026) national reports, including that from the Australian Institute of Health and Welfare reported that around 31% of Aboriginal and Torres Strait Islander Australians have a chronic respiratory disorder. Adjusting for age differences, Aboriginal and Torres Strait Islander Australians hospitalisation rate for respiratory conditions was 2.3 times the rate for non-Indigenous Australians.
Remote dwelling Aboriginal and Torres Strait Islander Australians were 2.4 times as likely to be hospitalised for respiratory diseases compared with those living in major cities (65 and 27 per 1,000 respectively). Specifically for bronchiectasis, age-adjusted hospitalisation data showed the rate in Aboriginal and Torres Strait Islander people was 2.9 times that of non-Indigenous Australians (AIHW).
Excluding dialysis, most common principal diagnoses why Aboriginal and Torres Strait Islander People are hospitalised are injury and poisoning (6.8% of hospitalisations), symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified (5.7%) and respiratory diseases (5.4%).
In previous AIHW reports, respiratory disease is the second most common self-reported chronic health condition but such data is no longer available as respiratory diseases are now reported as only asthma and COPD categories.
Human T-Lymphotropic Virus Type-1
In Central Australian adults with bronchiectasis, Human T-Lymphotropic Virus Type-1 (HTLV-1) infection has been associated with severe bronchiectasis.
Importantly, this is not the case in children where HTLV-1 is rare and not found in children with bronchiectasis (McCallum et al 2021).
HTLV-1 is an organism that infects T-lymphocytes – a type of white blood cell in the body. It is an ancient virus common to Indigenous populations worldwide. HTLV-1 is transmitted through bodily fluids.
HTLV-1 occurs at endemic rates in Central Australia. Reports of community epidemiology reported prevalence of 13.9% for the region and 59.8% of adults in-patients with bronchiectasis tested for HTLV-1 were seropositive (5), and 72% of bronchiectasis patients discharged from hospital were seropositive.
Further research is required to investigate the pathophysiology and interactions between HTLV-1, strongyloides stercoralis and bronchiectasis.
Bronchiectasis in Mãori people
Epidemiology
In 2003, the incidence of bronchiectasis in auckland children was 24/100,000 for Mãori compared to 4/100,000 for European groups (Edwards et al 2003).
The rate of hospitalisation for bronchiectasis in 2003-2005 were 3.6 times the rate for non-Mãori, with the rate rising to 6-fold at ages 45-64 (Crengle et al 2006).
In 2000, 27% of adults in South Auckland hospitalised with bronchiectasis were Mãori (Roberts et al 2012)
A recent study has shown hospital admission rates to be 5-fold higher for Mãori than non-Mãori (Bibby et al 2015).
Causes
Substandard housing, malnutrition, barriers to health care and inadequate education the the most likely contributors to the occurrence and outcomes of bronchiectasis (Crengle et al 2007).
In New Zealand, half of the cases of bronchiectasis in children and adults with a known cause were due to childhood infection (Edwards et al 2003, Roberts et al 2012).
Low immunisation rates in communities with social deprivation may also be a factor (Crengle et al 2007).