TUBERCULOSIS: tuberculosis among Indigenous people in Australia

It is almost certain that Indigenous people did not suffer from tuberculosis prior to 1788 [3]. There was evidence of a high prevalence of TB among the first Europeans to arrive in Australia, however, and it is likely that the disease was soon transmitted to Indigenous peoples. There is little evidence of TB having a major impact on Indigenous people until around the middle of the 19th century, after which time it became the leading cause of death for those living in the more settled parts of the country [4]. For Indigenous people living in more remote parts of Australia, TB did not have a major impact until much later [5].

By the mid 20th century, the disease had spread to Indigenous communities in all parts of the country, but its impact was still somewhat variable [5]. The rate in the non-Indigenous population declined from the mid 20th century, partly due to a highly successful national TB campaign (1948-1976) [6]. The persisting impact of TB on Indigenous people has been attributed to the poor living conditions and malnutrition experienced by Indigenous people, compounded by chronic chest diseases and alcohol use [4] [7] [8].

Tuberculosis in recent years
TB is considered to be well under control in Australia with one of the lowest rates in the world. Notifications of TB among Aboriginal and Torres Strait Islander peoples have declined slightly, but they still remain much higher than those in the Australian born population [9].
There were 1,142 new cases of TB notified in 2006, but 969 (85%) of these were for people born outside Australia [9]. Of the 173 new cases involving people born in Australia, 33 (19%) were identified as Indigenous and 140 (81%) as non-Indigenous. The number of new cases of TB among Indigenous people in 2006 was slightly more than the number in 2005 (27), but less than those in previous years [10] [11] [12] [13].
In view of the relatively small numbers of cases and the year-to-year variations in numbers, the following comparison of TB incidence among Indigenous and non-Indigenous Australian-born people considers new cases for the five-year period, 2002-2006. In that period, there were 174 new cases of TB notified among Indigenous people and 711 among non-Indigenous Australian-born people [9] [10] [11] [12] [13]. Almost one-half of the new cases among Indigenous people were reported by the Northern Territory (83 cases) and around one-quarter by Queensland (45 cases) (Table 1). The Australia-wide crude incidence rate of 7.2 cases per 100,000 population for Indigenous people was almost 10 times the rate of 0.7 per 100,000 for non-Indigenous people. The crude incidence rate was highest for the NT (28 cases per 100,000 population).
This comparison underestimates the true difference between Indigenous and non-Indigenous people because of differences in the age structures of the Indigenous and non-Indigenous populations - after adjusting for these differences, the incidence rate for Indigenous people was 14 times that of non-Indigenous people (Table 2). The incidence of TB is higher for Indigenous people than for non-Indigenous people across all age groups, with rate ratios being highest for the 45-54 years and 55-64 years age groups.
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