Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: a systematic review and meta-analysis of epidemiological studies.

BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups. OBJECTIVE To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations. METHODS MEDLINE, Embase, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis. RESULTS Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]). CONCLUSIONS Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.

[1]  B. Gorman,et al.  Racial and ethnic differences in adult asthma prevalence, problems, and medical care , 2009, Ethnicity & health.

[2]  M. King,et al.  Indigenous health part 1: determinants and disease patterns , 2009, The Lancet.

[3]  L. Boulet,et al.  Overdiagnosis of asthma in obese and nonobese adults , 2008, Canadian Medical Association Journal.

[4]  P. Barnes,et al.  A comparison of respiratory conditions between multiple race adults and their single race counterparts: an analysis based on American Indian/Alaska Native and white adults , 2008, Ethnicity & health.

[5]  Douglas G. Altman,et al.  Statistical Methods for Examining Heterogeneity and Combining Results from Several Studies in Meta‐Analysis , 2008 .

[6]  S. Helgerson,et al.  Is There a Disparity in the Prevalence of Asthma Between American Indian and White Adults? , 2008, The Journal of asthma : official journal of the Association for the Care of Asthma.

[7]  T. Vos,et al.  Excess Indigenous mortality: are Indigenous Australians more severely disadvantaged than other Indigenous populations? , 2007, International journal of epidemiology.

[8]  R. Hubbard.  The burden of lung disease , 2006, Thorax.

[9]  I. Anderson,et al.  Indigenous health performance measurement systems in Canada, Australia, and New Zealand , 2006, The Lancet.

[10]  J. Porter,et al.  Disappearing, displaced, and undervalued: a call to action for Indigenous health worldwide , 2006, The Lancet.

[11]  C. D. Mathers,et al.  Chronic obstructive pulmonary disease: current burden and future projections , 2006, European Respiratory Journal.

[12]  K. R. Chapman,et al.  Epidemiology and costs of chronic obstructive pulmonary disease , 2006, European Respiratory Journal.

[13]  Michael Marmot,et al.  Social determinants of health inequalities , 2005, The Lancet.

[14]  Naomi Adelson,et al.  The Embodiment of Inequity: Health Disparities in Aboriginal Canada , 2005, Canadian journal of public health = Revue canadienne de sante publique.

[15]  T. K. Young,et al.  Review of research on aboriginal populations in Canada: relevance to their health needs , 2003, BMJ : British Medical Journal.

[16]  M. Bird.  Health and indigenous people: recommendations for the next generation. , 2002, American journal of public health.

[17]  M. Whitehead,et al.  Challenging inequities in health: from ethics to action. , 2001 .

[18]  S. Hales,et al.  Asthma prevalence and deprivation: a small area analysis. , 1999, Journal of epidemiology and community health.

[19]  A. James,et al.  Respiratory symptoms and lung function in aborigines from tropical Western Australia. , 1998, American journal of respiratory and critical care medicine.

[20]  L W Chambers,et al.  Critical appraisal of the health research literature: prevalence or incidence of a health problem. , 1998, Chronic diseases in Canada.

[21]  S. Hales,et al.  Geographical variation in the prevalence of asthma symptoms in New Zealand. , 1997, The New Zealand medical journal.

[22]  C. Salome,et al.  Asthma and atopy in four rural Australian Aboriginal communities , 1996, The Medical journal of Australia.

[23]  Bruce G. Link,et al.  Social Conditions as Fundamental Causes of Disease , 1995 .

[24]  L. Crossland,et al.  The self reported prevalence of asthma symptoms amongst adult New Zealanders. , 1994, The New Zealand medical journal.

[25]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[26]  L. Hedges,et al.  Statistical Methods for Meta-Analysis , 1987 .

[27]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.