Quantifying the Excess Risk for Proteinuria, Hypertension and Diabetes

Objective: To estimate the magnitude of excess risk for proteinuria, high blood pressure and diabetes in Australian Aboriginal adults in three remote communities by comparing them with nationwide Australian data. Methods: Adult volunteers from three remote communities in the Northern Territory were screened for proteinuria (dipstick protein ≥1+), high blood pressure (BP ≥ 140/90 or antihypertensive treatment), and diabetes (WHO criteria) between 2000 and mid 2003. Rates for people age 25 to 74 years were compared with those from the nationwide AusDiab study conducted in 1999 and 2000. Results: Compared to AusDiab, rates of these conditions were elevated in all Aboriginal communities, but differed among them. With adjustment for age and sex, rates of proteinuria were elevated 2.5 to 5.3 fold, rates of high blood pressure were elevated 3.1 to 8.1-fold and rates of diabetes were elevated 5.4 to 10-fold (p<0.001 for all). The risk of having any condition ranged from 3.0 to 8.7-fold and the risk of having 2 or more conditions ranged from 5.8 to 14.2-fold. The relative accentuation of risk for hypertension and diabetes was highest among young adults, while that for proteinuria was higher in those age 35 yr and above. Discussion: The data are compatible with the excess morbidity and mortality from cardiovascular disease, diabetes and renal disease in these Aboriginal groups. They reflect the multitude of risk factors operating in these environments. They dictate urgent and systematic intervention to modify outcomes of established disease and to prevent their development. However, the resources required for effective secondary intervention will differ among communities according to the disease burden.