Metabolic syndrome in Australia: nationwide survey results by remoteness and Indigenous status, 2012–2019

Background: In Australia, the rising prevalence of metabolic syndrome (MetS) presents a significant public health challenge. However, research on geographic and ethnic disparities remains limited. This study aimed to investigate the prevalence and temporal trends of MetS by geographic remoteness and between Indigenous and non-Indigenous Australians. Methods: We analysed data from 44,760 adults (aged ≥18 years) derived from the National Health Survey (2014–2015 and 2017–2018) and the National Aboriginal and Torres Strait Islander Health Survey (2012–2013 and 2018–2019). Weighted prevalence estimates of MetS were calculated overall and stratified by remoteness. The Average Annual Rate of Change (AARC) in MetS prevalence was computed to assess temporal trends. Results: MetS prevalence varied notably by remoteness and ethnicity. In the most recent surveys, 7.1% (95% CI: 6.19–8.19) of Indigenous adults (2018–2019) and 4.6% (95% CI: 4.23–4.99) of non-Indigenous adults (2017–2018) had MetS. Prevalence was higher in remote areas for both groups. Among non-Indigenous adults, MetS declined across most regions but increased in remote areas from 4.5% to 7.1% (AARC: +15.77%), while among Indigenous adults it remained stable in remote areas but rose in major cities and regional settings. Central obesity and type 2 diabetes (T2D) were the most prominent contributors to MetS among Indigenous adults, whereas hypertension and high cholesterol were more prevalent among non-Indigenous adults in regional areas. Central obesity was the most common MetS risk factor, affecting 57.4% (95% CI: 55.14–59.63) of Indigenous and 40.9% (95% CI: 39.90–41.85) of non-Indigenous adults. High cholesterol was the least common risk factor among Indigenous adults (7.6% [95% CI: 6.58–8.67]), whereas elevated blood sugar was the least common among non-Indigenous adults (4.8% [95% CI: 4.44–5.21]). Conclusions: Substantial disparities in MetS exist across Australia, disproportionately affecting Indigenous Australians and residents of remote areas. Culturally tailored, region-specific interventions targeting obesity are urgently needed through Local Health Districts and Aboriginal Community Controlled Health Organisations.