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Hospitalisation

Statistics on hospital admissions and procedures provide some insights into ill-health in the population. They are, however, quite a poor reflection of the extent and patterns of treatable illness in the community, because they represent only illness that is serious enough to require hospitalisation and are influenced to some degree by the geographic accessibility of hospitals.

Another limitation of hospital statistics as an indicator of the health of the public is that they relate to episodes of hospitalisation rather than individual patients. Thus, multiple admissions by a relatively small number of patients-as occurs for end-stage renal disease, for example-limit the inferences that can be drawn about overall health patterns from aggregated statistics. These statistics are, of course, useful in assessing the need for health services, but of far less use in assessing health.

As is the case with other major health-related data collections (such as births and deaths), the identification of Indigenous status in the hospital data collection is incomplete. During 2007-2008, the AIHW conducted audits to assess the level of under-identification of Indigenous status in each state and territory and found that NSW, Vic, Qld, WA, SA and the NT had adequate identification, with 20% or less under-identification of Indigenous status [1][2].

Separation rates

Of the 7.58 million hospital separations for NSW, Vic, Qld, WA, SA and the NT during 2007-08, 271,290 (3.6%) were identified as Indigenous, with 41% of separations for Indigenous patients being for overnight stays (Table 1) [2].

The overall age-standardised separation rate of 916 per 1,000 for the Indigenous population was 2.6 times that of the non-Indigenous population (357 per 1,000) (Table 1) [2]. The age-standardised separation rate for Indigenous people living in the NT was 1,670 per 1,000, 7.3 times that rate of 228 per 1,000 for non-Indigenous people.

Table 1: Hospitalisation: separations and age-standardised separation rates, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2007-08
Jurisdiction Indigenous Non-Indigenous Rate ratio
Number Rate Number Rate
Source: AIHW, 2009 [2]
Notes
  1. Rates per 1,000 population have been standardised using the population estimates at 30 June 2005
  2. Non-Indigenous rates, but not numbers, include separations for which Indigenous status was not stated
  3. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
  4. Numbers and rates for the NT are for public hospitals only
NSW 54,189 566 2,242,332 320 1.8
Vic 12,970 684 2,118,578 396 1.7
Qld 69,305 868 1,451,366 374 2.3
WA 54,817 1,185 728,803 354 3.3
SA 18,446 1,000 567,474 350 2.9
NT 61,563 1,671 28,687 228 7.3
All jurisdictions 271,290 916 7,137,240 357 2.6

Age-specific separation rates

Separation rates were higher for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2007-08 than for non-Indigenous people for virtually all age groups, with the highest differences in the middle adult years (Table 2) [2].

Causes of hospitalisation

In 2007-08 the most common reason of hospitalisation for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT was ‘care involving dialysis' accounting for 43% of Indigenous separations (115,279 separations) [2]. Many of these separations involved repeat admissions for the same people, some on an almost daily basis. The ICD group ‘Injury, poisoning and certain other consequences of external causes' (including motor vehicle accidents, assaults, self-inflicted harm and falls) was the next most common cause of hospitalisation for Indigenous people, being responsible for 19,919 separations (7.3% of all separations, and 12.8% of separations excluding those for dialysis) (Table 3).

Excluding separations for dialysis and pregnancy-related conditions, most of which involved normal deliveries, the next leading causes of hospitalisation for Indigenous people were for respiratory conditions (responsible for more than 16,600 separations - 10.6% of separations excluding those for dialysis) and digestive diseases (more than 14,000 separations - 9.2% of separations excluding those for dialysis) (Table 3) [2].

Table 2: Age-specific hospital separation rates, by Indigenous status and sex, and Indigenous:non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2007-08
Age group Males Females
Indigenous rate Non-Indigenous rate Rate ratio Indigenous rate Non-Indigenous rate Rate ratio
Source: Derived from AIHW, 2009 [2]
Notes
  1. Rates per 1,000 population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
  3. Rates for the NT are for public hospitals only
  4. Due to the incomplete identification of Indigenous status, these figures probably under-estimate the true difference between Indigenous and non-Indigenous rates by 20-25%
0-4 363 273 1.3 183 205 0.9
5-14 117 95 1.2 349 75 4.7
15-24 160 135 1.2 422 226 1.9
25-34 343 151 2.3 666 375 1.8
35-44 728 212 3.4 869 332 2.6
45-54 1,186 317 3.7 1,263 338 3.7
55-64 2,903 561 3.4 1,067 493 2.2
65-74 2,359 952 2.5 2,376 764 3.1
75+ 2,388 1,483 1.6 1,693 1,047 1.6
Table 13: Hospitalisation: leading causes of Indigenous separations (excluding dialysis): numbers, proportions of separations and Indigenous:non-Indigenous ratios, NSW, Vic, Qld, WA, SA and the NT, 2007-08
Principal diagnosis Number of separations Proportion of separations (excl dialysis) Ratio
Source: Derived from AIHW, 2009 [2]
Notes:
  1. Excludes hospitalisation for dialysis
  2. Ratios are the standardised separation rates for Indigenous people divided by the standardised separation rates for non-Indigenous people
  3. Due to the incomplete identification of Indigenous status, these figures probably under-estimate the true difference between Indigenous and non-Indigenous rates by 20-25%
Injury/poisoning 19,919 12.8 2.0
Pregnancy-related 19,333 12.4 1.4
Respiratory diseases 16,601 10.6 2.9
Digestive diseases 14,325 9.2 1.0
Symptoms, signs not elsewhere classified 11,875 7.6 1.6
Circulatory diseases 8,552 5.5 1.8
Mental & behavioural disorders 11,283 7.2 1.9
Diseases of the skin & subcutaneous tissue 6,372 4.1 2.6
Genitourinary diseases 6,533 4.2 1.2
Infectious/parasitic diseases 5,418 3.5 2.6
Endocrine (incl diabetes) 5,443 3.5 3.2
Other 30,357  19.4 ---
All causes, excluding dialysis 156,011 100.0 1.4

References

  1. Australian Health Ministers’ Advisory Council (2008) Aboriginal and Torres Strait Islander health performance framework report 2008 Canberra: Department of Health and Ageing
  2. Australian Institute of Health and Welfare (2009) Australian hospital statistics 2007-08 Canberra: Australian Institute of Health and Welfare
 
Last updated: 14 December 2009
 
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