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Australian Indigenous HealthBulletin Alcohol and other drugs knowledge centre Yarning Places
 

Hospitalisation

Hospitalisation

Statistics on hospitalisation provide some insights into ill-health in the population [1]. They are, however, a fairly poor reflection of the extent and patterns of treatable illness in the community because they only represent illness that is serious enough to require hospitalisation and are influenced to some degree by the geographic accessibility of hospitals and variations in admission policies.

Another limitation of the available hospital statistics as an indicator of the health of the population is that they relate to episodes of hospitalisation rather than to individual patients [1]. Multiple admissions by a relatively small number of patients - as occurs for kidney dialysis, 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 hospital data collections is incomplete (See Appendix 1).

The Council of Australian Governments (COAG) targets for closing the gap involve strategic areas for action and one of these is early childhood development for which monitoring early childhood hospitalisations is an indicator [2]. As there is information available, specific information about hospitalisation for children aged 0-4 years is included below.

Separation rates

Of the more than 10 million hospital separations in Australia10 during 2014-15, 443,097 (4.4%) were identified as Aboriginal and Torres Strait Islander (Table 12) [3]. Around 93% of Indigenous hospital separations were of Aboriginal people, 3.8% were of Torres Strait Islander people, and 3.6% were of people who identified as being of both Aboriginal and Torres Strait Islander descent.

In 2014-15, the overall age-standardised separation rate of 950 separations per 1,000 population for Aboriginal and Torres Strait Islander people was 2.4 times that for non-Indigenous people (Table 12) [3]. The highest age-standardised separation rate was for Aboriginal and Torres Strait Islander people living in the NT (2,004 per 1,000), more than six times the rate for non-Indigenous people.

Table 12. Numbers of hospital separations and age-standardised separation rates, by Indigenous status and jurisdiction, and Indigenous: non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2014-15

Jurisdiction

Aboriginal and Torres Strait Islander

Non-Indigenous

Rate ratio

Number

Rate

Number

Rate

NSW

90,184

587

2,908,353

361

1.6

Vic

23,172

698

2,574,116

413

1.7

Qld

107,870

836

2,127,885

442

1.9

WA

94,844

1,650

986,619

386

4.3

SA

24,385

921

713,766

378

2.4

NT

94,136

2,004

38,146

319

6.3

Australia

443,097

950

9,707,270

393

2.4

Notes:

  1. Rates per 1,000 population
  2. Non-Indigenous rates and 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; separate numbers and rates are not included for Tas or the ACT, but included in totals where applicable
  5. The incomplete identification of Indigenous status means that these figures probably underestimate the true difference between Indigenous and non-Indigenous rates

Source: AIHW, 2016 [3]

In 2014-15, hospitalisation rates for Aboriginal and Torres Strait children 0-4 years were similar in major cities and regional areas (271 and 276 per 1,000 respectively) but were almost twice as high in remote areas (468 per 1,000). For non-Indigenous children, the rates decreased slightly as remoteness increased (from 240 per 1,000 to 208 per 1,000) [2].

Age-specific separation rates

The most recent national information available for all age-groups is from 2011-12 to 2012-13 when hospital separation rates were higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people in all age-groups except for 65 years and over (Table 13) [4].

Table 13. Age-specific hospital separation rates (excluding dialysis), by sex and Indigenous status, and Indigenous:non-Indigenous rate ratios, Australia, 2011-12 to 2012-13

Age-group

(years)

Males

Females

Indigenous

Non-Indigenous

Rate ratio

Indigenous

Non-Indigenous

Rate ratio

0-4

324

264

1.2

264

202

1.3

5-14

106

97

1.1

92

80

1.2

15-24

143

131

1.1

353

225

1.6

25-34

228

137

1.7

467

359

1.3

35-44

349

192

1.8

424

331

1.3

45-54

460

281

1.6

446

325

1.4

55-64

543

473

1.1

547

449

1.2

65+

794

980

0.8

753

837

0.9

Notes:

  1. Rates per 1,000 population
  2. Non-Indigenous includes separations for which Indigenous status was not stated
  3. Rate ratio is the Indigenous rate divided by the non-Indigenous rate

Source: AIHW, 2015 [4]

More recent information for 2014-15 is available for children aged 0-4 years. There were 310 per 1,000 Aboriginal and Torres Strait Islander children hospitalised nationally compared with 237 per 1,000 non-Indigenous children [2].

Causes of hospitalisation

In 2014-15, the most common reason for the hospitalisation of Aboriginal and Torres Strait Islander people in Australia was for ‘Factors influencing health status and contact with health services’ (mostly for care involving dialysis), responsible for 50% of Aboriginal and Torres Strait Islander separations (223,264 separations) [3]. Many of these separations involved repeat admissions for the same people, some on an almost daily basis. ICD ‘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 Aboriginal and Torres Strait Islander people, responsible for 29,237 separations (6.6% of all separations). Excluding separations for pregnancy-related conditions (most of which involved normal deliveries), the next leading cause of hospitalisation for Aboriginal and Torres Strait Islander people were respiratory conditions (responsible for 22,960 separations) (Table 14).

Table 14. Numbers, proportions (%), and age-standardised hospitalisation rates for leading causes of hospital separations, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, Australia, 2014-15

Principal diagnosis (ICD)

Number of separations

Proportion of separations (%)

Age-standardised separation rate

Rate ratio

Injury, poisoning and certain other consequences of external causes

29,237

6.6

47

1.8

Pregnancy, childbirth and the puerperium

23,831

5.4

30

1.4

Diseases of the respiratory system

22,960

5.2

41

2.4

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

21,644

4.9

42

1.4

Diseases of the digestive system

21,441

4.8

39

1.0

Mental and behavioural disorders

16,941

3.8

28

1.7

Diseases of the circulatory system

12,520

2.8

32

1.8

Diseases of the genitourinary system

12,038

2.7

24

1.2

Diseases of the skin and subcutaneous tissue

8,750

2.0

14

2.2

Diseases of the musculoskeletal system and connective tissue

8,398

1.9

18

0.8

Certain infectious and parasitic diseases

7,326

1.7

12

2.0

Endocrine, nutritional and metabolic diseases

6,920

1.6

15

2.3

Neoplasms

6,632

1.5

17

0.7

Diseases of the nervous system

5,843

1.3

11

0.9

Factors including health status and contact with health services

223,264

50.4

552

5.5

All causes

443,097

100

947

2.4

Notes:

  1. Information for the NT is for public hospitals only
  2. Some principal diagnoses have been excluded
  3. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate

Source: AIHW, 2016 [3]

In 2014-15 for Aboriginal and Torres Islander and non-Indigenous children aged 0-4 years nationally, the most common cause of hospitalisation was diseases of the respiratory system (1 in 4 and 1 in 5 hospitalisations respectively) [2]. Hospitalisation of Aboriginal and Torres Strait Islander children has decreased since 2004-05, but they were twice as likely as other children to be hospitalised due to infectious and parasitic diseases in 2014-15.

Potentially preventable hospitalisations

Potentially preventable hospitalisations are admissions which ‘could have been avoided with access to quality primary care and preventive care’ [5]. Rates for potentially preventable hospitalisations, including those for chronic conditions and vaccine-preventable conditions, may be used as an indirect measure of problems with access to care and effective primary care [3].

In 2014-15, the rate of overall potentially preventable hospitalisations was around three times higher for Aboriginal and Torres Strait Islander people than those for non-Indigenous people [3]. The highest rates for potentially preventable hospitalisations of Aboriginal and Torres Strait Islander people were for chronic conditions (35 per 1,000) (Table 15). The age-standardised rate for vaccine-preventable conditions was almost six times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.

Table 15. Age-standardised separation rates for potentially preventable hospitalisations, by Indigenous status, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, Australia, 2014-15

 

Aboriginal and Torres Strait Islander rate

Non-Indigenous rate

Rate ratio

Vaccine-preventable conditions

9.4

1.6

5.9

Acute conditions

28

12

2.4

Total chronic conditions

35

11

3.2

  Diabetes complications

6.7

1.6

4.2

  Chronic conditions (excluding diabetes)

28

9.4

3.0

Total

71

24

2.9

Note: Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate

Source: AIHW, 2016 [3]

In 2014-15, the national rate of hospitalisation of Aboriginal and Torres Strait Islander children aged 0-4 years for potentially preventable diseases and injuries was higher than the rate for non-Indigenous children (161 per 1,000 compared with 100 per 1,000 respectively) [2]. The rate of hospitalisation of Aboriginal and Torres Strait Islander children was almost twice as high in remote areas (306 per 1,000).

References

  1. Thomson N, Ali M (2003) Births, deaths, and hospitalisation. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 44-74
  2. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. Canberra: Productivity Commission
  3. Australian Institute of Health and Welfare (2016) Admitted patient care 2014-15: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  4. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  5. Clinical Epidemiology and Health Service Evaluation Unit (2009) Potentially preventable hospitalisations: a review of the literature and Australian policies: final report. Sydney: Australian Commission on Safety and Quality in Health Care

Footnotes

10. All hospitalisation data for the NT include only public hospitals.

 

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    Last updated: 9 March 2017
     
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