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Australian Indigenous HealthBulletin
 

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 renal 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. A study of the quality of Indigenous identification in records of public hospital separations in Australia’s states and territories found that nationally 88% of Indigenous patients in public hospitals were correctly identified as such in 2011-12 [2]. The accuracy of the identification of Indigenous people varied between states and territories, from 98% in the NT to 58% in the ACT. The accuracy of identification also varied with remoteness level, from 99% in very remote areas to 77% in major cities.

Separation rates1

Of the 9.7 million hospital separations in Australia2 during 2013-14, 408,165 (4.2%) were identified as Aboriginal and Torres Strait Islander (Table 13) [3]. Around 93% of Indigenous hospital separations were of Aboriginal people, 4% were of Torres Strait Islander people, and 4% were of people who identified as being of both Aboriginal and Torres Strait Islander descent.

In 2013-14, the overall age-standardised separation rate of 896 separations per 1,000 population for Aboriginal and Torres Strait Islander people was 2.3 times that for other Australians (Table 13) [3]. The highest age-standardised separation rate was for Aboriginal and Torres Strait Islander people living in the NT (1,874 per 1,000), almost six times the rate for non-Indigenous people.

Table 13. 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, 2013-14

Jurisdiction

Aboriginal and Torres Strait Islander

Non-Indigenous

Rate ratio

Number

Rate

Number

Rate

NSW

83,576

553

2,787,756

353

1.6

Vic

21,166

653

2,467,512

403

1.6

Qld

99,956

795

1,971,174

418

1.9

WA

85,801

1,554

984,598

394

3.9

SA

23,816

927

701,798

378

2.5

NT

86,536

1,874

37,297

319

5.9

Australia

408,165

896

9,294,139

384

2.3

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 under-estimate the true difference between Indigenous and non-Indigenous rates

Source: AIHW, 2015 [3]

Age-specific separation rates

The most recent national information available is from 2011-13 when hospital separation rates were higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people in all age-groups except the 65 years and over (Table 14) [4].

Table 14. Age-specific hospital separation rates (excluding dialysis), by sex and Indigenous status, and Indigenous:non-Indigenous rate ratios, Australia, 2011-2013

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
  4. Rates have not been adjusted for likely under-identification of Indigenous separations, so it is likely that the Indigenous rates, and hence the rate ratios, could be 25-30% higher

Source: AIHW, 2015 [4]

Causes of hospitalisation

In 2011-13, the most common reason for the hospitalisation of Indigenous people in Australia was for ‘Care involving dialysis’, responsible for 45% of Aboriginal and Torres Strait Islander separations (334,265 separations) [4]. 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 Indigenous people, responsible for 54,079 separations (7.2% of all separations). Excluding separations for pregnancy-related conditions (most of which involved normal deliveries), the next leading causes of hospitalisation for Indigenous people were respiratory conditions (responsible for 42,209 separations) and digestive diseases (37,612 separations) (Table 15).

Table 15. Numbers, proportions (%), age-standardised rates, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios for leading causes of hospital separations, Australia, 2011-13

Principal diagnosis (ICD)

Number of separations

Proportion of separations (%)

Age-standardised separation rate

Rate ratio

Injury, poisoning and certain other consequences of external causes

54,079

7.2

45

1.8

Pregnancy, childbirth and the puerperium

44,331

5.9

58

1.3

Diseases of the respiratory system

42,209

5.6

39

2.4

Diseases of the digestive system

37,612

5.0

36

0.9

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

36,054

4.8

37

1.4

Mental and behavioural disorders

31,402

4.2

28

2.0

Diseases of the circulatory system

22,580

3.0

31

1.5

Diseases of the genitourinary system

19,735

2.6

21

1.2

Diseases of the skin and subcutaneous tissue

16,304

2.2

14

2.2

Certain infectious and parasitic diseases

12,591

1.7

10

1.7

Endocrine, nutritional and metabolic diseases

11,066

1.5

12

2.3

Other

87,586

12

91

0.7

Care involving dialysis

334,265

45

432

9.9

All causes

751,698

100

827

2.2

Note: Information for the NT is for public hospitals only

Source: AIHW, 2015 [4]

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.

From July 2011 to June 2013, potentially preventable hospitalisations accounted for 21% of all Aboriginal and Torres Strait Islander hospitalisations [6]. Rates of potentially preventable hospitalisation were around three times higher for Aboriginal and Torres Strait Islander people than those for non-Indigenous people.

In 2011-13, potentially preventable hospitalisations for chronic conditions accounted for 56% of all potentially preventable hospitalisations among Aboriginal and Torres Strait Islander people, acute conditions accounted for 41%, and vaccine-preventable conditions accounted for 4% [6]. ‘Complications from diabetes’ was the leading cause of potentially preventable hospitalisations among Aboriginal and Torres Strait Islander people with a hospitalisation rate of 41 per 1,000 which was 7.9 times higher than the non-Indigenous rate. Other potentially preventable conditions included chronic obstructive pulmonary disease (COPD), pyelonephritis, convulsions/epilepsy, congestive heart failure, ear, nose and throat infections, and oral health problems.

In 2011-13, the hospitalisation rates for all potentially preventable conditions were highest for Aboriginal and Torres Strait Islander people living in remote and very remote areas, and lowest in inner regional areas and major cities (Table 16) [6]. Rates were higher for Aboriginal and Torres Strait Islander people in all remoteness levels compared to those for their non-Indigenous counterparts which were relatively equal across remoteness classifications.

Table 16. Rates and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios for potentially preventable hospitalisations by remoteness area, Australia, 2011-13

Remoteness area

Aboriginal and Torres Strait Islander rate

Non-Indigenous rate

Rate ratio

Major cities

72

27

2.7

Inner regional

66

31

2.1

Outer regional

91

32

2.8

Remote

254

35

7.3

Very remote

118

34

3.5

Source: AIHW, 2015 [6]

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. Australian Institute of Health and Welfare (2013) Indigenous identification in hospital separations data: quality report. Canberra: Australian Institute of Health and Welfare
  3. Australian Institute of Health and Welfare (2015) Admitted patient care 2013–14: 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
  6. Australian Health Ministers' Advisory Council (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report. Canberra: Department of the Prime Minister and Cabinet

Endnotes

1. 'Separation' refers to an episode of admitted patient care, which can be either a patient's total stay in hospital, or part of a patient's stay in hospital, that results in a change to the type of care (e.g. from acute care to rehabilitation) [3]. Hospital separations are more widely known as 'admissions', but can also be referred to as 'hospitalisations'.

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

 

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    Last updated: 18 May 2016
     
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