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Hospitalisation

Hospitalisation

Statistics on hospitalisation provide some insights into ill-health in the population [1]. 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 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]. Thus, 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 the hospital data collection is incomplete. An audit conducted by the AIHW in 2007-2008 found that NSW, Vic, Qld, WA, SA and the NT had adequate identification of Indigenous status, with 20% or less under-identification [2].

Separation rates ⁴

Of the 7.92 million hospital separations for NSW, Vic, Qld, WA, SA and the NT during 2009-10, 305,008 (3.9%) were identified as Indigenous (Table 12) [3]. Around two-fifths (39%) of separations for Indigenous patients were for overnight stays.

In 2009-10, the overall age-standardised separation rate of 898 per 1,000 for Indigenous people was 2.4 times that of other Australians (369 per 1,000) (Table 12) [3]. The age-standardised separation rate for Indigenous people living in the NT was 1,664 per 1,000, 7.9 times the rate of 211 per 1,000 for other people. About 80% of the difference between these rates was due to higher separations for Indigenous people admitted for renal dialysis.

Age-specific separation rates

Hospital separation rates were higher for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2009-10 than for non-Indigenous people for virtually all age-groups, with the highest ratios in the middle adult years (Table 13) [3].

Causes of hospitalisation

In 2009-10, the most common reason for the hospitalisation of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT was for the ICD group ‘factors influencing health status and contact with health services’, which was responsible for 48% of Indigenous separations (145,881 separations) [3]. 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 22,701 separations (7.4% of all separations, and 14.3% of separations excluding those for dialysis).

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 18,342 separations – 11.5% of separations excluding those for dialysis) and digestive diseases (14,687 separations – 9.2% of separations excluding those for dialysis) [3].

The most recent comparative information is from the two-year period from June 2006 to July 2008 which indicates that Indigenous people in NSW, Vic, Qld, WA, SA and the NT were hospitalised at higher rates than non-Indigenous Australians for all major causes except digestive diseases (Table 14) [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 (2010) Indigenous identification in hospital separations data: quality report. Canberra: Australian Institute of Health and Welfare
3. Australian Institute of Health and Welfare (2011) Australian hospital statistics 2009-10. Canberra: Australian Institute of Health and Welfare
4. Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991 to 2021. Canberra: Australian Bureau of Statistics
5. Australian Bureau of Statistics (2010) Australian demographic statistics, Dec 2009. Canberra: Australian Bureau of Statistics
6. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare

Endnote

4. ‘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’ [6][3].