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, and for 2005-06 was only considered acceptable for Queensland, Western Australia, South Australia and the Northern Territory [1] . Even for those jurisdictions deemed to have acceptable data, the aggregated data under-estimate the true difference between Indigenous and non-Indigenous hospitalisation, possibly by as much as 20-25%.

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Separation rates

Of the 2.86 million hospital separations for Queensland, WA, SA and the NT during 2005-06, 184,232 (6.4%) were identified as Indigenous, with 40% of separations for Indigenous patients being for overnight stays (Table 1) [1] .

The overall age-standardised separation rate of 971 per 1,000 for the Indigenous population was 2.8 times that of the non-Indigenous population (348 per 1,000) (Table 1) [1] . The age-standardised separation rate for Indigenous people living in the NT was 1,404 per 1,000, 6.0 times that rate of 234 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, Queensland, WA, SA and the NT, 2005-06

3.2
>3.2
Jurisdiction
Indigenous
Non-Indigenous
Rate ratio
 
Number
Rate
Number
Rate
 
Queensland
62,423
807
638,466
362
2.2
Western Australia
49,900
1,099
309,997
342
South Australia
16,349
924
216,832
355
2.6
Northern Territory
55,560
1,548
27,815
240
6.5
All jurisdictions
184,232
1,039
1,411,481
352
2.9

Source: AIHW, 2007 [1]

Notes:

  1. Rates per 1000 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
  5. The incomplete identification of Indigenous status means that these figures under-estimate the true difference between Indigenous and non-Indigenous rates, particularly for Queensland, WA and SA

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Age-specific separation rates

Separation rates were higher for Indigenous people living in Queensland, WA, SA and the NT in 2005-06 than for non-Indigenous people for virtually all age groups, with the highest differences in the middle adult years (Table 2) [1] .

Table 2 Age-specific hospital separation rates, by Indigenous status and sex, and Indigenous:non-Indigenous rate ratios, Queensland, WA, SA and the NT, 2005-06

Age group
Males
Females
 
Indigenous rate
Non-Indigenous rate
Rate ratio
Indigenous rate
Non-Indigenous rate
Rate ratio
0-4
375
270
1.4
175
203
1.4
5-14
105
94
1.1
331
75
1.2
15-24
181
137
1.3
529
239
1.7
25-34
337
155
2.2
688
388
1.7
35-44
923
206
4.5
1158
309
3.6
45-54
1679
308
5.4
1522
338
5.5
55-64
2288
544
4.2
1435
469
5.2
65-74
2494
903
2.8
2857
740
3.3
75+
1173
1386
1.1
1664
990
1.4

Source: Derived from AIHW, 2007 [1]

Notes:

  1. Rates per 100,000 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%

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Causes of hospitalisation

In 2005-06 the most common reason of hospitalisation for Indigenous people living in Queensland, WA, SA and the NT was ‘care involving dialysis’ accounting for 46% of Indigenous separations (more than 84,500 separations) [1] . Many of these separations involved repeat admissions for the same people, some on an almost daily basis. The ICD group ‘Injury and 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 13,819 separations (7.5% of all separations, and 13.9% 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 11,000 separations – 11.3% of separations excluding those for dialysis) and digestive diseases (more than 8,600 separations – 8.6% of separations excluding those for dialysis) (Table 3) [1] .

Separation rates were higher for Indigenous people than for non-Indigenous people for all main ICD groups except for digestive disorders.

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Table 3 Hospitalisation: leading causes of Indigenous separations (excluding dialysis): numbers, proportions of separations and Indigenous:non-Indigenous ratios, Queensland, WA, SA and the NT, 2005-06

Principal diagnosis
Number of separations
Proportion of Indigenous separations (excl dialysis)
Ratio
Injury/poisoning
13,186
13.9
2.3
Pregnancy related
12,521
12.6
1.5
Respiratory diseases
11,216
11.3
3.3
Digestive diseases
8,608
8.6
0.8
Symptoms, signs not elsewhere classified
6,947
7.0
1.8
Circulatory diseases
5,676
5.7
2.0
Mental and behavioural disorders
5,674
5.7
1.8
Diseases of the skin & subcutaneous tissue
4,468
4.5
2.8
Genitourinary diseases
4,305
4.3
1.3
Infectious/parasitic diseases
3,921
3.9
3.0
Endocrine (incl diabetes)
3,740
3.8
4.1
Other
19,302
 
-
All causes, excluding dialysis
99,564
100.0
1.4

Source: Derived from AIHW, 2007 [1]

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%

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References

1 Australian Institute of Health and Welfare (2007) Australian hospital statistics 2005-06. (AIHW catalogue no. HSE 50) Canberra: Australian Institute of Health and Welfare

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Last updated: 18 April 2008