Statistics on hospitalisation provide some insights into ill-health in the population . 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 . 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 hospital data collections 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, defined as 20% or less under-identification .
Of the 8.2 million hospital separations for NSW, Vic, Qld, WA, SA and the NT6 during 2010-11, 327,435 (4.0%) were identified as Indigenous (Table 11) . Around two-fifths (39%) of separations for Indigenous patients were for overnight stays.
In 2010-11, the overall age-standardised separation rate of 911 per 1,000 for Indigenous people was 2.5 times that for non-Indigenous people (Table 11) . The age-standardised separation rate for Indigenous people living in the NT was 1,704 per 1,000, 7.9 times the rate for non-Indigenous people. About 80% of the difference between these rates was due to higher separations for Indigenous people admitted for renal dialysis.
|Source: AIHW, 2012 |
Hospital separation rates were higher for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2010-11 than for their non-Indigenous counterparts for all age-groups, with the highest ratios in the middle adult years (Table 12) .
|Indigenous rate||Non-Indigenous rate||Rate ratio||Indigenous rate||Non-Indigenous rate||Rate ratio|
|Source: Derived from AIHW, 2012 , ABS, 2009 , ABS, 2012 |
In 2010-11, the most common reason for the hospitalisation of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT was for the care involving dialysis, which was responsible for 44% of Indigenous separations (143,306 separations) . Many of these separations involved repeat admissions for the same people, some on an almost daily basis. The 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, being responsible for 24,365 separations (7.4% of all separations, and 13% 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 in 2010-11 were respiratory conditions (responsible for 19,471 separations – 11% of separations excluding those for dialysis) and digestive diseases (16,647 separations – 9.0% of separations excluding those for dialysis) (Table 13) .
In 2010-11, Indigenous people were hospitalised at higher rates than non-Indigenous Australians for all major causes except for cancer and diseases of the musculoskeletal system and connective tissue .
|Principal diagnosis||Number of separations||Proportion of separations (excluding dialysis) (%)||Rate ratio|
|Source: AIHW, 2012 , AIHW, 2012 |
|Symptoms, signs and abnormal clinical and laboratory findings||15,470||8.4||1.5|
|Mental and behavioural disorders||13,824||7.5||2.1|
|Diseases of the skin and subcutaneous tissue||7,730||4.2||2.5|
|Musculoskeletal system and connective tissue diseases||5,956||3.2||0.8|
|All causes, excluding dialysis||184,129||100||1.3|
5. '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) . Hospital separations are more widely known as 'admissions', but can also be referred to as 'hospitalisations' .