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Hospitalisation

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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]. 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. 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. In comparison to a similar study conducted in 2007-2008, there had been little if any improvement to Indigenous identification in public hospital records [3]. In 2007-08, an estimated 89% of Indigenous patients were correctly identified in the records of public hospitals. Since 2007-08, there had been slight improvements to the accuracy of Indigenous identification in Qld, SA, Tas, and the NT [2]. The accuracy of Indigenous identification in NSW, Vic, WA, and the ACT had decreased between 2007-08 and 2011-12.

Separation rates10

Of the 9.4 million hospital separations in Australia11 during 2012-13, 384,638 (4.1%) were identified as Indigenous (Table 13) [4]. Around 93% of Indigenous hospital separations were of Aboriginal people, 4% were of Torres Strait Islander people, and 3% were of people who identified as being of both Aboriginal and Torres Strait Islander descent. Around two-fifths (38%) of separations for Indigenous patients were for overnight stays.

In 2012-13, the overall age-standardised separation rate of 1,038 per 1,000 for Indigenous people was 2.7 times that for non-Indigenous people (Table 13) [4]. Nationally, around 86% of the difference between Indigenous and non-Indigenous rates was due to higher separations for Indigenous people admitted for kidney dialysis. The age-standardised separation rate for Indigenous people living in the NT (1,911 per 1,000) was 5.8 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, 2012-13
JurisdictionIndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: AIHW, 2014 [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 under-estimate the true difference between Indigenous and non-Indigenous rates
NSW 78,647 678 2,720,642 358 1.9
Vic 19,280 779 2,353,554 403 1.9
Qld 94,505 917 1,883,167 420 2.2
WA 77,938 1,614 980,813 422 3.8
SA 24,092 1,233 687,823 383 3.2
NT 83,122 1,911 35,182 329 5.8
All jurisdictions 384,638 1,038 8,988,888 389 2.7

Age-specific separation rates

The most recent national information available is from 2012-13 when hospital separation rates were higher for Indigenous people than for non-Indigenous people in all age-groups, with the highest rate ratios in the middle adult years (Table 14) (Derived from [4][5][6][7]).

Table 14: Age-specific hospital separation rates, by sex and Indigenous status, and Indigenous:non-Indigenous rate ratios, Australia, 2012-2013
Age-group (years)MalesFemales
IndigenousNon-IndigenousRate ratioIndigenousNon-IndigenousRate ratio
Source: Derived from AIHW, 2014 [4], ABS, 2009 [7], ABS, 2013 [6], ABS, 2014 [5]
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
0-4 371 265 1.4 297 203 1.5
5-9 149 106 1.4 121 83 1.5
10-14 116 86 1.3 110 77 1.4
15-19 151 132 1.1 314 189 1.7
20-24 215 140 1.5 532 271 2.0
25-29 287 137 2.1 597 333 1.8
30-34 390 162 2.4 632 406 1.6
35-39 647 197 3.3 874 376 2.3
40-44 985 240 4.1 962 325 3.0
45-49 1,340 293 4.6 1,356 335 4.1
50-54 1,471 371 4.0 1,603 390 4.1
55-59 1,754 500 3.5 2,315 463 5.0
60-64 2,103 678 3.1 2,569 579 4.4
65+ 2,179 993 2.2 2,420 893 2.7

Causes of hospitalisation

In 2012-13, the most common reason for the hospitalisation of Indigenous people in Australia was for ICD ‘Factors including health status and contact with health services’ which were mostly for care involving dialysis. This diagnosis was responsible for 48% of Indigenous separations (185,289 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 27,653 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 in 2012-13 were respiratory conditions (responsible for 20,944 separations and digestive diseases (19,315 separations (Table 15) [4].

Table 15: Numbers and proportions (%) for leading causes of Indigenous hospital separations, Australia, 2012-13
Principal diagnosisNumber of separationsProportion (%) of separations (excluding dialysis)
Source: AIHW, 2014 [4]
Notes:
  1. Information for the NT are for public hospitals only
Injury, poisoning and certain other consequences of external causes 27,653 7.2
Pregnancy, childbirth and the puerperium 22,342 5.8
Diseases of the respiratory system 20,944 5.4
Diseases of the digestive system 19,315 5.0
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 18,616 4.8
Mental and behavioural disorders 16,393 4.3
Diseases of the circulatory system 11,588 3.0
Diseases of the genitourinary system 10,348 2.7
Diseases of the skin and subcutaneous tissue 8,310 2.2
Diseases of the musculoskeletal system and connective tissue 7,201 1.9
Certain infectious and parasitic diseases 6,601 1.7
Endocrine, nutritional and metabolic diseases 5,797 1.5
Neoplasms 5,394 1.4
Factors influencing health status and contact with health services 185,289 48
All causes 384,368 100

Potentially preventable hospitalisations

Potentially preventable hospitalisations are admissions which ‘could have been avoided with access to quality primary care and preventive care’ [8]. 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 2012 to June 2013, potentially preventable hospitalisations for chronic conditions accounted for 6.7% of all Indigenous hospitalisations in Australia [9]. After age-adjustment, the hospitalisation rate for potentially preventable chronic conditions was 4.3 times higher for Indigenous people than for non-Indigenous people (Table 16). The largest proportion of potentially preventable hospitalisations for chronic conditions was for diabetes complications followed by COPD. Table 16. Age-standardised rates of top five diagnoses of potentially preventable hospitalisations for chronic conditions, by Indigenous status, Australia, 2012-13

Table 16: Age-standardised rates of top five diagnoses of potentially preventable hospitalisations for chronic conditions, by Indigenous status, Australia, 2012-13
DiagnosisIndigenous rateNon-Indigenous rateRate ratio
Source: Steering Committee for the Review of Government Service Provision, 2014 [9]
Notes:
  1. Rates per 100,000 population, directly age-standardised using the 2001 Australian standard population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
Diabetes complications 4,476 731 6.1
Chronic obstructive pulmonary disease 1,119 252 4.4
Congestive heart failure 536 200 2.7
Angina 352 112 3.2
Asthma 300 162 1.9
All potentially preventable chronic conditions 6,713 1,549 4.3

In 2012-13, the age-adjusted rate for potentially preventable hospitalisations for acute conditions was 2.2 times higher for Indigenous people than for non-Indigenous people (Table 17) [9]. The majority of the Indigenous separations were due to kidney failure from bacterial infection (pyelonephritis), followed by convulsions and epilepsy.

Table 17: Age-standardised rates of top five diagnoses of potentially preventable hospitalisations for acute conditions, by Indigenous status, Australia, 2012-13
DiagnosisIndigenous rateNon-Indigenous rateRate ratio
Source: Steering Committee for the Review of Government Service Provision, 2014 [9]
Notes:
  1. Rates per 100,000 population, directly age-standardised using the 2001 Australian standard population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
Pyelonephritis 637 263 2.4
Convulsions and epilepsy 592 141 4.2
Cellulitis 465 182 2.6
Dehydration and gastroenteritis 385 266 1.4
Dental conditions 350 267 1.3
All potentially preventable acute conditions 2,931 1,349 2.2

The hospitalisation rates for all potentially preventable conditions increased with remoteness level for both Indigenous and non-Indigenous Australians [9].

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 (2010) Indigenous identification in hospital separations data-quality report. Canberra: Australian Institute of Health and Welfare
  4. Australian Institute of Health and Welfare (2014) Australian hospital statistics 2012-13. Canberra: Australian Institute of Health and Welfare
  5. Australian Bureau of Statistics (2014) Australia demographic statistics, December quarter 2013. Retrieved 19 June 2014 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Dec%202013?OpenDocument
  6. Australian Bureau of Statistics (2013) Australian demographic statistics, December quarter 2012. Retrieved 20 June 2013 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3101.0Main+Features1Dec%202012?OpenDocument
  7. Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991 to 2021. Canberra: Australian Bureau of Statistics
  8. 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
  9. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  10. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare

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) [10]. 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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