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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, Tasmania (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 rates8

Of the 9.3 million hospital separations in Australia9 during 2011-12, 366,118 (4.0%) were identified as Indigenous (Table 13) [4]. Around 92% 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. Around two-fifths (38%) of separations for Indigenous patients were for overnight stays.

In 2011-12, the overall age-standardised separation rate of 973 per 1,000 for Indigenous people was 2.5 times that for non-Indigenous people (Table 13) [4]. The age-standardised separation rate for Indigenous people living in the NT (1,779 per 1,000) was 5.7 times the rate for non-Indigenous people. Around 80% of the difference between national Indigenous and non-Indigenous rates was due to higher separations for Indigenous people admitted for kidney dialysis.

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, 2011-12
JurisdictionIndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: AIHW, 2013 [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 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 72,489 614 2,658,253 350 1.8
Vic 20,459 807 2,441,124 419 1.9
Qld 88,667 839 1,813,736 404 2.1
WA 75,306 1,563 949,156 408 3.8
SA 23,366 1,162 673,929 375 3.1
NT 78,416 1,779 33,707 314 5.7
All jurisdictions 366,118 973 8,890,051 385 2.5

Age-specific separation rates

Nationally in 2011-12, hospital separation rates were higher for Indigenous people than for non-Indigenous people in all age-groups, with the highest 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, 2011-12
Age-group (years)MalesFemales
IndigenousNon-IndigenousRate ratioIndigenousNon-IndigenousRate ratio
Source: Derived from AIHW, 2013 [4], ABS, 2009 [5], ABS, 2012 [6], ABS, 2013 [7]
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
0-4 365 269 1.4 307 208 1.5
5-9 143 109 1.3 115 86 1.3
10-14 112 89 1.3 104 76 1.4
15-19 145 137 1.1 319 193 1.7
20-24 210 142 1.5 536 272 2.0
25-29 281 142 2.0 598 340 1.8
30-34 414 167 2.5 633 413 1.5
35-39 648 202 3.2 867 382 2.3
40-44 1,008 246 4.1 970 329 2.9
45-49 1,278 301 4.2 1,311 337 3.9
50-54 1,472 379 3.9 1,526 393 3.9
55-59 1,863 513 3.6 2,185 465 4.7
60-64 2,003 691 2.9 2,521 579 4.4
65+ 2,033 1,291 1.6 2,317 1,006 2.3

Causes of hospitalisation

In 2011-12, the most common reason for the hospitalisation of Indigenous people in Australia was for care involving dialysis, which was responsible for 45% of Indigenous separations (162,993 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 26,426 separations (7% of all separations, and 13% of separations excluding those for dialysis).

Excluding separations for pregnancy-related conditions (most of which involved normal deliveries), the next leading causes of hospitalisation for Indigenous people in 2011-12 were respiratory conditions (responsible for 21,265 separations; 11% of separations excluding those for dialysis) and digestive diseases (18,297 separations; 9% of separations excluding those for dialysis) (Table 15) [4].

In 2011-12, Indigenous people were hospitalised at higher rates than non-Indigenous Australians for all major causes except for neoplasms (almost entirely cancers) and diseases of the musculoskeletal system and connective tissue [4].

Table 15: Numbers and proportions (%) of leading causes of Indigenous hospital separations (excluding dialysis), and Indigenous:non-Indigenous rate ratios, Australia, 2011-12
Principal diagnosisNumber of separationsProportion (%) of separations (excluding dialysis)Rate ratio
Source: AIHW, 2013 [4]
Notes:
  1. Excludes hospitalisation for dialysis
  2. Information for the NT is for public hospitals only
  3. Rate ratio is Indigenous rate divided by the non-Indigenous rate
  4. Due to the incomplete identification of Indigenous status, these figures probably under-estimate the true difference between Indigenous and non-Indigenous rates
Injury, poisoning and certain other consequences of external causes 26,426 13 2.0
Pregnancy, childbirth and the puerperium 21,989 10.8 1.5
Diseases of the respiratory system 21,265 10.5 2.7
Diseases of the digestive system 18,297 9.0 1.0
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified 17,438 8.6 1.5
Mental and behavioural disorders 15,009 7.4 2.1
Diseases of the circulatory system 6,517 5.4 1.7
Diseases of the genitourinary system 9,387 4.6 1.2
Diseases of the skin and subcutaneous tissue 7,994 3.9 2.5
Diseases of the musculoskeletal system and connective tissue 6,880 3.4 0.9
Certain infectious and parasitic diseases 5,990 2.9 1.9
Endocrine, nutritional and metabolic diseases 5,269 2.6 2.6
Neoplasms 5,240 2.6 0.7
All causes (excluding dialysis) 203,125 100 1.3

Potentially preventable hospitalisations

Potentially preventable hospitalisations are admissions which ‘could have been avoided with access to quality primary care and preventive care’ ([8], p.4). 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.

In the two-year period from July 2008 to June 2010, there were 87,750 potentially preventable hospitalisations of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT; after age-adjustment, the Indigenous hospitalisation rate for potentially preventable admissions was 4.7 times higher than that for non-Indigenous people [9].

During 2008-10, rates for potentially preventable hospitalisations were higher for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT than for their non-Indigenous counterparts in all age-groups [9]. Indigenous:non-Indigenous rate ratios were particularly high for the 45-54 years and 55-64 years age-groups (9.6 and 9.3, respectively).

The most common causes of potentially preventable hospitalisations of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2008-10 were complications of diabetes followed by convulsions and epilepsy, and chronic obstructive pulmonary disease (Table 16) [9]. The highest Indigenous:non-Indigenous rate ratios were for: vaccine preventable conditions (rate ratio of 4.6); potentially preventable chronic conditions (7.0); and potentially preventable acute conditions (2.4).

Table 16: Numbers and age-standardised rates of top 10 diagnoses of potentially preventable hospitalisation, Indigenous people, and Indigenous:non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2008-10
Diagnosis of potentially preventable hospitalisationNumber of Indigenous admissionsIndigenous rateRate ratio
Source: AIHW, 2013 [9]
Notes:
  1. Numbers and rates for the NT are for public hospitals only
  2. Rates per 1,000 population, directly age-standardised using the 2001 Australian standard population
  3. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
Diabetes complications 41,949 79 12.2
Convulsions and epilepsy 6,404 7.2 5.2
Chronic obstructive pulmonary disease 5,675 12.5 5.0
Dental conditions 4,839 3.4 1.3
Ear, nose and throat infections 4,764 3.4 2.2
Asthma 4,112 3.6 2.1
Pyelonephritis (type of kidney disease) 4,072 6.2 2.7
Cellulitis 4,033 4.6 2.9
Dehydrations and gastroenteritis 3,515 4.2 1.5
Congestive heart failure 2,728 6.0 3.2

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 (2013) Australian hospital statistics 2011–12. Canberra: Australian Institute of Health and Welfare
  5. Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991 to 2021. Canberra: Australian Bureau of Statistics
  6. Australian Bureau of Statistics (2012) Australian demographic statistics, March quarter 2012. Canberra: Australian Bureau of Statistics
  7. Australian Bureau of Statistics (2013) Australian demographic statistics, September quarter 2012. 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. 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
  10. 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

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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