Hospitalisation

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Overview of the health of Indigenous people in Western Australia 2011    Introduction    Population structure    Births and pregnancy outcome    Mortality    Hospitalisation    Selected health conditions       Cardiovascular health       Cancer       Diabetes       Social and emotional wellbeing (including mental health)       Kidney health (renal disease)       Injury       Respiratory disease       Communicable diseases          Sexually transmitted infections          Hepatitis          HIV/AIDS          Other communicable diseases       Eye health       Ear health       Oral health    Health risk factors    Concluding comments

Separation rates

During 2009-10, there were 825,607 hospital separations in WA, of which 61,602 (7.5%) were identified as Indigenous [1]. The age-standardised separation rate of 1,314 separations per 1,000 for the Indigenous population was more than three times the rate of 375 per 1,000 for the non-Indigenous population. There were 334,845 overnight hospital stays recorded in WA during 2009-10, of which 21,693 (6.5%) were identified as involving Indigenous people. The age-standardised separation rate of 361 per 1,000 for overnight stays for Indigenous people was more than two times the rate of 153 for non-Indigenous people. (Information about Indigenous status in hospital records is regarded as being of acceptable quality by the Western Australian Department of Health, but data for metropolitan hospitals are considered less accurate than data from remote areas [2].) Overall, it is likely that the Australia-wide numbers and rates for Indigenous hospitalisation could be up to 25% higher.)

Age-specific separation rates

Separate detailed data are not available for WA, but for Australia in 2009-10, separation rates were higher for Indigenous people than for non-Indigenous people for virtually all age groups, with the highest differences occurring in the middle adult years (Table 6) [1].

Table 6: Age-specific hospital separation rates, by Indigenous status and sex, and Indigenous: non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2009-10

Age group	Males			Females
	Indigenous rate	Non-Indigenous rate	Rate ratio	Indigenous rate	Non-Indigenous rate	Rate ratio
Source: Derived from AIHW, 2011 [1]. Notes: Numbers include separations for which Indigenous status was not stated. Rates are expressed as separations per 1,000 population. Rate ratio is the Indigenous rate divided by the non-Indigenous rate. The 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	390	271	1.4	307	207	1.5
5-9	127	101	1.3	94	78	1.2
10-14	1018	83	1.2	94	69	1.4
15-19	155	134	1.2	330	184	1.8
20-24	230	143	1.6	575	276	2.1
25-29	281	157	1.8	616	373	1.7
30-34	379	160	2.4	656	396	1.7
35-39	714	205	3.5	695	385	1.8
40-44	950	230	4.1	989	314	3.2
45-49	1276	296	4.3	1415	334	4.2
50-54	1614	390	4.1	1842	408	4.5
55-59	2197	501	4.4	2399	467	5.1
60-64	2581	802	3.2	3281	673	4.9
65+	1822	1367	1.3	1522	1037	1.5

Causes of hospitalisation

Separate detailed data are not available for WA, but for NSW, Vic, Qld, WA, SA and the NT combined, the most common reason of hospitalisation for Indigenous people in 2009-10 was ‘factors influencing health status and contact with health services’ (largely dialysis related) accounting for 48% of Indigenous separations (145,881 separations) [1]. (Many of these separations involved repeat admissions for the same people, some on an almost daily basis.) The international classification of diseases (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, responsible for 14.3% of separations (22,701 separations) [3]. The next leading causes of hospitalisation for Indigenous people (excluding pregnancy-related conditions, most of which involved normal deliveries) were for respiratory conditions responsible for 11.5% of separations (more than 18,000) (excluding those for dialysis).

The most recent comparative information indicates that Indigenous people were hospitalised in 2007-08 at higher rates than non-Indigenous people for all major causes (Table 7). Other recent data for 2008-09, for Qld, WA, SA and public hospitals in the NT, indicate similar findings for age-standardised rates by type of long term condition (Table 8).

Table 7: Numbers and proportions of Indigenous hospital separations, by principal diagnosis (excluding dialysis), and Indigenous: non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT, 2007-08

Principal diagnosis	Number of Indigenous separations	Proportion of Indigenous separations (excl. dialysis) (%)	Rate ratio
Source: Derived from AIHW, 2009 [4]. Notes: Excludes hospitalisation for dialysis. Ratios are the standardised separation rates for Indigenous people divided by the standardised separation rates for non-Indigenous people. 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%.
Injury/poisoning	19,919	12.8	2.0
Pregnancy related	19,333	12.4	1.4
Respiratory diseases	16,601	10.6	2.9
Digestive diseases	14,325	9.2	1.0
Symptoms, signs not elsewhere classified	11,875	7.6	1.6
Mental & behavioural disorders	11,283	7.2	1.9
Circulatory diseases	8,522	5.5	1.8
Genitourinary conditions	6,533	4.2	1.2
Diseases of the skin & subcutaneous tissue	6,372	4.1	2.6
Endocrine (incl. diabetes)	5,443	3.5	3.2
Infectious/parasitic diseases	5,418	3.5	2.6
Other	30,357	19.5	-
All causes (excluding dialysis)	156,011	100.0	1.4

Table 8: Age-standardised separation rates and rate ratios, by Indigenous status and type of chronic disease, Qld, WA, SA and the NT, 2008-09

Type of long term health condition	Separation rate (per 1,000)
	Indigenous	Non-Indigenous	Rate ratio
Source: [5]. Notes: Rate ratio is the Indigenous rate divided by the non-Indigenous rate. Data for Indigenous people and for non-Indigenous people exclude separations with a principal diagnosis of renal dialysis and an additional diagnosis of diabetes. Total may not sum to the individual categories as more than one chronic condition can be reported for a separation. Data for the NT are for public hospitals only.
Angina	5.7	1.2	4.8
Asthma	4.8	1.2	4.0
Chronic obstructive pulmonary disease	11.2	2.1	5.3
Congestive heart failure	7.6	1.8	4.2
Diabetes complications	38	5.9	6.5
Hypertension	0.5	0.2	2.5
Iron deficiency anaemia	1.9	1.3	1.5
Rheumatic heart disease	0.6	0.1	6.0
Total	63	13.0	4.8

Earlier information on hospital rates for male and female Indigenous Australians is available for Qld, WA, SA and the NT combined. In 2004-05, the age-standardised rate of hospitalisation was higher for Indigenous males and females than non-Indigenous males and females for all chronic diseases, except for cancer (Table 9) [6]. For end-stage renal disease (ESRD) the rates for Indigenous males and females were 10.9 and 21.4 times higher than the rates for non-Indigenous males and females, respectively.

Table 9: Age-standardised hospitalisation rate ratios of Indigenous to non-Indigenous people, by type of chronic disease and sex, Qld, WA, SA and public hospitals in the NT, 2004-05

Type of long term health condition	Males	Females
Source: [6]. Notes: The rate ratio is calculated by dividing the Indigenous age-standardised rate by the non-Indigenous age-standardised rate. Rate ratios were calculated using 2001 Australian population data. Indigenous hospitalisation data are reported for Qld, WA, SA and the NT only. These four jurisdictions are considered to have the highest level of accuracy of Indigenous identification, although the level of accuracy varies by jurisdiction and hospital. Non-Indigenous data includes hospitalisations of people identified as not Indigenous as well as those with a ‘not stated’ Indigenous status.
Cancer	0.6	0.6
Lung cancer	1.6	1.6
Cervical cancer	-	3.4
Mental & behavioural disorders	2.1	1.4
Circulatory diseases	1.6	2.2
Ischaemic heart diseases	1.8	3.0
Stroke	1.6	2.8
Hypertension	3.6	4.2
Rheumatic heart diseases	3.9	6.8
Other
Diabetes	4.2	6.2
End-stage renal diseases	10.9	21.4
Chronic obstructive pulmonary diseases	4.9	5.9

References

1. Australian Institute of Health and Welfare (2011) Australian hospital statistics 2009-10. Canberra: Australian Institute of Health and Welfare
2. Australian Institute of Health and Welfare (2005) Australian hospital statistics 2003-04. Canberra: Australian Institute of Health and Welfare
3. Australian Institute of Health and Welfare (2010) Australian hospital statistics 2008-09. Canberra: Australian Institute of Health and Welfare
4. Australian Institute of Health and Welfare (2009) Australian hospital statistics 2007-08. Canberra: Australian Institute of Health and Welfare
5. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
6. Steering Committee for the Review of Government Service Provision (2007) Overcoming Indigenous disadvantage: key indicators 2007. Canberra: Productivity Commission

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