Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.02 Top reasons for hospitalisation

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Why is it important?:

Hospitalisation rates indicate two main issues: the occurrence of serious acute illnesses and conditions requiring inpatient hospital treatment in a population; and the access to and use of hospital inpatient treatment by people with such conditions (see also measure 3.05). Hospitalisation rates for a particular disease do not directly indicate the level of occurrence of that disease in the population. For diseases that usually do not cause serious enough illness to require admission to hospital, a high level of occurrence will not be reflected in a high level of hospitalisation. Hospitalisation rates are calculated based on the number of hospital episodes rather than on the number of individual people who are hospitalised. A person who has frequent admissions for the same disease is counted multiple times in the hospitalisation rate for that disease. For example, each kidney dialysis treatment is counted as a separate hospital episode, so that each person receiving 3 dialysis treatments per week contributes approximately 150 hospital episodes per year. Therefore, it is especially important to separate hospitalisation rates for dialysis from rates for other conditions. Each hospitalisation involves a principal diagnosis (i.e. the problem that was chiefly responsible for the patient’s episode of care) and additional diagnoses where applicable (i.e. condition or complaint either coexisting or arising during care). This report focuses on the principal diagnosis for each hospitalisation. Analysis of additional diagnoses is available from http://www.aihw.gov.au. Rates of hospitalisation are also impacted by the availability of primary care services (see measure 3.06) and other alternative services.

Findings:

After adjusting for age differences, the hospitalisation rate (excluding dialysis) for Aboriginal and Torres Strait Islander peoples in the 2 years to June 2008 was 432 per 1,000 population compared with 310 per 1,000 population for other Australians (i.e. 1.4 times as high).

Hospital episodes of care involving dialysis accounted for 42% of all hospitalisations for Aboriginal and Torres Strait Islander peoples (compared with 12% for other Australians). The Indigenous hospitalisation rate for dialysis was 11 times as high as the rate for other Australians (see measure 1.09). Injury and poisoning was the second leading cause of hospitalisation (8%), followed by pregnancy and childbirth (7%), diseases of the respiratory system (6%) and diseases of the digestive system (5%). Hospitalisation rates for Aboriginal and Torres Strait Islander peoples were around 3 times as high for respiratory diseases and endocrine nutritional and metabolic diseases (including diabetes—see measure 1.08) than for non-Indigenous Australians. The key conditions for which there were more hospitalisations for Aboriginal and Torres Strait Islander peoples compared with other Australians include renal dialysis (an additional 200,000 admissions), respiratory conditions (an additional 19,000 admissions) and injury and poisoning (an additional 18,000 admissions). In jurisdictions with adequate data quality the highest rates are in Western Australia and South Australia (485 and 484 per 1,000 population) and the lowest in Victoria (298 per 1,000 population).

The Indigenous hospitalisation rate has increased significantly over the last few years and the gap has widened. Admission for dialysis was the main reason for this difference. However, once dialysis is excluded the gap is still widening.

Admissions to hospital are higher for Aboriginal and Torres Strait Islander peoples across all age groups below 65 years, although the differences are less pronounced for children aged 5–14 years.

Implications:

In the two-year period from July 2006 to June 2008, there were approximately 220,800 hospital episodes for Aboriginal and Torres Strait Islander peoples for dialysis treatment in the six jurisdictions analysed. Dialysis episodes for Aboriginal and Torres Strait Islander people are increasingly reflecting the very high and rising number of Aboriginal and Torres Strait Islander people with kidney failure, and the low number of Aboriginal and Torres Strait Islander patients receiving kidney transplants (see measure 1.09). Excluding dialysis, respiratory conditions, injury, chronic metabolic conditions (in particular diabetes), circulatory diseases and skin diseases are the conditions causing the greatest differential in hospitalisations for Aboriginal and Torres Strait Islander peoples. Hospitalisation for mental illness and childbirth are also more common for Aboriginal and Torres Strait Islander peoples than for other Australians.

The 40% higher hospitalisation rate for Aboriginal and Torres Strait Islander peoples is less than expected given the much greater occurrence of disease and injury and much higher mortality rates in this population (measure 1.22). Until the incidence of many health problems is reduced, hospitalisation rates for Indigenous Australians are likely to increase. Reductions in hospitalisation will eventually occur through concerted action to reduce incidence and prevalence of the underlying conditions, and prevent or delay complications, through more comprehensive primary health care.

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes with funding of $1.6 billion over 4 years will assist in reducing avoidable hospitalisation rates for Indigenous Australians through the prevention, early detection and management of chronic disease. This Agreement is centred on five priority areas: tackling smoking, providing a healthy transition to adulthood, making Indigenous health everyone’s business, delivering effective primary health care services and better coordinating the patient journey through the health system. Achievement of the objectives of this Agreement will be influenced and supported by the successful implementation of other Indigenous initiatives including early childhood reforms, broader health system changes and measures to address the underlying social determinants of poor health.

Figure 5 –Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08 ; NSW, Vic., Qld, WA, SA and NT, 2004–05 to 2007–08


Figure 5 –Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08 ; NSW, Vic., Qld, WA, SA and NT, 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 5 (TXT 1KB)

Figure 6 – Age-specific hospitalisation rates (excluding dialysis) by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008


Figure 6 – Age-specific hospitalisation rates (excluding dialysis) by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 6 (TXT 1KB)

Figure 7 – Age-standardised hospitalisation rates by principal diagnosis and Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008


Figure 7 – Age-standardised hospitalisation rates by principal diagnosis and Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 7 (TXT 1KB)

Figure 8 – Hospitalisation rate ratios (Aboriginal and Torres Strait Islander to other Australians) by principal diagnosis in NSW, Vic., Qld, WA, SA and NT,
July 2006–June 2008


Figure 8 – Hospitalisation rate ratios (Aboriginal and Torres Strait Islander to other Australians) by principal diagnosis in NSW, Vic., Qld, WA, SA and NT,
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 8 (TXT 1KB)

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