Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.04 Hospitalisation for pneumonia

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Why is it important?:

Aboriginal and Torres Strait Islander Australians experience considerably greater mortality and morbidity from pneumonia and invasive pneumococcal disease than other Australians. These high rates of pneumonia are associated with higher rates of common risk factors for pneumonia including infectious and chronic conditions, such as respiratory diseases; poor living conditions; malnutrition; and smoking and alcohol misuse. Young children and older age groups are most at risk. Indigenous children in the Northern Territory have rates of radiologically confirmed pneumonia that are among the highest in the world (O'Grady et al. 2010). Although hospitalisation statistics reflect admissions to hospital rather than the prevalence or incidence of pneumonia in the community, hospitalisation statistics are a measure of the occurrence of severe pneumonia requiring acute care.

Findings:

Hospitalisation for pneumonia is much more common for Aboriginal and Torres Strait Islander peoples than other Australians. In the two years between July 2006 and June 2008, there were an estimated 7,741 hospital episodes for pneumonia for Aboriginal and Torres Strait Islander people in the six jurisdictions with adequate data quality. These accounted for 2.5% of all hospitalisations for Aboriginal and Torres Strait Islander people. After adjusting for age, the hospitalisation rate for pneumonia was 4 times as high for Aboriginal and Torres Strait Islander peoples than other Australians. For other Australians, the pneumonia hospitalisation rate is high in early childhood, but very low through the adolescent to middle-adult age groups, before rising again from age 55 years. A pattern of high rates in early childhood is also seen in Aboriginal and Torres Strait Islander peoples, but rates increase again at a much younger age—from age 25 years. The greatest difference in rates occurred in the younger and older age groups.

There is wide variation in rates between the jurisdictions with adequate data quality, ranging from 5 per 1,000 in Victoria to 23 per 1,000 in the Northern Territory. The rate for other Australians is 3 per 1,000 nationally. Rates tend to be higher in jurisdictions with a higher proportion of Indigenous Australians living in remote areas.

Over the last seven years the pneumonia hospitalisation rate for Aboriginal and Torres Strait Islander peoples fell significantly. Rates for Aboriginal and Torres Strait Islander children aged 0–4 years over the same period declined significantly and the gap has narrowed.

In the period 2006–08, there were 534 notifications for invasive pneumococcal disease for Aboriginal and Torres Strait Islander peoples living in New South Wales, Victoria, Queensland, Western Australia, South Australia, Tasmania and the Northern Territory, equivalent to an age-standardised rate of 46 notifications per 100,000 persons. This compares with a rate of 6 per 100,000 persons for other Australians. Notification rates are greater across all age groups, particularly for those aged 65 years and above.

Rates of invasive pneumococcal disease in the general community have fallen since 2002, which appears to reflect the introduction and extension of pneumococcal vaccination in 2001 (see measure 3.02) (Roche et al. 2008).

Implications:

Hospitalisation rates for pneumonia have fallen, suggesting that the impact of pneumonia on Aboriginal and Torres Strait Islander peoples has reduced in recent years. This finding provides encouragement that progress is being achieved, and that further improvements are possible. It is possible that reduced pneumonia hospitalisation rates are associated with a reduction in the occurrence of this disease, possibly related to improvements in a range of factors such as overcrowded housing (see measure 2.02) and the introduction and extension of pneumococcal and influenza vaccination programs for children and adults (see measure 3.02). Improved influenza and pneumococcal vaccination coverage for the target groups within Aboriginal and Torres Strait Islander communities will be important in further reducing the burden of acute respiratory illness and death.

However, hospitalisation for pneumonia is 4 times more common for Aboriginal and Torres Strait Islander peoples than other Australians, and remains an important public health issue.

Comorbidities, poor living conditions, overcrowding, high rates of smoking, high rates of chronic disease and issues with access to health care are all likely to contribute to higher rates of pneumonia for Aboriginal and Torres Strait Islander peoples.

The large variation in hospitalisation rates between jurisdictions suggests that lower rates can be achieved. Higher rates for people living in more remote communities may partly reflect higher rates of respiratory diseases in those areas, gaps in primary care services to appropriately manage these conditions and the lack of alternatives to hospitalisation when pneumonia occurs.

Figure 11 – Age-standardised hospitalisation rates for pneumonia by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08


Figure 11 – Age-standardised hospitalisation rates for pneumonia by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 11 (TXT 1KB)

Figure 12 – Age-specific hospitalisation rates for a principal diagnosis of pneumonia, by Indigenous status and sex, NSW, Vic, Qld, WA, SA and NT, July 2006 to June 2008


Figure 12 – Age-specific hospitalisation rates for a principal diagnosis of pneumonia, by Indigenous status and sex, NSW, Vic, Qld, WA, SA and NT, July 2006 to June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 12 (TXT 1KB)

Figure 13 – Hospitalisation rates for pneumonia, Children aged 0–4 years by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08


Figure 13 – Hospitalisation rates for pneumonia, Children aged 0–4 years by Indigenous status, Qld, WA, SA and NT, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 13 (TXT 1KB)

Figure 14 – Invasive pneumococcal disease notification rate, by age group and Indigenous status, NSW, Vic., Qld, WA, SA, Tas. and NT, 2006–2008


Figure 14 – Invasive pneumococcal disease notification rate, by age group and Indigenous status, NSW, Vic., Qld, WA, SA, Tas. and NT, 2006–2008
Source: AIHW analysis of analysis of National Notifiable Disease Surveillance System
Text description of figure 14 (TXT 1KB)

Table 9 – Age-standardised hospitalisations for principal diagnosis of pneumonia for Aboriginal and Torres Strait Islander peoples by sex and jurisdiction, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008

Male
Female
Persons
Number
Rate per 1,000
Ratio
Number
Rate per 1,000
Ratio
Number
Rate per 1,000
Ratio
New South Wales
672
5.7
1.8*
651
5.9
2.4*
1,323
5.9
2.1*
Victoria
113
5.3
1.5*
94
3.9
1.5*
207
4.6
1.5*
Queensland
918
10.5
3.7*
847
8.3
3.8*
1,765
9.2
3.7*
Western Australia
915
17.5
6.6*
850
16.2
8.8*
1,765
16.9
7.7*
South Australia
220
11.2
3.6*
213
9.9
4.0*
433
10.4
3.8*
Northern Territory
1,149
25.7
7.2*
1,099
21.1
8.9*
2,248
22.9
7.6*
Australia
3,987
12
3.6*
3,754
10.1
4.2*
7,741
10.7
3.9*
Source: AIHW analysis of National Hospital Morbidity Database

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