Why is it important?:Hospitalisation rates indicate two main issues: the occurrence in a population of serious acute illnesses and conditions requiring inpatient hospital treatment; 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 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 three 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., conditions or complaints either coexisting or arising during care). This report focuses on the principal diagnosis for each hospitalisation. Analysis of additional diagnoses is available from the Australian Institute of Health and Welfare (AIHW). Rates of hospitalisation are also impacted by the availability of primary care services (see measure 3.06) and other alternative services.Top of page
Findings:During the two years to June 2010, there were an estimated 380,000 hospital admissions for Aboriginal and Torres Strait Islander peoples (excluding dialysis). After adjusting for differences in the age structure of the two populations, the hospitalisation rate (excluding dialysis) for Aboriginal and Torres Strait Islander peoples in the two years to June 2010 was 435 per 1,000 population compared with 305 per 1,000 population for non-Indigenous Australians (i.e., 1.4 times as high).
Hospital episodes of care involving dialysis accounted for 44% of all hospitalisations for Aboriginal and Torres Strait Islander peoples (compared with 12% for non-Indigenous Australians). The hospitalisation rate for dialysis among Indigenous Australians was 11 times the rate of non-Indigenous 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%).
In jurisdictions with adequate data quality (NSW, Victoria, Qld, WA, SA and the NT) the highest hospitalisation rates were in WA and SA (481 and 478 per 1,000 population) and the lowest in Victoria (342 per 1,000 population). Hospitalisation rates were highest in remote areas, lower in very remote areas and lowest in major cities. For non-Indigenous Australians, rates were similar across geographic areas.
Hospitalisation rates for Aboriginal and Torres Strait Islander peoples have increased significantly over both the long term (1998–99 to 2009–10 for Qld, WA, SA and the NT combined) and the short term (2004–05 to 2009–10 for NSW, Victoria, Qld, WA, SA and the NT combined). In the long-term trend, hospitalisation rate increases for non-Indigenous people have kept pace with increases in the rates for Indigenous people.
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:Top of pageIn the two-year period to June 2010, there were approximately 258,600 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 peoples are increasingly reflecting the very high and rising number of Aboriginal and Torres Strait Islander peoples with kidney failure, and the low number of Aboriginal and Torres Strait Islander patients receiving kidney transplants (see measure 1.09). Excluding dialysis, the greatest differences between hospitalisation rates for Indigenous and non-Indigenous people are for episodes of care due to injury and respiratory conditions.
The 40% higher overall 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 (see measure 1.22). Until the incidence of many health problems is reduced, hospitalisation rates for Aboriginal and Torres Strait Islander peoples are likely to increase. Reductions in hospitalisations will eventually occur through concerted action to reduce the incidence and prevalence of the underlying conditions, and in preventing or delaying 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 four years aims to assist in reducing avoidable hospitalisations of Aboriginal and Torres Strait Islander peoples 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-specific initiatives including early childhood reforms, broader health system changes, improvements in identification of Indigenous patients and measures to address the underlying social determinants of poor health.Top of page
Figure 14—Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status
Source: AIHW analysis of National Hospital Morbidity Database
Figure 15—Age-specific hospitalisation rates (excluding dialysis) by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010Top of page
Source: AIHW analysis of National Hospital Morbidity Database
Figure 16—Age-standardised hospitalisation rates by principal diagnosis and Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010Top of page
Source: AIHW analysis of National Hospital Morbidity DatabaseTop of page