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1.02 Top reasons for hospitalisation

Why is it important?

Hospitalisation rates indicate two main issues: the occurrence in a population of serious acute illnesses and conditions requiring admitted patient hospital treatment, and the access to and use of hospital admitted patient treatment by people with such conditions. 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 an illness that is serious enough 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 hospitalisations 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. 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 Australian Institute of Health and Welfare. Rates of hospitalisation are also impacted by the availability of primary care services (see measure 3.07) and other alternative services.

Findings

During the two years to June 2013, there was an estimated 453,000 hospital separations for Aboriginal and Torres Strait Islander peoples (excluding dialysis). After adjusting for differences in the age structure of the two populations, Indigenous Australians were hospitalised at 1.3 times the non-Indigenous rate.

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 10 times the rate of non-Indigenous Australians (see measure 1.10). Among Indigenous Australians, injury and poisoning was the second leading cause of hospitalisation (7%), followed by pregnancy and childbirth (6%), diseases of the respiratory system (6%) and diseases of the digestive system (5%).

Among Indigenous Australians, the highest hospitalisation rates were in the NT and WA (506 and 493 per 1,000 population) and the lowest in Tasmania (208 per 1,000 population). The difference between Indigenous and non-Indigenous hospitalisation rates was highest in the NT (248 per 1,000 population) followed by WA (148 per 1,000 population). Hospitalisation rates for Indigenous Australians were highest in remote areas (622 per 1,000), lower in very remote areas (471 per 1,000) and lowest in major cities (319 per 1,000). For non-Indigenous Australians, rates were similar across geographic areas (around 319–344 per 1,000) except in very remote areas where rates were lower (280 per 1,000). The largest gaps between rates for the two populations were in remote and very remote areas.

Hospitalisation rates for Aboriginal and Torres Strait Islander peoples increased significantly over both the long term (1998–99 to 2012–13 for Qld, WA, SA and the NT combined) and the short term (2004–05 to 2012–13 for NSW, Vic, Qld, WA, SA and the NT combined). Over the short term, rates increased faster for Indigenous Australians compared with non-Indigenous Australians, resulting in an increase in the difference between Indigenous and non-Indigenous hospitalisation rates.

Hospitalisations were higher for Aboriginal and Torres Strait Islander peoples across all age groups below 65 years. The difference was greatest in the 45–54 age group (difference of 149 separations per 1,000 population) and smallest among children aged 5–14 years (difference of 11 separations per 1,000 population). Hospitalisation rates for Indigenous Australians were highest in the 65 years and over age group. However, Indigenous rates were lower than non-Indigenous rates in this age group.

Implications

In the two-year period to June 2013, there were approximately 334,300 hospital episodes for Aboriginal and Torres Strait Islander peoples for dialysis treatment. Dialysis episodes for Aboriginal and Torres Strait Islander peoples reflect 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 who receive kidney transplants (see measure 1.10). Excluding dialysis, the greatest differences between hospitalisation rates for Indigenous and non-Indigenous Australians are for episodes of care due to injury and for respiratory conditions. The 30% 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 will not decrease. 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 primary health care.The Indigenous Australians' Health Programme, which commenced 1 July 2014, aims to assist in reducing avoidable hospitalisations of Aboriginal and Torres Strait Islander peoples by preventing and managing chronic disease through expanded access to and coordination of comprehensive primary health care. Achievement of the objectives of this programme will be influenced and supported by the successful implementation of other Indigenous-specific initiatives including early childhood reforms, broader health system changes, improvements in identifying Indigenous patients and measures to address the underlying social determinants of poor health.

Figure 1.02-1 Age-standardised hospitalisation rates (excluding dialysis) by Indigenous status 1999 to 2013
chart showing age-standardised hospitalisation rates

Figure 1.02-1 shows age-standardised hospitalisation rates (excluding dialysis) by Indigenous status (rate per 1,000 population). Data is presented for Aboriginal and Torres Strait Islander peoples in Queensland, WA, SA and NT from 1998-99 to 2012–13; Aboriginal and Torres Strait Islander peoples in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13; non-Indigenous Australians in Queensland, WA, SA and NT from 1998-99 to 2012–13; and non-Indigenous Australians in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13. Refer to the findings section of this measure for a description of key results found in this figure.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.02-2 Age-standardised hospitalisation rates (excluding dialysis) by state/territory and Indigenous status, July 2011–June 2013
chart showing age-standardised hospitalisation rates

Figure 1.02-2 shows age-standardised hospitalisation rates (excluding dialysis) by Indigenous status (rate per 1,000 population) and state/territory. After adjusting for differences in the age structure of the two populations, Indigenous Australians were hospitalised at 1.3 times the non-Indigenous rate.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.02-3 Age-standardised hospitalisation rates by principal diagnosis and Indigenous status, Australia, July 2011–June 2013
chart showing age-standardised hospitalisation rates

Figure 1.02-3 shows age-standardised hospitalisation rates by principal diagnosis and Indigenous status (rate per 1,000 population). Data is presented for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Data is presented for the following principal diagnoses: care involving dialysis; injury; respiratory system; digestive system; symptoms, signs, etc.; circulatory system; pregnancy and childbirth; mental illness; endocrine, etc.; genitourinary system; skin and subcutaneous tissue; infectious diseases; and other. Among Indigenous Australians, injury and poisoning was the second leading cause of hospitalisation (7%), followed by pregnancy and childbirth (6%), diseases of the respiratory system (6%) and diseases of the digestive system (5%).

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.02-4 Age-specific hospitalisation rates (excluding dialysis) by Indigenous status, Australia, July 2011–June 2013
chart showing age-specific hospitalisation rates

Figure 1.02-4 shows hospitalisations were higher for Aboriginal and Torres Strait Islander peoples across all age groups below 65 years. The difference was greatest in the 45–54 age group (difference of 149 separations per 1,000 population) and smallest among children aged 5–14 years (difference of 11 separations per 1,000 population). Hospitalisation rates for Indigenous Australians were highest in the 65 years and over age group. However, Indigenous rates were lower than non-Indigenous rates in this age group.

Source: AIHW analysis of National Hospital Morbidity Database