Notes on the data: Aboriginal hospital admissions

Aboriginal admissions by selected principal diagnosis (including by sex and by broad age group); and from potentially preventable conditions (including by vaccine-preventable, acute and chronic, and by broad age group), 2015/16 to 2017/18

 

Policy context:  Admission to hospital is a formal process, and follows a decision made by an accredited medical practitioner at that hospital that a patient needs to be admitted for appropriate management or treatment of their condition, or for appropriate care or assessment of needs [1].

Patients are usually admitted to hospital either as an emergency or as a booked admission. Emergency admission patients are usually admitted through the Accident and Emergency Department: these are seriously injured or ill patients who need immediate treatment. Most patients receive hospital-based services as a booked (elective) admission, either as a same-day patient or an inpatient. A same-day patient comes to hospital for a test or treatment and returns home the same day. An overnight admission is recorded where a patient receives hospital treatment for a minimum of 1 night (that is, the patient is admitted to and separated from the hospital on different dates) or longer in the hospital.

The majority of people who have had an episode of care in a hospital express satisfaction with the service when they leave [1]. However, admission to hospital carries with it a risk of harm. In Australia rates of serious adverse medical events are similar to those found in studies in the United States, with 0.3% of hospital admissions associated with an iatrogenic (medically caused) death and 1.7% associated with major iatrogenic disability [2]. Admission to hospital per se also carries a risk of adverse events, in addition to those related to any medical treatment undertaken. These include a risk of cross-infection, injury, or rarely, death.

In 2014–15, Aboriginal and Torres Strait Islander people had higher separation rates than that for other Australians. Separation rates for Indigenous Australians were at least twice the rates for other Australians for Factors influencing health status and contact with health services (which includes Care involving dialysis, with 12 times the rate for other Australians); Diseases of the respiratory system, Endocrine, nutritional and metabolic diseases (which includes Diabetes mellitus); Diseases of the skin and subcutaneous tissue; and Certain infectious and parasitic diseases [1].

References

  1. Australian Institute of Health and Welfare 2016. Admitted patient care 2014–15: Australian hospital statistics. Health services series no. 68. Cat. no. HSE 172. Canberra: AIHW.
  2. Runciman WB, Webb RK, Helps SC et al. A comparison of iatrogenic injury studies in Australia and America II: reviewer behaviour and quality of care. The International Journal of Quality in Healthcare 2000;12(5):379-88.
 

Notes:  

Introduction

Where used, the terms ‘Aboriginal’ and ‘Indigenous Australians’ refer to Aboriginal and Torres Strait Islander people.

The data presented are of the number of separations, or completions of the episode of care of a patient in hospital, where the completion can be the discharge, death or transfer of the patient, or a change in the type of care (e.g., from acute to rehabilitation). In this atlas the term 'admission' is used in place of the technically-correct 'separation'. As these data relate to short-term episodes of care, and not to long-stay episodes, the number of admissions is similar to the number of separations in any year.

Potentially preventable hospitalisations are admissions from a specified range of conditions where hospitalisation could have been potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings (including by general practitioners, medical specialists, dentists, nurses and allied health professionals). Data definitions for potentially preventable hospitalisations are in the National Healthcare Agreement: PI 18-Selected potentially preventable hospitalisations, 2017 available through METeOR (METeOR ID: 630028).

Note that the data are based on the count of all admissions. As such, repeat admissions for one person are counted as separate admissions. In addition, patients admitted to one hospital and transferred to another hospital are counted as separate admissions. Although such transfers occur in all areas, they are likely to be more prevalent from regional to metropolitan areas, thereby resulting in a higher rate of admissions in regional areas compared to the metropolitan areas; in addition, certain conditions are more likely to result in transfers.

Caution should be used in the interpretation of these data because of jurisdictional differences in data quality as well as under-identification of Aboriginal and Torres Strait Islander people. The AIHW found that nationally, about 88% of Indigenous Australians were identified correctly in hospital admissions data in the 2011–12 study period, and the ‘true’ number of separations for Indigenous Australians was about 9% higher than reported (for further information see item at Reference [1], above).

Data source

There is a substantial difference between the Census counts of Aboriginal and Torres Strait Islander Australians and the estimated resident population (ERP), adjusted for net undercount as measured by the Post Enumeration Survey undertaken by the ABS (the ERP is 17.5% higher for Australia than the Census count). Given this difference, and as the ABS has not released Aboriginal ERP by age at the Indigenous Area level used in the Social Health Atlases, PHIDU has produced an estimated resident population at 2016. This is of particular importance for the calculation of rates of hospitalisation, mortality etc.

The ERP for June 2016 for Aboriginal populations is available from the ABS for Statistical Areas Level 2 (SA2, total population only): PHIDU concorded the SA2 populations to produce a 2016 ERP for each IARE (total population only). The ERP for 2016 is available by Indigenous Region (IREG), by 5-year age group. To produce estimated resident populations by age group for each IARE, PHIDU applied the proportional age distribution from the Census counts (usual resident population) in each IARE to the ERP total for the IARE.

Exclusions

The national data exclude well babies (i.e., babies not admitted for acute care) who are nine days old or less, other than the second or subsequent live born infant of a multiple birth whose mother is currently an admitted patient (for further information see item at Reference [1], above).

Same-day admissions for dialysis for kidney disease have been excluded from the data in this atlas for the categories of admissions for males, females and total persons, and admissions by age. These admissions have been excluded as they represent many repeat visits by a relatively small number of patients, who may have multiple admissions in a week: their inclusion can dramatically alter the geographic distribution of other categories of admissions (see the separate note for Same-day hospital admissions for renal dialysis, Aboriginal personsfor further details); these data are presented separately. All other same-day admissions are included.

Publishing of Queensland data by Indigenous Area

As requested by Queensland Health, the Indigenous Area (IAREs) below were combined to ensure confidentiality.

Table 1: The codes and names of Queensland Indigenous Areas which have been combined to form the adjusted Indigenous areas.
Indigenous Area Code Indigenous Area Name Indigenous Area Name - Adjusted
305001 Banana Banana - North Burnett
305008 North Burnett Banana - North Burnett
304001 Boulia - Diamantina - Winton Boulia - Diamantina - Winton - Cloncurry - McKinlay
304003 Cloncurry - McKinlay Boulia - Diamantina - Winton - Cloncurry - McKinlay
302002 Cairns Cairns - Yarrabah
302003 Cairns - Far North Coast Cairns - Yarrabah
302004 Cairns - Southern Hinterlands Cairns - Yarrabah
302011 Yarrabah Cairns - Yarrabah
305002 Barcaldine - Blackall - Longreach Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
305004 Central Capricorn Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
305007 Nebo - Clermont Central Capricorn - Barcaldine - Blackall - Longreach - Nebo - Clermont
306003 Cherbourg Murgon - Cherbourg - South Burnett
306013 South Burnett Murgon - Cherbourg - South Burnett
306009 Murgon Murgon - Cherbourg - South Burnett
301005 Esk - Kilcoy Esk - Kilcoy - Nanango - Kilkivan
306011 Nanango - Kilkivan Esk - Kilcoy - Nanango - Kilkivan
308003 Charters Towers Flinders - Richmond - Dalrymple - Charters Towers
308004 Flinders - Richmond - Dalrymple Flinders - Richmond - Dalrymple - Charters Towers
308005 Ingham - Hinchinbrook Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
302007 Innisfail - Johnstone Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
308009 Palm Island Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
308015 Tully - Cardwell - Jumbun Ingham - Hinchinbrook - Tully - Cardwell - Jumbun - Innisfail - Johnstone - Palm Island
302001 Atherton Atherton - Eacham - Herberton - Ravenshoe
302005 Eacham Atherton - Eacham - Herberton - Ravenshoe
302006 Herberton - Ravenshoe Atherton - Eacham - Herberton - Ravenshoe
302008 Kuranda - Croydon Kuranda - Croydon - Mareeba
302009 Mareeba Kuranda - Croydon - Mareeba
308006 Mackay Mackay - Sarina - Mirani
308007 Mackay - Surrounds Mackay - Sarina - Mirani
308008 Mirani Mackay - Sarina - Mirani
308011 Sarina Mackay - Sarina - Mirani
306001 Balonne Maranoa - Roma - Mitchell - Balonne
306008 Maranoa - Roma - Mitchell Maranoa - Roma - Mitchell - Balonne
306002 Bulloo - Quilpie - Barcoo Murweh - Paroo - Bulloo - Quilpie - Barcoo
306010 Murweh Murweh - Paroo - Bulloo - Quilpie - Barcoo
306012 Paroo Murweh - Paroo - Bulloo - Quilpie - Barcoo
306004 Cooloola - Gympie Noosa - Cooloola - Gympie
301011 Noosa Noosa - Cooloola - Gympie
304002 Carpentaria - Burke - Mornington Northern Peninsula Area - Cape York - Carpentaria
303001 Aurukun Northern Peninsula Area - Cape York - Carpentaria
303002 Cape York Northern Peninsula Area - Cape York - Carpentaria
303003 Cooktown Northern Peninsula Area - Cape York - Carpentaria
303004 Hope Vale Northern Peninsula Area - Cape York - Carpentaria
307001 Kaiwalagal - Inner Islands Northern Peninsula Area - Cape York - Carpentaria
307002 Kalakawal - Top Western Islands Northern Peninsula Area - Cape York - Carpentaria
307003 Kalalagal - Western Islands Northern Peninsula Area - Cape York - Carpentaria
303005 Kowanyama Northern Peninsula Area - Cape York - Carpentaria
307004 Kulkalgal - Central Islands Northern Peninsula Area - Cape York - Carpentaria
303006 Lockhart River Northern Peninsula Area - Cape York - Carpentaria
303007 Mapoon - Napranum - Weipa Northern Peninsula Area - Cape York - Carpentaria
307005 Meriam - Eastern Islands Northern Peninsula Area - Cape York - Carpentaria
303008 Northern Peninsula Area Northern Peninsula Area - Cape York - Carpentaria
303009 Pormpuraaw Northern Peninsula Area - Cape York - Carpentaria
302010 Wujal Wujal and Outstations Northern Peninsula Area - Cape York - Carpentaria
308001 Bowen (Qld) Proserpine - Whitsunday - Bowen (Qld)
308010 Proserpine - Whitsunday Proserpine - Whitsunday - Bowen (Qld)
301012 Pine Rivers Redcliffe - Pine Rivers
301013 Redcliffe Redcliffe - Pine Rivers
301001 Beaudesert - Boonah Southern Downs - Beaudesert - Boonah
306014 Southern Downs Southern Downs - Beaudesert - Boonah
301006 Gatton - Laidley Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306007 Jondaryan - Oakey Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306015 Toowoomba - Central Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306016 Toowoomba - North Toowoomba - Jondaryan - Oakey - Gatton - Laidley
306017 Toowoomba - South Toowoomba - Jondaryan - Oakey - Gatton - Laidley
308002 Burdekin - Ayr Townsville - Burdekin - Ayr
308013 Townsville Townsville - Burdekin - Ayr
308014 Townsville - Surrounds Townsville - Burdekin - Ayr
306005 Dalby Western Downs - Dalby - Goondiwindi - Stanthorpe
306006 Goondiwindi - Stanthorpe Western Downs - Dalby - Goondiwindi - Stanthorpe
306018 Western Downs Western Downs - Dalby - Goondiwindi - Stanthorpe

 

Details of data presented

Refer to separate note for Same-day hospital admissions for renal dialysis, Aboriginal persons

Separate data are presented for:

1. Admissions by sex (excluding same-day admissions for renal dialysis - (Z491 to Z492)):

  • Total admissions, Aboriginal persons
  • Male admissions, Aboriginal males
  • Female admissions, Aboriginal females

2. Admissions by age (excluding same-day admissions for renal dialysis - (Z491 to Z492)):

  • Total admissions, Aboriginal persons aged 0 to 14 years
  • Total admissions, Aboriginal persons aged 15 to 24 years
  • Total admissions, Aboriginal persons aged 25 to 44 years
  • Total admissions, Aboriginal persons aged 45 to 64 years
  • Total admissions, Aboriginal persons aged 65 years and over
  • Total admissions, Aboriginal persons aged 15 years and over

3. Admissions by selected principal diagnosis:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters.

  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons
  • Admissions for all cancers (C00-D48), Aboriginal persons
  • Admissions for blood and blood-forming organ diseases and certain disorders involving the immune mechanism (D50-D89), Aboriginal persons
  • Admissions for endocrine, nutritional and metabolic diseases (E00-E90), Aboriginal persons
    • Admissions for diabetes (E10 to E14.9), Aboriginal persons
  • Admissions for mental health related conditions (F00-F99), Aboriginal persons
    • Admissions for mood affective disorders (F30-F39), Aboriginal persons
  • Admissions for nervous system diseases (G00-G99), Aboriginal persons
  • Admissions for eye and adnexa diseases (H00-H59), Aboriginal persons
  • Admissions for ear and mastoid process diseases (H60-H95), Aboriginal persons
  • Admissions for circulatory system diseases (I00-I99), Aboriginal persons
    • Admissions for ischaemic heart disease (I20-I25), Aboriginal persons
    • Admissions for heart failure (I50), Aboriginal persons
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons
    • Admissions for asthma (J45-J46), Aboriginal persons
    • Admissions for Chronic Obstructive Pulmonary Disease (COPD) (J40-J44), Aboriginal persons
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons
  • Admissions for skin and subcutaneous tissue diseases (L00-L99), Aboriginal persons
  • Admissions for musculoskeletal system and connective tissue diseases (M00-M99), Aboriginal persons
  • Admissions for genitourinary system diseases (N00-N99), Aboriginal persons
    • Admissions for chronic kidney disease (49.0, E10.2, E11.2, E13.2, E14.2, I12, I13, I15.0, I15.1, N00-N07, N08, N11, N12, N14, N15, N16, N18, N19, N25-N28, N39.1, N39.2, E85.1, D59.3, B52.0, Q60-Q63, T82.4, T86.1), Aboriginal persons
  • Admissions for pregnancy, childbirth and the puerperium (O00-O99), Aboriginal females aged 15 to 44 years
  • Admissions for certain conditions originating in the perinatal period (P00-P96), Aboriginal persons
  • Admissions for congenital malformations, deformations and chromosomal abnormalities (Q00-Q99), Aboriginal persons
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons

4. Admissions by selected principal diagnosis and age:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters).

  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons aged 0 to 14 years
  • Admissions for infectious and parasitic diseases (A00-B99), Aboriginal persons aged 15 years and over
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons aged 0 to 14 years
  • Admissions for respiratory system diseases (J00-J99), Aboriginal persons aged 15 years and over
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons aged 0 to 14 years
  • Admissions for digestive system diseases (K00-K93), Aboriginal persons aged 15 years and over
  • Admissions for skin and subcutaneous tissue diseases (L00-L99), Aboriginal persons aged 0 to 14 years
  • Admissions for skin and subcutaneous tissue diseases (L00-L99), Aboriginal persons aged 15 years and over
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons aged 0 to 14 years
  • Admissions for injury, poisoning and other external causes (S00-T98), Aboriginal persons aged 15 years and over
5. Admissions by principal diagnosis of injury or poisoning, by external cause:

Note: Bracketed numbers below refer to codes in the International Classification of Diseases (ICD-10-AM) chapters.

  • Admissions for transport crash Injury (V00-V99), Aboriginal persons
  • Admissions for falls (W00-W19), Aboriginal persons
  • Admissions for injury due to exposure to inanimate mechanical forces (W20-W49), Aboriginal persons
  • Admissions for injury due to exposure to animate mechanical forces (W50-W64), Aboriginal persons
  • Admissions for intentional self-harm (X60-X84), Aboriginal persons
  • Admissions for assault (X85-Y09), Aboriginal persons
  • Admissions for other diagnosis of injury or poisoning, by external cause (W65-W74, X00-X19, and other reported external cause codes), Aboriginal persons
  • Admissions for all diagnosis of injury or poisoning, by external cause , Aboriginal persons
6. Same-day admissions for renal dialysis:
  • Same-day admissions for dialysis for kidney disease, Aboriginal persons
7. Admissions for potentially preventable conditions (Vaccine-preventable, Acute and Chronic conditions):
  • Admissions for potentially preventable conditions, Aboriginal persons
8. Admissions for potentially preventable conditions by age (Vaccine-preventable, Acute and Chronic conditions)
  • Admissions for potentially preventable conditions, Aboriginal persons aged 0 to 14 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 15 to 24 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 25 to 44 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 45 to 64 years
  • Admissions for potentially preventable conditions, Aboriginal persons aged 65 years and over
  • Admissions for potentially preventable conditions, Aboriginal persons aged 15 years and over
9. Admissions for potentially preventable diagnosis – Vaccine-preventable conditions:
  • Admissions for pneumonia and influenza, Aboriginal persons
  • Admissions for other vaccine-preventable conditions, Aboriginal persons
  • Admissions for total vaccine-preventable conditions, Aboriginal persons
10. Admissions for potentially preventable diagnosis – Acute conditions:
  • Admissions for acute cellulitis, Aboriginal persons
  • Admissions for acute convulsions and epilepsy, Aboriginal persons
  • Admissions for acute dental conditions, Aboriginal persons
  • Admissions for acute ear, nose and throat infections, Aboriginal persons
  • Admissions for acute urinary tract infections, including pyelonephritis, Aboriginal persons
  • Admissions for other acute conditions, Aboriginal persons
  • Admissions for total acute conditions, Aboriginal persons
11. Admissions for potentially preventable diagnosis – Chronic conditions:
  • Admissions for chronic angina, Aboriginal persons
  • Admissions for chronic asthma, Aboriginal persons
  • Admissions for chronic congestive cardiac failure, Aboriginal persons
  • Admissions for Chronic Obstructive Pulmonary Disease (COPD), Aboriginal persons
  • Admissions for chronic diabetes complications, Aboriginal persons
  • Admissions for chronic iron deficiency anaemia, Aboriginal persons
  • Admissions for other chronic conditions, Aboriginal persons
  • Admissions for total chronic conditions, Aboriginal persons

Confidentiality of data

Counts of less than five admissions have been suppressed.

Where data are published by age, and either the age groups 0 to 14 years or 15 years and over has been confidentialised, the alternate age group has also been confidentialised for the same area, as their publication would allow identification of the confidentialised age group.

 

Geography: Data available by Indigenous Area, Primary Health Networks, Indigenous Quintiles and Indigenous Remoteness Areas

 

Numerator:  Admissions for the above categories

 

Denominator:  Total Aboriginal population

 

Detail of analysis:  Indirectly age-standardised rate per 100,000 (respective population); and/or indirectly age-standardised ratio, based on the Indigenous standard population (2016).

 

Source:  Compiled by PHIDU using data from the Australian Institute of Health and Welfare, supplied on behalf of State and Territory health departments for 2015/16 to 2017/18; 2016 estimated resident population (erp) calculated by PHIDU - see Data Source above.

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