Differential Impact of Malnutrition on Health Outcomes Among Indigenous and Non-Indigenous Adults Admitted to Hospital in Regional Australia-A Prospective Cohort Study.

Natasha Morris,Simon Stewart,Graeme Maguire,Malcolm Riley

doi:10.3390/nu10050644

Abstract

The burden of malnutrition in Indigenous people is a major health priority and this study’s aims are to understand health outcomes among Indigenous and non-Indigenous patients. This cohort study includes 608 medical inpatients in three regional hospitals. Participants were screened for malnutrition using the Subjective Global Assessment tool. Hospital length of stay, discharge destination, 30-day and six-month hospital readmission and survival were measured. Although no significant difference was observed between Indigenous participants who were malnourished or nourished (p = 0.120), malnourished Indigenous participants were more likely to be readmitted back into hospital within 30 days (Relative Risk (RR) 1.53, 95% CI 1.19–1.97, p = 0.002) and six months (RR 1.40, 95% Confidence Interval (CI) 1.05–1.88, p = 0.018), and less likely to be alive at six months (RR 1.63, 95% CI 1.20–2.21, p = 0.015) than non-Indigenous participants. Malnutrition was associated with higher mortality (Hazards Ratio (HR) 3.32, 95% CI 1.87–5.89, p < 0.001) for all participants, and independent predictors for six-month mortality included being malnourished (HR 2.10, 95% CI 1.16–3.79, p = 0.014), advanced age (HR 1.04, 95% CI 1.02–1.06, p = 0.001), increased acute disease severity (Acute Physiology and Chronic Health Evaluation score, HR 1.03, 95% CI 1.01–1.05, p = 0.002) and higher chronic disease index (Charlson Comorbidity Index, HR 1.36, 95% CI 1.16–3.79, p = 0.014). Malnutrition in regional Australia is associated with increased healthcare utilization and decreased survival. New approaches to malnutrition-risk screening, increased dietetic resourcing and nutrition programs to proactively identify and address malnutrition in this context are urgently required.

Highlights

Malnutrition is a highly prevalent problem in adult hospital patients in both low and high-income countries [1,2,3]
22 of of 10 and dispersed Australian population and presence of high-risk/vulnerable communities beyond dispersed Australian population and presence of high-risk/vulnerable communities beyond major major population centers [6,7], we recently examined the pattern and prevalence of malnutrition population centers [6,7], we recently examined the pattern and prevalence of malnutrition among a among a representative cohort of 608 inpatients admitted to three hospitals located in regional representative cohort of 608 inpatients admitted to three hospitals located in regional Australia [8]
Whyatt et al found that while inpatient length of stay in Indigenous Australian patients were similar to non-Indigenous patients, Indigenous Australians had much higher rates of Emergency

Summary

Introduction

Malnutrition is a highly prevalent problem in adult hospital patients in both low and high-income countries [1,2,3]. This is of clinical and public health significance given that recent cohort studies demonstrate a direct relationship between malnutrition and adverse health outcomes [2,4,5]. This includes increased healthcare utilization through longer lengths of hospital stay, frequent hospital admissions, and increased mortality when compared with nourished patients. We found a higher than expected prevalence of malnutrition (41.7%), which

Results

Discussion

Conclusion