Abstract
BackgroundAustralian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children.MethodsThis statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage.ResultsThere were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)).ConclusionsWe observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0706-7) contains supplementary material, which is available to authorized users.
Highlights
Australian Aboriginal children experience a disproportionate burden of social and health disadvantage
It is well established that Australian Aboriginal children start life with a disproportionate burden of social and health disadvantage [1,2,3]
Because of the identified need to target and monitor modifiable health gaps between Australian Aboriginal and non-Aboriginal children, we aim to quantify inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in the most populous state of Australia, New South Wales (NSW), by applying a pediatric avoidable hospitalization indicator to linked hospital data for children born between July 2000 and December 2012
Summary
Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Rates of avoidable hospitalization were originally conceived as an indicator of access to quality out-of-hospital care [9] These indicators use routinely collected hospital data and usually include a set of diagnosis and procedure codes for conditions that are considered amendable to non-hospital interventions. Australian government agencies routinely report on avoidable hospitalizations for a range of acute, chronic and vaccine-preventable conditions [10]. When it comes to children, the Australian indicator may have limited relevance because it includes a number of predominantly adult diseases [10]
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