The contribution of geography to disparities in preventable hospitalisations between indigenous and non-indigenous Australians.

Timothy C Harrold,Louisa R Jorm,Michael O Falster,Sanja Lujic,Deborah A Randall,Keitaro Matsuo

doi:10.1371/journal.pone.0097892

Abstract

ObjectivesTo quantify the independent roles of geography and Indigenous status in explaining disparities in Potentially Preventable Hospital (PPH) admissions between Indigenous and non-Indigenous Australians.Design, setting and participantsAnalysis of linked hospital admission data for New South Wales (NSW), Australia, for the period July 1 2003 to June 30 2008.Main outcome measuresAge-standardised admission rates, and rate ratios adjusted for age, sex and Statistical Local Area (SLA) of residence using multilevel models.ResultsPPH diagnoses accounted for 987,604 admissions in NSW over the study period, of which 3.7% were for Indigenous people. The age-standardised PPH admission rate was 76.5 and 27.3 per 1,000 for Indigenous and non-Indigenous people respectively. PPH admission rates in Indigenous people were 2.16 times higher than in non-Indigenous people of the same age group and sex who lived in the same SLA. The largest disparities in PPH admission rates were seen for diabetes complications, chronic obstructive pulmonary disease and rheumatic heart disease. Both rates of PPH admission in Indigenous people, and the disparity in rates between Indigenous than non-Indigenous people, varied significantly by SLA, with greater disparities seen in regional and remote areas than in major cities.ConclusionsHigher rates of PPH admission among Indigenous people are not simply a function of their greater likelihood of living in rural and remote areas. The very considerable geographic variation in the disparity in rates of PPH admission between Indigenous and non-Indigenous people indicates that there is potential to reduce unwarranted variation by characterising outlying areas which contribute the most to this disparity.

Highlights

There is overwhelming evidence that Indigenous Australians, like indigenous peoples worldwide, suffer profound health disadvantage
This routine reporting consistently shows that ageadjusted rates of Potentially Preventable Hospital (PPH) admission are much higher in Indigenous than non-Indigenous Australians, but the magnitude of the differential varies with jurisdiction, from about three-fold in New South Wales (NSW) [11] and Queensland [10] to four-fold in the Northern Territory [9]
Over the 5-year study period, PPH diagnoses accounted for 987,604 admissions in NSW

Summary

Introduction

There is overwhelming evidence that Indigenous Australians, like indigenous peoples worldwide, suffer profound health disadvantage. Rates of PPH admissions, by Indigenous status, are reported by both state and federal governments [10,11,12,13,14] and are a key performance indicator specified in the National Healthcare Agreement (NHA), with the aim of reducing PPH admissions to 8.5% of total admissions by 2014–15 [15] This routine reporting consistently shows that ageadjusted rates of PPH admission are much higher in Indigenous than non-Indigenous Australians, but the magnitude of the differential varies with jurisdiction, from about three-fold in New South Wales (NSW) [11] and Queensland [10] to four-fold in the Northern Territory [9]. Because Indigenous people make up a greater proportion of the population in rural areas, where admission rates tend to be higher, it is possible that some of the disparity is driven by the differential distribution of the Indigenous population

Objectives

Results

Conclusion