SUMMARY
This publication presents information about the hospitalisation of people identified as Aboriginal and/or Torres Strait Islander in hospital records, as well as the procedures performed on them while in hospital. Data are from the financial year 1997-98 (the latest year for which data are currently available), from almost all public and private hospitals in Australia.
Data quality remains a critical issue in the assessment of Indigenous hospital separations and procedures. Although data from all States and Territories have been included in the analyses reported here, previous studies have shown that not all Indigenous patients are identified correctly in hospital records. As a result, the observed differences reported in this publication are under-estimates of the true differences between Indigenous males and females and their all-Australian counterparts. In addition to data quality concerns specific to the Indigenous population, there are other more general issues which may affect the quality of the data, such as the accuracy and consistency of coding of diagnoses and procedures.
Despite under-identification of Indigenous patients in hospital records, there were almost twice as many hospital separations among Indigenous people in 1997-98 as would have been expected if the Indigenous population had experienced the same hospital separation rates as the Australian population as a whole. The observed hospital separation rates were higher for the Indigenous population than for the total Australian population in every age group, with the smallest differences among people aged 5-14 years. The vast majority (about 98%) of hospital separations among people identified as Indigenous were recorded in public rather than private hospitals.
Dialysis (which is used to treat kidney failure) accounted for about 25% of all separations identified as Indigenous, and over 40% of all principal procedures performed on patients identified as Indigenous in 1997-98. There were nearly seven times as many separations for haemodialysis procedures among Indigenous males as expected based on all-Australian rates, and about 11 times as many as expected among Indigenous females.
Dialysis, pregnancy and childbirth, respiratory diseases and injury were together responsible for the majority of all hospital separations among people identified as Indigenous. There were more than the expected number of separations for these diseases and conditions as well as for mental disorders, (especially for alcohol and drug-related conditions), circulatory diseases, nervous system disorders, diseases of the skin and subcutaneous tissue, infectious and parasitic diseases, and endocrine, nutritional and metabolic disorders (especially diabetes and nutritional deficiencies).
There were also more than the expected number of several types of procedures among Indigenous males and females, such as operations on the cardiovascular system (primarily haemodialysis), obstetrical procedures, operations on the integumentary system (primarily operations on the skin), operations on the respiratory system, and some types of ‘miscellaneous diagnostic and therapeutic procedures’.
Among those admitted to hospital, however, patients identified as Indigenous were less likely than other patients to have a principal procedure recorded. This was true for almost every type of principal diagnosis and in most jurisdictions and age groups. More work is needed to determine the reasons for this disparity.
Although the apparent rates of Indigenous hospital separations varied by State and Territory and by metropolitan, rural and remote area of residence, it is likely that at least some of this difference was due to differences in the quality of identification of Indigenous patients. The patterns with respect to main reasons for hospitalisation and main types of principal procedures among patients identified as Indigenous were generally similar across jurisdictions and areas of residence.
Limitations in the quality and availability of data compromise our ability to assess changes in Indigenous hospital use over time, both in absolute terms, and relative to the rest of the Australian population. There have been strong and sustained efforts in recent years by the Australian Bureau of Statistics and the Australian Institute of Health and Welfare in partnership with other organisations, such as State and Territory agencies, Indigenous organisations and individual hospitals, to improve the identification of Indigenous people in hospital records and other administrative collections, and recent progress has been encouraging. This work will help to increase the quality and availability of data in future years.
In the meantime, it is clear, despite the recognised deficiencies of the data, that Indigenous Australians are admitted to hospital at greater rates than the rest of the Australian population. This is not surprising, given the health disadvantages faced by the Indigenous population (see, for example, ABS & AIHW 1999), but admission to hospital is determined by a complex combination of factors in addition to the need for services, such as physical, economic and cultural access to services, the existence of alternative sources of care, and the referral patterns of primary health care providers. As a result, important areas of unmet need may co-exist with higher overall rates. More work is needed in this area, but improvements in the identification of Indigenous patients are required before this can be done with any degree of precision.
