Overview
In 2004-05 Indigenous Australians were about three times as likely to be hospitalised as other Australians, in Queensland, Western Australia, South Australia and the Northern Territory combined. The quality of Indigenous hospitalisations data, the analysis of Indigenous hospitals data and the most common reasons Indigenous people are hospitalised are discussed on this page.
Quality of Indigenous hospitalisations data
The analysis of hospital separation data for Indigenous Australians is complicated by difficulties in estimating both the numbers of Indigenous Australians in hospital and the numbers in the overall population. Information about the numbers of Indigenous Australians in hospital is limited by the accuracy with which they are identified in hospital records. In some cases, Indigenous status is not recorded at all. For example, although only about 3.6% of national hospital records for 2004-05 lacked information on patients' Indigenous status, this varied considerably for each jurisdiction. In addition, hospitals may use a variety of methods to capture and record information about Indigenous status.
Some states recorded a smaller proportion of Indigenous Australians receiving hospital treatment than their proportion of the general population while others recorded a very similar proportion. While this could suggest that Indigenous Australians were either healthier, or that they were accessing other types of health services in a particular jurisdiction, the known poorer health status of the Indigenous population does not support the former conclusion. It is probable that not all Indigenous patients were identified in the hospital records of these jurisdictions. In fact, studies in a number of hospitals across Australia have indicated that records of patients' Indigenous status varied from as few as 44% complete in some hospitals, to 100% in others (Shannon et al 1997; ATSIHWIU 1999). This indicates that the number of hospital separations recorded as Indigenous is an underestimate of the true number of Indigenous hospital separations. For analytical purposes, hospital separations data from Queensland, Western Australia, South Australia and the Northern Territory should be used. In 2003-04 these four jurisdictions were assessed as having adequate coverage of the Indigenous population (approximately 60%). These four jurisdictions are not representative of other states as they have a strong coverage of more remote and less urbanised Indigenous people.
Uncertainties regarding the accuracy of methods used to gather information about Indigenous people also make it difficult to draw conclusions about changes occurring over time. Improvements in the identification of Indigenous Australians in hospital records, for example, can lead to higher apparent rates of hospitalisation. It is not currently possible to ascertain whether a rise in hospitalisation is a result of improved Indigenous identification, or whether it reflects a real increase in hospital utilisation.
Hospital separations
Hospital separation records are reported to the National Hospital Morbidity Database, and provide a count of episodes of hospital care, rather than of the numbers of patients. A 'separation record' refers to a patient's record on discharge, and includes details of diagnosis and procedures performed. A person may be admitted to, and separated from, hospital many times in a year. Each of these separations will appear in the hospital separations dataset as a separate record. Where this occurs for people with conditions such as end stage renal disease, which requires admission for dialysis treatment several times a week, many hospital separations are recorded each year for each individual patient.
In 2004-05 there were over 7 million hospital separations recorded nationally, of which 228,712 (3.3%) were for people identified as Indigenous. This proportion is greater than the representation of Indigenous people in the total Australian population (2.4%), and is indicative of the lower health status experienced by Indigenous people.
Of the 228,712 hospital separations for Aboriginal and Torres Strait Islander patients, 75% were in the four jurisdictions with reliable data (Queensland, Western Australia, South Australia and the Northern Territory). In 2004-05, 94% of Indigenous hospital separations were in public hospitals, compared with only 61% of non-Indigenous separations.
The rate of hospitalisation of Indigenous people in the four jurisdictions was 971.0 per 1,000 Indigenous population. This was 2.8 times the rate of hospitalisation of non-Indigenous people (348.1 per 1,000).
Reasons for hospitalisation
In 2004-05, the most common principal diagnosis for Indigenous people was for a group of reasons called 'Factors influencing health status and contact with health services'. The majority of these (93%) were for 'care involving dialysis' which is used in the treatment of kidney failure.
If 'care involving dialysis' were removed as a principle diagnosis, then hospital separations for Indigenous people would decrease from 2.8 times to only 1.4 times the rate of hospital separations for non-Indigenous people.
For many principal diagnoses, separations for people identified as Indigenous were higher than expected, based on the hospitalisation rates for the total Australian population. If all separations for Indigenous Australians had been correctly recorded, these ratios would, in all probability, have been higher. Despite these limitations, the data available indicate that the Indigenous population experiences a higher burden of illness and disease resulting in hospitalisation than the rest of the population.
Further information
For more general information on hospitalisations, go to Hospitals.