Hospitalisation rates for diseases of the digestive system are lower among Indigenous peoples compared with other Australians. However, of those who are hospitalised with a disease of the digestive system, Indigenous people are less likely to have a procedure recorded than other Australians (ABS/AIHW 2008).
The aim of this study was to examine patterns of undergoing a procedure for diseases of the digestive tract once in hospital for Indigenous Australians compared with other Australians, after adjustment for a number of explanatory variables. Summary analyses were undertaken via generalised linear modelling to determine which variables were most important in terms of affecting the outcome of whether a hospitalised person underwent a procedure.
The key findings of this analysis are outlined below:
- Results from the multivariate analyses showed that Indigenous people were significantly less likely than other Australians to receive the relevant procedure for complicated and uncomplicated hernias (adjusted odds ratio (OR) 0.71) and selected diseases of the extrahepatic biliary tree (adjusted OR 0.88), after adjusting for age, sex, sector, urgency of admission, remoteness of usual residence and additional diagnoses.
- The relative odds of receiving the relevant procedure for Indigenous people compared with other Australians were not significant for appendicitis (adjusted OR 1.27) and selected non-neoplastic anorectal disease (adjusted OR 0.88). The odds for malignant neoplasms of the large intestine and rectum were only of borderline significance (adjusted OR 0.85).
- Remoteness of hospital, gender, hospital sector (public versus private), urgency of admission and most of the comorbidities were all variables that were significantly associated with whether a procedure was recorded during hospital separations involving one of the principal diagnoses chosen for analysis. In most cases, these variables had a stronger association than Indigenous status in terms of their overall influence on whether a hospital separation had a corresponding procedure recorded. Variables not controlled for in our analysis (such as disease severity, socioeconomic status, patient preferences and compliance, smoking status, level of alcohol use and cultural appropriateness of hospital services) are also likely to influence the likelihood of a hospital procedure being recorded.
- It is important that Indigenous-specific health programs, such as those aiming to improve access to hospital procedures for Indigenous patients, are implemented with understanding of the significance of broader factors, such as remoteness of hospital and hospital sector in mind. This also applies to broader health programs that are not necessarily Indigenous-specific.