Hospitalisation

Statistics on hospitalisation provide some indication of the burden of disease in the population [1]. They are, however, a poor reflection of the extent and patterns of treatable illness in the community because they only represent the most serious illnesses, which require hospitalisation [2]. Hospitalisations are also influenced, to some extent, by the geographic accessibility of hospitals and variations in admission policies and practices for illnesses [3][4]. As is the case with other major health-related data collections (such as births and deaths), the identification of Indigenous status in hospital data collections is incomplete (see Appendix 1) [4].

Another limitation of the available hospital statistics as an indicator of the health of the population, is that they relate to episodes of hospitalisation rather than to individual patients [3][5]. Also, it is difficult to analyse patterns of care for patients hospitalised multiple times (for example for kidney dialysis) from the current national hospitalisation data [3][6].

Hospitalisation rates will be determined by advancements in the health system [2], improvements in self-identification by Aboriginal and Torres Strait Islander people [7], and reforms that tackle the social determinants of health [2].

Hospital separation rates

Of the 12.1 million hospital separations in Australia1^, 2 during 2022-23, there were 656,760 (5.4%) identified as Aboriginal and/or Torres Strait Islander (Table 1) [6]. Of these hospital separations, 91% were for Aboriginal people, 3.9% were for Torres Strait Islander people and 4.7% were for people who identified as being of both Aboriginal and Torres Strait Islander descent. Of the 656,760 hospital separations, 58% were for females and 42% for males.

In 2022-23, the overall age-standardised hospital separation rate for Aboriginal and Torres Strait Islander people was 914 per 1,000 (Table 1) [6]. The highest age-standardised hospital separation rate was for Aboriginal and Torres Strait Islander people living in the NT (2,380 per 1,000) and the lowest in NSW (499 per 1,000).

Table 1. Numbers of hospital separations and age-standardised hospital separation rates for Aboriginal and Torres Strait Islander people, by jurisdiction, 2022-23

For 2017-19, there were around 1.1 million hospital separations among Aboriginal and Torres Strait Islander people at an age-standardised rate of 925 per 1,000 population (crude rate 656 per 1,000) [2]. Dialysis accounted for 475,671 of these separations and when care involving dialysis was excluded, the age-standardised rate was 470 per 1,000 (crude rate 369 per 1,000).

Age-specific hospital separation rates

In 2017-19, age-specific hospital separation rates (excluding dialysis) for Aboriginal and Torres Strait Islander people increased with age for males (except for 0-4 year olds), with the highest rate in the 65 years and over age-group (Table 2) [2]. For females, rates increased with age (except 0-4 and 35-44 year olds), the highest rate, like their male counterparts, was in the 65 years and over age-group. For Aboriginal and Torres Strait Islander females, the rates, compared with males, were higher across all age-groups from 15 to 64 years of age.

Table 2. Age-specific hospital separation rates (excluding dialysis), by sex, Aboriginal and Torres Strait Islander people, 2017-19

Causes of hospitalisation

In 2022-23, the most common reason for the hospitalisation of Aboriginal and Torres Strait Islander people in Australia was for conditions in the ICD ‘Factors influencing health status and contact with health services’, mostly for care involving dialysis, responsible for 46% of Aboriginal and Torres Strait Islander hospital separations (301,049 of 656,760 separations) [6]. Many of these separations involved repeat admissions for the same people. The next ICD leading cause of hospitalisation for Aboriginal and Torres Strait Islander people was ‘Injury, poisoning and certain other consequences of external causes’ (including motor vehicle accidents, assaults, self-inflicted harm and falls) responsible for 43,070 hospital separations (6.6% of all separations) and ‘Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified’, responsible for 38,914 hospital separations (5.9% of all separations (Table 3).

Table 3. Numbers, proportions (%), and age-standardised hospitalisation rates for leading causes of hospital separations among Aboriginal and Torres Strait Islander people, Australia, 2022-23

Potentially preventable hospitalisations

Potentially preventable hospitalisations are admissions which ‘could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings’ [8]. Rates for potentially preventable hospitalisations, including those for chronic conditions, acute conditions and vaccine preventable conditions, may be used as an indirect measure of problems with access to care and effective primary care [9].

In 2022-23, the age-standardised rate of overall potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people was 66 per 1,000 [6]. The highest rates for potentially preventable hospitalisations of Aboriginal and Torres Strait Islander people were for chronic conditions: 31 per 1,000 (including 6.8 per 1,000 for diabetes complications) and acute conditions (28 per 1,000). The rate for vaccine preventable conditions was 9.5 per 1,000. Information by jurisdiction (Table 4) reveals that the NT had the highest rate for potentially preventable hospitalisations of 139 per 1,000, followed by WA of 86 per 1,000.

Table 4. Age-standardised hospital separation rates for selected potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people, by condition type, by jurisdiction, all hospitals, 2022-23

For 2022-23, age-standardised potentially preventable hospitalisation rates by remoteness indicated that vaccine preventable conditions, acute conditions and chronic conditions all experienced the highest rates in a remote setting (27, 47and 52 per 1,000 respectively) (Table 5) [6]. When comparing between condition types and remoteness settings, vaccine preventable conditions had the greatest difference in rates between settings, with the rate for remote areas 4.1 times the rate for major cities (27 per 1,000 compared with 6.6 per 1,000 respectively) and 3.9 times the rate for regional areas (27 per 1,000 compared with 6.9 per 1,000 respectively).

Table 5. Age-standardised hospital separation rates for potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people, by condition type, by remoteness, 2022-23

Footnotes

2 273,440 (2.3%) had no Indigenous status reported [6].