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Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a
Kathleen Falster1,2,3, Emily Banks4,5, Sanja Lujic6,7
1National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. kathleen.falster@anu.edu.au.
Insights
Australian Aboriginal children face higher rates of avoidable hospitalizations compared to non-Aboriginal children, highlighting significant health inequities. Targeted interventions in primary care and social support are crucial to address this gap, especially in early childhood.
Area of Science:
- Pediatric health services research
- Public health and epidemiology
- Indigenous health disparities
Background:
- Australian Aboriginal children experience significant social and health disadvantages.
- Avoidable hospitalizations represent a key area for intervention and monitoring of health gaps.
- This study quantifies disparities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia.
Purpose of the Study:
- To quantify inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children.
- To analyze hospitalization rates for avoidable, ambulatory care sensitive, and non-avoidable conditions.
- To examine the influence of individual and area-level factors on these inequalities.
Main Methods:
- Statewide population-based cohort study of 1,121,440 children in New South Wales (2000-2012).
- Linked hospital data (2000-2013) to identify hospitalization rates.
- Analysis of absolute and relative inequalities using rate differences and rate ratios, adjusting for covariates.
Main Results:
- Avoidable hospitalization rates were significantly higher in Aboriginal children (90.1/1000 person-years) compared to non-Aboriginal children (44.9/1000 person-years), with an adjusted rate ratio of 1.7.
- Inequalities were most pronounced in younger children (<2 years) and persisted across different geographic locations.
- Non-avoidable hospitalization rates were nearly identical between the two groups, underscoring the preventability of the observed disparities.
Conclusions:
- Substantial inequalities in avoidable hospitalizations exist between Aboriginal and non-Aboriginal children, particularly in younger age groups.
- Policy interventions focusing on social determinants of child development and enhancing primary care access are recommended.
- Addressing these inequities is critical for improving health outcomes for Aboriginal children.
Background:
Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children.
Methods:
This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage.
Results:
There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6-10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6-9.7)).
Conclusions:
We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap.
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