Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence study of linked public hospital data

Abstract

Objectives: To determine disparities in rates, length of stay (LOS) and hospital costs of potentially preventable hospitalisations (PPH) for selected chronic conditions among Aboriginal and non-Aboriginal South Australians (SA), then examine associations with area-level socioeconomic disadvantage and remoteness.

Setting: Period prevalence study using linked, administrative public hospital records.

Participants: Participants included all SA residents in 2005-2006 to 2010-2011. Analysis focused on those individuals experiencing chronic PPH as defined by the Australian Institute of Health and Welfare.

Primary outcome measures: Number and rates (unadjusted, then adjusted for sex and age) of chronic PPH, total LOS and direct hospital costs by Aboriginality.

Results: Aboriginal SAs experienced higher risk of index chronic PPH compared with non-Aboriginals (11.5 and 6.2 per 1000 persons per year, respectively) and at younger ages (median age 48 vs 70 years). Once hospitalised, Aboriginal people experienced more chronic PPH events, longer total LOS with higher costs than non-Aboriginal people (2.6 vs 1.9 PPH per person; 11.7 vs 9.0 days LOS; at $A17 928 vs $A11 515, respectively). Compared with population average LOS, the standardised rate ratio of LOS among Aboriginal people increased by 0.03 (95% CI 0.00 to 0.07) as disadvantage rank increased and 1.04 (95% CI 0.63 to 1.44) as remoteness increased. Non-Aboriginal LOS also increased as disadvantage increased but at a lower rate (0.01 (95% CI 0.01 to 0.01)). Costs of Aboriginal chronic PPH increased by 0.02 (95% CI 0.00 to 0.06) for each increase in disadvantage and 1.18 (95% CI 0.80 to 1.55) for increased remoteness. Non-Aboriginal costs also increased as disadvantage increased but at lower rates (0.01 (95% CI 0.01 to 0.01)).

Conclusion: Aboriginal people's heightened risk of chronic PPH resulted in more time in hospital and greater cost. Systematic disparities in chronic PPH by Aboriginality, area disadvantage and remoteness highlight the need for improved uptake of effective primary care. Routine, regional reporting will help monitor progress in meeting these population needs.

Keywords: hospital costs; indigenous population; length of stay; potentially preventable hospitalisation; primary care.

Figure 1

Rate of individuals with first chronic PPH and subsequent mean of chronic PPH by age and Aboriginality, South Australian public hospitals 2005–2006 to 2010–2011. PPH, potentially preventable hospitalisations.

Figure 2

Ratio of sex and age adjusted public hospital LOS (panel A) and costs (panel B) for chronic PPH by Aboriginality, disadvantage and remoteness in SA, 2005–2006 to 2010–2011*. ARIA+, Accessibility/Remoteness Index of Australia; IRSD, Index of Relative Socioeconomic Disadvantage; LOS, length of stay; PPH, potentially preventable hospitalisations; SA, South Australia.