Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012

Abstract

The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA). We conducted a retrospective cohort study of all children born in WA between 1996 and 2012 (n = 469,589). Of these, 31,348 (6.7%) were Aboriginal and 240,237 (51.2%) were boys. We report the annual age-specific hospital admission rates by geographical location and diagnostic category. We applied log-linear regression modelling to analyse changes in temporal trends of hospitalizations. Hospitalization rates for skin infections in Aboriginal children (31.7/1000 child-years; 95% confidence interval [CI] 31.0-32.4) were 15.0 times higher (95% CI 14.5-15.5; P<0.001) than those of non-Aboriginal children (2.1/1000 child-years; 95% CI 2.0-2.1). Most admissions in Aboriginal children were due to abscess, cellulitis and scabies (84.3%), while impetigo and pyoderma were the predominant causes in non-Aboriginal children (97.7%). Admissions declined with age, with the highest rates for all skin infections observed in infants. Admissions increased with remoteness. Multiple admissions were more common in Aboriginal children. Excess admissions in Aboriginal children were observed during the wet season in the Kimberley and during summer in metropolitan areas. Our study findings show that skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, with Aboriginal children at a particularly high risk. Improved community-level prevention of skin infections and the provision of effective primary care are crucial in reducing the burden of skin infection associated hospitalizations. The contribution of sociodemographic and environmental risk factors warrant further investigation.

Fig 1. Map of Western Australia.

Shows metropolitan (black), rural (white) and remote (grey) areas.

Fig 2. Skin infection hospital admission rates in children in Western Australia, 1996–2012.

Shows rates in non-Aboriginal (A & B) and Aboriginal (C & D) children. The calculated admissions included all hospital discharge records with evidence of scabies, impetigo and pyoderma, cellulitis, abscess, fungal infections, head lice and other skin infections. Note the differences in scale. In children aged 1–4 years, the admission rate of skin infection was 34.1/1000 in Aboriginal children and 2.5/1000 in non-Aboriginal children (Table 2). In Aboriginal children of this age group, significant declines were mainly seen in admissions for scabies (4.2%), impetigo and pyoderma (2.7%), and cellulitis (5.0%). Conversely, abscess increased by 2.1% in Aboriginal children (P = 0.03). In children aged 5–9 years and 10–15 years, the highest rates of admissions were for abscess, while the highest disparity in admissions between Aboriginal and non-Aboriginal was due to scabies. There were no significant changes in admission rates during the follow-up period in both these age groups.