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Stroke among Indigenous Australians at Royal Darwin Hospital, 2001–02 

Elizabeth May Pepper, Dominique A Cadilhac, Dora C Pearce, James Burrow and Tarun S Weeramanthri
Med J Aust 2006; 184 (4): 195.
Published online: 20 February 2006

Elizabeth May Pepper,* Dominique A Cadilhac, Dora C Pearce, James Burrow,§ Tarun S Weeramanthri

* Neurology Registrar, John Hunter Hospital, Newcastle, NSW. Manager, Public Health Division; Biostatistician; National Stroke Research Institute, Melbourne, VIC. § Neurologist; ¶ Physician, Royal Darwin Hospital, NT. hornblowerATinternode.on.net

To the Editor: Although the age-standardised stroke mortality rates among Australia’s Indigenous people is more than twice that of the non-Indigenous population,1 the medical literature contains only one audit of Indigenous stroke patients in Perth metropolitan hospitals.2 No review of hospital care has been reported.

Royal Darwin Hospital (RDH) is the referral centre for Australia’s “Top End”, where 8.7% of Indigenous Australians reside; 40% of RDH inpatients are Indigenous. In 2002, while planning for the RDH stroke service, we audited stroke admissions from the previous year.

Among 121 eligible patients admitted between 1 July 2001 and 31 June 2002 with International classification of diseases, 10th revision, Australian modification (ICD-10-AM) codes 160–164 (haemorrhages [subarachnoid, intracerebral, other non-traumatic intracranial] and cerebral infarction), records for 116 (96%) were available, but six patients were excluded because of incorrect coding.

Box 1 outlines patient characteristics, while Box 2 examines risk factors and medication use for ischaemic stroke (because haemorrhages were few). Despite the observed differences between subgroups, there were no significant differences in mortality (4/36 for Indigenous v 7/42 for non-Indigenous; P = 0.204) or stroke severity at admission or discharge.

Box 3 highlights differences in risk factors between Indigenous males and females.

Retrospective data, particularly from a sample identified by medical record coding, should be interpreted with caution. In addition, the potential for random error due to small numbers, and the referral bias inherent in tertiary hospital admissions, mean our results may not truly represent the “Top End” Indigenous population. However, our data corroborate findings that Indigenous Australians suffer premature cerebrovascular disease, and have higher rates of vascular risk factors than other Australians,1 with some risk factor differences between males and females. Further, recent evidence suggests differences in standards of stroke care in regional (Queensland) hospitals.3 We found disparity in hospital care of Indigenous patients, and this requires further detailed investigation. A prospective, community-based study is urgently needed.

1 Baseline characteristics for 110 patients admitted to Royal Darwin Hospital with subarachnoid, intracerebral, and other non-traumatic intracranial haemorrhages and cerebral infarction in 2001–02

Baseline characteristics     

Indigenous

Other

P


Number of patients

45

65

Female sex

22 (49%)

19 (29%)

    0.018

Mean age (years)

54

61

    0.005

Rural dwelling

41 (91%)

22 (34%)

< 0.001

Ischaemic stroke

36 (80%)

42 (65%)

    0.081

2 Risk factors and medication use for the 78 patients who had ischaemic stroke

Risk factors and medications      

Indigenous

Other

P


All patients

36

42

Smoking

23 (64%)

11 (26%)

 0.001

Diabetes mellitus

16 (44%)

10 (24%)

 0.030

Rheumatic heart disease

  8 (22%)

 1 (2%)

< 0.001  

Males

19 (53%)

30 (71%)

 0.089

Smoking

14 (74%)

12 (40%)

 0.017

Diabetes mellitus

10 (53%)

7 (23%)

 0.030

Females

17 (47%)

12 (29%)

 0.089

Smoking

  9 (53%)

0

 0.002

Rheumatic heart disease

  6 (35%)

0

 0.026

Antiplatelet therapy

Before admission

    11 (31%)

    19 (45%)

 0.078

Admission

    20 (56%)

    38 (91%)

< 0.001  

Discharge

18/32 (56%)

29/35 (83%)

 0.013

Anticoagulant therapy

Before admission

     4 (11%)

    1 (2%)

< 0.001  

Discharge

4/32 (13%)

6/35 (17%)

 0.235

3 Risk factor differences between Indigenous males and females who had ischaemic stroke

Males

Females

P


Number of patients

19

17

Hypertension

16 (84%)

6 (35%)

0.003

Non cerebral vascular disease

  6 (32%)

1 (6%)  

< 0.001

Excessive alcohol intake

  7 (37%)

1 (6%)  

< 0.001

  • Elizabeth May Pepper2
  • Dominique A Cadilhac3
  • Dora C Pearce4
  • James Burrow4
  • Tarun S Weeramanthri4

  • 1 John Hunter Hospital, Newcastle, NSW.
  • 2 Public Health Division
  • 3 Melbourne, VIC.
  • 5 Royal Darwin Hospital, NT.


  • 1. Australian Institute of Health and Welfare. Heart, stroke and vascular diseases — Australian facts 2004. Canberra: AIHW, 2004: 140.
  • 2. Crowley P, Hankey GJ. Stroke among Australian Aboriginals in Perth WA, 1988–1992 [letter]. Aust N Z J Med 1995; 25: 55.
  • 3. Read SJ, Levy J. Differences in stroke care practices between regional and metropolitan hospitals. Intern Med J 2005; 35: 447-450.

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