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Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000–2005

Lloyd J Einsiedel, Liselle A Fernandes and Richard J Woodman
Med J Aust 2008; 188 (10): 568-571.

Summary

Objective: To compare infection-related mortality rates and pathogens isolated for Indigenous and non-Indigenous adult patients at Alice Springs Hospital (ASH).

Design, participants and setting: Retrospective study of inhospital deaths of adults (patients aged 15 years) associated with an infection during a medical or renal admission to ASH between 1 January 2000 and 31 December 2005.

Main outcome measures: Admission- and population-based infection-related mortality rates and mortality rate ratios (MRRs) for Indigenous versus non-Indigenous adults.

Results: There were 513 deaths, of 351 Indigenous and 162 non-Indigenous patients. For Indigenous patients, 60% of deaths were infection-related, compared with 25% for non-Indigenous patients (P < 0.001). The admission-based infection-related MRR for Indigenous versus non-Indigenous adults was 2.2 (95% CI, 1.6–3.1) (15.3 v 6.8 deaths per 1000 admissions; P < 0.001). After adjusting for age and year of death, the population-based infection-related MRR was 11.3 (95% CI, 8.0–15.8) overall (351 v 35 deaths per 100 000 population; P < 0.001) and 31.5 (95% CI, 16.1–61.8) for patients aged < 60 years. The median age of patients who died with an infection was 49 (interquartile range [IQR], 38–67) years for Indigenous and 73 (IQR, 58–80) years for non-Indigenous patients (P < 0.001). For Indigenous patients, 56% of infection-related deaths were associated with bacterial sepsis, with half of these due to enteric organisms. Other deaths followed chronic hepatitis B infection, invasive fungal infections and complications of strongyloidiasis.

Conclusion: Indigenous patients at ASH are 11 times more likely than non-Indigenous patients to die with an infectious disease. This racial disparity reflects the ongoing socioeconomic disadvantage experienced by Indigenous Australians.

  • Lloyd J Einsiedel1
  • Liselle A Fernandes2
  • Richard J Woodman3

  • 1 Department of Medicine, Alice Springs Hospital, Alice Springs, NT.
  • 2 Clinical Research, Northern Territory Rural Clinical School, Alice Springs, NT.
  • 3 Department of General Practice, Flinders University, Adelaide, SA.

Correspondence: lloyd.einsiedel@nt.gov.au

Acknowledgements: 

We wish to thank Ms Jill Burgoyne for all data obtained from CARESYS and Dr Yuejen Zhao for providing regional population data. This study received funding from the Northern Territory Rural Clinical School, which is an initiative of the Australian Government Department of Health and Ageing.

Competing interests:

None identified.

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