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Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life

Kerry-Ann F O’Grady, Paul J Torzillo and Anne B Chang
Med J Aust 2010; 192 (10): 586-590.

Summary

Objective: To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life.

Design: A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Immunisation Register.

Participants and setting: All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age.

Main outcome measures: Incidence of ALRI and bronchiectasis (ICD-10-AM codes) and radiologically confirmed pneumonia (World Health Organization protocol).

Results: Data on 9295 infants, 8498 child-years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child-years (95% CI, 416.2–437.2). Incidence rates were two times higher (relative risk, 2.12; 95% CI, 1.98–2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6–7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child-years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child-years (95% CI, 0.60–2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI.

Conclusions: Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

  • Kerry-Ann F O’Grady1,2
  • Paul J Torzillo3
  • Anne B Chang1,4

  • 1 Menzies School of Health Research, Charles Darwin University, Darwin, NT.
  • 2 Centre for Clinical Research Excellence in Child and Adolescent Immunisation, Menzies School of Health Research and University of Melbourne, Darwin, NT.
  • 3 Royal Prince Alfred Hospital, Sydney, and University of Sydney, Sydney, NSW.
  • 4 Queensland Children’s Respiratory Centre, Queensland Children’s Medical Research Institute, Royal Children’s Hospital, Brisbane, QLD.

Correspondence: k.ogrady@uq.edu.au

Acknowledgements: 

We would like to thank the PICTURE study team: Alan Ruben, Debbie Taylor-Thomson, Peter Morris, Grant Mackenzie, Paul Bauert, Gavin Wheaton, John DeCampo, Margaret DeCampo and Jane Benson. Kerry-Ann O’Grady is funded by a National Health and Medical Research Council (NHMRC) Postdoctoral Training Fellowship in Indigenous Health.

Competing interests:

The study that led to this secondary analysis was funded by Wyeth Vaccines. Wyeth Vaccines had no role in the design, data collection, analysis and interpretation of the study, or in the writing of the article.

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