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Two nations: racial disparities in bloodstream infections recorded at Alice Springs Hospital, central Australia, 2001–2005

Lloyd J Einsiedel and Richard J Woodman
Med J Aust 2010; 192 (10): 567-571.

Summary

Objective: To compare bloodstream infection (BSI) rates, pathogens and mortality among Indigenous and non-Indigenous adults in central Australia.

Design, participants and setting: Retrospective study of adult patients (aged ≥ 15 years) admitted to Alice Springs Hospital (ASH) between 1 January 2001  and 31 December 2005. Patients were followed up until 30 June 2008.

Main outcome measures: Admission-based and population-based BSI rates and mortality rates for Indigenous and non-Indigenous adults.

Results: During the study period, there were 824 BSI episodes (Indigenous, 753; non-Indigenous, 71). The admission-based BSI rate for Indigenous patients was 26.5 (95% CI, 26.4–26.6) per 1000 adult admissions, compared with 5.2 (95% CI, 5.1–5.2) per 1000 adult admissions for non-Indigenous patients (infection rate ratio [IRR], 5.13 [95% CI, 5.10–5.18]). The population-based BSI rate was 1354.7 (95% CI, 1256.3–1460.8) per 100 000 persons per year among Indigenous patients and 69.9 (95% CI, 55.1–88.6) per 100 000 persons per year among non-Indigenous patients (IRR, 19.4 [95% CI, 15.1–24.9]). These differences were not explained by higher comorbidity levels among Indigenous patients. Human T-cell lymphotropic virus type 1 and Strongyloides stercoralis infected 43% and 35%, respectively, of Indigenous patients tested. The risk of death during the follow-up period was 32.1% for Indigenous and 13.4% for non-Indigenous patients (hazard ratio [HR], 2.69 [95% CI, 1.38–5.25]; P = 0.004). Mortality rates were higher among Indigenous patients who had more than a single BSI (HR, 1.86 [95% CI, 1.32–2.62]; P < 0.001). The mean age at death was 48.5 years (SD, 16.2 years) for Indigenous patients and 75.1 years (SD, 18.7 years) for non-Indigenous patients (P < 0.001).

Conclusion: Indigenous adults living in central Australia experience BSI rates that are among the highest reported in the world. These are associated with a high risk of death, and are a likely consequence of the poor socioeconomic circumstances of Indigenous people.

  • Lloyd J Einsiedel1
  • Richard J Woodman2

  • 1 Department of Medicine, Alice Springs Hospital, Alice Springs, NT.
  • 2 Department of General Practice, Flinders University, Adelaide, SA.

Correspondence: lloyd.einsiedel@nt.gov.au

Acknowledgements: 

We wish to thank Liselle Fernandes and Sheela Joseph for providing the comorbidity data. We received funding from the Northern Territory Rural Clinical School, an initiative of the Australian Department of Health and Ageing.

Competing interests:

None identified.

  • 1. Australian Institute of Health and Welfare and Australian Bureau of Statistics. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Canberra: ABS, 2005. (AIHW Cat. No. IHW 14; ABS Cat. No. 4704.0.)
  • 2. Zhao Y, Dempsey K. Causes of inequality in life expectancy between Indigenous and non-Indigenous people in the Northern Territory, 1981–2000: a decomposition analysis. Med J Aust 2006; 184: 490-494. <MJA full text>
  • 3. Einsiedel LJ, Fernandes L, Woodman RJ. Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000–2005. Med J Aust 2008; 188: 568-571. <MJA full text>
  • 4. Torzillo PJ, Hanna JN, Morey F, et al. Invasive pneumococcal disease in central Australia. Med J Aust 1995; 162: 182-186.
  • 5. Steinfort DP, Brady S, Weisinger HS, Einsiedel L. Bronchiectasis in Central Australia: a young face to an old disease. Respir Med 2008; 102: 574-578.
  • 6. Bastian I, Hinuma Y, Doherty RR. HTLV-1 among Northern Territory Aborigines. Med J Aust 1993; 159: 12-16.
  • 7. Einsiedel L, Fernandes L. Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia. Intern Med J 2008; 38: 697-703.
  • 8. Hengge U, Currie BJ, Jager G, Schwartz RA. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis 2006; 6: 769-779.
  • 9. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546-1554.
  • 10. Douglas MW, Lum G, Roy J, et al. Epidemiology of community-acquired and nosocomial bloodstream infections in tropical Australia: a 12-month prospective study. Trop Med Int Health 2004; 9: 795-804.
  • 11. Geerdes HF, Ziegler D, Lode H, et al. Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989. Clin Infect Dis 1992; 15: 991-1002.
  • 12. Alausa KO, Montefiore D, Sogbetun AO, et al. Septicemia in the tropics. A prospective epidemiological study of 146 patients with a high case fatality rate. Scand J Infect Dis 1977; 9: 181-185.
  • 13. Chierakul W, Rajanuwong A, Wuthiekanun V, et al. The changing pattern of bloodstream infections associated with the rise in HIV prevalence in northeastern Thailand. Trans R Soc Trop Med Hyg 2004; 98: 678-686.
  • 14. Hoa NT, Diep TS, Wain J, et al. Community-acquired septicaemia in southern Viet Nam: the importance of multidrug-resistant Salmonella typhi. Trans R Soc Trop Med Hyg 1998; 92: 503-508.
  • 15. Gosbell IB, Newton PJ, Sullivan EA. Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993–1994. Aust N Z J Med 1999; 29: 684-692.
  • 16. Brun-Buisson C, Doyon F, Carlet J. Bacteraemia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals. Am J Crit Care Med 1996; 154: 617-624.
  • 17. Esper AN, Moss M, Lewis CA, et al. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med 2006; 34: 2576-2582.
  • 18. O’Brien JM, Lu B, Ali NA, et al. Alcohol dependence is independently associated with sepsis, septic shock and hospital mortality among adult intensive care unit patients. Crit Care Med 2007; 35: 345-350.
  • 19. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in diabetic patients. N Engl J Med 1999; 341: 1906-1912.
  • 20. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Occurrence and outcomes of sepsis: influence of race. Crit Care Med 2007; 35: 763-768.
  • 21. McDonald MI, Towers RJ, Andrews RM, et al. Low rates of streptococcal pharyngitis and high rates of pyoderma in Australian Aboriginal communities where acute rheumatic fever is hyperendemic. Clin Infect Dis 2006; 43: 683-689.
  • 22. Bailie RS, Stevens MR, McDonald E, et al. Skin infection, housing and social circumstances in children living in remote Indigenous communities: testing conceptual and methodological approaches. BMC Public Health 2005; 5: 128.
  • 23. McDonald E, Bailie RS, Brewster D, Morris P. Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature. BMC Public Health 2008; 8: 153-167.
  • 24. Shuval HI, Tilden RL, Perry BH, Grosse RN. Effect of investments in water supply and sanitation on health status: a threshold saturation theory. Bull World Health Organ 1981; 59: 243-248.
  • 25. Australian Department of Health and Aged Care. A National Aboriginal Health Strategy 1989. Canberra: Commonwealth of Australia, 1989 (reprinted 1996). http://www.health.gov.au/internet/main/publishing.nsf/Content/health-oatsih-pubs-NAHS1998 (accessed Apr 2010).

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