Racial disparities in infection-related mortality at Alice Springs Hospital, Central Australia, 2000--2005.
OBJECTIVE
To compare infection-related mortality rates and pathogens isolated for Indigenous and non-Indigenous adult patients at Alice Springs Hospital (ASH).


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


METHODS
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.


CONCLUSIONS
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.
Einsiedel
Lloyd J
LJ
Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia. lloyd.einsiedel@nt.gov.au
Fernandes
Liselle A
LA
Woodman
Richard J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007239:Infections / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends