title: Two nations: racial disparities in bloodstream infections recorded at Alice Springs Hospital, central Australia, 2001-2005.
abstract: OBJECTIVE
  To compare bloodstream infection (BSI) rates, pathogens and mortality among Indigenous and non-Indigenous adults in central Australia.
  
  
  METHODS
  Retrospective study of adult patients (aged > or = 15 years) admitted to Alice Springs Hospital (ASH) between 1 January 2001 and 31 December 2005. Patients were followed up until 30 June 2008.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia. lloyd.einsiedel@nt.gov.au
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: Einsiedel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Woodman
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies