Reduction in disparity for pneumonia hospitalisations between Australian Indigenous and non-Indigenous children.
BACKGROUND
In the 1990s pneumonia hospitalisation rates in Western Australia (WA) were 13 times higher in Indigenous children than in non-Indigenous children. Rates of invasive pneumococcal disease in Indigenous children declined following the introduction in 2001 of 7-valent pneumococcal conjugate vaccine (7vPCV) in a 2-4-6 month schedule with an 18-month pneumococcal polysaccharide booster (PPV). We investigated population trends for pneumonia hospitalisations between 1996 and 2005.


METHODS
Population-based retrospective data linkage cohort study of singleton live births from 1996-2005. Hospitalisations for acute lower respiratory infections in Indigenous and non-Indigenous children less than 5 years of age were extracted and trends in age-specific incidence rates were examined using log-linear modelling.


RESULTS
From 245 249 births (7.1% Indigenous), there were 7727 pneumonia episodes. Between 1996 and 2000 and 2001 and 2005 all-cause pneumonia hospitalisations fell by 28-44% in Indigenous children aged 6-35 months with no equivalent decline in non-Indigenous children or for other acute lower respiratory infections. Incidence rate ratios for pneumonia comparing Indigenous with non-Indigenous children aged 6-11 months fell from 14.6 (95% CI 12.3 to 17.2) in 1996-2000 to 9.9 (8.4 to 11.6) in 2001-2005. Log-linear modelling showed a steady decline in Indigenous children of 9%/annum (5-12%) at age 12-23 months for all-cause pneumonia and 37%/annum (20-50%) at age 6-11 months for pneumococcal pneumonia from 1996 to 2005, including the years prior to introduction of pneumococcal vaccines.


CONCLUSIONS
Pneumonia hospitalisations and the disparity between Indigenous and non-Indigenous children has declined by a third. The unique Australian pneumococcal vaccine programme is likely to have had a significant effect but changes in socioeconomic factors have also contributed to the declines.
Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Western Australia, Australia. hannahm@ichr.uwa.edu.au
Hannah C
HC
Moore
Deborah
D
Lehmann
Nicholas
N
de Klerk
Peter
P
Jacoby
Peter C
PC
Richmond
D001315:Australia; D001988:Bronchiolitis / Q000208:ethnology; D002675:Child, Preschool; D054625:Healthcare Disparities; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D011014:Pneumonia / Q000208:ethnology*; D000095283:Australian Aboriginal and Torres Strait Islander Peoples