title: Australia's seizure divide - indigenous versus non-indigenous seizure hospitalization.
abstract: Indigenous Australians suffer the highest mortality and morbidity rates of any ethnic minority in the developed world. To determine if the health outcome gulf between indigenous and non-indigenous Australians also applied to seizures, we conducted a retrospective analysis of seizure hospitalization (1998-2004) based on ethnicity (indigenous (I) and non-indigenous (NI)) for four Australian jurisdictions - Northern Territory (NT), Queensland (Qld), South Australia (SA), and Western Australia (WA). Total admissions were converted to age-standardized rates (ASR) and I/NI ASR ratios (I/NIRR) and compared across multiple variables. The summed admission (combined jurisdictions over six years) was 71,185 (I=11,593 and NI=59,592). Seizure hospitalization rate was always higher in the indigenous population (six-year I/NIRR - NT=5.6, Qld=4.0, SA=6.4, and WA=10.9; combined jurisdictions=5.6). Disparity was greatest for ages 40-64years (13.8) and 15-39years (7.0) and for indigenous males (7.4). As socioeconomic status rose, non-indigenous admission rates fell (ASR=1.7 to 1.1), yet indigenous admission rates rose (ASR=7.9 to 14.0). Indigenous emergency to elective admission ratios were higher (I=27 and NI=8), as were readmissions (1.5-2 fold), self-discharge separations (I=9.4% and NI=1.4%), bed days (I/NIRR=5.1), and admissions with an additional diagnosis (I/NIRR=3.3) or procedure (I/NIRR=3.4). Indigenous Australians maintained disproportionately high rates of emergency seizure hospitalization; from 1998 to 2004, the combined jurisdiction rate was more than five times the mean non-indigenous rate. Indigenous males aged 15-64years were overrepresented. Indigenous patients had lengthier admissions but higher self-discharge and readmission rates. The socioeconomic data raise the concern that social disadvantage restricts access to hospital-based seizure care for indigenous patients.
authors.affiliation: Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia. Electronic address: chris.plummer@svhm.org.au.
authors.forename: Chris
authors.initials: C
authors.lastname: Plummer
authors.affiliation: Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cook
authors.affiliation: Murrup Barak Melbourne Institute for indigenous Development Population Health, University of Melbourne, Grattan Street, Parkville, Melbourne, Victoria 3052, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Anderson
authors.affiliation: Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia.
authors.forename: Wendyl J
authors.initials: WJ
authors.lastname: D'Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019370:Observation; D044382:Population Groups; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology* / Q000208:ethnology*; D012923:Social Class; D055815:Young Adult
keywords: Australia; Indigenous; Non-indigenous; Seizure hospitalization