title: Disparities in cataract surgery between Aboriginal and non-Aboriginal people in New South Wales, Australia.
abstract: BACKGROUND
  To investigate variation in rates of cataract surgery in New South Wales, Australia by area of residence for Aboriginal and non-Aboriginal adults.
  
  
  METHODS
  Observational data linkage study of hospital admissions.
  
  
  METHODS
  Two hundred eighty-nine thousand six hundred forty-six New South Wales residents aged 30 years and over admitted to New South Wales hospitals for 444,551 cataract surgery procedures between 2001 and 2008.
  
  
  METHODS
  Analysis of linked routinely collected hospital data using direct standardization and multilevel negative binomial regression models accounting for clustering of individuals within Statistical Local Areas.
  
  
  METHODS
  Age-standardized cataract surgery rates and adjusted rate ratios.
  
  
  RESULTS
  Aboriginal people had lower rates of cataract procedures than non-Aboriginal people of the same age and sex, living in the same Statistical Local Area (adjusted rate ratio 0.71, 95% confidence interval 0.68-0.75). There was significant variation in cataract surgery rates across Statistical Local Areas for both Aboriginal and non-Aboriginal people, with the disparity greater in major cities and less disadvantaged areas. Rates of surgery were lower for Aboriginal than non-Aboriginal people in most Statistical Local Areas, but in a few, the rates were similar or higher for Aboriginal people.
  
  
  CONCLUSIONS
  Aboriginal people in New South Wales received less cataract surgery than non-Aboriginal people, despite evidence of higher cataract rates. This disparity was greatest in urban and wealthier areas. Higher rates of surgery for Aboriginal people observed in some specific locations are likely to reflect the availability of public ophthalmology services, targeted services for Aboriginal people and higher demand for surgery in these populations.
authors.affiliation: Centre for Health Research, School of Medicine, University of Western Sydney, Penrith, Australia.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Randall
authors.forename: Tracie
authors.initials: T
authors.lastname: Reinten
authors.forename: Louise
authors.initials: L
authors.lastname: Maher
authors.forename: Sanja
authors.initials: S
authors.lastname: Lujic
authors.forename: Jessica
authors.initials: J
authors.lastname: Stewart
authors.forename: Lisa
authors.initials: L
authors.lastname: Keay
authors.forename: Alastair H
authors.initials: AH
authors.lastname: Leyland
authors.forename: Louisa R
authors.initials: LR
authors.lastname: Jorm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000706:statistics & numerical data*; D003625:Data Collection; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors
keywords: Aboriginal health; cataract surgery; data linkage; disadvantage