title: Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study.
abstract: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children.
  
  
  
  This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage.
  
  
  
  There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6-10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6-9.7)).
  
  
  
  We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap.
authors: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. kathleen.falster@anu.edu.au.|The Sax Institute, Sydney, Australia. kathleen.falster@anu.edu.au.|Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. kathleen.falster@anu.edu.au.
authors: Kathleen
authors: 0000-0003-2035-5485
authors: K
authors: Falster
authors: National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.|The Sax Institute, Sydney, Australia.
authors: Emily
authors: E
authors: Banks
authors: Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.|Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia.
authors: Sanja
authors: S
authors: Lujic
authors: Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.|Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia.
authors: Michael
authors: M
authors: Falster
authors: School of Public Health, University of Adelaide, Adelaide, Australia.
authors: John
authors: J
authors: Lynch
authors: Sydney Children's Hospitals Network, Sydney, Australia.|School of Women and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors: Karen
authors: K
authors: Zwi
authors: Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors: Sandra
authors: S
authors: Eades
authors: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland.
authors: Alastair H
authors: AH
authors: Leyland
authors: Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.|Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Australia.
authors: Louisa
authors: L
authors: Jorm
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016247:Information Storage and Retrieval; D008297:Male; D009517:New South Wales; D012959:Socioeconomic Factors
keywords: Avoidable hospitalisations; Child health; Indigenous health; Inequalities; Preventable hospitalisations