Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: 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. Methods: 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. Results: 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)). Conclusions: 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

Closing the Aboriginal child injury gap: targets for injury prevention

Objective: To describe the leading mechanisms of hospitalised unintentional injury in Australian Aboriginal children and identify the injury mechanisms with the largest inequalities between Aboriginal and non-Aboriginal children. Methods: We used linked hospital and mortality data to construct a whole of population birth cohort including 1,124,717 children (1,088,645 non-Aboriginal and 35,749 Aboriginal) born in the state of New South Wales (NSW), Australia, between 1 July 2000 and 31 December 2012. Injury hospitalisation rates were calculated per person years at risk for injury mechanisms coded according to the ICD10-AM classification. Results: The leading injury mechanisms in both groups of children were falls from playground equipment. For 66 of the 69 injury mechanisms studied, Aboriginal children had a higher rate of hospitalisation compared with non-Aboriginal children. The largest relative inequalities were observed for injuries due to exposure to fire and flame, and the largest absolute inequalities for injuries due to falls from playground equipment. Conclusion: Aboriginal children in NSW experience a significant higher burden of unintentional injury compared with their non Aboriginal counterparts. Implications for Public Health: We suggest the implementation of targeted injury prevention measures aimed at injury mechanism and age groups identified in this study

Social and emotional developmental vulnerability at age five in Aboriginal and non-Aboriginal children in New South Wales: a population data linkage study

Background Early childhood social and emotional development underpins later social, emotional, academic and other outcomes. The first aim of this study was to explore the association between child, family and area-level characteristics associated with developmental vulnerability, amongst Aboriginal and non-Aboriginal children in their first year of school. The second aim was to quantify the magnitude of the social and emotional developmental inequalities between Aboriginal and non-Aboriginal children and the extent to which differences in socioeconomic disadvantage and perinatal characteristics explained this inequality. Methods This retrospective cohort study used cross-sectoral data linkage to identify and follow participants from birth to school age. In this way, social and emotional development was examined in 7,384 Aboriginal and 95,104 non-Aboriginal children who were included in the Australian Early Development Census in their first year of full-time school in New South Wales (NSW) in 2009 or 2012 and had a birth registration and/or perinatal record in NSW. The primary outcome measures were teacher-reported social competence and emotional maturity as measured using the Australian version of the Early Development Instrument. Results The mean age at the start of the school year for children in the study sample was 5.2 years (SD = 0.36 years). While 84% of Aboriginal children scored favourably - above the vulnerability threshold – for social competence and 88% for emotional maturity, Aboriginal children were twice as likely as non-Aboriginal children to be vulnerable on measures of social development (RR = 2.00; 95%CI, 1.89–2.12) and had 89% more risk of emotional vulnerability (RR = 1.89; 95%CI, 1.77–2.02). The inequality between Aboriginal and non-Aboriginal children was largely explained by differences in the socioeconomic and perinatal health characteristics of children and families. Thus, after adjusting for differences in measures of socioeconomic advantage and disadvantage (Model 2), the relative risk was attenuated to 1.31 (95% CI: 1.23–1.40) on the social competence domain and 1.24 (95% CI, 1.15–1.33) on the emotional maturity domain. Child, family and area-level characteristics associated with vulnerability were identified. Conclusions Most of the gap in early childhood social and emotional development between Aboriginal and non-Aboriginal children can be attributed to socioeconomic and early life health disadvantage. Culturally safe health and social policies addressing the socioeconomic and health inequalities experienced by Aboriginal children are urgently required.This work was supported by National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1061713) and a Financial Markets Foundation for Children (Australia) grant (2016–341). AW was supported by a NSW Health Early-Mid Career Fellowship. KF was supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). EB was supported by an NHMRC Principal Research Fellowship (#1136128). SE was supported by an NHMRC Career Development Fellowship (#1013418)

Inequalities in ventilation tube insertion procedures between Aboriginal and non-Aboriginal children in New South Wales, Australia: a data linkage study

OBJECTIVES Australian Aboriginal children experience earlier, more frequent and more severe otitis media, particularly in remote communities, than non-Aboriginal children. Insertion of ventilation tubes is the main surgical procedure for otitis media. Our aim was to quantify inequalities in ventilation tube insertion (VTI) procedures between Australian Aboriginal and non-Aboriginal children, and to explore the influence of birth characteristics, socioeconomic background and geographical remoteness on this inequality. DESIGN Retrospective cohort study using linked hospital and mortality data from July 2000 to December 2008. SETTING AND PARTICIPANTS A whole-of-population cohort of 653 550 children (16 831 Aboriginal and 636 719 non-Aboriginal) born in a New South Wales hospital between 1 July 2000 and 31 December 2007 was included in the analysis. OUTCOME MEASURE First VTI procedure. RESULTS VTI rates were lower in Aboriginal compared with non-Aboriginal children (incidence rate (IR), 4.3/1000 person-years; 95% CI 3.8 to 4.8 vs IR 5.8/1000 person-years; 95% CI 5.7 to 5.8). Overall, Aboriginal children were 28% less likely than non-Aboriginal children to have ventilation tubes inserted (age-adjusted and sex-adjusted rate ratios (RRs) 0.72; 95% CI 0.64 to 0.80). After adjusting additionally for geographical remoteness, Aboriginal children were 19% less likely to have ventilation tubes inserted (age-adjusted and sex-adjusted RR 0.81; 95% CI 0.73 to 0.91). After adjusting separately for private patient/health insurance status and area socioeconomic status, there was no significant difference (age-adjusted and sex-adjusted RR 0.96; 95% CI 0.86 to 1.08 and RR 0.93; 95% CI 0.83 to 1.04, respectively). In the fully adjusted model, there were no significant differences in VTI rates between Aboriginal and non-Aboriginal children (RR 1.06; 95% CI 0.94 to 1.19). CONCLUSIONS Despite a much higher prevalence of otitis media, Aboriginal children were less likely to receive VTI procedures than their non-Aboriginal counterparts; this inequality was largely explained by differences in socioeconomic status and geographical remoteness.This work was supported by the National Health and Medical Research Council (NHMRC; grant number 573113). KF was supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). EB was supported by an NHMRC Senior Research Fellowship (#1042717)

Developmental vulnerability at age five among children who enter and progress through the child protection system in New South Wales, Australia: a cross-sectoral data linkage study

Introduction A recent independent review of the child protection system in New South Wales (NSW), Australia, highlighted the need for whole-of-government reform to improve outcomes for children at risk of, or experiencing, maltreatment. Population-level evidence on outcomes of children who enter and progress through the child protection system is currently lacking. Objectives and Approach We aimed to quantify developmental vulnerability at age five among children who enter and progress through the child protection system during early childhood to demonstrate the value of cross-sectoral data linkage to inform and evaluate policy at a population-level. We used Australian Early Development Census (AEDC) data linked to cross-sectoral population datasets in NSW, including birth registrations, perinatal, and child protection notification and out-of-home care (OOHC) placement data. Linked AEDC data, collected in 2009 and 2012, are available for 153,670 NSW children. Socio-demographic and perinatal characteristics available in the linked data were used to characterise the population. Results 21,179 (13.9%) children had ≥1 ‘screened in’ notification, 4927 (3.2%) had ≥1 substantiated abuse and neglect notification, and 2177 (1.4%) had ≥1 OOHC placement before their fifth birthday. Indicators of disadvantage and adverse birth outcomes were more common among children who progressed to higher levels of the child protection system. The proportion developmentally vulnerable on ≥1 domains of the AEDC increased for children who entered and progressed through the child protection system; from 21% of children with no contact with child protection before age five, to 39% of children with ≥1 ‘screened in’ notification, 50% with ≥1 substantiated notification, and 54% with ≥1 OOHC placement before their fifth birthday. Comparison of findings from other Australian jurisdictions with similar data will be discussed. Conclusion/Implications This study demonstrates there is scope to improve developmental outcomes through targeted interventions among children who become known to child protection during early childhood in NSW. Moreover, it illustrates that cross-sectoral data linkage can be used to inform and evaluate policy reforms to drive better outcomes for vulnerable children

Cumulative incidence of child protection system contacts among a cohort of Western Australian Aboriginal children born 2000 to 2013

Background: Reducing the over-representation of Aboriginal children in the child protection system is a key target for the Australian government. Objective: We aimed to provide more recent evidence on the population-level cumulative incidence of contacts for Aboriginal children with child protective services (CPS) in Western Australia (WA). Participants and Setting: Linked administrative data was provided for WA CPS between 2000 and 2015 for 33,709 Aboriginal children born in WA between 2000 and 2013. Methods: Descriptive summaries and cumulative incidence estimates were used to examine changes in CPS contact trends over time and within sibling groups. Results: There was an increase in early-childhood contacts for children born more recently, with 7.6 % and 2.3 % of children born in 2000–2001 having a notification and placement in out-of-home care by age one, respectively, compared to 15.1 % and 4.3 % of children born in 2012–2013. Among sibling groups where at least one sibling had a CPS contact, approximately half of children had their first contacts on the same date as another sibling. For children born after one of their siblings had been placed in out-of-home care, 31.9 % had themselves been placed in out-of-home care by age one. Conclusions: Multiple children tend to be placed into out-of-home care when at least one sibling is, which is likely to have a significant impact on families affected. The additional risk of placement also carries over to children born after the first removal in a sibling group, highlighting the need for further support to prevent future removals

Relation of child, caregiver, and environmental characteristics to childhood injury in an urban Aboriginal cohort in New South Wales, Australia

Objective : Despite being disproportionately affected by injury, little is known about factors associated with injury in Aboriginal children. We investigated factors associated with injury among urban Aboriginal children attending four Aboriginal Community Controlled Health Services in New South Wales, Australia. Methods : We examined characteristics of caregiver-reported child injury, and calculated prevalence ratios of ‘ever-injury’ by child, family, and environmental factors. Results : Among children in the cohort, 29% (n=373/1,303) had ever broken a bone, been knocked out, required stitches or been hospitalised for a burn or poisoning; 40–78% of first injuries occurred at home and 60–91% were treated in hospital. Reported ever-injury was significantly lower (prevalence ratio ≤0.80) among children who were female, younger, whose caregiver had low psychological distress and had not been imprisoned, whose family experienced few major life events, and who hadn’t experienced alcohol misuse in the household or theft in the community, compared to other cohort members. Conclusions : In this urban Aboriginal child cohort, injury was common and associated with measures of family and community vulnerability. Implications for public health : Prevention efforts targeting upstream injury determinants and Aboriginal children living in vulnerable families may reduce child injury. Existing broad-based intervention programs for vulnerable families may present opportunities to deliver targeted injury prevention. Key words : Aboriginal child health, child injury, social determinants of health, injury prevention, Aboriginal Community Controlled Health ServicesKF is supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). EB is supported by the National Health and Medical Research Council of Australia (grant number 1042717)

Data Resource Profile: Seeding Success: a cross-sectoral data resource for early childhood health and development research in Australian Aboriginal and non-Aboriginal children

This work was supported by an Australian National Health and Medical Research Council (NHMRC) Project Grant (#1061713). K.F. was supported by an NHMRC Early Career Fellowship (#1016475) and an NHMRC capacity building grant (#573122). E.B. was supported by an NHMRC Senior Research Fellowship (#1042717). S.E. was supported by an NHMRC Career Development Fellowship (#1013418). M.B. was supported by the Manitoba Center for Health Policy Population-Based Child Health Research Award. S.G. was supported by an NHMRC Career Development Fellowship (#1082922)