Oral Presentation 46th Annual ARA NSW-ACT Branch Meeting 2024

Public hospital utilisation for rheumatological conditions by First Nations people in Western Sydney (111488)

Jason EZ Sines 1 2 , Ryan Pieters 3 , Belinda Cashman 4 , Tony Hunter 5 , Peter KK Wong 1 6 , Ken Cai 1 6 , Nicholas Manolios 1 6
  1. Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
  2. South-West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
  3. South East Sydney Psychiatry Training Network, Sydney, NSW
  4. Aboriginal Executive Unit, Westmead Hospital, Sydney, NSW, Australia
  5. Marrin Weejali Aboriginal Corporation, Blackett, NSW, Australia
  6. Westmead Clinical School, Faculty of Medicine and Health Sciences, Sydney University, Sydney, NSW, Australia

Background: Most First Nations rheumatology research has occurred in regional/remote settings. However, there are significant First Nations populations in metropolitan areas. Western Sydney Local Health District (WSLHD) covers four Local Government Areas (LGAs): Parramatta, Blacktown, Cumberland, and the Hills. 

Aim: To characterise public hospital utilisation by First Nations people in WSLHD for five rheumatological conditions [gout, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), osteoarthritis (OA), and osteoporosis (OSP)].

Methods: All Emergency Department (ED) presentations to a WSLHD hospital with a primary diagnosis of gout, SLE, RA, OA, or OSP (including fractured femoral necks) between 1 January 2014 and 31 December 2019 were reviewed. Identification using ICD-10 codes and demographic/encounter data were extracted. Populations of the WSLHD LGAs were taken from the 2021 Census. Continuous variables were analysed using student's t-test/Mann-Whitney U test and Chi-squared testing for categorical variables. Rate of hospital utilisation was calculated using the direct method.

Results: 150/6727 encounters were by First Nations patients. First Nations patients were more likely to be male (65.3% vs 54.4%, p = 0.009) and younger (mean age: 58.2 vs 62.9 years, p < 0.001) than non-First Nations patients. Most First Nations presentations were due to gout (n = 110, 73.3%), followed by OSP complications (n = 25, 16.67%), SLE (n = 9, 6.0%) and RA (n = 6, 4.0%). First Nations people were more likely to present to Blacktown (39.3% vs 30.1%, p = 0.015) and Mount Druitt Hospital (19.3% vs 11.8%, p = 0.005). First Nations people were more likely to present with gout (73.3% vs 62.4%, p < 0.03). However, they were less likely to present with SLE (6.0% vs 11.5%, p < 0.02) and OSP complications (16.7% vs 23.3%, p = 0.03). First Nations people had a significantly shorter length of stay (LOS) (median LOS 3.08 vs 4.14 days, p = 0.03) and higher mean combined Charlson Comorbidity Index (mean CCI 1.18 vs 0.95, p = 0.02). In patients aged > 45 years, the public hospital utilisation rate was 5.0 per 1, 000 in non-First Nations people and 13.1 per 1, 000 in First Nations people. 

Discussion: This is the first study to characterise public hospital utilisation for rheumatological conditions by a metropolitan First Nations population. Public hospital utilisation by First Nations people was almost three times higher than the non-First Nations population. First Nations people had more gout presentations, and were less likely to present with SLE, OSP complications or OA.

 

  1. Sines J, Cai K, Cashman B, Abbott P, Zengin A, Manolios N, Wong PKK. The burden of rheumatologic disease in Aboriginal and Torres Strait Islander Australians. Intern Med J. 2024 Aug 13. doi: 10.1111/imj.16489. Epub ahead of print. PMID: 39136359.
  2. Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians. Canberra. 2021.
  3. Butler, L. The Indigenous population of Greater Western Sydney. 2022. WESTIR.
  4. Australian Bureau of Statistics. 2021. Blacktown: 2021 Census Aboriginal and Torres Strait Islander people QuickStats. Available at https://abs.gov.au/census/find-census-data/quickstats/2021/IARE107003
  5. Australian Bureau of Statistics. 2021 Australian Census: Community Profiles by LGA. Available at https://www.abs.gov.au/census/find-census-data/search-by-area
  6. Australian Institute of Health and Welfare. 2011. Principles on the use of direct age-standardisation in administrative data collections: for measuring the gap between Indigenous and non-Indigenous Australians. Canberra, AIHW.