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Long term outcomes for Aboriginal and Torres Strait Islander Australians after hospital intensive care
Author(s) -
Mitchell William G,
Deane Adam,
Brown Alex,
Bihari Shailesh,
Wong Hao,
Ramadoss Rajaram,
Finnis Mark
Publication year - 2020
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.50649
Subject(s) - medicine , indigenous , hazard ratio , odds ratio , intensive care , demography , population , pediatrics , emergency medicine , confidence interval , intensive care medicine , environmental health , ecology , sociology , biology
Objectives To assess long term outcomes for Aboriginal and Torres Strait Islander (Indigenous) Australians admitted non‐electively to intensive care units ( ICU s). Design Data linkage cohort study; analysis of ICU patient data (Australian and New Zealand Intensive Care Society Adult Patient Database), prospectively collected during 2007–2016. Setting All four university‐affiliated level 3 ICU s in South Australia. Main outcomes Mortality (in‐hospital, and 12 months and 8 years after admission to ICU ), by Indigenous status. Results 2035 of 39 784 non‐elective index ICU admissions (5.1%) were of Indigenous Australians, including 1461 of 37 661 patients with South Australian residential postcodes. The median age of Indigenous patients (45 years; IQR , 34–57 years) was lower than for non‐Indigenous ICU patients (64 years; IQR , 47–76 years). For patients with South Australian postcodes, unadjusted mortality at discharge and 12 months and 8 years after admission was lower for Indigenous patients; after adjusting for age, sex, diabetes, severity of illness, and diagnostic group, mortality was similar for both groups at discharge (adjusted odds ratio [ aOR ], 0.95; 95% CI , 0.81–1.10), but greater for Indigenous patients at 12 months ( aOR , 1.14; 95% CI , 1.03–1.26) and 8 years (adjusted hazard ratio, 1.23; 95% CI , 1.13–1.35). The number of potential years of life lost was greater for Indigenous patients (median, 24.0; IQR , 15.8–31.8 v 12.5; IQR , 0–22.3), but, referenced to respective population life expectancies, relative survival at 8 years was similar (proportions: Indigenous, 0.78; 95% CI , 0.75–0.80; non‐Indigenous, 0.77; 95% CI , 0.76–0.78). Conclusions Adjusted long term mortality and median number of potential life years lost are higher for Indigenous than non‐Indigenous patients after intensive care in hospital. These differences reflect underlying population survival patterns rather than the effects of ICU admission.