Table 3 Reports
From: Heart failure among Indigenous Australians: a systematic review
Author(s)/year | Population and Calendar period | Methods | Key findings pertinent to heart failure | Validity and generalizability issues (including Indigenous identification) |
|---|---|---|---|---|
1. Prevalence or incidence, either population-based or within clinical groups or clinical service settings | ||||
NATSIHS Survey reported in Penm (2008) [33] | Whole of Australia Indigenous population (Residents in Very Remote areas not included in non-Indigenous NHS comparator group) | Design: | Standardised prevalence ratio of HF among Indigenous Australians 1.7 (males 1.9; females 1.6) | • Ascertainment of HF based on self-report; conflated with self-report of oedema. |
Cross-sectional survey | ||||
Data source: questionnaire of persons usually resident in private dwellings | ||||
• Comparator non-Indigenous data excluded subjects in Very Remote areas. | ||||
Period: August 2004 to July 2005 | Outcome: Self-reported health problems | • Low precision of SPR estimate, especially for males | ||
• Indigenous status according to self-identification in Census | ||||
2. Aetiology, risk factors, clinical presentation and pathophysiology | ||||
Nil | ||||
3. Co-morbidities | ||||
Nil | ||||
4. Mortality & survival | ||||
Field (2003) [34] | SA, Qld, WA, NT population | Design: Descriptive study | Indigenous HF mortality rates almost threefold higher than non-Indigenous. Disproportionately high HF mortality among Indigenous males aged 55–64 years. | • Rates calculated for population aged ≥45 years only |
Data source: Administrative data (NMD) | ||||
• Inter-jurisdictional variation in Indigenous identification data quality | ||||
Period: 1995–96 to 1997–98 and 1998–99 to 2000-01 | Outcome: Deaths | |||
• Inherent shortcomings of HF identification on death certificates | ||||
Penm (2008) [33] | SA, Qld, WA, NT population | Design: Descriptive study | Age-adjusted Indigenous HF mortality rates more than double non-Indigenous rates. | • Inter-jurisdictional variation in Indigenous identification data quality |
Period: 2002-05 | Data source: Administrative data (NMD) | In 45–64 year age-group, mortality rate ratio 6.4. | ||
• Inherent shortcomings of HF identification on death certificates | ||||
Outcome: Deaths | ||||
5. Quality of life | ||||
Nil | ||||
6. Therapeutic interventions | ||||
Nil | ||||
7. Health service utilisation (including medication adherence, outpatient attendances, hospitalisations, cardiac rehabilitation) | ||||
(a) Primary care attendances | ||||
BEACH Survey reported in AIHW (2008) [35] | GP practices Australia-wide | Design: Cross-sectional survey | Crude proportion of HF encounters lower among Indigenous (1.0/100, CI 0.6-1.3) than non-Indigenous patients (0.7, CI 0.7-0.8) | • Data difficult to interpret: not person-based (cannot identify recurrent attendances for the same person), estimates conflate differences in underlying morbidity with differences in service access and utilisation |
Period: 2002–03 to 2006-07 | ||||
Data source: Written questionnaires (100 consecutive encounters from ~1000 participating GPs nationwide) | ||||
Age-standardised proportion of HF encounters higher for Indigenous patients (ratio 2.6) | ||||
Outcome: Indications for GP encounters | ||||
• No formal basis for Indigenous identification; patients not providing Indigenous status conflated with ‘non-Indigenous’ | ||||
• Imprecise estimates for Indigenous attendances | ||||
Beach Survey AIHW (2011) [36] | GPs Australia-wide | Design: Cross-sectional survey | Crude proportion of HF encounters lower among Indigenous (0.9/100, CI 0.6-1.2) than non-Indigenous patients (0.7, CI 0.7-0.7) | • Data difficult to interpret: not person-based (cannot identify recurrent attendances for the same person), estimates conflate differences in underlying morbidity with differences in service access and utilisation |
Period: April 2004-March 2005 to April 2008-March 2009 | ||||
Data source: Written questionnaires (100 consecutive encounters from ~1000 participating GPs nationwide) | ||||
Age-standardised proportion of HF encounters higher for Indigenous patients (ratio 2.6) | ||||
Outcome: Indications for GP encounters | • No formal basis for Indigenous identification; patients not providing Indigenous status conflated with ‘non-Indigenous | |||
Imprecise estimates for Indigenous attendances | ||||
(b) Hospitalisations | ||||
Nichol (1999) [37] | Patients admitted to Australian public and private hospitals | Design: Descriptive study | 970 separations with principal diagnosis HF among indigenous; 39,305 Non-Indigenous | • Separation rate-ratio not provided |
Data source: Administrative data (NHMD) | Crude average length of hospital stay for ‘congestive heart failure) shorter for Indigenous than non-Indigenous patients (6.5 vs 9.4 days) | • Data not person-based: cannot identify recurrent separations for the same person | ||
Period:July 1995-June 1996 | Outcome: Principal diagnosis reported for hospital separations |  | • Indigenous identification varies between jurisdictions, Indigenous identity likely under-identified at a single separation | |
• Caveats of HF-related code as principal diagnosis | ||||
Field (2003) [34] | Patients admitted to SA and NT hospitals only | Design: Descriptive study | July 1998-June 2001 triennium: age-standardised separation rates (HF or hypertensive heart disease) higher among Indigenous than non-Indigenous patients (males: 1555/105 vs 743/105; females: 1579/105 vs 541/105) | • Rates calculated for population aged ≥45 years only |
Data source: Administrative data (NHMD) | ||||
• Data not person-based so cannot distinguish repeat recurrent separations for the same person. | ||||
Period: 1995–96 to 1997–98 and 1998–99 to 2000-01 | Outcome: Principal diagnosis reported for hospital separations | |||
HF hospitalisation rates fell among both sexes, in both Indigenous and non-Indigenous populations, between 1995–98 and 1998–2001 triennia. | ||||
• Not nationwide data: SA/NT only. | ||||
• Indigenous identity likely under-identified at a single separation. | ||||
AIHW (2008) [35] | Patients admitted to private (excluding NT) and public hospitals in NSW, Vic, Qld, WA, SA and NT. | Design: Descriptive study | Age-standardised hospital separation ratio (Indigenous:non-Indigenous) for HF 3.4. | • Data not person-based: cannot identify recurrent separations for the same person |
Data source: Administrative data (NHMD) | Average bed days for congestive heart failure 5.7 (Indigenous patients); 7.7 (non-Indigenous) | |||
• Report restricted to jurisdictions with better Indigenous identification, however this varies between included jurisdictions, Indigenous identity likely under-identified at a single separation | ||||
Period: July 2004 to June 2006 | Outcome: Diagnoses reported for hospital separations | |||
AIHW (2011) [36] | Patients admitted to private (excluding NT) and public hospitals in NSW, Vic, Qld, WA, SA and NT. | Design: Descriptive study | Age-standardised hospital separation ratio (Indigenous:non-Indigenous) for HF 3.0. | • Data not person-based: cannot identify recurrent separations for the same person |
Data source: Administrative data (NHMD) | ||||
Period: July 2006 to June 2008 | Outcome: Diagnoses reported for hospital separations | Average bed days for congestive heart failure 5.4 (Indigenous patients); 7.5 (non-Indigenous) | • Report restricted to jurisdictions with better Indigenous identification, however this varies between included jurisdictions, Indigenous identity likely under-identified at a single separation | |
Steering Committee (2011) [38] | Patients admitted to private (excluding NT) and public hospitals in NSW, Vic, Qld, WA, SA and NT. | Design: Descriptive study | Age-standardised hospital separation rates for congestive heart failure 6.1 (Indigenous) vs 2.0 (non-Indigenous) | • Data not person-based: cannot identify recurrent separations for the same person |
Data source: Administrative data (NHMD) | ||||
Period: 2008-09 | Outcome: Diagnoses reported for hospital separations | • Indigenous identification varies between jurisdictions, Indigenous identity likely under-identified at a single separation | ||
AIHW (2011) [39] | Patients admitted to public and private hospitals in all states and territories. | Design: Descriptive study | Crude hospital separation rates for congestive heart failure: | • Data from all states and territories. |
Data source: Administrative data (NHMD) | Indigenous: 2.8/1000 Non-Indigenous: 2.1/1000 | • Data not person-based: cannot identify recurrent separations for the same person | ||
Period: 2008-2009 | Outcome: Principal diagnosis reported for hospital separations | (Rate ratio: 1.33) | ||
• Rates adjusted for Indigenous under-identification. | ||||
• Crude rates only. | ||||
Bureau of Health Information (NSW) (2011) [40] | Patients >45 years admitted to public and private hospitals in NSW. | Design: Descriptive study | 2% of ‘potentially avoidable’ HF admissions of patients occurred among patients identified as Aboriginal, with ‘2% of the NSW population’ considered to be Aboriginal. | • Data not person-based: cannot identify recurrent separations for the same person |
Data source: Administrative data (APDC) | ||||
Period: July 2009-June 2010 | Outcome: ‘potentially avoidable’ admissions for specified conditions (including HF) | • Crude proportion only | ||
No adjustment for Indigenous under-identification in hospitalisation data | ||||
Bureau of Health Information (NSW) (2012) [41] | Patients >45 years with pre-existing record of HF hospitalisation admitted to public and private hospitals in NSW. | Design: Cohort study | Patients with pre-identified HF admitted on >1 occasion with HF during year of study were more likely to be Aboriginal (3%) than those with 0–1 HF admissions (2%) | • Person-based data |
Data source: Linked administrative data (APDC and mortality) | • Proportion of cohort identified as Aboriginal not stated | |||
No adjustment for Indigenous under-identification | ||||
Period: July 2009-June 2010 | Outcome: admissions and re-admissions | |||
8. Health service delivery issues (including needs, access and barriers) | ||||
Nil | ||||
9. Costs related to HF diagnosis and care | ||||
AIHW (2011) [39] | Patients admitted to public and private hospitals in all states and territories. | Design: Descriptive study | For congestive heart failure, patients identified as Indigenous accounted for 3.9% of total expenditure for this condition. Expenditure on CHF hospitalisation per person: | • Data from all states and territories. |
Data source: Administrative data (NHMD) | • Indigenous identification varies between jurisdictions, Indigenous identity likely under-identified at a single separation | |||
Period: 2008-2009 | Outcome: Expenditure on potentially preventable hospital separations | Indigenous $26.70 | ||
Non-Indigenous $16.90 | ||||
(Indigenous:non-Indigenous expenditure ratio 1.58) | ||||