Two nations: racial disparities in bloodstream infections recorded at Alice Springs Hospital, central Australia, 2001–2005

• Published in: Medical journal of Australia 2010-05, Vol.192 (10), p.567-571
• Main Authors: Einsiedel, Lloyd J, Woodman, Richard J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Australia - epidemiology; Bacteremia - epidemiology; Bacteremia - mortality; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Comorbidity; Environment and public health; Female; Fungemia - epidemiology; Fungemia - mortality; General aspects; Human bacterial diseases; Humans; Indigenous health; Infectious diseases; Male; Medical sciences; Middle Aged; Retrospective Studies
• ISSN: 0025-729X; 1326-5377
• DOI: 10.5694/j.1326-5377.2010.tb03638.x

Objective: To compare bloodstream infection (BSI) rates, pathogens and mortality among Indigenous and non‐Indigenous adults in central Australia. Design, participants and setting: Retrospective study of adult patients (aged ≥ 15 years) admitted to Alice Springs Hospital (ASH) between 1 January 2001 and 31 December 2005. Patients were followed up until 30 June 2008. Main outcome measures: Admission‐based and population‐based BSI rates and mortality rates for Indigenous and non‐Indigenous adults. Results: During the study period, there were 824 BSI episodes (Indigenous, 753; non‐Indigenous, 71). The admission‐based BSI rate for Indigenous patients was 26.5 (95% CI, 26.4–26.6) per 1000 adult admissions, compared with 5.2 (95% CI, 5.1–5.2) per 1000 adult admissions for non‐Indigenous patients (infection rate ratio [IRR], 5.13 [95% CI, 5.10–5.18]). The population‐based BSI rate was 1354.7 (95% CI, 1256.3–1460.8) per 100 000 persons per year among Indigenous patients and 69.9 (95% CI, 55.1–88.6) per 100 000 persons per year among non‐Indigenous patients (IRR, 19.4 [95% CI, 15.1–24.9]). These differences were not explained by higher comorbidity levels among Indigenous patients. Human T‐cell lymphotropic virus type 1 and Strongyloides stercoralis infected 43% and 35%, respectively, of Indigenous patients tested. The risk of death during the follow‐up period was 32.1% for Indigenous and 13.4% for non‐Indigenous patients (hazard ratio [HR], 2.69 [95% CI, 1.38–5.25]; P = 0.004). Mortality rates were higher among Indigenous patients who had more than a single BSI (HR, 1.86 [95% CI, 1.32–2.62]; P < 0.001). The mean age at death was 48.5 years (SD, 16.2 years) for Indigenous patients and 75.1 years (SD, 18.7 years) for non‐Indigenous patients (P < 0.001). Conclusion: Indigenous adults living in central Australia experience BSI rates that are among the highest reported in the world. These are associated with a high risk of death, and are a likely consequence of the poor socioeconomic circumstances of Indigenous people.