Abstracts

Rationale: Hospital admission often represents crisis care for epilepsy and therefore represents severe disease. We examined patterns of hospitalization for seizures/epilepsy in Indigenous and non-Indigenous Australians as disparities are likely to provide a useful marker of access to appropriate epilepsy management. Methods: The Australian National Hospital Morbidity Database has the most reliable Indigenous status identification for the Northern Territory (NT), Queensland (QLD), South Australia (SA) and Western Australia (WA). For these jurisdictions, we studied hospitalisation rates with a primary diagnosis of epilepsy, status epilepticus, or other convulsions from 1998-2004. Annual age-standardised rates per 1000 were calculated and their distribution by age group, gender and jurisdiction analysed separately for Indigenous and non-Indigenous Australians. Rate ratios (RR) comparing Indigenous to non-Indigenous Australians were calculated. Results: Epilepsy as a proportion of all neurological hospitalisations was 96.8% (11,593/11,981) for Indigenous and 20.5% (59,592/290,236) for non-Indigenous (p<0.001). The number of total bed days (RR 5.0, CI 4.6 to 5.4) and hospitalisations with ‘emergency’ status (RR 6.0, CI 5.2 to 6.8) were higher in Indigenous. The rate of hospitalisation was higher in Indigenous with a RR of 5.6 (95% CI 5.5 to 5.7) increasing non-significantly over the six year period (p for trend = 0.66). RR was higher in Indigenous compared to non-Indigenous: males 7.4 (95% CI 7.1 to 7.7); females 4.2 (95% CI 3.9 to 4.5); each age group (0-14 years RR 1.4, 15-39 years RR 7.0, 40-64 years RR 13.8, 65+ years RR 4.1); and all jurisdictions (WA RR 10.6, SA RR 6.5, NT RR 5.4 and QLD RR 4.0). Conclusions: For Indigenous Australians, seizures/epilepsy accounts for most neurological hospital admissions. Marked ethnic disparities exist in hospitalisations for seizures/epilepsy between Indigenous and non-Indigenous and remain unchanged over the six years to 2004. These observed differences are likely to reflect ethnic differences in prevalence, severity and/or inadequate access to appropriate epilepsy management for Indigenous Australians.