Australia's seizure divide - indigenous versus non-indigenous seizure hospitalization

- This is the first study of Australian seizure hospitalization based on indigenous ethnicity.
- The indigenous seizure hospitalization rate was 5.6 times the non-indigenous seizure hospitalization rate.
- Indigenous admissions were lengthier, and males aged 15-64 years are overrepresented.
- Indigenous patients had higher self-discharge and readmission rates.
- Socioeconomic data suggest that indigenous seizure care was limited to crisis care.

Indigenous Australians suffer the highest mortality and morbidity rates of any ethnic minority in the developed world. To determine if the health outcome gulf between indigenous and non-indigenous Australians also applied to seizures, we conducted a retrospective analysis of seizure hospitalization (1998-2004) based on ethnicity (indigenous (I) and non-indigenous (NI)) for four Australian jurisdictions - Northern Territory (NT), Queensland (Qld), South Australia (SA), and Western Australia (WA). Total admissions were converted to age-standardized rates (ASR) and I/NI ASR ratios (I/NIRR) and compared across multiple variables. The summed admission (combined jurisdictions over six years) was 71,185 (I = 11,593 and NI = 59,592). Seizure hospitalization rate was always higher in the indigenous population (six-year I/NIRR - NT = 5.6, Qld = 4.0, SA = 6.4, and WA = 10.9; combined jurisdictions = 5.6). Disparity was greatest for ages 40-64 years (13.8) and 15-39 years (7.0) and for indigenous males (7.4). As socioeconomic status rose, non-indigenous admission rates fell (ASR = 1.7 to 1.1), yet indigenous admission rates rose (ASR = 7.9 to 14.0). Indigenous emergency to elective admission ratios were higher (I = 27 and NI = 8), as were readmissions (1.5-2 fold), self-discharge separations (I = 9.4% and NI = 1.4%), bed days (I/NIRR = 5.1), and admissions with an additional diagnosis (I/NIRR = 3.3) or procedure (I/NIRR = 3.4). Indigenous Australians maintained disproportionately high rates of emergency seizure hospitalization; from 1998 to 2004, the combined jurisdiction rate was more than five times the mean non-indigenous rate. Indigenous males aged 15-64 years were overrepresented. Indigenous patients had lengthier admissions but higher self-discharge and readmission rates. The socioeconomic data raise the concern that social disadvantage restricts access to hospital-based seizure care for indigenous patients.