Stroke among Indigenous Australians at Royal Darwin Hospital, 2001-02 (original) (raw)
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International Journal of Stroke, 2013
on behalf of the National Stroke Foundation Background Indigenous Australians have greater stroke mortality rates than non-Indigenous people (97% Indigenous Australians are aged <65 years). Quality of care in hospital is an important factor for avoiding death and disability. No national review of acute stroke care for Indigenous Australians is available. Aims We aimed to compare adherence with clinical processes and outcomes among Indigenous and non-Indigenous patients with acute stroke admitted to hospital. Methods Hospitals participating in the National Stroke Audit of acute services in 2009 that provided data for at least one Indigenous patient were included (n = 33, 37%). Differences in death/dependency (modified Rankin Score 3-6) at discharge were determined using two-level multivariate analysis adjusting for hospital site and patient variables. A matched subgroup analysis in those aged 18 to 64 years was also undertaken. Results Among 1162 eligible patients (60% male; 18-64 years n = 305), 7% were Indigenous (18-64 years: 18%). Indigenous patients had a greater prevalence of stroke risk factors, e.g. diabetes, more had intracerebral hemorrhages (25% vs. 16% non-Indigenous, P = 0·05), and were less likely be treated in a stroke unit and receive timely allied health assessments than non-Indigenous patients. Indigenous patients aged 18-64 years had a threefold odds of dying or being dependent at discharge (Adjusted odds ratio = 3·09, 95% confidence interval = 1·07-8·95). Conclusions Australian Indigenous patients with stroke received a reduced quality of care in hospitals and experienced worse outcomes than non-Indigenous patients. Indigenous patients require the provision of evidence-based care to increase their opportunities for optimal health outcomes following stroke. Further research to explain the differences is needed.
BMJ Open, 2020
ObjectivesWe aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities.DesignA retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014.SettingAlice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2.Participants161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke.Primary and secondary outcome measuresRates of first-ever stroke, overall ...
Aboriginal and Torres Strait Islander Peoples and the Burden of Stroke
International Journal of Stroke, 2007
Aboriginal and Torres Strait Islander peoples comprise about 2·4% of the Australian population. There is little information about stroke among these groups of people. Most information comes from national mortality and hospital morbidity data, and population-based surveys of risk factors. Hospitalisations for stroke among Aboriginal and Torres Strait Islander peoples are 1·2-fold that of non-Indigenous males and 1·9-fold that of non-Indigenous females. Similarly, deaths from stroke are greater among Indigenous Australians, being approximately double that of non-Indigenous Australians. The disparity in stroke deaths is greatest among younger individuals. Differences in hospitalisations and mortality from stroke can be attributed to both a greater prevalence of modifiable risk factors for stroke among the Indigenous population and poorer access to acute care services. Access to appropriate primary health care is also problematic for many Indigenous Australians, mainly because of their ...
Rural and Remote Health, 2019
Introduction: The burden of stroke for Aboriginal and Torres Strait Islander peoples in Australia is significant. The National Stroke Foundation has identified that Aboriginal and Torres Strait Islander people are more likely to have a stroke at a younger age than the non-Indigenous population and are twice as likely for stroke to result in death, and that those Aboriginal and Torres Strait Islander people living in rural and remote areas are less likely to have access to an acute stroke unit. The only acute stroke unit in Far North Queensland treats six times more Aboriginal and Torres Strait Islander patients than the Queensland average, a large proportion of whom reside in the rural and remote communities of the Cape and Torres Strait. This article describes part of the qualitative phase of a project titled 'Culturally appropriate stroke services for Aboriginal and Torres Strait Islander people', received Closing the Gap funding to identify the needs of Aboriginal and Torres Strait Islander stroke survivors in Far North Queensland and Rural and Remote Health rrh.org.au
International journal of stroke : official journal of the International Stroke Society, 2018
Background Retrospective data indicate increased stroke incidence in Aboriginal/Torres Strait Islander (Indigenous) Australians, possibly with poorer outcomes. We present the first prospective population-based stroke incidence study in Indigenous Australians. Methods We pooled data from ASCEND and SEARCH, two prospective "ideal" South Australian stroke incidence studies, ASCEND conducted in urban Northwestern Adelaide (2009-2010) and SEARCH in five South Australian rural centers (2009-2011). We calculated age-standardized incidence for Aboriginal and non-Aboriginal people. Results The study population comprised 261,403 inhabitants. Among 432 first-ever strokes, 13 were in Aboriginal people (median age 51 vs. 78 years for non-Aboriginal people, p < 0.001). Age-standardized stroke incidence per 100,000 in Aboriginal patients (116, 95% CI: 95-137) was nearly two-fold that of non-Aboriginal patients (67, 95% CI: 51-84). Age-stratified excess incidence in Aboriginal people w...
Burden of Stroke in Indigenous Western Australians: A Study Using Data Linkage
Stroke, 2011
Background and Purpose-Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997)(1998)(1999)(2000)(2001)(2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia. Methods-Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status.
Abstract Aims: 1. Investigate the illness pathway of people dying of stroke in Singapore, New Zealand and Australia; and 2. Undertake a comparison of the needs of people dying of stroke between these countries. Methods: A pilot retrospective medical record review was conducted with patients who died of stroke aged 18 years and over during 2008 to 2011 within acute care hospitals in Australia (n=10), New Zealand (n=10) and Singapore (n=7). This sample was designed to identify significant issues in the treatment and care of people who die of stroke, and will be used to inform a larger study. Sites chosen represented the key hospital for the treatment of people with stroke for a population of 200,000. Medical record data were collected using an agreed template and concerns of patients, relatives and health professionals were also extracted. One researcher led the analysis, which included descriptive statistics and thematic analysis. Electronic and telephone discussions between research...
Considering Aboriginal palliative care models: the challenges for mainstream services
Rural and remote health
This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care ...
Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives
BMC Palliative Care, 2013
Background: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data.