Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory

Shaun M. Flint, Joshua S. Davis, Jiunn Yih Su, Erin P. Oliver-Landry, Benjamin A. Rogers, Aaron Goldstein, Jane H. Thomas, Uma Parameswaran, Colin Bigham, Kevin Freeman, Paul Goldrick, Steven Y C Tong

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels.

    Design, setting and participants: We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed.

    Main outcome measures: Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status.

    Results: There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% CI, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5-12.6) on hospital admission.

    Conclusions: Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.

    Original languageEnglish
    Pages (from-to)617-622
    Number of pages6
    JournalMedical Journal of Australia
    Volume192
    Issue number10
    Publication statusPublished - 17 May 2010

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    Northern Territory
    Pandemics
    Human Influenza
    Intensive Care Units
    Patient Admission
    Population Groups
    Population
    Hospitalization
    Odds Ratio
    Hospital Planning
    Community Hospital
    Hospital Emergency Service
    Vaccination
    Thorax
    X-Rays
    Outcome Assessment (Health Care)
    Incidence
    Health

    Cite this

    Flint, Shaun M. ; Davis, Joshua S. ; Su, Jiunn Yih ; Oliver-Landry, Erin P. ; Rogers, Benjamin A. ; Goldstein, Aaron ; Thomas, Jane H. ; Parameswaran, Uma ; Bigham, Colin ; Freeman, Kevin ; Goldrick, Paul ; Tong, Steven Y C. / Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory. In: Medical Journal of Australia. 2010 ; Vol. 192, No. 10. pp. 617-622.
    @article{47db2c30c8834d719f7780c5587c63cb,
    title = "Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory",
    abstract = "Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels. Design, setting and participants: We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed. Main outcome measures: Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status. Results: There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95{\%} CI, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95{\%} CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5-12.6) on hospital admission. Conclusions: Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.",
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    author = "Flint, {Shaun M.} and Davis, {Joshua S.} and Su, {Jiunn Yih} and Oliver-Landry, {Erin P.} and Rogers, {Benjamin A.} and Aaron Goldstein and Thomas, {Jane H.} and Uma Parameswaran and Colin Bigham and Kevin Freeman and Paul Goldrick and Tong, {Steven Y C}",
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    Flint, SM, Davis, JS, Su, JY, Oliver-Landry, EP, Rogers, BA, Goldstein, A, Thomas, JH, Parameswaran, U, Bigham, C, Freeman, K, Goldrick, P & Tong, SYC 2010, 'Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory', Medical Journal of Australia, vol. 192, no. 10, pp. 617-622.

    Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory. / Flint, Shaun M.; Davis, Joshua S.; Su, Jiunn Yih; Oliver-Landry, Erin P.; Rogers, Benjamin A.; Goldstein, Aaron; Thomas, Jane H.; Parameswaran, Uma; Bigham, Colin; Freeman, Kevin; Goldrick, Paul; Tong, Steven Y C.

    In: Medical Journal of Australia, Vol. 192, No. 10, 17.05.2010, p. 617-622.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Oliver-Landry, Erin P.

    AU - Rogers, Benjamin A.

    AU - Goldstein, Aaron

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    N2 - Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels. Design, setting and participants: We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed. Main outcome measures: Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status. Results: There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% CI, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5-12.6) on hospital admission. Conclusions: Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.

    AB - Objective: To describe the impact of pandemic (H1N1) 2009 influenza (nH1N1) on Indigenous people in the Top End of the Northern Territory at community, hospital and intensive care unit (ICU) levels. Design, setting and participants: We analysed influenza notifications for the Top End from 1 June to 31 August 2009, as well as data on patients admitted through Top End emergency departments with an influenza-like illness. In addition, data on patients with nH1N1 who were admitted to Royal Darwin Hospital (RDH) and the RDH ICU were prospectively collected and analysed. Main outcome measures: Age-adjusted notification rates for nH1N1 cases, Top End hospital admission rates for patients with nH1N1 and RDH ICU admission rates for patients with nH1N1, stratified by Indigenous status. Results: There were 918 nH1N1 notifications during the study period. The age-adjusted hospital admission rate for nH1N1 was 82 per 100 000 (95% CI, 68-95) estimated resident population (ERP) overall, with a markedly higher rate in the Indigenous population compared with the non-Indigenous population (269 per 100 000 versus 29 per 100 000 ERP; adjusted incidence rate ratio, 12 [95% CI, 7.8-18]). Independent predictors of ICU admission compared with hospitalisation were hypoxia (adjusted odds ratio [aOR], 4.5; CI, 1.5-13.1) and chest x-ray infiltrates (aOR, 4.3; CI, 1.5-12.6) on hospital admission. Conclusions: Pandemic (H1N1) 2009 influenza had a disproportionate impact on Indigenous Australians in the Top End, with hospitalisation rates higher than those reported elsewhere in Australia and overseas. These findings have implications for planning hospital and ICU capacity during an influenza pandemic in regions with large Indigenous populations. They also confirm the need to improve health and living circumstances and to prioritise vaccination in this population.

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