Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement
Hargovan, Satyen, Groch, Taissa, Brooks, James, Sivalingam, Sayonne, Bond, Tatum, and Carter, Angus (2024) Indigenous Australians critically ill with sepsis: Characteristics, outcomes, and areas for improvement. Australian Critical Care, 37 (4). pp. 548-557.
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Abstract
Objective The objective of this study was to describe the characteristics, short- and long-term outcomes of non-Indigenous, Aboriginal Australian and Torres Strait Islander Australians admitted with sepsis to an intensive care unit (ICU) to inform healthcare outcome improvement.
Methods A retrospective cohort study of 500 consecutive sepsis admissions to the Cairns Hospital ICU compared clinical characteristics, short-term (before ICU discharge) and long-term (2000 days posthospital discharge) outcomes. Cohort stratification was done by voluntary disclosure of Indigenous status.
Results Of the 442 individual admissions, 145 (33%) identified as Indigenous Australian. Indigenous and non-Indigenous Australians had similar admission Acute Physiology and Chronic Health Evaluation-3 scores (median [interquartile range]: 70 [52–87] vs. 69 [53–87], P = 0.87), but Indigenous patients were younger (53 [43–60] vs. 62 [52–73] years, P < 0.001) and were more likely to have chronic comorbidities such as type 2 diabetes (58% vs. 23%, P < 0.001), cardiovascular disease (40% vs 28%, P = 0.01), and renal disease (39% vs. 10%, P < 0.001). They also had more hazardous healthcare behaviours such as smoking (61% vs. 45%, P = 0.002) and excess alcohol consumption (40% vs. 18%, P < 0.001). Despite this, the case-fatality rate of Indigenous and non-Indigenous Australians before ICU discharge (13% vs. 12%, P = 0.75) and 2000 days post hospital discharge (25 % vs. 28 %, P = 0.40) was similar. Crucially, however, Indigenous Australians died younger both in the ICU (median [interquartile range] 54 (50–60) vs. 70 [61–76], P < 0.0001) and 2000 days post hospital discharge (58 [53–63] vs. 70 [63–77] years, P < 0.0001).
Conclusions Although Indigenous Australians critically ill with sepsis have similar short and long-term mortality rates, they present to hospital, die in-hospital, and die post-discharge significantly younger. Unique cohort characteristics may explain these outcomes, and assist clinicians, researchers and policy-makers in targeting interventions to these characteristics to best reduce the burden of sepsis in this cohort and improve their healthcare outcomes.
Item ID: | 82073 |
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Item Type: | Article (Research - C1) |
ISSN: | 1036-7314 |
Keywords: | Improving outcomes, Indigenous, Intensive care unit, Primary health care, Public health, Sepsis |
Copyright Information: | © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Date Deposited: | 01 Apr 2025 04:09 |
FoR Codes: | 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450417 Aboriginal and Torres Strait Islander public health and wellbeing @ 100% |
SEO Codes: | 28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280114 Expanding knowledge in Indigenous studies @ 100% |
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