Hospital admissions for skin infections among Western Australian children and adolescents from 1996 to 2012

Abstract

The objective of this study was to describe the occurrence of skin infection associated hospitalizations in children born in Western Australia (WA). We conducted a retrospective cohort study of all children born in WA between 1996 and 2012 (n = 469,589). Of these, 31,348 (6.7%) were Aboriginal and 240,237 (51.2%) were boys. We report the annual age-specific hospital admission rates by geographical location and diagnostic category. We applied log-linear regression modelling to analyse changes in temporal trends of hospitalizations. Hospitalization rates for skin infections in Aboriginal children (31.7/1000 child-years; 95% confidence interval [CI] 31.0–32.4) were 15.0 times higher (95% CI 14.5–15.5; P<0.001) than those of non-Aboriginal children (2.1/1000 child-years; 95% CI 2.0–2.1). Most admissions in Aboriginal children were due to abscess, cellulitis and scabies (84.3%), while impetigo and pyoderma were the predominant causes in non-Aboriginal children (97.7%). Admissions declined with age, with the highest rates for all skin infections observed in infants. Admissions increased with remoteness. Multiple admissions were more common in Aboriginal children. Excess admissions in Aboriginal children were observed during the wet season in the Kimberley and during summer in metropolitan areas. Our study findings show that skin infections are a significant cause of severe disease, requiring hospitalization in Western Australian children, with Aboriginal children at a particularly high risk. Improved community-level prevention of skin infections and the provision of effective primary care are crucial in reducing the burden of skin infection associated hospitalizations. The contribution of sociodemographic and environmental risk factors warrant further investigation.

Perinatal risk factors associated with skin infection hospitalisation in Western Australian Aboriginal and Non‐Aboriginal children

“…We conducted a population‐based retrospective cohort study of WA births between 1996 and 2012 (n = 469 589, of which 31 348, 6.7% were Aboriginal). Further details on the cohort are provided elsewhere . Ethical approval was obtained from the Western Australian Department of Health Human Research Ethics Committee and the WA Aboriginal Health Ethics Committee.…”

“…The point prevalence of scabies has been reported to range from 5% to 35% in remote Australian contexts, with Aboriginal children also having one of the highest reported prevalences in the world, a burden only surpassed by Panama (78%) and Fiji (44%) . Whilst skin infections are generally viewed as a primary care issue, we have previously identified in WA that 14.8% of Aboriginal children and 1.5% of non‐Aboriginal children are hospitalised at least once for skin infections (1996‐2012) during childhood, with rates in Aboriginal infants 20 times that of their non‐Aboriginal counterparts . We have also confirmed that skin infections are under‐reported in hospitalised patients due to under‐recognition and normalisation, suggesting that the burden of skin infection hospitalisations might be substantially higher …”

Skin infections in Australian Aboriginal children: a narrative review

“…More than 50% of all children admitted to hospital in two regional centres studied had a skin infection (49% had impetigo and 8% had scabies), and in these high prevalence settings, health care workers were under‐reporting skin infections . Linked hospitalisation data for all children born in WA between 1996 and 2012 ( n = 469 589), of whom 6.7% were Aboriginal, found that hospitalisation rates for skin infections were 15 times higher for Aboriginal children than non‐Aboriginal children (95% CI, 14.5–15.5; P < 0.001), and most commonly they were for abscesses (42.2%), cellulitis (26.0%), impetigo (14.3%) and scabies (15.8%) …”

“…The burden of abscesses disproportionately affects Aboriginal children. Skin abscesses are the most common reason for skin‐related hospitalisation in Aboriginal children in WA, accounting for almost half of all admissions to hospital for skin diseases, and the hospital length of stay is longer for Aboriginal children …”

“…This condition is a source of health inequity. In all children born in WA between 1996 and 2012, the highest disparity between Aboriginal and non‐Aboriginal hospital admission rates was in admissions for scabies among infants (incidence rate ratio, 417.0; 95% CI, 308.8–576.7) …”