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

Abstract

Background Hospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. Objective We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalisation in WA children, focussing on Aboriginal children aged <17 years. Methods We conducted a retrospective population‐based cohort study with linked perinatal and hospitalisation data on WA‐born children (1996‐2012), of whom 31 348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to first hospitalisation with skin infection. To identify specific risk factors for early‐onset infection, we further restricted the cohort to infants aged <1 year. Results Overall, 5439 (17.4%) Aboriginal and 6750 (1.5%) non‐Aboriginal children were hospitalised at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalisation rate (63.2 per 1000 child‐years). The strongest risk factors in Aboriginal children aged <17 years were socio‐economic disadvantage, very remote location at birth, and multi‐parity (≥3 previous pregnancies) accounting for 24%, 23%, and 15% of skin infection hospitalisations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy, and low birthweight. Conclusions We have quantified the relative influence of perinatal risk factors associated with skin infection hospitalisations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalisations. Our evidence not only supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families.

Describing skin health and disease in urban-living Aboriginal children: co-design, development and feasibility testing of the Koolungar Moorditj Healthy Skin pilot project

“…To our knowledge this association has not previously been described in Aboriginal children; however, both conditions occur more frequently in children where health inequities exist, including Indigenous, refugee and immigrant children [ 46 , 47 ]. In the pilot cohort, low birthweight was associated with a greater odds of ever having BSI, consistent with an earlier study of WA Aboriginal children that demonstrated low birthweight to be a risk factor for skin infection hospitalisation [ 48 ].…”

Smoking increases the risk of infectious diseases: A narrative review

“…Smoke-free pregnancy can reduce the rate of hospitalization for skin infections in children by 9.6%. Smoking during pregnancy may lower the child's immunity and increase the risk of infection 155 .…”

Predictors of hospital readmission in infants less than 3 months old

“…The following were considered a priori to be potential risk factors for hospitalisation for infection 13,14 : sex, Aboriginal status, mode of delivery, gestational age, percent optimal birthweight, maternal smoking during pregnancy, maternal age, number of previous pregnancies, season of birth (based on temperate climate characteristics of metropolitan WA), socio-economic index for area, age group and length of stay (LOS) of index hospitalisation. Socioeconomic disadvantage was categorised by the Index of Relative Socioeconomic Advantage and Disadvantage, a summary statistic for a range of socio-economic indicators for the geographic area of residence, measured at the time of the child's birth and grouped into quintiles.…”