Predictors of In-Hospital Mortality in Aboriginal Children Admitted to a Tertiary Paediatric Hospital

Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children's hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children's Hospitals Network (SCHN) over five years (2011-2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, < 0.001), neoplasm/blood/immune disorders (OR 2.77, < 0.001), emergency admissions (OR 1.94, < 0.001), aboriginality (OR 1.73, = 0.005) and longer length of stay (OR 1.012; < 0.001). Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions.