Indigenous Australians experience greater health disadvantage and have a higher prevalence of many chronic health conditions. Liver diseases leading to cirrhosis are among the most common contributor to the mortality gap between Indigenous and other Australian adults. However, no comparative data exist assessing differences in presentation and patient outcomes between Indigenous and non-Indigenous Australians hospitalised with cirrhosis. Using data from the Hospital Admitted Patient Data Collection and the Death Registry, this retrospective, population-based, cohort study including all people hospitalised for cirrhosis in the state of Queensland during 2008–2017 examined rate of readmission (Poisson regression), cumulative survival (Kaplan–Meier), and assessed the differences in survival (Multivariable Cox regression) by Indigenous status. Predictor variables included demographic, health service characteristics and clinical data. We studied 779 Indigenous and 10,642 non-Indigenous patients with cirrhosis. A higher proportion of Indigenous patients were younger than 50 years (346 [44%] vs. 2063 [19%] non-Indigenous patients), lived in most disadvantaged areas (395 [51%) vs. 2728 [26%]), had alcohol-related cirrhosis (547 [70%] vs. 5041 [47%]), had ascites (314 [40%] vs. 3555 [33%), and presented to hospital via the Emergency Department (510 [68%] vs. 4790 [47%]). Indigenous patients had 3.04 times the rate of non-cirrhosis readmissions (95%CI 2.98–3.10), 1.35 times the rate of cirrhosis-related readmissions (95%CI 1.29–1.41), and lower overall survival (17% vs. 27%; unadjusted hazard ratio (HR) = 1.16 95%CI 1.06–1.27), compared to non-Indigenous patients. Most of the survival deficit was explained by Emergency Department presentation (adj-HR = 1.03 95%CI 0.93–1.13), and alcohol-related aetiology (adj-HR = 1.08 95%CI 0.99–1.19). The remaining survival deficit was influenced by the other clinico-demographic and health service factors (final adj-HR = 1.08 95%CI 0.96–1.20). There was evidence of differential presentation, higher rates of readmissions, and poorer survival for Indigenous Australians with cirrhosis, compared to other Australians. The increased prevalence of Emergency Department presentation among Indigenous patients suggests missed opportunities for early intervention to prevent progressive cirrhosis complications and hospital readmissions.

中文翻译：

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澳大利亚肝硬化的住院治疗：澳大利亚土著居民的表现和结局存在差异。

澳大利亚土著人在健康方面面临更大的不利条件，在许多慢性健康状况中的患病率更高。导致肝硬化的肝病是造成土著人和其他澳大利亚成年人之间死亡率差距的最常见原因。但是，尚无比较数据评估住院肝硬化的澳大利亚土著居民和非土著澳大利亚人的表现和患者预后之间的差异。这项回顾性，基于人群的队列研究使用了《医院住院患者数据收集》和《死亡登记册》中的数据，包括2008-2017年昆士兰州所有因肝硬化住院的人，研究了再入院率（泊松回归），累积生存率（ Kaplan–Meier），并通过土著身份评估了生存差异（多变量Cox回归）。预测变量包括人口统计，健康服务特征和临床数据。我们研究了779例原发性肝硬化患者和10,642例非原发性肝硬化患者。居住在大多数弱势地区的土著患者中，年龄小于50岁的比例更高（346 [44％]比2063 [19％]）（395 [51％]比2728 [26％]），患有酒精相关性肝硬化（547 [70％]比5041 [47％]），腹水（314 [40％]比3555 [33％]）并通过急诊科就诊（510 [68％]）对比4790 [47％]）。土著患者的非肝硬化再入院率（95％CI 2.98–3.10）的3.04倍，肝硬化相关的再入院率（95％CI 1.29–1.41）的1.35倍，总体生存率较低（17％比27％ ；与非土著患者相比，未经调整的危险比（HR）= 1.16 95％CI 1.06-1.27）。大部分的生存缺陷是由急诊科介绍（adj-HR = 1.03 95％CI 0.93–1.13）和酒精相关病因（adj-HR = 1.08 95％CI 0.99–1.19）解释的。其余的生存赤字受到其他临床人口统计学和健康服务因素的影响（最终调整HR = 1.08 95％CI 0.96-1.20）。与其他澳大利亚人相比，有证据表明肝硬化的澳大利亚原住民存在差异表现，再入院率更高，生存期较差。土著患者中急诊科就诊率的增加表明，缺乏早期干预以预防进行性肝硬化并发症和住院再住院的机会。其余的生存赤字受到其他临床人口统计学和健康服务因素的影响（最终调整HR = 1.08 95％CI 0.96-1.20）。与其他澳大利亚人相比，有证据表明肝硬化的澳大利亚原住民存在差异表现，再入院率更高，生存期较差。土著患者中急诊科就诊率的增加表明错过了早期干预的机会，以防止进行性肝硬化并发症和住院再住院。其余的生存赤字受到其他临床人口统计学和健康服务因素的影响（最终调整HR = 1.08 95％CI 0.96-1.20）。与其他澳大利亚人相比，有证据表明肝硬化的澳大利亚原住民存在差异表现，再入院率更高，生存期较差。土著患者中急诊科就诊率的增加表明错过了早期干预的机会，以防止进行性肝硬化并发症和住院再住院。