University of Western Australia, Crawley, Australia.
BMC Med Res Methodol. 2010 Dec 30;10:111. doi: 10.1186/1471-2288-10-111.
Measuring the real burden of cardiovascular disease in Australian Aboriginals is complicated by under-identification of Aboriginality in administrative health data collections. Accurate data is essential to measure Australia's progress in its efforts to intervene to improve health outcomes of Australian Aboriginals. We estimated the under-ascertainment of Aboriginal status in linked morbidity and mortality databases in patients hospitalised with cardiovascular disease.
Persons with public hospital admissions for cardiovascular disease in Western Australia during 2000-2005 (and their 20-year admission history) or who subsequently died were identified from linkage data. The Aboriginal status flag in all records for a given individual was variously used to determine their ethnicity (index positive, and in all records both majority positive or ever positive) and stratified by region, age and gender. The index admission was the baseline comparator.
Index cases comprised 62,692 individuals who shared a total of 778,714 hospital admissions over 20 years, of which 19,809 subsequently died. There were 3,060 (4.9%) persons identified as Aboriginal on index admission. An additional 83 (2.7%) Aboriginal cases were identified through death records, increasing to 3.7% when cases with a positive Aboriginal identifier in the majority (≥50%) of previous hospital admissions over twenty years were added and by 20.8% when those with a positive flag in any record over 20 years were incorporated. These results equated to underestimating Aboriginal status in unlinked index admission by 2.6%, 3.5% and 17.2%, respectively. Deaths classified as Aboriginal in official records would underestimate total Aboriginal deaths by 26.8% (95% Confidence Interval 24.1 to 29.6%).
Combining Aboriginal determinations in morbidity and official death records increases ascertainment of unlinked cardiovascular morbidity in Western Australian Aboriginals. Under-identification of Aboriginal status is high in death records.
在澳大利亚原住民中，心血管疾病的实际负担很难衡量，因为行政健康数据收集对原住民身份的识别不足。准确的数据对于衡量澳大利亚在努力改善原住民健康结果方面的进展至关重要。我们估计了在患有心血管疾病住院的患者的链接发病率和死亡率数据库中，原住民身份确定不足的情况。
从链接数据中确定了 2000-2005 年期间在西澳大利亚州因心血管疾病住院的患者（及其 20 年的住院史）或随后死亡的患者。对于给定个体的所有记录中的原住民身份标志，用于确定其种族（索引阳性，并且在所有记录中都是多数阳性或曾经阳性），并按地区、年龄和性别分层。索引入院是基线比较器。
索引病例包括 62692 名患者，他们在 20 年内共共享了 778714 次住院治疗，其中 19809 人随后死亡。在索引入院时，有 3060 人（4.9%）被确定为原住民。通过死亡记录额外确定了 83 例（2.7%）原住民病例，当将过去 20 年中大多数（≥50%）住院记录中具有阳性原住民标识符的病例添加进来时，该比例增加到 3.7%，当将过去 20 年中任何记录中具有阳性标志的病例加起来时，该比例增加到 20.8%。这些结果相当于分别低估了未链接索引入院的原住民身份 2.6%、3.5%和 17.2%。在官方记录中被归类为原住民的死亡人数将低估西澳大利亚原住民的总死亡人数 26.8%（95%置信区间 24.1 至 29.6%）。
将发病率和官方死亡记录中的原住民确定结合起来，可以增加西澳大利亚原住民未链接心血管发病率的确定。死亡记录中对原住民身份的识别不足情况很高。
