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

PLoS One. 2017 Nov 30;12(11):e0188803. doi: 10.1371/journal.pone.0188803. eCollection 2017.

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.

Publication types

  • Historical Article

MeSH terms

  • Adolescent
  • Child
  • Female
  • History, 20th Century
  • History, 21st Century
  • Hospitalization*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Patient Admission*
  • Seasons
  • Skin Diseases, Infectious / epidemiology*
  • Western Australia / epidemiology

Grants and funding

This study was funded through a National Health and Medical Research Council (NHMRC; www.nhmrc.gov.au) Project Grant (APP1045668). DH was supported by a University of Western Australia International Scholarship and the Stan Perron Charitable Trust. DH and RW were supported with funding through the NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing (APP1000886). CCB, HCM and ACB are supported by NHMRC Fellowships (APP1111596, APP1034254 and APP1088735 respectively). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.