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Admissions to New Zealand Public Hospitals for Dental Care

A 20 Year Review

A report prepared for the New Zealand Ministry of Health

July 2012

FINAL REPORT









Admissions to New Zealand Public Hospitals for Dental Care

A 20 Year Review

Authors

This study was undertaken by

Dr Robin A Whyman BDS, MComDent, FRACDS, FRACDS (DPH), FICD, FADI

Dr Erin K Mahoney BDS, MDSc, PhD, FRACDS, MRACDS (Paed)

Dr James Stanley BA(Hons), PhD

Mr David Morrison BScTech (Hons)

This report has been prepared in partial fulfilment of the terms of an agreement between the Ministry of Health and Hutt Valley District Health Board (DHB) entitled “Oral Health Admissions Research”.

The use, ownership, citation and distribution of the material contained in this paper must be managed in a manner consistent with the terms and conditions of that agreement.



Acknowledgments

The research team acknowledge the support of the New Zealand Ministry of Health, in particular with access to the National Minimum Dataset source information, funding for the research team and constructive feedback on the initial research plan.

The team also acknowledge the support of Hutt Valley District Health Board and the University of Otago Wellington as employers of the research team and for ongoing support with time and with access to the facilities necessary to enable the analysis and writing to occur.

Table of Contents



List of Tables and Figures 7

Executive Summary 13

Introduction 19

Methods 21

Total Admissions, Age, Gender and Ethnicity Distribution 23

Total Admissions (Table 1) 23

Gender (Figure 1) 25

Age (Figure 2 and 3) 27

Ethnicity (Figure 4 and 5 and Table 2) 29

Regional Variations (Figure 6-8 and Table 3) 37

Deprivation (Figures 9-11) 47

Discussion 51

Length of Stay (Figures 12-14) 59

Discussion 63

Admission Types (Figures 15-17) 65

Discussion 71

Reasons for Admission and Treatment Provided (Figure 18-21 and Tables 4 and 5) 75

Discussion 81

Repeat Admissions for Dental Care (Figure 22-25) 87

Discussion 91

Hospital Discharges by Case Weighting (Figures 26-30 and Tables 6 and 7) 97

Discussion 105

Dental Admissions as a Result of Injury (Figures 31-39) 109

Discussion 121

Co-morbidities Associated with Dental Admissions (Table 8) 127

Additional Co-morbidity Analysis 133

Intellectual Disability 133

Diabetes 137

Cancer 139

Mental Health 141

Discussion 143

References 151



Appendix 1: Detailed Methodology and Data Management 159

List of Tables and Figures


Table 1. Total hospital admissions and growth rates for inpatient dental care (1990 – 2009).

Table 2. Crude hospital admission rates for inpatient dental care and rates of growth by total ethnicity (1996 – 2009).

Table 3. Age and ethnicity standardised hospital admission rates for inpatient dental care by DHB of domicile (2005 – 2009).

Table 4. Hospital admissions for inpatient dental care by principal diagnosis ICD code (1990-1994 and 2005 – 2009)

Table 5. Hospital admissions for inpatient dental care by DRG code (1990 – 1994 and 2005 – 2009).

Table 6. Caseweighted admissions for inpatient dental care with dental as the primary diagnosis (2001 – 2009).

Table 7. Median caseweighting of admissions for inpatient dental care with dental as the primary diagnosis by DHB (2001 – 2009).

Table 8. Comorbidities coded for primary dental admissions to hospital in people under 18 years and 18 years and over (2005 – 2009).

Table 9. Prevalence of an intellectual disability as a comorbidity associated with a primary dental admission to hospital by age group (2005 – 2009).

Table 10. Prevalence of an intellectual disability as a comorbidity associated with a primary dental admission to hospital by ethnicity (2005 – 2009).

Table 11. Prevalence of an intellectual disability as a comorbidity associated with a primary dental admission to hospital by DHB (2005 – 2009).

Table 12. Prevalence of a diabetes comorbidity associated with a primary dental admissions to hospital by age group (2005 – 2009).

Table 13. Prevalence of a cancer comorbidity associated with a primary dental admission to hospital by age group (2005 – 2009).

Table 14: Prevalence of a mental health comorbidity associated with a primary dental admission to hospital by age group (2005 – 2009).

Table 15: ICD-10-AM codes used to define “dental health admissions” for analysis.

Table 16: ICD-10-AM codes used to define “dental injury admissions” for analysis.

Table 17: ICD10 codes used to identify intellectual disabilities listed as comorbidities on dental primary reason admissions.

Table 18: ICD10 codes used to identify mental health conditions listed as comorbidities on dental primary reason admissions.

Table 19. ICD10 codes used to identify oral cancers listed as comorbidities on dental primary reason admissions.

Figure 1. Hospital admission rates for inpatient dental care by gender (1990 – 2009).

Figure 2. Mean hospital admission rate for inpatient dental care by age (1990 – 2009).

Figure 3. Hospital admission rates for inpatient dental care by age (1990 – 2009).

Figure 4. Hospital admission rates for inpatient dental care by total ethnicity (1990 – 2009).

Figure 5. Age standardised hospital admission rates for inpatient dental care by total ethnicity (1990 – 2009).

Figure 6. Hospital admissions rates for inpatient dental care by DHB of domicile (2005 – 2009).

Figure 7. Hospital admissions rates for inpatient dental care by DHB of domicile (1990 – 2009).

Figure 8. Age and ethnicity standardised hospital admission rates for inpatient dental care by DHB of domicile (2005 – 2009).

Figure 9. Percentage of total hospital admissions for inpatient dental care by gender and deprivation index (2005 – 2009).

Figure 10. Percentage of total hospital admissions for inpatient dental care by deprivation level for each ethnic group (2005 – 2009).

Figure 11. Percentage of total hospital admissions for inpatient dental care by deprivation level for each age group (2005 – 2009).

Figure 12. Percentage of primary hospital admissions for inpatient dental care with an overnight stay by gender (1990 – 2009).

Figure 13. Percentage of primary hospital admission rates for inpatient dental care with an overnight stay by total ethnicity (1990 – 2009).

Figure 14. Percentage of primary hospital admissions for inpatient dental care with an overnight stay by age group (1990 – 2009).

Figure 15. Admission types as a percentage of hospital admissions for inpatient dental care (1990 – 2009).

Figure 16. Admission types of hospital admission for inpatient dental care (1990 – 2009).

Figure 17. Admission types as a percentage of hospital admissions for inpatient dental care by age group (2005 – 2009).

Figure 18. Percentage of hospital admissions for inpatient dental care with dental as the primary diagnosis by age group (1990 – 2009).

Figure 19. Percentage of hospital admissions for inpatient dental care with dental as the primary diagnosis by total ethnicity (1990 – 2009).

Figure 20. Hospital admissions for inpatient dental care by DRG code and age group (1990 – 1994).

Figure 21. Hospital admissions for inpatient dental care by DRG code and age group (2005 – 2009).

Figure 22. Percentage of people who had one or more repeat admissions for inpatient dental care following a first admission (1990 – 2005).

Figure 23. Percentage of repeat admissions for inpatient dental care by total ethnicity (1990 – 2004).

Figure 24. Percentage of repeat admissions for inpatient dental care by age group (1990 – 2004).

Figure 25. Percentage of repeat admissions for inpatient dental care by DHB of domicile (2000 – 2004).

Figure 26. Total admissions and summed caseweighting for inpatient dental care with dental as the primary diagnosis (2001 – 2009).

Figure 27. Median caseweighting of admissions for inpatient dental care with dental as the primary diagnosis by age group (2001 – 2009).

Figure 28. Summed caseweighting of admissions for inpatient dental care with dental as the primary diagnosis by age group (2009).

Figure 29. Summed annual caseweighting of admissions for inpatient dental care with dental as the primary diagnosis by DHB (2009).

Figure 30. Summed annual caseweighting (per 1,000 population) of admissions for inpatient dental care with dental as the primary diagnosis by DHB (2009).

Figure 31. Hospital admissions for inpatient dental care as a result of dental injury (1990 – 2009).

Figure 32. Rate of admissions due to dental injury (includes maxillofacial) per 100,000 population (1990 – 2009).

Figure 33. Rate of admissions due to dental injury (includes maxillofacial) per 100,000 population by total ethnicity (1990 – 2009).

Figure 34. Hospital admissions as a result of dental and/or maxillofacial injury as a percentage of total dental admissions (1990 – 2009).

Figure 35. Hospital admissions as a result of dental injury as a percentage of total dental admissions by total ethnicity (2005 – 2009).

Figure 36. Hospital admissions as a result of dental injury as a percentage of total dental admissions by age group (2005-2009).

Figure 37. Rate of admissions due to dental injury (includes maxillofacial) per 100,000 population (1990 – 2009).

Figure 38. Rate of admissions due to dental injury (includes maxillofacial) per 100,000 population by total ethnicity (1996 – 2009).

Figure 39. Rates of admission per 100,000 population as a result of dental and/or maxillofacial injury by DHB (2005-2009).



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