Hospitalisation rates

Hospitalisation rates 2019 (reported in 2020)

All figures below are reproduced (renumbered), and text adapted, from the Child Poverty Monitor 2020.

If further interpretation of these statistics is required, please contact CPAG Health Spokesperson Innes Asher at i.asher@auckland.ac.nz.  

Hospitalisations and deaths from physical illness are a barometer of the wider wellbeing of children and young people in Aotearoa. While good physical health is intrinsically valuable, it also has knock-on effects for improved educational outcomes, mental wellbeing, and quality of life into adulthood. Children in high deprivation areas are more frequently hospitalised and face higher mortality rates than children in lower deprivation areas, reflecting significant inequities, for instance in living conditions, household income and access to health services. Poor health itself can further increase these inequities.

The following statistics present analyses of the deaths and hospitalisations of children. Data are from 2019, presented in the Child Poverty Monitor 2020.

Overall hospitalisation rates

Hospitalisation rates of under-15 year olds for medical conditions have risen between 1991 and 2019; from 50.2 hospitalisations per 1,000 age-specific population in 1991, to 79.3 hospitalisations per 1,000 age‑specific population in 2019. Hospitalisation rates for injury in this age group rose between 1991 and 1994 to 15.6 hospitalisations per 1,000 age-specific population, and have since fallen to 11.2 in 2019.

Social gradient of ‘all cause’ hospitalisation rates

Hospitalisation rates have a social gradient, i.e. they are highest in high deprivation areas. Figure 2 illustrates how hospitalisation rates increase with increasing NZDep (NZ index of deprivation; quintile 5 = highest deprivation). The gap between quintile 1 and quintile 5 increased between 2007 and 2009 and has remained high since.

Demographic breakdown of hospitalisation rates for medical conditions

Younger children have higher hospitalisation rates. The highest hospitalisation rates for medical conditions were among children under 5 (see Figure 3). Hospitalisation rates for medical conditions were lowest for European/Other children, with higher hospitalisation rates for Pacific children, and those of Middle Eastern, Latin American and African (MELAA), Māori and Asian/Indian ethnicity.

Under-15 year olds in the highest deprivation areas experienced twice the hospitalisation rate for medical conditions of those living in areas with the lowest deprivation score.

Hospitalisations by diagnosis

The most common diagnoses for children hospitalised with a medical condition in the five years from 2015–2019 were diseases of the respiratory system, accounting for 37% of all hospitalisations for medical conditions in this time period. Respiratory diseases include acute respiratory infections, pneumonia, acute bronchiolitis, and asthma and wheeze. Many children hospitalised with respiratory infections are likely to be exposed to poor housing, which may increase their risk of repeated disease and ongoing health problems.

Hospitalisation rates for asthma and wheeze, acute bronchiolitis and acute respiratory infections increased from 2000–2019 with some year-to-year fluctuation. There has been an overall decline in hospitalisation rates for all-cause pneumonia since 2008 when vaccination against pneumococcal disease was introduced to the New Zealand childhood immunisation schedule.

Death rates in children

The all-cause mortality rate for under-15 year olds declined from 62.0 to 21.27 deaths per 100,000 age-specific population between 1990-91 and 2016-17 (see Figure 5). Note that due to delays in reporting deaths under investigation, there is a lag in the release of mortality data (2017 data were released in 2020).

Causes of childhood deaths

In the five years from 2013–2017 there were 1,020 deaths of 0–14 year olds (excluding neonates). Of these deaths, 55% were as a result of medical conditions (an annual average of 111 deaths), 24% as a result of injury (annual average of 50 deaths) and 21% sudden unexpected deaths in infancy (SUDI) (annual average of 40 deaths).

From 2013–2017, the mortality rate was highest in the first year of life, mainly as a result of SUDI and of perinatal conditions and congenital anomalies as the main underlying cause of death. The most common main underlying medical causes of death were congenital anomalies and perinatal-related conditions, and cancers (neoplasms). The most common modes of fatal injury were motor vehicle traffic, suffocation, and drowning.

Demographic breakdown of childhood deaths

There were significant ethnic disparities in childhood death rates in the five years from 2013-2017; Māori and Pacific under-15 year olds experienced a significantly higher mortality rate compared with Asian/Indian and European/Other children (see Figure 6). The mortality rate for children living in neighbourhoods with the highest deprivation scores was just over three times as high as the mortality rate in the lowest deprivation area.

The social gradient in all-cause mortality rates in under-15 year olds has been present throughout the whole period from 1990–2017, with a marked gap between mortality rates for children living in areas with the highest deprivation scores (quintile 5) and others. Although mortality rates have declined in all NZDep quintiles, there has been no sustained narrowing of the gap between children living in the most deprived areas (quintile 5) and their peers (see Figure 7).

As Figure 8 illustrates, since 1996-97, there has been persistent inequity between mortality rates for Māori and for Pacific children aged under 15 years, compared with mortality rates of their European/Other and Asian/Indian peers. A decrease in mortality rates has been seen across all ethnic groups, with some narrowing of the equity gaps; however, a gap still remains, and thus the need for policy responses which are more effective remains.

Infant deaths

Inequities in infants’ chance of survival are affected by both the effectiveness of health systems as well as household income, living conditions, and parent education status. The resources and choices available to whānau available for preventing infant death are often contingent on factors outside their control. The infant mortality rate in New Zealand is higher than the OECD average (see Figure 9).