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The cost of hospitalisation for youth self-harm: differences across age groups, sex, Indigenous and non-Indigenous populations

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Abstract

Objective

To report the comparative rates, average length of stay and cost per episode of hospital management for self-harm in three age cohorts: 15–19 years, 20–24 years and 25–29 years; by sex and indigeneity.

Design, setting, participants

A secondary data analysis of the Australian Institute of Health and Welfare (AIHW) dataset between 1st January 2014 and 31st December 2014 inclusive.

Main outcome measures

Cost per episode of hospitalised self-harm and rates by age group, sex and Indigenous status.

Results

The rate of hospitalised self-harm among Australian youth was 254.0 per 100,000 population. This rate resulted in an annual cost to the healthcare system of AU$55 million or an average cost per episode of $4649 (95% CI $4488:$4810). Hospitalised self-harm was 21 times higher than the rate of suicide (11,820 episodes of hospitalised self-harm/564 suicides). Indigenous youth had on average a 1.4 times higher rate of hospitalised self-harm and 2.2 times higher rate of suicide than non-Indigenous counterparts. When controlling for age and sex, the average cost per episode was significantly lower for Indigenous youth compared to non-Indigenous youth, estimated marginal means $4538 and $4954, respectively (p < 0.001).

Conclusions

Hospitalised self-harm among Australian youth resulted in a substantial cost to the healthcare system. This cost is only part of the overall burden associated with self-harm. The rate of hospitalised self-harm was significantly higher in Indigenous youth, but the associated cost per episode was significantly lower.

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Acknowledgements

We wish to acknowledge the Department of Justice and Regulation for proving access to the Australian National Coronial Information System (NCIS), the Australian Institute of Health and Welfare (AIHW) for providing self-harm hospitalisation data and Central Queensland University for providing financial support to access the data.

Author information

Authors and Affiliations

  1. Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, Australia

    Irina Kinchin

  2. Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, Australia

    Irina Kinchin, Janya McCalman & Christopher M. Doran

  3. School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia

    Alex M. T. Russell

  4. Centre for Applied Health Economics, Griffith University, Brisbane, Australia

    Joshua Byrnes

  5. Cairns and Hinterland Hospital and Health Service, Cairns, Australia

    Ernest Hunter

Authors
  1. Irina Kinchin
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  2. Alex M. T. Russell
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  3. Joshua Byrnes
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  4. Janya McCalman
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  5. Christopher M. Doran
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  6. Ernest Hunter
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Corresponding author

Correspondence to Irina Kinchin.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

The known: Suicide is the leading cause of death among Australians between 15 and 24 years of age. While the data on suicides are broadly available, data on self-harm and its cost implications are scarce. The new: This study is the first to provide a cost for hospital management per episode of self-harm; and to compare rates, average length of stay and cost implications by age group, sex and for Indigenous and non-Indigenous youth. The implications: Evidence of significantly higher rates of hospitalised self-harm in Indigenous youth points to the need to better delineate drivers of self-harm and to improve targeted and culturally appropriate prevention responses.

Appendices

Appendix 1

See Table 3.

  1. 1.

    Scoping of the extract:

    1. a.

      Includes:

      1. i.

        Separations with a reported principal diagnosis code in the range (S00-T75, T79) with the first encountered external cause code in the record in the range (X60-X84).

      2. ii.

        Separations for person aged 15–29 years (inclusive) at time of admission.

      3. iii.

        Separations with a separation date between 1st January 2014–31st December 2014 (inclusive).

    2. b.

      Excludes separations for which care type is reported as Newborn (with unqualified days only), Posthumous organ procurement and Hospital boarders, or for which care type was not reported.

  2. 2.

    Principal diagnosis and external cause codes as per the ICD-10-AM 8th edition.

  3. 3.

    To ensure confidentiality, AR-DRG codes are not provided where:

    • There are fewer than three reporting units;

    • There are three or more reporting units and one contributed more than 85% of the total separations;

    • There are three or more reporting units and two contributed more than 90% of the total separations.

Table 3 List of data variables included in the extract
Full size table

Appendix 2

See Table 4.

Table 4 Mean (SD and 95% CI) cost of general hospital management of self-harm in three age cohorts: 15–19 years, 20–24 years and 25–29 years by sex, death (or not) of patient and average length of stay
Full size table

Appendix 3

See Table 5.

Table 5 Separations by top 10 DRG codes
Full size table

Appendix 4

See Table 6.

Table 6 Suicide rate (2014) in three cohorts of Australians: 15–19 years, 20–24 years and 25–29 years by sex and Indigenous status
Full size table

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Kinchin, I., Russell, A.M.T., Byrnes, J. et al. The cost of hospitalisation for youth self-harm: differences across age groups, sex, Indigenous and non-Indigenous populations. Soc Psychiatry Psychiatr Epidemiol 55, 425–434 (2020). https://doi.org/10.1007/s00127-019-01807-6

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  • DOI: https://doi.org/10.1007/s00127-019-01807-6

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