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Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000–2012)

A Record Linkage Cohort Study

Fathima, Parveen, MID*; Snelling, Thomas Laurence, PhD*,†,‡; de Klerk, Nicholas, PhD*; Lehmann, Deborah, MSc*; Blyth, Christopher Charles, PhD*,†,§,¶; Waddington, Claire Shelley, DPhil*; Moore, Hannah Catherine*

The Pediatric Infectious Disease Journal: February 2019 - Volume 38 - Issue 2 - p 169–175
doi: 10.1097/INF.0000000000002063
Maternal-Neonatal Reports

Background: Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations.

Methods: We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000–2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission.

Results: There were a total of 15,888 gastroenteritis-related hospital admissions (25.7% occurring among non-Aboriginal children). The overall gastroenteritis hospitalization rate for children <15 years of age was 4.6/1000 child-years for non-Aboriginal children and 21.5/1000 child-years for Aboriginal children. Male gender, <20 years of maternal age, preterm birth, low birth weight, residence in remote regions of Western Australia and birth in the pre-rotavirus vaccine era were significant independent risk factors for gastroenteritis hospitalization in both Aboriginal and non-Aboriginal children. Additionally, birth by caesarean section and low socioeconomic status were identified as being associated with gastroenteritis hospitalization in non-Aboriginal children. Population attributable fractions suggest that 39% of all gastroenteritis hospitalizations in non-Aboriginal children (38% in Aboriginal children) could be averted if all children receive the rotavirus vaccine.

Conclusions: Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk.

From the *Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia

Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia

Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia

§School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia

PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Western Australia, Australia.

Accepted for publication March 5, 2018.

This study was funded by Princess Margaret Hospital Foundation. H.C.M. is supported by a NHMRC Fellowship (1034254). C.C.B. is supported by a NHMRC Career Development Fellowship (1111596). T.L.S. is supported by a NHMRC Career Development Fellowship (1111657) and a Raine Practitioner Fellowship. The funding bodies had no part in the design, conduct, analysis or interpretation of this study. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Parveen Fathima, MID, BDS, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia. E-mail:

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