COPD Exacerbation in Aboriginal Australians: Examining Ethnic Disparity in AECOPD Guideline Alignment Between Aboriginal and Non-Aboriginal Patients

Background Chronic obstructive pulmonary disease (COPD) exacerbations and hospital admission rates remain high in the Top End of Northern Territory (NT), Australia, particularly among Aboriginal people. Aims To examine the clinical characteristics of patients admitted with acute exacerbations of COPD (AECOPD) and evaluate the alignment of care with the Australian COPD-X guidelines in a regional and remote context. Methods Retrospective study included adult Aboriginal and non-Aboriginal patients aged > 18 years admitted to the Royal Darwin Hospital with a primary diagnosis of AECOPD between June 2022 and June 2023. Results A total of 211 hospital admissions were recorded (Aboriginal 140 (41.4% remote air retrievals)) and non-Aboriginal 71) from 140 patients (Aboriginal 89 and non-Aboriginal 51). The median age was 64.1 years (Aboriginal: 56.5 years, non-Aboriginal: 74.5 years), males 51.4%, current smokers 66% (Aboriginal: 69.3%, non-Aboriginal: 59.2%). The most common symptom at presentation was shortness of breath in both groups. The median length of hospital stay was 3.83 in Aboriginal and 4.9 days in non-Aboriginal patients. Recommended interventions, including chest X-rays, sputum microbiology, corticosteroids use, antibiotics, supplemental oxygen, and non-invasive ventilation, were administered appropriately in alignment with COPD-X guidelines. However, discrepancies in guideline recommendations were observed between Aboriginal and non-Aboriginal patients. Notably, among Aboriginal patients’ spirometry was recorded in only 55.1%, referral for chest physiotherapy or pulmonary rehabilitation, smoking cessation, vaccination coverage, and home support were low. Post-discharge follow-up care was inadequate, including adherence to treatment recommendations. Further, homelessness was associated with recurrent hospital admissions. These disparities were assessed to be related to geographic and social barriers to healthcare faced by Aboriginal Australians. Conclusion This study demonstrates a substantial burden of AECOPD among patients in the Top End of the NT, including younger age and frequent air retrievals and higher hospital admission rates among Aboriginal patients. Although acute inpatient management was generally consistent with Australian COPD-X guideline recommendations, important gaps were identified in COPD management for long-term outcomes, particularly among Aboriginal patients. These findings may reflect the influence of social determinants of health, limited access to healthcare, and geographic isolation. Future revisions of the COPD guidelines could consider the unique challenges of regional and remote settings to support more equitable, culturally appropriate, and effective COPD management.