ORCID Profile
0000-0002-0718-6368
Current Organisations
Australian National University
,
The University of Auckland
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Publisher: Springer Science and Business Media LLC
Date: 18-05-2022
DOI: 10.1007/S11764-021-01041-7
Abstract: To quantify the relationship of cancer diagnosis to workforce participation in Australia, according to cancer type, clinical features and personal characteristics. Questionnaire data (2006–2009) from participants aged 45–64 years ( n =163,556) from the population-based 45 and Up Study ( n =267,153) in New South Wales, Australia, were linked to cancer registrations to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for non-participation in the paid workforce—in participants with cancer ( n =8,333) versus without ( n =155,223), for 13 cancer types. Overall, 42% of cancer survivors and 29% of people without cancer were out of the workforce (PR=1.18 95%CI=1.15–1.21). Workforce non-participation varied substantively by cancer type, being greatest for multiple myeloma (1.83 1.53–2.18), oesophageal (1.70 1.13–2.58) and lung cancer (1.68 1.45–1.93) and moderate for colorectal (1.23 1.15–1.33), breast (1.11 1.06–1.16) and prostate cancer (1.06 0.99–1.13). Long-term survivors, 5 or more years post-diagnosis, had 12% (7–16%) greater non-participation than people without cancer, and non-participation was greater with recent diagnosis, treatment or advanced stage. Physical disability contributed substantively to reduced workforce participation, regardless of cancer diagnosis. Cancer survivors aged 45–64 continue to participate in the workforce. However, participation is lower than in people without cancer, varying by cancer type, and is reduced particularly around the time of diagnosis and treatment and with advanced disease. While many cancer survivors continue with paid work, participation is reduced. Workforce retention support should be tailored to survivor preferences, cancer type and cancer journey stage .
Publisher: Cold Spring Harbor Laboratory
Date: 03-08-2022
DOI: 10.1101/2022.08.01.22278086
Abstract: Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics - reflecting increasing multimorbidity and complex causation patterns - is recognised internationally. This review aims to identify and appraise relevant multiple cause analytical methods and practices. We searched Medline, PubMed, Scopus and Web of Science from inception to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles included those analysing multiple causes of death from death certificates. The process identified 4,080 articles after screening, 434 full texts were reviewed. Most reviewed articles (77%, n=332) were published since 2001. The majority examined mortality by “any-mention” of a cause of death (87%, n=377) and assessed pairwise combinations of causes (56%, n=245). Recently emerging (since 2001) were applications of methods to group deaths based on common cause patterns using, for ex le, cluster analysis (2%, n=9), and the application of multiple cause weights to re-evaluate mortality burden (1%, n=5). Multiple cause methods applied to specific research objectives are described for recently emerging approaches. This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview of methods and practices to date. Available multiple cause methods are erse but suit a range of research objectives, that with greater data availability and technology could be further developed and applied across a range of settings.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JPSYCHORES.2019.109748
Abstract: Cardiac patients with psychological distress have a poorer prognosis than patients without distress, potentially reflecting differences in preventive care. We aimed to examine distress-related variation in guideline-recommended medication use for secondary prevention of cardiovascular disease (CVD). Baseline questionnaire data from the 45 and Up Study (collected 2006-2009) were linked to hospitalisation, pharmaceutical dispensing and death records (to exclude those who died). Among participants hospitalised with myocardial infarction, angina, stroke/transient ischaemic attack in the six years before the questionnaire, Modified Poisson regression was used to estimate relative risks (RR) for distress (Kessler 10 scores: low[10- < 12], mild[12- < 16], moderate[16- < 22] and high[22-50]) and use of both blood pressure- and lipid-lowering medications, and use of neither medication in the three months following the questionnaire, adjusting for sociodemographic and health characteristics. Among 7598 participants, 34.0% had low, 35.4% mild, 18.3% moderate and 12.3% high psychological distress. Around two-thirds (63.4%) were using both medications and the proportion declined with increasing levels of distress: RRs were 1.01(95%CI:0.97-1.05), 0.95(0.90-1.00) and 0.91(0.86-0.97) for mild, moderate and high compared to low distress, respectively (p(trend) = 0.001). The proportion using neither medication was 9.1% and increased with increasing distress: RRs for mild, moderate and high compared to low distress were 0.99(0.82-1.19), 1.30(1.06-1.59) and 1.60(1.28-1.98), respectively (p(trend) < 0.001). Patients with psychological distress may need more support to optimise their use of secondary CVD prevention medications. Increasing the use of these medications for distressed patients may improve prognosis for patients with distress and improve population-level secondary prevention of CVD more broadly.
Publisher: Springer Science and Business Media LLC
Date: 18-08-2021
Publisher: Springer Science and Business Media LLC
Date: 11-05-2016
Publisher: AMPCo
Date: 05-2018
DOI: 10.5694/MJA17.00222
Publisher: Public Library of Science (PLoS)
Date: 04-03-2015
Publisher: Springer International Publishing
Date: 23-11-2016
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: Four fifths of deaths in Australia involve multiple causes, but statistics typically use a single underlying cause of death (UC). The UC approach alone is insufficient for understanding the impact of non-underlying causes and identifying comorbid disease associations at death. Analysis of multiple causes of death (MC) is needed to measure the impact of all causes. We described MC patterns, considering cause-of-death coding and certification practices in Australia. Using deaths registered in Australia from 2006 to 2017 (n = 1773525) coded to the International Classification of Diseases (ICD) and an extended classification (n = 136 causes) based on a World Health Organization short list, we described MCoD data by cause. Age-standardised rates based on UC and MC were compared using the standardised ratio of multiple to underlying causes (SRMU) to estimate the contribution of the cause to mortality compared to using the UC approach. Comorbidity was explored using the cause of death association indicator (CDAI) to compare the observed joint frequency of a contributory-underlying cause combined with expected frequency of the contributory cause (with any UC). On average 3.4 conditions caused each death and 24.4% of deaths had 5 plus causes. Largest SRMUs were for genitourinary diseases (8.0), blood diseases (7.8) and musculoskeletal conditions (6.7). CDAIs showed high associations between, for ex le, accidental alcohol and opioid poisoning, septicaemia and skin infections, and traumatic brain injury and falls. MC indicators enhance measures of mortality and reassess the role of causes of death for descriptive and analytical epidemiology. This research demonstrates the value of MC analysis for Australian mortality data.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2013
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.EJON.2022.102123
Abstract: Modern treatments, including surgery and palliative chemotherapy without surgery, enable longer survival for people with advanced/recurrent colorectal cancer (CRC). Qualitative research comparing the physical and psychosocial outcomes of these different treatments is lacking. This study therefore aimed to explore and compare the physical and psychosocial challenges and survivorship experiences of people who receive different treatments for advanced CRC, through a qualitative study. Adults with CRC who have undergone treatment for advanced/recurrent CRC were recruited 0.5-2 years post-surgery or, for palliative chemotherapy participants, 0.5-2 years post-diagnosis of advanced CRC. Qualitative semi-structured telephone interviews, analysed via framework analysis, explored quality of life (QoL) experiences. Demographic, clinical, and QoL data (Functional Assessment of Cancer Therapy - Colorectal (FACT-C), Distress Thermometer) were collected to characterise the s le and inform the framework analysis. A erse s le of 38 participants (22 female) participated, with ages ranging 27-84 (Median = 59), FACT-C 56-132 (Median = 102), and distress 0-10 (median = 3). Analysis of interviews revealed three overarching themes: 1) the overwhelming impact of protracted, complex illness 2) compounding and interacting effects of multiple treatments, impacts, and multimorbidity and 3) the long haul is unpredictable, bumpy, and wearing. These themes reveal that people with advanced CRC experience many challenges due to the complex nature of the illness, its treatment, and side effects. Survivors require continued multi-disciplinary supportive care throughout follow-up to manage survivorship challenges. Guideline-led survivorship care and routine monitoring of physical and psychosocial wellbeing throughout follow up is imperative to manage patient expectations and support advanced CRC survivors.
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: Mortality statistics are typically based on a single underlying cause of death (UCoD). Although UCoD provides a useful construct, the relevance of assuming that a single disease caused the death is diminishing, especially with increased life expectancy and high proportions of deaths in older ages from chronic/degenerative diseases. Focussing on common underlying causes of death in Australia, we quantified mortality incorporating weighting strategies for multiple causes of death (MCoD). All deaths registered in Australia from 2015-2017 (478,396 deaths) and coded using International Classification of Diseases Version 10 were classified using an extended cause list (n = 136 causes) based on a World Health Organization short list. Age-standardised rates (ASR) were estimated using three weighting methods: (1) traditional approach using UCoD alone (2) UCoD and associated causes of death (ACoDs) equally weighted and (3) UCoD weighted 0.5 arbitrarily and remaining 0.5 apportioned to the remaining ACoDs. Common UCoD were ischaemic heart diseases, cerebrovascular diseases, dementia 57671, 31515 and 27377 deaths respectively. There were substantial changes in ASR depending on the weighting method used. Variation in mortality patterns estimated using the three weighting methods and challenges to further refinement of the weighting strategy will be discussed. Mortality indicators incorporating MCoD enhance traditional measures of mortality and provide a means to reassess the role of diseases in causing death. Further disease specific methods are required to refine current weighting strategies. Weighting strategies for are useful for quantifying mortality incorporating MCoD, but methodological challenges exist.
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: With the majority of people with cancer surviving long-term, holistic consideration of health and wellbeing outcomes is critical to optimise survivorship. We quantified short- and long-term physical and mental health-related outcomes in people with and without cancer, including according to cancer type and clinical characteristics. 45 and Up Study (n = 267,153) baseline survey data (2006-2009) were linked to cancer registrations (by the Centre for Health Record Linkage) and cancer diagnoses up to enrolment identified. Modified Poisson regression estimated age-and-sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes - severe physical functioning limitations, moderate/high psychological distress and fair oor quality of life - in participants with versus without cancer. Cancer survivors (n = 22,205) had significantly higher prevalence of physical functioning limitations compared to participants without cancer (21% versus 13%) PR = 1.28(95%CI=1.25-1.32), overall and in all population subgroups examined. Corresponding estimates were 22% versus 24% (1.05(1.02-1.08)) for psychological distress and 15% versus 10% (1.28(1.24-1.32) for fair oor quality of life. Outcomes varied by cancer type, being worse for multiple myeloma, lung cancer and non-Hodgkin’s lymphoma worse outcomes were also associated with recent diagnosis, recent treatment and advanced stage. Physical functioning limitations in cancer survivors were major contributors to adverse distress and quality of life outcomes. Cancer survivors experience adverse physical and mental health outcomes substantial parts of elevated distress and poor quality of life are likely attributable to physical disability. In addition to routine screening for psychological distress, management of physical disability and other symptoms are important to optimise cancer survivorship.
Publisher: BMJ
Date: 08-2016
Publisher: MDPI AG
Date: 20-02-2023
Abstract: Physical activity typically decreases during teenage years and has been identified as a health priority by Aboriginal adolescents. We examined associations between physical activity levels and sociodemographic, movement and health variables in the Aboriginal led ‘Next Generation: Youth Well-being (NextGen) Study’ of Aboriginal people aged 10–24 years from Central Australia, Western Australia and New South Wales. Baseline survey data collected by Aboriginal researchers and Aboriginal youth peer recruiters from 2018 to 2020 examined demographics and health-related behaviours. Logistic regression was used to estimate odds ratios (OR) for engaging in high levels of physical activity in the past week (3–7 days 0–2 days (ref), or ‘don’t remember’) associated with demographic and behavioural factors. Of 1170 adolescents, 524 (41.9%) had high levels of physical activity 455 (36.4%) had low levels 191 (15.3%) did not remember. Factors independently associated with higher odds of physical activity 3–7 days/week were low weekday recreational screen time [55.3% vs. 44.0%, OR 1.79 (1.16–2.76)], having non-smoking friends [50.4% vs. 25.0%, OR 2.27 (1.03–5.00)] and having fewer friends that drink alcohol [48.1% vs. 35.2%, OR 2.08 (1.05–4.14)]. Lower odds of high physical activity were independently associated with being female [40.2% vs. 50.9%, OR 0.57 (0.40–0.80)] and some findings differed by sex. The NextGen study provides evidence to inform the co-design and implementation of strategies to increase Aboriginal adolescent physical activity such as focusing on peer influences and co-occurring behaviours such as screen time.
Publisher: Oxford University Press (OUP)
Date: 25-01-2021
DOI: 10.1093/IJE/DYAA274
Abstract: Despite generally high smoking prevalences, stemming from colonization, the relationship of smoking to mortality has not been quantified reliably in an Indigenous population. We investigate smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia, where current adult daily smoking prevalence is 40.2%. A prospective study of 1388 cardiovascular disease- and cancer-free Aboriginal adults aged ≥45 years, of the 267 153 45 and Up Study participants randomly s led from the New South Wales general population over 2006–09. Questionnaire and mortality data were linked (through the Centre for Health Record Linkage) to mid-2019. Adjusted hazard ratios (called relative risks, RRs) for all-cause mortality—among current- and past- versus never-smokers—were estimated overall, by smoking intensity and by age at cessation. Smoking-attributable fractions and associated deaths were estimated. Over 14 586 person-years’ follow-up (median 10.6 years), 162 deaths accrued. Mortality RRs [95% confidence interval (CI)] were 3.90 (2.52–6.04) for current- and 1.95 (1.32–2.90) for past- versus never-smokers, with age heterogeneity. RRs increased with smoking intensity, to 4.29 (2.15–8.57) in current-smokers of ≥25 cigarettes/day. Compared with never-smokers, RRs were 1.48 (0.85–2.57) for those quitting at & years of age and 2.21 (1.29–3.80) at 45–54 years. Never-smokers lived an average & years longer than current-smokers. Around half of deaths among adults aged ≥45 years were attributable to smoking, exceeding 10 000 deaths in the past decade. In this population, & % of never-smokers would survive to 75 years, versus ∼40% of current-smokers. Quitting at all ages examined had substantial benefits versus continuing smoking those quitting before age 45 years had mortality risks similar to never-smokers. Smoking causes half of deaths in older Aboriginal and Torres Strait Islander adults Indigenous tobacco control must receive increased priority.
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: Dr Grace Joshy, Fellow, Research School of Population Health, Australian National University. Mortality statistics are typically based on a single underlying cause of death (UCoD), derived from multiple conditions on the death certificate, and have provided critical evidence for policy and practice for over a century. There have been radical shifts in patterns of death in the past couple of decades deaths in older ages are increasingly from chronic and degenerative diseases. The relevance of assuming that a single disease is causing the death is diminishing, especially with an aging population structure and increasing life expectancy. This symposium will enable participants to understand the complexities associated with mortality reporting/coding, strengths and limitations of available statistical methods for using multiple causes of death (MCoD) and the importance of quantifying mortality incorporating MCoD. The use of a single UCoD rather than MCoD means that vast amounts of potentially useful data are largely ignored, which is likely to bias mortality estimates (including under- and over-reporting of the importance of certain causes of death). Despite global recognition of the urgent need to better integrate data on MCoD into mortality statistics, use of these data are challenging and limited. Complexities arise from the way mortality information is reported on death certificates and coded to form mortality collections limited understanding of available statistical methods also adds to the complexity. International Classification of Diseases 10th Revision (ICD-10) has been translated into 43 languages and it is being used by over 100 countries to report mortality data, a primary indicator of health status. The 2018 release of the 11th revision of the International Classification of Diseases, enriching data on multiple parameters including comorbidity, confers further urgency and a unique opportunity to optimise the use of MCoD in mortality reporting. The World Congress of Epidemiology 2020 will provide a unique platform for wider discussions on the challenges and opportunities for using MCoD data. The symposium will provide a deeper understanding and enhanced the use of MCoD data. The speakers are engaged in cutting-edge NHMRC-funded research on mortality incorporating MCoD and development of novel statistical methods. The symposium will feature presentations from six speakers. James Eynstone-Hinkins, Lauren Moran, Saliu Balogun, Karen Bishop, Margarita Moreno-Betancur, Grace Joshy
Publisher: The Sax Institute
Date: 2015
DOI: 10.17061/PHRP2531532
Abstract: Objectives and importance of the study: Routine hospital administrative data provide an important source of information about cardiovascular disease (CVD) for health statistics reporting, health services and research. How such conditions are classified and grouped has implications for the use and interpretation of these data. International Classification of Diseases (ICD) diagnosis codes from hospital data collections are often used to classify CVD, but there is little published evidence on the most appropriate ways to use these codes to categorise CVD in a way that maximises the usefulness of hospital data for reporting and research. In particular, ICD codes under 'Diseases of the circulatory system' (I00-I99) are often grouped together into a general CVD category. However, this category is heterogeneous and combines common severe atherosclerotic and thrombotic CVDs (such as myocardial infarction and pulmonary embolism) with common, less severe and pathologically dissimilar conditions (such as varicose veins and haemorrhoids). In addition, hospital data collections contain a range of data fields, including those relating to primary and additional diagnoses and those relating to procedures. All of these have the potential to contribute valuable information on CVD. This paper proposes a pragmatic approach to using ICD diagnosis codes and procedure codes to capture major atherosclerotic and arteriovenous thromboembolic and related CVD. We reviewed the ICD diagnosis codes and procedure codes and developed an algorithm for classifying and categorising major CVD diagnoses. This approach was then applied to linked hospitalisation data from in iduals participating in the 45 and Up Study, a cohort study of 267 153 New South Wales residents aged 45 and over, to investigate the implications of the proposed approach for quantifying CVD. Large differences were observed in the numbers of events in grouped CVD outcomes, depending on the methods used. In cases where the reporting and research interest relates to incident disease, it may be appropriate to prioritise specific disease categories and pathological homogeneity.
Publisher: Elsevier BV
Date: 07-2016
Publisher: Oxford University Press (OUP)
Date: 14-06-2022
DOI: 10.1093/IJE/DYAB080
Abstract: Socioeconomic inequalities in mortality are evident in all high-income countries, and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide the first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. We used Australian Census (2016) linked to 13 months of Death Registrations (2016–17). We estimated relative rates (RR) and rate differences (RD, per 100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high (tertiary) education for in idual causes of death (among those aged 25–84 years) and grouped according to preventability (25–74 years), separately by sex and age group, adjusting for age, using negative binomial regression. Among 13.9 M people contributing 14 452 732 person-years, 84 743 deaths occurred. All-cause mortality rates among men and women aged 25–84 years with low education were 2.76 [95% confidence interval (CI): 2.61–2.91] and 2.13 (2.01–2.26) times the rates of those with high education, respectively. We observed inequalities in most causes of death in each age-sex group. Among men aged 25–44 years, relative and absolute inequalities were largest for injuries, e.g. transport accidents [RR = 10.1 (5.4–18.7), RD = 21.2 (14.5–27.9)]). Among those aged 45–64 years, inequalities were greatest for chronic diseases, e.g. lung cancer [men RR = 6.6 (4.9–8.9), RD = 57.7 (49.7–65.8)] and ischaemic heart disease [women RR = 5.8 (3.7–9.1), RD = 20.2 (15.8–24.6)], with similar patterns for people aged 65–84 years. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population.
Publisher: Springer Science and Business Media LLC
Date: 02-07-2020
Publisher: Elsevier BV
Date: 04-2018
Abstract: To explore factors associated with high psychological distress among Aboriginal and non-Aboriginal Australians and their contribution to the elevated distress prevalence among Aboriginal people. Questionnaire data from 1,631 Aboriginal and 233,405 non-Aboriginal 45 and Up Study (NSW, Australia) participants aged ≥45 years were used to calculate adjusted prevalence ratios for high psychological distress (Kessler-10 score ≥22) for socio-demographic, health and disability-related factors, and to quantify contributions to differences in distress prevalence. While high-distress prevalence was increased around three-fold in Aboriginal versus non-Aboriginal participants, distress-related risk factors were similar. Morbidity and physical disability had the strongest associations high distress affected 43.8% of Aboriginal and 20.9% of non-Aboriginal participants with severe physical limitations and 9.5% and 3.9% of those without limitations, respectively. Differences in distress prevalence between Aboriginal and non-Aboriginal participants were essentially attributable to differences in SES, morbidity, disability/functional limitations and social support (fully-adjusted PR 1.19 [95% 1.08, 1.30]) physical morbidity and disability explained the bulk. The markedly elevated prevalence of high distress among older Aboriginal Australians appears largely attributable to greater physical morbidity and disability. Implications for public health: Addressing upstream determinants of physical morbidity and improved integration of social and emotional wellbeing care into primary care and chronic disease management are essential.
Publisher: Cold Spring Harbor Laboratory
Date: 22-09-2020
DOI: 10.1101/2020.09.21.20193516
Abstract: Socioeconomic inequalities in mortality are evident in all high-income countries and ongoing monitoring is recommended using linked census-mortality data. Using such data, we provide first estimates of education-related inequalities in cause-specific mortality in Australia, suitable for international comparisons. Using Australian Census (2016) linked to 13-months of Death Registrations data (2016-17), we estimated relative rates (RR) and rate differences (RD, per100 000 person-years), comparing rates in low (no qualifications) and intermediate (secondary school) with high education (tertiary), for in idual causes of death (among those 25-84y) and grouped according to preventability (25-74y), separately by sex and age group, adjusting for age, using negative binomial regression. Among 13.9M people contributing 14 452 732 person-years, 84 743 deaths occurred. We observed inequalities in most causes of death for each age-sex group. Among men aged 25-44y, absolute and relative inequalities (low versus high education) were largest for injuries, e.g. transport accidents (RR=10.1 [95%CI: 5.4-18.7], RD=21.1 [15.9-26.3]). Among those aged 45-64y, inequalities were greatest for chronic diseases, e.g. lung cancer (men RR=6.6 [4.9-8.9], RD=55.6 [51.1-60.1]) and ischaemic heart disease (women RR=5.8 [3.7-9.1], RD=19.2 [17.0-21.5]), with similar patterns for people aged 65-84y. When grouped according to preventability, inequalities were large for causes amenable to behaviour change and medical intervention for all ages and causes amenable to injury prevention among young men. Australian education-related inequalities in mortality are substantial, generally higher than international estimates, and related to preventability. Findings highlight opportunities to reduce them and the potential to improve the health of the population. Using linked Australian Census (2016) and Death Registrations data (2016-17), we provide the first estimates of education-related inequalities in cause-specific mortality for Australia, broadly suitable for international comparisons. Among men aged 25-44 years, inequalities were largest for injuries, with mortality rates among those with low education six-to-ten times that of those with high education. Among the mid- and older-age groups, inequalities were largest for chronic diseases, where mortality rates among those with the lowest education were between two- and seven-times those with the highest education. In 2016-17, around half of all deaths for men and one-third of deaths for women aged 25-84 were associated with less than tertiary education. The majority of these excess deaths were attributable to leading causes. The substantial inequalities seen in preventable deaths highlight ongoing opportunities to reduce inequalities in mortality and to improve the overall health of the Australian population. Australian estimates are generally consistent with, but higher than, those for comparable countries and earlier time periods, but further standardisation of methods and reporting would enhance the validity of such comparisons
Publisher: Royal College of General Practitioners
Date: 28-11-2022
Abstract: In response to the COVID-19 pandemic, general practice in Australia underwent a rapid transition, including the roll-out of population-wide telehealth, with uncertain impacts on GP use and costs. To describe how use and costs of GP services changed in 2020 — following the COVID-19 pandemic and introduction of telehealth — compared with 2019, and how this varied across population subgroups. Linked-data analysis of whole-population data for Australia. Multi-Agency Data Integration Project data for ∼19 million in iduals from the 2016 census were linked to Medicare data for 2019–2020. Regression models were used to compare age- and sex-adjusted GP use and out-of-pocket costs over time, overall, and by sociodemographic characteristics. Of the population, 85.5% visited a GP in Q2–Q4 2020, compared with 89.5% in the same period of 2019. The mean number of face-to-face GP services per quarter declined, while telehealth services increased overall use of GP services in Q4 2020 was similar to, or higher than, that of Q4 2019 for most groups. The proportion of total GP services by telehealth stabilised at 23.5% in Q4 2020. However, in iduals aged 3–14 years, ≥70 years, and those with limited English proficiency used fewer GP services in 2020 compared with 2019, with a lower proportion by telehealth, compared with the rest of the population. Mean out-of-pocket costs per service were lower across all subgroups in 2020 compared with 2019. The introduction of widespread telehealth maintained the use of GP services during the COVID-19 pandemic and minimised out-of-pocket costs, but not for all population subgroups.
Publisher: Swansea University
Date: 16-03-2020
Abstract: Background In the ongoing debate on optimum methods for identification of Indigenous people within linked administrative data, few studies have examined the impacts of method on population counts and outcomes in family-based linkage studies of Aboriginal children. Objective To quantify differences between three validated algorithms in ascertaining Aboriginal and Torres Strait Islander children in linked administrative data. Methods Linked administrative health data for children born in WA from 2000-2013, were used to examine the cohorts identified by three methods: A) the Indigenous Status Flag (ISF, derived by the WA Data Linkage Branch using a multistage-median approach) for the children alone B) the ISF of the children, their parents and grandparents and C) Indigenous status of the child, mother or father on either of the child’s perinatal records (Midwives or birth registration), to determine differing characteristics of each cohort. Results Method B established a larger cohort (33,697) than Method C (33,510) and Method A (27,482), with all methods identifying a core group of 26,993 children (80-98%). Compared with children identified by Method A, additional children identified by Methods B or C, were from less-disadvantaged and more urban areas, and had better perinatal outcomes (e.g. lower proportions of small-for-gestational age, 10% vs 16%). Differences in demographics and health outcomes between Methods C and B were minimal. Conclusions Demographic and perinatal health characteristics differ by Indigenous identification method. Using perinatal records or the ISF of parents and grandparents (in addition to the ISF of the child) appear to be more inclusive methods for identifying young Indigenous children in administrative datasets.
Publisher: Wiley
Date: 20-11-2021
DOI: 10.1002/GPS.5463
Abstract: To assess associations between physical, mental, and social well‐being and suicide and self‐harm in a community‐based s le of older adults. Using a cohort design, questionnaire data from 102,880 in iduals aged 65 years or older living in New South Wales, Australia during 2006–2009 were linked to hospital and cause‐of‐death databases until 2017. Poisson regressions obtained adjusted incidence rate ratios (IRRs). One hundred nine suicides and 191 deliberate self‐harm (DSH) events occurred. Compared to those reporting excellent/good overall health, older adults reporting fair overall health had higher suicide rates (IRR = 2.8, 95% confidence interval: 1.8–4.4). Also, suffering from physical limitations was associated with higher rates of suicide. A fair versus excellent/good memory was associated with higher rates of suicide (IRR = 2.0, 1.3–3.3). Male erectile dysfunction was linked to self‐harm (IRR = 2.8, 1.0–7.7). Suicide rates were elevated with baseline Kessler‐10 scores of 20–50 versus 10–15 (IRR = 5.0, 2.9–8.9) the corresponding IRR for DSH was 2.9 (1.8–4.8). Elevated rates were observed for both self‐reported depression and anxiety. Poor versus excellent/good quality of life was associated with suicide (IRR = 4.3, 1.7–10.7) and achieving less than desired to due to emotional problems was linked to self‐harm (IRR = 1.8 1.3–2.4). Rates of suicide ande DSH were lower in those with ≥5 people to depend on versus one (suicide: IRR = 0.5, 0.3–0.9 DSH: IRR = 0.5, 0.3–0.7). Older adults experiencing health problems, including those relating to overall health or memory, and those with psychological distress had elevated rates of suicidal behavior. Rates of subsequent self‐harm and/or death by suicide were elevated in participants with small social networks.
Publisher: Public Library of Science (PLoS)
Date: 08-04-2021
DOI: 10.1371/JOURNAL.PONE.0249738
Abstract: Workforce participation is reduced among people with cardiovascular disease (CVD). However, detailed quantitative evidence on this is limited. We examined the relationship of CVD to workforce participation in older working-age people, by CVD subtype, within population subgroups and considering the role of physical disability. Questionnaire data (2006–2009) for participants aged 45–64 years (n = 163,562) from the population-based 45 and Up Study (n = 267,153) were linked to hospitalisation data through the Centre for Health Record Linkage. Prior CVD was from self-report or hospitalisation. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for non-participation in the workforce in people with versus without CVD, adjusting for sociodemographic factors. There were 19,161 participants with CVD and 144,401 without. Compared to people without CVD, workforce non-participation was greater for those with CVD (40.0% vs 23.5%, PR = 1.36, 95%CI = 1.33–1.39). The outcome varied by CVD subtype: myocardial infarction (PR = 1.46, 95%CI = 1.36–1.55) cerebrovascular disease (PR = 1.92, 95%CI = 1.80–2.06) heart failure (PR = 1.83, 95%CI = 1.68–1.98) and peripheral vascular disease (PR = 1.76, 95%CI = 1.65–1.88). Workforce non-participation in those with CVD versus those without was at least 21% higher in all population subgroups examined, with PRs ranging from 1.75 (95%CI = 1.65–1.85) in people aged 50–55 years to 1.21 (95%CI = 1.19–1.24) among those aged 60–64. Compared to people with neither CVD nor physical functioning limitations, those with physical functional limitations were around three times as likely to be out of the workforce regardless of CVD diagnosis participants with CVD but without physical functional limitations were 13% more likely to be out of the workforce (PR = 1.13, 95%CI = 1.07–1.20). While many people with CVD participate in the workforce, participation is substantially lower, especially for people with cerebrovascular disease, than for people without CVD, highlighting priority areas for research and support, particularly for people experiencing physical functioning limitations.
Publisher: Wiley
Date: 20-03-2023
DOI: 10.5694/MJA2.51890
Abstract: To review and synthesise the global evidence regarding the health effects of electronic cigarettes (e‐cigarettes, vapes). Umbrella review (based on major independent reviews, including the 2018 United States National Academies of Sciences, Engineering, and Medicine [NASEM] report) and top‐up systematic review of published, peer‐reviewed studies in humans examining the relationship of e‐cigarette use to health outcomes published since the NASEM report. Umbrella review: eight major independent reviews published 2017–2021. Systematic review: PubMed, MEDLINE, Scopus, Web of Science, the Cochrane Library, and PsycINFO (articles published July 2017 – July 2020 and not included in NASEM review). Four hundred eligible publications were included in our synthesis: 112 from the NASEM review, 189 from our top‐up review search, and 99 further publications cited by other reviews. There is conclusive evidence linking e‐cigarette use with poisoning, immediate inhalation toxicity (including seizures), and e‐cigarette or vaping product use‐associated lung injury (EVALI largely but not exclusively for e‐liquids containing tetrahydrocannabinol and vitamin E acetate), as well as for malfunctioning devices causing injuries and burns. Environmental effects include waste, fires, and generation of indoor airborne particulate matter (substantial to conclusive evidence). There is substantial evidence that nicotine e‐cigarettes can cause dependence or addiction in non‐smokers, and strong evidence that young non‐smokers who use e‐cigarettes are more likely than non‐users to initiate smoking and to become regular smokers. There is limited evidence that freebase nicotine e‐cigarettes used with clinical support are efficacious aids for smoking cessation. Evidence regarding effects on other clinical outcomes, including cardiovascular disease, cancer, development, and mental and reproductive health, is insufficient or unavailable. E‐cigarettes can be harmful to health, particularly for non‐smokers and children, adolescents, and young adults. Their effects on many important health outcomes are uncertain. E‐cigarettes may be beneficial for smokers who use them to completely and promptly quit smoking, but they are not currently approved smoking cessation aids. Better quality evidence is needed regarding the health impact of e‐cigarette use, their safety and efficacy for smoking cessation, and effective regulation. Systematic review: PROSPERO, CRD42020200673 (prospective).
Publisher: Springer Science and Business Media LLC
Date: 05-03-2020
DOI: 10.1186/S12874-020-00938-8
Abstract: Single time-point assessments of psychological distress are often used to indicate chronic mental health problems, but the validity of this approach is unclear. The aims of this study were to investigate how a single assessment of distress relates to longer-term assessment and quantify misclassification from using single measures to indicate chronic distress. Data came from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative study of Australian adults. Psychological distress, measured with the Kessler10 and categorised into low (scores:10- 12), mild (12- 16), moderate (16- 22) and high (22–50), has been assessed in the Survey biennially since wave 7. Among respondents who were aged ≥25 years and participated in all waves in which distress was measured, we describe agreement in distress categories, and using a mixed linear model adjusting for age and sex we estimate change in scores, over a two-, four-, six- and eight-year follow-up period. We applied weights, benchmarked to the Australian population, to all analyses. Two-years following initial assessment, proportions within identical categories of distress were 66.0% for low, 54.5% for mild, 44.0% for moderate and 50.3% for high, while 94.1% of those with low distress initially had low/mild distress and 81.4% with high distress initially had moderate/high distress. These patterns did not change materially as follow-up time increased. Over the full eight-year period, 77.3% of in iduals with high distress initially reported high distress on ≥1 follow-up occasion. Age-and sex- adjusted change in K10 scores over a two-year period was 1.1, 0.5, − 0.7 and − 4.9 for low, mild, moderate and high distress, respectively, and also did not change materially as follow-up time increased. In the absence of repeated measures, single assessments are useful proxies for chronic distress. Our estimates could be used in bias analyses to quantify the magnitude of the bias resulting from use of single assessments to indicate chronic distress.
Publisher: BMJ
Date: 07-03-2018
Abstract: High body mass index (BMI) is the second leading contributor to Australia’s burden of disease and is particularly prevalent among Aboriginal peoples. This paper aims to provide insight into factors relating to obesity among Aboriginal adults and Aboriginal–non-Aboriginal differences. Cross-sectional analysis of data from the 45 and Up Study, comparing obesity (BMI ≥30 kg/m 2 ) prevalence and risk factors among 1515 Aboriginal and 213 301 non-Aboriginal adults in New South Wales. Age–sex-adjusted prevalence ratios (PRs) for obesity by sociodemographic factors, health behaviours and health status were estimated (multivariable log-binomial regression) for Aboriginal and non-Aboriginal participants separately. We quantified the extent to which key factors (physical activity, screen time, education, remoteness, area-level disadvantage) accounted for any excess Aboriginal obesity prevalence. Obesity prevalence was 39% among Aboriginal and 22% among non-Aboriginal participants (PR=1.65, 95% CI 1.55 to 1.76). Risk factors for obesity were generally similar for Aboriginal and non-Aboriginal participants and included in idual-level and area-level disadvantage, physical inactivity, and poor physical and mental health, with steeper gradients observed among non-Aboriginal participants for some factors (P interaction .05). Many risk factors were more common among Aboriginal versus non-Aboriginal participants key factors accounted for % of the excess Aboriginal obesity prevalence. A substantial proportion of the excess obesity prevalence among Aboriginal versus non-Aboriginal participants was explained by physical activity, screen time, education, remoteness and area-level disadvantage. Socioeconomic and health behaviour factors are potential targets for promoting healthy BMI, but these must be considered within the context of upstream social and cultural factors. Adults with health needs and disability require particular attention.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2018-022767
Abstract: People with diabetes experience an elevated risk of psychological distress compared with people without diabetes. It is unclear how much of this elevated risk is attributable to the greater levels of physical disability in people with diabetes, and how this risk varies according to sociodemographic and health-behavioural characteristics. This study quantified levels of psychological distress in people with and without diabetes, considering these factors. Cross-sectional analysis of questionnaire data. Men and women aged ≥45 years, in the 45 and Up Study, from New South Wales, Australia. 236 441 people who completed the baseline postal questionnaire (distributed from 1 January 2006–31 December 2008), with valid data for diabetes status and psychological distress. High psychological distress (Kessler-10 ). Modified Poisson regression with robust error variance was used to estimate prevalence ratios (PRs), comparing prevalence of high psychological distress among those with and without diabetes and across physical functional limitation (PFL) levels, adjusting for potential confounders. Overall, 8.4% (19 803/236 441) of participants reported diabetes. 11.8% (2339) of in iduals with diabetes and 7.2% (15 664) without diabetes had high psychological distress: age-adjusted and sex-adjusted PR=1.89 (95% CI 1.81 to 1.97), becoming 1.58 (1.52 to 1.65) and 1.22 (1.17 to 1.27) following additional adjustment for sociodemographic factors, health behaviours and additionally for PFL, respectively. Compared with in iduals with neither diabetes nor PFL, the adjusted PRs for high psychological distress were: 1.37 (1.17 to 1.60) with diabetes but no PFL, 7.33 (7.00 to 7.67) without diabetes but with severe PFL and 8.89 (8.36 to 9.46) with both diabetes and severe PFL. People with diabetes have a 60% greater risk of high psychological distress than people without diabetes a substantial proportion of this elevation is attributable to higher levels of disability with diabetes, especially factoring in measurement error. Psychological distress is strongly related to physical impairment.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2020
DOI: 10.1186/S12939-020-01235-Y
Abstract: Contemporary Australian evidence on socioeconomic variation in secondary cardiovascular disease (CVD) care, a possible contributor to inequalities in cardiovascular disease outcomes, is lacking. This study examined the relationship between education, an in idual-level indicator of socioeconomic position, and receipt of angiography and revascularisation procedures following incident hospitalisation for acute myocardial infarction (AMI) or angina, and the role of private care in this relationship. Participants aged ≥45 from the New South Wales population-based 45 and Up Study with no history of prior ischaemic heart disease hospitalised for AMI or angina were followed for receipt of angiography or revascularisation within 30 days of hospital admission, ascertained through linked hospital records. Education attainment, measured on baseline survey, was categorised as low (no school certificate/qualifications), intermediate (school certificate/trade/apprenticeship/diploma) and high (university degree). Cox regression estimated the association (hazard ratios [HRs]) between education and coronary procedure receipt, adjusting for demographic and health-related factors, and testing for linear trend. Private health insurance was investigated as a mediating variable. Among 4454 patients with AMI, 68.3% received angiography within 30 days of admission (crude rate: 25.8 erson-year) and 48.8% received revascularisation (rate: 11.7 erson-year) corresponding figures among 4348 angina patients were 59.7% (rate: 17.4 erson-year) and 30.8% (rate: 5.3 erson-year). Procedure rates decreased with decreasing levels of education. Comparing low to high education, angiography rates were 29% lower among AMI patients (adjusted HR = 0.71, 95% CI: 0.56–0.90) and 40% lower among angina patients (0.60, 0.47–0.76). Patterns were similar for revascularisation among those with angina (0.78, 0.61–0.99) but not AMI (0.93, 0.69–1.25). After adjustment for private health insurance status, the HRs were attenuated and there was little evidence of an association between education and angiography among those admitted for AMI. There is a socioeconomic gradient in coronary procedures with the most disadvantaged patients being less likely to receive angiography following hospital admission for AMI or angina, and revascularisation procedures for angina. Unequal access to private health care contributes to these differences. The extent to which the remaining variation is clinically appropriate, or whether angiography is being underused among people with low socioeconomic position or overused among those with higher socioeconomic position, is unclear.
Publisher: Oxford University Press (OUP)
Date: 09-2021
Abstract: Mortality reporting and research are typically focused on a single underlying cause of death (UCoD) selected from multiple reported causes. The need to incorporate multiple causes of death (MCoD) in mortality statistics is now recognised internationally, but there is scant methodological work to guide analytical approaches. This review aims to identify and appraise current methods and practices used to analyse MCoD data. The Web of Science, Medline, Pubmed and Scopus (from inception to December 2019) were queried. Studies reporting MCoD alone or in comparison with single UCoD were included. The review is supplemented by qualitative interview with international experts. 3491 studies were identified 141 full texts were included in the review. The measures usually estimated when analysing MCoD can be broadly categorised into descriptive measures (n = 93 studies), measures of associations between diseases (n = 46 studies) and advanced statistical methods (n = 11 studies). Descriptive statistics commonly used include standardized ratio of multiple to underlying cause (SRMU) and mortality rates based on any mention of a disease. Approaches used to assess measures of associations between diseases include the Cause-of-Death Association Indicator (CDAI) and social network analysis. The advanced statistical methods include weighting MCoD and lethal defect-wear model of mortality. Audit results will be discussed. This review provides a comprehensive and updated summary of methodological approaches used to analyse MCoD data. The merit of each analytical framework is discussed. More work is needed to develop methodological frameworks that could be used to support routine consideration of MCoD in practice.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.YPMED.2021.106884
Abstract: Cardiovascular disease (CVD) events are highly preventable through appropriate treatment and disproportionally affect socioeconomically disadvantaged in iduals. This study quantified the relationship of socioeconomic factors to dispensing and persistent use of lipid- and blood pressure-lowering medication following hospital admission for a major CVD event (myocardial infarction, ischaemic stroke/transient ischaemic attack). Data from 8285 people with such events aged ≥45 years from the Australian 45 and Up Study with linked medication data were used to estimate relative risks (RRs) for combined lipid- and blood pressure-lowering dispensing at three-months following hospital discharge and for 12-month persistent use, in relation to education, income, and level of medication subsidisation. Overall, 56% were dispensed guideline-recommended medications at three months and 37% persistently used them across 12 months. After adjusting for demographic factors, type of CVD and history of CVD hospitalisation, RRs for lowest (no educational qualifications) compared to highest education level (university degree) were 1.14 (95% CI: 1.06, 1.22) for medication dispensing and 1.15 (1.02, 1.29) for persistent medication use 1.14 (1.06, 1.22) and 1.17 (1.04, 1.32) respectively for lowest (<$20,000) versus highest (≥$70,000) household pre-tax income and 1.25 (1.17, 1.33) and 1.28 (1.15, 1.43) respectively for those receiving highest versus lowest subsidisation. There was little to no evidence of a relationship of income and education to medication use after adjustment for medication subsidisation. While preventive medication use is sub-optimal, subsidisation is substantially associated with increased use and accounts for most of the relationship with socioeconomic position, suggesting subsidy schemes are working in the intended direction.
Publisher: BMJ
Date: 11-02-2009
Abstract: The prevalence of diagnosed diabetes among different ethnic groups and the influence of deprivation on the prevalence of diabetes among Māori and New Zealand Europeans was investigated. This was a cross-sectional survey on all patients registered with 10 practices in the Rotorua General Practice Group on 1 July 2007. Patients diagnosed with diabetes were identified though diagnostic codes for diabetes, prescriptions for diabetes medications and laboratory tests for glycosylated haemoglobin (HbA(1c)). Prevalence of diabetes by ethnicity, age group, gender and NZDep2001 quintiles was calculated. Adjusted ORs for the risk of diabetes were obtained from logistic regression analysis. Of the 45 500 patients registered, 1819 had been diagnosed with diabetes mellitus. In the 40+ age groups, the prevalence of diabetes in Māori and Pacific people was around three times that in Europeans. With increasing deprivation, the age-standardised prevalence of diagnosed diabetes increased among European males (2.7-5.0%) and females (2.1-3.1%). However, the prevalence of diabetes was highest among the least deprived Māori (males 9.7%, females 6.2%). The adjusted risk of diabetes for the most deprived Māori is not significantly different from that for the least deprived Māori. The most deprived Europeans had nearly twice the risk of having diabetes than the least deprived Europeans. Although the rising prevalence of diabetes with increasing deprivation among Europeans shows a similar trend to results from national and international studies, the trend among Māori seems to be different because the least deprived are equally at risk of diabetes. Diabetes interventions aimed at Māori should be tailor-made to include the least deprived groups.
Publisher: Wiley
Date: 31-05-2021
DOI: 10.1002/IJC.33685
Abstract: Tobacco smoke is a known carcinogen, but the magnitude of smoking‐related cancer risk depends on country‐specific, generational smoking patterns. We quantified cancer risk in relation to smoking in a population‐based cohort, the 45 and Up Study (2006‐2009) in New South Wales, Australia. Cox proportional hazards regressions estimated adjusted hazard ratios (HR) by self‐reported smoking history at baseline (2006‐2009) for incident, primary cancers via linkage to cancer registry data to 2013 and cancer death data to 2015. Among 229 028 participants aged ≥45 years, 18 475 cancers and 5382 cancer deaths occurred. Current‐smokers had increased risks of all cancers combined (HR = 1.42, 95% confidence interval [CI], 1.34‐1.51), cancers of the lung (HR = 17.66, 95%CI, 14.65‐21.29), larynx (HR = 11.29, 95%CI, 5.49‐23.20), head‐and‐neck (HR = 2.53, 95%CI, 1.87‐3.41), oesophagus (HR = 3.84, 95%CI, 2.33‐6.35), liver (HR = 4.07, 95%CI, 2.55‐6.51), bladder (HR = 3.08, 95%CI, 2.00‐4.73), pancreas (HR = 2.68, 95%CI, 1.93‐3.71), colorectum (HR = 1.31, 95%CI, 1.09‐1.57) and unknown primary site (HR = 3.26, 95%CI, 2.19‐4.84) versus never‐smokers. Hazards increased with increasing smoking intensity compared to never‐smokers, lung cancer HR = 9.22 (95%CI, 5.14‐16.55) for 1‐5 cigarettes/day and 38.61 (95%CI, 25.65‐58.13) for cigarettes/day. Lung cancer risk was lower with quitting at any age but remained higher than never‐smokers for quitters aged y. By age 80y, an estimated 48.3% of current‐smokers (41.1% never‐smokers) will develop cancer, and 14% will develop lung cancer, including 7.7% currently smoking 1‐5 cigarettes/day and 26.4% for cigarettes/day (1.0% never‐smokers). Cancer risk for Australian smokers is significant, even for 'light' smokers. These contemporary estimates underpin the need for continued investment in strategies to prevent smoking uptake and facilitate cessation, which remain key to reducing cancer morbidity and mortality worldwide.
Publisher: Public Library of Science (PLoS)
Date: 29-01-2013
Publisher: Frontiers Media SA
Date: 31-05-2019
Publisher: Elsevier BV
Date: 08-2016
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJOPEN-2020-038761
Abstract: Cardiovascular disease (CVD) is highly preventable and optimal treatments based on absolute risk can halve risk of future events. Compared with women, men have higher risks of developing CVD. However, women can experience suboptimal treatment. We aimed to quantify sex differences in CVD risk, assessment and treatment in Australian adults. Cross-sectional analysis of nationally representative data from interview, physical measures, medication review and blood and urine s les, from 2011 to 2012 Australian Health Survey participants aged 45–74 (n=11 518). CVD risk factors, absolute 5-year risk of a primary CVD event, blood pressure and cholesterol assessment in the previous 2 and 5 years and use of recommended CVD preventive medications were compared using Poisson regression to estimate age-adjusted male versus female prevalence ratios (PRs). Women had a generally more favourable CVD risk factor profile than men, including lower: current smoking prevalence (women=14.5% men=18.4%, PR=0.78, 95% CI=0.70 to 0.88) body mass index (women (mean)=28.3 kg/m 2 men (mean)=28.8 kg/m 2 , p .01) systolic and diastolic blood pressure (systolic: women (mean)=127.1 mm Hg men (mean)=130.5 mm Hg, p .001) blood glucose (women (mean)=5.2 mmol/L men (mean)=5.5 mmol/L) diabetes prevalence (women=6.8% men=12.5%, PR=0.55, 95% CI=0.44 to 0.67) prior CVD (women=7.9% men=11.3%) and absolute primary CVD risk (absolute 5-year CVD risk %: women=6.6%, 95% CI=5.4 to 7.8 men=15.4%, 95% CI=13.9% to 16.9%). Compared with men, women had higher low-density lipoprotein, high-density lipoprotein and total cholesterol and sedentary behaviour and lower physical activity. Blood pressure and cholesterol assessment were common in both sexes. Among those at high absolute risk, age-adjusted proportions receiving recommended CVD medications were low, without sex differences (women=21.3% men=23.8%, PR=0.93, 95% CI=0.49 to 1.78). Fewer women than men with prior atherosclerotic CVD were receiving recommended treatment (women=21.8%, men=41.4%, PR=0.55, 95% CI=0.31 to 0.96). Women have a more favourable CVD risk factor profile than men. Preventive treatment is uncommon and women with prior atherosclerotic CVD are around half as likely as men to be receiving recommended treatment.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-045603
Abstract: To review and summarise the current evidence on the uptake of combustible cigarette smoking following e-cigarette use in non-smokers—including never-smokers, people not currently smoking and past smokers—through an umbrella review, systematic review and meta-analysis. Umbrella review, systematic review and meta-analysis. PubMed, Scopus, Web of Science, PsychINFO (Ovid), Medline (Ovid) and Wiley Cochrane Library up to April 2020. Of 6225 results, 25 studies of non-smokers—never, not current and former smokers—with a baseline measure of e-cigarette use and an outcome measure of combustible smoking uptake were included. All 25 studies found increased risk of smoking uptake with e-cigarette exposure, although magnitude varied substantially. Using a random-effects model, comparing e-cigarette users versus non-e-cigarette users, among never-smokers at baseline the OR for smoking initiation was 3.19 (95% CI 2.44 to 4.16, I 2 85.7%) and among non-smokers at baseline the OR for current smoking was 3.14 (95% CI 1.93 to 5.11, I 2 91.0%). Among former smokers, smoking relapse was higher in e-cigarette users versus non-users (OR=2.40, 95% CI 1.50 to 3.83, I 2 12.3%). Across multiple settings, non-smokers who use e-cigarettes are consistently more likely than those avoiding e-cigarettes to initiate combustible cigarette smoking and become current smokers. The magnitude of this risk varied, with an average of around three times the odds. Former smokers using e-cigarettes have over twice the odds of relapse as non-e-cigarettes users. This study is the first to our knowledge to review and pool data on the latter topic. CRD42020168596.
Publisher: Public Library of Science (PLoS)
Date: 30-09-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-01-2023
Publisher: Springer Science and Business Media LLC
Date: 13-09-2023
Publisher: Springer Science and Business Media LLC
Date: 10-02-2022
DOI: 10.1186/S12916-022-02253-Z
Abstract: The World Health Organization’s (WHO) 25X25 goal aims for a 25% relative reduction in premature death due to four non-communicable diseases (NCD4)—cancer, cardiovascular disease, chronic respiratory diseases and diabetes—by 2025 compared to 2010. This study aimed to quantify the premature mortality in the Australian population due to NCD4, quantify the variation in mortality rates by age and sex, predict the premature mortality due to NCD4 in 2025 and evaluate the progress towards the WHO 25X25 goal. A population-based study using cause-specific mortality data of all deaths which occurred in Australia from 2010 to 2016 and registered up to 2017, for adults aged 30–69 years, was conducted. Age-specific and age-standardised mortality rates (ASMR) and probability of death for NCD4 were calculated for each year. ASMRs in 2016 were calculated for men and women. Deaths and the probability of death in 2025 were predicted using Poisson regression based on data from 2006 to 2016. To assess the progress against the WHO 25X25 goal, the relative reduction in the probability of death from NCD4 conditions in 2025 compared to 2010 was calculated. ASMRs for NCD4 decreased from 2010 to 2016, except for diabetes which increased on average by 2.5% per year. Across sociodemographic factors, ASMRs were highest in males and increased with age. The projected probability of premature death in 2025 was 7.36%, equivalent to a relative reduction of 25.16% compared to 2010 levels. Premature mortality due to cancer, cardiovascular disease, respiratory diseases and diabetes declined in Australia from 2010 to 2016. This trend is consistent across age groups and by sex, and higher mortality rates were observed in males and at older ages. Nationally, if the current trends continue, we estimate that Australia will achieve a 25.16% relative reduction in premature deaths due to NCD4 in 2025 compared to 2010, signifying substantial progress towards the WHO 25X25 goal. Concerted efforts will need to continue to meet the 25X25 goal, especially in the context of the COVID-19 pandemic.
Publisher: Public Library of Science (PLoS)
Date: 19-02-2015
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-027305
Abstract: To quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors. Prospective cohort analysis. Questionnaire data from a population-based cohort study of in iduals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009–June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations. HMR receipt during the 5-year study period. Over 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using medications at baseline, 6.8% with 5–9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5–9 and ≥10 versus medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus good self-reported health this association was attenuated substantially following additional adjustment for polypharmacy. HMR was common in in iduals using multiple medications, a formal indication for general practitioner referral and, to a lesser extent, with poorer health and other markers of high-risk prescribing. Despite this, HMR use over a 5-year period was generally below 10%, even in high-risk groups, suggesting substantial potential for improvement in uptake and targeting.
Publisher: Cold Spring Harbor Laboratory
Date: 04-11-2020
DOI: 10.1101/2020.11.02.20224212
Abstract: To systematically review and meta-analyse evidence regarding the efficacy of electronic nicotine delivery systems (ENDS) as smoking cessation aids. PubMed, Scopus, Web of Science, PsycINFO, MEDLINE and Cochrane Library were searched up to February-March 2020 (PROSPERO registration CRD42020170692). Published peer-reviewed randomised controlled trials (RCTs) of the efficacy of ENDS for sustained cessation of combustible tobacco smoking and/or nicotine use, compared with no intervention, placebo or nicotine replacement therapy (NRT) by intention-to-treat, with a minimum of four months follow-up. Data were extracted independently into a pre-specified template. Risk of bias was assessed with the Cochrane Collaboration’s tool and evidence quality rated using GRADE. From 3,973 titles identified, nine RCTs were identified 330 of 5,445 smokers randomised quit. Smoking cessation did notPublic health consequences differ significantly for randomisation to ENDS versus: no intervention (three studies, random-effects meta-analysis RR 1.95 95%CI 0.90-4.22) placebo (three studies, 1.61 0.93-2.78) or NRT (three studies 1.25 0.74-2.11). Fixed-effects sensitivity analyses showed significant results for ENDS vs NRT (1.43 1.10-1.86). Smokers randomised to ENDS were substantially more likely than control to use nicotine at follow-up. Overall evidence quality was low. Considering only studies without potential competing interests further limited evidence but did not materially change conclusions. There is insufficient evidence that ENDS are efficacious for smoking cessation compared to no intervention, placebo or NRT. Results are promising, particularly for therapeutic use, but vary according to analytic method. ENDS may lead to greater ongoing nicotine exposure than other smoking cessation methods. This systematic review and meta-analysis consolidates current evidence on the efficacy of ENDS as an aid to sustained smoking and nicotine cessation and considers these findings in the context of potential competing interests. While findings are promising more research - preferably independent of industry funding - is needed to provide robust evidence of the efficacy of ENDS for smoking cessation. Future research should investigate nicotine cessation in addition to smoking cessation.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-039628
Abstract: Cardiovascular disease (CVD) incidence is elevated among people with psychological distress. However, whether the relationship is causal is unclear, partly due to methodological limitations, including limited evidence relating to longer-term rather than single time-point measures of distress. We compared CVD relative risks for psychological distress using single time-point and multi-time-point assessments using data from a large-scale cohort study. We used questionnaire data, with data collection at two time-points (time 1: between 2006 and 2009 time 2: between 2010 and 2015), from CVD-free and cancer-free 45 and Up Study participants, linked to hospitalisation and death records. The follow-up period began at time 2 and ended on 30 November 2017. Psychological distress was measured at both time-points using Kessler 10 (K10), allowing assessment of single time-point (at time 2: high (K10 score: 22–50) vs low (K10 score: )) and multi-time-point (high distress (K10 score: 22–50) at both time-points vs low distress (K10 score: ) at both time-points) measures of distress. Cox regression quantified the association between distress and major CVD, with and without adjustment for sociodemographic and health-related characteristics, including functional limitations. Among 83 906 respondents, 7350 CVD events occurred over 410 719 follow-up person-years (rate: 17.9 per 1000 person-years). Age-adjusted and sex-adjusted rates of major CVD were elevated by 50%–60% among those with high versus low distress for both the multi-time-point (HR=1.63, 95% CI 1.40 to 1.90) and single time-point (HR=1.53, 95% CI 1.39 to 1.69) assessments. HRs for both measures of distress attenuated with adjustment for sociodemographic and health-related characteristics, and there was little evidence of an association when functional limitations were taken into account (multi-time-point HR=1.09, 95% CI 0.93 to 1.27 single time-point HR=1.14, 95% CI 1.02 to 1.26). Irrespective of whether a single time-point or multi-time-point measure is used, the distress–CVD relationship is substantively explained by sociodemographic characteristics and pre-existing physical health-related factors.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2015
Publisher: Elsevier BV
Date: 2011
Abstract: The study aimed to evaluate the effect of upper extremity resistance training for patients with COPD on dyspnea during activity of daily living (ADL), arm function, arm exercise capacity, muscle strength, and health-related quality of life (HRQL). Patients were randomly assigned to an intervention or control group. The intervention group underwent arm resistance training. The control group performed a sham. Both groups exercised three times a week for 6 weeks. Dyspnea during ADL and HRQL were measured using the Chronic Respiratory Disease Questionnaire (CRDQ). Arm function and exercise capacity were measured using the 6-min pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX), respectively. Muscle strength for the biceps, triceps, and anterior and middle deltoids was obtained using an isometric dynamometer. Thirty-six patients with COPD (66 ± 9 years) participated in the study. Compared with the control group, the magnitude of change in the intervention group was greater for the 6PBRT (P = .03), UULEX (P = .01), elbow flexion force (P = .01), elbow extension force (P = .02), shoulder flexion force (P = .029), and shoulder abduction force (P = .01). There was no between-group difference in dyspnea during ADL, HRQL, or symptoms during the 6PBRT or UULEX (all P values > .08). Resistance-based arm training improved arm function, arm exercise capacity, and muscle strength in patients with COPD. No improvement in dyspnea during ADL, HRQL, or symptoms was demonstrated.
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-022613
Abstract: To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality. Prospective cohort study using questionnaire data linked to mortality data. Men aged ≥45years randomly s led from the general population of New South Wales, Australia, participating in the 45 and Up Study. 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases. The primary outcome was all-cause mortality. 12 160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827 95% CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45–85 years. We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men’s decision making would be small in the recommended age (50–69 years) for PSA testing, but it may discourage testing at older ages.
Publisher: Public Library of Science (PLoS)
Date: 10-06-2016
Publisher: Elsevier BV
Date: 12-2022
Publisher: Elsevier BV
Date: 02-2012
Publisher: BMJ
Date: 02-2017
Publisher: AMPCo
Date: 27-03-2021
DOI: 10.5694/MJA2.50995
Publisher: Elsevier BV
Date: 04-2023
Publisher: American Association for Cancer Research (AACR)
Date: 11-2014
DOI: 10.1158/1055-9965.EPI-14-0206
Abstract: Background: Quantifying the risk of colorectal cancer for in iduals is likely to be useful for health service provision. Our aim was to develop and externally validate a prediction model to predict 5-year colorectal cancer risk. Methods: We used proportional hazards regression to develop the model based on established personal and lifestyle colorectal cancer risk factors using data from 197,874 in iduals from the 45 and Up Study, Australia. We subsequently validated the model using 24,233 participants from the Melbourne Collaborative Cohort Study (MCCS). Results: A total of 1,103 and 224 cases of colorectal cancer were diagnosed in the development and validation s le, respectively. Our model, which includes age, sex, BMI, prevalent diabetes, ever having undergone colorectal cancer screening, smoking, and alcohol intake, exhibited a discriminatory accuracy of 0.73 [95% confidence interval (CI), 0.72–0.75] and 0.70 (95% CI, 0.66–0.73) using the development and validation s le, respectively. Calibration was good for both study s les. Stratified models according to colorectal cancer screening history, that additionally included family history, showed discriminatory accuracies of 0.75 (0.73–0.76) and 0.70 (0.67–0.72) for unscreened and screened in iduals of the development s le, respectively. In the validation s le, discrimination was 0.68 (0.64–0.73) and 0.72 (0.67–0.76), respectively. Conclusion: Our model exhibited adequate predictive performance that was maintained in the external population. Impact: The model may be useful to design more powerful cancer prevention trials. In the group of unscreened in iduals, the model may be useful as a preselection tool for population-based screening programs. Cancer Epidemiol Biomarkers Prev 23(11) 2543–52. ©2014 AACR.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2014
DOI: 10.1038/IJO.2013.192
Publisher: Public Library of Science (PLoS)
Date: 06-12-2018
Publisher: Springer Science and Business Media LLC
Date: 03-07-2019
Publisher: Wiley
Date: 06-2006
DOI: 10.1111/J.1834-7819.2006.TB00417.X
Abstract: The aims of this study were to describe dental health and perceived barriers to dental care in a regional centre and surrounding smaller towns in rural Victoria. A stratified, randomized, face-to-face household survey was undertaken to assess levels of edentulism and access to oral health services. A study response rate of 70.3 per cent (6316/9260) was achieved. When compared with those in the regional centre, people living in the shire capitals were more likely to travel greater distances to see a dentist and were less likely to have seen a dentist within the past 12 months. While there was little difference in the edentulous proportion living in shire capitals compared with the regional centre, the level of edentulousness over the entire region was greater than overall Australian estimates. Differences in perceived barriers to care within the region were less than expected. Existing perceived barriers were lack of need, time until available appointments, attitudes of dentists and lack of public dental facilities. Differences in these barriers existed between socio-economic groups. This study shows that the prevalence of edentulism was higher in the areas studied relative to the Australian population. Significant patient perceived barriers to care exist which may contribute to the problem.
Publisher: AMPCo
Date: 12-2012
DOI: 10.5694/MJA12.11035
Abstract: To investigate variation, and quantify socioeconomic inequalities, in the uptake of primary bariatric surgery in an obese population. Prospective population-based cohort study of 49,364 in iduals aged 45-74 years with body mass index (BMI)≥30 kg/m2. Data from questionnaires (distributed from 1 January 2006 to 31 December 2008) were linked to hospital and death data to 30 June 2010. The s le was drawn from the 45 and Up Study (approximately 10% of New South Wales population aged 45 included, response rate approximately 18%). Rates of bariatric surgery and adjusted rate ratios (RRs) in relation to health and sociodemographic characteristics. Over 111,757 person-years (py) of follow-up, 312 participants had bariatric surgery, a rate of 27.92 per 10,000 py (95% CI, 24.91-31.19). Rates were highest in women, those living in major cities and those with diabetes, and increased significantly with a higher BMI and number of chronic health conditions. Adjusted RRs were 5.27 (95% CI, 3.18-8.73) for those with annual household income≥ $70 000 versus those with household income<$20,000, and 4.01 (95% CI, 2.41-6.67) for those living in areas in the least disadvantaged quintile versus those in the most disadvantaged quintile. Having versus not having private health insurance (age- and sex-adjusted RR, 9.25 95% CI, 5.70-15.00) partially explained the observed inequalities. Bariatric surgery has been shown to be cost-effective in treating severe obesity and associated illnesses. While bariatric surgery rates in Australia are higher in those with health problems, large socioeconomic inequalities are apparent. Our findings suggest these procedures are largely available to those who can afford private health insurance and associated out-of-pocket costs, with poor access in populations who are most in need. Continuing inequalities in access are likely to exacerbate existing inequalities in obesity and related health problems.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2020
DOI: 10.1038/S41416-020-01101-2
Abstract: Although overall alcohol consumption is known to increase the risk of a number of cancers internationally, evidence for Australia and evidence regarding the pattern of drinking and cancer risk is limited. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cancer risk in relation to overall alcohol consumption (drinks/week) and pattern of drinking were calculated using Cox proportional hazard regressions for 226,162 participants aged ≥45 years (2006–2009) in the 45 and Up Study, an Australian prospective cohort study. Incident primary cancer cases were ascertained by linkage to the New South Wales Cancer Registry to 2013 by the Centre for Health Record Linkage. Over a median of 5.4 years, 17,332 cancers were diagnosed. Increasing levels of alcohol intake were associated with increased risk of cancers of the upper aerodigestive tract (1.19 1.10–1.29), mouth and pharynx (1.18 1.08–1.29), oesophagus (1.22 1.04–1.43), colorectum (1.09 1.04–1.15), colon (1.13 1.06–1.20), liver (1.22 1.04–1.44) and breast (1.11 1.02–1.21). Breast cancer risk was marginally associated with drinking pattern, with higher risk when intake was concentrated on 1–3 days/week compared to the same amount spread over 4–7 days ( P interaction = 0.049). Alcohol consumption confers a significant risk of cancer, and drinking pattern may be independently related to breast cancer risk.
Publisher: Wiley
Date: 07-03-2019
DOI: 10.1111/ACER.13981
Abstract: Evidence suggests that people who develop serious health conditions are likely to cease drinking alcohol (sometimes known as "sick-quitters"). We quantified the likelihood of quitting drinking in relation to the onset of a variety of health conditions. Odds ratios (ORs) and 95% confidence intervals (CIs) of ceasing alcohol consumption after diagnosis of 28 health conditions and 4 general indicators of health were derived from logistic regression among 97,852 drinkers aged ≥ 45 years between baseline (2006 to 2009) and median 5.3 years of follow-up in the New South Wales 45 and Up Study. Incident health conditions at follow-up were self-reported. At follow-up, 9.6% (n = 9,438) of drinkers had ceased drinking. Drinking cessation was significantly associated with 24 of 32 health conditions examined: 15.4% of participants with newly diagnosed diabetes quit drinking (OR for quitting vs. continuing 1.77, 95% CI: 1.60 to 1.96), 16.4% with Parkinson's disease (1.71, 1.35 to 2.17), 17.8% with poor memory (1.68, 1.43 to 1.97), 19.2% with hip fracture (1.64, 1.30 to 2.06), 14.7% with stroke (1.45, 1.27 to 1.66), 12.5% with depression (1.40, 1.26 to 1.55), 15.0% with breast cancer (1.38, 1.18 to 1.61), 12.3% with heart disease (1.34, 1.25 to 1.44), and 13.3% with osteoarthritis (1.22, 1.12 to 1.33). Strong associations with quitting were observed in those with a decline in self-rated overall health (2.93, 2.53 to 3.40) and quality of life (2.68, 2.24 to 3.21). Some health conditions not significantly associated with quitting were prostate cancer, melanoma, nonmelanoma skin cancer, hay fever, and hearing loss. Findings were generally consistent for men and women, by age group and by smoking status. Diagnosis with a variety of health conditions appears to prompt drinking cessation in older adults.
Publisher: Wiley
Date: 03-2015
DOI: 10.1002/DMRR.2570
Abstract: Gestational diabetes mellitus (GDM) is an important and increasing health problem. This study aims to investigate and explain the marked variation in reported GDM prevalence among Australian Indigenous women. We searched five databases to August 2013 for studies of GDM prevalence two people independently assessed search results, extracted data, and appraised risk of bias. Meta-analysis was conducted, and between-study heterogeneity examined using subgroup analyses. Within-study findings were synthesized narratively. The pooled GDM prevalence from 23 of the 25 total studies (5.74%, 4.78-6.71) was similar to that reported in national studies, but heterogeneity was substantial (I(2) = 97%), making conclusions from between-study comparisons difficult. The greatest reductions in heterogeneity were seen within subgroups using localized diagnostic criteria (I(2) = 43%, 3 studies), universal screening (I(2) = 58%) and some jurisdictions, probably reflecting proxy measures of increased consistency in diagnostic and screening methods. Insufficient data were available to assess the effect of factors such as rurality, diagnostic criteria, study design and data sources on prevalence. Synthesis of within-study findings showed: higher age-adjusted prevalences of GDM in Indigenous versus non-Indigenous women Indigenous women have greater increases in prevalence with maternal age and non-Indigenous women appear to have a steeper increase in GDM prevalence over time. Prevalence increased almost fourfold in two studies following introduction of universal screening when compared with selective risk-based screening, although numbers were small. The published GDM prevalence among Indigenous women varies markedly, probably due to variation in diagnostic and screening practices.
Publisher: Public Library of Science (PLoS)
Date: 12-02-2014
Publisher: Elsevier BV
Date: 09-2011
Publisher: Elsevier BV
Date: 12-2014
Abstract: To assess the cross-cultural validity of two Kessler psychological distress scales (K-10 and K-5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non-Aboriginal in iduals from NSW Australia. Self-reported questionnaire data from the 45 and Up Study for 1,631 Aboriginal and 231,774 non-Aboriginal people were used to examine the factor structure, convergent validity, internal consistency and levels of missing data of K-10 and K-5. We found excellent agreement in classification of distress of Aboriginal participants by K-10 and K-5 (weighted kappa=0.87), high internal consistency (Cronbach's alpha K-10: 0.93, K-5: 0.88), and factor structures consistent with those for the total Australian population. Convergent validity was evidenced by a strong graded relationship between the level of distress and the odds of: problems with daily activities due to emotional problems current treatment for depression or anxiety and poor quality of life. K-10 and K-5 scales are promising tools for measuring psychological distress among Aboriginal and Torres Strait Islanders aged 45 and over in research and clinical settings.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12916-020-01830-4
Abstract: Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. Questionnaire data from an Australian population-based cohort study (45 and Up Study ( n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes—severe physical functional limitations (disability), moderate/high psychological distress and fair oor quality of life (QoL)—in participants with versus without cancer, for 13 cancer types. Compared to participants without cancer ( n = 244,000), cancer survivors ( n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25–1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02–1.08)) and poor/fair QoL (15.2% versus 10.2% 1.28 (1.24–1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56–3.77 distress 1.53, 1.20–1.96 poor/fair QoL 2.40, 1.87–3.07), lung cancer (disability 2.81, 2.50–3.15 distress 1.67, 1.46–1.92 poor/fair QoL 2.53, 2.21–2.91) and non-Hodgkin’s lymphoma (disability 1.56, 1.37–1.78 distress 1.20, 1.05–1.36 poor/fair QoL 1.66, 1.44–1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16–1.32 distress 0.95, 0.90–1.01 poor/fair QoL 1.15, 1.05–1.25), prostate cancer (disability 1.11, 1.04–1.19 distress 1.09, 1.02–1.15 poor/fair QoL 1.15, 1.08–1.23) and melanoma (disability 1.02, 0.94–1.10 distress 0.96, 0.89–1.03 poor/fair QoL 0.92, 0.83–1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.
Publisher: Springer Science and Business Media LLC
Date: 12-01-2017
Publisher: Springer Science and Business Media LLC
Date: 13-05-2009
DOI: 10.1007/S00125-009-1380-1
Abstract: We estimated the incidence of chronic renal failure, the incidence of end-stage renal disease (ESRD) and renal mortality rates among New Zealand European and Maori patients with diabetes and estimated the ethnic difference in the risk of developing renal failure. A renal complication-free cohort of adult diabetes patients registered with Waikato regional diabetes service, diagnosed with diabetes before 2003, were retrospectively followed for 4 years. Events of interest were renal hospital admission, ESRD and death coded with renal disease. Incidences of renal hospital admission, ESRD and death from renal disease were calculated for NZ Europeans and Maori patients with diabetes. Ethnic and sex differences in the risks of these renal outcomes were estimated using a Cox proportional hazards model. Of the 7,900 patients followed up, 116 (1.5%) had a renal admission, 42 (0.5%) started dialysis/transplantation and 21 (0.27%) died from renal disease. Maori diabetes patients had significantly higher incidences of dialysis or transplantation and rates of renal admission and renal death. Adjusted hazard ratios indicate that, compared with NZ Europeans with diabetes, Maori diabetes patients had a significantly higher risk of ESRD, renal admission and renal death (46-fold, seven-fold and four-fold increases, respectively). Maori patients progressed at a significantly faster rate from first hospital admission for chronic renal disease to ESRD. There were huge ethnic disparities in outcomes from renal disease. Screening for early kidney disease among Maori diabetes patients, intensive management of risk factors and further research on the aetiology of renal disease among Maoris is recommended.
Publisher: Springer Science and Business Media LLC
Date: 28-05-2019
Publisher: BMJ
Date: 03-2018
DOI: 10.1136/BMJOPEN-2017-021236
Abstract: Empirical evidence on family and community risk and protective factors influencing the comparatively high rates of potentially preventable hospitalisations and deaths among Aboriginal and Torres Strait Islander infants and children is limited. As is evidence on geographical variation in these risks. The ‘Defying the Odds’ study aims to explore the impact of perinatal outcomes, maternal social and health outcomes and level of culturally secure service availability on the health outcomes of Western Australian (WA) Aboriginal infants and children aged 0–5 years. The study combines a retrospective cohort study that uses state-wide linked health and administrative data from 12 data sources for multiple generations within Aboriginal families in WA, with specifically collected survey data from health and social services supporting Aboriginal families in regions of WA. Data sources include perinatal/birth registration, hospital, emergency department, mental health services, drug and alcohol service use, mortality, infectious disease notifications, and child protection and family services. Multilevel regression models will be used to examine the intensity of admissions and presentations, mortality, intensity of long stays and morbidity-free survival (no admissions) for Aboriginal children born in WA in 2000–2013. Relationships between maternal (and grand-maternal) health and social factors and child health outcomes will be quantified. Community-level variation in outcomes for Aboriginal children and factors contributing to this variation will be examined, including the availability of culturally secure services. Online surveys were sent to staff members at relevant services to explore the scope, reach and cultural security of services available to support Aboriginal families across selected regions of WA. Ethics approvals have been granted for the study. Interpretation and dissemination are guided by the study team’s Aboriginal leadership and reference groups. Dissemination will be through direct feedback and reports to health services in the study and via scientific publications and policy recommendations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-03-2019
Abstract: Few studies have investigated the longitudinal association between breastfeeding and maternal cardiovascular disease ( CVD ) outcomes. This study examined the association between breastfeeding and CVD hospitalization and mortality in a large Australian cohort. Baseline questionnaire data (2006–2009) from a s le of 100 864 parous women aged ≥45 years from New South Wales, Australia, were linked to hospitalization and death data until June 2014 and December 2013, respectively. Analysis was restricted to women without self‐reported medically diagnosed CVD at baseline or without past CVD hospitalization 6 years before study entry. Never versus ever breastfeeding and average breastfeeding duration per child, derived from self‐reported lifetime breastfeeding duration and number of children, and categorized as never breastfed, , to 12, or months/child, were assessed. Cox proportional hazards models were used to explore the association between breastfeeding and CVD outcomes. Covariates included sociodemographic characteristics, lifestyle risk factors, and medical and reproductive history. There were 3428 (3.4%) first CVD ‐related hospital admissions and 418 (0.4%) deaths during a mean follow‐up time of 6.1 years for CVD hospitalization and 5.7 years for CVD mortality. Ever breastfeeding was associated with lower risk of CVD hospitalization (adjusted hazard ratio [95% CI]: 0.86 [0.78, 0.96] P =0.005) and CVD mortality (adjusted hazard ratio [95% CI]: 0.66 [0.49, 0.89] P =0.006) compared with never breastfeeding. Breastfeeding ≤12 months/child was significantly associated with lower risk of CVD hospitalization. Breastfeeding is associated with lower maternal risk of CVD hospitalization and mortality in middle‐aged and older Australian women. Breastfeeding may offer long‐term maternal cardiovascular health benefits.
Publisher: Wiley
Date: 29-04-2014
DOI: 10.1111/AJO.12213
Abstract: Evidence on long-term trends in gestational diabetes mellitus (GDM) prevalence in Australia is lacking. To assess and compare trends in GDM prevalence among Indigenous and non-Indigenous Australian women. Analysis of crude and age-adjusted GDM prevalence over time by Indigenous status and age, using routinely collected midwives data from Australian states and territories on mothers giving birth from 1990 to 2009. Despite considerable data variation, particularly in 1990-1999, and likely underestimation of GDM prevalence, crude and age-adjusted GDM prevalences were higher in Indigenous than non-Indigenous women at all time-points (4.7% vs 3.1% in 1990-1999 5.1% vs 4.5% in 2000-2009, P < 0.0001). Data variability precluded quantitative assessment of trends and changes in prevalence ratios before 2000. From 2000 to 2009, GDM prevalence increased significantly among Indigenous women by a mean 2.6% annually (Ptrend <0.0001), and non-Indigenous women by 3.2% annually (Ptrend <0.0001), with no significant trend in the age-adjusted Indigenous/non-Indigenous prevalence ratios (PR) (P = 0.34). GDM prevalence increased significantly with age (P < 0.0001), although the increase with age was significantly greater among Indigenous women (PR 5.34 (4.94-5.77), ≥35 vs <25 years) compared to non-Indigenous women (PR 3.72 (3.64-3.81), ≥35 vs <25 years), Pinteraction <0.0001. Bearing data quality concerns in mind, GDM prevalence is increasing rapidly among Australian women, more than doubling in non-Indigenous women between 1990 and 2009. Prevalence is consistently higher in Indigenous versus non-Indigenous women, with statistically consistent differences between the groups in recent years. The marked increase in prevalence with age highlights an important period for prevention, particularly for Indigenous women.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2013
Abstract: Despite large disparities in health outcomes between Aboriginal and non-Aboriginal Australians, detailed evidence on the health and lifestyle characteristics of older Aboriginal Australians is lacking. The aim of this study is to quantify socio-demographic and health risk factors and mental and physical health status among Aboriginal participants from the 45 and Up Study and to compare these with non-Aboriginal participants from the study. The 45 and Up Study is a large-scale study of in iduals aged 45 years and older from the general population of New South Wales, Australia responding to a baseline questionnaire distributed from 2006–2008. Odds ratios (OR) and 95% confidence intervals (CI) of self-reported responses from the baseline questionnaire for Aboriginal versus non-Aboriginal participants relating to socio-demographic factors, health risk factors, current and past medical and surgical history, physical disability, functional health limitations and levels of current psychological distress were calculated using unconditional logistic regression, with adjustments for age and sex. Overall, 1939 of 266,661 45 and Up Study participants examined in this study identified as Aboriginal and/or Torres Strait Islander (0.7%). Compared to non-Aboriginal participants, Aboriginal participants were significantly more likely to be: younger (mean age 58 versus 63 years) without formal educational qualifications (age- and sex- adjusted OR = 6.2, 95% CI 5.3-7.3) of unemployed (3.7, 2.9-4.6) or disabled (4.6, 3.9-5.3) work status and with a household income $20,000/year versus ≥ $70,000/year (5.8, 5.0-6.9). Following additional adjustment for income and education, Aboriginal participants were significantly more likely than non-Aboriginal participants to: be current smokers (2.4, 2.0-2.8), be obese (2.1, 1.8-2.5), have ever been diagnosed with certain medical conditions (especially: diabetes [2.1, 1.8-2.4] depression [1.6, 1.4-1.8] and stroke [1.8, 1.4-2.3]), have care-giving responsibilities (1.8, 1.5-2.2) have a major physical disability (2.6, 2.2-3.1) have severe physical functional limitation (2.9, 2.4-3.4) and have very high levels of psychological distress (2.4, 2.0-3.0). Aboriginal participants from the 45 and Up Study experience greater levels of disadvantage and have greater health needs (including physical disability and psychological distress) compared to non-Aboriginal participants. The study highlights the need to address the social determinants of health in Australia and to provide appropriate mental health services and disability support for older Aboriginal people.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JPSYCHORES.2019.109794
Abstract: Cardiac patients with psychological distress have a poorer prognosis than patients without distress which may in part reflect differences in treatment. We quantified variation in coronary angiography and revascularisation procedures according to psychological distress among patients admitted with incident acute myocardial infarction (AMI) or angina. Questionnaire data (collected 2006-09) from 45 and Up Study participants were linked to hospitalisation and mortality data, to 30 June 2016. Among patients free from ischaemic heart disease at baseline and subsequently hospitalised with AMI or angina, Cox regression was used to model the association between distress (Kessler-10 scores: low [10-<12], mild [12-<16], moderate [16-<22] and high [22-50]) - assessed on the questionnaire - and coronary angiography and revascularisation procedures (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) within 30 days of admission, adjusting for personal characteristics, including physical functioning. Proportions receiving angiography and PCI/CABG were 71.4% and 51.7% following AMI (n = 3749), and 61.3% and 31.3% for angina patients (n = 3772), respectively. Following AMI, age-sex-adjusted rates of PCI/CABG were lower with higher levels of distress (test for trend: p = .037), as were rates of angiography and PCI/CABG (p < .01) following admission with angina. After additional adjustment for personal characteristics, associations between distress and procedure rates attenuated substantively and were no longer significant, except that PCI/CABG rates remained lower among angina patients with high versus low distress (HR = 0.76, 95%CI: 0.59-0.99). Distress-related variation in coronary procedures largely reflects differences in personal characteristics. Whether lower revascularisation rates among angina patients with high compared to low distress are clinically appropriate or represent under-treatment remains unclear.
Publisher: The Sax Institute
Date: 2022
DOI: 10.17061/PHRP3242233
Publisher: Elsevier BV
Date: 06-2016
Publisher: Mary Ann Liebert Inc
Date: 10-2006
Abstract: With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines.
Publisher: Oxford University Press (OUP)
Date: 16-05-2023
DOI: 10.1093/IJE/DYAD059
Publisher: Wiley
Date: 03-11-2016
DOI: 10.1111/AJO.12416
Abstract: Detailed analyses of long-term trends in Aboriginal maternal and newborn health characteristics are lacking. To examine trends in maternal and newborn health characteristics for all mothers who were recorded as Aboriginal in the Western Australian Midwives' Notification System from 1986 to 2009. Births were categorised into four-year time intervals (1986-1989, 1990-1993, 1994-1997, 1998-2001, 2002-2005, 2006-2009). Trends in maternal demographic characteristics, pre-existing medical conditions, pregnancy complications and neonatal characteristics were examined. For 37 424 births recorded from 1986 to 2009, the proportion of births to mothers aged ≤19 years decreased (31-22%, P < 0.001) along with the prevalence of pre-ecl sia (6.8-4.0%, P < 0.001) and antepartum haemorrhage (4.8-3.2%, P < 0.001). There were increases in the prevalence of diabetes in pregnancy (3.8-6.6%, P < 0.001), induction of labour (17.8-21.4%, P < 0.001), elective caesarean (6.6-8.2%, P < 0.001) and emergency caesarean (9.5-14.9%, P < 0.001) deliveries. There were no changes in the overall prevalence of preterm births (15.4-15.9%, P = 0.32). However, increases were observed in the prevalence of medically indicated preterm births with and without prelabour rupture of membranes (1.0-1.7% P < 0.001 and 3.3-4.3% P = 0.005, respectively). There were no significant changes in the rates of smoking during pregnancy (51-52% from 1998 to 2009, P = 0.18), small-for-gestational age (16.9-17.2%, P = 0.07), suboptimal-birthweight (20.4-20.1%, P = 0.92), stillbirths (14.7 per 1000-12.1 per 1000, P = 0.22) and neonatal deaths (6.2 per 1000-5.5 per 1000, P = 0.68). Encouraging trends include reduced rates of teenage pregnancy, pre-ecl sia and antepartum haemorrhage. The persistent high rates of smoking during pregnancy, preterm births, stillbirths, neonatal deaths and increasing rates of diabetes in pregnancy are of concern.
Publisher: Swansea University
Date: 25-08-2022
Abstract: ObjectivesCardiovascular disease (CVD) events are highly preventable through appropriate treatment and disproportionally affect socioeconomically disadvantaged in iduals. This study quantified the relationship of socioeconomic factors to dispensing and persistent use of lipid- and blood pressure-lowering medication following hospital admission for a major CVD event (myocardial infarction, ischaemic stroke/transient ischaemic attack). ApproachData from 8,285 people with major CVD events aged ≥45 years from the Australian 45 and Up Study with linked medication dispensing data were used. Modified Poisson regression was used to estimate relative risks (RRs) for combined lipid- and blood pressure-lowering dispensing at three-months following hospital discharge and for 12-month persistent use, in relation to education, income, and level of medication subsidisation. ResultsOverall, 56% were dispensed guideline-recommended medications at three months and 37% persistently used them across 12 months. After adjusting for demographic factors, type of CVD and history of CVD hospitalisation, RRs for lowest (no educational qualifications) compared to highest education level (university degree) were 1.14 (95% CI: 1.06, 1.22) for medication dispensing and 1.15 (1.02, 1.29) for persistent medication use 1.14 (1.06, 1.22) and 1.17 (1.04, 1.32) respectively for lowest ( $20,000) versus highest (≥$70,000) household pre-tax income and 1.25 (1.17, 1.33) and 1.28 (1.15, 1.43) respectively for those receiving highest versus lowest subsidisation. There was little to no evidence of a relationship of income and education to medication use after adjustment for medication subsidisation. ConclusionsWhile preventive medication use is sub-optimal, subsidisation is substantially associated with increased use and accounts for most of the relationship with socioeconomic position, suggesting medication subsidy schemes are working in the intended direction.
Publisher: AMPCo
Date: 16-08-2020
DOI: 10.5694/MJA2.50737
Publisher: BMJ
Date: 19-09-2017
Abstract: Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality-that is, undiagnosed disease causing distress-is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease. Questionnaire data (2006-2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease). Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%-41% in those with no/minor limitations, leaving a significant but relatively weak dose-response relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association. A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease. Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor.
Publisher: Elsevier BV
Date: 04-2023
No related grants have been discovered for Grace Joshy.