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0000-0003-4952-0990
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Menzies School of Health Research
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Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.JCV.2014.04.013
Abstract: Data on the prevalence of cervical HPV genotypes in Australia by age and by grade of cytological abnormality are sparse. Measure prevalence of HPV genotypes among 2620 Australian women by age and cytology status. Women presenting for routine Pap smear screening were recruited from erse regions, including a significant s le of Indigenous women. DNA extracts prepared from Thinprep specimens were HPV genotyped by Roche LINEAR ARRAY HPV. HPV prevalence and genotype distribution were stratified by age (mean 32.6y) and Pap smear result (cytology normal in 86.7%). Overall HPV prevalence was 38.7% with high-risk HPV prevalence of 26.5%. Prevalence of HPV (66.3% in women 40y), multiple HPV infection (45.5% in 40y) and vaccine-targeted genotypes (HPV 6/11/16/18) (34.1% in 40y) declined significantly with age. The six most common genotypes were: HPV 16 (8.3%), 51 (5.1%), 53 (4.7%), 62 (4.3%), 89 (3.9%) and 52 (3.8%). HR-HPV prevalence increased from 21.1% in women with normal cytology to 80.9% in those with cytologically predicted high-grade abnormalities (HGAs) (p<0.001). The most common genotypes in women with HGAs were HPV 16 (51.1%), 18 (14.9%), 52 (12.8%), 31 (10.6%), and 33 (10.6%): all HR-types. Pre-vaccination cross-sectional prevalence of HR-HPV infection was high in this s le of Australian women attending for screening. HPV 16 was the commonest high-risk type detected at all ages and cytological grades.
Publisher: SAGE Publications
Date: 21-01-2021
Abstract: Despite Australia’s National Cervical Screening Program, Indigenous women have a disproportionately high burden of cervical cancer. We describe temporal and area-level patterns in prevalence of histologically conformed high-grade cervical abnormalities (hHGA) among cytologically screened women by Indigenous status. This was a population-based study of 2,132,925 women, aged 20–69, who underwent cervical screening between 2008 and 2017, in Queensland, Australia. Of these, 47,136 were identified as Indigenous from linked hospital records. Overall patterns in hHGA prevalence by Indigenous status were quantified using prevalence rate ratios (PrRR) from negative binomial models. Bayesian spatial models were used to obtain smoothed prevalence estimates of hHGA across 528 small areas compared to the state average. Results are presented as maps and graphs showing the associated uncertainty of the estimates. Overall, screened Indigenous women had significantly higher hHGA prevalence than non-Indigenous women. However, the magnitude of the difference reduced over time ( p 0.001). Adjusted for age and area-level variables, Indigenous women had 36% higher hHGA prevalence (PrRR 1.36, 95% confidence interval [1.21–1.52]) than non-Indigenous women between 2013 and 2017. The overall effect of age decreased over time ( p = 0.021). Although there was evidence of moderate spatial variation in 10-year prevalence estimates for both groups of women, the high levels of uncertainty for many estimates, particularly for Indigenous women, limited our ability to draw definitive conclusions about the spatial patterns. While the temporal reduction in Indigenous: non-Indigenous differential in hHGA prevalence is encouraging, further research into the key drivers of the continuing higher risk among Indigenous women is warranted.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1111/J.1753-6405.2011.00762.X
Abstract: To assess data quality of cancer registrations for Indigenous Australians and produce reliable national Indigenous cancer incidence statistics. Completeness of Indigenous identification was assessed for the eight Australian cancer registries using an innovative indirect assessment method based on registry-specific registration rates for smoking-related cancers. National age-standardised incidence rates and rate ratios (Indigenous:non-Indigenous) were calculated for all cancers combined and 26 in idual cancer sites. Multivariate regression analysis was used to investigate trends in Indigenous cancer incidence by time or remoteness of residence, and whether the incidence rate ratio (Indigenous:non-Indigenous) was different in younger than older age-groups. Four registries covering 84% of the Indigenous population had sufficiently complete Indigenous identification to be included in analysis. Compared to other Australians, Indigenous Australians had much higher incidence of lung and other smoking-related cancers, cervix, uterus and liver cancer, but much lower incidence of breast, prostate, testis, colorectal and brain cancer, melanoma of skin, lymphoma and leukaemia. Incidence was higher in remote areas for some cancers (including several smoking-related cancers) but lower for others. The incidence rate ratios (IRRs) for smoking-related cancers were higher in younger than older people. Indigenous Australians have a different pattern of incidence of specific cancers than other Australians and large geographical variations for several cancers. All cancer registries need to further improve Indigenous identification, but national Indigenous cancer incidence statistics can, and should, be regularly reported. Tobacco control is a critical cancer-control issue for Indigenous Australians.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.CANEP.2016.05.002
Abstract: The survival inequality faced by Indigenous Australians after a cancer diagnosis is well documented what is less understood is whether this inequality has changed over time and what this means in terms of the impact a cancer diagnosis has on Indigenous people. Survival information for all patients identified as either Indigenous (n=3168) or non-Indigenous (n=211,615) and diagnosed in Queensland between 1997 and 2012 were obtained from the Queensland Cancer Registry, with mortality followed up to 31st December, 2013. Flexible parametric survival models were used to quantify changes in the cause-specific survival inequalities and the number of lives that might be saved if these inequalities were removed. Among Indigenous cancer patients, the 5-year cause-specific survival (adjusted by age, sex and broad cancer type) increased from 52.9% in 1997-2006 to 58.6% in 2007-2012, while it improved from 61.0% to 64.9% among non-Indigenous patients. This meant that the adjusted 5-year comparative survival ratio (Indigenous: non-Indigenous) increased from 0.87 [0.83-0.88] to 0.89 [0.87-0.93], with similar improvements in the 1-year comparative survival. Using a simulated cohort corresponding to the number and age-distribution of Indigenous people diagnosed with cancer in Queensland each year (n=300), based on the 1997-2006 cohort mortality rates, 35 of the 170 deaths due to cancer (21%) expected within five years of diagnosis were due to the Indigenous: non-Indigenous survival inequality. This percentage was similar when applying 2007-2012 cohort mortality rates (19% 27 out of 140 deaths). Indigenous people diagnosed with cancer still face a poorer survival outlook than their non-Indigenous counterparts, particularly in the first year after diagnosis. The improving survival outcomes among both Indigenous and non-Indigenous cancer patients, and the decreasing absolute impact of the Indigenous survival disadvantage, should provide increased motivation to continue and enhance current strategies to further reduce the impact of the survival inequalities faced by Indigenous people diagnosed with cancer.
Publisher: Springer Science and Business Media LLC
Date: 03-09-2008
DOI: 10.1007/S10552-008-9218-6
Abstract: To describe the epidemiological features of a possible disease cluster of vulvar cancer and pre-cancers in Australian Indigenous women living in the Northern Territory (NT) of Australia. We identified NT-resident women with a confirmed histological diagnosis of vulvar cancer or high-grade vulvar intraepithelial neoplasia (VIN) between 1 January 1996 and 31 December 2005. Seventy-one women were identified 32 diagnosed with vulvar cancer and 39 with high-grade VIN. Most women diagnosed were Indigenous, aged less than 50 years and living in remote communities in the East Arnhem (EA) district, on the north-east coast of the NT. The age-adjusted incidence rate of vulvar cancer in EA Indigenous women aged 0-49 years was 31.1 per 100,000 (95% CI 13.1-49.1), over 50 times higher than the national Australian rate (0.4 per 100,000, 95% CI 0.4-0.5) for the same age-group. In the age-group of 0-49 years, the age-adjusted incidence rate of VIN for EA Indigenous women was 34.7 per 100,000 (95% CI 15.2-54.3), compared with 6.7 per 100,000 (95% CI 2.0-11.4) for Indigenous women living elsewhere in the Top End of the NT. These data provide evidence of a geographic cluster of vulvar cancer in remote Indigenous communities in northern Australia.
Publisher: MDPI AG
Date: 09-05-2018
Publisher: Wiley
Date: 12-07-2023
DOI: 10.1002/AJS4.275
Abstract: In Australia, Aboriginal and Torres Strait Islander peoples are much more likely to be arrested, charged with criminal offences and imprisoned than other Australians. Aboriginal and Torres Strait Islanders comprise 49% of young people in detention but only 5.8% of the Australian population aged 10–17. This study investigated changes between 1997 and 2019 in the interaction of Aboriginal and non‐Aboriginal young people with the justice system in the Northern Territory (NT) of Australia. The prevalence of young people being charged with an alleged offence decreased by more than 60% between 1999 and 2001, co‐incident with the introduction of the Juvenile Diversion Scheme in August 2000. Thereafter, for non‐Aboriginal young people there was a small and temporary increase, but for Aboriginal young people prevalence increased almost back to pre‐2000 levels by 2015 before starting to decrease. Aboriginal young people comprised 57% of those charged with any offence in 1997, rising to 88% in 2019. Further investigation is needed to understand the reasons for ergent trends in the prevalence of alleged offending for Aboriginal and non‐Aboriginal young people, which may include the role of ersion, differences in the nature of offences and systemic bias and racism.
Publisher: Wiley
Date: 07-2012
DOI: 10.1111/J.1445-5994.2011.02539.X
Abstract: Indigenous Australians have higher prevalence of chronic diseases and worse acute care outcomes than other Australians. The extent to which higher chronic disease comorbidity levels are responsible for their worse outcomes is not clear, and the performance of comorbidity indices has not been assessed for this population with very high comorbidity levels. Using hospital separations data, the Charlson and Elixhauser comorbidity indices were used to measure chronic disease prevalence in 2035 indigenous and non-indigenous patients hospitalised after their first acute myocardial infarction (AMI) in the Northern Territory of Australia between 1992 and 2004, and to adjust for comorbidity in multivariate analysis of mortality outcomes (in-hospital and long-term deaths from coronary heart disease and all causes). Index performance was assessed by the difference between C statistic, Akaike information criterion statistic and estimate of excess indigenous mortality in models with and without comorbidity adjustment. Comorbidity index scores were higher for indigenous than non-indigenous patients and increased considerably over time, at least partly because of information bias. Indigenous patients' higher risk of in-hospital all-cause death was almost fully explained by their higher comorbidity levels. Their higher risk of long-term coronary heart disease and all-cause death was partially explained by higher comorbidity levels. Charlson and Elixhauser indices performed satisfactorily and similarly in this population. Comorbidity indices performed well in a population with very high chronic disease prevalence. After adjusting for comorbidity, short-term outcomes were similar for indigenous and non-indigenous AMI patients, but comorbidity at the time of the acute episode only partly explained the worse long-term outcomes for indigenous patients.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/SH11179
Abstract: Background A high incidence of vulvar cancer, and its precursor lesion, high-grade vulvar intraepithelial neoplasia (VIN) has been identified in young Indigenous women living in the Arnhem Land region of the Northern Territory (NT) of Australia. This clustering is restricted to women aged years, suggesting that oncogenic human papillomavirus (HPV) is a key causal factor. This study compared the HPV genotype prevalence, HPV-16 variant distribution and p16INK4aexpression in stored vulvar cancer and high-grade VIN biopsy specimens from women residing in Arnhem Land, with specimens taken from Indigenous and non-Indigenous women in other regions of NT where there is no observed increase in vulvar cancer incidence. Methods: Twenty high-grade VIN and 10 invasive cancer biopsies were assessed from Arnhem Land along with 24 high-grade VIN and 10 invasive cancer biopsies from other regions of NT. Results: Biopsies from Arnhem Land were similar to those from other regions in the detection of high-risk (HR) or possible HR HPV (VIN: 95% and 84% respectively for Arnhem Land and other regions, P = 0.356 invasive cancer: 100% and 80%, P = 0.473), HPV-16 (VIN: 60% and 80%, P = 0.364 invasive cancer: 70% and 70%, P = 1.0) and p16INK4a expression (VIN: 90% and 84%, P = 0.673 invasive cancer: 100% and 80%, P = 0.474). All HPV-16 variants were of the European prototype. Conclusion: Comparison of biopsies revealed no significant difference in the frequency of oncogenic HPVs or HPV-16 variant types between Arnhem Land and other regions, suggesting another cofactor in this cluster.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/SH11113
Abstract: Background The study aimed to examine the trends in notification and testing for genital gonorrhoea (Neisseria gonorrhoeae) in the Darwin Remote District of Northern Territory, Australia, between 2004 and 2008. Methods: Using laboratory testing data and notification data, we calculated the annual sex- and age-specific notification rates, testing rates and positivity rates, and examined their trends. A deterministic matching method was used to identify unique in iduals tested in order to estimate the number of years out of five in which each in idual was tested. The correlation between testing rates and notification rates was calculated. Results: The notification rates for the 15–24 year age group increased sharply from 2004 to 2005, and then trended downwards between 2005 and 2008, with a decrease of 48.2% in females and 59.9% in males. No evident trends were found in testing rates. The positivity rates for this age group decreased by 46.3% in females (from 8.9% to 4.8%), and by 70.4% in males (from 10.8% to 3.2%) between 2004 and 2008. Over 76% of the population in this age-group had been tested at least once during the study period. A moderate correlation was found between notification rates and testing rates in both sexes. Conclusions: There was a significant decreasing trend in the notification rate of gonorrhoea between 2005 and 2008, which was most probably due to a decrease in prevalence. This study demonstrates the importance and utility of population-level testing data in understanding the epidemiology of common bacterial sexually transmissible infections such as gonorrhoea.
Publisher: Elsevier BV
Date: 08-1999
DOI: 10.1111/J.1467-842X.1999.TB01275.X
Abstract: A process evaluation of the Northern Territory (NT) mammography program, NT Breast Screen (NTBS), during its initial 18 months of operation. The study was undertaken in Darwin, NT, from December 1994 to May 1996. Clinical outcomes were obtained by reviewing computerised and manual program records to determine waiting times for results, recall rates and cancer detection rates. Client satisfaction was assessed by a questionnaire sent to all women with normal results over a 12-week period. General practitioner satisfaction was assessed by a questionnaire sent to all general practitioners in the region who had one or more clients who had attended the service. During this time, 2,882 screening mammograms were performed 98 women were recalled for assessment (3.4%). Breast cancer was detected in 10 women (3.5 per 1000 women screened). The program was well accepted by clients and general practitioners. Performance criteria were not met for waiting times for results. NTBS faced challenges because of its small and dispersed population, a lack of local radiologists with mammographic experience and the conflict with other pressing health issues, particularly in Aboriginal health. Despite these challenges, the program functioned effectively during its initial 18 months. Mammography screening programs in isolated areas can function effectively. The constraints encountered by NTBS are likely to apply to similar programs. Issues identified requiring further research are the psychological consequences of long waiting times for results, and the prioritisation of mammography for Aboriginal women.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/AH14146
Abstract: Objective The aim of the present study was to investigate changes in stroke survival among Indigenous and non-Indigenous patients in the Northern Territory (NT). Methods A longitudinal study was undertaken of stroke patients admitted to NT public hospitals between 1992 and 2013. The Kaplan–Meier method and proportional hazards regression were used for survival analysis. A marginal structural model was applied to adjust for time-dependent confounders and informative censoring. Results There were 4754 stroke in-patients over the period, with 3540 new cases and 837 stroke deaths. Mean age of onset for Indigenous patients (51.7 years) was 12.3 years younger than that for non-Indigenous patients. After adjustments for confounders and loss to follow-up, in-hospital deaths were more likely among Indigenous patients (hazard ratio (HR) = 1.56 P 0.01) and less likely among males (HR = 0.86 P 0.05) and patients from remote areas (HR = 0.72 P 0.01). There was a 3% decrease annually in mortality hazard from 1992 to 2013. Renal disease, cancer and chronic obstructive pulmonary disease had deleterious effects on stroke survival. Conclusions Stroke survival has improved in the NT over the past two decades. The marginal structural models provide a powerful methodological tool that can be applied to hospital administrative data to assess changes in quality of care and the impact of interventions. What is known about the topic? Stroke-related mortality has fallen in the past 30 years in Australia. Indigenous Australians have much worse health outcomes than other Australians, including higher stroke incidence and mortality, but it is not known whether stroke survival has improved for Indigenous stroke patients. What does this paper add? This study measured long-term survival for Indigenous and non-Indigenous patients after hospital admissions for stroke care, using hospital admission data analysed by marginal structural models. The present study demonstrates the usefulness of this approach to the quality assessment of health care interventions. What are the implications for practitioners? Hospital administrative data can, and should, be routinely used for monitoring long-term outcomes of acute care. Although survival has improved for Indigenous stroke patients over the past two decades, their survival remains lower than that of non-Indigenous patients. Coordinated acute and primary care plays a vital role in management of chronic diseases to improve stroke survival.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH15035
Abstract: Background The prevalence of human papillomavirus (HPV) at the cervix varies with age, peaking following sexual debut and declining thereafter in most populations. In some populations, a second peak is observed. Here we describe the prevalence of HPV at the cervix among Australian women before the commencement of the HPV vaccination program. Methods: Women aged 15 to 60 years attending health services for cervical screening between 2005 and 2008 were invited to participate. Liquid based cervical specimens were tested for 37 types of HPV using linear array. The percentage and 95% confidence interval of women with any type of HPV, any of 13 high risk HPV types, and with vaccine-preventable HPV types (types 6, 11, 16 and 18) were estimated in 5-year age bands. Results: Among 1929 women aged 15–60 years, HPV prevalence peaked at 64% at age 15–20 years, then declined gradually to 12% at age 41–45 years, whereafter it rose to 19% in women 51–55 years then returned to 14% in 56–60 year olds. Prevalence curves were similar for high-risk HPV types and vaccine-targeted HPV types 6, 11, 16 and 18 and when results were restricted to women with only normal cytology. Conclusions: The shape of the prevalence curve we observed is similar to those from other Western populations. Variation in prevalence curves is likely due to differences in sexual behaviour between populations and over time, reactivation of HPV during perimenopause, and possibly the presence of cervical screening programs. These data are the first such data from the Oceania region.
Publisher: Wiley
Date: 10-2011
DOI: 10.1111/J.1741-6612.2011.00532.X
Abstract: To investigate the effectiveness of the Australian Government's aged care planning framework for Indigenous Australians, particularly the use of a lower planning age of 50 years. We analysed published data and administrative datasets relating to population demographics, aged care assessments, admissions and usage, need for assistance and expenditure, comparing the Indigenous 50-69 and 70+ age groups with the non-Indigenous 70+ age group. Indigenous people aged 50-69 years have much lower utilisation, and a different pattern of utilisation, of aged care services than either Indigenous or non-Indigenous people aged 70 and over. Community-based services are much more important for Indigenous than non-Indigenous people, regardless of age. The planning framework conflates the erse needs of Indigenous people across a wide age range and does not set a meaningful target for service provision. It has not ensured the right balance of services across geographic areas and between different levels of care.
Publisher: Wiley
Date: 11-04-2016
DOI: 10.1002/CNCR.29954
Publisher: Public Library of Science (PLoS)
Date: 11-04-2016
Publisher: Springer Science and Business Media LLC
Date: 31-01-2014
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.MOLMED.2012.08.003
Abstract: Indigenous populations, in common with all populations, stand to benefit from the potential of genetic research to lead to improvements in diagnostic and therapeutic tools for a wide range of complex diseases. However, many Indigenous communities, especially ones that are isolated, are not included in genetic research efforts. This situation is largely a consequence of the challenges of ethically conducting genetic research in Indigenous communities and compounded by Indigenous peoples' negative past experiences with genetic issues. To examine ways of addressing these challenges, we review one investigation of a cancer cluster in remote Aboriginal communities in Arnhem Land, Australia. Our experiences demonstrate that genetic research can be both ethically and successfully conducted with Indigenous communities by respecting the authority of the community, involving community members, and including regular community review throughout the research process.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11996
Abstract: Objective. To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. Methods. Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. Results. At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. Conclusion. The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people. What is known about the topic? The empirical basis for the Australian Government’s use of age 50 for Indigenous aged care planning, compared to age 70 for the non-indigenous population, is not well established. It is not clear whether Indigenous people’s poorer health outcomes and lower life expectancy are associated with premature ageing. What does this paper add? This paper compares Indigenous and non-indigenous life expectancy and prevalence of health conditions. Only some conditions associated with ageing appear to affect Indigenous people earlier than other Australians. The proposition of premature ageing based on this explanatory framework is uncertain. The estimated gap between Indigenous and non-indigenous life expectancy in later life is ~6 years. What are the implications for practitioners? The current rationale for using a lower Indigenous planning age is problematic however, further research is required to assess the effectiveness of this policy measure. The much higher prevalence of preventable chronic conditions among Indigenous Australians in middle-age groups is clear. The ‘early ageing’ frame can imply irremediable disability and disease. The aged care sector may be filling gaps in other services. The community care services for this group require a more tailored approach than simply lowering the planning age for aged care services.
Publisher: Springer Science and Business Media LLC
Date: 2003
Abstract: To summarize for the first time evidence of the impact of cancer on Indigenous Australians. Medline search of peer-reviewed scientific journals, and extensive search of reports of government agencies, publications of cancer registries and non-government organizations, and other non-peer-reviewed sources. Indigenous Australians have much higher incidence rates than other Australians of cancers of the lung, liver, and cervix but much lower rates of cancers of the breast, colon and rectum, prostate, melanoma of skin, and lymphoma. Some of these differences can be explained, in part at least, by differences in risk factor prevalence. Indigenous Australians also have higher mortality and lower survival from cancer as a whole than other Australians. More advanced disease at diagnosis, and possibly poorer treatment, are partly responsible for these differences, but other factors may also be involved. Less accessible and less effective health programs are as great a problem for cancer control as for other aspects of Indigenous health in Australia. Major improvements in preventive services, screening, primary care, and specialist treatment services are required to reduce cancer incidence and improve cancer outcomes for Australia's Indigenous people.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1111/J.1753-6405.2010.00561.X
Abstract: To measure changes over time in the burden of disease for Northern Territory (NT) Indigenous and non-Indigenous population. The numbers, and crude and age-adjusted rates of disability adjusted life years (DALY) were calculated for periods 1994-1998 and 1999-2003. A measure of information bias was developed to adjust for the tendency of years lost to disability (a component of DALY) to increase over time because of increasing data availability. The jackknife method was used for DALY uncertainty assessment. The all-cause DALY rate was stable for the non-Indigenous population, but increased for the Indigenous population. For both populations, the burden of premature death decreased while the burden of disability increased. For the Indigenous population, there were substantial increases in DALY rates for type 2 diabetes, depression, nephritis/nephrosis, suicide and sense organ disorders. The burden of disease for Indigenous people increased over the study periods, with improvement in the burden of fatal outcomes more than offset by substantial increase in the prevalence and severity of non-fatal conditions. The paradoxical shift of living longer with a greater health burden has not been previously reported for Indigenous Australians, and highlights the critical importance of prevention for sustaining life expectancy improvement and managing escalation of health costs. This study also demonstrated the usefulness of the DALY to monitor population health.
Publisher: Elsevier BV
Date: 04-2007
DOI: 10.1111/J.1753-6405.2007.00039.X
Abstract: To assess the extent of changes in life expectancy at birth for the Indigenous population of the Northern Territory (NT) over the period 1967-2004, and to determine which age-specific mortality rates were mostly responsible for such change. Life expectancy at birth figures were obtained via life table calculations using a high-quality and internally consistent dataset of NT Indigenous deaths and populations covering the period 1967-2004. A life expectancy at birth age decomposition technique was then applied. Indigenous life expectancy at birth has risen considerably in the NT, increasing from about 52 years for males and 54 years females in the late 1960s to about 60 years for males and 68 years for females in recent years. Significantly, for NT Indigenous females the gap with total Australian life expectancy has narrowed. In contrast to popular perception, Indigenous life expectancy in the Northern Territory has improved substantially from the late 1960s to the present. The widespread pessimism that surrounds Indigenous health and mortality is largely unfounded, at least for the NT. Although much remains to be done to reduce Indigenous mortality, the results in this paper demonstrate that improvements are occurring and that sustained and increased effort is worthwhile and will succeed.
Publisher: The American Association of Immunologists
Date: 07-2010
Abstract: Biological therapies, even humanized mAbs, may induce antiglobulin responses that impair efficacy. We tested a novel strategy to induce tolerance to a therapeutic mAb. Twenty patients with relapsing–remitting multiple sclerosis received an initial cycle of alemtuzumab (C ath-1H), up to 120 mg over 5 d, preceded by 500 mg SM3. This Ab differs from alemtuzumab by a single point mutation and is designed not to bind to cells. Twelve months later, they received a second cycle of alemtuzumab, up to 72 mg over 3 d. One month after that, 4 of 19 (21%) patients had detectable serum anti-alemtuzumab Abs compared with 145 of 197 (74%) patients who received two cycles of alemtuzumab without SM3 in the phase 2 CAMMS223 trial (p & 0.001). The efficacy and safety profile of alemtuzumab was unaffected by SM3 pretreatment. Long-lasting “high-zone” tolerance to a biological therapy may be induced by pretreatment with a high i.v. dose of a drug variant, altered to reduce target-binding.
Publisher: SAGE Publications
Date: 12-11-2018
Abstract: Cervical cancer mortality has halved in Australia since the national cervical screening program began in 1991, but elevated mortality rates persist for Aboriginal and Torres Strait Islander women (referred to as Aboriginal women in this report). We investigated differences by Aboriginal status in abnormality rates predicted by cervical cytology and confirmed by histological diagnoses among screened women. Using record linkage between cervical screening registry and public hospital records in South Australia, we obtained Aboriginal status of women aged 20–69 for 1993–2016 (this was not recorded by the registry). Differences in cytological abnormalities were investigated by Aboriginal status, using relative risk ratios from mixed effect multinomial logistic regression modelling. Odds ratios were calculated for histological high grade results for Aboriginal compared with non-Aboriginal women. Of 1,676,141 linkable cytology tests, 5.8% were abnormal. Abnormal results were more common for women who were younger, never married, and living in a major city or socioeconomically disadvantaged area. After adjusting for these factors and numbers of screening episodes, the relative risk of a low grade cytological abnormality compared with a normal test was 14% (95% confidence interval 5–24%) higher, and the relative risk of a high grade cytological abnormality was 61% (95% confidence interval 44–79%) higher, for Aboriginal women. The adjusted odds ratio of a histological high grade was 76% (95% confidence interval 46–113%) higher. Ensuring that screen-detected abnormalities are followed up in a timely way by culturally acceptable services is important for reducing differences in cervical cancer rates between Aboriginal and non-Aboriginal women.
Publisher: SAGE Publications
Date: 15-01-2015
DOI: 10.1111/IJS.12429
Abstract: Stroke is a leading cause of death and disability in Australia. The impact of stroke on the Australia Indigenous people is, however, unclear. This study describes hospital-based stroke incidence and case fatality in the Northern Territory population in Australia. Retrospective study of Northern Territory residents with a first-ever stroke episode and case fatality among Northern Territory residents in 1999–2011. The rate ratio of age-adjusted stroke incidence between Indigenous and non-Indigenous populations was 2·8 for men and 2·7 for women, similar to those reported elsewhere in Australia. The rate ratio increased to 3·8 (95% confidence interval: 3·4–4·3) after adjusting for multiple risk factors. There was no change in annual incidence between 1999 and 2011 for either non-Indigenous (incidence rate ratio per year 1·01, 95% confidence interval: 1·00–1·03) or Indigenous people (incidence rate ratio: 1·00, 95% confidence interval: 0·98–1·02), although incidence did increase for non-Indigenous people in the 15–39 year age group (incidence rate ratio:1·09, 95% confidence interval:1·02–1·17) and for Indigenous people in the 40–64 year age group (incidence rate ratio:1·03, 95% confidence interva 1·00–1·06). The case fatality rate decreased from 22% in 1999 to 12% in 2011. In-hospital deaths were more common among older and Indigenous people, for those with other chronic diseases, and from haemorrhagic stroke compared with ischemic stroke. In the Northern Territory, as elsewhere in Australia, Indigenous Australians are more likely than other Australians to suffer a stroke. Lack of falling in incidence in the Northern Territory population highlights the importance for ongoing comprehensive primary and acute care in reducing risk factors and managing stroke patients.
Publisher: SAGE Publications
Date: 09-09-2015
DOI: 10.1111/IJS.12600
Abstract: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival. This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians. A retrospective cohort study of first hospitalization for stroke ( n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes). Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients’ excess risk for case fatality (odds ratio: 1.25, 0.88-1.78) and long-term death (standard hazard ratio: 1.27, 1.01-1.61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence. Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-03-2014
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.YGYNO.2014.03.566
Abstract: A cluster of vulvar cancer exists in young Aboriginal women living in remote communities in Arnhem Land, Australia. A genetic case-control study was undertaken involving 30 cases of invasive vulvar cancer and its precursor lesion, high-grade vulvar intraepithelial neoplasia (VIN), and 61 controls, matched for age and community of residence. It was hypothesized that this small, isolated population may exhibit increased autozygosity, implicating recessive effects as a possible mechanism for increased susceptibility to vulvar cancer. Genotyping data from saliva s les were used to identify runs of homozygosity (ROH) in order to calculate estimates of genome-wide homozygosity. No evidence of an effect of genome-wide homozygosity on vulvar cancer and VIN in East Arnhem women was found, nor was any in idual ROH found to be significantly associated with case status. This study found further evidence supporting an association between previous diagnosis of CIN and diagnosis of vulvar cancer or VIN, but found no association with any other medical history variable. These findings do not eliminate the possibility of genetic risk factors being involved in this cancer cluster, but rather suggest that alternative analytical strategies and genetic models should be explored.
Publisher: Public Library of Science (PLoS)
Date: 08-12-2014
Publisher: BMJ
Date: 02-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 30-07-2013
DOI: 10.1161/CIRCULATIONAHA.113.001477
Abstract: Although acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD), continue to cause a large burden of morbidity and mortality in disadvantaged populations, most studies investigating the effectiveness of control programs date from the 1950s. A control program, including a disease register, in the Northern Territory of Australia where the Indigenous population has high rates of ARF and RHD allowed us to examine current disease incidence and progression. ARF and RHD incidence rates, ARF recurrence rates, progression rates from ARF to RHD to heart failure, and RHD survival and mortality rates were calculated for Northern Territory residents from 1997 to 2010. For Indigenous people, ARF incidence was highest in the 5- to 14-year age group (males, 162 per 100 000 females, 228 per 100 000). There was little evidence that the incidence of ARF or RHD had declined. The ARF recurrence rate declined by 9% per year after diagnosis. After a first ARF diagnosis, 61% developed RHD within 10 years. After RHD diagnosis, 27% developed heart failure within 5 years. For Indigenous RHD patients, the relative survival rate was 88.4% at 10 years after diagnosis and the standardized mortality ratio was 1.56 (95% confidence interval, 1.23–1.96). For Indigenous Australians in the Northern Territory, ARF and RHD incidence and associated mortality remain very high. The reduction in ARF recurrence indicates that the RHD control program has improved secondary prophylaxis a decline in RHD incidence is expected to follow.
Publisher: Informa UK Limited
Date: 11-2021
DOI: 10.2147/JIR.S337405
Publisher: AMPCo
Date: 10-2014
DOI: 10.5694/MJA13.11117
Abstract: To describe the epidemiology, clinical features, management and outcomes of hepatocellular carcinoma (HCC) in the Northern Territory over the past decade. An NT-wide epidemiology study covering the period 1991-2010 and a clinical cohort study including patients diagnosed during 2000-2011. HCC diagnoses were provided by the NT Cancer Registry and cross-checked against clinical records. Age-adjusted incidence of HCC management clinical features and median and 1-year survival. There were 145 incident cases of HCC in the NT during 1991-2010, giving an age-adjusted annual incidence of 22.7/100 000 (95% CI, 17.2-26.8) for Indigenous Australians and 4.0/100 000 (95% CI, 2.1-5.8) for non-Indigenous Australians - an incidence rate ratio of 5.9 (95% CI, 4.7-7.4). There was no significant change in annual age-adjusted incidence over this period. The most common causative factors were hepatitis B virus in Indigenous people and hepatitis C virus in non-Indigenous people. Most people were diagnosed late, only 13/80 were diagnosed by screening, and outcomes were poor, with 28/80 overall surviving to 1 year. Outcomes were better among those managed through a centralised multidisciplinary service than among those who were not (adjusted hazard ratio for death at 1 year, 0.35 [95% CI, 0.16-0.81]). HCC incidence remains high in the Indigenous people of the NT. More resources are needed for HCC surveillance and management programs in this population.
Publisher: Springer Science and Business Media LLC
Date: 17-09-2008
Publisher: Hindawi Limited
Date: 19-09-2014
DOI: 10.1111/ECC.12244
Abstract: Since its inception in 1991, Australia's organised approach to cervical screening, the National Cervical Screening Program (NCSP), has seen a 50% reduction in both incidence and mortality from cervical cancer in Australia. However, Indigenous Australian women continue to experience a disproportionately higher burden of cervical cancer. No national data on screening participation of Indigenous women currently exist, in large part because pathology forms, the primary source of data for Pap Test Registers (PTR), do not record Indigenous status. While including Indigenous status on pathology forms is the obvious solution for producing essential information about cervical screening of Indigenous women, this will require an appropriate consultative process and it will be many years before reliable data are available. One interim option being explored is the feasibility of linking the PTR to another data source which includes Indigenous status, such as hospital data. However, despite its promise, there remain major impediments to obtaining useful linked data in Australia, and it continues to be unclear whether such an approach is viable for routine reporting. If we are to understand and improve cervical screening participation and outcomes for Indigenous women in the foreseeable future, Australia needs to act now to include Indigenous status in pathology forms and (subsequently) PTRs.
Publisher: AMPCo
Date: 12-2012
DOI: 10.5694/MJA12.10133
Abstract: To examine trends in reports of child maltreatment to the Northern Territory Department of Children and Families among Aboriginal and non-Aboriginal children. A historical cohort study using administrative data collections of notifications and substantiated cases of maltreatment among children aged from 0 to 17 years. Annual rates of notification and substantiation of different types of child maltreatment. From 1999 to 2010, the overall annual rates of notification for maltreatment of Aboriginal children showed an average increase of 21% (incidence rate ratio [IRR], 1.21 95% CI, 1.19-1.24). The greatest increases were in notifications for neglect and emotional abuse. There were parallel increases in rates of substantiated cases of maltreatment. Among non-Aboriginal children, the overall annual rates of notification also increased (IRR, 1.10 95% CI, 1.07-1.14) however, changes in annual rates of substantiated cases for all types of maltreatment were not statistically significant. There have been considerable increases in both notifications and substantiated cases of child maltreatment, most prominently among Aboriginal children. It is possible that the observed increases reflect increasing incidence of maltreatment however, they are also consistent with a mix of increased surveillance, improved service access, changes in policy and a shift in public attitudes.
Publisher: Wiley
Date: 07-07-2006
DOI: 10.1111/J.1445-5994.2006.01134.X
Abstract: Indigenous Australians with cancer are diagnosed with more advanced disease and have lower survival than other Australians. To investigate reasons for these differences. Retrospective cohort study of 1197 indigenous and nonindigenous people in the Northern Territory diagnosed with cancers of the colon and rectum, lung, breast, cervix and non-Hodgkin lymphoma between 1991 and 2000. Outcome measures were stage at diagnosis and relative risk of cancer death. Indigenous people compared with nonindigenous people had higher relative odds of advanced stage of cancer at diagnosis (relative odds 1.9, 95% CI 1.3-2.7) for four cancers but lower relative odds for lung cancer (relative odds 0.3, 95% CI 0.2-0.5). None of the potentially contributing factors examined could explain this difference. Risk of cancer death (adjusted for cancer type and age and stage at diagnosis) was higher in indigenous than in nonindigenous people (relative risk 1.7, 95% CI 1.4-2.1). This difference, however, was confined to indigenous people with an indigenous first language (relative risk 2.9, 95% CI 2.2-3.8). Adjustment for cancer treatment variables further reduced but did not eliminate this higher risk of death. Although more advanced stage at diagnosis appeared to be a sufficient explanation for poorer cancer outcome in indigenous people whose first language was English, poorer treatment also contributed to, but was still not sufficient to explain, poorer outcome in those who had an indigenous first language. Other factors, possibly including communication difficulties, knowledge of and attitudes to cancer symptoms and treatment and social and cultural 'distance' from mainstream health services, may also be involved.
Publisher: AMPCo
Date: 08-2014
DOI: 10.5694/MJA14.00015
Abstract: To use hospital admissions data to investigate trends in maltreatment among Northern Territory Aboriginal and non-Aboriginal children. A historical cohort study using diagnosis and external cause codes from hospital admissions among children aged 0-17 years. Annual rates of admission with either a definitive or indicative code for child maltreatment. From 1 January 1999 to 31 December 2010, the average annual rates of hospital admission of NT Aboriginal and non-Aboriginal children with a definitive code of maltreatment were 8.8 (95% CI, 7.4-10.2) and 0.91 (95% CI, 0.59-1.22) per 10 000 children, respectively. There was no evidence for change over time in either population. The corresponding rates of admission with a code indicative of maltreatment were 28.4 (95% CI, 25.8-31.1) and 5.2 (95% CI, 4.4-6.0) per 10 000 children, with average annual increases of 3% (incidence rate ratio [IRR], 1.03 95% CI, 1.00-1.07) and 4% (IRR, 1.04 95% CI, 0.96-1.11). Physical abuse was the prominent type of maltreatment-related admission in both populations. There were increases in rates of admission for older Aboriginal children (13-17 years) and older non-Aboriginal boys. Most perpetrators in the assault of younger children were family members, while among older children most were not specified. Our study shows the utility of hospital admissions for population surveillance of child maltreatment. The relatively stable rate of maltreatment-related hospital admissions among NT Aboriginal children shown here is in contrast to substantial increases reported from child protection data. The results also highlight the overlap between violence within families and in the wider community, particularly for older children, and lends support for population-level interventions to protect vulnerable children.
Publisher: Elsevier BV
Date: 06-2008
Publisher: Springer Science and Business Media LLC
Date: 13-09-2011
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1111/J.1467-842X.2005.TB00061.X
Abstract: To compare cancer incidence and survival for the Northern Territory (NT) Indigenous population with that of other Australians, and to assess NT Indigenous incidence time trends. Cancer registry data were used to calculate cancer incidence rate ratios (NT Indigenous to total Australian), the average annual change in NT Indigenous cancer incidence and the relative risk of cancer death after diagnosis of cancer (NT Indigenous to combined Western Australian and Tasmanian cases) for 1991-2001. For NT Indigenous people, incidence rates were high for cancers of the liver, gallbladder, cervix, vulva and thyroid and, in younger people only, for cancers of the oropharynx, oesophagus, pancreas and lung, but low for cancers of the colon and rectum, breast, ovary, prostate, bladder, kidney, melanoma and lymphoma. Incidence rate ratios ranged from 0.1 for melanoma to 7.4 for liver cancer. Incidence increased for breast and pancreatic cancers. Survival was low for almost all specific cancers examined, and for all cancers combined (relative risk of death 1.9, 95% CI 1.7-2.1). Compared with other Australians, NT Indigenous people have higher, and increasing, incidence for some cancers (particularly smoking-related cancers) and lower survival for most. Cancer has a greater impact on NT Indigenous people than other Australians. Well-established cancer risk factors should be more effectively tackled in Indigenous people and known effective screening programs more effectively implemented. Research is urgently required into the reasons why survival from cancer in NT Indigenous people is so much lower than in other Australians.
Publisher: Wiley
Date: 02-2015
DOI: 10.1111/AJR.12169
Abstract: To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Systematic review and matched retrospective cohort study. Australia. Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians.
Publisher: Wiley
Date: 23-07-2009
DOI: 10.1111/J.1440-1584.2009.01060.X
Abstract: To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness. A mixed methods design in which an exploratory phase of qualitative research was followed by a nested randomised controlled trial. Psycho-education resources and a brief intervention, motivational care planning (MCP), were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia. A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP (n = 24) with a clinical control condition (treatment as usual, n = 25). The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months. The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self-management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up. Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales (P < 0.001) and Kessler 10 (P = 0.001), which were sustained over time. There was also significant advantage for treatment for alcohol dependence (P = 0.05), with response also evident in cannabis dependence (P = 0.064) and with changes in substance dependence sustained over time. These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities.
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/PY08052
Abstract: This study was designed to provide important new information about relapse prevention in Indigenous 1 people with chronic mental illness. It aimed to explore Indigenous mental health promotion with Aboriginal mental health workers (AMHW) in order to develop strategies for effective mental health intervention. The research was conducted in three remote Indigenous communities in the top end of the Northern Territory with AMHW. Assessment, psycho-education, and care-planning resources were developed with local AMHW through exploration of local Indigenous perspectives of mental health promotion. Qualitative research methods and an ethnographic approach were used to elicit information, and data included key informant interviews, participant observation, music, photography and story telling. The study confirms that Indigenous people in remote communities prefer to use story telling and local language, local artwork and local music to convey health information. It also confirms that family and local practitioners are key cultural informants and that indirect, holistic and ‘two-way’ messages are preferred.
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for John Condon.