A population-based study of repeat hospital admissions due to interpersonal violence for children aged 0–9 years

To assess the magnitude and nature of interpersonal violence resulting in hospitalisation of children and to identify subgroups at risk of repeat hospital admissions, a population-based, retrospective study of all violence hospitalisations in Western Australia for children aged 9 years or less was undertaken, using the 1990–2004 linked data retrieved from the Western Australian Mortality Database and the Hospital Morbidity Data System.
Of the 747 patients aged <10 years incurring 834 hospitalisations for the consequences of violence during the study period, 570 (76%) were less than 4 years of age. A total of 43 deaths from violence were recorded and 74 (9%) patients were admitted for more than one episode of violence. Victims aged 0–4 years from rural (hazard ratio [HR] = 2.72; 95% confidence interval [CI] 1.35, 5.43) and remote parts (HR = 2.79; 95% CI 1.25, 6.25) of the state were at increased risk of a subsequent admission for violence compared with those residing within the metropolitan area. Indigenous children aged 5–9 years were significantly more likely (HR = 3.57; 95% CI 1.14, 11.13) to incur a second hospitalisation for violence than their non-Indigenous counterparts. The identification of young victim subgroups at high risk of repeat hospitalisations is important for developing intervention strategies to reduce the burden of interpersonal violence. Young children aged 0–4 years living in rural and remote locations and Indigenous children aged 5–9 years should be specifically targeted for attention.     

Impact of the national targeted Hepatitis A immunisation program in Australia: 2000–2014

In November 2005, hepatitis A vaccine was funded under the Australian National Immunisation Program for Aboriginal and Torres Strait Islander (Indigenous) children aged 12–24 months in the targeted jurisdictions of Queensland, South Australia, Western Australia and the Northern Territory.We reviewed the epidemiology of hepatitis A from 2000 to 2014 using data from the Australian National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and Australian Bureau of Statistics causes-of-death data. The impact of the national hepatitis A immunisation program was assessed by comparison of pre-vaccine (2000–2005) and post-vaccine time periods (2006–2014), by age group, Indigenous status and jurisdiction using incidence rate ratios (IRR) per 100,000 population and 95% confidence intervals (CI).The national pre-vaccine notification rate in Indigenous people was four times higher than the non-Indigenous rate, and declined from 8.41 per 100,000 (95% CI 5.03–11.79) pre-vaccine to 0.85 per 100,000 (95% CI 0.00–1.99) post-vaccine, becoming similar to the non-Indigenous rate. Notification and hospitalisation rates in Indigenous children aged <5 years from targeted jurisdictions declined in the post-vaccine period when compared to the pre-vaccine period (notifications: IRR = 0.07; 95% CI 0.04–0.13; hospitalisations: IRR = 0.04; 95% CI 0.01–0.16). As did notification rates in Indigenous people aged 5–19 (IRR = 0.08; 95% CI 0.05–0.13) and 20–49 years (IRR = 0.06; 95% CI 0.02–0.15) in targeted jurisdictions. For non-Indigenous people from targeted jurisdictions, notification rates decreased significantly in children aged <5 years (IRR 0.47; 95% CI 0.31–0.71), and significantly more overall (IRR = 0.43; 95% CI 0.39–0.47) compared to non-Indigenous people from non-targeted jurisdictions (IRR = 0.60; 95% CI 0.56–0.64).The national hepatitis A immunisation program has had a significant impact in the targeted population with relatively modest vaccine coverage, with evidence suggestive of substantial herd protection effects.     

Baseline indicators for measuring progress in preventing falls injury in older people

Objective: Over recent years, there has been increasing attention given to preventing falls and falls injury in older people through policy and other initiatives. This paper presents a baseline set of fall injury outcome indicators against which these preventive efforts can be assessed in terms of monitoring the rate of fall-related deaths and hospitalisations.
Methods: ICD-10-AM coded hospital separations, Australian Bureau of Statistics (ABS) mortality and ABS population data were used to determine the rate of fall-related injury mortality and hospitalisations occurring in people aged 65+ years in New South Wales (NSW), Australia, over the six-year period from 1998/99 to 2003/04, inclusive.
Results: Baseline trends for one fatality and five separations-based metrics are presented. Overall, fall mortality rates increased over the six years, with higher rates in males. Falls hospitalisation rates also increased slightly, with higher rates in females. The rates of hip fracture and pelvic fracture hospital separations generally declined over the six years and were highest in females. The level of unspecified and missing information about the place where falls occur increased by 1.5%.
Conclusion: Baseline trends in fall injury outcome metrics highlight the severity and frequency of fall injuries before wide scale implementation of the Management Policy to Reduce Fall Injury Among Older People in NSW.
Implications: Future use of these metrics will help to evaluate and monitor the progress of falls prevention in older people in NSW. They could also be adopted in other jurisdictions.     

At risk in two worlds: Injury mortality among Indigenous people in the US and Australia, 1990–92

This paper outlines the commonalties and unique differences in injury experience among the Indigenous people in the United States and Australia. Injury mortality rates among Indigenous people in the United States and Australia are approximately 2–3 times greater than rates for the non-Indigenous population in each country. Motor vehicle-related injuries accounted for one-third of the injury deaths for Native Americans and Australian Aboriginals. Suicide accounted for more deaths in Native Americans (15.5 per 100,000) than it did for Australian Aboriginals (11.1 per 100,000), whereas the injury death rate in Australian Aboriginals due to poisoning was almost twice that of Native Americans. Culturally appropriate interventions tailored to specific local settings and problems will be necessary to reduce injury mortality among Indigenous people.     

Gender differences in the occurrence of farm related injuries

Aims: To use national surveillance data in Canada to describe gender differences in the pattern of farm fatalities and severe injuries (those requiring hospitalisation). Methods: Data from the Canadian Agricultural Injury Surveillance Program (CAISP) included farm work related fatalities from 1990 to 1996 for all Canadian provinces and abstracted information from hospital discharge records from eight provinces for the five fiscal years of 1990 to 1994. Gender differences in fatalities and injuries were examined by comparison of proportions and stratified by sex, injury class (machinery, non-machinery), and age group. Results: Over the six year period of 1990 to 1996 there were approximately 11 times as many agriculture related fatalities for males compared to females (655 and 61, respectively). The most common machinery mechanisms of fatal injuries were roll-over (32%) for males and run-over (45%) for females. Agricultural machinery injuries requiring hospitalisation showed similar patterns, with proportionally more males over age 60 injured. The male:female ratio for non-machinery hospitalisations averaged 3:1. A greater percentage of males were struck by or caught against an object, whereas for females, animal related injuries predominated. Conclusions: Gender is an important factor to consider in the interpretation of fatal and non-fatal farm injuries. A greater number of males were injured, regardless of how the occurrence of injury was categorised, particularly when farm machinery was involved. As women increasingly participate in all aspects of agricultural production, there is a need to collect, interpret, and disseminate information on agricultural injury that is relevant for both sexes.     

How do trends in smoking prevalence among Indigenous and non‐Indigenous Australian secondary students between 1996 and 2005 compare?

Objective: To compare trends in smoking prevalence between 1996 and 2005 among Indigenous and non-Indigenous secondary students across Australia.
Methods: Representative random samples of secondary students aged 12-17 years completed self-report anonymous surveys. Questionnaires assessed any cigarette smoking in lifetime, and smoking in past month, week and on at least three of the previous seven days. Intention to smoke in the next 12 months was assessed on a 7-point scale. Students self-identified as being of Aboriginal or Torres Strait Islander descent.
Results: Three to four per cent of students identified as being Indigenous at each survey. Smoking was more common among Indigenous than non-Indigenous students. Between 1996 and 2005, the proportion of smoking declined among both Indigenous and non-Indigenous students. However, among 12-15 year olds, the rate of decline was different for the two groups. Among non-Indigenous students in this age group, prevalence decreased steadily between 1996 and 2005. Among Indigenous students, the decrease mainly occurred between 1999 and 2002. Smoking intention was higher for Indigenous than non-Indigenous students. The mean intention decreased between 1996 and 2005 among both student groups.
Conclusions: Smoking prevalence decreased among both Indigenous and non-Indigenous students between 1996 and 2005.
Implications: Reductions in Indigenous students' tobacco use and intentions coincided with a period of increased tobacco control activity, suggesting that these activities may positively influence smoking behaviours.     

Estimating the cost of hospital treatment for injuries using linked morbidity data

This paper describes the analysis of injury-related linked hospital morbidity data by admissions and by individual patients in Western Australia (WA) from 1990 to 1994. Over this five-year period, there were an average of 35,385 admissions and 30,524 people admitted each year for injuries in WA. The age-standardised rates for injury-related hospital admissions and persons admitted for injuries increased significantly, by 2.4% and 1.5% per year respectively, over the five-year period. The number of admissions and the number of persons admitted peaked in the 20–24 years age group but the highest rates were among those aged 75 years and above.
Injuries accounted for nearly 10% of all hospital bed day costs and cost about $50 per head of population per year. The cost of hospitalisation rose steadily from $85.2 million in 1990 to $113.6 million in 1994, the average cost being nearly $100 million per year. The average cost per injury related hospital episode was $2,748.
Generally, the cost per hospital episode was higher for males and increased with age, following a similar pattern to that for the average length of stay.     

Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines

Objective: This study compares prevalence of obesity, hypertension and diabetes in two groups of Aboriginal adults: those living in homelands versus centralised communities in central Australia. It also compares weight gain, incidence of diabetes, mortality and hospitalisation rates between the groups over a seven-year period.
Methods: Baseline survey of 826 Aboriginal adults in rural central Australian communities in 1987-88 with a follow-up survey of 416 (56% response rate, excluding deaths). Each time, they had a 75 g oral glucose tolerance test (OGTT), and blood pressure and anthropometry measurement. Deaths and hospitalisations for all of the original cohort were recorded for the seven-year period.
Results: Homelands residents had a lower baseline prevalence of diabetes (risk ratio [RR]=0.77, 0.59–1.00), hypertension (RR=0.66, 0.54–0.80) and overweight/ obesity (RR=0.70, 0.59–0.83). The incidence of diabetes was lower among homelands residents (RR=0.70, 0.46–1.06). They were less likely to die than those living in centralised communities (RR=0.56, 0.37–0.85) and less likely to be hospitalised for any cause (RR=0.79, 0.71–0.87), particularly infections (RR=0.70, 0.61–0.80), injury involving alcohol (RR=0.61, 0.47–0.79) and other injury (RR=0.75, 0.60–0.93). Mean age at death was 58 and 48 years for residents of homelands and centralised communities respectively.
Conclusion: Aboriginal people who live in homelands communities appear to have more favourable health outcomes with respect to mortality, hospitalisation, hypertension, diabetes and injury, than those living in more centralised settlements in Central Australia. These effects are most marked among younger adults.     

Indigenous mortality in remote Queensland, Australia

OBJECTIVES: To quantify Indigenous mortality, compare it with non-Indigenous mortality, and identify causes of excess Indigenous mortality by remoteness in Queensland, 1997-2000. DESIGN: Cross-sectional survey of all deaths of Queensland residents registered in Australia during the study period. MAIN OUTCOME MEASURES: Mortality rates were standardised to the concurrent non-Indigenous population and categorised by age and sex. RESULTS: Death rates in Indigenous people were higher in remote areas. The difference between Indigenous and non-Indigenous mortality was also highest in remote areas. The leading causes of deaths were ischaemic heart disease, diabetes mellitus, respiratory diseases, malignant neoplasms, and injury, which accounted for more than 60% of excess deaths. CONCLUSIONS: Despite limitations with Indigenous identification, particularly in urban areas, Indigenous people, compared with the non-Indigenous population, have elevated mortality rates that increase by remoteness. This is in agreement with past work. To the extent that some of the causes of excess mortality can be attributed to lifestyle conditions, the health of Indigenous Australians can be substantially improved.     

Chronic disease and hospitalisation for pandemic (H1N1) 2009 influenza in Indigenous and non-Indigenous Western Australians

Indigenous and non-indigenous Western Australians with pandemic (H1N1) 2009 influenza (pH1N1) infection were compared for risk factors, influenza vaccination history, symptoms, use of antiviral medications, and hospitalisation. Data were collected systematically on 856 notified cases with laboratory confirmed pH1N1 infection during the first 10 weeks of pH1N1 virus transmission in Western Australia in 2009. Indigenous people with pH1N1 were approximately 3 times more likely to be hospitalised and were more likely to have a range of underlying medical conditions and be smokers, compared with non-Indigenous cases. Age (P < 0.001) and the presence of two or more co-morbidities (P < 0.001) were independent predictors of hospitalisation, while Indigenous status was not, indicating that higher pH1N1 hospitalisation rates in Indigenous Australians during the 2009 winter season were attributable to the higher prevalence of underlying chronic disease. These results underscore the need to ensure that influenza vaccination is delivered as widely as possible among those with chronic health conditions.     

Trends in neural tube defects in Western Australia in Indigenous and non-Indigenous populations

Neural tube defects (NTD) were 43% more common in Indigenous than in non-Indigenous infants in Western Australia in the 1980s, and there has been a fall in NTD overall in Western Australia since promotion of folate and voluntary fortification of food has occurred. In order to investigate whether the fall had occurred in both indigenous and non-Indigenous infants, data on NTD (births and terminations) were obtained from the WA Birth Defects Registry, and on all births from the Maternal and Child Health Research Data Base. Knowledge of folate was asked in a survey of indigenous women interviewed postpartum. Before the promotion of folate (1980-92), there has been a 42% increase in NTD in Indigenous compared with non-Indigenous infants (prevalence ratio (PR)=1.42 [95% confidence interval (CI) 1.04, 1.94]); while in the most recent period (1996-2000), the prevalence in Indigenous infants was almost twice that of non-Indigenous infants (PR 1.98 [CI 1.25, 3.15]). Fifty-five per cent of Indigenous women knew about folate in pregnancy. Similar to sudden infant death syndrome, this study has highlighted health promotion that has been successful in reducing the risk of a childhood condition overall, but has failed to be effective for Indigenous children.     

The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in Australia

Objective: To examine the differences in health services utilisation and the associated risk factors between Indigenous and non-Indigenous infants at a national level in Australia.
Methods: We analysed data from a national representative longitudinal study, the Longitudinal Study for Australian Children (LSAC) starting in 2004. We used survey logistic regression and survey multiple linear regression to examine the factors associated with health services utilisation.
Results: Health status of Indigenous infants was poorer than that of non-Indigenous. In comparison to non-Indigenous infants, in the previous 12-month period, the Indigenous infants were significantly less likely to use the following health services: maternal and child health centre or help lines (OR=0.35, 95%CI: 0.24-0.49); maternal and child health nurse visits (OR=0.45, 95%CI: 0.32-0.63); general practitioners (GPs) (OR=0.45, 95%CI: 0.31-0.64); and paediatrician (OR=0.52, 95%CI: 0.35-0.77). In contrast, they were more likely to visit a hospital outpatient clinic (OR=1.82, 95%CI: 1.16-2.85). Mothers' age, education and marital status were associated with certain health services use. Financial status and residential location were the important predictors of the use of health services.
Conclusion: The rates of health services utilisation by Indigenous infants were lower and were associated with mothers' characteristics and socio-economic status.
Implications: The gaps in health services utilisation between Indigenous and non-Indigenous infant requires immediate policy initiatives. Further research is needed to explore the causal pathways between health status, health services utilisation and multiple risk factors at different levels.     

Farm injury hospitalisations in New South Wales (2010 to 2014)

Objective: To examine gender differences in the characteristics, treatment costs and health outcomes of farm injuries resulting in hospitalisation of New South Wales (NSW) residents. Method: A population‐based study of individuals injured on a farm and admitted to hospital using linked hospital admission and mortality records from 1 January 2010 to 30 June 2014 in NSW. Health outcomes, including injury severity, hospital length of stay (LOS), 28‐day readmission and 30‐day mortality were examined by gender. Results: A total of 6,270 hospitalisations were identified, with males having a higher proportion of work‐related injuries and injuries involving motorbikes compared to females. Females had a higher proportion of equestrian‐related injuries. There were no differences in injury severity, with around 20% serious injuries, in mean LOS or 28‐day hospital re‐admission. Treatment costs totalled $42.7 million, with males accounting for just under 80% of the total. Conclusions: There are some gender differences in the characteristics of farm injury‐related hospitalisations. Farm injury imposes modest, but nonetheless relatively considerable, financial costs on hospital services in NSW. Implications for public health: Continued efforts to ameliorate these injuries in a farm environment, which are mainly preventable, will have personal and societal benefits.     

First-time hospital admissions with illicit drug problems in indigenous and non-indigenous Western Australians: an application of record linkage to public health surveillance

OBJECTIVE: To monitor incidence rates of first-time hospital admission with an illicit drug problem in the Indigenous and non-Indigenous populations of Western Australia in 1980-95. METHOD: Some 10,533 first admissions among 16,294 total admissions mentioning any of 19 groups of illicit drug problems were identified using linked hospital separation data from the WA Health Services Research Linked Database. RESULTS: Trends in age-standardised rates showed two distinct features: a rapid acceleration in first-time admission rates commencing from about 1991; and a cross-over of the rates in Indigenous and non-Indigenous people. In 1980, the rates were 9.2 per 100,000 PY in Indigenous and 16.4 per 100,000 PY in non-Indigenous people. By 1995, the respective rates were 180.7 and 95.5 per 100,000 PY. Largest proportional increases were observed in first-time admissions mentioning amphetamine dependence or abuse, although increases were seen also in problems due to opiates, hallucinogens, cocaine and cannabis. CONCLUSION: The results are consistent with data on the rising use of injectable amphetamines and other illicit drugs, especially among Aboriginal people. IMPLICATIONS: Urgent attention is required to identify ways of reducing health problems due to illicit substance use in both Indigenous and non-Indigenous Australians.     

Socioeconomic status and self-reported asthma in Indigenous and non-Indigenous Australian adults aged 18-64 years: analysis of national survey data

Background

Asthma is more common among Indigenous than non-Indigenous Australian adults, but little is known about socioeconomic patterning of asthma within the Indigenous population, or whether it is similar to the non-Indigenous population.

Methods

I analysed weighted data on self-reported current diagnosed asthma and a range of socio-economic and demographic measures for 5,417 Indigenous and 15,432 non-Indigenous adults aged 18-64 years from two nationally representative surveys conducted in parallel by the Australian Bureau of Statistics in 2004-05.

Results

Current asthma prevalence was higher for Indigenous than non-Indigenous people in every age group. After adjusting for age and sex, main language and place of residence were significantly associated with asthma prevalence in both populations. Traditional SES variables such as education, income and employment status were significantly associated with asthma in the non-Indigenous but not the Indigenous population. For example, age-and sex-adjusted relative odds of asthma among those who did not complete Year 10 (versus those who did) was 1.2 (95% confidence interval (CI) 1.0-1.5) in the non-Indigenous population versus 1.0 (95% CI 0.8-1.3) in the Indigenous population.

Conclusions

The socioeconomic patterning of asthma among Indigenous Australians is much less pronounced than for other chronic diseases such as diabetes and kidney disease, and contrasts with asthma patterns in the non-Indigenous population. This may be due in part to the episodic nature of asthma, and the well-known challenges in diagnosing it, especially among people with limited health literacy and/or limited access to health care, both of which are more likely in the Indigenous population. It may also reflect the importance of exposures occurring across the socioeconomic spectrum among Indigenous Australians, such as racism, and discrimination, marginalization and dispossession, chronic stress and exposure to violence.

     

Cancer incidence and cancer mortality in a cohort of UK semiconductor workers, 1970-2002

OBJECTIVE: To examine cancer risks in a cohort of workers employed in the manufacture of semiconductors. METHODS: The mortality (1970-2002) and cancer morbidity (1971-2001) experienced by a cohort of 1807 male and female workforce employees from a semiconductor factory in the West Midlands (UK) have been investigated. Standardized mortality ratios (SMRs) and standardized registration ratios (SRRs) were used to assess mortality and morbidity, respectively. RESULTS: Overall mortality was close to expectation in males [SMR 99, 95% (confidence interval) CI 79-122] and significantly below expectation in females (SMR 74, 95% CI 65-85). Incidence of all sites of cancer was somewhat elevated in males (SRR 130, 95% CI 95-173) but close to expectation in females (SRR 94, 95% CI 82-109). There were significant deficits of deaths from cancer of the oesophagus in males and females combined and from cancer of the breast in females. Significantly elevated SRRs were found in males for cancer of the rectum [Observed (Obs) 6, SRR 284, 95% CI 104-619], in females for cancer of the pancreas (Obs 10, SRR 226, 95% CI 108-415) and malignant melanoma (Obs 11, SRR 221, 95% CI 110-396) and in males and females combined for cancer of the rectum (Obs 19, SRR 199, 95% CI 120-310) and malignant melanoma (Obs 12, SRR 217, 95% CI 112-379). Detailed work history data were unavailable for analysis. The finding of excess morbidity was not mirrored in the corresponding mortality findings. CONCLUSIONS: The study found elevated morbidity for a number of cancer sites that may be unconnected with occupation. Elimination of all possible occupational causes will, however, require more detailed analyses of cancer risks in relation to exposure histories.     

Potential effectiveness of specific anti-smoking mass media advertisements among Australian Indigenous smokers

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have more than twice the smoking prevalence of non-Indigenous Australians. Anti-smoking campaigns have demonstrated success in the general population but little is known about their impact among Indigenous people. A total of 143 Indigenous and a comparison group of 156 non-Indigenous smokers from South Australia were shown 10 anti-smoking advertisements representing a range of advertisements typically aired in Australia. Participants rated advertisements on a five-point Likert scale assessing factors including message acceptance and personalized effectiveness. On average, Indigenous people rated the mainstream advertisements higher than non-Indigenous people and were more likely to report that they provided new information. Advertisements with strong graphic imagery depicting the health effects of smoking were rated highest by Indigenous smokers. Advertisements featuring real people describing the serious health consequences of smoking received mixed responses. Those featuring an ill person were rated higher by Indigenous people than those featuring the family of the person affected by a smoking-related disease. With limited Indigenous-specific messages available and given the finite resources of most public health campaigns, exposure to mainstream strong graphic and emotive first-person narratives about the health effects of smoking are likely to be highly motivating for Indigenous smokers.     

The incidence of public sector hospitalisations due to dog bites in Australia 2001–2013

Objective : To estimate the incidence of dog bite‐related injuries requiring public sector hospitalisation in Australia during the period 2001–13. Methods : Summary data on public sector hospitalisations due to dog bite‐related injuries with an ICD 10‐AM W54.0 coding were sourced from the Australian Institute of Health and Welfare for the study period 2001–2013. Results : In Australia, on average, 2,061 persons were hospitalised each year for treatment for dog bite injuries at an annual rate of 12.39 (95%CI 12.25–12.53) per 100,000 during 2001–13. The highest annual rates of 25.95 (95%CI 25.16–26.72) and 18.42 (95%CI 17.75–19.07) per 100,000 were for age groups 0–4 and 5–9 years respectively. Rates of recorded events increased over the study period and reached 16.15 (95%CI 15.78–16.52) per 100,000 during 2011–13. Conclusion : Dog bites are a largely unrecognised and growing public health problem in Australia. Implications for public health : There is an increasing public sector burden of hospitalisations for injuries from dog bites in Australia.