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Junaid M, Slack-Smith L, Wong K, Hewitt T, Bourke J, Baynam G, Calache H, Leonard H. Patterns, trends, and factors influencing hospitalizations for craniosynostosis in Western Australia. A population-based study. Eur J Pediatr 2023; 182:2379-2392. [PMID: 36899143 PMCID: PMC10175457 DOI: 10.1007/s00431-023-04922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
Understanding hospital service use among children with a diagnosis of craniosynostosis (CS) is important to improve services and outcomes. This study aimed to describe population-level trends, patterns, and factors influencing hospitalizations for craniosynostosis in Western Australia. Data on live births (1990-2010; n = 554,624) including craniosynostosis, episodes of death, demographic, and perinatal factors were identified from the midwives, birth defects, hospitalizations, and death datasets. Information on craniosynostosis and non-craniosynostosis-related admissions, cumulative length of hospital stay (cLoS), intensive care unit, and emergency department-related admissions were extracted from the hospitalization dataset and linked to other data sources. These associations were examined using negative binomial regression presented as annual percent change and associations of hospitalizations by age groups, demographic, and perinatal factors were expressed as incidence rate ratio (IRR). We found an increasing trend in incident hospitalizations but a marginal decline in cLoS for craniosynostosis over the observed study period. Perinatal conditions, feeding difficulties, nervous system anomalies, respiratory, and other infections contributed to majority of infant non-CS-related admissions.Respiratory infections accounted for about twice the number of admissions for individuals with CS (IRRs 1.94-2.34) across all observed age groups. Higher incidence of non-CS hospitalizations was observed among females, with associated anomalies, to families with highest socioeconomic disadvantage and living in remote areas of the state. Conclusion: Marginal reduction in the cLoS for CS-related admissions observed over the 21-year period are potentially indicative of improved peri-operative care. However, higher incidence of respiratory infection-related admissions for syndromic synostosis is concerning and requires investigation.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia. .,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
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Pulok MH, van Gool K, Hall J. The link between out-of-pocket costs and inequality in specialist care in Australia. AUST HEALTH REV 2022; 46:652-659. [PMID: 36175167 DOI: 10.1071/ah22126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.
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Affiliation(s)
- Mohammad Habibullah Pulok
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia; and Department of Medicine, Geriatric Medicine Research, Dalhousie University, 1314, Camp Hill Veteran's Memorial Building, 5955 Veteran's Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Australia, PO Box 123 Broadway, NSW 2007, Australia
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Harding G, Hu N, Larter N, Montgomery A, Stephensen J, Callaghan L, Zwi K, Lingam R, Woolfenden S. Health status and health service use of urban Aboriginal children attending an Aboriginal community child health service in Sydney. J Paediatr Child Health 2021; 57:1072-1077. [PMID: 33629409 DOI: 10.1111/jpc.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
AIM There is limited information on the health status of urban Australian Aboriginal children and young people attending community-based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. METHODS Cross-sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0-18 years who visited the service between January 2013 and December 2017. RESULTS A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty-six percent of occasions of service noted >3 diagnoses; 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty-five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear-nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. CONCLUSION It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.
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Affiliation(s)
- Georgia Harding
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Nan Hu
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Natasha Larter
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Alicia Montgomery
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Lola Callaghan
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
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Meregaglia M, Croci I, Brusco C, Herich LC, Di Lallo D, Gargano G, Carnielli V, Zeitlin J, Fattore G, Cuttini M. Low socio-economic conditions and prematurity-related morbidities explain healthcare use and costs for 2-year-old very preterm children. Acta Paediatr 2020; 109:1791-1800. [PMID: 31977107 DOI: 10.1111/apa.15183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 12/29/2022]
Abstract
AIM To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit. METHODS As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs. RESULTS The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs. CONCLUSION Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children.
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Affiliation(s)
- Michela Meregaglia
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Carla Brusco
- Medical Direction Department, Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | - Lena C. Herich
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
| | | | - Giancarlo Gargano
- Neonatal Intensive Care Unit Department of Obstetrics and Pediatrics Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy
| | - Virgilio Carnielli
- Maternal and Child Health Institute Marche University and Salesi Hospital Ancona Italy
| | - Jennifer Zeitlin
- Obstetrics, Perinatal and Pediatric Epidemiology Research Team Centre for Epidemiology and Biostatistics (U1153), INSERM and DHU Risks in Pregnancy, Paris‐Descartes UniversityParis France
| | - Giovanni Fattore
- Department of Social and Political Sciences Bocconi University & Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi Milan Italy
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
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Wehrmeister FC, Victora CG, Horta BL, Menezes AMB, Santos IS, Bertoldi AD, da Silva BGC, Barros FC. Hospital admissions in the first year of life: inequalities over three decades in a southern Brazilian city. Int J Epidemiol 2019; 48:i63-i71. [PMID: 30883660 PMCID: PMC6422058 DOI: 10.1093/ije/dyy228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospital admissions in infancy are declining in several countries. We describe admissions to neonatal intensive care units (NICU) and other hospitalizations over a 33-year period in the Brazilian city of Pelotas. METHODS We analysed data from four population-based birth cohorts launched in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. NICU and other hospital admissions during infancy were reported by the mothers in the perinatal interview and at the 12-month visit, respectively. We describe these outcomes by sex of the child, family income and maternal skin colour. RESULTS In 1982, NICUs did not exist in the city; admissions into NICUs increased from 2.7% of all newborns in 1993 to 6.7% in 2015, and admission rates were similar in all income groups. Hospitalizations during the first year of life fell by 29%, from 23.7% in 1982 to 16.8% in 2015, and diarrhoea admissions fell by 95.2%. Pneumonia admissions fell by 46.3% from 1993 to 2015 (no data available for 1982). Admissions due to perinatal causes increased during the period. In the poorest income quintile, total admissions fell by 33% (from 35.7% to 23.9%), but in the richest quintile these remained stable at around 10%, leading to a reduction in inequalities. Over the whole period, children born to women with black or brown skin were 30% more likely to be admitted than those of white-skinned mothers. CONCLUSIONS Whereas NICU admissions increased, total admissions in the first year of life declined by nearly one-third. Socioeconomic disparities were reduced, but important gaps remain.
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Affiliation(s)
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Bruna G C da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
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