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Harrop DL, Bryce V, Kitchener T, Grugan S, Renouf S, Mitchell S, Hasking G, Pauza D, Richards G, Ng ACT, Wang WYS. Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study. Lancet Glob Health 2024; 12:e623-e630. [PMID: 38485429 DOI: 10.1016/s2214-109x(23)00601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. METHODS For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. FINDINGS The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 vs 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40-0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 vs 21 [18%] of 119; 0·55, 0·35-0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 vs 93 [20%] of 467; 1·08, 0·83-1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). INTERPRETATION Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. FUNDING Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).
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Affiliation(s)
- Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Vivian Bryce
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tanya Kitchener
- Aboriginal and Torres Strait Islander Liaison Service, Mater Hospital, Brisbane, QLD, Australia
| | - Sean Grugan
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sonia Renouf
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott Mitchell
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Debra Pauza
- First Nations Health Office, Queensland Health, Brisbane, QLD, Australia
| | - Gregory Richards
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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McGee M, Shephard L, Sugito S, Baker D, Brienesse S, Al-Omary M, Nathan-Marsh R, Ngo DTM, Oakley P, Boyle AJ, Garvey G, Sverdlov AL. Mind The Gap, Aboriginal and Torres Strait Islander Cardiovascular Health: A Narrative Review. Heart Lung Circ 2023; 32:136-142. [PMID: 36336616 DOI: 10.1016/j.hlc.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Australia's First Nations Peoples, Aboriginal and Torres Strait Islanders, have reduced life expectancy compared to the wider community. Cardiovascular diseases, mainly driven by ischaemic heart disease, are the leading contributors to this disparity. Despite over a third of First Nations Peoples living in New South Wales, the bulk of the peer-reviewed literature is from Central Australia and Far North Queensland. Regardless of the site of publication, First Nations Peoples are significantly younger at disease onset and have higher rates of comorbidities, in turn driving adverse health events. On top of this, very few First Nations Peoples specific cardiovascular interventions or programs have been shown to improve outcomes. The traditional biomedical model of care is less efficacious and non-traditional models of communication such as clinical yarning may benefit both clinicians and patients. The key purpose of this review is to highlight the deficiencies of our knowledge of cardiovascular burden of disease for First Nations Peoples; and to serve as a catalyst for more dedicated research. We need to have relationships with communities and concentrate on community improvement and partnerships. By involving First Nations Peoples researchers in collaboration with local communities in all levels of health care design and intervention will improve outcomes.
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Affiliation(s)
- Michael McGee
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Shephard
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Sugito
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David Baker
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stephen Brienesse
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Mohammed Al-Omary
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rhian Nathan-Marsh
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/DoanNgo4
| | - Patrick Oakley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Aboriginal Health Unit, Hunter New England Health, Wallsend Health Campus, Newcastle, NSW, Australia; General Medicine Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew J Boyle
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Aaron L Sverdlov
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Feng X, Navakatikyan MA, Toms R, Astell-Burt T. Leafier Communities, Healthier Hearts: An Australian Cohort Study of 104,725 Adults Tracking Cardiovascular Events and Mortality Across 10 Years of Linked Health Data. Heart Lung Circ 2023; 32:105-113. [PMID: 36586794 DOI: 10.1016/j.hlc.2022.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Green space reduces cardiovascular disease (CVD) risk, but few studies examine what types of green space matter, which is an important consideration as cities densify and apartments become more common. METHOD Participants were 86,727 in houses and 17,998 in apartments from the 45 and Up Study (Sax Institute) baseline survey with 10 years of linked hospitalisation and death data used to define: (i) all-cause; and (ii) CVD-mortality; (iii) fatal and non-fatal CVD events; and (iv) acute myocardial infarction (AMI). Associations with total green space, tree canopy cover and open grass within 1.6 km buffers were assessed using survival analysis adjusted for potential confounders. RESULTS Mean percentage green space indicators were all higher among participants in houses than in apartments. Among residents of houses, a 10% increase in total green space was associated with reduced risk of CVD mortality (HR 0.97, 95%CI 0.95-1.00). A 10% increase in tree canopy cover was associated with reduced risks of all-cause mortality (HR 0.97, 95%CI 0.95-0.99), CVD mortality (HR 0.96, 95%CI 0.93-0.98), and fatal or non-fatal AMI (HR 0.93, 95%CI 0.89-0.96). In contrast, a 10% increase in open grass was associated with an increased risk of fatal or non-fatal AMI (HR 1.15, 95%CI 1.09-1.20) in residents of houses. Among residents of apartments, a 10% increase in total green space was associated with increased risk of all-cause mortality (HR 1.04, 95%CI 1.00-1.08) and CVD mortality (HR 1.03, 95%CI 1.00-1.08). CONCLUSIONS Urban reforestation may be a population-level intervention to protect cardiovascular health, especially for people living in houses. The intersection of urban greening and cardiovascular health among residents of apartments warrants further investigation.
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Affiliation(s)
- Xiaoqi Feng
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia; The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia.
| | - Michael A Navakatikyan
- School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Renin Toms
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia
| | - Thomas Astell-Burt
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Health and Society, Faculty of Arts, Social Sciences, and Humanities, University of Wollongong, Wollongong, NSW, Australia; Population Wellbeing and Environment Research Lab (PowerLab), Sydney, NSW, Australia.
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Win KTH, Thomas B, Emeto TI, Fairley L, Thavarajah H, Vangaveti VN, Danda N, Wai HN, New RH, Muñoz MA, Basu S, Yadav R. A Comparison of Clinical Characteristics and Outcomes Between Indigenous and Non-Indigenous Patients Presenting to Townsville Hospital Emergency Department With Chest Pain. Heart Lung Circ 2021; 31:183-193. [PMID: 34373190 DOI: 10.1016/j.hlc.2021.06.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Indigenous Australians have a high rate of ischaemic heart disease (IHD). There is a paucity of local data for North Queensland regarding the clinical characteristics of Indigenous people who present to the emergency department (ED) with chest pain. The aim of the study is to compare the cardiovascular risk factors, social characteristics, and the clinical outcomes between Indigenous and non-Indigenous patients who presented with cardiac-related chest pain. METHODS This is a retrospective single-centre audit. The data was collected through chart reviews of chest pain presentations to the Townsville University Hospital Emergency Department from January to December 2017. We categorised the patients into Indigenous and non-Indigenous groups and compared their cardiac risk factors and social characteristics. We further classified the patients into three diagnosis groups and we measured the clinical outcomes in the patients with a diagnosis of cardiac-related chest pain. We used a data linkage to the Registry of Births, Deaths and Marriages for the death outcomes. A multivariable analysis was done to determine the risk of major adverse cardiac event (MACE) for Indigenous vs non-Indigenous patients. RESULTS Indigenous patients were over-represented making up 19.1% of the total cohort (compared with 11.1% of the North Queensland Indigenous population) and presented at a younger age (median age: 45 vs 52, p<0.005). Traditional cardiovascular risk factors were significantly higher in Indigenous patients. The incidence of discharge against medical advice was also higher (6.5% vs 2.7%, p<0.005). There was an underutilisation of the local chest pain pathway amongst the Indigenous group (35.8% vs 44.7%, p<0.005). In patients with a diagnosis of cardiac-related chest pain, the rate of receiving invasive coronary angiogram procedures was similar in both cohorts (44.5% vs 43.7%, p=0.836). With regards to outcomes, Indigenous patients suffered from acute coronary syndrome (ACS) at a younger median age (51 vs 64, p<0.005) and were more likely to have severe three vessel disease (17% vs 6%, p<0.005) leading to coronary bypass graft surgery (CABG) (19% vs 6%, p<0.005). When adjusted for age, gender, and comorbidities, Indigenous patients were more likely to have MACE within 1 year of their chest pain presentation, compared with non-Indigenous patients with the same diagnosis (adjusted odds ration [AOR]=2.0, 95% CI [1.1, 3.8], p=0.03). CONCLUSION In our study, Indigenous patients carried a heavier burden of cardiovascular risk factors, presented at a younger age, with more severe coronary disease and had a higher rate of CABG. We found an underutilisation of the local chest pain protocol amongst the Indigenous cohort, which suggests a need to improve support structures in the ED. In our multivariable analysis, Indigenous patients suffered from a significantly higher MACE compared to non-Indigenous patients which indicates that more collaborative efforts are needed to improve the cardiovascular health of local Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Kyi T H Win
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Benjamin Thomas
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia; Australian Institute of Tropical Health and Medicine Health, James Cook University, Townsville, Qld, Australia. https://twitter.com/ti_Emeto
| | | | | | - Venkat N Vangaveti
- College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Nita Danda
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Htet N Wai
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Ru H New
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Miguel A Muñoz
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Sonali Basu
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
| | - Raibhan Yadav
- Department of Cardiology, Townsville University Hospital, Townsville, Qld, Australia
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Kearns T, Diaz A, Whop LJ, Moore SP, Condon JR, Andrews RM, Katzenellenbogen JM, Matthews V, Wang W, Johnston T, Taylor C, Potts B, Kathage A, Suleman A, Stanley L, Mitchell L, Garvey G, Williamson D. Investigating inequities in cardiovascular care and outcomes for Queensland Aboriginal and Torres Strait Islander people: protocol for a hospital-based retrospective cohort data linkage project. BMJ Open 2021; 11:e043304. [PMID: 33741666 PMCID: PMC7986649 DOI: 10.1136/bmjopen-2020-043304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) represents a significant burden of disease for Aboriginal and Torres Strait Islander people, a population that continues to experience a lower life expectancy than other Australians. The aim of the Better Cardiac Care Data Linkage project is to describe patient care pathways and to identify disparities in care and health outcomes between Aboriginal and Torres Strait Islander people and other Queensland residents diagnosed with CVD in the state of Queensland. METHODS This is a population-based retrospective cohort study using linked regional, state and national health and administrative data collections to describe disparities in CVD healthcare in primary and secondary prevention settings and during hospitalisation. The CVD cohort will be identified from the Queensland Hospital Admitted Patient Data Collection for admissions that occurred between 1 July 2010 and 31 June 2016 and will include relevant International Classification of Disease codes for ischaemic heart disease, congestive heart failure, stroke, acute rheumatic fever and rheumatic heart disease. Person-level data will be linked by Data Linkage Queensland and the Australian Institute of Health and Welfare (AIHW) in accordance with ethical and public health approvals to describe the patient journey prior to, during and post the hospital admission. ANALYSIS This project will focus largely on descriptive epidemiological measures and multivariate analysis of clinical care standards and outcomes for Aboriginal and Torres Strait Islander people compared with other Queenslanders, including identification of risk factors for suboptimal care and change over time. Variation in care pathways and patient outcomes will be compared by Indigenous status, sex, age group, remoteness of residence, year of index hospitalisation and socioeconomic status. Cox models for time-to-event data and mixed models or generalised estimating equations for longitudinal data will be used to measure change over time where temporal effects exist. ETHICS AND DISSEMINATION Ethical approval has been granted by Human Research Ethics Committees of the Prince Charles Hospital (HREC/15/QPCH/289) and the AIHW (EO2016-1-233). The Northern Territory Department of Health and Menzies School of Health Research have also provided reciprocal ethical approval of the project (HREC 2019-3490). The deidentified results will be summarised in a report and shared with investigators, advisory groups, Queensland Health and key stakeholders. Findings will be disseminated through workshops, conferences and will be published in peer-reviewed journals.
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Affiliation(s)
- Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Abbey Diaz
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Lisa J Whop
- College of Health and Medicine, National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
| | - Suzanne P Moore
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Queensland, Australia
| | - John R Condon
- Menzies School of Health Research, Charles Darwin University, Melbourne, Victoria, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Brisbane, Queensland, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Veronica Matthews
- University Centre for Rural Health, North Coast, The University of Sydney, Lismore, New South Wales, Australia
| | - William Wang
- Faculty of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
- Cardiology, Princess Alexandra Hospital Health Service District, Woolloongabba, Queensland, Australia
| | - Trisha Johnston
- Data Linkage Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Catherine Taylor
- Queensland Record Linkage Group, Queensland Health, Brisbane, Queensland, Australia
| | - Boyd Potts
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Alex Kathage
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Abdulla Suleman
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Lucy Stanley
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Louise Mitchell
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Division, Queensland Health, Brisbane, Queensland, Australia
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Win KTH, Emeto TI, Adams C, Fairley L, Thomas B, Thavarajah H, Danda N, Wai HN, New RH, Muñoz MA, Basu S, Yadav R. Association Between Indigenous Status and Severity of Coronary Artery Disease: A Comparison of Coronary Angiogram Findings in Patients With Chest Pain Presenting to a Regional Hospital Emergency Department. Heart Lung Circ 2021; 30:1193-1199. [PMID: 33712400 DOI: 10.1016/j.hlc.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the leading cause of death amongst Indigenous Australians accounting for 12.1% of all deaths in this population. However, there is little evidence to suggest that Indigenous status is an independent risk factor for the development of coronary artery disease. This study assessed the association between Indigenous status and the severity of CAD in patients presenting with chest pain at a regional hospital emergency department. METHODS This was a retrospective single-centre audit over 12 months from January to December 2017. Charts were reviewed for both Indigenous and non-Indigenous patients 18 years and older who presented with chest pain and subsequently underwent an invasive coronary angiogram. Multivariable logistic regression was performed to examine the association of Indigenous status with the severity of CAD. RESULTS Indigenous patients are 2.7 times more likely to experience significant CAD compared to non-Indigenous patients (Adjusted odds ratio [AOR]=2.73, 95% CI [1.38, 5.39], p≤0.001) even after adjusting for other risk factors. Those aged 65 years and older are more prone to significant CAD (AOR=2.96, 95% CI [1.12, 7.78], p=0.03), while women were less likely to have significant CAD compared to men, (AOR=0.46, 95% CI [0.27, 0.78], p<0.01). CONCLUSION In this study cohort, our analysis indicates that there is a strong association between Indigenous status and significant coronary artery disease, independent of the increased burden of traditional cardiovascular risk factors among Indigenous Australians.
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Affiliation(s)
- Kyi T H Win
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia; Department of Cardiology, Gold Coast University Hospital, Southport, Qld, Australia.
| | - Theophilus I Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia; Australian Institute of Tropical Health and Medicine Health, James Cook University, Townsville, Qld, Australia
| | - Cobi Adams
- Faculty of Medicine, Bond University, Gold Coast, Qld, Australia
| | - Lachlan Fairley
- The Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Benjamin Thomas
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | | | - Nita Danda
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Htet N Wai
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Ru H New
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Miguel A Muñoz
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Sonali Basu
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
| | - Raibhan Yadav
- Department of Cardiology, Townsville University Hospital, Douglas, Qld, Australia
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Tan EJ, Hayen A, Clarke P, Jackson R, Knight J, Hayes AJ. Trends in Ischaemic Heart Disease in Australia, 2001-2015: A Comparison of Urban and Rural Populations. Heart Lung Circ 2021; 30:971-977. [PMID: 33454212 DOI: 10.1016/j.hlc.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/24/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Ischaemic heart disease (IHD) is a major source of disease burden worldwide. Recent trends show incidence is declining but it is unclear whether the trends are similar in urban and rural populations. This study examines the trends of IHD events (i.e. hospitalisations and deaths) in New South Wales, Australia by rurality. METHODS This was a retrospective analysis of linked administrative data for hospitalisation and death records across NSW between 2001 and 2015. Participants were NSW residents aged 15-105 years who died or were hospitalised with a principal diagnosis of IHD. The main outcome measures were annual age-standardised mortality and hospitalisations for IHD by calendar year and rurality. RESULTS Between 2001 and 2015, age-standardised annual IHD hospitalisations declined in urban areas from 587 to 260 and in rural areas from 766 to 395 per 100,000 people. The annual decline in hospitalisations was greater in urban than rural areas, with Annual Percentage Change (APC) of -5.6% (95% CI, -6.1%, -5.0%) and -4.5% (95% CI, -5.0%, -4.0%), respectively (p=0.012). Ischaemic heart disease mortality declined at a similar rate in urban and rural regions (APC -7.6% and -6.7% per annum, p=0.28). Absolute inequalities in IHD deaths persisted until 2015 when there were 49 (urban) and 70 (rural) IHD deaths per 100,000 people. CONCLUSIONS Ischaemic heart disease hospitalisations and mortality have declined considerably between 2001 and 2015 in both rural and urban areas, yet inequalities persist, suggesting more intensive preventive efforts are required to further reduce the burden of IHD in rural populations.
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Affiliation(s)
- Eng Joo Tan
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia
| | - Andrew Hayen
- Discipline of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Philip Clarke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rod Jackson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Alison J Hayes
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, NSW, Australia.
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Davey RX. Health Disparities among Australia's Remote-Dwelling Aboriginal People: A Report from 2020. J Appl Lab Med 2020; 6:125-141. [PMID: 33241298 DOI: 10.1093/jalm/jfaa182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Australia has 2 distinct indigenous groups, Torres Strait Islanders and Aborigines. The Aborigines, described in this report, first colonized the continent 65 millennia ago. Those still living in the Northern Territory (NT) retain much ancestrally derived genetic complement but also are the most health-challenged by environment and lifestyle in 21st century. Reports providing overviews of these disparities are, as yet, rare. CONTENT This review defines the studied population and then describes and attempts to explain contemporary clinical findings among Australia's remote-dwelling Aborigines, principally in the NT. The report is structured by life stage and then by organ system. Finally, a brief synthesis is advanced concerning the disparities that Australia's Aboriginals face. SUMMARY In 2015-2017, NT aboriginal life expectancy for people then born was 66.6 years for men and 69.9 years for women compared with 78.1 and 82.7 years, respectively, among nonindigenous Territorians. Principal causes of the reduced longevity, with nonindigenous comparisons, include adolescent pregnancy, with maternal use of alcohol and tobacco (each 7-fold greater); fetal alcohol spectrum disorder and attention deficit hyperactivity disorder; skin infections, both scabies and impetigo (50-fold greater); rheumatic heart disease (260-fold greater); premature acute myocardial infarction (9-fold greater); bronchiectasis (40-fold greater); lung cancer (2-fold greater); diabetes mellitus (10-fold greater); renal failure (30-fold greater); and suicide (2-fold greater). Some disease has genetic roots, secondary to prolonged genetic drift. Much arises from avoidable stressors and from contemporary environmental disparities in housing. The Europid diet is also not helpful.
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Doan TN, Wilson K, Schultz BV, Rogers B, Vollbon W, Prior M, Rashford S, Bosley E. Survival in Patients with Paramedic-Identified ST-Segment Elevation Myocardial Infarction. PREHOSP EMERG CARE 2020; 25:487-495. [PMID: 32790490 DOI: 10.1080/10903127.2020.1809753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of care for these patients. There is a paucity of studies in the setting of paramedic-identified STEMI. This study investigated mortality and factors associated with mortality in a large state-wide prehospital STEMI sample. Methods: Included were adult STEMI patients identified and treated with reperfusion therapy by paramedics in the field between January 2016 and December 2018 in Queensland, Australia. 30-day and one-year all-cause mortality was compared between two prehospital reperfusion pathways: prehospital fibrinolysis versus direct referral to a hospital for primary percutaneous coronary intervention (direct percutaneous coronary intervention [PCI] referral). For prehospital fibrinolysis patients, factors associated with failed fibrinolysis were investigated. For direct PCI referral patients, factors associated with mortality were examined. Results: The 30-day mortality was 2.2% for prehospital fibrinolysis group and 1.8% for direct PCI referral group (p = 0.661). One-year mortality for the two groups was 2.7% and 3.2%, respectively (p = 0.732). Failed prehospital fibrinolysis was observed in 20.1% of patients receiving this therapy, with male gender and history of heart failure being predictors. For direct PCI referral group, low left ventricular ejection fraction (LVEF) on admission and cardiogenic shock prior to PCI were predictors of both 30-day and one-year mortality. Aboriginal and Torres Strait Islander status, and impaired kidney function on admission, were associated with one-year but not 30-day mortality. Being overweight was associated with lower 30-day mortality. Conclusions: Mortality in STEMI patients identified and treated by paramedics was low, and the prehospital fibrinolysis treatment pathway was effective with a mortality rate comparable to that of patients undergoing primary PCI. Key words: prehospital; Queensland; cardiac reperfusion; STEMI.
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McNamara BJ, Jones J, Shepherd C, Gubhaju L, Joshy G, McAullay D, Preen DB, Jorm L, Eades SJ. Identifying young Aboriginal and Torres Strait Islander children in linked administrative data: A comparison of methods. Int J Popul Data Sci 2020; 5:1100. [PMID: 32935045 PMCID: PMC7473276 DOI: 10.23889/ijpds.v5i1.1100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background In the ongoing debate on optimum methods for identification of Indigenous people within linked administrative data, few studies have examined the impacts of method on population counts and outcomes in family-based linkage studies of Aboriginal children. Objective To quantify differences between three algorithms in ascertaining Aboriginal and Torres Strait Islander children in linked administrative data. Methods Linked administrative health data for children born in Western Australia (WA) from 2000-2013, were used to examine the cohorts identified by three methods: A) the Indigenous Status Flag (ISF, derived by the WA Data Linkage Branch using a multistage-median approach) for the children alone; B) the ISF of the children, their parents and grandparents; and C) Indigenous status of the child, mother or father on either of the child's perinatal records (Midwives or birth registration), to determine differing characteristics of each cohort. Results Method B established a larger cohort (33,489) than Method C (33,306) and Method A (27,279), with all methods identifying a core group of 26,790 children (80-98%). Compared with children identified by Method A, additional children identified by Methods B or C, were from less-disadvantaged and more urban areas, and had better perinatal outcomes (e.g. lower proportions of small-for-gestational age, 10% vs 16%). Differences in demographics and health outcomes between Methods C and B were minimal. Conclusions Demographic and perinatal health characteristics differ by Aboriginal identification method. Using perinatal records or the ISF of parents and grandparents (in addition to the ISF of the child) appear to be more inclusive methods for identifying young Indigenous children in administrative datasets. Keywords Aboriginal health, identification, data linkage, Indigenous, child, methodology.
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Affiliation(s)
- B J McNamara
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - J Jones
- Faculty of Health and Medical Sciences University of Western Australia, Perth, Australia
| | - Ccj Shepherd
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.,Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch, Western Australia
| | - L Gubhaju
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - G Joshy
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - D McAullay
- Faculty of Health and Medical Sciences University of Western Australia, Perth, Australia
| | - D B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - L Jorm
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, Australia
| | - S J Eades
- Centre of Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
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11
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Passmore E, Donato-Hunt C, Maher L, Havrlant R, Hennessey K, Milat A, Farrell L. Evaluation of a pilot school-based physical activity challenge for primary students. Health Promot J Austr 2019; 28:103-109. [PMID: 27923111 DOI: 10.1071/he16021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Physical inactivity and sedentary behaviour among children are growing public health concerns. The Culture Health Communities Activity Challenge (hereafter known as the Challenge) is a school-based pedometer program in which classes compete to achieve the highest class average daily steps in an 8-week period. The Challenge aims to encourage physical activity in primary school students, with a focus on engaging Aboriginal students. The program was piloted in 15 classes in New South Wales in 2014. Methods The evaluation aimed to explore students' and teachers' experiences of the Challenge, and assess its impact on the students' physical activity levels. Data sources were a pre- and post-intervention survey of students' physical activity levels and sedentary time (n=209), qualitative interviews with teachers (n=11) and discussions with 10 classes. Results Fifteen Year 5 and 6 classes comprising 318 students participated. Fifty percent of participants were girls, the average age was 11 years and the majority (57%) were Aboriginal students. Participation in the Challenge was associated with a slight but statistically significant increase in students' physical activity levels (P<0.05), and a significant decrease in weekend screen time (P<0.05). However, when stratified by Aboriginality these changes were not statistically significant for Aboriginal students. Qualitative feedback from teachers and students indicated high levels of engagement and satisfaction with the Challenge. Teachers and students reported positive impacts, including increased motivation to be physically active, and improved student attendance and engagement in class activities and teamwork. Conclusions Participation in the Challenge was associated with increased physical activity and decreased screen time for some students. Students and teachers also reported a range of positive social and educational outcomes. So what? The findings highlight the importance of primary schools as a setting for health promotion activities, and demonstrate that school-based physical activity programs can be engaging and appropriate for classes with high proportions of Aboriginal students.
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Affiliation(s)
- E Passmore
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
| | - C Donato-Hunt
- Cultural and Indigenous Research Centre Australia, Level 1, 93 Norton Street, Leichhardt, NSW 2040, Australia
| | - L Maher
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
| | - R Havrlant
- NSW Agency for Clinical Innovation, 67 Albert Avenue, Chatswood, NSW 2067, Australia
| | - K Hennessey
- NSW Agency for Clinical Innovation, 67 Albert Avenue, Chatswood, NSW 2067, Australia
| | - A Milat
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
| | - L Farrell
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
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A Review of Coronary Artery Bypass Grafting in the Indigenous Australian Population. Heart Lung Circ 2018; 28:530-538. [PMID: 30377077 DOI: 10.1016/j.hlc.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/14/2018] [Accepted: 08/04/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Ischaemic heart disease is a leading contributor to the mortality gap which exists between Indigenous and non-Indigenous Australians. METHODS We reviewed the literature in regards to Indigenous Australians undergoing coronary artery bypass grafting (CABG) for management of ischaemic heart disease. RESULTS Younger patients with higher rates of preventable risk factors constitute the Indigenous Australian CABG population. Indigenous Australian females are over-represented in series to date. High rates of left ventricular dysfunction are seen in the Indigenous CABG cohorts potentially reflecting barriers to medical care or the influence of high rates of diabetes observed in the Indigenous Australian population. The distribution of coronary artery disease appears to differ between Indigenous Australian and non-Indigenous CABG cohorts likely reflecting a difference in the referral patterns of the two population groups with diabetes again likely influencing management decisions. Reduced utilisation of arterial conduits in Indigenous Australian cohorts has been identified in a number of series. This is of particular concern given the younger age structure of the Indigenous Australian cohorts. Indigenous Australian patients suffer excess morbidity and mortality in the longer term after undergoing CABG. Ventricular dysfunction and excess comorbidities in the Indigenous Australian CABG population appear largely responsible for this. CONCLUSION Excess morbidity and mortality endured by Indigenous Australians in the longer term following CABG appears largely contributed to by higher rates of ventricular dysfunction and comorbidities in the Indigenous Australian CABG population. Maximising internal mammary artery use and continued focus on strategies to reduce the impact of diabetes, renal impairment and heart failure in the Indigenous Australian population is essential to reduce the mortality gap experienced by Indigenous Australians secondary to ischaemic heart disease.
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Schultz ASH, Dahl L, McGibbon E, Brownlie RJ, Cook C, Elbarouni B, Katz A, Nguyen T, Sawatzky JA, Sinclaire M, Throndson K, Fransoo R. Index coronary angiography use in Manitoba, Canada: a population-level descriptive analysis of First Nations and non-First Nations recipients. BMJ Open 2018; 8:e020856. [PMID: 29581209 PMCID: PMC5875607 DOI: 10.1136/bmjopen-2017-020856] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate recipient characteristics and rates of index angiography among First Nations (FN) and non-FN populations in Manitoba, Canada. SETTING Population-based, secondary analysis of provincial administrative health data. PARTICIPANTS All adults 18 years or older who received an index angiogram between 2000/2001 and 2008/2009. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Descriptive statistics for age, sex, income quintile by rural and urban residency and Charlson Comorbidity Index for FN and non-FN recipients. (2) Annual index angiogram rates for FN and non-FN populations and among those rates of 'urgent' angiograms based on acute myocardial infarction (AMI)-related hospitalisations during the previous 7 days. (3) Proportions of people who did not receive an angiogram in the 20 years preceding an ischaemic heart disease (IHD) diagnosis or a cardiovascular death; stratified by age (<65 or ≥65 years old). RESULTS FN recipients were younger (56.3vs63.8 years; p<0.0001) and had higher Charlson Comorbidity scores (1.32vs0.78; p<0.001). During all years examined, index angiography rates were lower among FN people (2.67vs3.33 per 1000 population per year; p<0.001) with no notable temporal trends. Among the index angiogram recipients, a higher proportion was associated with an AMI-related hospitalisation in the FN group (28.8%vs25.0%; p<0.01) and in both groups rates significantly increased over time. FN people who died from cardiovascular disease or were older (65+years old) diagnosed with IHD were more likely to have received an angiogram in the preceding 20-30 years (17.8%vs12.5%; p<0.01 and 50.9%vs49.5%; p<0.03, respectively). FN people diagnosed with IHD who were under the age of 65 were less likely to have received an angiogram (47.8%vs53.1%; p<0.01) CONCLUSIONS: Index angiogram use differences are suggested between FN and non-FN populations, which may contribute to reported IHD disparities. Investigating factors driving these rates will determine any association between ethnicity and angiography services.
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Affiliation(s)
- Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lindsey Dahl
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth McGibbon
- Rankin School of Nursing Faculty of Health Sciences, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - R Jarvis Brownlie
- Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Cook
- Indigenous Health, Rady Faculty of Health Sciences (RFHS), First Nations, Métis and Inuit Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Basem Elbarouni
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thang Nguyen
- Max Rady College of Medicine, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jo Ann Sawatzky
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Moneca Sinclaire
- College of Nursing, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Throndson
- Clinical Nurse Specialist Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Randy Fransoo
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada
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Wiemers PD, Marney L, Yadav S, Tam R, Fraser JF. An Overview of Indigenous Australian Disadvantage in Terms of Ischaemic Heart Disease. Heart Lung Circ 2018; 27:1274-1284. [PMID: 29929920 DOI: 10.1016/j.hlc.2018.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/18/2017] [Accepted: 03/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Indigenous Australians experience poorer health outcomes than non-Indigenous Australians and a significant life expectancy gap exists. Ischaemic heart disease (IHD) represents the leading specific cause of death in Indigenous Australians and is a significant, if not the most significant, contributor to the mortality gap. With this narrative review we aim to describe the burden of IHD within the Indigenous Australian community and explore the factors driving this disparity. METHODS A broad search of the literature was undertaken utilising an electronic search of the PubMed database along with national agency databases-the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). RESULTS A complex interplay between multiple factors contributes to the excess burden of IHD in the Indigenous Australian population: CONCLUSIONS: In terms of IHD, Indigenous Australians experience disadvantage at multiple stages of the disease process. Ongoing efforts are needed to continue to inform clinicians of both this disadvantage and strategies to assist negating it. Further research is needed to develop evidence based practices which may help reduce this disparity in outcomes.
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Affiliation(s)
- Paul D Wiemers
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia; University of Queensland School of Medicine, Brisbane, Qld, Australia; Royal Brisbane & Women's Hospital, Herston, Qld, Australia.
| | - Lucy Marney
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia
| | - Robert Tam
- Department of Cardiothoracic Surgery, The Townsville Hospital, Townsville, Qld, Australia; James Cook University, College of Medicine and Dentistry, Townsville, Qld, Australia
| | - John F Fraser
- University of Queensland School of Medicine, Brisbane, Qld, Australia; Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Qld, Australia
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15
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Rural Inequalities in the Australian Burden of Ischaemic Heart Disease: A Systematic Review. Heart Lung Circ 2017; 26:122-133. [DOI: 10.1016/j.hlc.2016.06.1213] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/17/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022]
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16
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Mogre V, Aleyira S, Nyaba R. Factors associated with central overweight and obesity in students attending the University for Development Studies in Tamale, Ghana: a cross-sectional study. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2014.11734490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Kotwal S, Ranasinghe I, Brieger D, Clayton P, Cass A, Gallagher M. Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals. Heart Lung Circ 2016; 25:124-31. [DOI: 10.1016/j.hlc.2015.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/20/2015] [Accepted: 07/29/2015] [Indexed: 01/05/2023]
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18
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Ahmadi A, Soori H, Mehrabi Y, Etemad K, Sajjadi H, Sadeghi M. Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data. Int J Prev Med 2015; 6:112. [PMID: 26730342 PMCID: PMC4689097 DOI: 10.4103/2008-7802.170026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/13/2015] [Indexed: 01/10/2023] Open
Abstract
Background: Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis. Methods: This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data. Results: Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality. Conclusions: Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI.
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Affiliation(s)
- Ali Ahmadi
- Department of Epidemiology and Biostatistics, Research Center for Modeling of Non Communicable Disease, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Hamid Soori
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yadollah Mehrabi
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homeira Sajjadi
- Department of Community Medicine, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
| | - Mehraban Sadeghi
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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19
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Lee LL, Lin SH, Philp I. Health needs of older Aboriginal people in Taiwan: a community-based assessment using a multidimensional instrument. J Clin Nurs 2015; 24:2514-21. [PMID: 25899876 DOI: 10.1111/jocn.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the health needs of older Aboriginal people, using a multidimensional instrument. The gender differences related to their health needs were also addressed. BACKGROUND Health status and life expectancy between Aborigines and non-Aborigines have been shown to differ. The investigation of the health needs of Aboriginal people is however scarce, particularly among the older adult population. There is a need to address unmet health needs and improve information on the health needs assessment of the older Aboriginal population. DESIGN A cross-sectional design was used. METHODS Aboriginal people aged 65 and over were randomly sampled to take part in the present study. A multidimensional instrument consisting of eight domains and three cross-domain categories was used to assess their health needs. RESULTS A group of older Aboriginal people was recruited (n = 90, mean age = 73·5). The top three identified needs were 'mental health and well-being', 'staying healthy' and 'social participation'. The female participants had statistically significant higher scores for the 'mental health and well-being', 'getting around' domains and in the 'risk of falls' than the male ones. A regression model demonstrated that the health need of 'looking after oneself' was associated with all cross-domain categories of health need, which are 'independence', 'risk of breakdown in care' and 'risk of falls'. CONCLUSIONS The present study has revealed major health needs among older Aboriginal people and found that older female Aborigines have more health needs than older male Aborigines. Further study to identify effective approaches to address these needs among this group is warranted. RELEVANCE TO CLINICAL PRACTICE The findings can be used to identify effective approaches to addressing health needs among older Aboriginal people with a consideration of gender. Only then can resources be allocated and prioritised in a culturally sensitive and gender-specific manner nationally and globally.
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Affiliation(s)
- Ling-Ling Lee
- Department of Nursing and Research Centre for Environment and Physical Activity, Tzu Chi College of Technology, Hualien, Taiwan
| | - Shu-Huan Lin
- Community Health Centre, Department of Community Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ian Philp
- Hull and East Yorkshire NHS Hospitals Trust, UK
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Randall D, Jorm L, Lujic S, Eades S, Churches T, O’Loughlin A, Leyland A. Exploring disparities in acute myocardial infarction events between Aboriginal and non-Aboriginal Australians: Roles of age, gender, geography and area-level disadvantage. Health Place 2014; 28:58-66. [DOI: 10.1016/j.healthplace.2014.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 11/30/2022]
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Ilton MK, Walsh WF, Brown AD, Tideman PA, Zeitz CJ, Wilson J. A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia. Med J Aust 2014; 200:639-43. [DOI: 10.5694/mja12.11175] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 05/20/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Marcus K Ilton
- Cardiology Department, Royal Darwin Hospital, Darwin, NT
| | - Warren F Walsh
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW
| | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, SA
- School of Population Health, University of South Australia, Adelaide, SA
| | - Philip A Tideman
- Integrated Cardiovascular Clinical Network (iCCnet), Country Health SA Local Health Network, Adelaide, SA
- Southern Adelaide Local Health Network, Adelaide, SA
| | | | - Jinty Wilson
- Clinical Programs, National Heart Foundation of Australia, Melbourne, VIC
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Randall DA, Lujic S, Leyland AH, Jorm LR. Statistical methods to enhance reporting of Aboriginal Australians in routine hospital records using data linkage affect estimates of health disparities. Aust N Z J Public Health 2014; 37:442-9. [PMID: 24090327 DOI: 10.1111/1753-6405.12114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate under-recording of Aboriginal people in hospital data from New South Wales (NSW), Australia, define algorithms for enhanced reporting, and examine the impact of these algorithms on estimated disparities in cardiovascular and injury outcomes. METHODS NSW Admitted Patient Data were linked with NSW mortality data (2001-2007). Associations with recording of Aboriginal status were investigated using multilevel logistic regression. The number of admissions reported as Aboriginal according to six algorithms was compared with the original (unenhanced) Aboriginal status variable. Age-standardised admission, and 30- and 365-day mortality ratios were estimated for cardiovascular disease and injury. RESULTS Sixty per cent of the variation in recording of Aboriginal status was due to the hospital of admission, with poorer recording in private and major city hospitals. All enhancement algorithms increased the number of admissions reported as Aboriginal, from between 4.1% and 37.8%. Admission and mortality ratios varied markedly between algorithms, with less strict algorithms resulting in higher admission rate ratios, but generally lower mortality rate ratios, particularly for cardiovascular disease. CONCLUSIONS The choice of enhancement algorithm has an impact on the number of people reported as Aboriginal and on estimated outcome ratios. The influence of the hospital on recording of Aboriginal status highlights the importance of continued efforts to improve data collection. IMPLICATIONS Estimates of Aboriginal health disparity can change depending on how Aboriginal status is reported. Sensitivity analyses using a number of algorithms are recommended.
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Affiliation(s)
- Deborah A Randall
- Centre for Health Research, University of Western Sydney, New South Wales MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK Centre for Health Research, University of Western Sydney, New South Wales; The Sax Institute, New South Wales
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Randall DA, Jorm LR, Lujic S, O'Loughlin AJ, Eades SJ, Leyland AH. Disparities in revascularization rates after acute myocardial infarction between aboriginal and non-aboriginal people in Australia. Circulation 2013; 127:811-9. [PMID: 23319820 DOI: 10.1161/circulationaha.112.000566] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examined revascularization rates after acute myocardial infarction (AMI) for Aboriginal and non-Aboriginal patients sequentially controlling for admitting hospital and risk factors. METHODS AND RESULTS Hospital data from the state of New South Wales, Australia (July 2000 through December 2008) were linked to mortality data (July 2000 through December 2009). The study sample were all people aged 25 to 84 years admitted to public hospitals with a diagnosis of AMI (n=59 282). Single level and multilevel Cox regression was used to estimate rates of revascularization within 30 days of admission. A third (32.9%) of Aboriginal AMI patients had a revascularization within 30 days compared with 39.7% non-Aboriginal patients. Aboriginal patients had a revascularization rate 37% lower than non-Aboriginal patients of the same age, sex, year of admission, and AMI type (adjusted hazard ratio, 0.63; 95% confidence interval, 0.57-0.70). Within the same hospital, however, Aboriginal patients had a revascularization rate 18% lower (adjusted hazard ratio, 0.82; 95% confidence interval, 0.74-0.91). Accounting for comorbidities, substance use and private health insurance further explained the disparity (adjusted hazard ratio, 0.96; 95% confidence interval, 0.87-1.07). Hospitals varied markedly in procedure rates, and this variation was associated with hospital size, remoteness, and catheterization laboratory facilities. CONCLUSIONS Aboriginal Australians were less likely to have revascularization procedures after AMI than non-Aboriginal Australians, and this was largely explained by lower revascularization rates at the hospital of first admission for all patients admitted to smaller regional and rural hospitals, a higher comorbidity burden for Aboriginal people, and to a lesser extent a lower rate of private health insurance among Aboriginal patients.
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Affiliation(s)
- Deborah A Randall
- Centre for Health Research, Building 3, Campbelltown Campus, University of Western Sydney, Locked Bag 1797 Penrith NSW 2751, Australia.
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24
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Thompson SC, Woods JA, Katzenellenbogen JM. The quality of indigenous identification in administrative health data in Australia: insights from studies using data linkage. BMC Med Inform Decis Mak 2012; 12:133. [PMID: 23157943 PMCID: PMC3536611 DOI: 10.1186/1472-6947-12-133] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Missing or incorrect Indigenous status in health records hinders monitoring of Indigenous health indicators. Linkage of administrative data has been used to improve the ascertainment of Indigenous status. Data linkage was pioneered in Western Australia (WA) and is now being used in other Australian states. This systematic review appraises peer-reviewed Australian studies that used data linkage to elucidate the impact of under-ascertainment of Indigenous status on health indicators. METHODS A PubMed search identified eligible studies that used Australian linked data to interrogate Indigenous identification using more than one identifier and interrogated the impact of the different identifiers on estimation of Indigenous health indicators. RESULTS Eight papers were included, five from WA and three from New South Wales (NSW). The WA papers included a self-identified Indigenous community cohort and showed improved identification in hospital separation data after 2000. In CVD hospitalised patients (2000-05), under-identification was greater in urban residents, older people and socially more advantaged Indigenous people, with varying algorithms giving different estimates of under-count. Age-standardised myocardial infarction incidence rates (2000-2004) increased by about 10%-15% with improved identification. Under-ascertainment of Indigenous identification overestimated secular improvements in life expectancy and mortality whereas correcting infectious disease notifications resulted in lower Indigenous/ non-Indigenous rate ratios. NSW has a history of poor Indigenous identification in administrative data systems, but the NSW papers confirmed the usefulness of data linkage for improving Indigenous identification and the potential for very different estimates of Indigenous disease indicators depending upon the algorithm used for identification. CONCLUSIONS Under-identification of Indigenous status must be addressed in health analyses concerning Indigenous health differentials - they cannot be ignored or wished away. This problem can be substantially diminished through data linkage. Under-identification of Indigenous status impacts differently in different disease contexts, generally resulting in under-estimation of absolute and relative Indigenous health indicators, but may perversely overestimate Indigenous rates and differentials in the setting of stigma-associated conditions such as sexually-transmitted and blood-borne virus infections. Under-numeration in Census surveys also needs consideration to address the added problem of denominator undercounts.
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Affiliation(s)
- Sandra C Thompson
- Combined Universities Centre for Rural Health, University of Western Australia, PO Box 109, Geraldton, WA, 6530, Australia
| | - John A Woods
- Combined Universities Centre for Rural Health, University of Western Australia, PO Box 109, Geraldton, WA, 6530, Australia
| | - Judith M Katzenellenbogen
- Combined Universities Centre for Rural Health, University of Western Australia, PO Box 109, Geraldton, WA, 6530, Australia
- Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, 6845, Australia
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Davidson PM, MacIsaac A, Cameron J, Jeremy R, Mahar L, Anderson I. Problems, solutions and actions: addressing barriers in acute hospital care for indigenous Australians and New Zealanders. Heart Lung Circ 2012; 21:639-43. [PMID: 22980672 DOI: 10.1016/j.hlc.2012.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/04/2012] [Indexed: 10/27/2022]
Abstract
The burden of cardiovascular disease for Indigenous people in Australia and New Zealand is high and reflects the failings of our health care system to meet their needs. Improving the hospital care for Indigenous people is critical in improving health outcomes. This paper provides the results from a facilitated discussion on the disparities in acute hospital care and workforce issues. The workshop was held in Alice Springs, Australia at the second Cardiac Society of Australia and New Zealand (CSANZ) Indigenous Cardiovascular Health Conference. Critical issues to be addressed include: addressing systemic racism; reconfiguring models of care to address the needs of Indigenous people; cultural competence training for all health professionals; increasing participation of Indigenous people in the health workforce; improving information systems and facilitating communication across the health care sector and with Indigenous communities.
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