Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort

Associations of socioeconomic and health factors with dental non-attendance: A comparison of three cohorts of women

OBJECTIVES

Most studies on factors influencing dental attendance are cross-sectional and focus on specific age groups. The associations between private ancillary health insurance, tobacco smoking, alcohol consumption and overweight/obesity with dental attendance were examined in three cohorts of Australian women of different ages using multiple waves of data over similar time periods.

METHODS

Data from 10 233, 12 378 and 7892 women born in 1973-1978, 1946-1951 and 1921-1926 participating in the Australian Longitudinal Study on Women's Health were used. Poisson regression using generalized estimating equations was used to investigate factors associated with self-report of not visiting the dentist in the 12 months before completing each wave.

RESULTS

The role of dental non-attendance was higher in women without insurance (versus those with insurance) in all cohorts with adjusted rate ratios (RR) of 1.52 95% CI 1.48-1.57, RR 1.45 95% CI 1.41-1.49 and RR 1.32 95% CI 1.28-1.36 in the 1973-78, 1946-51 and 1921-26 cohorts respectively. Current smokers at any intensity (versus never smokers) had a higher risk of non-attendance and the risk was strongest for women in the 1946-51 cohort who smoked ≥20 cigarettes/day (RR 1.35 95% CI 1.30-1.41). Compared with low-risk drinkers, non-drinkers were more likely to be non-attenders, but only in the two older cohorts. Women who were overweight or obese (versus healthy weight) were more likely to be non-attenders in all cohorts, with the risk of non-attendance higher with increasing BMI.

CONCLUSIONS

This study emphasizes the continued need to address socioeconomic inequities in access to dental care, along with strategies to overcome barriers for those who are obese or smoke. In this study, barriers to access existed for women of all ages, indicating that interventions need to be appropriate across age groups.

Colon and rectal cancer treatment patterns and their associations with clinical, sociodemographic and lifestyle characteristics: analysis of the Australian 45 and Up Study cohort

BACKGROUND

Colorectal cancer is the third most diagnosed cancer globally and the second leading cause of cancer death. We examined colon and rectal cancer treatment patterns in Australia.

METHODS

From cancer registry records, we identified 1,236 and 542 people with incident colon and rectal cancer, respectively, diagnosed during 2006-2013 in the 45 and Up Study cohort (267,357 participants). Cancer treatment and deaths were determined via linkage to routinely collected data, including hospital and medical services records. For colon cancer, we examined treatment categories of "surgery only", "surgery plus chemotherapy", "other treatment" (i.e. other combinations of surgery/chemotherapy/radiotherapy), "no record of cancer-related treatment, died"; and, for rectal cancer, "surgery only", "surgery plus chemotherapy and/or radiotherapy", "other treatment", and "no record of cancer-related treatment, died". We analysed survival, time to first treatment, and characteristics associated with treatment receipt using competing risks regression.

RESULTS

86.4% and 86.5% of people with colon and rectal cancer, respectively, had a record of receiving any treatment ≤2 years post-diagnosis. Of those treated, 93.2% and 90.8% started treatment ≤2 months post-diagnosis, respectively. Characteristics significantly associated with treatment receipt were similar for colon and rectal cancer, with strongest associations for spread of disease and age at diagnosis (p<0.003). For colon cancer, the rate of "no record of cancer-related treatment, died" was higher for people with distant spread of disease (versus localised, subdistribution hazard ratio (SHR)=13.6, 95% confidence interval (CI):5.5-33.9), age ≥75 years (versus age 45-74, SHR=3.6, 95%CI:1.8-7.1), and visiting an emergency department ≤1 month pre-diagnosis (SHR=2.9, 95%CI:1.6-5.2). For rectal cancer, the rate of "surgery plus chemotherapy and/or radiotherapy" was higher for people with regional spread of disease (versus localised, SHR=5.2, 95%CI:3.6-7.7) and lower for people with poorer physical functioning (SHR=0.5, 95%CI:0.3-0.8) or no private health insurance (SHR=0.7, 95%CI:0.5-0.9).

CONCLUSION

Before the COVID-19 pandemic, most people with colon or rectal cancer received treatment ≤2 months post-diagnosis, however, treatment patterns varied by spread of disease and age. This work can be used to inform future healthcare requirements, to estimate the impact of cancer control interventions to improve prevention and early diagnosis, and serve as a benchmark to assess treatment delays/disruptions during the pandemic. Future work should examine associations with clinical factors (e.g. performance status at diagnosis) and interdependencies between characteristics such as age, comorbidities, and emergency department visits.

Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

Contributions of prognostic factors to socioeconomic disparities in cancer survival: protocol for analysis of a cohort with linked data

INTRODUCTION

Socioeconomic disparities in cancer survival have been reported in many developed countries, including Australia. Although some international studies have investigated the determinants of these socioeconomic disparities, most previous Australian studies have been descriptive, as only limited relevant data are generally available. Here, we describe a protocol for a study to use data from a large-scale Australian cohort linked with several other health-related databases to investigate several groups of factors associated with socioeconomic disparities in cancer survival in New South Wales (NSW), Australia, and quantify their contributions to the survival disparities.

METHODS AND ANALYSIS

The Sax Institute's 45 and Up Study participants completed a baseline questionnaire during 2006-2009. Those who were subsequently diagnosed with cancer of the colon, rectum, lung or female breast will be included. This study sample will be identified by linkage with NSW Cancer Registry data for 2006-2013, and their vital status will be determined by linking with cause of death records up to 31 December 2015. The study cohort will be divided into four groups based on each of the individual education level and an area-based socioeconomic measure. The treatment received will be obtained through linking with hospital records and Medicare and pharmaceutical claims data. Cox proportional hazards models will be fitted sequentially to estimate the percentage contributions to overall socioeconomic survival disparities of patient factors, tumour and diagnosis factors, and treatment variables.

ETHICS AND DISSEMINATION

This research is covered by ethical approval from the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated to different interest groups and organisations through scientific conferences, social media and peer-reviewed articles.

An evaluation of pregnant women's knowledge and attitudes about newborn bloodspot screening

OBJECTIVES

research suggests that information provided to parents about newborn bloodspot screening (NBS) can be inconsistent. The majority of international NBS programmes recommend that parents should receive information about NBS in the antenatal period, however prior studies have mostly focused on postnatal women's knowledge, with no quantitative study of women's knowledge in the antenatal period conducted to date. Thus, the aim of this study was to determine if antenatal women received information about NBS in the antenatal period and to evaluate their knowledge and attitudes about NBS.

DESIGN/PARTICIPANTS

we conducted a cross-sectional study among antenatal attendees at three maternity hospitals in Ireland. A total of 662 antenatal women (≥36 weeks gestation) were recruited into the study (279 primiparous, 368 multiparous). Women were asked to complete a self reported knowledge and attitude questionnaire about NBS.

FINDINGS

primiparity (OR 2.75; 95% CI 1.65, 4.59) lower educational status (OR 1.79; 95% CI 1.02, 3.15) and not having private health insurance (OR 1.84; 95% CI 1.19, 2.85) were independently associated with poor NBS knowledge. Fourteen per cent of antenatal women recalled receiving an information leaflet about NBS, yet over 87 % reported that they would like more information. Thirty four per cent of women agreed that they understand everything they need to know about NBS.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

the process of providing women with information about NBS in the antenatal period is inconsistent; consequently their awareness about NBS is limited. To make an informed choice about NBS women require information to be provided in a more structured format. There are many missed opportunities in the antenatal period for maternity care providers to provide women with information about NBS. Our study recommends that healthcare providers should have a more formal and structured approach with regard to the provision of information about NBS in the antenatal period. This could be achieved by incorporating NBS education into antenatal education classes or through multimedia while women are waiting in the antenatal clinic. Healthcare providers may need education about the importance and benefits of providing women with information about NBS in the antenatal period.

Health care characteristics of basal cell carcinoma in Germany: the role of insurance status and socio-demographic factors

BACKGROUND

In Germany population-based data on health care of basal cell carcinoma (BCC) are rare.

OBJECTIVE

To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of BCC.

METHODS

Data base was from a nationwide dermatopathology laboratory. All consecutive excisions from 2010 were analyzed regarding tumor-specific and socioeconomic characteristics of BCC.

RESULTS

9,467 histologically verified BCC derived from 7,116 patients (54.1 % male, mean age 70 years) were analyzed. 33 % of patients had multiple tumors. The average vertical depth of invasion of BCC was 1.27 mm. It was increased significantly (p ≤ 0.001) in men (1.33 mm vs. 1.19 mm in women) and in persons over 70 years of age (1.36 mm vs. 1.14 mm). Controlled for age and sex, members of agricultural health-insurances (LKK) and of German local public health insurances (AOK) showed the highest tumor depths (1.45 mm resp.1.42 mm). The lowest depths (1.17 mm) were found in insurees of the substitute health funds (Ersatzkassen) (p ≤ 0.001). Vertical depth of invasion was significantly increased for patients living in rural counties (1.34 mm) compared to patients from urban areas (1.21 mm). Furthermore, the distribution of BCC locations varied by type of health insurance.

CONCLUSIONS

Area of residence, health insurance status, age and gender are relevant determinants of BCC health care in Germany. Prevention programs and activities to improve early detection by health insurances should take this into account.

Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women

BACKGROUND

Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date.

OBJECTIVE

To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage.

METHODS

Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage.

RESULTS

In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10.

CONCLUSIONS

Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion, thus indicating the prominence of back pain as a major economic, social and health burden.

Investigation of the relationship between sleep duration, all-cause mortality, and preexisting disease

OBJECTIVE

To examine the relationship between sleep duration and mortality and to quantify the likely impact of residual confounding due to poor health status on any observed association.

METHODS

The sample included 227,815 Australian adults aged 45 years and older recruited from 2006-2009 (the 45 and Up Study). Sleep duration and relevant covariates (e.g., health status, demographic factors) were assessed through a self-report questionnaire. These data were linked with mortality data from the New South Wales Registry of Births, Deaths, and Marriages up to December 2010 (mean follow-up period, 2.8 y). Cox proportional hazards models examined the relationship between sleep duration and all-cause mortality adjusting for relevant sociodemographic covariates (e.g., age, gender, marital status), with further stratification by baseline health status based on physical functioning and preexisting disease.

RESULTS

The adjusted mortality risk was significantly higher in individuals reporting <6 hours of sleep (hazard ratio [HR], 1.13[1.01-1.25]) and ≥10 hours of sleep (HR, 1.26[1.16-1.36]), compared to those reporting 7 hours of sleep per night. These associations differed by baseline health status (p[interaction]=0.026) such that there was no significant relationship of sleep duration to mortality in those with good health at baseline.

CONCLUSION

Following careful prospective controlling for baseline health, mortality risk does not significantly vary according to sleep duration. Previous findings suggesting a relationship between sleep duration and mortality could be affected by residual confounding by poor preexisting health, as reflected by a combination of preexisting illnesses and functional limitations.

Short and long sleep duration are associated with prevalent cardiovascular disease in Australian adults

A growing number of studies from a range of different countries have observed an association between sleep duration and cardiovascular disease. The objective of this paper was to examine the associations between sleep duration and prevalent cardiovascular disease in a large sample of Australian adults, and identify the sociodemographic and health-related factors moderating these associations. Participants included 218,155 Australian adults aged 45years and over. The results indicated that 6h versus 7h sleep was associated with increased odds of heart disease [odds ratio (OR)=1.11 (1.06-1.17)], diabetes [OR=1.15 (1.09-1.22)], stroke [OR=1.25 (1.14-1.38)] and high blood pressure [OR=1.08 (1.04-1.11)]. Long sleep (≥9h sleep) was also related to elevated odds of heart disease [OR=1.14 (1.09-1.19)], diabetes [OR=1.25 (1.19-1.31)], stroke [OR=1.50 (1.38-1.62)] and high blood pressure [OR=1.04 (1.01-1.08)] compared to 7h sleep. Some of these relationships varied by age, and were not evident in adults aged 75years and over. The magnitude of some associations varied significantly by body mass index, smoking and physical activity. These findings provide further insight into the nature of the relationship between sleep and cardiovascular health.

Is sleep duration associated with obesity in older Australian adults?

OBJECTIVES

To investigate the relationship between sleep duration and obesity in older Australian adults.

METHOD

Self-reported health data were collected through the 45 and Up Study. Multinomial logistic regression models were used to test the relationship between sleep duration and body mass index, controlling for a range of demographic and health-related variables.

RESULTS

The sample included 45,325 Australian adults aged 55 to 95 years. The regression models demonstrated that short and long sleep were associated with obesity in 55- to 64-year-olds but not in those aged 65 years and above.

DISCUSSION

The present results suggest that the relationships between sleep duration and obesity previously reported in young and middle-aged adults are not evident in older adults. The absence of these relationships could reflect a combination of age-related factors that impact on sleep and body composition.