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Howarth T, Gibbs C, Heraganahally SS, Abeyaratne A. Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis - a ten-year retrospective cohort study. BMC Pulm Med 2024; 24:118. [PMID: 38448862 PMCID: PMC10918854 DOI: 10.1186/s12890-024-02909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND This study assessed hospitalisation frequency and related clinical outcomes among adult Aboriginal Australians with bronchiectasis over a ten-year study period. METHOD This retrospective study included patients aged ≥ 18 years diagnosed with bronchiectasis between 2011 and 2020 in the Top End, Northern Territory of Australia. Hospital admissions restricted to respiratory conditions (International Classification of Diseases (ICD) code J) and relevant clinical parameters were assessed and compared between those with and without hospital admissions. RESULTS Of the 459 patients diagnosed to have bronchiectasis, 398 (87%) recorded at least one respiratory related (ICD-J code) hospitalisation during the 10-year window. In comparison to patients with a recorded hospitalisation against those without-hospitalised patients were older (median 57 vs 53 years), predominantly females (54 vs 46%), had lower body mass index (23 vs 26 kg/m2) and had greater concurrent presence of chronic obstructive pulmonary disease (COPD) (88 vs 47%), including demonstrating lower spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) (median FVC 49 vs 63% & FEV1 36 vs 55% respectively)). The total hospitalisations accounted for 3,123 admissions (median 4 per patient (IQR 2, 10)), at a median rate of 1 /year (IQR 0.5, 2.2) with a median length of 3 days (IQR 1, 6). Bronchiectasis along with COPD with lower respiratory tract infection (ICD code-J44) was the most common primary diagnosis code, accounting for 56% of presentations and 46% of days in hospital, which was also higher for patients using inhaled corticosteroids (81 vs 52%, p = 0.007). A total of 114 (29%) patients were recorded to have had an ICU admission, with a higher rate, including longer hospital stay among those patients with bronchiectasis and respiratory failure related presentations (32/35, 91%). In multivariate regression model, concurrent presence of COPD or asthma alongside bronchiectasis was associated with shorter times between subsequent hospitalisations (-423 days, p = 0.007 & -119 days, p = 0.02 respectively). CONCLUSION Hospitalisation rates among adult Aboriginal Australians with bronchiectasis are high. Future interventions are required to explore avenues to reduce the overall morbidity associated with bronchiectasis among Aboriginal Australians.
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Affiliation(s)
- Timothy Howarth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, NT, Australia
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Claire Gibbs
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, NT, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, NT, Australia.
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, NT, Australia.
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia.
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Keramat SA, Perales F, Alam K, Rashid R, Haque R, Monasi N, Hashmi R, Siddika F, Siddiqui ZH, Ali MA, Gebremariam ND, Kondalsamy-Chennakesavan S. Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis. Qual Life Res 2024; 33:195-206. [PMID: 37587324 PMCID: PMC10784343 DOI: 10.1007/s11136-023-03500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β = - 6.527; Standard Error [SE] = 1.579), mental-component scale (β = - 3.765; SE = 1.590) and short-form six-dimension utility index (β = - 0.075; SE = 0.017). CONCLUSION This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.
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Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | - Francisco Perales
- School of Social Science, The University of Queensland, Michie Building (#9), St Lucia, Brisbane, QLD, 4067, Australia
| | - Khorshed Alam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rumana Rashid
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Rezwanul Haque
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Nahid Monasi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rubayyat Hashmi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Farzana Siddika
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Zubayer Hassan Siddiqui
- Department of Business Administration, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Mohammad Afshar Ali
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Zanker J, Scott D, Szoeke C, Vogrin S, Patel S, Blackwell T, Bird S, Kirk B, Center J, Alajlouni DA, Gill T, Jones G, Pasco JA, Waters DL, Cawthon PM, Duque G. Predicting Slow Walking Speed From a Pooled Cohort Analysis: Sarcopenia Definitions, Agreement, and Prevalence in Australia and New Zealand. J Gerontol A Biol Sci Med Sci 2023; 78:2415-2425. [PMID: 37428864 PMCID: PMC10692428 DOI: 10.1093/gerona/glad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. METHODS Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK). RESULTS Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC. CONCLUSIONS Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.
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Affiliation(s)
- Jesse Zanker
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Cassandra Szoeke
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Stefanie Bird
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
| | - Jacqueline Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dima A Alajlouni
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Pasco
- Department of Medicine, Western Health, The University of Melbourne, St. Albans, Victoria, Australia
- IMPACT-Institute for Mental and Physical Health and Clinical Translation, Barwon HealthDeakin University, Geelong, Victoria, Australia
| | - Debra L Waters
- Department of Medicine, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- Department of Internal Medicine/Geriatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Camilleri S, Tsai D, Langham F, Ullah S, Chiong F. Epidemiology, clinical outcomes and risk factors of third-generation cephalosporin-resistant Escherichia coli hospitalized infections in remote Australia-a case-control study. JAC Antimicrob Resist 2023; 5:dlad138. [PMID: 38115858 PMCID: PMC10729849 DOI: 10.1093/jacamr/dlad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
Background Incidence of third-generation cephalosporin-resistant (3GCR) Escherichia coli infections has increased in remote Australia from 2012 to 2018. Objectives To describe the epidemiology of 3GCR E. coli in Central Australia. Methods A case-control study was conducted in the primary Central Australian hospital. Patient characteristics, antibiotic usage and clinical outcomes were compared between adult hospitalizations with 3GCR and susceptible E. coli isolates in 2018-19. Poisson regression was used to compare the incidence of 3GCR hospitalizations between Indigenous and non-Indigenous individuals. Patient characteristics and antibiotic usage were tested for associations with 3GCR isolates using univariate analysis. Results A total of 889 E. coli isolates were identified, of which 187 (21%) were 3GCR. The incidence of 3GCR E. coli infection was 2.15 per 1000 person-years, with an incidence rate ratio of 6.8 (95% CI 4.6-10.1) between Indigenous and non-Indigenous individuals. When compared with the control group, 3GCR E. coli infections were associated with a higher Charlson comorbidity index (CCI ≥3 in 30.7% versus 15.0%, P < 0.001) and were more commonly healthcare associated (52.4% versus 26.7%, P < 0.001). A higher 1 year mortality was observed in the 3GCR group after adjustment for comorbidity (OR = 4.43, P = 0.002), but not at 30 days (2.4% versus 0.0%, P = 0.2). The 3GCR group used more antibiotics in the past 3 months (OR = 5.75, P < 0.001) and 12 months (OR = 3.65, P < 0.001). Conclusions 3GCR E. coli infections in remote Australia disproportionally affect Indigenous peoples and are associated with a high burden of comorbidities and antibiotic use. Strategies to enhance antimicrobial stewardship should be considered in this remote setting.
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Affiliation(s)
- Shayne Camilleri
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia
| | - Danny Tsai
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Freya Langham
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
- Department of Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - Shahid Ullah
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
- Department of Infectious Diseases, Canberra Hospital, Canberra, ACT, Australia
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Banham D, Roder D, Thompson S, Williamson A, Bray F, Currow D. The effect of general practice contact on cancer stage at diagnosis in Aboriginal and non-Aboriginal residents of New South Wales. Cancer Causes Control 2023; 34:909-926. [PMID: 37329444 PMCID: PMC10460337 DOI: 10.1007/s10552-023-01727-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Older age, risks from pre-existing health conditions and socio-economic disadvantage are negatively related to the prospects of an early-stage cancer diagnosis. With older Aboriginal Australians having an elevated prevalence of these underlying factors, this study examines the potential for the mitigating effects of more frequent contact with general practitioners (GPs) in ensuring local-stage at diagnosis. METHODS We compared the odds of local vs. more advanced stage at diagnosis of solid tumours according to GP contact, using linked registry and administrative data. Results were compared between Aboriginal (n = 4,084) and non-Aboriginal (n = 249,037) people aged 50 + years in New South Wales with a first diagnosis of cancer in 2003-2016. RESULTS Younger age, male sex, having less area-based socio-economic disadvantage, and fewer comorbid conditions in the 12 months before diagnosis (0-2 vs. 3 +), were associated with local-stage in fully-adjusted structural models. The odds of local-stage with more frequent GP contact (14 + contacts per annum) also differed by Aboriginal status, with a higher adjusted odds ratio (aOR) of local-stage for frequent GP contact among Aboriginal people (aOR = 1.29; 95% CI 1.11-1.49) but not among non-Aboriginal people (aOR = 0.97; 95% CI 0.95-0.99). CONCLUSION Older Aboriginal Australians diagnosed with cancer experience more comorbid conditions and more socioeconomic disadvantage than other Australians, which are negatively related to diagnosis at a local-cancer stage. More frequent GP contact may act to partly offset this among the Aboriginal population of NSW.
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Affiliation(s)
- David Banham
- Cancer Statistics and Information Division, Cancer Institute of New South Wales, St Leonards, NSW, Australia
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, Australia
| | - Sandra Thompson
- WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research On Cancer, Lyon, France
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.
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6
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Baker R. Improving life expectancy with primary health care. J Prim Health Care 2023; 15:104-105. [PMID: 37390027 DOI: 10.1071/hc23058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023] Open
Affiliation(s)
- Richard Baker
- Department of Population Health Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Secombe PJ, Brown A, Bailey MJ, Huckson S, Chavan S, Litton E, Pilcher D. Twelve-month mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units in Australia: a registry-based data linkage study. Med J Aust 2023; 218:77-83. [PMID: 36310397 PMCID: PMC10092659 DOI: 10.5694/mja2.51763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/07/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare longer term (12-month) mortality outcomes for Indigenous and non-Indigenous people admitted to intensive care units (ICUs) in Australia. DESIGN, SETTING, PARTICIPANTS Retrospective registry-based data linkage cohort study; analysis of all admissions of adults (16 years or older) to Australian ICUs, 1 January 2017 - 31 December 2019, as recorded in the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD), linked using the SLK-581 key to National Death Index data. MAIN OUTCOME MEASURES Unadjusted and adjusted mortality risk, censored at twelve months from the start of index ICU admission. Secondary outcomes were unadjusted and adjusted mortality twelve months from admission to the ICU. RESULTS The APD recorded 330 712 eligible ICU admissions during 2017-2019 (65% of all ICU admissions registered), of which 11 322 were of Indigenous people (3.4%). Median age at admission was lower for Indigenous patients (51.2 [IQR, 36.7-63.6] years) than for non-Indigenous patients (66.5 [IQR, 52.7-76.1] years). Unadjusted mortality risk was similar for Indigenous and non-Indigenous patients (hazard ratio, 1.01; 95% CI, 0.97-1.06), but was higher for Indigenous patients after adjusting for age, admission diagnosis, illness severity, hospital type, jurisdiction, remoteness and socio-economic status (adjusted hazard ratio, 1.20; 95% CI, 1.14-1.27). Twelve-month mortality was higher for Indigenous than non-Indigenous patients (adjusted odds ratio, 1.24; 95% CI, 1.16-1.33). CONCLUSIONS Twelve-month mortality outcomes are poorer for people admitted to ICUs in Australia than for the general population. Further, after adjusting for age and other factors, survival outcomes are poorer for Indigenous than non-Indigenous people admitted to ICUs. Critical illness may therefore contribute to shorter life expectancy among Indigenous Australians.
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Affiliation(s)
- Paul J Secombe
- Alice Springs Hospital, Alice Springs, NT.,Monash University, Melbourne, VIC
| | - Alex Brown
- Australian National University, Canberra, ACT.,South Australian Health and Medical Research Institute, Adelaide, SA
| | | | - Sue Huckson
- Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC
| | - Shaila Chavan
- Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC
| | - Edward Litton
- Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC.,Fiona Stanley Hospital, Perth, WA
| | - David Pilcher
- Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
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8
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Tsai D, Secombe P, Chiong F, Ullah S, Lipman J, Hewagama S. Prediction accuracy of commonly used pneumonia severity scores in Aboriginal patients with severe community-acquired pneumonia: a retrospective study. Intern Med J 2023; 53:51-60. [PMID: 34524713 DOI: 10.1111/imj.15534] [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: 07/09/2021] [Revised: 08/18/2021] [Accepted: 09/12/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is highly prevalent in the Aboriginal population. Few pneumonia severity scores are validated in this population. AIMS To assess the prediction accuracy of pneumonia severity scores in Aboriginal patients with SCAP and to identify risk factors for poor prognosis. METHODS Retrospective cohort study examining Aboriginal patients admitted to the intensive care unit with confirmed SCAP between January 2011 and December 2014. Severity scores were calculated for SMARTCOP (systolic blood pressure, multi-lobar, albumin, respiratory rate, tachycardia, confusion, oxygenation and arterial pH), SMARTACOP (systolic blood pressure, multi-lobar, albumin, respiratory rate, tachycardia, Aboriginal status, confusion, oxygenation and arterial pH), CURB-65 (confusion, urea, respiratory rate, blood pressure and age ≥65 years), pneumonia severity index, Infectious Diseases Society of America and American Thoracic Society SCAP, and Acute Physiology and Chronic Health Evaluation (APACHE) II/III using medical records. Prediction accuracy of 30-day mortality and requirement for intensive respiratory and/or vasoactive support (IRVS) were assessed using logistic regression and the area under the receiver operating characteristic curve (AUROC). Multivariate analysis was used to test associations between poor prognosis and demographic/clinical variables. RESULTS A total of 203 cases (49% women) was identified. Thirty-day mortality was 6.4% (n = 13), and 53% (n = 107) required IRVS. None of the tested pneumonia severity scores accurately predicted mortality. SMARTCOP and SMARTACOP predicted IRVS requirement with the highest diagnostic accuracy, but only achieved acceptable discrimination (P <0.001 and <0.001; AUROC = 0.74 and 0.75 respectively). APACHE II/III predicted both mortality (P = 0.003 and 0.001; AUROC = 0.74 and 0.73 respectively) and IRVS requirement (P <0.001 and <0.001; AUROC = 0.72 and 0.73 respectively). Multivariate analysis associated mortality with male gender, cirrhosis, immunosuppression and acidaemia, and IRVS requirement with multi-lobar pneumonia, hypotension and tachypnoea. Multivariate analysis for mortality and IRVS requirement achieved an AUROC of 0.93 and 0.87 respectively. CONCLUSION None of the pneumonia severity scores accurately predicted mortality. We recommend SMARTACOP to predict IRVS requirement in Aboriginal patients with SCAP. Given Aboriginal patients are over-represented in Australian intensive care units, a new score is warranted for this understudied population.
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Affiliation(s)
- Danny Tsai
- University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Rural and Remote Health NT, Flinders University, Alice Springs, Northern Territory, Australia.,Pharmacy Department, Alice Springs Hospital, Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Paul Secombe
- Department of Intensive Care Medicine, Alice Springs Hospital, Central Australian Health Service, Alice Springs, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jeffrey Lipman
- University of Queensland Centre of Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,ICU and Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Saliya Hewagama
- Department of Medicine, Alice Springs Hospital, Central Australian Health Service, Alice Springs, Northern Territory, Australia.,Department of Infectious Diseases, The Northern Hospital, Melbourne, Victoria, Australia
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Carman W, Ishida M, Trounson JS, Mercer SW, Anindya K, Sum G, Armstrong G, Oldenburg B, McPake B, Lee JT. Epidemiology of physical-mental multimorbidity and its impact among Aboriginal and Torres Strait Islander in Australia: a cross-sectional analysis of a nationally representative sample. BMJ Open 2022; 12:e054999. [PMID: 36220313 PMCID: PMC9557280 DOI: 10.1136/bmjopen-2021-054999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to examine the differences in multimorbidity between Aboriginal and Torres Strait Islander people and non-Indigenous Australians, and the effect of multimorbidity on health service use and work productivity. SETTING Cross-sectional sample of the Household, Income and Labour Dynamics in Australia wave 17. PARTICIPANTS A nationally representative sample of 16 749 respondents aged 18 years and above. OUTCOME MEASURES Multimorbidity prevalence and pattern, self-reported health, health service use and employment productivity by Indigenous status. RESULTS Aboriginal respondents reported a higher prevalence of multimorbidity (24.2%) compared with non-Indigenous Australians (20.7%), and the prevalence of mental-physical multimorbidity was almost twice as high (16.1% vs 8.1%). Multimorbidity pattern varies significantly among the Aboriginal and non-Indigenous Australians. Multimorbidity was associated with higher health service use (any overnight admission: adjusted OR=1.52, 95% CI=1.46 to 1.58), reduced employment productivity (days of sick leave: coefficient=0.25, 95% CI=0.19 to 0.31) and lower perceived health status (SF6D score: coefficient=-0.04, 95% CI=-0.05 to -0.04). These associations were found to be comparable in both Aboriginal and non-Indigenous populations. CONCLUSIONS Multimorbidity prevalence was significantly greater among Aboriginal and Torres Strait Islanders compared with the non-Indigenous population, especially mental-physical multimorbidity. Strategies are required for better prevention and management of multimorbidity for the aboriginal population to reduce health inequalities in Australia.
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Affiliation(s)
- William Carman
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin S Trounson
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stewart W Mercer
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Kanya Anindya
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Gregory Armstrong
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Health Service Research, Faculty of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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10
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Damarell RA, Morgan DD, Tieman JJ, Senior T. Managing multimorbidity: a qualitative study of the Australian general practitioner experience. Fam Pract 2022; 40:360-368. [PMID: 36063437 DOI: 10.1093/fampra/cmac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age. OBJECTIVE To explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision. METHOD A qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis. RESULTS Twelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners' ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients. CONCLUSIONS Australian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future.
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Affiliation(s)
- Raechel A Damarell
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deidre D Morgan
- Tharawal Aboriginal Corporation/School of Medicine. Western Sydney University, Sydney, NSW, Australia
| | - Jennifer J Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Tim Senior
- Tharawal Aboriginal Corporation/School of Medicine. Western Sydney University, Sydney, NSW, Australia
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11
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Churchill SA, Appau S. Introduction to the Special Issue: Socioeconomic Outcomes of Indigenous Groups — Determinants and Trends. JOURNAL OF ECONOMICS, RACE, AND POLICY 2022; 5:149-150. [PMID: 35847162 PMCID: PMC9273917 DOI: 10.1007/s41996-022-00105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022]
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12
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Sehgal A, Barnabe C, Crowshoe L(L. Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review. PLoS One 2022; 17:e0273841. [PMID: 36044532 PMCID: PMC9432764 DOI: 10.1371/journal.pone.0273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
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Affiliation(s)
- Anika Sehgal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden (Lindsay) Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Temple J, Wilson T, Radford K, LoGiudice D, Utomo A, Anstey KJ, Eades S. Demographic drivers of the growth of the number of Aboriginal and Torres Strait Islander people living with dementia, 2016-2051. Australas J Ageing 2022; 41:e320-e327. [PMID: 35993283 PMCID: PMC10087408 DOI: 10.1111/ajag.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the demographic drivers that contribute to the future growth in the population of Aboriginal and Torres Strait Islander peoples living with dementia in Australia. METHODS Design: Multistate, Indigenous status, cohort component, population projection model. SETTING National-level, Aboriginal and Torres Strait Islander population. DATA Data prepared by the Australian Bureau of Statistics on births, deaths, migration and identification change. Australian Institute of Health and Welfare estimates of dementia prevalence alongside estimates from several studies. MAJOR OUTCOME MEASURES Number of older people living with dementia alongside a decomposition of demographic drivers of growth. RESULTS By 2051, the relative growth in the number of Aboriginal and Torres Strait Islander peoples aged 50+ with dementia ranges from 4½ to 5½ times (under three prevalence scenarios) its 2016 estimate. Cohort flow (the gradual movement of younger cohorts into the 50+ age group, and the depletion of older cohorts from death, over time) is a key driver of the growth in the number of older people living with dementia. CONCLUSIONS High growth in the number of people living with dementia poses implications for culturally appropriate care, health-care access and support for Aboriginal and Torres Strait Islander families, carers and their communities.
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Affiliation(s)
- Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Wilson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kylie Radford
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ariane Utomo
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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14
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Acharibasam JB, Chapados M, Langan J, Starblanket D, Hagel M. Exploring health and wellness with First Nations communities at the "knowing your health symposium". Healthc Manage Forum 2022; 35:265-271. [PMID: 35612601 PMCID: PMC9425725 DOI: 10.1177/08404704221084042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Indigenous older adults living in rural communities require accessibility to and readiness for new technologies to support the monitoring of health data and health status, as well as dementia education. Morning Star Lodge partnered with the File Hills Qu'Appelle Tribal Council, a Community Research Advisory Committee and All Nations Hope Network to bring a diverse group of First Nations community members to the “Knowing Your Health Symposium” to learn about traditional health and First Nations’ wellness. Indigenous research methods and community-based involvement informed and guided the research. An environmental scan was conducted relating to co-researchers’ nutrition, exercise, and self-management of health and health issues through an anonymous survey distributed at the symposium. The purpose of the symposium was to provide communities with information about healthy lifestyles as it relates to dementia and equip community members with the ability to make constructive decisions regarding their health.
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Affiliation(s)
| | - Meghan Chapados
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jennifer Langan
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Mikayla Hagel
- 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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15
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Hensen L, Illing PT, Rowntree LC, Davies J, Miller A, Tong SYC, Habel JR, van de Sandt CE, Flanagan K, Purcell AW, Kedzierska K, Clemens EB. T Cell Epitope Discovery in the Context of Distinct and Unique Indigenous HLA Profiles. Front Immunol 2022; 13:812393. [PMID: 35603215 PMCID: PMC9121770 DOI: 10.3389/fimmu.2022.812393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
CD8+ T cells are a pivotal part of the immune response to viruses, playing a key role in disease outcome and providing long-lasting immunity to conserved pathogen epitopes. Understanding CD8+ T cell immunity in humans is complex due to CD8+ T cell restriction by highly polymorphic Human Leukocyte Antigen (HLA) proteins, requiring T cell epitopes to be defined for different HLA allotypes across different ethnicities. Here we evaluate strategies that have been developed to facilitate epitope identification and study immunogenic T cell responses. We describe an immunopeptidomics approach to sequence HLA-bound peptides presented on virus-infected cells by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Using antigen presenting cell lines that stably express the HLA alleles characteristic of Indigenous Australians, this approach has been successfully used to comprehensively identify influenza-specific CD8+ T cell epitopes restricted by HLA allotypes predominant in Indigenous Australians, including HLA-A*24:02 and HLA-A*11:01. This is an essential step in ensuring high vaccine coverage and efficacy in Indigenous populations globally, known to be at high risk from influenza disease and other respiratory infections.
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Affiliation(s)
- Luca Hensen
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Patricia T. Illing
- Department of Biochemistry and Molecular Biology & Infection and Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Louise C. Rowntree
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Jane Davies
- Menzies School of Health Research, Darwin, NT, Australia
| | - Adrian Miller
- Indigenous Engagement, CQUniversity, Townsville, QLD, Australia
| | - Steven Y. C. Tong
- Menzies School of Health Research, Darwin, NT, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jennifer R. Habel
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Carolien E. van de Sandt
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
- Department of Hematopoiesis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Katie L. Flanagan
- Department of Infectious Diseases and Tasmanian Vaccine Trial Centre, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences and School of Medicine, University of Tasmania, Launceston, TAS, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
| | - Anthony W. Purcell
- Department of Biochemistry and Molecular Biology & Infection and Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
- *Correspondence: Katherine Kedzierska,
| | - E. Bridie Clemens
- Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
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16
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Wang L, Qiu H, Luo L, Zhou L. Age- and Sex-Specific Differences in Multimorbidity Patterns and Temporal Trends on Assessing Hospital Discharge Records in Southwest China: Network-Based Study. J Med Internet Res 2022; 24:e27146. [PMID: 35212632 PMCID: PMC8917436 DOI: 10.2196/27146] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/06/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
Background Multimorbidity represents a global health challenge, which requires a more global understanding of multimorbidity patterns and trends. However, the majority of studies completed to date have often relied on self-reported conditions, and a simultaneous assessment of the entire spectrum of chronic disease co-occurrence, especially in developing regions, has not yet been performed. Objective We attempted to provide a multidimensional approach to understand the full spectrum of chronic disease co-occurrence among general inpatients in southwest China, in order to investigate multimorbidity patterns and temporal trends, and assess their age and sex differences. Methods We conducted a retrospective cohort analysis based on 8.8 million hospital discharge records of about 5.0 million individuals of all ages from 2015 to 2019 in a megacity in southwest China. We examined all chronic diagnoses using the ICD-10 (International Classification of Diseases, 10th revision) codes at 3 digits and focused on chronic diseases with ≥1% prevalence for each of the age and sex strata, which resulted in a total of 149 and 145 chronic diseases in males and females, respectively. We constructed multimorbidity networks in the general population based on sex and age, and used the cosine index to measure the co-occurrence of chronic diseases. Then, we divided the networks into communities and assessed their temporal trends. Results The results showed complex interactions among chronic diseases, with more intensive connections among males and inpatients ≥40 years old. A total of 9 chronic diseases were simultaneously classified as central diseases, hubs, and bursts in the multimorbidity networks. Among them, 5 diseases were common to both males and females, including hypertension, chronic ischemic heart disease, cerebral infarction, other cerebrovascular diseases, and atherosclerosis. The earliest leaps (degree leaps ≥6) appeared at a disorder of glycoprotein metabolism that happened at 25-29 years in males, about 15 years earlier than in females. The number of chronic diseases in the community increased over time, but the new entrants did not replace the root of the community. Conclusions Our multimorbidity network analysis identified specific differences in the co-occurrence of chronic diagnoses by sex and age, which could help in the design of clinical interventions for inpatient multimorbidity.
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Affiliation(s)
- Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Hang Qiu
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.,School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, China
| | - Li Zhou
- Health Information Center of Sichuan Province, Chengdu, China
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17
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Ethnic variation, socioeconomic status, and factors associated with cardio-metabolic multi-morbidity among uncontrolled hypertension in multiethnic Singapore. J Hum Hypertens 2022; 36:218-227. [PMID: 33837292 DOI: 10.1038/s41371-020-00457-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Identifying patients with hypertension at high risk of cardio-metabolic multi-morbidity (CMM) is key for intervention. We examined the independent association of CMM with ethnicity and socioeconomic status (SES) among patients with uncontrolled hypertension. Demographic, socioeconomic, lifestyle, and clinical factors were obtained from 921 patients aged ≥40 years with hypertension in the multiethnic Singapore. CMM was defined as having ≥2 chronic diseases (diabetes mellitus, heart disease, stroke, and chronic kidney disease), which were confirmed by medical records or laboratory measurements. The overall CMM prevalence was 20.9% (95% confidence interval [CI]: 18.4-23.6%). The CMM prevalence was higher in Malays (27.1%) and Indians (30.2%) than Chinese (18.8%), and it was higher among patients with lower SES (ranging from 21.3 to 23.9% using education, employment status, housing ownership and housing types as proxies) compared to those with higher SES (13.1-20.8%). In a multivariate model comprising demographic and socioeconomic factors (age, sex, ethnicity and SES), higher CMM odds were independently associated with ethnic minorities (Malays [OR 1.81; 95% CI: 1.10-2.98] or Indians [OR 2.21; 95% CI: 1.49-3.29] vs. Chinese) and lower SES (unemployment [OR 1.45; 95% CI: 1.02-2.05] and residing in smaller public housing [OR 1.95; 95% CI: 1.16-3.28]). Other correlates of CMM included age, men, central obesity, and poorer dietary quality (lower fruits and vegetables intakes). CMM affected one out of five patients with hypertension in Singapore. Intervention programs should target patients with hypertension, particularly those of ethnic minorities and from lower socioeconomic strata.
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18
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Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes. Int Psychogeriatr 2022; 34:71-78. [PMID: 32985391 DOI: 10.1017/s104161022000174x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people. METHOD This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined. RESULTS Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48-5.51). CONCLUSIONS Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.
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19
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Lewis ET, Howard L, Cardona M, Radford K, Withall A, Howie A, Rockwood K, Peters R. Frailty in Indigenous Populations: A Scoping Review. Front Public Health 2021; 9:785460. [PMID: 34881221 PMCID: PMC8646043 DOI: 10.3389/fpubh.2021.785460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Indigenous populations experience high rates of age-related illness when compared to their non-Indigenous counterparts. Frailty is a challenging expression of aging and an important public health priority. The purpose of this review was to map what the existing literature reports around frailty in Indigenous populations and to highlight the current gaps in frailty research within the Indigenous landscape. Method: Scoping review of English language original research articles focusing on frailty within Indigenous adult populations in settler colonial countries (Australia, Canada, New Zealand and USA). Ten electronic databases and eight relevant institutional websites were searched from inception to October 2020. Results: Nine articles met our inclusion criteria, finding this population having a higher prevalence of frailty and frailty occurring at younger ages when compared to their non-Indigenous counterparts, but two did not use a formal frailty tool. Females presented with higher levels of frailty. No culturally specific frailty tool was identified, and the included articles did not assess strategies or interventions to manage or prevent frailty in Indigenous peoples. Conclusions: There was little definitive evidence of the true frailty prevalence, approaches to frailty screening and of potential points of intervention to manage or prevent the onset of frailty. Improvements in the quality of evidence are urgently needed, along with further research to determine the factors contributing to higher rates of frailty within Indigenous populations. Incorporation of Indigenous views of frailty, and instruments and programs that are led and designed by Indigenous communities, are crucial to address this public health priority.
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Affiliation(s)
- Ebony T Lewis
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Leanne Howard
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Magnolia Cardona
- Gold Coast Hospital and Health Service, Southport, QLD, Australia.,Institute for Evidence-Based Healthcare, Bond University, Robina, QLD, Australia
| | - Kylie Radford
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Adam Howie
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ruth Peters
- School of Psychology, Faculty of Science, University of New South Wales, Kensington, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
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20
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de Witt A, Matthews V, Bailie R, Valery PC, Adams J, Garvey G, Martin JH, Cunningham FC. Aboriginal and Torres Strait Islander patients' cancer care pathways in Queensland: Insights from health professionals. Health Promot J Austr 2021; 33:701-710. [PMID: 34767657 DOI: 10.1002/hpja.556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work. METHODS Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework. RESULTS This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n = 9) and from six Aboriginal Community Controlled Health Services (n = 17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians. CONCLUSION The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer. SUMMARY Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.
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Affiliation(s)
- Audra de Witt
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Veronica Matthews
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Ross Bailie
- University Centre for Rural Health, University of Sydney, Sydney, NSW, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Southside Clinical School, University of Queensland, Brisbane, QLD, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Gail Garvey
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer H Martin
- Southside Clinical School, University of Queensland, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Frances C Cunningham
- Menzies School of Health Research, Brisbane QLD, Charles Darwin University, Darwin, NT, Australia
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Robust and prototypical immune responses toward influenza vaccines in the high-risk group of Indigenous Australians. Proc Natl Acad Sci U S A 2021; 118:2109388118. [PMID: 34607957 PMCID: PMC8522271 DOI: 10.1073/pnas.2109388118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 12/01/2022] Open
Abstract
Indigenous populations worldwide are highly susceptible to influenza virus infections. Vaccination with inactivated virus is highly recommended to protect Indigenous populations, including Indigenous Australians. There is no study to date that assessed immune responses induced by the inactivated seasonal influenza vaccine in the Indigenous population. Vaccine recommendations are thus based on data generated for non-Indigenous populations and might not be representative for Indigenous people. We found robust antibody responses to influenza vaccination induced in Indigenous Australians, with activation profiles of cTFH1 cells at the acute response strongly correlating with total change of antibody vaccine titers induced by vaccination. Our work strongly supports the recommendation of influenza vaccination to protect Indigenous populations from severe seasonal influenza virus infections and subsequent complications. Morbidity and mortality rates from seasonal and pandemic influenza occur disproportionately in high-risk groups, including Indigenous people globally. Although vaccination against influenza is recommended for those most at risk, studies on immune responses elicited by seasonal vaccines in Indigenous populations are largely missing, with no data available for Indigenous Australians and only one report published on antibody responses in Indigenous Canadians. We recruited 78 Indigenous and 84 non-Indigenous Australians vaccinated with the quadrivalent influenza vaccine into the Looking into InFluenza T cell immunity - Vaccination cohort study and collected blood to define baseline, early (day 7), and memory (day 28) immune responses. We performed in-depth analyses of T and B cell activation, formation of memory B cells, and antibody profiles and investigated host factors that could contribute to vaccine responses. We found activation profiles of circulating T follicular helper type-1 cells at the early stage correlated strongly with the total change in antibody titers induced by vaccination. Formation of influenza-specific hemagglutinin-binding memory B cells was significantly higher in seroconverters compared with nonseroconverters. In-depth antibody characterization revealed a reduction in immunoglobulin G3 before and after vaccination in the Indigenous Australian population, potentially linked to the increased frequency of the G3m21* allotype. Overall, our data provide evidence that Indigenous populations elicit robust, broad, and prototypical immune responses following immunization with seasonal inactivated influenza vaccines. Our work strongly supports the recommendation of influenza vaccination to protect Indigenous populations from severe seasonal influenza virus infections and their subsequent complications.
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22
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Thompson KJ, Finfer SR, Coombes J, Eades S, Hunter K, Leong RNF, Lewis E, Liu B. Incidence and outcomes of sepsis in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales: population-based cohort study. CRIT CARE RESUSC 2021; 23:337-345. [PMID: 38046084 PMCID: PMC10692574 DOI: 10.51893/2021.3.oa11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To estimate the incidence and outcomes of sepsis hospitalisations in Aboriginal and Torres Strait Islander and non-Indigenous residents of New South Wales. Design and participants: Prospective cohort study of residents aged 45 years and older, recruited between 2006 and 2009, and followed for hospitalisation for sepsis. Main outcome measures: Incidence and hazard ratio (HR) of sepsis hospitalisation and intensive care unit (ICU) admission identified using International Classification of Diseases (10th revision) coding on discharge data. Length of stay, readmission and mortality in those admitted for sepsis. Results: Of 264 678 participants, 1928 (0.7%) identified as Aboriginal and/or Torres Strait Islander. Sepsis hospitalisation was higher in Aboriginal and Torres Strait Islander participants (8.67 v 6.12 per 1000 person-years; age- and sex-adjusted HR, 2.35; 95% CI, 1.98-2.80) but was attenuated after adjusting for sociodemographic factors, health behaviour and comorbidities (adjusted HR, 1.56; 95% CI, 1.31-1.86). Among those hospitalised for sepsis, after adjusting for age and sex, there were no differences between the proportions of Aboriginal and Torres Strait Islander and non-Indigenous participants admitted to an ICU (18.0% v 16.1%; P = 0.42) or deceased at 1 year (36.1% v 36.8%; P = 0.92). Aboriginal and Torres Strait Islander participants had shorter lengths of hospital stay (9.98 v 11.72 days; P < 0.001) and ICU stay (4.38 v 6.35 days; P < 0.001) than non-Indigenous participants. Overall, more than 70% of participants were readmitted to hospital within 1 year. Conclusion: We found that the rate of sepsis hospitalisation in NSW was higher for Aboriginal and Torres Strait Islander adults. Culturally appropriate, community-led strategies targeting chronic disease prevention and the social determinants of health may reduce this gap. Preventing readmission following sepsis is a priority for all Australians.
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Affiliation(s)
| | - Simon R. Finfer
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | | | - Sandra Eades
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Asutralia
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Kate Hunter
- The George Institute for Global Health, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Ebony Lewis
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Bette Liu
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Lavrencic LM, Donovan T, Moffatt L, Keiller T, Allan W, Delbaere K, Radford K. Ngarraanga Giinganay ('thinking peacefully'): Co-design and pilot study of a culturally-grounded mindfulness-based stress reduction program with older First Nations Australians. EVALUATION AND PROGRAM PLANNING 2021; 87:101929. [PMID: 33711689 DOI: 10.1016/j.evalprogplan.2021.101929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/08/2020] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
First Nations 'survivors' are ageing in increasing numbers. Life-course stress and depression are of concern for older First Nations Australians, yet there are limited psychosocial interventions. This study aimed to co-design a culturally-grounded mindfulness-based program ('Ngarraanga Giinganay') and evaluate acceptability/feasibility with an Aboriginal community on Gumbaynggirr Country. An expert Working Group guided program development, with Aboriginal and non-Aboriginal clinicians/consultants. A workshop, collaborative yarning group with older Aboriginal people (n = 9), and further consultation contributed to the design/refinement of the 8-session group-based program, ensuring content aligned with therapeutic principles of mindfulness and cultural understandings of the Gumbaynggirr community. A single-group pilot study was conducted (n = 7, 62-81 years), co-facilitated by an Aboriginal clinician and Elder. Outcomes were qualitative (understandings of mindfulness, program acceptability, benefits to health/wellbeing). Pilot results demonstrated feasibility, acceptability and preliminary effectiveness. The program enhanced understandings of mindfulness and participants highlighted benefits such as helping anxiety, relaxation, focusing on the moment and connection to Country/land. Trends were seen for reducing depression, anxiety and stress symptoms, and blood pressure. This study provides insight into partnering with underrepresented populations through ageing research, highlighting the effectiveness of this co-design approach. Ngarraanga Giinganay has considerable potential for supporting health and wellbeing of First Nations peoples.
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Affiliation(s)
- Louise M Lavrencic
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia.
| | | | - Lindy Moffatt
- Neuroscience Research Australia, Sydney, NSW, Australia
| | | | - Wendy Allan
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia
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Dawson LP, Burchill L, O'Brien J, Dinh D, Duffy SJ, Stub D, Brennan A, Clark D, Oqueli E, Hiew C, Freeman M, Reid CM, Ajani AE. Differences in outcome of percutaneous coronary intervention between Indigenous and non-Indigenous people in Victoria, Australia: a multicentre, prospective, observational, cohort study. LANCET GLOBAL HEALTH 2021; 9:e1296-e1304. [PMID: 34274040 DOI: 10.1016/s2214-109x(21)00224-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data on the patient characteristics and health outcomes of Indigenous Australians having revascularisation for treatment of coronary artery disease are scarce. The aim of this study was to assess differences in patient characteristics, presentations, and outcomes among Indigenous and non-Indigenous Australians having percutaneous coronary intervention (PCI) in urban and larger regional centres in Victoria, Australia. METHODS In this multicentre, prospective, observational cohort study, data were prospectively collected from six government-funded tertiary hospitals in the state of Victoria, Australia. The Melbourne Interventional Group PCI registry was used to identify patients having PCI at Victorian metropolitan and large regional hospitals between Jan 1, 2005, and Dec 31, 2018. The primary outcome was long-term mortality. Secondary outcomes were 30 day mortality and 30 day major adverse cardiovascular events (MACE), defined as a composite endpoint of death, myocardial infarction, and target-vessel revascularisation. Regression analyses, adjusted for clinically relevant covariates and geographical and socioeconomic indices, were used to establish the influence of Indigenous status on these study outcomes. FINDINGS 41 146 patient procedures were entered into the registry, of whom 179 (0·4%) were recorded as identifying as Indigenous Australian, 39 855 (96·9%) were not Indigenous Australian, and 1112 (2·7%) had incomplete data regarding ethnicity and were excluded. Compared with their non-Indigenous counterparts, Indigenous patients were younger, more often women, and more likely to have comorbidities. Indigenous Australians were also more likely to live in a regional community and areas of socioeconomic disadvantage. Procedural success and complication rates were similar for Indigenous and non-Indigenous patients having PCI. At 30 day follow-up, Indigenous Australians were more likely to be taking optimal medical therapy, although overall follow-up rates were lower and prevalence of persistent smoking was higher. Multivariable analysis showed that Indigenous status was independently associated with increased risk of long-term mortality (hazard ratio 2·49, 95% CI 1·79-3·48; p<0·0001), 30 day mortality (odds ratio 2·78, 95% CI 1·09-7·12; p=0·033), and 30-day MACE (odds ratio 1·87, 95% CI 1·03-3·39; p=0·039). INTERPRETATION Indigenous Australians having PCI in urban and larger regional centres are at increased risk of mortality and adverse cardiac events. Clinically effective and culturally safe care pathways are urgently needed to improve health outcomes among Indigenous Australians who are having PCI. FUNDING National Health and Medical Research Council, National Heart Foundation.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Luke Burchill
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medicine, Melbourne University, Melbourne, VIC, Australia
| | - Jessica O'Brien
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia
| | - Stephen J Duffy
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, VIC, Australia; School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital, Geelong, VIC, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, VIC, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia; Centre of Clinical Research and Education, School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Medicine, Melbourne University, Melbourne, VIC, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, VIC, Australia.
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25
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Harding G, Hu N, Larter N, Montgomery A, Stephensen J, Callaghan L, Zwi K, Lingam R, Woolfenden S. Health status and health service use of urban Aboriginal children attending an Aboriginal community child health service in Sydney. J Paediatr Child Health 2021; 57:1072-1077. [PMID: 33629409 DOI: 10.1111/jpc.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/31/2021] [Accepted: 02/03/2021] [Indexed: 11/30/2022]
Abstract
AIM There is limited information on the health status of urban Australian Aboriginal children and young people attending community-based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia. METHODS Cross-sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0-18 years who visited the service between January 2013 and December 2017. RESULTS A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty-six percent of occasions of service noted >3 diagnoses; 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty-five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear-nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses. CONCLUSION It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this.
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Affiliation(s)
- Georgia Harding
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Nan Hu
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Natasha Larter
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Alicia Montgomery
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Lola Callaghan
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Outreach Clinic, La Perouse Aboriginal Community Health Centre, Sydney, New South Wales, Australia
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Secombe P, Moynihan G, McAnulty G. Long-term outcomes of dialysis-dependent chronic kidney disease patients requiring critical care: an observational matched cohort study. Intern Med J 2021; 51:548-556. [PMID: 31990145 DOI: 10.1111/imj.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/25/2019] [Accepted: 01/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of dialysis-dependent chronic kidney disease (CKD5D) patients in Australia is increasing. AIMS To describe the long-term outcome and resource utilisation of CKD5D patients requiring critical care admission. METHODS Retrospective matched cohort study conducted in the intensive care unit (ICU) of Alice Springs Hospital. CKD5D patients admitted between 1 January 2011 and 31 December 2013 were matched by sex, age, Indigenous status and APACHE III score in a 1:1 ratio with a patient without CKD5D. Primary outcome was mortality censored at 31 December 2018, to allow a minimum 5-year follow up. Secondary outcomes explored resource use including ICU and hospital length of stay (LoS). RESULTS During the study period, 178 (9%) admissions were coded as having CKD5D, 148 (83%) of which were successfully matched. CKD5D patients were older (52 vs 49 years, P < 0.01), with more chronic cardiovascular disease (34 vs 23%, P < 0.01). Five-year mortality was similar (49.5 vs 41.5%, P = 0.28), with a significantly longer time to death in the CKD5D cohort (1179 vs 341 days, P < 0.01). CKD5D patients had a shorter median ICU LoS (1.9 vs 3.0 days, P < 0.01) and lower rates of mechanical ventilation (12.2 vs 35.4%, P < 0.01). CONCLUSION CKD5D patients frequently require intensive care during acute illness. While they have an equivalent 5-year survival rate, time to death is longer suggesting mortality is related to chronic disease progression rather than their acute illness. These results suggest the presence of CKD5D in isolation should not be a reason to limit critical care.
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Affiliation(s)
- Paul Secombe
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,School of Medicine, Flinders University, Adelaide, South Australia, Australia.,School of Epidemiology and Public Health, Monash University, Melbourne, Victoria, Australia
| | - Gerard Moynihan
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Greg McAnulty
- Department of Intensive Care, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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Vincze L, Barnes K, Somerville M, Littlewood R, Atkins H, Rogany A, Williams LT. Cultural adaptation of health interventions including a nutrition component in Indigenous peoples: a systematic scoping review. Int J Equity Health 2021; 20:125. [PMID: 34022886 PMCID: PMC8140502 DOI: 10.1186/s12939-021-01462-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous populations throughout the world experience poorer health outcomes than non-indigenous people. The reasons for the health disparities are complex and due in part to historical treatment of Indigenous groups through colonisation. Evidence-based interventions aimed at improving health in this population need to be culturally safe. However, the extent to which cultural adaptation strategies are incorporated into the design and implementation of nutrition interventions designed for Indigenous peoples is unknown. The aim of this scoping review was to explore the cultural adaptation strategies used in the delivery of nutrition interventions for Indigenous populations worldwide. METHODS Five health and medical databases were searched to January 2020. Interventions that included a nutrition component aimed at improving health outcomes among Indigenous populations that described strategies to enhance cultural relevance were included. The level of each cultural adaptation was categorised as evidential, visual, linguistic, constituent involving and/or socio-cultural with further classification related to cultural sensitivity (surface or deep). RESULTS Of the 1745 unique records screened, 98 articles describing 66 unique interventions met the inclusion criteria, and were included in the synthesis. The majority of articles reported on interventions conducted in the USA, Canada and Australia, were conducted in the previous 10 years (n = 36) and focused on type 2 diabetes prevention (n = 19) or management (n = 7). Of the 66 interventions, the majority included more than one strategy to culturally tailor the intervention, combining surface and deep level adaptation approaches (n = 51), however, less than half involved Indigenous constituents at a deep level (n = 31). Visual adaptation strategies were the most commonly reported (n = 57). CONCLUSION This paper is the first to characterise cultural adaptation strategies used in health interventions with a nutrition component for Indigenous peoples. While the majority used multiple cultural adaptation strategies, few focused on involving Indigenous constituents at a deep level. Future research should evaluate the effectiveness of cultural adaptation strategies for specific health outcomes. This could be used to inform co-design planning and implementation, ensuring more culturally appropriate methods are employed.
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Affiliation(s)
- Lisa Vincze
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia.
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia.
| | - Katelyn Barnes
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Academic Unit of General Practice, Medical School, College of Health & Medicine, The Australian National University, Canberra, Australian Capital Territory, 2601, Australia
| | - Mari Somerville
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia
| | - Robyn Littlewood
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Health & Wellbeing Queensland, Queensland Government, Brisbane, Queensland, Australia
| | - Heidi Atkins
- Queensland Child and Youth Clinical Network, Clinical Excellence Queensland, Queensland Government, Brisbane, Queensland, Australia
| | - Ayala Rogany
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland Government, Brisbane, Queensland, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Parklands Drive, Gold Coast, Queensland, 4222, Australia
- Menzies Health Institute Queensland, Griffith Health Centre, G40_8.86, Gold Coast, Queensland, 4222, Australia
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Obstructive Sleep Apnoea and Cardiac Disease Among Aboriginal Patients in the Northern Territory of Australia. Heart Lung Circ 2021; 30:1184-1192. [PMID: 33741255 DOI: 10.1016/j.hlc.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 10/10/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is paucity of information on obstructive sleep apnoea (OSA) and cardiac diseases among Aboriginal Australian patients. This study evaluates the association of various cardiac disease profiles among Aboriginal patients undergoing a diagnostic polysomnography (PSG). METHOD In this 5-year retrospective study demographics, clinical characteristics, medical and cardiac -conditions were analysed. RESULTS There were total of 340 eligible patients included in the study. The median age was 47 (38-57) years, 51% were males and obesity was noted in 78%. In the overall study participants, cardiac diseases were present in 46%: coronary artery disease (CAD) in 27%, pulmonary hypertension (PH) 19% and atrial fibrillation (AF) 14%. Diabetes and hypertension were noted in 42 and 41% of patients. Overall, 73/340 (21.5%) had two, 69/340 (20.3%) three, 55/340 (16.2%) four, 40/340 (11.8%) five and 10/340 (2.9%) had six comorbidities. In the overall study participants, 297/340 (87%) had OSA (Apnoea-Hypopnoea Index [AHI]>5/hour). Co-occurrence of OSA and cardiac diseases was found in 140/297 (47%), CAD being the commonest (27%). Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Hospital admissions frequency showed a median 2 (IQR: 0-4) times readmission rates since the diagnosis of OSA overall compliance with CPAP therapy was observed in 63 (43%). CONCLUSION Our study demonstrated that a significant proportion of Aboriginal patients with OSA have co-existing cardiac diseases, with CAD being the commonest. Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Furthermore, hospital admission frequency increased among OSA patients with multiple comorbidities.
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Woods JA, Katzenellenbogen JM, Murray K, Johnson CE, Thompson SC. Occurrence and timely management of problems requiring prompt intervention among Indigenous compared with non-Indigenous Australian palliative care patients: a multijurisdictional cohort study. BMJ Open 2021; 11:e042268. [PMID: 33727263 PMCID: PMC7970279 DOI: 10.1136/bmjopen-2020-042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Anticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient's condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of 'unstable' phases (which indicate unanticipated deterioration in a patient's condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups. DESIGN Cohort study. SETTING Australia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015). PARTICIPANTS 139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients. OUTCOME MEASURES Indigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models. RESULTS Unstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398). CONCLUSIONS Despite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community.
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Affiliation(s)
- John A Woods
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- The Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
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Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
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Benn E, Wirth H, Short T, Howarth T, Heraganahally SS. The Top End Sleepiness Scale (TESS): A New Tool to Assess Subjective Daytime Sleepiness Among Indigenous Australian Adults. Nat Sci Sleep 2021; 13:315-328. [PMID: 33707978 PMCID: PMC7941568 DOI: 10.2147/nss.s298409] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To illustrate the utility of a newly developed culturally safe and clinically relevant subjective daytime sleepiness assessment tool "Top End Sleepiness Scale" (TESS) for use among Indigenous Australians. PATIENTS AND METHODS The TESS questionnaire consists of pictorial representations of 6 items representing daily activities that would induce daytime sleepiness specific for Indigenous Australians living in the regional and remote Australia. Consecutive adult Indigenous patients who consented to pilot the TESS questionnaire prior to undergoing a diagnostic polysomnography (PSG) at the Top End Health Service region, Northern Territory of Australia were assessed. The TESS questionnaire was evaluated for its correlation in predicting obstructive sleep apnea (OSA) according to apnea-hypopnea index. RESULTS Eighty-two patients were included. The majority (70%) had moderate to severe OSA (AHI ≥15). Patients were aged in their mid-40's (45.47 95% CI (42.9, 48.05)) with a tendency to obesity (median BMI 33.67 IQR 30.86, 38.95) and a high prevalence of chronic conditions (72%) (hypertension, diabetes or heart disease). The TESS showed high internal consistency (Split half Spearman correlation=0.71, Cronbach's α =0.81), and a cut-off value ≥3 resulted in sensitivity 84%, specificity 38%. Comparison of area under the curve for TESS to Epworth Sleepiness Scale (ESS) in this sample showed the TESS to have greater sensitivity and specificity overall, which approached significance (p=0.072) when cut-off values of ≥3 and ≥8 (TESS & ESS respectively) were used. The sensitivity and specificity for TESS was also comparable to the other currently used questionnaires, such as the Berlin Questionnaire, STOP-BANG and OSA 50. CONCLUSION Currently, there are no subjective daytime sleepiness assessment toll available specifically for Indigenous population. The proposed TESS sleepiness screening tool represented in this study can potentially complement or adopted alongside other existing questionnaire, which may offer greater utility in the assessment of sleep disorders among Indigenous people.
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Affiliation(s)
- Edmund Benn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hugh Wirth
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Teagan Short
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Timothy Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Jayakody A, Oldmeadow C, Carey M, Bryant J, Evans T, Ella S, Attia J, Towle S, Sanson-Fisher R. Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic conditions in New South Wales, Australia: a historical cohort study. BMC Health Serv Res 2020; 20:1082. [PMID: 33238996 PMCID: PMC7690010 DOI: 10.1186/s12913-020-05950-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic conditions, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. METHODS A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years. RESULTS Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR = 1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR = 1.90; 95% CI = 1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p = 0.859; 0.860 respectively). CONCLUSION Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.
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Affiliation(s)
- Amanda Jayakody
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Christopher Oldmeadow
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tiffany Evans
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Stephen Ella
- Nunyara Aboriginal Health Unit, Central Coast Local Health District, Ward Street, Gosford, NSW, 2250, Australia
| | - John Attia
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Simon Towle
- The Cairns Institute, James Cook University, PO Box 6811, Cairns, QLD, 4870, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Staying in touch with the community: understanding self-reported health and research priorities in older Aboriginal Australians. Int Psychogeriatr 2020; 32:1303-1315. [PMID: 31747978 DOI: 10.1017/s1041610219001753] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Aboriginal Australians experience higher rates of non-communicable chronic disease, injury, dementia, and mortality than non-Aboriginal Australians. Self-reported health is a holistic measure and may fit well with Aboriginal views of health and well-being. This study aimed to identify predictors of self-reported health in older Aboriginal Australians and determine acceptable research methodologies for future aging research. DESIGN Longitudinal, population-based study. SETTING Five communities across New South Wales, Australia (two urban and three regional sites). PARTICIPANTS Aboriginal and Torres Strait Islander people (n = 227; 60-88 years, M = 66.06, SD = 5.85; 145 female). MEASUREMENTS Participants completed baseline (demographic, medical, cognitive, mental health, and social factors) and follow-up assessments (self-reported health quantified with 5-point scale; sharing thoughts on areas important for future research). Predictors of self-reported health were examined using logistic regression analyses. RESULTS Self-reported health was associated with sex, activities of daily living, social activity participation, resilience, alcohol use, kidney problems, arthritis, falls, and recent hospitalization. Arthritis, kidney problems, and resilience remained significant in multiple logistic regression models. CONCLUSIONS Perceived resilience and the absence of certain chronic age-related conditions predict older Aboriginal peoples' self-reported health. Understanding these factors could inform interventions to improve well-being. Findings on acceptable research methodologies suggest that many older Aboriginal people would embrace a range of methodologies within long-standing research partnerships, which is an important consideration for Indigenous population research internationally.
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Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207390. [PMID: 33050541 PMCID: PMC7600369 DOI: 10.3390/ijerph17207390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians’ perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants’ health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.
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Ryan BL, Allen B, Zwarenstein M, Stewart M, Glazier RH, Fortin M, Wetmore SJ, Shariff SZ. Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20950598. [PMID: 32923405 PMCID: PMC7457707 DOI: 10.1177/2235042x20950598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 01/23/2020] [Accepted: 07/24/2020] [Indexed: 01/17/2023]
Abstract
Objective: To examine the relationship between multimorbidity and mortality, and whether
relationship varied by material deprivation/rural location and by age. Methods: Retrospective population-based cohort study conducted using 2013–14 data from
previously created cohort of Ontario, Canada residents classified according
to whether or not they had multimorbidity, defined as having 3+ of 17
chronic conditions. Adjusted rate ratios were calculated to compare
mortality rates for those with and without multimorbidity, comparing rates
by material deprivation/rural location, and by age group. Results: There were 13,581,191 people in the cohort ages 0 to 105 years; 15.2% had
multimorbidity. Median length of observation was 365 days. Adjusted
mortality rate ratios did not vary by material deprivation/rural location;
overall adjusted mortality rate ratio was 2.41 (95% CI 2.37–2.45). Adjusted
mortality rate ratios varied by age with ratios decreasing as age increased.
Overall rate ratio was 14.7 (95% CI 14.48–14.91). Children (0–17 years) had
highest ratio, 40.06 (95% CI 26.21–61.22). Youngest adult age group (18–24
years) had rate ratio of 9.96 (95% CI 7.18–13.84); oldest age group (80+
years) had rate ratio of 1.97 (95% CI 1.94–2.04). Conclusion: Compared to people without multimorbidity, multimorbidity conferred higher
risk of death in this study at all age groups. Risk was greater in early and
middle adulthood than in older ages. Results reinforce the fact
multimorbidity is not just a problem of aging, and multimorbidity leads not
only to poorer health and higher health care utilization, but also to a
higher risk of death at a younger age.
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Affiliation(s)
- B L Ryan
- Centre for Studies in Family Medicine & Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - B Allen
- ICES Western, London, ON, Canada
| | - M Zwarenstein
- Centre for Studies in Family Medicine & Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,ICES Central, Toronto, ON, Canada
| | - M Stewart
- Centre for Studies in Family Medicine & Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - R H Glazier
- ICES Central, Toronto, ON, Canada.,Centre for Research on Inner City Health at St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - M Fortin
- Department of Family Medicine, Université de Sherbrooke, Chicoutimi, QC, Canada
| | - S J Wetmore
- Centre for Studies in Family Medicine & Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - S Z Shariff
- ICES Western, London, ON, Canada.,Arthur Labatt School of Nursing, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
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Read DJ, Frentzas S, Ward L, De Ieso P, Chen S, Devi V. Do histopathological features of breast cancer in Australian Indigenous women explain the survival disparity? A two decade long study in the Northern Territory. Asia Pac J Clin Oncol 2020; 16:348-355. [PMID: 32573084 DOI: 10.1111/ajco.13377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
AIMS In the Northern Territory (NT) of Australia, Indigenous women have a lower incidence of breast cancer, but a higher mortality than Non-indigenous women. The aim of this study was to describe and compare breast cancer pathological features related to stage and biological aggression between the two groups. METHODS Subjects were identified by extract from the NT Cancer Registry in two separate cohorts, cohort 1 (1991-2000) and cohort 2 (2001-2010). Data from cohort 1 included age, stage, tumor grade and estrogen receptor status (ER) and treatment completion. Additional pathological variables including tumor size, HER2 status, lymphovascular invasion and derived tumor phenotype were available for cohort 2. Bivariate P values for categoric variables were calculated using Fisher's exact tests. The Wilcoxon rank-sum test was used to compare cohort 2. Logistic regression was used to calculate odds ratios. RESULTS There were 359 (44 indigenous) eligible women in cohort 1 and 526 (100 indigenous) for cohort 2. In cohort 1, in both cohorts, indigenous women were more likely to present at an advanced stage, but there was no difference in ER status or tumor grade. When derived phenotypes were compared, indigenous women were less likely to have better prognosis luminal A tumors, and more likely to have HER2-enriched tumors. CONCLUSION This two decade long comparison of the pathological features of breast cancer between indigenous and nonindigenous women of the NT has confirmed that Indigenous women not only present at a later stage than NI women but are also afflicted by poorer prognosis tumors, particularly HER2 enriched.
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Affiliation(s)
- David J Read
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sophia Frentzas
- Alan Walker Cancer Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Linda Ward
- Menzies School of Health Research, Northern Territory, Australia
| | - Paolo De Ieso
- Northern Territory Radiation Oncology, Northern Territory, Australia
| | - Samantha Chen
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Vanitha Devi
- Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Abdullahi I, Wong K, de Klerk N, Mutch R, Glasson EJ, Downs J, Cherian S, Leonard H. Hospital admissions in children with developmental disabilities from ethnic minority backgrounds. Dev Med Child Neurol 2020; 62:470-476. [PMID: 31498429 DOI: 10.1111/dmcn.14348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 01/04/2023]
Abstract
AIM To compare hospital admission patterns after the first year of life in Australian children with developmental disabilities and children with no known disability, according to maternal country of birth and Indigenous status. METHOD This was a retrospective cohort study using linked data across health, disability, and hospital admission databases. The study investigated 656 174 children born in Western Australia between 1983 and 2008 with a total of 1 091 834 records of hospital admissions. RESULTS Children with no known disability born to Indigenous mothers had the highest rate of hospital admissions compared to children of non-Indigenous mothers. Children of foreign-born mothers from low-income countries had the highest rate of hospital admissions if disability was present. Children with cerebral palsy (CP) with or without associated intellectual disability had the highest rate of hospital admissions among children with developmental disability, especially if mothers were foreign-born. INTERPRETATION Children with CP and intellectual disability, particularly from minority backgrounds (Indigenous Australian and foreign-born mothers), were at higher risk of being admitted to hospital after the first year of life. WHAT THIS PAPER ADDS Hospital admissions in Australian children with and without disabilities differ according to maternal country of birth. Hospital admission rates in children without a developmental disability were greatest for Australian-born Indigenous children. Disabled Australian-born children of foreign-born mothers from low-income countries had the highest hospital admission rates. Hospital admission risk was greatest for Australian-born children with cerebral palsy, especially if mothers were foreign-born.
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Affiliation(s)
- Ifrah Abdullahi
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Raewyn Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.,Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia
| | - Emma J Glasson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Sarah Cherian
- School of Paediatrics and Child Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, WA, Australia.,Department of General Paediatrics, Perth Children's Hospital, Perth, WA, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Hanieh S, High H, Boulton J. Nutrition Justice: Uncovering Invisible Pathways to Malnutrition. Front Endocrinol (Lausanne) 2020; 11:150. [PMID: 32265841 PMCID: PMC7105685 DOI: 10.3389/fendo.2020.00150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/04/2020] [Indexed: 11/20/2022] Open
Abstract
We propose the use of the analytic frame of "nutrition justice" to reconcile the separate imperatives of Global Health for nutritional sufficiency for all, the requirement to eradicate childhood malnutrition, and the need for strategies to check the emerging pandemic of the double burden of malnutrition in the Global South. Malnutrition and its consequences of growth stunting are the result of disruption to the nutritional ecology of childhood from structural violence. This is mediated through loss of food security and perturbation to the cultural status of food, and on the prerequisites for nurture during infancy and early childhood. These socio-political factors obscure the role of biological adaptation to nutritional constraint on growth and hence the causal pathway to the double burden of malnutrition. In this paper we describe how the effects of historical and contemporary structural violence on the nutritional ecology of childhood are mediated using the examples of remote Aboriginal Australia and the Lao PDR. Both populations live by force of circumstance in a "metabolic ghetto" that has disrupted the prerequisites for parental nurturing through loss of food security and of traditional sources of transitional staple foods for weaning. Growth faltering and stunting of stature are markers of adaptation to nutritional constraint yet are also the first steps on the track to the double burden. We discuss the implications of these observations for strategies for global food sufficiency by mean of a thought-experiment of the effect of food and nutrient sufficiency for growth on future health and metabolic adaptation.
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Affiliation(s)
- Sarah Hanieh
- Department of Medicine, Peter Doherty Institute of Immunity and Infection, University of Melbourne, Melbourne, VIC, Australia
| | - Holly High
- The Department of Anthropology, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia
| | - John Boulton
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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LoGiudice D, Josif CM, Malay R, Hyde Z, Haswell M, Lindeman MA, Etherton-Beer C, Atkinson D, Bessarab D, Flicker L, Smith K. The Well-Being of Carers of Older Aboriginal People Living in the Kimberley Region of Remote Western Australia: Empowerment, Depression, and Carer Burden. J Appl Gerontol 2020; 40:693-702. [PMID: 31920136 DOI: 10.1177/0733464819898667] [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] [Indexed: 11/17/2022] Open
Abstract
Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider.
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Affiliation(s)
- Dina LoGiudice
- Melbourne Health, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Cathryn M Josif
- The University of Western Australia, Perth, Australia.,The University of Notre Dame Australia, Broome, Western Australia, Australia
| | - Roslyn Malay
- The University of Western Australia, Perth, Australia
| | - Zoë Hyde
- The University of Western Australia, Perth, Australia
| | - Melissa Haswell
- Queensland University of Technology, Kelvin Grove, Australia
| | | | | | | | - Dawn Bessarab
- The University of Western Australia, Perth, Australia
| | - Leon Flicker
- The University of Western Australia, Perth, Australia
| | - Kate Smith
- The University of Western Australia, Perth, Australia
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Mehra S, Ghimire RH, Mingi JJ, Hatch M, Garg H, Adams R, Heraganahally SS. Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2020; 12:593-602. [PMID: 32922104 PMCID: PMC7455593 DOI: 10.2147/nss.s258330] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). METHODS In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. RESULTS Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. CONCLUSION This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.
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Affiliation(s)
- Sumit Mehra
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Ram H Ghimire
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joy J Mingi
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia.,Department of Public Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Monica Hatch
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Himanshu Garg
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, a Flinders Centre for Research Excellence, Bedford Park, South Australia, Australia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
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Secombe PJ, Brown A, Bailey MJ, Pilcher D. Equity for Indigenous Australians in intensive care. Med J Aust 2019; 211:297-299.e1. [PMID: 31523822 DOI: 10.5694/mja2.50339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul J Secombe
- Alice Springs Hospital, Alice Springs, NT.,Monash University, Melbourne, VIC
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of South Australia, Adelaide, SA
| | | | - David Pilcher
- Alfred Health, Melbourne, VIC.,Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC
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Read DJ, Hayes I. Do Indigenous patients in Australia's Northern Territory present with more advanced colorectal cancer? A cohort study based on registry data. ANZ J Surg 2019; 89:1296-1301. [PMID: 31464001 DOI: 10.1111/ans.15376] [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: 03/10/2019] [Revised: 05/30/2019] [Accepted: 06/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies show that Indigenous Australians (IndA) of the Northern Territory (NT) present later and have lower survival for colorectal cancer (CRC) compared with non-Indigenous (NI) Territorians. This study compared the odds of presenting with advanced-stage CRC between IndA and NI adjusted for demographic, histopathological and surgical features. METHODS A cohort study of NT Cancer Registry (NTCR) CRC cases from 2005 to 2014. All (667) persons notified to the NTCR with a new diagnosis of CRC were included, of which 504 had sufficient data for analysis. The NTCR was used for case identification and linked to available hospital clinical data. The principal exposure was IndA compared with NI and the principal outcome was odds of presenting with advanced-stage tumour (III and IV) compared with early-stage (I and II). Univariable and multivariable logistic regression were performed on all relevant variables. RESULTS Univariable logistic regression found no difference in the odds of advanced CRC between IndA and NI (odds ratio (OR) 0.99, 95% confidence interval (CI) 0.56-1.76, P = 0.982). This effect remained insignificant adjusted for the effects of sex, tumour position, remoteness and time period (OR 0.85, 95% CI 0.47-1.55, P = 0.606) and when adjusted for tumour grade, lympho-vascular invasion, lymph node harvest and emergency status (OR 1.39, 95% CI 0.64-3.03, P = 0.401). CONCLUSIONS In distinction from previous studies, there was no evidence that IndA of the NT presented with later stage CRC in 2005-2014. Other factors (incomplete treatment or comorbidity) may be responsible for the continued observed survival disparity.
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Affiliation(s)
- David J Read
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian Hayes
- Colorectal Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Broe GT, Radford K. Multimorbidity in Aboriginal and non-Aboriginal people. Med J Aust 2019; 209:16-17. [PMID: 29954309 DOI: 10.5694/mja18.00348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Ga Tony Broe
- Neuroscience Research Australia (NeuRA), Sydney, NSW
| | - Kylie Radford
- Neuroscience Research Australia (NeuRA), Sydney, NSW
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Indigenous compared with non-Indigenous Australian patients at entry to specialist palliative care: Cross-sectional findings from a multi-jurisdictional dataset. PLoS One 2019; 14:e0215403. [PMID: 31048843 PMCID: PMC6497232 DOI: 10.1371/journal.pone.0215403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background There are few quantitative studies on palliative care provision to Indigenous Australians, a population known to experience distinctive barriers to quality healthcare and to have poorer health outcomes than other Australians. Objectives To investigate equity of specialist palliative care service provision through characterising and comparing Indigenous and non-Indigenous patients at entry to care. Methods Using data (01/01/2010–30/06/2015) from all services participating in the multi-jurisdictional Palliative Care Outcomes Collaboration, Indigenous and non-Indigenous patients entering palliative care were compared on proportions vis-à-vis those expected from national statutory datasets, demographic characteristics, and entry-to-care status across fourteen ‘problem’ domains (e.g., pain, functional impairment) after matching by age, sex, and specific diagnosis. Results Of 140,267 patients, 1,465 (1.0%, much lower than expected from statutory data) were Indigenous, 133,987 (95.5%) non-Indigenous, and 4,905 (3.5%) had a missing identifier. The proportion of patients with a missing identifier diminished markedly over the study period, without a corresponding increase in the proportion identified as Indigenous. Indigenous compared with non-Indigenous patients were younger (mean 62.8 versus 73.0 years, p<0.001), a higher proportion were female (51.5% versus 46.3%; p<0.001) or resided outside major cities (44.2% versus 21.5%, p<0.001). Across all domains, Indigenous compared with matched non-Indigenous patients had lower or equal risk of status requiring prompt intervention. Conclusions Indigenous patients (especially those residing outside major cities) are substantially under-represented in care by services participating in the nationwide specialist palliative care Collaboration, likely reflecting widespread access barriers. However, the similarity of status indicators among Indigenous and non-Indigenous patients at entry to care suggests that Indigenous patients who are able to access these services do not disproportionately experience clinically important impediments to care initiation.
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Hussain MA, Katzenellenbogen JM, Sanfilippo FM, Murray K, Thompson SC. Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia. PLoS One 2018; 13:e0201496. [PMID: 30106971 PMCID: PMC6091927 DOI: 10.1371/journal.pone.0201496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs. METHODS AND FINDINGS We used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25-59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the "minimally diseased" (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity. CONCLUSION Multimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.
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Affiliation(s)
- Mohammad Akhtar Hussain
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
| | - Judith M. Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M. Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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Thompson GN, Gee C, Talley Ac NJ. Indigenous health: one gap is closed. Med J Aust 2018; 209:14-15. [PMID: 29954307 DOI: 10.5694/mja18.00483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 11/17/2022]
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