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Almeida OP, Page A, Sanfilippo FM, Preen DB, Etherton-Beer C. Observational evidence linking psychotropic medicines to the dispensing of opioid agents in later life. Psychogeriatrics 2024; 24:665-674. [PMID: 38561326 DOI: 10.1111/psyg.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The use of opioid medicines is common in developed countries, particularly among older adults and those with mental health disorders. It is unclear if the association between mental disorders and opioid medicines is causal, or is due to reverse causality or confounding. METHODS We used a 10% random sample of the Australian Pharmaceutical Benefits Scheme (years 2012-2022) to examine the cross-sectional, case-control and longitudinal association between the dispensing of antidepressants, anxiolytics, hypnotics, antipsychotics and lithium, and opioid medicines. We used logistic regression, structural equation models (SEM), and Cox regression to analyze the data. Analyses were adjusted for age (years), sex, and number of non-psychotropic medicines dispensed during the year. RESULTS The 2022 file contained 804 334 individuals aged 50 years or over (53.1% women), of whom 181 690 (22.6%) received an opioid medicine. The adjusted odds ratio of being dispensed opioid medicines was 1.44 (99% CI = 1.42-1.46) for antidepressants, 1.97 (99% CI = 1.92-2.03) for anxiolytics, 1.55 (99% CI = 1.51-1.60) for hypnotics, 1.32 (99% CI = 1.27-1.38) for antipsychotics, and 0.60 (99% CI = 0.53-0.69) for lithium. Similar associations were noticed when we compared participants who were or not dispensed opioid medicines in 2022 for exposure to psychotropic agents between 2012 and 2021. SEM confirmed that this association was not due to reverse causality. The dispensing of antidepressants was associated with increased adjusted hazard (HR) of subsequent dispensing of opioid medicines (HR = 1.29, 99% CI = 1.27-1.30). Similar associations were observed for anxiolytics, hypnotics and antipsychotics, but not lithium. CONCLUSIONS The dispensing of opioid medicines is higher among older individuals exposed to antidepressants, anxiolytics, hypnotics and antipsychotics than those who are not. These associations are not due to reverse causality or study design. Preventive strategies seeking to minimise the risk of inappropriate use of opioid medicines in later life should consider targeting this high-risk population.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Australia
| | - Frank M Sanfilippo
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
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Chen L, Ashton-James CE, Shi B, Radojčić MR, Anderson DB, Chen Y, Preen DB, Hopper JL, Li S, Bui M, Beckenkamp PR, Arden NK, Ferreira PH, Zhou H, Feng S, Ferreira ML. Variability in the prevalence of depression among adults with chronic pain: UK Biobank analysis through clinical prediction models. BMC Med 2024; 22:167. [PMID: 38637815 PMCID: PMC11027372 DOI: 10.1186/s12916-024-03388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The prevalence of depression among people with chronic pain remains unclear due to the heterogeneity of study samples and definitions of depression. We aimed to identify sources of variation in the prevalence of depression among people with chronic pain and generate clinical prediction models to estimate the probability of depression among individuals with chronic pain. METHODS Participants were from the UK Biobank. The primary outcome was a "lifetime" history of depression. The model's performance was evaluated using discrimination (optimism-corrected C statistic) and calibration (calibration plot). RESULTS Analyses included 24,405 patients with chronic pain (mean age 64.1 years). Among participants with chronic widespread pain, the prevalence of having a "lifetime" history of depression was 45.7% and varied (25.0-66.7%) depending on patient characteristics. The final clinical prediction model (optimism-corrected C statistic: 0.66; good calibration on the calibration plot) included age, BMI, smoking status, physical activity, socioeconomic status, gender, history of asthma, history of heart failure, and history of peripheral artery disease. Among participants with chronic regional pain, the prevalence of having a "lifetime" history of depression was 30.2% and varied (21.4-70.6%) depending on patient characteristics. The final clinical prediction model (optimism-corrected C statistic: 0.65; good calibration on the calibration plot) included age, gender, nature of pain, smoking status, regular opioid use, history of asthma, pain location that bothers you most, and BMI. CONCLUSIONS There was substantial variability in the prevalence of depression among patients with chronic pain. Clinically relevant factors were selected to develop prediction models. Clinicians can use these models to assess patients' treatment needs. These predictors are convenient to collect during daily practice, making it easy for busy clinicians to use them.
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Affiliation(s)
- Lingxiao Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Baoyi Shi
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA
| | - Maja R Radojčić
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Yujie Chen
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Paula R Beckenkamp
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Paulo H Ferreira
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hengxing Zhou
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China.
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China.
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Almutairi KB, Inderjeeth CA, Preen DB, Keen HI, Nossent JC. The temporal association between adverse drug reactions and antirheumatic drugs utilisation in Western Australia: a retrospective study from real-world data (1995-2015). Rheumatol Int 2024:10.1007/s00296-024-05588-3. [PMID: 38615313 DOI: 10.1007/s00296-024-05588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND/OBJECTIVES Adverse drug reactions (ADRs) can result in morbidity, mortality, and higher healthcare costs. Given the limited information available on ADRs associated with antirheumatic medications, this study aims to analyse and compare ADR reporting for these drugs in the pharmacovigilance datasets of Western Australia (WA) and the United States (US). METHODS Therapeutic Goods Administration provided WA pharmacovigilance data of selected antirheumatic drugs to from 1995 to 2015. The proportional reporting ratio (PRR) for WA case reports was compared to corresponding USA pharmacovigilance data by assessing the disproportionality of each ADR. clinically significant or true ADRs were determined using the Evans 2001 criteria (n > 2, chi-square > 4, PRR > 2). RESULTS A total of 232 reports were found in WA, mostly on sixty-nine women aged 45 to 69. Methotrexate, leflunomide, azathioprine, sulfasalazine, and infliximab had the highest reported ADRs, related to gastrointestinal disorders. Patients who used biological agents in WA had 2.7 times the likelihood of reporting true ADRs compared to conventional antirheumatic drugs. The ADR rates in the two datasets were comparable over the study period. CONCLUSIONS The PRR values of ADRs were consistent between WA and US databases. Methotrexate and infliximab use were commonly associated with ADR reports in WA females, with incidence rates comparable to the US; while patients using biological agents were more likely to report true ADRs than those on conventional antirheumatic drugs in WA.
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Affiliation(s)
- Khalid B Almutairi
- School of Medicine, The University of Western Australia, Perth, Australia.
- King Fahd Specialist Hospital, Burydah, Saudi Arabia.
| | - Charles A Inderjeeth
- School of Medicine, The University of Western Australia, Perth, Australia
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Perth, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Johannes C Nossent
- School of Medicine, The University of Western Australia, Perth, Australia
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
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Ho C, Ha NT, Youens D, Abhayaratna WP, Bulsara MK, Hughes JD, Mishra G, Pearson SA, Preen DB, Reid CM, Ruiter R, Saunders CM, Stricker BH, van Rooij FJA, Wright C, Moorin R. Association between long-term use of calcium channel blockers (CCB) and the risk of breast cancer: a retrospective longitudinal observational study protocol. BMJ Open 2024; 14:e080982. [PMID: 38458796 DOI: 10.1136/bmjopen-2023-080982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Calcium channel blockers (CCB), a commonly prescribed antihypertensive (AHT) medicine, may be associated with increased risk of breast cancer. The proposed study aims to examine whether long-term CCB use is associated with the development of breast cancer and to characterise the dose-response nature of any identified association, to inform future hypertension management. METHODS AND ANALYSIS The study will use data from 2 of Australia's largest cohort studies; the Australian Longitudinal Study on Women's Health, and the 45 and Up Study, combined with the Rotterdam Study. Eligible women will be those with diagnosed hypertension, no history of breast cancer and no prior CCB use at start of follow-up (2004-2009). Cumulative dose-duration exposure to CCB and other AHT medicines will be captured at the earliest date of: the outcome (a diagnosis of invasive breast cancer); a competing risk event (eg, bilateral mastectomy without a diagnosis of breast cancer, death prior to any diagnosis of breast cancer) or end of follow-up (censoring event). Fine and Gray competing risks regression will be used to assess the association between CCB use and development of breast cancer using a generalised propensity score to adjust for baseline covariates. Time-varying covariates related to interaction with health services will also be included in the model. Data will be harmonised across cohorts to achieve identical protocols and a two-step random effects individual patient-level meta-analysis will be used. ETHICS AND DISSEMINATION Ethical approval was obtained from the following Human research Ethics Committees: Curtin University (ref No. HRE2022-0335), NSW Population and Health Services Research Ethics Committee (2022/ETH01392/2022.31), ACT Research Ethics and Governance Office approval under National Mutual Acceptance for multijurisdictional data linkage research (2022.STE.00208). Results of the proposed study will be published in high-impact journals and presented at key scientific meetings. TRIAL REGISTRATION NUMBER NCT05972785.
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Affiliation(s)
- Chau Ho
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ninh Thi Ha
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David Youens
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Walter P Abhayaratna
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Max K Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jeffery David Hughes
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- PainChek, Sydney, New South Wales, Australia
| | - Gita Mishra
- School of Public Health, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Sallie-Anne Pearson
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The NHMRC Medicines Intelligence Centre of Research Excellence, Sydney, New South Wales, Australia
| | - David B Preen
- The NHMRC Medicines Intelligence Centre of Research Excellence, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher M Reid
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Christobel M Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Cameron Wright
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rachael Moorin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
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Russell DJ, Wyrwoll CS, Preen DB, Kelty E. Investigating maternal and neonatal health outcomes associated with continuing or ceasing dexamphetamine treatment for women with attention-deficit hyperactivity disorder during pregnancy: a retrospective cohort study. Arch Womens Ment Health 2024:10.1007/s00737-024-01450-4. [PMID: 38424254 DOI: 10.1007/s00737-024-01450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Attention-deficit hyperactivity disorder (ADHD) is becoming more commonly diagnosed in women, consequently, more women of reproductive age are taking ADHD medication, such as dexamphetamine. However, the safety associated with continuing or ceasing dexamphetamine during pregnancy is unclear. This study investigates outcomes associated with the continuation of dexamphetamine during pregnancy compared to those who ceased or were unexposed. METHODS A population-based retrospective cohort of women from Western Australia who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018. Women had either continued to take dexamphetamine throughout pregnancy (continuers, n = 547) or ceased dexamphetamine before the end of the second trimester (ceasers, n = 297). Additionally, a matched (1:1) comparison group of women who were dispensed an ADHD medication prior to pregnancy but not during pregnancy (unexposed) was included in the study (n = 844). Multivariable generalised linear models were used to compare maternal and neonatal health outcomes. RESULTS Compared to continuers, ceasers had greater odds of threatened abortion (OR: 2.28; 95%CI: 1.00, 5.15; p = 0.049). The unexposed had some benefits compared to the continuers, which included lower risk of preeclampsia (OR: 0.58; 95%CI: 0.35, 0.97; p = 0.037), hypertension (OR: 0.32; 95%CI: 0.11, 0.93; p = 0.036), postpartum haemorrhage (OR: 0.57; 95%CI: 0.41, 0.80; p = 0.001), neonatal special care unit admittance (OR: 0.16; 95%CI: 0.12, 0.20; p < 0.001) and fetal distress (OR: 0.73; 95%CI: 0.54, 0.99; p = 0.042). CONCLUSION Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing. Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine. However, this is something that requires further investigation due to the small sample size, difficulties examining timing, and the inability to examine spontaneous abortions. The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.
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Affiliation(s)
- Danielle J Russell
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia.
| | - Caitlin S Wyrwoll
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Erin Kelty
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
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Feng YR, Ward S, Lopez D, Minto C, Blane S, Preen DB. Evaluation of the awareness of Western Australian SunSmart campaigns between 2008 and 2022. Health Promot J Austr 2024. [PMID: 38402863 DOI: 10.1002/hpja.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
ISSUE ADDRESSED It is unknown whether SunSmart health promotion campaigns in Western Australia are still effectively reaching their target audience of young people (under 45 years). This study examined trends over time in awareness, relevancy and believability of SunSmart advertisements and identified socio-demographic characteristics and risk factors associated with campaign awareness. METHOD Linear regression and log-binomial modelling were undertaken using data from the annual SunSmart post-campaign evaluation surveys between 2008/2009 and 2021/2022. SunSmart campaigns were analysed and categorised into the following themes: (1) personal real-life stories; (2) daily activities/sun exposure leads to skin cancer; or (3) cartoon/animated. RESULTS Between 2008 and 2022, there were declines in total awareness (74.2% to 20.4%), unprompted awareness (33.7% to 4.9%) and relevancy (89.5% to 54.8%) of SunSmart advertisements (representing annual percent decreases of 3.6%, 3.1% and 1.8%, respectively). However, believability remained high over time (>94% in each annual survey). Trends were inconsistent between the awareness of campaign themes and socio-demographic characteristics and risk factors. Several campaigns had greater awareness in their subsequent years, compared with the first campaign year. CONCLUSION In more recent years, SunSmart advertisements and campaigns may not have reached their target audience. In addition to socio-demographic characteristics, particularly age, advertisement factors may also affect the awareness of specific campaigns. SO WHAT?: Given the changing advertising landscape and its rising costs, ongoing funding is pertinent to increase the reach of future SunSmart campaigns. Increasing advertisements on alternative platforms and designing campaigns which separately target adolescents and adults need to be considered.
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Affiliation(s)
- Ying Ru Feng
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Ward
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Carolyn Minto
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Sally Blane
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Abdalla T, Preen DB, Pole JD, Walwyn T, Bulsara M, Ives A, Choong CS, Ohan JL. Psychiatric disorders in childhood cancer survivors: A retrospective matched cohort study of inpatient hospitalisations and community-based mental health services utilisation in Western Australia. Aust N Z J Psychiatry 2024:48674241233871. [PMID: 38404162 DOI: 10.1177/00048674241233871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We examined the impact of long-term mental health outcomes on healthcare services utilisation among childhood cancer survivors in Western Australia using linked hospitalisations and community-based mental healthcare records from 1987 to 2019. METHOD The study cohort included 2977 childhood cancer survivors diagnosed with cancer at age < 18 years in Western Australia from 1982 to 2014 and a matched non-cancer control group of 24,994 individuals. Adjusted hazard ratios of recurrent events were estimated using the Andersen-Gill model. The cumulative burden of events over time was assessed using the method of mean cumulative count. The annual percentage change in events was estimated using the negative binomial regression model. RESULTS The results showed higher community-based service contacts (rate/100 person-years: 30.2, 95% confidence interval = [29.7-30.7] vs 22.8, 95% confidence interval = [22.6-22.9]) and hospitalisations (rate/1000 person-years: 14.8, 95% confidence interval = [13.6-16.0] vs 12.7, 95% confidence interval = [12.3-13.1]) in childhood cancer survivors compared to the control group. Childhood cancer survivors had a significantly higher risk of any event (adjusted hazard ratio = 1.5, 95% confidence interval = [1.1-2.0]). The cumulative burden of events increased with time since diagnosis and across age groups. The annual percentage change for hospitalisations and service contacts significantly increased over time (p < 0.05). Substance abuse was the leading cause of hospitalisations, while mood/affective and anxiety disorders were common causes of service contacts. Risk factors associated with increased service events included cancer diagnosis at age < 5 years, leukaemia diagnosis, high socioeconomic deprivation, and an attained age of < 18 years. CONCLUSIONS The elevated utilisation of healthcare services observed among childhood cancer survivors emphasises the need for periodic assessment of psychiatric disorders, particularly in high-risk survivors, to facilitate early management and optimise healthcare resources.
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Affiliation(s)
- Tasnim Abdalla
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Jason D Pole
- Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Thomas Walwyn
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Max Bulsara
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Angela Ives
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Catherine S Choong
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
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Almeida OP, Etherton-Beer C, Sanfilippo F, Preen DB, Page A. Dispensing of antineoplastic medications and their impact on the dispensing of anti-dementia drugs for adults aged ≥60 years: A cohort study. Maturitas 2024; 180:107888. [PMID: 38006816 DOI: 10.1016/j.maturitas.2023.107888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/25/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
History of cancer has been associated with decreased risk of dementia, but it is unclear if this is due to the use of antineoplastic medications. Participants were 442,795 adults aged ≥60 years, of whom 235,841 (53.26 %) were women. Those dispensed antineoplastic medications during 2012-2013 had lower odds of being dispensed an anti-dementia drug between 2015 and 2021 (age/sex-adjusted OR = 0.60, 95%CI = 0.55-0.66). The dispensing of antineoplastic medications was associated with an adjusted hazard ratio of 0.72 (95%CI = 0.65-0.80) of subsequent dispensing of an anti-dementia drug. Understanding the mechanisms that support this association may contribute to the introduction of novel approaches to dementia prevention.
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Affiliation(s)
| | | | - Frank Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Australia
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Almeida OP, Page A, Sanfilippo FM, Preen DB, Etherton-Beer C. Research Letter: Effect of antivirals for COVID-19 on the mortality of older adults dispensed treatment with lithium, antipsychotics, antidepressants, anxiolytics and hypnotics. Aust N Z J Psychiatry 2024; 58:183-186. [PMID: 38084609 PMCID: PMC10838474 DOI: 10.1177/00048674231217700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Osvaldo P Almeida
- Medical School, WA Centre for Health & Ageing (M577), University of Western Australia, Perth, WA, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Christopher Etherton-Beer
- Medical School, WA Centre for Health & Ageing (M577), University of Western Australia, Perth, WA, Australia
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Cumming C, Kinner SA, McKetin R, Young JT, Li I, Preen DB. Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study. Addiction 2024; 119:236-247. [PMID: 37855049 PMCID: PMC10952305 DOI: 10.1111/add.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. DESIGN A prospective cohort study. SETTING Prisons in Queensland and Western Australia. PARTICIPANTS Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. MEASUREMENTS Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. FINDINGS During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). CONCLUSIONS Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- Griffith Criminology InstituteGriffith UniversityMt GravattAustralia
- School of Population HealthCurtin UniversityPerthAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Jesse T. Young
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthTorontoCanada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
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Arena G, Kitsos A, Hamdorf JM, D’Arcy‐Evans M, Kilpatrick M, Venn A, Preen DB. Evaluation of prescription medication changes following sleeve gastrectomy surgery. Obes Sci Pract 2024; 10:e742. [PMID: 38352066 PMCID: PMC10863745 DOI: 10.1002/osp4.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Objective The increasing global prevalence of obesity, coupled with its association with chronic health conditions and rising healthcare costs, highlights the need for effective interventions; however, despite the availability of treatment options, the ongoing success of primary interventions in maintaining long-term weight loss remains limited. This study examined the prescription medication dispensing changes following sleeve gastrectomy in Australians aged 45 years and over. Methods In a retrospective analysis of 847 bariatric surgery patients from the New South Wales 45 and Up Study, the assessment of medication patterns categorizing into three groups: gastrointestinal, metabolic, cardiorespiratory, musculoskeletal, and nervous systems was conducted. Each drug class was analyzed, focusing on patients with dispensing records within the 12 months before surgery. This study employed interrupted time-series analysis to compare pre- and post-surgery medication usage. Results With a predominantly female population (76.9%) and an average age of 57.2 (standard deviation 5.71), there were statistically significant reductions in both unique medications (12.5% decrease, p = 0.004) and total medications dispensed (15.9% decrease, p = 0.003) from 12 months before surgery to 13-24 months after bariatric surgery. All medication categories, except opioids, showed reductions. Notably, the most significant reductions were observed in diabetes (38.6%), agents acting on the renin-angiotensin system (40.4%), lipid modifying agents (26.5%), anti-inflammatory products (46.3%), and obstructive airway diseases (53.3%) medications during this time frame. Conclusion These findings suggest that sleeve gastrectomy provides an effective therapeutic intervention for patients with comorbidities requiring multiple medications, especially for obesity-related diseases such as diabetes, cardiovascular, respiratory and musculoskeletal disorders.
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Affiliation(s)
- Gina Arena
- School of Population and Global HealthThe University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Alex Kitsos
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Jeffrey M. Hamdorf
- Medical SchoolThe University of Western AustraliaNedlandsWestern AustraliaAustralia
- Western Surgical HealthNedlandsWestern AustraliaAustralia
| | | | - Michelle Kilpatrick
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Alison Venn
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - David B. Preen
- School of Population and Global HealthThe University of Western AustraliaNedlandsWestern AustraliaAustralia
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Nossent JC, Keen HI, Preen DB, Inderjeeth CA. Population-wide long-term study of incidence, renal failure, and mortality rates for lupus nephritis. Int J Rheum Dis 2024; 27:e15079. [PMID: 38396352 DOI: 10.1111/1756-185x.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Given limited regional data, we investigate the state-wide epidemiology, renal and patient outcomes for lupus nephritis (LN) in Western Australia (WA). METHODS Patients hospitalized with incident SLE (≥2 diagnostic codes in the state-wide WA Health Hospital Morbidity Data Collection) in the period 1985-2015 were included (n = 1480). LN was defined by the presence of glomerulonephritis and/or raised serum creatinine. Trends over three study decades for annual incidence rate (AIR)/100.000 population, mortality (MR), and end-stage renal disease (ESRD) rates/100 person years were analyzed by least square regression and compared with a matched control group (n = 12 840). RESULTS Clinical evidence of LN developed in 366 SLE patients (25.9%) after a median disease duration of 10 months (IQR 0-101) with renal biopsy performed in 308 (84.2%). The AIR for LN (0.63/100.000) did not change significantly over time (R2 = .11, p = .85), while point prevalence reached 11.9/100.000 in 2015. ESRD developed in 14.1% (n = 54) of LN patients vs. 0.2% in non-LN SLE patients and 0.05% in controls (all p ≤ 0.01). ESRD rates increased over time in LN patients (0.4 to 0.7, R2 = .52, p = .26). The odds ratio for death was 8.81 (CI 3.78-22.9) for LN and 6.62 (CI 2.76-17.9) for non-LN SLE patients compared to controls and MR for LN patients increased over time (1.3 to 2.2, R2 = .84, p = .26). CONCLUSIONS The incidence rate of LN in WA remained unchanged over 30 years. A lack of improvement in renal failure and mortality rates illustrates the pressing need for better long-term treatment options and/or strategies in LN.
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Affiliation(s)
- Johannes C Nossent
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Rheumatology Group, School of Medicine, University Western Australia, Crawley, Western Australia, Australia
| | - Helen I Keen
- Rheumatology Group, School of Medicine, University Western Australia, Crawley, Western Australia, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University Western Australia, Crawley, Western Australia, Australia
| | - Charles A Inderjeeth
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Rheumatology Group, School of Medicine, University Western Australia, Crawley, Western Australia, Australia
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Nossent J, Keen H, Preen DB, Inderjeeth CA. The spectrum of idiopathic inflammatory myopathies in Western Australia: epidemiological characteristics and mortality over time. Rheumatol Int 2024; 44:329-337. [PMID: 37819456 PMCID: PMC10796655 DOI: 10.1007/s00296-023-05475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
To determine long term overall and subgroup specific incidence rates and associated mortality for idiopathic inflammatory myopathies (IIM) in a population wide study. We included patients hospitalised between 1980 and 2015 with incident IIM as defined by relevant diagnostic codes for dermatomyositis (DM) polymyositis (PM), inclusion body myositis (IBM), other IIM and overlap myositis (OM) in the Western Australia Health Hospital Morbidity Data Collection (n = 846). Trends over time for annual incidence rate per million population (AIR) were analysed by least square regression and Kaplan-Meier survival and mortality rates (MR)/100 person years compared with a matched control group (n = 3681). The averaged AIR for all IIM was 19 (CI 10.4-27.5) and stable over time with point prevalence reaching 205.3 (CI 185.6-226.6) per million in 2015. Over time, the AIR for DM 5.0 (CI 0.6-9.4) and IBM 3.3 (CI 0.7-9.6) was stable, while AIR decreased for PM (p < 0.01) and increased for other IIM (p < 0.01) and OM (p < 0.01). IBM patients were eldest at diagnosis (68 years, CI 59-77) with male preponderance in IBM (53.4%) and other IIM (55.8%) groups. Crude mortality (54.5 vs 41.3%), MR ratio (6.65 vs 5.91) and 5 (65.8% vs 71.6%) and 10-year (52.5% vs 58.7%) survival were all worse for IIM patients (all p < 0.05). IBM patients had highest MR (10.1; CI 8.38-12.14) and lowest 10-year survival (39.2%). While cardiovascular disease and cancer were predominant causes of death, they were proportionally lower in IIM patients, where respiratory and rheumatic disease were more frequent causes of death. While the overall incidence of IIM in WA was stable over 35 years, the spectrum of IIM has changed significantly with increases especially in other IIM and OM. The overall prognosis with IIM remains guarded with 10-year survival just over 50%.
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Affiliation(s)
- Johannes Nossent
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
| | - Helen Keen
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University Western Australia, Perth, Australia
| | - Charles A Inderjeeth
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
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Arena G, Cumming C, Lizama N, Mace H, Preen DB. Hospital length of stay and readmission after elective surgery: a comparison of current and former smokers with non-smokers. BMC Health Serv Res 2024; 24:85. [PMID: 38233897 PMCID: PMC10792937 DOI: 10.1186/s12913-024-10566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate differences between non-smokers, ex-smokers and current smokers in hospital length of stay (LOS), readmission (seven and 28 days) and cost of readmission for patients admitted for elective surgery. METHODS A retrospective cohort study of administrative inpatient data from 24, 818 patients admitted to seven metropolitan hospitals in Western Australia between 1 July 2016 and 30 June 2019 for multiday elective surgery was conducted. Data included smoking status, LOS, procedure type, age, sex and Indigenous status. LOS for smoking status was compared using multivariable negative binomial regression. Odds of readmission were compared for non-smokers and both ex-smokers and current smokers using separate multivariable logistic regression models. RESULTS Mean LOS for non-smokers (4.7 days, SD=5.7) was significantly lower than both ex-smokers (6.2 days SD 7.9) and current smokers (6.1 days, SD=8.2). Compared to non-smokers, current smokers and ex-smokers had significantly higher odds of readmission within seven (OR=1.29; 95% CI: 1.13, 1.47, and OR=1.37; 95% CI: 1.19, 1.59, respectively) and 28 days (OR=1.35; 95% CI: 1.23, 1.49, and OR=1.53; 95% CI: 1.39, 1.69, respectively) of discharge. The cost of readmission for seven and 28-day readmission was significantly higher for current smokers compared to non-smokers (RR=1.52; 95% CI: 1.1.6, 2.0; RR=1.39; 95% CI: 1.18, 1.65, respectively). CONCLUSION Among patients admitted for elective surgery, hospital LOS, readmission risk and readmission costs were all higher for smokers compared with non-smokers. The findings indicate that provision of smoking cessation treatment for adults undergoing elective surgery is likely to produce multiple benefits.
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Affiliation(s)
- Gina Arena
- School of Population and Global Health M431, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Craig Cumming
- School of Population and Global Health M431, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Natalia Lizama
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
- Curtin University, Bentley, Western Australia, Australia
| | - Hamish Mace
- Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health M431, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
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Kelty E, Rae K, Jantzie LL, Wyrwoll CS, Preen DB. Prenatal Opioid Exposure and Immune-Related Conditions in Children. JAMA Netw Open 2024; 7:e2351933. [PMID: 38231512 PMCID: PMC10794935 DOI: 10.1001/jamanetworkopen.2023.51933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Prenatal opioid exposure (POE) may alter with fetal development of the immune system, which may influence long-term health and susceptibility to immune-related conditions. Objective To compare the risk of hospitalization and emergency department presentation for immune-related conditions in children with and without POE. Design, Setting, and Participants This retrospective, population-based cohort study used linked administrative health records of all children born in Western Australia between January 1, 2003, and December 31, 2018 (N = 401 462). Exposure Prenatal exposure to prescription opioids (overall and by trimester), neonatal abstinence syndrome diagnosis, and opioid indication (pain or opioid use disorder [OUD]). Main Outcomes and Measures The main outcome was hospital admissions and emergency department presentations during which a child was diagnosed with an immune-related condition, including infections, conditions associated with an overactive immune system (eg, asthma, eczema, and allergy and anaphylaxis), and autoimmune diseases diagnosed before age 5 years or June 30, 2020. Data were analyzed between August 30, 2022, and February 27, 2023. Results Neonates with POE (1656 [0.4%]; mean [SD] gestational age, 37.7 [2.1] weeks; 836 females [50.5%]; 820 males [49.5%]) were more likely to be born preterm, have low birth weight for gestational age, and be coexposed to cigarette smoke compared with nonexposed neonates. Perinatal opioid exposure was associated with an increased risk of perinatal infection (adjusted odds ratio [AOR], 1.62; 95% CI, 1.38-1.90) and eczema and dermatitis (AOR, 11.91; 95% CI, 9.84-14.41) compared with nonexposure. Neonatal abstinence syndrome was also associated with both conditions (AOR, 2.91 [95% CI, 2.36-3.57] and 31.11 [95% CI, 24.64-39.28], respectively). Prenatal opioid exposure was also associated with an increased risk of childhood asthma (adjusted hazard ratio [AHR], 1.44; 95% CI, 1.16-1.79), but not allergies and anaphylaxis. It was also associated with an increased risk of childhood eczema and dermatitis, but only in children with POE from opioids used to treat OUD (AHR, 1.47; 95% CI, 1.08-1.99) rather than pain. In contrast, POE from opioids used for pain was associated with an increased risk of infection (AHR, 1.44; 95% CI, 1.32-1.58), but POE to opioids used to treat OUD was not. Autoimmune conditions were rare and were not observed to be associated with POE. Conclusions and Relevance In this cohort study, POE was associated with an increased risk of infection, eczema and dermatitis, and asthma, but not allergies and anaphylaxis or autoimmune conditions. These findings highlight the importance of further study of opioid-induced immune changes during pregnancy, the potential impact on long-term health in exposed children, and the mechanisms of opioid-induced immune dysregulation.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kaitlyn Rae
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lauren L. Jantzie
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Caitlin S. Wyrwoll
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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Beasley AB, Preen DB, McLenachan S, Gray ES, Chen FK. Incidence and Mortality of Conjunctival Melanoma in Australia (1982 to 2014). Invest Ophthalmol Vis Sci 2023; 64:2. [PMID: 37910093 PMCID: PMC10627298 DOI: 10.1167/iovs.64.14.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose The purpose of this study was to estimate the incidence and mortality of conjunctival melanoma in Australia from 1982 to 2014. Methods De-identified unit data for all cases of ocular melanoma were extracted from the Australian Cancer Database from 1982 to 2014. Conjunctival melanoma cases were extracted, and the incidence and mortality were analyzed. Incidence rates were age-standardized against the 2001 Australian Standard Population. Mortality was assessed using log-rank and Cox regression. Results From 1982 to 2014, there were 299 cases of conjunctival melanoma. The age-standardized incidence rate was 0.48 (95% confidence interval [CI] = 0.41 to 0.54) per million per year. Women (0.52, 95% CI = 0.42 to 0.62) had a higher incidence than men (0.42, 95% CI = 0.33 to 0.51). The incidence of conjunctival melanoma increased in men (+1.46%) and significantly women (+1.41%, P = 0.023) over the study period. The mean 5-, 10-, and 15-year disease-specific survival were 90%, 82%, and 80%, respectively, during the 33-year interval. Comparisons of survival among age, sex, and state revealed no significant differences when tested using log-rank or Cox regression. Conclusions In conclusion, we found an increase in the rate of conjunctival melanoma diagnoses in Australia from 1982 to 2014. Over the same period, disease survival remained unchanged at a mean of 90%.
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Affiliation(s)
- Aaron B. Beasley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Elin S. Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Fred K. Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, Victoria, Australia
- Ocular Genetics, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Christensen D, Gibberd A, McNamara B, Eades S, Shepherd C, Preen DB, McAullay D, Strobel N. Hospital and emergency department discharge against medical advice in Western Australian Aboriginal children aged 0-4 years from 2002 to 2018: A cohort study. Paediatr Perinat Epidemiol 2023; 37:691-703. [PMID: 37983972 PMCID: PMC10946741 DOI: 10.1111/ppe.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia. OBJECTIVES Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30-day readmission/ re-presentation. METHODS We conducted a cohort study of Aboriginal children born in Western Australia (2002-2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed-effects logistic regression. RESULTS In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re-presenting to an ED within 30 days. CONCLUSIONS The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.
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Affiliation(s)
- Daniel Christensen
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Alison Gibberd
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Data Sciences, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Barwon South West Public Health Unit, Barwon Health, Geelong, Victoria, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carrington Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel McAullay
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Natalie Strobel
- Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families (ISAC), Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
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Orr C, Kelty E, O'Donnell M, Fisher CM, Glauert R, Preen DB. Reproductive and sexual health of Australian adolescents exposed to family and domestic violence. BMJ Sex Reprod Health 2023; 49:245-253. [PMID: 36889813 DOI: 10.1136/bmjsrh-2022-201684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a dearth of research investigating sexually transmitted infections (STIs) in children exposed to family and domestic violence (FDV). Further, there is no research on terminations of pregnancy in children exposed to FDV. METHODS This retrospective cohort study used linked administrative data from Western Australia to investigate whether exposure to FDV is associated with a risk of hospitalisations for STIs and terminations of pregnancy in adolescents. This study involved children born from 1987 to 2010 whose mother was a victim of FDV. Identification of family and domestic violence was from two sources: police and hospital records. This approach provided an exposed cohort of 16 356 and a non-exposed cohort of 41 996. Dependant variables were hospitalisations for pregnancy terminations and STIs in children aged from 13 up to 18 years of age. The primary explanatory variable was exposure to FDV. Multivariable Cox regression was used to investigate the association of FDV exposure and the outcomes. RESULTS Following adjustment for sociodemographic and clinical factors, children exposed to FDV had an increased risk of hospitalisations for STIs (HR 1.49, 95% CI 1.15 to 1.92) and terminations of pregnancy (HR 1.34, 95% CI 1.09 to 1.63) as an adolescent than non-exposed peers. CONCLUSION Children exposed to FDV are at an increased risk of hospitalisation for STI and termination of pregnancy as an adolescent. Effective interventions are needed to support children exposed to FDV.
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Affiliation(s)
- Carol Orr
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Colleen M Fisher
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rebecca Glauert
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Bell MF, Segal L, Dennison S, Kinner SA, Dawe S, Spittal MJ, Preen DB. Numeracy and literacy attainment of children exposed to maternal incarceration and other adversities: A linked data study. J Sch Psychol 2023; 100:101241. [PMID: 37689438 DOI: 10.1016/j.jsp.2023.101241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/20/2023] [Accepted: 07/27/2023] [Indexed: 09/11/2023]
Abstract
Parental incarceration has been associated with educational disadvantages for children, such as lower educational attainment, increased grade retention, and truancy and suspensions. However, children exposed to parental incarceration often experience other adversities that are also associated with educational disadvantage; the contribution of these co-occurring adversities has not been considered in previous research. This study aimed to investigate the educational outcomes of children exposed to (a) maternal incarceration alone and (b) maternal incarceration plus other adversities (i.e., maternal mental illness and/or child protective services [CPS] contact). We used linked administrative data for a sample of children whose mothers were incarcerated during the children's childhood (i.e., from the time of mother's pregnancy through the child's 18th birthday; n = 3828) and a comparison group of children whose mothers had not been incarcerated (n = 9570). Multivariate multinomial logistic regressions examined the association between exposure to the three adversities (i.e., maternal incarceration, maternal mental illness, and child CPS contact) and above or below average reading and numeracy attainment in Grades 3, 5, 7 and 9. At all grade levels, children exposed to maternal incarceration alone and those exposed to maternal incarceration plus other adversities had increased odds of below average numeracy and reading attainment and decreased odds of above average numeracy and reading attainment compared to children without any of the recorded exposures. Children exposed to maternal incarceration and CPS contact and those exposed to all three adversities had increased odds of below average reading and numeracy attainment compared to children exposed to maternal incarceration alone. The findings highlight the complex needs of children of incarcerated mothers that must be considered when designing and delivering educational support programs. These children would benefit from the implementation of multi-tiered, trauma-informed educational and clinical services.
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Affiliation(s)
- Megan F Bell
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia.
| | - Leonie Segal
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia.
| | - Susan Dennison
- School of Criminology and Criminal Justice, Griffith University, Mt Gravatt, Queensland, Australia; Griffith Criminology Institute, Griffith University, Mt Gravatt, Queensland, Australia.
| | - Stuart A Kinner
- Griffith Criminology Institute, Griffith University, Mt Gravatt, Queensland, Australia; Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, New South Wales, Australia; Mater Research Institute-UQ, University of Queensland, South Brisbane, Queensland, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Sharon Dawe
- School of Psychology, Griffith University, Mt Gravatt, Queensland, Australia.
| | - Matthew J Spittal
- Justice Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia.
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20
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Abdalla T, Walwyn T, White D, Choong CS, Bulsara M, Preen DB, Ohan JL. Hospitalizations and Cost of Inpatient Care for Physical Diseases in Survivors of Childhood Cancer in Western Australia: A Longitudinal Matched Cohort Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1249-1259. [PMID: 37409970 DOI: 10.1158/1055-9965.epi-22-1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The long-term effects of childhood cancer are unclear in the Australian context. We examined hospitalization trends for physical diseases and estimated the associated inpatient care costs in all 5-year childhood cancer survivors (CCS) diagnosed in Western Australia (WA) from 1982 to 2014. METHODS Hospitalization records for 2,938 CCS and 24,792 comparisons were extracted from 1987 to 2019 (median follow-up = 12 years, min = 1, max = 32). The adjusted hazard ratio (aHR) of hospitalization with 95% confidence intervals (CI) was estimated using the Andersen-Gill model for recurrent events. The cumulative burden of hospitalizations over time was assessed using the mean cumulative count method. The adjusted mean cost of hospitalization was estimated using the generalized linear models. RESULTS We identified a higher risk of hospitalization for all-cause (aHR, 2.0; 95% CI, 1.8-2.2) physical disease in CCS than comparisons, with the highest risk for subsequent malignant neoplasms (aHR, 15.0; 95% CI, 11.3-19.8) and blood diseases (aHR, 6.9; 95% CI, 2.6-18.2). Characteristics associated with higher hospitalization rates included female gender, diagnosis with bone tumors, cancer diagnosis age between 5 and 9 years, multiple childhood cancer diagnoses, multiple comorbidities, higher deprivation, increased remoteness, and Indigenous status. The difference in the mean total hospitalization costs for any disease was significantly higher in survivors than comparisons (publicly funded $11,483 United States Dollar, P < 0.05). CONCLUSIONS The CCS population faces a significantly higher risk of physical morbidity and higher cost of hospital-based care than the comparisons. IMPACT Our study highlights the need for long-term follow-up healthcare services to prevent disease progression and mitigate the burden of physical morbidity on CCS and hospital services.
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Affiliation(s)
- Tasnim Abdalla
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Thomas Walwyn
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Paediatric and Adolescent Oncology and Hematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Daniel White
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Catherine S Choong
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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21
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Almeida OP, Etherton-Beer C, Kelty E, Sanfilippo F, Preen DB, Page A. Lithium Dispensed for Adults Aged ≥ 50 Years Between 2012 and 2021: Analyses of a 10% Sample of the Australian Pharmaceutical Benefits Scheme. Am J Geriatr Psychiatry 2023; 31:716-725. [PMID: 37080815 DOI: 10.1016/j.jagp.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Lithium use seems to be declining in clinical practice. We examined the proportion of adults aged ≥ 50 years dispensed lithium between 2012 and 2021, and investigated the proportion of lithium users dispensed other medications. METHODS We used a 10% random sample data of the Australian Pharmaceutical Benefits Scheme from 2012 to 2021, and limited our analyses to adults aged ≥ 50 years. We retrieved data on lithium, other mood stabilisers, antipsychotics, antidepressants, anxiolytics and hypnotics, and medications for the treatment of other health systems. RESULTS We received 7081939 person-years records (53.2% women). The proportion of participants dispensed lithium decreased with age: 0.4% for those aged 50-59 years to < 0.1% for people aged ≥ 90 years. The dispensing of lithium increased over 10 years for those aged 50-69 and decreased in those older than 80 years. Among people dispensed lithium, nearly 1 in 5 were dispensed another mood stabiliser. Antipsychotics and antidepressants were dispensed to about 60% of participants dispensed lithium, with antidepressants dispensed more frequently to women than men. About 20% of people dispensed lithium were dispensed anxiolytics/hypnotics, more frequently for women than men. Medications to treat diseases of the alimentary, cardiovascular, endocrine and nervous systems were commonly dispensed to those dispensed lithium, as were antibiotics. CONCLUSIONS While the dispensing of lithium increased among young older adults since 2015 when guidelines for the management of mood disorders were published, our findings suggest that lithium may be under-utilised for the management of bipolar disorder in later life.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School (OPA, CE-B), University of Western Australia, Perth, Australia..
| | | | - Erin Kelty
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - Frank Sanfilippo
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - David B Preen
- School of Population and Global Health (EK, FS, DBP), University of Western Australia, Perth, Australia
| | - Amy Page
- School of Allied Health (AP), University of Western Australia, Perth, Australia
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22
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Feng YR, Valuri GM, Morgan VA, Preen DB, O’Leary CM, Crampin E, Waterreus A. Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review. Aust N Z J Psychiatry 2023; 57:1208-1222. [PMID: 37161341 PMCID: PMC10466987 DOI: 10.1177/00048674231172116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours. METHODS A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'. RESULTS Studies in young people (n = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies (n = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%. CONCLUSION This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
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Affiliation(s)
- YR Feng
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - GM Valuri
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - DB Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Colleen M O’Leary
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - E Crampin
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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23
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Orr C, Kelty E, Fisher C, O'Donnell M, Glauert R, Preen DB. The lasting impact of family and domestic violence on neonatal health outcomes. Birth 2023; 50:578-586. [PMID: 36190166 DOI: 10.1111/birt.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/14/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the health of neonates born to women who experienced family and domestic violence (FDV) 12 months prior to birth, with the health of neonates born to women with an earlier history of FDV and women with no history of FDV. METHODS A retrospective cohort of women who experienced FDV within 12 months of birth (antenatal FDV [AFDV]) (n = 1230) was identified using data from the Western Australia (WA) Police Force Incident Management System and WA Hospital Morbidity Data Collection. Two comparison cohorts were used, the first including women with a history of FDV (HFDV) 12-60 months prior to birth (n = 1549) and the second with no history of FDV (NFDV) recorded (n = 3690). Hospital, birth, mortality, and congenital anomaly data were used in generalized linear models to examine and compare neonatal health outcomes. RESULTS Women in the AFDV group had higher proportions of factors associated with poor neonatal outcomes including smoking (42.4%), substance use (23.0%), and mental health disorders (34.8%). Neonates born to AFDV mothers had significantly higher odds of congenital anomalies (OR: 1.51, 95% CI: 1.18-1.94), low birth weight (1.74, 1.45-2.10), and preterm birth (1.48, 1.22-1.79) compared with neonates born to NFDV mother. Neonatal health outcomes in those born to AFDV women were not significantly different from those born to HFDV women. CONCLUSIONS Antenatal and historical FDV were associated with poor neonatal health outcomes. Additional pregnancy and social support should be offered to women who have experienced FDV during or prior to pregnancy.
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Affiliation(s)
- Carol Orr
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Colleen Fisher
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- Australian Centre for Child Protection, The University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Glauert
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- The Raine Study, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Almutairi KB, Inderjeeth CA, Preen DB, Keen HI, Nossent JC. Mortality Trends Among Patients with Rheumatoid Arthritis in Western Australia. Rheumatol Ther 2023; 10:1021-1037. [PMID: 37335433 PMCID: PMC10326173 DOI: 10.1007/s40744-023-00562-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/10/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION With scarce comparative data on mortality in Australian patients with rheumatoid arthritis (RA), we investigated temporal changes in standardized mortality rates for patients with RA using longitudinal linked population-wide health data in Western Australia (WA) over the period 1980 to 2015. METHODS The study included 17,125 patients with a first-time hospital contact for RA (ICD-10-AM M05.00-M06.99 and ICD-9-AM 714.00-714.99) in the study period. Standardized mortality rate ratios (SMRRs) for the RA cohort versus the WA general population was estimated using direct age standardization. We analyzed temporal trends over with dates and causes provided by the WA Death Registry. RESULTS During 356,069 patient-years of follow-up, a total of 8955 (52%) deaths occurred in the RA cohort. The SMRR was 2.24 (95% CI 2.15-2.34) in males and 3.09 (95% CI 3.00-3.19) in females over the study period. SMRR decreased since 2000 to 1.59 (95% CI 1.39-1.81) for the period 2011-2015. Median survival was 26.80 years (95% CI 26.30-27.30), where age and comorbidity independently increased the risk of death. The leading causes of deaths were cardiovascular diseases (26.60%), cancer (16.80%), rheumatic diseases (5.80%), chronic pulmonary disease 491 (5.50%), dementia (3.00%), and diabetes 235 (2.6%). CONCLUSIONS The mortality rate in patients with RA in WA has decreased but remains 1.59-times higher than in community counterparts, suggesting that there is room for further improvement. Comorbidity is the main modifiable risk factor to further reduce mortality in patients with RA.
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Affiliation(s)
- Khalid B Almutairi
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia.
- Pharmacy Department, King Fahd Specialist Hospital, Burydah, Al Qassim, Saudi Arabia.
| | - Charles A Inderjeeth
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- Rheumatology Department, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Helen I Keen
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- Rheumatology Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Johannes C Nossent
- School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
- Rheumatology Department, Sir Charles Gairdner and Osborne Park Health Care Group, Perth, WA, Australia
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25
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Kelty E, Chitty K, Preen DB. Safety of Alprazolam Use in Pregnancy in Western Australia: A Retrospective Cohort Study Using Linked Health Data. J Psychoactive Drugs 2023:1-7. [PMID: 37504800 DOI: 10.1080/02791072.2023.2241465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
The use of alprazolam in pregnancy can adversely affect maternal and neonatal health. This study examined neonatal outcomes following exposure to alprazolam in pregnancy. Women prescribed alprazolam during pregnancy (n = 48) between 2014 and 2018 were identified from routinely-collected state administrative prescribing records and perinatal data. Two comparison groups of women; 1) prescribed alprazolam outside of pregnancy (n = 96) and 2) women never prescribed alprazolam (n = 96) were also identified. The health of women and their children was examined using administrative hospital, mortality and perinatal data and compared to the comparison groups using generalized linear models. Prenatal alprazolam exposure was not associated with a reduction in average birth weight or gestational age. However, neonates prenatally exposed to alprazolam were more likely be classified as having low birth weight for gestational age compared with alprazolam comparison group (OR: 4.46, 95% CI: 1.54-12.95) and the non-alprazolam comparison group (OR: 3.27, 95% CI: 1.22-8.79). There were no cases of perinatal mortality or floppy baby syndrome in alprazolam-exposed neonates. While the use of alprazolam during pregnancy was not associated with an increased risk of severe adverse neonatal outcomes (e.g. perinatal mortality), it was associated with neonates being born with a low birth weight for gestational age.
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Affiliation(s)
- Erin Kelty
- School of Population & Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kate Chitty
- School of Population & Global Health, The University of Western Australia, Crawley, Western Australia, Australia
- School of Medical Sciences, The University of Sydney, Camperdown, New South Wales, Australia
| | - David B Preen
- School of Population & Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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26
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Chitty KM, Buckley NA, Lim J, Ali Z, Schumann JL, Cairns R, Daniels B, Pearson SA, Preen DB, Schaffer AL. Psychotropic and other medicine use at time of death by suicide: a population-level analysis of linked dispensing and forensic toxicology data. Med J Aust 2023; 219:63-69. [PMID: 37230472 PMCID: PMC10952140 DOI: 10.5694/mja2.51985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine the numbers and types of medicines dispensed around the time of death to people who die by suicide; to compare the medicines recently dispensed and those recorded in post mortem toxicology reports. DESIGN, SETTING, PARTICIPANTS Analysis of linked National Coronial Information System (NCIS) and Pharmaceutical Benefits Scheme (PBS) data from the Australian Suicide Prevention using Health Linked Data (ASHLi) study, a population-based case series study of closed coronial cases for deaths of people in Australia aged ten years or more during 1 July 2013 - 10 October 2019 deemed by coroners to be the result of intentional self-harm. MAIN OUTCOME MEASURES Proportions of people to whom medicines were dispensed around the time of death, by medicine group, class, and specific medicine; comparison of medicines recently dispensed and those detected by post mortem toxicology. RESULTS Toxicology reports were available for 13 541 of 14 206 people who died by suicide (95.3%; 10 246 men, 75.7%); poisoning with medicines contributed to 1163 deaths (8.6%). At least one PBS-subsidised medicine had been dispensed around the time of death to 7998 people (59.1%). For three medicine classes, the proportions of people in whom the medicines were detected post mortem and their death was deemed medicine-related were larger for those without records of recent dispensing than for people for whom they had been dispensed around the time of death: antidepressants (17.7% v 12.0%), anxiolytics (16.3% v 14.8%), and sedatives/hypnotics (24.3% v 16.5%). At least one recently dispensed medicine not detected post mortem was identified for 6208 people (45.8%). CONCLUSIONS A considerable proportion of people who died by suicide were not taking psychotropic medicines recently dispensed to them, suggesting non-adherence to pharmacotherapy, and a smaller than expected proportion were using antidepressants. Conversely, medicines that had not recently been dispensed were detected post mortem in many people for whom poisoning with medicines was a contributing factor, suggesting medicine stockpiling.
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Affiliation(s)
- Kate M Chitty
- The University of SydneySydneyNSW
- The University of Western AustraliaPerthWA
| | - Nicholas A Buckley
- The University of SydneySydneyNSW
- Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| | | | - Zein Ali
- The University of SydneySydneyNSW
| | - Jennifer L Schumann
- Victorian Institute of Forensic MedicineMonash UniversityMelbourneVIC
- Monash Addiction Research CentreMonash UniversityMelbourneVIC
- Monash UniversityMelbourneVIC
| | - Rose Cairns
- The University of SydneySydneyNSW
- Poisons Information CentreChildren's Hospital at WestmeadSydneyNSW
| | | | | | | | - Andrea L Schaffer
- The Bennett Institute of Applied Data ScienceUniversity of OxfordOxfordUnited Kingdom
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27
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Kelty E, Havard A, Preen DB. Trends in smoking during pregnancy stratified by the use of opioid agonist therapy and the contribution of smoking to poor outcome in neonates prenatally exposed to opioid agonist treatment. Arch Womens Ment Health 2023:10.1007/s00737-023-01342-z. [PMID: 37368055 DOI: 10.1007/s00737-023-01342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
High rates of cigarette smoking have been observed in pregnant women on opioid agonist therapy (OAT). However, it is unclear if these rates have changed overtime in line with the general population and the degree to which smoking contributes to poor outcomes in neonates born to women on OAT. Women who gave birth in Western Australia (WA) between 2003 and 2018 were identified from whole-population midwives records. Linked records were used to identify women who had been dispensed OAT during pregnancy and those who had smoking during pregnancy. Temporal changes in smoking during pregnancy were examined for women on OAT (n = 1059) and women not on OAT (n = 397,175) using Joinpoint regression. In women treated with OAT during pregnancy, neonatal outcomes were compared between smoking and non-smoking women using generalised linear models. During the study period, 76.3% of women on OAT smoked during pregnancy compared with 12.0% of the general population. There was a decrease in the prevalence of smoking during pregnancy among women not on OAT (APC: - 5.7, 95%CI: - 6.3, - 5.2), but not in women on OAT (APC: 0.8, 95%CI: - 0.4, 2.1). For women receiving OAT, smoking was associated with an increased odds of low birth weight (OR: 1.57, 95%CI: 1.06, 2.32) and neonatal abstinence syndrome (OR: 1.34, 95%CI: 1.01, 1.78) compared with non-smoking. Despite reductions in the prevalence of smoking during pregnancy in the general population, similar reductions have not occurred in pregnant women on OAT. The high prevalence of smoking in pregnant women on OAT is contributing to poor neonatal outcomes.
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Affiliation(s)
- Erin Kelty
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Nedlands, Western Australia, Australia.
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - David B Preen
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Nedlands, Western Australia, Australia
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Cumming C, Kinner SA, McKetin R, Young JT, Li I, Preen DB. The predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for moderate- to high-risk cannabis, methamphetamine and opioid use after release from prison. Addiction 2023; 118:1107-1115. [PMID: 36680769 PMCID: PMC10952147 DOI: 10.1111/add.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Illicit substance use is common among people entering prisons, as is returning to substance use after release from prison. We aimed to assess the predictive validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for returning to substance use after release from prison. DESIGN A longitudinal design with baseline survey conducted between 2008 and 2010 in the 6 weeks before expected prison release and up to three follow-up surveys in the 6 months after release. SETTING Prisons in Queensland, Australia. PARTICIPANTS A total of 1054 adults within 6 weeks of expected release from prison. MEASUREMENTS The ASSIST was used to assess problematic use of cannabis, methamphetamine, heroin and other non-prescribed opioids in the 3 months before incarceration. Post-incarceration substance use was measured at 1, 3 and 6 months after release. We calculated the area under the receiver operating characteristic curve (AUROC) and the optimal ASSIST cut-off score for each substance, using Youden's index (J). FINDINGS Forty-one per cent (n = 434) of the cohort reported any substance use during follow-up: 33% (n = 344) used cannabis, 20% (n = 209) methamphetamine, 10% (n = 109) heroin and 9% (n = 97) illicit other opioids. The optimal ASSIST cut-off score was ≥ 4 for heroin, methamphetamine and cannabis and ≥ 1 for other opioids. Using these cut-offs, the AUROC was highest for heroin in predicting both any use (AUROC = 0.82) and weekly use (AUROC = 0.88) in the past 4 weeks. AUROCs for other drugs ranged from 0.73 to 0.79. CONCLUSIONS The ASSIST shows promise as an accurate and potentially scalable tool that may be useful for predicting a return to substance use after release from prison and could inform service delivery. The substantial rates of returning to substance use after release from prison suggest that prison serves to interrupt rather than cease substance use.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyWAAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children’s Research InstituteParkvilleVICAustralia
- Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVICAustralia
- Griffith Criminology InstituteGriffith UniversityMt GravattQLDAustralia
- School of Population HealthCurtin UniversityPerthWAAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Jesse T. Young
- Centre for Health Equity, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVICAustralia
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleVICAustralia
- National Drug Research InstituteCurtin UniversityPerthWAAustralia
- School of Population and Global HealthUniversity of Western AustraliaCrawleyWAAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaCrawleyWAAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyWAAustralia
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Lopez D, Dwivedi G, Nossent J, Preen DB, Murray K, Raymond W, Inderjeeth C, Keen HI. Risk of Major Adverse Cardiovascular Event Following Incident Hospitalization for Acute Gout: A Western Australian Population-Level Linked Data Study. ACR Open Rheumatol 2023. [PMID: 37170735 DOI: 10.1002/acr2.11540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death in people with gout. Acute inflammation, which is a characteristic of gout, may have a mechanistic role in major adverse cardiovascular events (MACEs). We aimed to examine the relationship between admissions to a hospital with acute gout and MACEs in a large population-based data set. METHODS We extracted data from the Hospital Morbidity Data Collection and Death Registrations of the Western Australian Rheumatic Disease Epidemiology Registry. We identified patients admitted to hospital with incident acute gout and who had admissions or a death record because of MACEs. We compared the risk of MACEs during the postdischarge period (1-30 days after acute gout admission) and control period (365 days prior to admission and 365 days after the postdischarge period) using a self-controlled case-series (SCCS) design, which is a within-person design that controls for time-invariant patient-specific confounding. We performed conditional fixed-effects Poisson regression to obtain rate ratios (RRs). RESULTS We identified 941 patients (average age: 76.4 years; SD: 12.6; 66.7% male) with an incident acute gout admission and documented MACEs during the control and/or postdischarge periods. Of the 941 patients, 898 (95%) experienced MACEs during the combined control period (730-day period) and 112 (12%) during the postdischarge period (30-day period). The rates of MACEs during the total control and postdischarge periods were 0.84 and 1.45 events per person-year, respectively. Regression analysis confirmed increased rate during the postdischarge period (RR: 1.67; 95% CI: 1.38-2.03) compared with the control period. Sensitivity analyses indicated that our results were robust in relation to known limitations of the SCCS design. CONCLUSION We report an increased risk of MACEs in the first 30 days after an incident hospital admission with acute gout, suggesting a temporal association between acute inflammation and subsequent MACEs in patients with gout.
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Affiliation(s)
- Derrick Lopez
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Girish Dwivedi
- The University of Western Australia, Crawley, Fiona Stanley Hospital, Murdoch, and Harry Perkins Institute of Medical Research, Western Australia, Australia
| | - Johannes Nossent
- The University of Western Australia, Crawley, and Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David B Preen
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Murray
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Warren Raymond
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Charles Inderjeeth
- The University of Western Australia, Crawley, and Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Helen I Keen
- The University of Western Australia, Crawley, and Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Cumming C, Bell MF, Segal L, Spittal MJ, Kinner SA, Dennison S, Dawe S, Preen DB. Maternal incarceration increases the risk of self-harm but not suicide: a matched cohort study. Epidemiol Psychiatr Sci 2023; 32:e33. [PMID: 37161898 DOI: 10.1017/s2045796023000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
AIMS Children of incarcerated mothers are at increased risk of experiencing multiple adversity such as poverty, mental illness and contact with child protection services (CPS), including being taken into out of home care (OOHC). However, little is known about whether these children are at increased risk of suicide or self-harm compared to children not exposed to maternal incarceration or about the factors that may contribute to this. We aimed to investigate differences in the risk of suicide and self-harm between children exposed to maternal incarceration and those not exposed and examine how socio-demographic factors, maternal mental illness and CPS contact (with or without OOHC) may affect these outcomes. METHODS We used a retrospective matched cohort study design, comparing 7674 children exposed to maternal incarceration with 7674 non-exposed children. We used multivariable Cox proportional hazards regression to compare the risk of suicide and self-harm between exposed and non-exposed groups, controlling for geographical remoteness, CPS contact and maternal mental illness. RESULTS There was no significant difference in the rate of suicide (rate ratio [RR] = 1.49; 95% confidence interval [CI]: 0.78, 2.87) or risk of suicide (adjusted hazard ratio [aHR] = 0.92; 95% CI: 0.43, 1.96) between the two groups. However, the exposed group had a significantly higher rate of self-harm (RR = 2.83; 95% CI: 2.50, 3.21) and a significantly higher risk of self-harm (aHR = 1.74; 95% CI: 1.45, 2.09) compared to those non-exposed. CPS contact with or without OOHC was independently associated with an increased risk of self-harm for both groups. CONCLUSION Children exposed to maternal incarceration are at an increased risk of self-harm and should be prioritized to receive targeted, multimodal support that continues after the mother's release from prison. The association between CPS contact and self-harm warrants further research.
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Affiliation(s)
- Craig Cumming
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Megan F Bell
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
- Justice Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Susan Dennison
- Griffith Criminology Institute, Griffith University, Brisbane, Australia
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Australia
- The Hopkins Centre, Griffith University, Brisbane, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Australia
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Segal L, Dawe S, Nguyen H, Dennison S, Gnanamanickam ES, Bell M, Spittal M, Kinner S, Preen DB. Child protection system involvement in children of incarcerated mothers: A linked data study. Child Abuse Negl 2023; 139:106126. [PMID: 36889149 DOI: 10.1016/j.chiabu.2023.106126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Women prisoners are a growing portion of the prison population. Health and social outcomes of their children have been studied and found to be poor, but little is known about child protection outcomes. OBJECTIVES Ascertain child protection system contact of children exposed to maternal incarceration. PARTICIPANTS AND SETTING All children born between 1985 and 2011 exposed to the incarceration of their mothers in a Western Australian correctional facility and a matched comparison group. METHODS A matched cohort study using linked administrative data on 2637 mothers entering prison between 1985 and 2015 and their 6680 children. We estimated hazard ratios (HRs) and incidence rate ratios (IRRs) of child protection service (CPS) contact post maternal incarceration (four concern levels), comparing rates for children exposed to maternal incarceration with a matched non-exposed group, adjusting for maternal and child factors. FINDINGS Exposure to maternal incarceration increased risk of CPS contact. Unadjusted HRs exposed vs unexposed children were 7.06 (95%CI = 6.49-7.69) for substantiated child maltreatment and 12.89 (95%CI = 11.42-14.55) for out-of-home care (OOHC). Unadjusted IRRs were 6.04 (95%CI = 5.57-6.55) for number of substantiations and 12.47 (95%CI = 10.65-14.59) for number of removals to OOHC. HRs and IRRs were only slightly attenuated in adjusted models. CONCLUSIONS Maternal incarceration is a warning flag for a child at high risk of serious child protection concerns. Family-friendly rehabilitative women's prisons, incorporating support for more nurturing mother-child relationships could provide a placed-based public health opportunity for disrupting distressing life trajectories and intergenerational pathways of disadvantage of these vulnerable children and their mothers. This population should be a priority for trauma-informed family support services.
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Affiliation(s)
- Leonie Segal
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia.
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Qld, Australia
| | - Ha Nguyen
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia
| | - Susan Dennison
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Qld, Australia
| | - Emmanuel S Gnanamanickam
- Health Economcis and Social Policy Group, University of South Australia, Adelaide, SA, Australia
| | - Megan Bell
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Matthew Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Stuart Kinner
- Justice Health Unit, The University of Melbourne, Melbourne, Vic, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Cumming C, Kinner SA, McKetin R, Li I, Preen DB. The health needs of people leaving prison with a history of methamphetamine and/or opioid use. Drug Alcohol Rev 2023; 42:778-784. [PMID: 36917515 PMCID: PMC10947398 DOI: 10.1111/dar.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/30/2023] [Accepted: 02/12/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Methamphetamine use is more common than opioid use among prison entrants in some countries, including Australia, yet most research and policy focuses on opioid use. This suggests that traditional opioid-focused interventions are no longer appropriate for the majority of this group in countries such as Australia. To inform policy and practice, we compared socio-demographic characteristics and health needs of people leaving prison with a history of methamphetamine use and/or opioid use. METHODS A cross-sectional survey of incarcerated adults administered the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test was used to identify moderate-/high-risk methamphetamine use (n = 909), opioid use (n = 115) or combined methamphetamine/opioid use (n = 356) before incarceration. We compared groups using modified log-linked Poisson regression with robust error variance. RESULTS Compared to the opioid-only group, the methamphetamine-only group were: significantly more often aged <25 years; significantly more likely to identify as Indigenous; significantly less likely to have a history of prior incarceration, drug injection or overdose. A significantly lower proportion of methamphetamine-only and methamphetamine-and-opioid participants self-reported current hepatitis C infection compared to opioid-only participants. A majority of participants in all groups screened positive for current psychological distress according to the K10. DISCUSSION AND CONCLUSIONS People leaving prison with a history of methamphetamine use differ from opioid users with respect to demographics, patterns of substance use and related health concerns. Treatment and harm reduction efforts for people who experience incarceration must respond to patterns of drug use in this population, and invest at scale in coordinated, continuous services for co-occurring substance use and mental health problems.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research InstituteMelbourneAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Griffith Criminology InstituteGriffith UniversityBrisbaneAustralia
- School of Population HealthCurtin UniversityPerthAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUNSW SydneySydneyAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaPerthAustralia
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Kelty E, Quintrell E, Preen DB, Manners P, Nossent J. The effect of TNF treatment uptake on incident hospital admission in Western Australia. Pediatr Rheumatol Online J 2023; 21:29. [PMID: 36973788 PMCID: PMC10045824 DOI: 10.1186/s12969-023-00810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Treatment strategies for juvenile idiopathic arthritis (JIA) have shifted significantly over the last 20 years. We examined the effect of the introduction of government-subsidised TNF inhibitor (TNFi) treatment on incident hospitalisation for JIA. METHODS Western Australian (WA) hospital data were used to identify patients < 16 years hospitalised with JIA between 1990 and 2012. Changes in the number of patients with an incident hospitalisation, overall admissions and admissions for joint aspiration were examined using join-point regression TNFi dispensing data from 2002-2012 was used to describe defined daily doses (DDD)/1000 population/day. RESULTS We included 786 patients (59.2% girls, median age 8 years) with a first-time admission with JIA. The annual incident admission rate was 7.9 per 100,000 person-years (95%CI: 7.3, 8.4) which did not change significantly between 1990 and 2012 (annual percentage change (APC): 1.3, 95%CI: -0.3, 2.8). Annual hospital-based prevalence of JIA reached 0.72/1000 in 2012. DDD for TNFi usage rose steadily from 2003 indicating TNFi usage by 1/2700 children in 2012, while overall admission rates (APC 3.7; 95%CI: 2.3, 5.1) and admission rates for joint injections (APC 4.9%; 95%CI: 3.8, 6.0) also increased significantly in that period. CONCLUSION Incident inpatient admission rates for JIA were stable over a 22-year period. The uptake of TNFi was not associated with lower admission rates for JIA, due mainly to an increase in admissions for joint injection. These results indicate a notable but unexpected change in hospital-based management of JIA since the introduction of TNFi therapy in WA, where hospital-based prevalence of JIA is slightly higher than in North America.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia.
| | - Ebony Quintrell
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia
- Telethon Kids Institute, Perth, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia
| | - Prue Manners
- Rheumatology Section, Division Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Johannes Nossent
- Rheumatology Section, Division Medicine, Medical School, The University of Western Australia, Perth, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
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Beasley AB, Preen DB, McLenachan S, Gray ES, Chen FK. Incidence and mortality of uveal melanoma in Australia (1982-2014). Br J Ophthalmol 2023; 107:406-411. [PMID: 34880052 PMCID: PMC9985731 DOI: 10.1136/bjophthalmol-2021-319700] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/11/2021] [Indexed: 12/27/2022]
Abstract
AIMS We aimed to estimate the incidence and mortality of uveal melanoma (UM) in Australia from 1982 to 2014. METHODS Deidentified unit data for all cases of ocular melanoma were extracted from the Australian Cancer Database from 1 January 1982 to 31 December 2014. UM cases were extracted and trends in incidence and disease-specific mortality were calculated. Incidence rates were age-standardised against the 2001 Australian Standard Population. Mortality was assessed using Cox regression. RESULTS From 1982 to 2014, there were 5087 cases of ocular melanoma in Australia, of which 4617 were classified as UM. The average age-standardised incidence rate of UM was 7.6 (95% CI 7.3 to 7.9) per million. There was an increase (p=0.0502) in the incidence of UM from 1982 to 1993 with an annual percent change (APC) of +2.5%, followed by a significant decrease in the incidence of UM from 1993 to 2014 (APC -1.2%). The average 5-year survival from 1982 to 2011 did not significantly change from an average of 81%, with an average APC (AAPC) of +0.1%. A multivariate Cox regression revealed that residence in Western Australia (p=0.001) or Tasmania (p=0.05), age ≥60 years (p<0.001) and histological classification as mixed (p<0.001) or epithelioid cells (p<0.001) were significantly associated with reduced survival. CONCLUSION In conclusion, we found that the incidence of UM peaked in the 1990s. Although treatment for primary UM has improved in the last 30 years, overall survival did not change significantly in the last 30 years.
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Affiliation(s)
- Aaron B Beasley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia .,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Perth, Western Australia, Australia
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Nossent JC, Keen HI, Preen DB, Inderjeeth CA. Trends in Hospitalization for Tuberculosis and Other Opportunistic Infections in Australian Patients with Inflammatory Joint Diseases. Rheumatol Ther 2023; 10:563-573. [PMID: 36738423 PMCID: PMC10140214 DOI: 10.1007/s40744-023-00534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE As immune-modulating therapy has become the standard of care for idiopathic inflammatory joint diseases (IJD), we investigated whether this has changed the rates for hospitalization with opportunistic infections (OI). METHODS Administrative longitudinal state-wide health data identified patients hospitalized at least twice with diagnostic codes for rheumatoid arthritis (RA, n = 7730), psoriatic arthritis (PsA, n = 529) or axial spondylarthritis (AS, n = 1126) in Western Australia in the period 1985-2015. Overall incidence rates/1000 person-years (IR with 95% CI) for microbiologically confirmed OI (mycobacterial, fungal, and viral infections) during 180,963 person-years were analyzed across 10-year periods with IR trend rates analyzed by least square regression (R2) for all IJD categories. RESULTS A total of 2584 OI occurred with higher IR rates observed in RA (15.34, CI 14.71-15.99) than PsA (8.73, CI 7.14-10.56) and AS (10.88, CI 9.63-12.24) patients (p < 0.001). IR rates were highest for Candidiasis across all three IJD categories (IR 10.0 vs. 6.32 vs. 6.88, respectively), while Varicella-zoster (VZV) was most frequent non-candida OI (IR 2.83.0 vs. 1.50 vs. 1.49, respectively) followed by mycobacterial (IR 1.14 vs. 0.08 vs. 0.24, respectively) and other mycotic infections (IR 0.60 vs. 0.58 vs. 0.86, respectively). Over time, the IR for tuberculosis and pneumocystosis decreased and remained stable for VZV infections in RA patients, but IR for all other OI increased across all disease categories. OI admission associated with 6.5% (CI 5.6-7.5) in-hospital mortality. CONCLUSIONS Despite decreasing admission rates for tuberculosis and pneumocystosis in RA patients, an overall increase in mycotic and viral infection rates over time was seen across all three IJD. Together with a significant case fatality rate, this indicates continued efforts are needed to improve OI prevention in the management of IJD patients.
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Affiliation(s)
- Johannes C Nossent
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
- Rheumatology Group, School of Medicine, University Western Australia, 35 Stirling Highway (M503), Perth, Australia.
| | - Helen I Keen
- Rheumatology Group, School of Medicine, University Western Australia, 35 Stirling Highway (M503), Perth, Australia
- Department Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University Western Australia, Perth, Australia
| | - Charles A Inderjeeth
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
- Rheumatology Group, School of Medicine, University Western Australia, 35 Stirling Highway (M503), Perth, Australia
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Almutairi K, Inderjeeth C, Preen DB, Keen H, Nossent J. The prevalence of rheumatoid arthritis in Western Australia. BMC Rheumatol 2022; 6:93. [PMID: 36585680 PMCID: PMC9804946 DOI: 10.1186/s41927-022-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is the most common form of autoimmune arthritis, but the prevalence in Australia is unknown. We estimated RA period prevalence and identified factors associated with frequent RA hospitalisations, using linked administrative health and state-specific Australian Pharmaceutical Benefits Scheme (PBS) datasets in Western Australia (WA) from 1995 to 2014. METHODS This was a longitudinal population-based cohort study using two independent datasets to identify prevalent RA patients. RA prevalence was calculated per 1000 hospital separations and biological therapy users. RA patients were identified in the WA linked health dataset using ICD codes 714.0-714.9 and M05.00-M06.99. Dispensing data on biological therapy for RA were obtained from PBS records and converted to defined daily doses /1000 population/day. Multivariable logistic regression was used to analyse factors associated with frequent RA hospitalisations (> 2/year), controlling for sex, age, and geographic locations. Potential interactions were assessed using logistic regression in a stepwise approach. RESULTS A total of 17,125 RA patients had 50,353 hospital separations between 1995 and 2014, averaging three hospitalisations per patient over 20 years. The RA period prevalence was 3.4 per 1000 separations (0.34%; 95% CI 0.33-0.34), while the RA period prevalence based on biological therapy use was 0.36% (95% CI 0.35-0.37). The corrected RA prevalence based on biological therapy usage was 0.36% (95% CI 0.35-0.37) for the 2005-2009 and increased to 0.72% (95% CI 0.70-0.74) in 2010-2014 period. Associated factors for frequent RA hospitalisations were being female [1.21 (95% CI 1.15-1.26)], aged 60-69 years [4.45 (95% CI 3.74-5.30)], living in rural areas [1.12 (95% CI 1.02-1.24)]. The odd ratio of interaction between these associated factors was 1.34 (95% CI 1.16-1.55). CONCLUSION The minimal prevalence of RA in Western Australia is 0.34-0.36%, which falls within the literature range. Older female RA patients in rural were more likely to be hospitalised, suggesting unmet primary care for needs.
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Affiliation(s)
- Khalid Almutairi
- grid.1012.20000 0004 1936 7910Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009 Australia ,grid.415280.a0000 0004 0402 3867King Fahd Specialist Hospital, Burydah, Saudi Arabia
| | - Charles Inderjeeth
- grid.1012.20000 0004 1936 7910Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009 Australia ,Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
| | - David B Preen
- grid.1012.20000 0004 1936 7910Faculty of Health and Medical Sciences, School of Population and Global Health, University of Western Australia, Perth, WA Australia
| | - Helen Keen
- grid.1012.20000 0004 1936 7910Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009 Australia ,grid.459958.c0000 0004 4680 1997Fiona Stanley Hospital, Murdoch, WA Australia
| | - Johannes Nossent
- grid.1012.20000 0004 1936 7910Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009 Australia ,Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia
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Orr C, Fisher C, O'Donnell M, Glauert R, Preen DB. Epilepsy in children exposed to family and domestic violence in the first 5 years of life. J Paediatr Child Health 2022; 58:2183-2189. [PMID: 36054645 PMCID: PMC10087942 DOI: 10.1111/jpc.16179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 04/03/2022] [Accepted: 07/17/2022] [Indexed: 11/27/2022]
Abstract
AIM To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure. METHODS A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n = 7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children. RESULTS Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P = 0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P = 0.018). CONCLUSIONS FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy.
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Affiliation(s)
- Carol Orr
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Collen Fisher
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Melissa O'Donnell
- The Australian Centre for Child Protection, The University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Glauert
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - David B Preen
- The School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Nossent J, Raymond W, Keen H, Preen DB, Inderjeeth CA. Adult-onset Still's disease in Western Australia: Epidemiology, comorbidity and long-term outcome. Int J Rheum Dis 2022; 25:1306-1314. [PMID: 36004429 PMCID: PMC9805040 DOI: 10.1111/1756-185x.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 08/09/2022] [Indexed: 01/09/2023]
Abstract
AIM Adult-onset Still's disease (ASD) is a rare, potentially life-threatening autoinflammatory condition. As reported prevalence shows regional variation and long-term outcome data are scarce, we investigated epidemiology and long-term health outcomes of ASD in Western Australia (WA). METHODS Population-based cohort study using longitudinally linked administrative health data from all WA hospitals between 1999 and 2013 for ASD patients (ICD-10-AM M06.1) and controls matched for age, gender, and index year. Rate ratios and odds ratios (RR/OR) with 95% confidence intervals (CI) compared ASD patients with controls. RESULTS The average ASD incidence (n = 52) was 0.22/100 000 with 2.4/100 000 point-prevalence as of December 31, 2013. ASD patients (median age 41.5 years, 59.6% female) had higher odds of previous liver disease (OR 2.67, 95% CI 1.31-5.45), fever (OR 54.10, 95% CI 6.60-433.0), rash (OR 15.70, 95% CI 4.08-60.80), and serious infections (OR 4.36, 95% CI 2.11-22.80) than controls. Despite biological disease-modifying antirheumatic drugs in 27% of patients, ASD patients had higher odds for joint replacement (n = 7, 13.5%) (OR 45.5, 95% CI 4.57-93.70), osteoporosis (OR 31.3, 95% CI 3.43-97), and serious infections (RR 5.68; 95% CI 6.61-8.74) during follow up. However, crude mortality (11.5% vs 7.5%; P = 0.34), survival at 1 and 5 years (P= 0.78), and last modified Charlson Comorbidity score (median 2 vs 2) were similar between groups. CONCLUSION The epidemiology and demographics of ASD in Western Australia fall within the internationally reported range. ASD patients present increased rates of liver disease, rash, and serious infections before disease onset. Mortality following ASD was not increased for 5 years despite high rates of chronic arthritis requiring joint replacement, serious infections, and osteoporosis.
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Affiliation(s)
- Johannes Nossent
- Department of RheumatologySir Charles Gairdner HospitalPerthWestern AustraliaAustralia,Rheumatology Group, School of MedicineUniversity Western AustraliaPerthWestern AustraliaAustralia
| | - Warren Raymond
- Rheumatology Group, School of MedicineUniversity Western AustraliaPerthWestern AustraliaAustralia
| | - Helen Keen
- Rheumatology Group, School of MedicineUniversity Western AustraliaPerthWestern AustraliaAustralia,Department of RheumatologyFiona Stanley HospitalPerthWestern AustraliaAustralia
| | - David B. Preen
- School of Population and Global HealthPerthWestern AustraliaAustralia
| | - Charles A. Inderjeeth
- Department of RheumatologySir Charles Gairdner HospitalPerthWestern AustraliaAustralia,Rheumatology Group, School of MedicineUniversity Western AustraliaPerthWestern AustraliaAustralia
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Kelty E, Terplan M, Orr C, Preen DB. Neonatal outcomes associated with in utero exposure to oxycodone, overall and by trimester of exposure: A retrospective cohort study. The Journal of Pain 2022; 24:617-626. [PMID: 36423793 DOI: 10.1016/j.jpain.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
Oxycodone is commonly used by pregnant women for the treatment of pain. However, the potential risk associated with its use in pregnancy have not been robustly evaluated. The objective of this study was to examine neonatal outcomes associated with prenatal oxycodone exposure. State dispensing records were matched with midwives records to identify women who had been dispensed oxycodone during pregnancy (n=302). A matched comparison group of women who had been prescribed oxycodone prior to pregnancy was also identified (n=604). Hospital, mortality and congenital abnormality data were obtained for each mother-child dyad. Neonatal outcomes were examined for association with any exposure during pregnancy and trimester specific exposure, using generalized linear models. First trimester exposure was not associated with a significant increased risk of congenital anomalies (OR: 1.74 95%CI: 0.78, 3.87). Second trimester exposure to oxycodone was associated with reduction in average length of gestation (aCoef:-0.83, 95%CI: -1.26, -0.41) and birth weight (aCoef:-188, 95%CI: -299, -76). Second trimester exposure was also associated with an increased risk of very preterm birth (<32 weeks) (OR: 5.03, 95%CI: 1.95, 12.98) and admission to the special care nursery (aOR:1.99, 95%CI: 1.30, 3.03). Third trimester exposure to oxycodone was associated with a reduction in average length of gestation (aCoef:-0.33, 95%CI: -0.63, -0.02) compared with the comparison group. The use of oxycodone in pregnancy was not associated with an increased risk of congenital anomalies. However, oxycodone exposure was associated with a short period of gestation, preterm birth, and NAS, which likely contributed to a longer period of hospitalization following birth. PERSPECTIVE: This article assesses the neonatal risks associated with prenatal exposure to oxycodone, providing clinicians and patients with important information on the safety of oxycodone in the treatment of pain in pregnancy.
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Kelty E, Pyle A, Preen DB. Opioid poisoning during pregnancy: prevalence, characteristics, and neonatal outcomes. Arch Womens Ment Health 2022; 25:957-963. [PMID: 35984500 PMCID: PMC9492584 DOI: 10.1007/s00737-022-01260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
While it has been postulated that opioid poisoning during pregnancy may cause adverse maternal and neonatal outcomes, the harm associated with opioid poisoning during pregnancy has not been robustly examined. Pregnant women admitted to hospital or presenting to the emergency department (ED) in Western Australia (WA) with a diagnosis of opioid poisoning were identified by linking state midwifery records with hospital and ED administrative data. Maternal and neonatal outcomes were compared with opioid poisoning that occurred in the 12 months prior to conception or the 12 months following birth. Between 2003 and 2018, 57 neonates were born to women who had experienced opioid poisoning during pregnancy (14.1 per 100,000 births) in WA. The incidence of opioid poisoning in the year prior to pregnancy (IRR: 3.04, 95%CI: 2.30, 4.02) and the year following pregnancy (IRR: 1.96, 95%CI: 1.46, 2.64) was significantly higher than during pregnancy. Opioid poisoning during pregnancy was less likely to involve multiple substances and be intentional (rather than accidental). Neonatal conditions associated with in utero hypoxia were significantly less common in neonates born to women who experience opioid poisoning prior to pregnancy compared with during pregnancy (OR: 0.17, 95%CI: 0.04, 0.80). Opioid poisoning in pregnancy was not associated with an increased risk of other serious adverse neonatal outcomes. Opioid poisoning during pregnancy is uncommon and less likely to be intentional and involve multiple substances. Opioid poisoning during pregnancy is likely associated with an increased risk of conditions associated with in utero hypoxia.
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Affiliation(s)
- Erin Kelty
- The School of Population and Global Health, the University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia.
| | - Anwyn Pyle
- The Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - David B Preen
- The School of Population and Global Health, the University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia
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Lopez D, Murray K, Preen DB, Sanfilippo FM, Trevenen M, Hankey GJ, Yeap BB, Golledge J, Almeida OP, Flicker L. The Hospital Frailty Risk Score Identifies Fewer Cases of Frailty in a Community-Based Cohort of Older Men Than the FRAIL Scale and Frailty Index. J Am Med Dir Assoc 2022; 23:1348-1353.e8. [PMID: 34740563 DOI: 10.1016/j.jamda.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The recently developed Hospital Frailty Risk Score (HFRS) allows ascertainment of frailty from administrative data. We aimed to compare the HFRS against the widely used FRAIL Scale and Frailty Index. DESIGN Population-based cohort study linked to Western Australian Hospital Morbidity Data Collection and Death Registrations. SETTING AND PARTICIPANTS The Health in Men Study with frailty determined at Wave 2 (2001/2004), mortality in the 1-year period following Wave 2, and disability at Wave 3 (2008). Participants were 4228 community-based men aged ≥75 years, followed until Wave 3. MEASUREMENTS We used multivariable regression to determine the association between each frailty measure and outcomes of length of stay (LOS), death, and disability. We also determined if the additional cases of frailty identified by one measure over the other was associated with these outcomes. RESULTS Of 4228 men studied, the HFRS (n = 689) identified fewer men as frail than the FRAIL Scale (n = 1648) and Frailty Index (n = 1820). In the fully adjusted models, all 3 frailty measures were associated with longer LOS and mortality, whereas only the FRAIL Scale and Frailty Index were significantly associated with disability. The additional cases of frailty identified by the FRAIL Scale and Frailty Index had longer LOS and greater risks of death and disability. The fully adjusted hazard ratio for death among the additional cases of frailty identified by the FRAIL Scale (compared to being not frail on both HFRS and FRAIL Scale) was 2.14 (95% CI 1.48-3.08). CONCLUSIONS AND IMPLICATIONS The HFRS is associated with adverse outcomes. However, it identified approximately 60% fewer men who were frail than the FRAIL Scale and Frailty Index, and the additional cases identified were also at high risks of adverse outcomes. Users of the HFRS should be aware of the differences with other frailty measures.
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michelle Trevenen
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Graeme J Hankey
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Bu B Yeap
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Nossent J, Keen H, Preen DB, Inderjeeth CA. Temporal trends in hospitalisation for opportunistic infections in lupus patients in Western Australia. Lupus 2022; 31:1434-1440. [PMID: 35839098 DOI: 10.1177/09612033221115965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lupus patients often require aggressive immunosuppressive therapy, which increases the risk for infections. We studied the temporal rates for opportunistic infections (OI) and associated mortality in lupus patients hospitalised in Western Australia. METHODS All patients hospitalized in the period 1985-2015 with ≥2 ICD based diagnostic codes for SLE were included. OI was defined as a microbiologically confirmed mycobacterial, fungal, or viral infection. Descriptive data are given as median (IQR) and frequency (%) with incidence rates (IR) calculated per 1000 person years and IR trend rates analysed across 10-year periods by least square regression (R2). RESULTS The study cohort (n = 1408) contained 85.3% females with age at entry 35 years (IQR 22-51). During median follow-up of 21.1 years (IQR 17.5-29.6) hospitalisation for OI occurred in 121 (8.6%) patients with recurrent or multiple OI observed in 42 (34.7%) patients. During 29.771 thousand person years, a total of 295 OI were diagnosed for an overall IR rate of 9.91 (CI 8.82-11.09)/1000 person years which did not decrease significantly over time (R2 0.14). Significant decreases were however seen in the IR for tuberculosis (R2 0.88), cryptococcal (R2 0.98) and pneumocystis (R2 0.98) infections, with increasing IR observed for other mycobacteria (R2 0.99) and aspergillosis (R2 0.55) and little change seen for H Zoster (R2 0.18) and Varicella (R2 0.10) infections. In-hospital death during OI admission occurred in 9/121 patients (7.4%). There was no significant gender difference in IR or outcome of OI. CONCLUSIONS Hospitalization rates for OI in lupus patients have not changed significantly over time, but there has been a clear shift in the underlying OI. The decrease in mycobacterial and pneumocystis infections suggest successful prophylaxis but the increase in viral and mycotic infections indicate a sustained need to improve prevention of these OI in lupus patients.
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Affiliation(s)
- Johannes Nossent
- Dept, Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, Perth, Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, Perth, Australia.,Dept, Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, Perth, Australia
| | - Charles A Inderjeeth
- Dept, Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, Perth, Australia
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Calais-Ferreira L, Butler A, Dent S, Preen DB, Young JT, Kinner SA. Multimorbidity and quality of primary care after release from prison: a prospective data-linkage cohort study. BMC Health Serv Res 2022; 22:876. [PMID: 35799190 PMCID: PMC9264593 DOI: 10.1186/s12913-022-08209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The period after release from prison can be challenging, especially due to a higher risk of morbidity and mortality despite commonly increased use of healthcare services. However, little is known about the quality of the healthcare offered to this population, which limits the possibility of addressing this important health inequity. This study characterised multimorbidity and investigated the relationship between multimorbidity and quality of primary healthcare in adults within 2 years after release from prison. Methods This was a prospective cohort study of 1046 participants of a service brokerage intervention after release from prison between August 2008 and July 2010 in Queensland, Australia. Participants had their baseline survey and clinical data linked prospectively with their medical, correctional and death records. Multimorbidity was ascertained using the Cumulative Illness Rating Scale and classified into three categories: none, moderate (morbidity in 2–3 domains) and complex (morbidity in 4 or more domains). Outcomes were Usual Provider Continuity Index (UPCI), Continuity of Care (COC) Index, and having at least one extended primary care consultation (> 20 minutes). Descriptive statistics and logistic regression were used in the analyses. Results Multimorbidity was present for 761 (73%) participants, being more prevalent among females (85%) than males (69%), p < 0.001. Moderate multimorbidity was not associated with UPCI or COC, but was associated with having at least one long consultation (AOR = 1.64; 95% CI:1.14–2.39), after adjusting for covariates. Complex multimorbidity was positively associated with all outcomes in the adjusted models. Indigenous status was negatively associated with UPCI (AOR = 0.54; 95% CI: 0.37–0.80) and COC (AOR = 0.53; 95% CI: 0.36–0.77), and people younger than 25 years were at 36% lower odds (AOR = 0.64; 95% CI: 0.44–0.93) of having a long consultation than the middle-aged group (25–44 years) in the adjusted models. Conclusion Moderate multimorbidity was associated with having at least one extended primary care consultation, but not with adequate continuity of care, for adults within 2 years of being released from prison. Nearly half of those with complex multimorbidity did not receive adequate continuity of care. The quality of primary care is inadequate for a large proportion of adults released from prison, constituting an important and actionable health inequity. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08209-6.
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Affiliation(s)
- Lucas Calais-Ferreira
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia. .,Centre for Adolescent Health, Murdoch Children's Research Institute, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia. .,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.
| | - Amanda Butler
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephan Dent
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.,Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Level 3, 207 Bouverie St, Carlton, Melbourne, Victoria, 3070, Australia.,School of Population Health, Curtin University, Perth, Western Australia, Australia.,Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
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Snow KJ, Petrie D, Young JT, Preen DB, Heffernan E, Kinner SA. Impact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study. Aust J Prim Health 2022; 28:264-270. [PMID: 35512815 DOI: 10.1071/py21142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective. METHODS A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs. RESULTS Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6-4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6-5.0), compared with no past diagnosis of either mental illness or substance use disorder. CONCLUSIONS People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.
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Affiliation(s)
- K J Snow
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - D Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Vic., Australia
| | - J T Young
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic. 3053, Australia; and School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; and National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - D B Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - E Heffernan
- Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Qld, Australia
| | - S A Kinner
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic. 3053, Australia; and Centre for Adolescent Health, Murdoch Children's Research Institute, Carlton, Vic., Australia; and Griffith Criminology Institute, Griffith University, Mount Gravatt, Qld, Australia; and Mater Research Institute-UQ, School of Medicine, University of Queensland, Brisbane, Qld, Australia; and School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Kelty EA, Cumming CN, Preen DB. Contribution of pharmaceutical drugs of dependence to the incidence of neonatal abstinence syndrome in Western Australia between 2003 and 2018. Pharmacotherapy 2022; 42:405-410. [PMID: 35342965 PMCID: PMC9541824 DOI: 10.1002/phar.2678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
Study objective The aim of this study was to examine the incidence of neonatal abstinence syndrome (NAS) in Western Australia (WA) and estimate the contribution of pharmaceutical drugs of dependence (PDD) to NAS. Design A population‐based birth cohort study. Data source Neonates were identified through the Midwives Notification Scheme. Linked medication dispensing and hospital records were used to identify exposure to PDD and NAS diagnosis. Patients All live born neonates born in WA between 2003 and 2018. Measurements The incidence of NAS and percentage of NAS diagnoses associated with exposure to PDD. Main results During the study period, the incidence of NAS did not significantly change (annual percentage change (APC): 0.6, 95%CI: −1.3, 2.6), with 3.8 neonates per 1,000 live births diagnosed with NAS. PDD were dispensed to 41.4% of mothers of neonates with NAS, with PDD used to treat opioid use disorders the most commonly prescribed (35.2% of neonates with NAS), while opioid PDD used in the treatment of pain contributed to 5.2% of NAS cases. Non‐opioid PDD contributed to 1.7% of cases of NAS. The incidence of NAS associated with the use of opioids used to treat opioid use disorders (OUD) decreased over the study period (APC: −6.5, 95%CI: −9.5, −3.4), while NAS associated with opioids used to treat pain remained stable (APC: −2.7, 95%CI: −7.1, 1.9). Conclusion The incidence of neonatal abstinence syndrome in WA remained stable from 2003 to 2018. Medications used to treat opioid use disorders were a substantial driver of NAS, although NAS associated with these medications has declined over time.
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Affiliation(s)
- Erin A. Kelty
- The School of Population and Global Health The University of Western Australia Crawley Western Australia Australia
| | - Craig N. Cumming
- The School of Population and Global Health The University of Western Australia Crawley Western Australia Australia
| | - David B. Preen
- The School of Population and Global Health The University of Western Australia Crawley Western Australia Australia
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Kelty E, Ognjenovic M, Raymond W, Inderjeeth C, Keen H, Preen DB, Nossent J. Mortality rates in patients with ankylosing spondylitis with and without extra-articular manifestations and co-morbidities: A retrospective cohort study. J Rheumatol 2022; 49:688-693. [DOI: 10.3899/jrheum.210909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Objective To examine the mortality rates in hospitalised patients with ankylosing spondylitis (AS), and the association of extra-articular manifestations (EAM) and co-morbidities with mortality rates. Methods The study was a retrospective population-based cohort study using linked administrative data of hospitalised AS patients (n=1,791) and a matched comparison group (n=8,955). Mortality data for patients were obtained from the Western Australian Death Register. The presence of EAM and co-morbidities were identified from hospital records. Mortality rates were compared between the two groups using Cox proportional hazard models, overall and stratified by a history of EAM, comorbidities and smoking status. Results Crude mortality rates were significantly higher in AS patients than the comparison group (HR:1.85, 95%CI:1.62-2.12) with excess mortality in the AS group associated with cardiovascular disease (HR:5.32, 95%:3.84-7.35), cancer (HR:1.68, 95%CI:1.27-2.23), external causes (HR:3.92, 95%CI:2.28-6.77) and infections (HR:25.92, 95%CI:7.50-89.56). When patients were stratified by a history of EAM, cardiovascular disease, and smoking the risk of mortality was elevated in both patients with and without each risk factor. Within patients with AS, a history of cardiovascular disease (HR:6.33, 95%CI:4.79-8.38), diabetes (HR:2.81, 95%CI:1.99-3.95), smoking (HR:1.49, 95%CI:1.18-1.89) and EAM (HR:1.62, 95%CI: 1.24–2.11) were associated with an increased risk of mortality. Conclusion The presence of co-morbidities, EAMs, and smoking contribute to an increased risk of all-cause mortality in hospitalised AS patients compared to the comparison group. These results support the need to prevent or reduce the occurrence of co-morbidity and smoking in AS patients.
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Taylor-Williams O, Inderjeeth CA, Almutairi KB, Keen H, Preen DB, Nossent JC. Total Hip Replacement in Patients with Rheumatoid Arthritis: Trends in Incidence and Complication Rates Over 35 Years. Rheumatol Ther 2022; 9:565-580. [PMID: 34997912 PMCID: PMC8964887 DOI: 10.1007/s40744-021-00414-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Advances in rheumatoid arthritis (RA) management have made disease remission achievable. We evaluated trends in total hip replacement (THR) and postoperative outcomes in patients with RA in Western Australia (WA) over more than three decades. METHODS This was a retrospective analysis of routinely collected prospective data from a state-wide registry containing longitudinally linked administrative health data based on International Classification of Diseases (ICD) diagnostic and procedural codes. We included patients with two or more diagnostic codes for RA (between 1980 and 2015) and studied THR incidence rates (THR IR) and complication rates (revision, peri-prosthetic fracture, infection, venous thrombosis, and mechanical loosening). Survival rates were estimated by Kaplan-Meier method and predictors analyzed by Cox regression. RESULTS We followed 9201 RA patients over 111,625 person-years, during which 1560 patients (16.9%) underwent THR. From 1985 to 2015, THR IR (per 1000 RA patient-years) decreased from 20.8 (95% CI 20.1-21.5) to 7.3 (95% CI 7.2-7.5), and 5-year THR-free survival increased from 84.3 to 95.3% (1980-2015). Ten-year prosthetic survival was 91.2%. Complication rates in the first 5 years post-THR decreased significantly from 13.1 to 3.7% (p < 0.001). Mechanical complications such as loosening and periprosthetic fracture rates decreased significantly (> 35%, P < 0.05), while infection and revision did not change over the observation period (p > 0.05). CONCLUSIONS Over the last 30 years in RA patients, THR IR and mechanical complication rates decreased significantly, but the medical complication of infection has not changed significantly.
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Affiliation(s)
- Owen Taylor-Williams
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Charles A Inderjeeth
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Khalid B Almutairi
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia
| | - Helen Keen
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Johannes C Nossent
- Rheumatology Group, Medical School, University of Western Australia, 35 Stirling Highway (M503), Perth, WA, Australia.
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
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Taylor CL, Christensen D, Venn AJ, Preen DB, Stafford J, Hansen E, Jose K, Zubrick SR. Use of administrative record linkage to examine patterns of universal early childhood health and education service use from birth to Kindergarten (age four years) and developmental vulnerability in the Preparatory Year (age five years) in Tasmania, Australia. Int J Popul Data Sci 2022; 6:1681. [PMID: 35136844 PMCID: PMC8780991 DOI: 10.23889/ijpds.v6i1.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In Australia, the health and education sectors provide universal early childhood services for the same population of children. Therefore, there is a strong imperative to view service use and outcomes through a cross-sectoral lens to better understand and address the service needs of young children and their families. OBJECTIVES To investigate patterns of health and education service use from birth through Kindergarten (age four years), the associations with cumulative risks, and developmental vulnerability in the first year of full-time school (age five years). METHODS A retrospective cohort study that used population-wide linkage of health and education administrative data records for 5,440 children with a Tasmanian 2015 Australian Early Development Census (AEDC) record who were born in Tasmania (2008-2010). RESULTS Four service use patterns were identified: Regular (46% of children), Declining (24%); Low (18%); and Selective service use (12%). Regular service use (aOR 0.8, 95% CI 0.7 to 0.9), adjusted for cumulative risks, was associated with decreased odds of developmental vulnerability, compared to the other service use groups. Low (OR 6.1, 95% CI 4.5 to 8.2) and Declining service use (OR 2.5 95% CI 1.9 to 3.4) were more likely for children with the highest levels of cumulative risks. Low and Declining service use, adjusted for cumulative risks were associated with increased odds of developmental vulnerability, compared to the Regular service use group. CONCLUSION This study provides a whole population view of the differential use of universal services and the complex risk circumstances that influence service use. The association between patterns of multiple risk and service use points to barriers to service use, and the varying level of developmental vulnerability within each service use group draws attention to children who may benefit from higher sustained participation in core health and education services across the whole of early childhood.
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Affiliation(s)
- Catherine L. Taylor
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia,Corresponding author: Catherine L. Taylor
| | - Daniel Christensen
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Alison J. Venn
- Menzies Institute for Medical Research, The University of Tasmania. Hobart, Tasmania, Australia
| | - David B. Preen
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Joel Stafford
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Emily Hansen
- School of Social Sciences, University of Tasmania, Hobart, Tasmania
| | - Kim Jose
- Menzies Institute for Medical Research, The University of Tasmania. Hobart, Tasmania, Australia
| | - Stephen R. Zubrick
- Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
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49
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Gnanamanickam ES, Nguyen H, Armfield JM, Doidge JC, Brown DS, Preen DB, Segal L. Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood. Child Abuse Negl 2022; 123:105397. [PMID: 34823123 DOI: 10.1016/j.chiabu.2021.105397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Child maltreatment (CM) is a serious global public health issue, with documented impacts on health. OBJECTIVE To examine the association between different levels of CM concern, and Emergency Department (ED) visits from infancy to early adulthood. PARTICIPANTS AND SETTING Individuals born in Adelaide, South Australia from January 1986 to June 2017 (N = 443,754). METHODS Using linked administrative data, we examined frequency and adjusted rate ratios for all-cause and cause specific ED visits among individuals with varying levels of CM concern. RESULTS Cumulative mean ED visits to age 14.5 years were higher for individuals with any CM concern, ranging from 10.2 to 14.8, compared with 6.4 in persons with no recorded CM concern. Adjusted rate ratios for ED visits varied from 1.26 (95% CI: 1.23-1.30) to 1.54 (1.48-1.60) in children (birth to 12 years), 1.98 (CI: 1.92-2.04) to 4.34 (CI: 4.09-4.60) in adolescence and 2.22 (CI: 2.14-3.48) to 3.48 (3.27-3.72) in young adults, increasing with severity of maltreatment concerns. ED visits coded as self-harm or poisoning, injuries, substance use or mental illness were particularly high, with incidence rate ratios mostly 3 to 15 times for mental health/substance related visits and 1.5 to 3.2 for other accidents or injury for individuals with any CM concern versus none. CONCLUSIONS The high rate ratios for ED visits in children with CM concern, especially for self-harm, substance use and mental health during adolescence and adulthood highlights the enduring mental health needs of victims of child maltreatment, providing further impetus for prevention.
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Affiliation(s)
- Emmanuel S Gnanamanickam
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia.
| | - Ha Nguyen
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia
| | - Jason M Armfield
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - James C Doidge
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; Intensive Care National Audit and Research Centre, London, UK; UCL Great Ormond Institute of Child Health, University College London, London, UK
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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50
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Orr C, Fisher CM, Glauert R, Preen DB, O'Donnell M, Ed D. A Demographic Profile of Mothers and Their Children Who Are Victims of Family and Domestic Violence: Using Linked Police and Hospital Admissions Data. J Interpers Violence 2022; 37:NP500-NP525. [PMID: 32370589 DOI: 10.1177/0886260520916272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to examine the key sociodemographic characteristics of Australian mothers and their children who were victims of family and domestic violence (FDV) that resulted in the male perpetrator being criminally charged for the offense or the mother being hospitalized. A population-based retrospective cohort study using de-identified linked health and police data of mothers with children born 1987-2010 who were victims of FDV 2004-2008 was utilized. Results indicate that mothers who were identified in police data are different demographically from those identified in health data and differed again from mothers identified in both health and police data. Within Western Australia, 3% of the population identify as Aboriginal; however, 44% of mothers identified as victims in police data and 73% within the health data were Aboriginal. Of the mothers identified in police data, 30% were under 25 years of age at their first assault recorded in police data compared with 21% in those identified in both police and hospital data. Most mothers identified as victims of FDV in police data had children present at their assault (60.6%). Prevalence of FDV exposure, identified in police data, was significantly different in Aboriginal children compared with non-Aboriginal children. Aboriginal children had a 19-fold (p < .0001) increased difference in prevalence of exposure compared with their non-Aboriginal counterparts. The study reveals the challenges in identifying victims of FDV when relying on a single data source for research and highlights the need for multiple datasets when investigating FDV. The overrepresentation of Aboriginal mothers and children should be taken in the context of the long-lasting impact of colonization. As such, prevention and early intervention strategies need to be underpinned by Aboriginal communities' cultural authority.
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Affiliation(s)
- Carol Orr
- The University of Western Australia, Perth, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Rebecca Glauert
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - David B Preen
- The University of Western Australia, Perth, Australia
| | | | - Dip Ed
- Telethon Kids Institute, Perth, Western Australia, Australia
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