Corrigendum to: Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

231The West Australian Burden of Disease Study 2015: mental health in Aboriginal West Australians

Background

Mental disorders represent a growing health problem: an estimated 45% of Australians experience a mental disorder in their lifetime. The Western Australian (WA) Burden of Disease study 2015 produced detailed data for sub-populations within the state to inform policy and planning. Using this, we describe the burden of mental, substance use disorders and self-inflicted injuries in the WA Aboriginal population.

Methods

The study generated estimates for over 200 diseases to create ranked disease-level estimates of burden in the WA Aboriginal population for the first time. Eleven individual conditions in the mental disorders disease group, and suicide and self-inflicted injuries were analysed.

Results

Mental disorders contributed 18% of Aboriginal male and 16% of Aboriginal female DALYs in WA. Among Aboriginal males, alcohol use disorders ranked 3rd among all diseases (ASR: 33.6 DALYs per 1,000 males). Among Aboriginal females, anxiety disorders ranked 3rd (ASR: 17.3 per 1,000 females). Suicide and self-inflicted injuries ranked 2nd among all diseases among Aboriginal males (ASR: 39.8 DALYs per 1,000 males) and 5th among Aboriginal females (ASR: 10.8 per 1,000 females).

Conclusions

The study highlighted the high burden of disease from mental disorders and self-inflicted injuries among Aboriginal West Australians: self-inflicted injuries, alcohol use disorders and anxiety disorders ranked in the top 10 of all diseases.

Key messages

Mental disorders contribute substantially to the disease burden in WA among the Aboriginal residents. The findings can inform health policy and planning around mental health in the Aboriginal population, as well as informing social and liquor licensing policy.

Value of a national burden-of-disease study: a comparison of estimates between the Australian Burden of Disease Study 2015 and the Global Burden of Disease Study 2017

BACKGROUND

Estimates of burden of disease are important for monitoring population health, informing policy and service planning. Burden estimates for the same population can be reported differently by national studies [e.g. the Australian Burden of Disease Study (ABDS) and the Global Burden of Disease Study (GBDS)].

METHODS

Australian ABDS 2015 and GBDS 2017 burden estimates and methods for 2015 were compared. Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life Years (DALY) measures were compared for overall burden and 'top 50' causes. Disease-category definitions (based on ICD-10), redistribution algorithms, data sources, disability weights, modelling methods and assumptions were reviewed.

RESULTS

GBDS 2017 estimated higher totals than ABDS 2015 for YLL, YLD and DALY for Australia. YLL differences were mainly driven by differences in the allocation of deaths to disease categories and the redistribution of implausible causes of death. For YLD, the main drivers were data sources, severity distributions and modelling strategies. Most top-50 diseases for DALY had a similar YLL:YLD composition reported.

CONCLUSIONS

Differences in the ABDS and GBDS estimates reflect the different purposes of local and international studies and differences in data and modelling strategies. The GBDS uses all available evidence and is useful for international comparisons. National studies such as the ABDS have the flexibility to meet local needs and often the advantage of access to unpublished data. It is important that all data sources, inputs and models be assessed for quality and appropriateness. As studies evolve, differences should be accounted for through increased transparency of data and methods.

The attitudes and knowledge of medical students towards surrogacy

We aimed to evaluate the attitudes and knowledge of medical students' towards surrogacy as a means of assisted reproduction. An online survey was sent to medical students from UK universities, 185 anonymous replies were received. A total of 72.2% agreed with surrogacy as a means of assisted reproduction; 43.9% thought the intended mother was the legal mother at birth; 28.7% correctly identified the surrogate mother as the legal mother; 76.0%felt that the intended mother should be the legal mother at birth; 15.2% thought surrogacy arrangements were enforceable by law; 29.2% correctly knew they were not. There was no difference in knowledge of surrogacy among students who had studied obstetrics and gynaecology compared with those who had not. Medical students were generally tolerant in their attitudes to surrogacy. There were discrepancies between the position of UK law governing surrogacy and the personal views of medical students.

Pulmonary embolism: even your patient is at risk

The American Society of Plastic Surgeons' Clinical Guidelines specifically focuses on reducing complications from deep vein thrombosis and pulmonary embolism (PE). The incidence of these problems in plastic surgery is low. A 1998 survey of plastic surgeons found the incidence of deep vein thrombosis and PE in facelift patients to be 0.39% and 0.16% respectively (McDevitt, 1999). Despite the low occurrence of these complications in plastic surgical patients, PE is the third leading cause of death in the United States. PE is evasive and often deadly and therefore requires respect and understanding by all members of the health care team.

Taxing health benefits: snake oil ... or smart health policy?

Limiting the tax-free treatment of employer-paid health benefits is a cornerstone of managed competition, the health reform approach favored by the Clinton Administration. Organized labor argues that the idea is a double-whammy for wage-strapped workers, while a leading academic calls it a good solution to one of the nation's worst public policies.

Achieving healthy weights

Only 5% of patients dieting to achieve permanent weight loss will be successful and reap the associated health benefits. Ninety-five percent will be unsuccessful. The health implications of failed dieting attempts are numerous and include negative effects on both physical and psychological well-being. Better alternatives to dieting help patients take small, positive, enjoyable steps toward healthy eating, active living, and a positive self-image.

Coronary artery bypass grafting in a predominately black group of patients

The preoperative profiles of a predominately non-white group of patients undergoing coronary artery bypass grafting were reviewed. Data were obtained from a retrospective analysis of medical records of 163 patients operated on at Howard University Hospital between July 1983 and July 1986. The analysis was carried out primarily to determine whether patients requiring myocardial revascularization were somehow different from their non-black counterparts. Ninety-one percent of the patients were black, 5 percent white, 0.5 percent Hispanic, and 3.5 percent others (Iranian, Filipino, etc).The study was not designed to review the prevalence of coronary disease in blacks, or to determine the natural history following coronary artery bypass grafting, but to determine whether those with established coronary disease of such a severity as to warrant revascularization had the usual clustering of risk factors. Patient records were reviewed to determine the prevalence of hypertension, diabetes, obesity, cigarette smoking, previous myocardial injury, and total serum cholesterol. Because of the well-recognized increased incidence of hypertension in black patients, and its role as a major risk factor in coronary heart disease, the sequelae of hypertension were considered in relation to results of surgical therapy.The study population included 93 men (57 percent) and 70 women (43 percent); mean age was 59 years (fourth to ninth decade). Seventy-four percent of the patients were hypertensive, 35 percent were diabetic, and 77 percent had a smoking history. Obesity was prevalent among the female patients in general, with 36 percent of the diabetics and 21 percent of the nondiabetics being greater than 50 percent over ideal body weight. Ninety percent of the female patients and 80 percent of the male patients presented with New York Heart Association class III or IV angina. Left ventricular function was, on the average, well preserved. The immediate surgical mortality (following exclusion of patients in extremis) was 4 percent. The surgical mortalities were related to easily identifiable factors. Peri-operative infarctions were profoundly influenced by the presence of diabetes.Although this group was distinguished from most reported groups of patients undergoing aortocoronary bypass grafting by the presence of advanced age, the large percentage of women and diabetics and the marked prevalence of hypertension, and the usual risk factors for coronary artery disease reported in the majority population, the study reconfirms previous epidemiologic findings. It appears that racial "clumping" of a heterogeneous non-white population has minimal usefulness, except as it may be related to socioeconomic status and access to quality health care.

Chronic primary chylopericardium. Report of a case and review of the literature

The case of a 36-year-old white man who had recurrent milky pericardial effusion and repeated pericardiocenteses over a period of 1 year with minimal disability or symptoms is presented. Surgical management included thoracotomy with ligation of all structures resembling lymphatic channels in the chest in several places and hemipericardiectomy. Neither the source of chyle in the pericardium nor the etiological agent of this condition could be found. Criteria for successful management of this condition are re-emphasized.