The future burden of oesophageal and stomach cancers attributable to modifiable behaviours in Australia: a pooled cohort study

BACKGROUND

We quantified the individual and joint contribution of contemporaneous causal behavioural exposures on the future burden of oesophageal and stomach cancers and their subtypes and assessed whether these burdens differ between population groups in Australia, as such estimates are currently lacking.

METHODS

We combined hazard ratios from seven pooled Australian cohorts (N = 367,058) linked to national cancer and death registries with exposure prevalence from the 2017-2018 National Health Survey to estimate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death.

RESULTS

Current and past smoking explain 35.2% (95% CI = 11.7-52.4%), current alcohol consumption exceeding three drinks/day 15.7% (95% CI = 0.9-28.4%), and these exposures jointly 41.4% (95% CI = 19.8-57.3%) of oesophageal squamous cell carcinomas in Australia. Current and past smoking contribute 38.2% (95% CI = 9.4-57.9%), obesity 27.0% (95% CI = 0.6-46.4%), and these exposures jointly 54.4% (95% CI = 25.3-72.1%) of oesophageal adenocarcinomas. Overweight and obesity explain 36.1% (95% CI = 9.1-55.1%), current and past smoking 24.2% (95% CI = 4.2-40.0%), and these exposures jointly 51.2% (95% CI = 26.3-67.8%) of stomach cardia cancers. Several population groups had a significantly higher smoking-attributable oesophageal cancer burden, including men and those consuming excessive alcohol.

CONCLUSIONS

Smoking is the leading preventable behavioural cause of oesophageal cancers and overweight/obesity of stomach cancers.

Transitions in health service use among women with poor mental health: a 7-year follow-up

OBJECTIVE

Women suffering from mental health problems require varied needs of mental health service utilisation. Transition between general practitioner and mental health services use are available through the Better Access Scheme initiative, for those in need of treatment. The study's aim was to identify trajectories of mental health service utilisation by Australian women.

DESIGN

The Australian Longitudinal Study on Women's Health data linked to the administrative medical claims dataset were used to identify subgroups of women profiled by their mental health service use from 2006 to 2013. Latent growth mixture model is a statistical method to profile subgroups of individuals based on their responses to a set of observed variables allowing for changes over time. Latent class groups were identified, and used to examine predisposing factors associated with patterns of mental health service use change over time.

SETTING

This study was conducted in Australia.

PARTICIPANTS

National representative sample of women of born in 1973-1978, who were aged between 28 and 33 years at the start of our study period.

RESULTS

Six latent class trajectories of women's mental health service use were identified over the period 2006-2013. Approximately, one-quarter of the sample were classified as the most recent users, while approximate equal proportions were identified as either early users, late/low user or late-high users. Additional, subgroups were defined as the consistent-reduced user and the late-high users, over time. Only 7.2% of the sample was classified as consistent high users who potentially used the services each year.

CONCLUSION

These findings suggest that use of the Better Access Scheme mental health services through primary care was varied over time and may be tailored to each individual's needs for the treatment of depressive symptoms.

Validation of a residential aged care consumer experience survey, 2019

OBJECTIVES

Residential aged care (RAC) quality is often measured as part of regulatory compliance. To inform care delivery and service improvements, we developed a consumer experience survey.

METHODS

Validation study incorporating 2018-2019 survey data (n = 1504 individuals, 25 RAC homes) and test-retest reliability evaluation.

RESULTS

Most of the respondents were women (67%) with 38% of the surveys completed by residents, 39% with staff support, and 23% by family members. Moderate-to-high correlations (0.46-0.84) between individual items indicate the survey is a coherent measure of satisfaction; good inter-item correlation was found across all sections (0.61-0.70) with high internal consistency (Cronbach's alpha 0.90-0.94); and moderate correlation for test-retest reliability was found on the same individual when providing an overall recommendation score (individual ICC 0.684).

CONCLUSIONS

The RAC Consumer Experience Survey is a validated measure of lived experience and satisfaction that aligns closely with the Australian Aged Care Quality Standards, affording providers a standardised tool for benchmarking and informing care quality across the sector.

Thyroid cancers potentially preventable by reducing overweight and obesity in Australia: A pooled cohort study

Thyroid cancer incidence and the prevalence of overweight and obesity are increasing, but the future thyroid cancer burden attributable to contemporary levels of overweight and obesity has not been evaluated before. We quantified this burden in Australia, and assessed whether the overweight/obesity-attributable burden differed by sex or other population subgroupings. We estimated the strength of the associations of overweight and obesity with thyroid cancer with adjusted proportional hazards models using pooled data from seven Australian cohorts (N = 367 058) with 431 thyroid cancer cases ascertained from linked national cancer registry data during a maximum 22-year follow-up. We combined these estimates with nationally representative 2017 to 2018 estimates of overweight and obesity prevalence to estimate population attributable fractions (PAFs) of future thyroid cancers attributable to overweight and obesity, accounting for competing risk of death, and compared PAFs for population subgroups. Contemporary levels of overweight and obesity explain 18.6% (95% confidence interval [CI] = 5.2%-30.2%), and obesity alone 13.7% (95% CI: 5.2%-21.4%), of the future thyroid cancer burden. The obesity-attributable thyroid cancer burden is 21.4% (95% CI: 2.8%-36.5%) for men and 10.1% (95% CI: 0.8%-18.6%) for women. Were the currently obese overweight instead, 9.9% (95% CI: 1.0%-18.1%) of thyroid cancers could be avoided. The relative overweight/obesity-attributable burden is higher for those consuming on average more than two alcoholic drinks per day (63.4%) and for those who are not married/co-habiting (33.2%). In conclusion, avoiding excess weight, especially obesity, should be a priority for thyroid cancer prevention. Further studies, with findings stratified by tumour size, may reveal the potential role of overdiagnosis in our results.

704The preventable future burden of cancer in Australia

Background

Estimates of the future burden of invasive cancer attributable to current modifiable causal exposures can guide cancer prevention.

Methods

We linked pooled data from seven Australian cohort studies (N = 367,058) to national cancer and death registries, and estimated exposure-cancer and exposure-death associations using adjusted proportional hazards models. We estimated exposure prevalence from contemporary national health surveys and calculated population attributable fractions (PAFs) and 95% confidence intervals, using advanced methods accounting for competing risk of death.

Results

Current levels of past and current smoking explain 36.1% (95%CI 33.2%-38.9%), body fatness 13.6% (10.9%-16.2%) and alcohol consumption exceeding two drinks/day 2.3% (1.0%-3.6%) of cancers causally related to these exposures, corresponding to 210,000, 81,300 and 14,800 cancers in Australia in the next 10 years, respectively. Ever smoking is the leading modifiable cause of lung (82.1%), bladder (49.8%), oesophageal (42.8%), liver (39.8%), head and neck (35.6%), and pancreatic (21.3%) cancer burden. Body fatness is the leading modifiable cause of corpus uteri (42.5%), gastric cardia (33.6%), renal cell (29.1%), thyroid (20.1%), colorectal (12.6%) and postmenopausal breast (12.6%) cancer burden. The absolute numbers of cancers in the next 10 years attributable to smoking are highest for lung cancer (114,000). The numbers of cancers attributable to body fatness and alcohol are highest for colorectal cancer (23,000 and 9,900, respectively).

Conclusions

More reliable advanced methods demonstrate large proportions and numbers of cancers are preventable by modifying behaviours.

Key messages

Ever smoking and body fatness are the leading causes of preventable future burden of causally related cancers in Australia.

Polypharmacy trajectories among older women with and without dementia: A longitudinal cohort study

Background

Objective

Method

Results

Conclusion

Determinants of driving among oldest-old Australian women

This study examined predictors of driving among oldest-old Australian women in their late 80s in accordance with the World Health Organization's healthy aging framework. The study used data from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, wave-6 (n = 4025). The result of the multivariable logistic regression showed providing care, living alone, volunteering, living in rural/outer regional Australia, having higher educational attainment, and social interactions were associated with driving. The findings indicate driving should not be dismissed based on age alone. Policymakers need to also consider social roles, driving environment and context with the goals of healthy aging.

Housing and Care for Older Women in Australia

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs.

Methods: Data from 12,432 women in the 1921–26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life.

Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services.

Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.

Exposure to heavy metals from point pollution sources and risk of incident type 2 diabetes among women: a prospective cohort analysis

Heavy metal exposures may contribute to diabetes risk but prospective studies are uncommon. We analyzed the Australian Longitudinal Study on Women's Health (three cohorts aged 18-23, 45-50, or 70-75 at baseline in 1996, N = 34,191) merged with emissions data for 10 heavy metals (As, Be, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn) from the National Pollutant Inventory. Over 20-year follow-up, 2,584 women (7.6%) reported incident diabetes. Cox proportional hazards regression models showed that women aged 45-50 at baseline had higher diabetes risk in association with exposure to total air emissions, total water emissions, all individual metals air emissions, and six individual water emissions. After correction for false discovery rate, nine of 11 air emissions and five water emissions remained significant. Associations were not observed for land-based emissions, or for younger or older cohorts. Emissions were dominated by mining, electricity generation and other metals-related industrial processes.

The Future Burden of Head and Neck Cancers Attributable to Modifiable Behaviors in Australia: A Pooled Cohort Study

BACKGROUND

Estimates of future burden of cancer attributable to current modifiable causal exposures can guide cancer prevention. We quantified future head and neck cancer burden in Australia attributable to individual and joint causal exposures, and assessed whether these burdens differ between population subgroups.

METHODS

We estimated the strength of the associations between exposures and head and neck cancer using adjusted proportional hazards models from pooled data from seven Australian cohorts (N = 367,058) linked to national cancer and death registries and estimated exposure prevalence from the 2017 to 2018 Australian National Health Survey. We calculated population attributable fractions (PAF) with 95% confidence intervals (CI), accounting for competing risk of death, and compared PAFs for population subgroups.

RESULTS

Contemporary levels of current and former smoking contribute 30.6% (95% CI, 22.7%-37.8%), alcohol consumption exceeding two standard drinks per day 12.9% (95% CI, 7.6%-17.9%), and these exposures jointly 38.5% (95% CI, 31.1%-45.0%) to the future head and neck cancer burden. Alcohol-attributable burden is triple and smoking-attributable burden is double for men compared with women. Smoking-attributable burden is also at least double for those consuming more than two alcoholic drinks daily or doing less than 150 minutes of moderate or 75 minutes of vigorous activity weekly, and for those aged under 65 years, unmarried, with low or intermediate educational attainment or lower socioeconomic status, compared with their counterparts.

CONCLUSIONS

Two-fifths of head and neck cancers in Australia are preventable by investment in tobacco and alcohol control.

IMPACT

Targeting men and other identified high-burden subgroups can help to reduce head and neck cancer burden disparities.

Impact of Diabetes on Life and Healthy Life Expectancy Among Older Women

BACKGROUND

Diabetes is a major chronic condition with ever-increasing health and economic burden. This study aimed to measure the impact of diabetes on total life expectancy (TLE) and healthy life expectancy (HLE) at ages 70 and 80 and to assess how educational level, obesity, and comorbidity affected the expectancies.

METHODS

The study involved 9849 population-representative women born between 1921 and 1926 from the Australian Longitudinal Study on Women's Health (ALSWH). Self-rated health was obtained from the ALSWH surveys. Diabetes diagnosis was ascertained using survey and health care administrative data. Total life expectancy and HLE were estimated for women with and without diabetes using multistate modeling.

RESULTS

Diabetes was associated with an increased risk of poor health (adjusted risk ratio: 1.63, 95% confidence interval: 1.49-1.79). Diabetes was also associated with a reduction of 0.9 years in HLE and 2.6 years in TLE at age 70 and 0.4 years in HLE and 1.3 years in TLE at age 80. If a woman had low education, obesity, and more than 2 comorbidities in addition to diabetes, these reductions increased to 3.0 years in TLE and 7.9 years in HLE at age 70 and 1.5 years in TLE and 3.8 years in HLE at age 80.

CONCLUSIONS

Diabetes substantially reduced older women's quantity and quality of life, with further reductions for those with lower education, obesity, and comorbidities. These findings underscore the importance of optimally managing diabetes by maintaining a healthy weight and delaying the onset of comorbidities, to promote healthy aging for older women with diabetes.

BMI trajectory and subsequent risk of type 2 diabetes among middle-aged women

BACKGROUND AND AIMS

Little is known about how weight trajectories among women during menopausal transition and beyond may be related to risk of type 2 diabetes mellitus (T2DM). The aim of this study was to examine associations between body mass index (BMI) trajectories over 20 years, age of obesity onset, cumulative obese-years and incidence of T2DM among middle-aged women.

METHODS AND RESULTS

12,302 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed in 1996 (Survey 1, age 45-50), 1998 and then every three years to 2016. Self-reported weight and height were collected for up to eight time points. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes. Growth mixture models were used to identify distinct BMI trajectories. A total of 1380 (11.2%) women newly developed T2DM over an average 16 years of follow-up. Seven distinct BMI trajectories were identified with differential risk of developing T2DM. Initial BMI was positively associated with T2DM risk. We also observed that risk of T2DM was positively associated with rapid weight increase, early age of obesity onset and greater obese-years.

CONCLUSION

Slowing down weight increases, delaying the onset of obesity, or reducing cumulative exposure to obesity may substantially lower the risk of developing T2DM.

Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D

PURPOSE

To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores.

METHODS

This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA₂DS₂-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only.

RESULTS

The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility.

CONCLUSION

This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.

Patterns of Medications for Atrial Fibrillation Among Older Women: Results From the Australian Longitudinal Study on Women's Health

PURPOSE

Examine patterns of medication use, changes in medication patterns over time, and investigate factors associated with medication patterns among older Australian women with Atrial Fibrillation (AF).

METHODS

It is a retrospective analysis of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), diagnosed with AF between 2000-2015 (N = 1206). Survey data of these women was linked with national registries for medications and death. Latent Transition Analysis (LTA) identified distinct patterns of medication use and transitions among these patterns for 3 consecutive years following AF diagnosis. LTA with co-variates determined the factors associated with latent status membership.

RESULTS

One-tenth (9.6%, 11.7%, 11.4%) of the study population did not receive any medication for AF in all 3 years following AF diagnosis and about 60% did not receive any medication for the prevention of thromboembolism. Among those who received medications, almost three-quarters (76.6%, 68.4%, 68.5%) received some kind of combination of medications. LTA indicated at least 6 different patterns of AF medications. These patterns had transition probabilities >85% for most of the latent statuses. All factors but diabetes mellitus among the CHA₂DS₂-VA scoring scheme were independently associated with latent status membership at the time of AF diagnosis.

CONCLUSIONS

Evaluation of pharmacological treatment indicates that prevention of thromboembolism is inadequate among women with AF. There exists wide variations in medication patterns. However, once in a particular pattern, women are likely to continue the same medications long-term. This underscores the importance of initial assessment of patient profile and stroke risk score in determining the treatment for AF. Failure to assess risk makes women susceptible to devastating AF complications.

Age and cohort rise in diabetes prevalence among older Australian women: Case ascertainment using survey and healthcare administrative data

BACKGROUND

Due to the absence and or costliness of biological measures such as glycated haemoglobin, diabetes case ascertainment and prevalence studies are usually conducted using surveys or routine health service use databases. However, the use of each of these sources is associated with its limitations potentially impacting the quality of the case ascertainment and prevalence estimation. This study aimed at ascertaining diabetes cases and estimating prevalence among mid- and older-age women through simultaneous use of a longitudinal survey and multiple healthcare administrative data sources.

METHODS

Data were available for 12,432 and 13,714 women born in 1921-26 and 1946-51 from the Australian Longitudinal Study on Women's Health (ALSWH). Diabetes was ascertained using the ALSWH survey, health service use, and cause of death data. Parsimonious multiple logistic regression analyses tested associations between sociodemographic and health variables and the presence of diabetes.

RESULTS

In both cohorts, two or more of the sources captured more than 80% of the women with diabetes. The point prevalence of diabetes increased from 8.4% when the mean age of the women were aged 73, to 22.0% of surviving women at age 90 in the 1921-26 cohort; and from 2.6% at age 48 to 15.8% at age 68 in the 1946-51 cohort. In the 1921-26 cohort, women who were obese (OR: 3.56; 95 CI: 3.04-4.17) and women who were sedentary (OR: 1.18; 95 CI: 1.09-1.40) were more likely to have diabetes compared to those who had a normal weight and engaged in a moderate level of physical activity. In the 1946-51 cohort, the odds of diabetes increased three times (OR: 2.99; 95 CI: 2.54-3.52) for overweight women and nine times (OR: 8.78; 95 CI: 7.46-10.33) for obese women compared to those who had normal weight.

CONCLUSIONS

The simultaneous use of multiple data sources improved the validity of diabetes case ascertainment. Application of this methodology in future studies may have important benefits including estimation of disease burden, health service needs, and resource allocation with improved precision. Diabetes prevalence increased with age, was much higher in the 1946-51 cohort than in 1921-26 at similar ages, and was significantly associated with physical inactivity and obesity. Interventions to promote physical activity and a healthy weight are needed to prevent the rising prevalence of diabetes across successive generations.

Latent Class Analysis of Low Birth Weight and Preterm Delivery among Australian Women

OBJECTIVES

To identify patterns of health, socioeconomic, behavioral, and psychosocial indicators that may be associated with low birth weight delivery or preterm birth.

STUDY DESIGN

Data were analyzed from the Australian Longitudinal Study on Women's Health. A total of 9075 live singleton births among 3801 women were linked to state perinatal records with birth outcome data. Survey data were used to identify 11 indicators for latent class analysis. Latent classes were tested for association to birth outcomes. These indicators also were used along with covariates in main effect multiple logistic regression analyses of birth outcomes.

RESULTS

Latent class analysis revealed 5 classes, including those characterized by low education, recent drug use, stress/anxiety/depression, smoking/drinking/low education/multi-risk, and a low risk referent group. The stress/anxiety/depression class was associated with preterm delivery (OR 1.87, 95% CI 1.20-2.92), and the smoking/drinking/low education/multirisk class was associated with low birth weight (OR 1.54, 95% CI 1.02-2.30). Traditional logistic regression analyses for main effects identified some measures not captured by the latent classes, and the latent classes identified variable combinations not captured by the main effect analysis.

CONCLUSIONS

Unique latent classes were associated with preterm delivery vs low birth weight. Both latent class analysis and main effects analyses may be combined to improve understanding of birth outcome risks. Clinical and programmatic interventions to reduce risks of low birth weight and preterm delivery may benefit from risk profiles that women experience.

Age of obesity onset, cumulative obesity exposure over early adulthood and risk of type 2 diabetes

AIMS/HYPOTHESIS

Obesity is a risk factor for type 2 diabetes, yet little is known about how timing and cumulative exposure of obesity are related to disease risk. The aim of this study was to examine the associations between BMI trajectories, age of onset of obesity and obese-years (a product of degree and duration of obesity) over early adulthood and subsequent risk of type 2 diabetes.

METHODS

Women aged 18-23 years at baseline (n = 11,192) enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) in 1996 were followed up about every 3 years via surveys for up to 19 years. Self-reported weights were collected up to seven times. Incident type 2 diabetes was self-reported. A growth mixture model was used to identify distinct BMI trajectories over the early adult life course. Cox proportional hazards regression models were used to examine the associations between trajectories and risk of diabetes.

RESULTS

One hundred and sixty-two (1.5%) women were newly diagnosed with type 2 diabetes during a mean of 16 years of follow-up. Six distinct BMI trajectories were identified, varying by different initial BMI and different slopes of increase. Initial BMI was positively associated with risk of diabetes. We also observed that age at onset of obesity was negatively associated with risk of diabetes (HR 0.87 [95% CI 0.79, 0.96] per 1 year increment), and number of obese-years was positively associated with diabetes (p for trend <0.0001).

CONCLUSIONS/INTERPRETATION

Our data revealed the importance of timing of obesity, and cumulative exposure to obesity in the development of type 2 diabetes in young women, suggesting that preventing or delaying the onset of obesity and reducing cumulative exposure to obesity may substantially lower the risk of developing diabetes.

Obesity Risk Among Young Australian Women: A Prospective Latent Class Analysis

OBJECTIVE

Prospective studies on obesity incidence specifically among young adults have not been reported. This study examined risks of obesity incidence over 19 years among young women without obesity at baseline.

METHODS

Women aged 18 to 23 years at baseline (N = 8,177) were followed up every 2 to 3 years to ages 37 to 42 using the Australian Longitudinal Study on Women's Health. A latent class analysis identified obesity-risk classes based on time-dependent measures of income, education, physical activity, sleep quality, dietary behavior, depression, stressful events, and social functioning. Cox proportional hazards regression models examined associations between incident obesity and latent classes, controlling for covariates.

RESULTS

Four latent classes were identified, including a lower-risk referent class and classes characterized by poor exercise and diet, stress and low income, and multiple intermediate-level risks. Compared with the referent, all three risk classes had significantly higher obesity risk, with the highest risk in the stress and low-income group (hazard ratio = 2.22; 95% CI: 1.92-2.56). Individual risks associated with obesity included lower education, stressful life events, and lower vigorous physical activity.

CONCLUSIONS

Young women without baseline obesity were at risk of developing obesity when they experienced co-occurring behavioral, socioeconomic, and psychosocial risks. Both latent classes and individual risk indicators offer insights into prevention strategies.

Air pollution exposures from multiple point sources and risk of incident chronic obstructive pulmonary disease (COPD) and asthma

BACKGROUND

Exposure to environmental air pollutants exacerbates respiratory illness, but prospective studies of disease incidence are uncommon. Further, attempts to estimate effects from multiple point sources have rarely been undertaken. The current study examined risk of incident chronic obstructive pulmonary disease (COPD) and asthma in association with emissions of multiple air pollutants from point pollution sources in Australia.

METHODS

We analyzed prospective cohort data from the Australian Longitudinal Study on Women's Health. Women from three age-cohorts (N = 35,755) were followed for up to 21 years for incident COPD and asthma. Exposures were measured from the National Pollutant Inventory and included carbon monoxide, nitrogen oxides, sulfur dioxide, and particulate matter (PM2.5 and PM10). We identified inverse-distance weighted emissions in kilograms that women experienced over time from point sources within 10 km of their residences. Cox proportional hazards regression models examined risk of self-reported doctor-diagnosed COPD and asthma in association with pollutant exposures and covariates.

RESULTS

New COPD cases numbered 3616 (11.5%) and new asthma cases numbered 2725 (9.4%). Participants were exposed to an average of 47-59 sites with air pollution emissions within 10 km of their residences. Fossil fuel electricity generation and mining made the largest contributions to air pollution but hundreds of other types of emissions also occurred. Controlling for covariates, all five air pollutants modeled individually were significantly associated with risk of COPD. Modeled jointly, only sulfur dioxide (SO₂) remained significantly associated with COPD (HR = 1.038, 95% CI = 1.010-1.067), although the five pollutants were highly correlated (r = 0.89). None of the pollutants were significantly associated with adult onset asthma. Cohort-specific analyses indicated that COPD risk was significantly associated with SO₂ exposure for younger (HR = 1.021, CI = 1.001-1.047), middle-age (HR = 1.019, CI = 1.004-1.034) and older cohorts (HR = 1.025, CI = 1.004-1.047).

CONCLUSIONS

Multiple exposure sources and pollutants contributed to COPD risk, including electricity generation and mining but extending to many industrial processes. The results highlight the importance of policy efforts and technological improvements to reduce harmful air pollution emissions across the industrial landscape.

Successful ageing from old to very old: a longitudinal study of 12,432 women from Australia

OBJECTIVES

We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women's later life.

METHODS

We used survey data from 12,432 participants of the 1921-26 birth cohort of the Australian Longitudinal Study of Women's Health from 1996 (age 70-75) to 2016 (age 90-95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants' baseline characteristics and membership of the latent classes.

RESULTS

Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support.

CONCLUSIONS

The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Trajectories of Long-Term Residential Care Needs Among Older Australian Women: A Cohort Study Using Linked Data

OBJECTIVE

Older women are more likely than men to enter residential aged care (RAC) and generally stay longer. We aimed to identify and examine their trajectories of care needs over time in RAC across 3 fundamental care needs domains, including activities of daily living (ADL), behavior, and complex health care.

DESIGN

Population-based longitudinal cohort study.

SETTING

RAC facilities in Australia.

PARTICIPANTS

A total of 3519 participants from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who used permanent RAC between 2008 and 2014.

METHODS

We used data from the Aged Care Funding Instrument, National Death Index, and linked ALSWH survey. Participants' care needs in the 3 domains were followed every 6 months up to 60 months from the date of admission to RAC. Trajectories of care needs over time were identified using group-based multitrajectory modeling.

RESULTS

Five distinct trajectory groups were identified, with large variation in the combinations of levels of care needs over time. Approximately 28% of residents belonged to the "high dependent-behavioral and complex need" group, which had high care needs in all 3 domains over time, whereas around one-third of residents (31%) were included in 2 trajectory groups ("less dependent-low need" and "less dependent-increasing need"), which had low or low to medium care needs over time. More than two-fifths of residents (41%) comprised 2 trajectory groups ("high dependent-complex need" and "high dependent-behavioral need"), which had medium to high care needs in 2 domains. Higher age at admission to RAC and multiple morbidities were associated with increased odds of being a member of the high dependent-complex need group than the less dependent-increasing need group.

CONCLUSIONS AND IMPLICATIONS

Identification of the differential trajectories of care needs among older women in RAC will help to better understand the circumstances of their changing care needs over time. This will facilitate appropriate care planning and service delivery for RAC residents, who are mostly older women.

Transitioning of older Australian women into and through the long-term care system: a cohort study using linked data

Background

Over two-thirds of older Australians use different types/levels of aged care at some point in later life. Our aims were to estimate transitional probabilities and to identify risk factors influencing the movement between different levels of long-term care.

Methods

The sample consisted of 9007 women from the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health. Transitional probabilities between different levels of long-term care were estimated using a continuous-time Markov model.

Results

An 11-fold transition rates ratio was observed for the movement from non-user to home and community care (HACC) versus non-user to residential aged care (RAC). The predicted probabilities of remaining in the non-user state, HACC, and RAC after 10 years from the baseline were .28, .24, and .11, respectively. While the corresponding probabilities of dying from these states were .36, .65, and .90. The risk of transitioning from the non-user state to either HACC or RAC was greater for participants who were older at baseline, widowed, living outside of major cities, having difficulties in managing income, or having chronic condition, poor/fair self-rated health, or lower SF-36 scores (p < .05).

Conclusion

Women spend a substantial period of their later life using long-term care. Typically, this will be in the community setting with a low level of care. The transition to either HACC or RAC was associated with several demographic and health-related factors. Our findings are important for the planning and improvement of long-term care among future generations of older people.

Trial registration

Not applicable.

Older women's patterns of home and community care use and transition to residential aged care: An Australian cohort study

OBJECTIVE

To examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC).

STUDY DESIGN

A prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women's Health who used HACC services between 2001 and 2014.

MAIN OUTCOME MEASURES

Time from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models.

RESULTS

Of the 8062 participants, 60% belonged to the 'basic HACC' group, who used few services minimally; 16% belonged to the 'moderate HACC' group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the 'complex HACC' group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p < 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 - 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20-1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38-1.72), having a physical functioning score <40 (sdHR = 1.16, 95%CI = 1.05-1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05-1.25).

CONCLUSIONS

Our findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.

Dietary patterns, dietary lead exposure and hypertension in the older Chinese population

BACKGROUND AND OBJECTIVES

With rapid population ageing and an increasing rate of hypertension in China, this study aims to examine the association between dietary patterns, dietary lead and hypertension among older Chinese population.

METHODS AND STUDY DESIGN

We analysed the 2009 China Health and Nutrition Survey data (2,634 individuals with dietary and hypertension measurement data, aged ≥60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Dietary lead intake is based on a published systematic review of food lead concentration and dietary lead exposure in China. Factor analysis was used to identify dietary patterns. Poisson regression and multinomial logistic regression models were used to explore the association between dietary patterns and hypertension.

RESULTS

The prevalence of hypertension was 47.0% in men and 48.9% in women. Traditional dietary pattern (high intake of rice, pork and vegetables) was significantly inversely associated with known hypertension. In the fully adjusted model, compared with the lowest quartile of traditional dietary pattern, the highest quartile had a lower risk of known hypertension, with Relative Risk Ratio=0.69 (95% CI: 0.50; 0.95). However, associations between modern dietary pattern and hypertension differed by urbanization; an inverse, positive and null association was seen in low, medium and high urbanization. Additionally, dietary lead showed a significant positive association with hypertension and known hypertension.

CONCLUSIONS

Policies that facilitate and promote healthy diets, and the availability of healthy foods particularly at the regional and local levels, are important for the prevention of hypertension.

Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Uptake, prevalence and predictors of first-time use for the 75+ Health Assessment Scheme

In 1999, the Australian Federal Government introduced Medicare items for Health Assessments for people aged 75 years and older (75+ health assessments). This research examined uptake of these assessments and identified predictors of use by women from the Australian Longitudinal Study on Women's Health (ALSWH). Assessments were identified for each year from 1999 to 2013 using linked Medicare data. Time to first assessment was examined, as well as social and health factors associated with having an assessment. From 1999 to 2013, 61.8% of women had at least one assessment. Almost one-third had an assessment within 2 years of their introduction, 25% of women died before having an assessment and 13% survived but did not have an assessment. Factors associated with assessment included being widowed, private health insurance, marital status, education, having arthritis and urinary incontinence, and less difficulty managing on income. Many women never received an assessment, and many only received one. Promotion of the 75+ health assessments is necessary among older women to increase uptake.

The future burden of kidney and bladder cancers preventable by behavior modification in Australia: A pooled cohort study

Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10-year follow-up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3-38.7%), current or past smoking 15.5% (CI = 6.0-24.1%) and these exposures jointly 39.6% (CI = 27.5-49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4-52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged <65 years (28.0%) and those consuming >2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change.

Factors associated with length of stay in hospital for men and women aged 85 and over: A quantile regression approach

OBJECTIVES

Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS).

DATA SOURCE/STUDY SETTING

NSW 45 and Up Study linked with hospital data.

STUDY DESIGN

Longitudinal cohort study.

METHODS

Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution.

PRINCIPAL FINDINGS

86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer.

CONCLUSIONS

Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

Predictors of 15-year survival among Australian women with diabetes from age 76-81

AIMS

To assess the impact of diabetes on the survival of older women, adjusted for other all-cause mortality predictors.

METHODS

Data were used from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, when the women were aged 76-81 years at baseline, with linkage to the National Death Index. Survival curves were plotted to compare the survival of women with no diabetes, incident diabetes and prevalent diabetes over 15 years. Cox proportional hazards models were used to examine the association between diabetes and all-cause mortality risks.

RESULTS

A total of 972 (11.7%) of 8296 eligible women reported either incident, 522 (6.3%) or prevalent, 450 (5.4%) diabetes. The median survival times were 10.1, 11.4 and 12.7 years among women with prevalent, incident and no diabetes, respectively. The risks of death were 30% [HR: 1.30 (95% CI: 1.16-1.45)] and 73% [HR: 1.73 (CI: 1.57-1.92)] higher for women with incident and prevalent diabetes compared to women without diabetes. These associations were sustained after controlling for demographics, body mass index, smoking status, comorbidities and health care use.

CONCLUSIONS

This study revealed that diabetes is associated with reduced survival probabilities for older women with minimal moderation after adjustment for other predictors. Our findings suggest that diabetes management guidelines for older women need to integrate factors such as comorbidities, smoking and being underweight to reduce the risk of mortality.

The preventable burden of endometrial and ovarian cancers in Australia: A pooled cohort study

OBJECTIVE

Evidence on the endometrial and ovarian cancer burden preventable through modifications to current causal behavioural and hormonal exposures is limited. Whether the burden differs by population subgroup is unknown.

METHODS

We linked pooled data from six Australian cohort studies to national cancer and death registries, and quantified exposure-cancer associations using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We then calculated Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups.

RESULTS

During a median 4.9 years follow-up, 510 incident endometrial and 303 ovarian cancers were diagnosed. Overweight and obesity explained 41.9% (95% CI 32.3-50.1) of the endometrial cancer burden and obesity alone 34.5% (95% CI 27.5-40.9). This translates to 12,800 and 10,500 endometrial cancers in Australia in the next 10 years, respectively. The body fatness-related endometrial cancer burden was highest (49-87%) among women with diabetes, living remotely, of older age, lower socio-economic status or educational attainment and born in Australia. Never use of oral contraceptives (OCs) explained 8.1% (95% CI 1.8-14.1) or 2500 endometrial cancers. A higher BMI and current long-term MHT use increased, and long-term OC use decreased, the risk of ovarian cancer, but the burden attributable to overweight, obesity or exogenous hormonal factors was not statistically significant.

CONCLUSIONS

Excess body fatness, a trait that is of high and increasing prevalence globally, is responsible for a large proportion of the endometrial cancer burden, indicating the need for effective strategies to reduce adiposity.

The burden of pancreatic cancer in Australia attributable to smoking

OBJECTIVE

To estimate the burden of pancreatic cancer in Australia attributable to modifiable exposures, particularly smoking.

DESIGN

Prospective pooled cohort study.

SETTING, PARTICIPANTS

Seven prospective Australian study cohorts (total sample size, 365 084 adults); participant data linked to national registries to identify cases of pancreatic cancer and deaths.

MAIN OUTCOME MEASURES

Associations between exposures and incidence of pancreatic cancer, estimated in a proportional hazards model, adjusted for age, sex, study, and other exposures; future burden of pancreatic cancer avoidable by changes in exposure estimated as population attributable fractions (PAFs) for whole population and for specific population subgroups with a method accounting for competing risk of death.

RESULTS

There were 604 incident cases of pancreatic cancer during the first 10 years of follow-up. Current and recent smoking explained 21.7% (95% CI, 13.8-28.9%) and current smoking alone explained 15.3% (95% CI, 8.6-22.6%) of future pancreatic cancer burden. This proportion of the burden would be avoidable over 25 years were current smokers to quit and there were no new smokers. The burden attributable to current smoking is greater for men (23.9%; 95% CI, 13.3-33.3%) than for women (7.2%; 95% CI, -0.4% to 14.2%; P = 0.007) and for those under 65 (19.0%; 95% CI, 8.1-28.6%) than for older people (6.6%; 95% CI, 1.9-11.1%; P = 0.030). There were no independent relationships between body mass index or alcohol consumption and pancreatic cancer.

CONCLUSIONS

Strategies that reduce the uptake of smoking and encourage current smokers to quit could substantially reduce the future incidence of pancreatic cancer in Australia, particularly among men.

The future burden of lung cancer attributable to current modifiable behaviours: a pooled study of seven Australian cohorts

Background

Knowledge of preventable disease and differences in disease burden can inform public health action to improve health and health equity. We quantified the future lung cancer burden preventable by behavioural modifications across Australia.

Methods

We pooled seven Australian cohort studies (n = 367 058) and linked them to national registries to identify lung cancers and deaths. We estimated population attributable fractions and their 95% confidence intervals (CIs) for modifiable risk factors, using risk estimates from the cohort data and risk factor exposure distribution from contemporary national health surveys.

Results

During the first 10-year follow-up, there were 2025 incident lung cancers and 20 349 deaths. Stopping current smoking could prevent 53.7% (95% CI, 50.0-57.2%) of lung cancers over 40 years and 18.3% (11.0-25.1%) in 10 years. The smoking-attributable burden is highest in males, those who smoke <20 cigarettes per day, are <75 years of age, unmarried, of lower educational attainment, live in remote areas or are healthy weight. Increasing physical activity and fruit consumption, if causal, could prevent 15.6% (6.9-23.4%) and 7.5% (1.3-13.3%) of the lung cancer burden, respectively. Jointly, the three behaviour modifications could prevent up to 63.0% (58.0-67.5%) of lung cancers in 40 years, and 31.2% (20.9-40.1%) or 43 300 cancers in 10 years. The preventable burden is highest among those with multiple risk factors.

Conclusions

Smoking remains responsible for the highest burden of lung cancer in Australia. The uneven burden distribution distinguishes subgroups that could benefit the most from activities to control the world's deadliest cancer.

Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BACKGROUND

Women live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.

METHODS

The sample consisted of 8768 women from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.

RESULTS

We identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.

CONCLUSIONS

Distinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.

A Large Linked Study to Evaluate the Future Burden of Cancer in Australia Attributable to Current Modifiable Behaviours

IntroductionThe cancer burden preventable through modifications to risk factors can be quantified by calculating their population attributable fractions (PAFs). PAF estimates require large, prospective data to inform risk estimates and contemporary population-based prevalence data to inform the current exposure distributions, including among population subgroups. Objectives and ApproachWe provide estimates of the preventable future cancer burden in Australia using large linked datasets. We pooled data from seven Australian cohort studies (N=367,058) and linked them to national registries to identify cancers and deaths. We estimated the strength of the associations between behaviours and cancer risk using a proportional hazards model, adjusting for age, sex, study and other behaviours. Exposure prevalence was estimated from contemporary National Health Surveys. We harmonised risk factor data across the data sources, and calculated PAFs and their 95% confidence intervals using a novel method accounting for competing risk of death and risk factor interdependence. ResultsDuring the first 10-years follow-up, there were 3,471 incident colorectal cancers, 640 premenopausal and 2,632 postmenopausal breast cancers, 2,025 lung cancers and 22,078 deaths. The leading preventable causes were current smoking (53.7% of lung cancers), body fatness or BMI ≥ 25kg/m2 (11.1% of colorectal cancers, 10.9% of postmenopausal breast cancers), and regular alcohol consumption (12.2% of premenopausal breast cancers). Three in five lung cancers, but only one in four colorectal cancers and one in five breast cancers, were attributable to modifiable factors, when we also considered physical inactivity, dietary and hormonal factors. The burden attributable to modifiable factors was markedly higher in certain population subgroups, including men (colorectal, lung), people with risk factor clustering (colorectal, breast, lung), and individuals with low educational attainment (breast, lung). Conclusion/ImplicationsEstimating PAFs for modifiable risk factors across cancers using contemporary exposure prevalence data can inform timely public health action to improve health and health equity. Testing PAF effect modification may identify population subgroups with the most to gain from programs that support behaviour change and early detection.

The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study

BACKGROUND

Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences.

METHODS

We pooled data from seven prospective Australian cohort studies (n = 367 058) and linked them to national registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests were two-sided.

RESULTS

During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] = 19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, P difference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, P difference = .047). We observed modification of the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace.

CONCLUSIONS

We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed novel differences between men and women, and other high-CRC burden subgroups that could potentially benefit most from programs that support behavioral change and early detection.

The impact of childhood parental quality on mental health outcomes in older adults

OBJECTIVE

Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.

METHODS

Participants (N = 1255) were aged 60-64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.

RESULTS

A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.

CONCLUSION

Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

Differences in food and nutrient intakes between Australian- and Asian-born women living in Australia: Results from the Australian Longitudinal Study on Women's Health

AIM

To determine differences in food and nutrient intakes between Australian- and Asian-born women living in Australia.

METHODS

Data were obtained from the Australian Longitudinal Study on Women's Health, including 6461 women born in Australia or Asia who completed food frequency questionnaires in 2001 and 2013. Diet was assessed using the Dietary Questionnaire for Epidemiological Studies version 2. Longitudinal generalised estimating-equation modelling was performed to determine the effect of country of birth and survey year on fruit and vegetable intake.

RESULTS

Asian-born women ate more cereals, soybeans and fish but less vegetables, legumes, dairy, meat and meat products than Australian-born women both in 2001 and in 2013. Asian-born women ate less cereals, rice and noodles, meat and its products (P < 0.05) in 2013 than in 2001. The earlier people came to Australia, the less their rice and noodle intake per day. However, the reverse was demonstrated regarding vegetable intake. Asian-born women had a lower daily intake of fat, calcium, zinc, thiamin, riboflavin, folate and retinol compared with those born in Australia.

CONCLUSIONS

Asian-born women living in Australia show different food and nutrient intakes from Australian-born women, although their diets tend to deviate from typical Asian characteristics and approach a Western diet.

The dynamic of non-communicable disease control policy in Indonesia

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

The burden of cancer attributable to modifiable risk factors: the Australian cancer-PAF cohort consortium

PURPOSE

To estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk factor interdependence and statistical uncertainty.

PARTICIPANTS

365 173 adults from seven Australian cohort studies. We linked pooled harmonised individual participant cohort data with population-based cancer and death registries to estimate exposure-cancer and exposure-death associations. Current Australian exposure prevalence was estimated from representative external sources. To illustrate the utility of the new PAF method, we calculated fractions of cancers causally related to body fatness or both tobacco and alcohol consumption avoidable in the next 10 years by risk factor modifications, comparing them with fractions produced by traditional PAF methods.

FINDINGS TO DATE

Over 10 years of follow-up, we observed 27 483 incident cancers and 22 078 deaths. Of cancers related to body fatness (n=9258), 13% (95% CI 11% to 16%) could be avoided if those currently overweight or obese had body mass index of 18.5-24.9 kg/m2. Of cancers causally related to both tobacco and alcohol (n=4283), current or former smoking explains 13% (11% to 16%) and consuming more than two alcoholic drinks per day explains 6% (5% to 8%). The two factors combined explain 16% (13% to 19%): 26% (21% to 30%) in men and 8% (4% to 11%) in women. Corresponding estimates using the traditional PAF method were 20%, 31% and 10%. Our PAF estimates translate to 74 000 avoidable body fatness-related cancers and 40 000 avoidable tobacco- and alcohol-related cancers in Australia over the next 10 years (2017-2026). Traditional PAF methods not accounting for competing risk of death and interdependence of risk factors may overestimate PAFs and avoidable cancers.

FUTURE PLANS

We will rank the most important causal factors and their combinations for a spectrum of cancers and inform cancer control activities.

Circumstances of Falls With Fractured Femur in Residents of Australian Nursing Homes: An Analysis of Falls Reports

OBJECTIVE

This study aimed to explore the circumstances and characteristics of falls with fractured femur reported in nursing homes.

METHOD

Mixed methods were used. There were reports on 401 eligible falls from 88 residential care facilities in the Hunter region of Australia. A falls report form was developed for the study and was completed by nursing staff. Information was collected about the circumstances of falls with fractured femur and resident data. Descriptive and qualitative analyses were used.

RESULTS

Falls with fractured neck of femur were associated with being ambulant, having dementia, increasing age, and a high falls risk assessment. Themes from the falls report data were resident-related factors, organizational or environmental issues, and activities at the time of the fall.

DISCUSSION

Falls in residential care settings are very complex and difficult to prevent. Attention should be given to the needs of recently admitted residents and management of the facility environment.

Exploring Workforce Participation Patterns and Chronic Diseases Among Middle-Aged Australian Men and Women Over the Life Course

OBJECTIVE

This study identified associations between chronic diseases (diabetes, asthma, depression, and arthritis) and workforce participation patterns with a gendered perspective.

METHOD

We used data from 1,261 middle-aged participants of the Australian Life Histories and Health (LHH) Survey, aged 60 to 64 years in 2011. Latent class analysis identified dominant workforce patterns and associations between chronic diseases and these patterns were explored by multinomial regression models.

RESULTS

Diabetes, asthma, depression, and arthritis were less prevalent in men and women in class "mostly full-time work," compared with other workforce patterns. The odds of "mostly full-time work" were lower for men reporting depression or arthritis, whereas among women, depression was associated with "increasing part-time work" after adjusting early and adult life factors.

DISCUSSION

The results strengthen the importance of gender focused policies aimed to promote and preserve health of young and middle-aged workers, and creating supportive environment for those with chronic health issues over the life course.

Contextualizing urban living as a determinant of women's health in Jakarta, Indonesia

Big cities can offer great opportunities for women to have a better life. At the same time, however, the physical and social environment in cities can negatively affect their health. We conducted focus groups with 24 women (aged 18-72 years) living in Jakarta, Indonesia from October to November 2014. Our aim was to elicit women's experiences of living in Jakarta, including their health and accessing health care. The most frequent health problems reported by women in this study were hypertension and arthritis. Women often gave priority to their family, particularly their children, over themselves and their own health. Discussants also thought that the city's physical and social conditions could affect their health, and that women were more prone to feel stress than men. The results of this study highlight the importance of addressing social determinants of health across the life course, including gender, to improve women's health status. Moreover, multi-sectoral collaboration at the municipal and national level is needed for urban planning to create better living conditions for women in the cities.

Change in physical function among women as they age: findings from the Australian Longitudinal Study on Women's Health

PURPOSE

Decline in physical function is common in older age, with important consequences for health-related quality of life, health care utilisation, and mortality. This study aimed to identify patterns of change in physical functioning (PF) for women in later life.

METHODS

PF was measured longitudinally using the ten-item subscale of the Medical Outcomes Study 36-item Short Form Health Survey, for 10 515 participants of the Australian Longitudinal Study on Women's Health, who completed at least two surveys between 1999 (aged 73-78 years) and 2011 (aged 85-90 years). Conditional and unconditional latent profile analysis was conducted separately for deceased and surviving subgroups of women to uncover latent patterns of change in PF scores over time.

RESULTS

Four patterns of change were identified for women who were still alive in 2011 (N = 5928), and four similar classes for deceased women (N = 4587): (1) 'poor PF' representing women with low PF scores, (2) 'moderate PF', (3) 'high PF', and (4) 'very high PF', where scores remained very high. All patterns exhibited a decrease in PF over time. Factors which predict low PF included sedentary levels of exercise, obese and overweight BMI, difficulty managing on income, and lower education.

CONCLUSIONS

The results provided evidence for a gradual decrease in PF for all women with age; however, there was no evidence for an increased rate of decline prior to death.