Death In Australia Research Articles

Causes of perinatal deaths in Australia: Slow progress in the preterm period.

AimThe majority of perinatal deaths occur in the preterm period; however, current approaches predominantly focus on prevention in the term period. Reducing perinatal deaths in the preterm period is, therefore, key to reducing the rates of perinatal death overall in Australia. The aim was to understand the classifications of causes of preterm stillbirth and neonatal death in Victoria over time and by gestation.Materials and methodsRetrospective study using state‐wide, publicly available data. All births in Victoria between 2010 and 2018 included in the Victorian Perinatal Data Collection, excluding terminations of pregnancy for maternal psychosocial indications, were studied. Differences in causes of preterm perinatal mortality gestation group and over time were determined.ResultsOut of 7977 perinatal deaths reported, 85.9% (n = 6849) were in the preterm period. The most common cause of preterm stillbirths was congenital anomalies (n = 1574, 29.8%), followed by unexplained antepartum deaths (n = 557, 14.2%). The most common cause of preterm neonatal death was spontaneous preterm birth (sPTB; n = 599, 38.2%), followed by congenital anomalies (n = 493, 31.4%). The rate of preterm stillbirths due to hypertension (−14.9% (95% CI −27.1% to −2.7%; P = 0.02)), maternal conditions (−24.1% (95% CI −44.2% to −4.0%; P = 0.03)) and those that were unexplained (−5.4% (95% CI −9.8% to −1.2%; P = 0.02)) decreased per annum between 2010 and 2018. All other classifications did not change significantly over time.ConclusionPrevention of congenital anomalies and sPTB is critical to reducing preterm perinatal mortality. Greater emphasis on understanding causes of preterm deaths through mortality investigations may reduce the proportion of those considered ‘unexplained’.

Epidemiological trends of gallbladder cancer in Australia between 1982 to 2018: A population-based study utilizing the Australian Cancer Database.

Backgrounds/AimsGallbladder cancer (GBC) is a rare neoplasm. The epidemiology of GBC has not been updated in Australia for over five decades.MethodsData of all Australian patients diagnosed with GBC at any age from 1982 to 2018 were identified from the Australian Cancer Database. Age-standardized rates were calculated and joinpoint analysis was performed to ascertain the trends of incidence and mortality of GBC.ResultsBetween 1982 and 2018, there were 22,745 cases of GBC and 11,054 GBC-related deaths in Australia. There were three distinct periods showing changed incidence. Period 1 (1982–1995) was stable. Period 2 (1996–2006) showed reduced incidence in females (3.6 to 2.8/100,000; p < 0.01) and all Australians (3.7 to 2.8/100,000, p < 0.01). Period 3 (2006–2017) demonstrated significantly increased incidence in all groups (males: 2.7 to 4.0/100,000, p < 0.01; females: 2.8 to 3.5/100,000, p < 0.01; all Australians: 2.8 to 3.7/100,000, p < 0.01). Incidence between females and males had declined from 1.10 : 1 in 1982 to 0.87 : 1 in 2017. There was a 71% reduction in mortality (3.1 to 0.9/100,000; p < 0.01). Median age at diagnosis increased from 69.7 to 74.3 years for females and from 67.2 to 73.3 years for males. Increasing incidence in the 6th to 8th decade of life in males, compared to previous years, was noted.ConclusionsIncidence, mortality, sex, and age of GBC have significantly changed in Australia since 1982. Rising incidence of GBC in Australia warrants further investigation.

A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study

BackgroundCardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard).MethodsInternational Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data.ResultsThere were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals.ConclusionsOur study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes.

Australian vaccine preventable disease epidemiological review series: Pertussis, 2013-2018.

Significant recent changes in Australian pertussis immunisation policy include the progressive introduction of funded pertussis immunisation programs for pregnant women, from late 2014 to mid-2015 at jurisdictional level and then under the National Immunisation Program from July 2018, and reintroduction of the 18-month booster dose in 2016. This study analyses pertussis notification, hospitalisation, and mortality data from 2013 to 2018 in the context of trends since 1995. This study used data from the National Notifiable Diseases Surveillance System, the National Hospital Morbidity Database, and the Australian Coordinating Registry, for descriptive analysis of pertussis notifications, hospitalisations and deaths in Australia by Aboriginal and Torres Strait Islander (Indigenous) status from 2013 to 2018, examining trends between 1995 and 2012 at both the national and jurisdictional level. Incidence rate ratios (IRR) were utilised to compare pertussis incidence in infants aged < 2 months and 6-11 months for each year from the 2015-2018 (post-maternal-vaccination) period against the 2010-2013 (pre-maternal-vaccination) period. Annual national all-age incidence of pertussis notifications between 2013 and 2018 was 63.6 per 100,000 population, 40% less than between 2006 and 2012. Between 2016 and 2018, infants aged < 2 months had the lowest notification rates of age groups < 5 years old, with the highest notification rates in pre-adolescents aged 9-11 years. Compared with the baseline period (2010-2013), the IRR for infants aged < 2 months decreased in each year during the post-maternal-vaccination period from 0.4 (95% confidence interval [95% CI]: 0.3-0.5) in 2015 to 0.1 (95% CI: 0.1-0.2) in 2018. For infants aged 6-11 months, the IRR was 0.9 (95% CI: 0.8-1.0) in 2015, 1.1 (95% CI: 1.0-1.2) in 2016 and declined to 0.7 (95% CI: 0.6-0.8) in 2017 and 2018. Notification and hospitalisation rates in Indigenous children were 3-8 times as high as rates in non-Indigenous children across all age groups < 5 years old. Pertussis remains the second most frequently notified vaccine preventable disease in Australia, after influenza, but dramatic decreases in incidence have been observed in infants too young to receive any doses of pertussis-containing vaccine.

Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with 'take-home naloxone' in emergency departments.

Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take-home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN-BIs) with intranasal naloxone in EDs. This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne. ED staff were surveyed about their perspectives regarding THN before completing a 30-min training programme in THN-BI delivery. Patients presenting with opioid overdose or considered high risk for future overdose were eligible to receive the THN-BI. Staff survey responses were compared between hospitals and provider types using one-way analysis of variances. Patient demographic and clinical characteristics were extracted from medical records and compared between hospitals and overdose type using Fisher's exact test and one-way analysis of variances. One hundred and twenty-two ED staff completed the survey. One hundred and ten (90.2%) agreed that EDs should provide THN-BIs, whereas 23 (19.2%) identified time constraints and 17 (12.9%) felt uncomfortable discussing overdose with patients. Fifty-seven patients received the THN-BI, with the majority (n= 50, 87.7%) having presented following opioid overdose. The median age was 44 years and 40 (71.4%) were men. Two-thirds of the overdoses (n= 31, 66.0%) were attributed to heroin with one-third (n= 16, 34%) being attributed to pharmaceutical opioids. ED-based delivery of THN-BIs can reach a wide range of individuals at-risk of overdose. The present study supports the feasibility of THN interventions in EDs and underscores the importance of addressing implementation barriers including staff training.

10 Years of ST Elevation Myocardial Infarctions (STEMIs) in the Illawarra Shoalhaven Local Health District (ISLHD) – Patient Demographics

Coronary heart disease remains the leading cause of death in Australia in 2021. Therefore, the primary prevention of cardiovascular disease is crucial, particularly in under-resourced regional areas. Our centre at the ISLHD serves an area extending more than 250 km and including an excess of 400,000 residents. We collected data from STEMI presentations over the 10 years to examine these patients’ demographics.

What can We Learn From High-Performing Screening Programs to Increase Bowel Cancer Screening Participation in Australia?

BackgroundColorectal cancer (CRC) is the second most diagnosed cancer in men and women and second most common cause of cancer death in Australia; Australia’s CRC incidence and mortality are among the world’s highest. The Australian National Bowel Cancer Screening Program began in 2006; however, only 33% of those approached for the first time by the Program between 2018 and 2019 returned the kit. Of the 5.7 million kits sent during this period, only 44% were returned. Our aim was to identify practices and features of national bowel cancer screening programs in countries with similar programs but higher screening participation, to identify potential interventions for optimising Australian CRC screening participation.MethodsWe searched published and grey literature for CRC screening programs reporting at least 50% screening participation using postal invitation and free return of iFOBT home kits. Interviews were conducted with cancer registry staff and academic researchers, focused on participant and practitioner engagement in screening.ResultsNational programs in Netherlands, Scotland, Denmark, and Finland reported over 50% screening participation rates for all invitation rounds. Shared characteristics include small populations within small geographic areas relative to Australia; relatively high literacy; a one-sample iFOBT kit; national registration systems for population cancer screening research; and screening program research including randomised trials of program features.ConclusionsApart from the one-sample kit, we identified no single solution to persistent Australian low uptake of screening. Research including randomised trials within the program promises to increase participation.ImpactThis screening program comparison suggests that within-program intervention trials will lead to increased Australian screening participation.

Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021

IntroductionLung cancer is the leading cause of cancer death in Australia and has the highest cancer burden. Numerous reports describe variations in lung cancer care and outcomes across Australia. There...

"Multi‐domain interventions for dementia prevention – A Systematic Review"

AbstractBackgroundThe increase in the ageing population is accompanied by increased rates of cognitive decline and dementia, which has a profound impact on both morbidity and mortality and a significant care‐related stress and financial burden. In the new global economy, dementia has become a central issue for public health in Australia. Dementia is the second greatest cause of death in Australia and about 60% of all dementia cases are due to Alzheimer’s disease (AD). In AD, damage starts occurring in the brain 20 to 30 years prior to any cognitive symptom. There is currently no cure for AD. However, the year between the start of its development and the appearance of symptoms represent a window of opportunity for implementing strategies to delay or prevent the progression of the disease through lifestyle interventions.MethodThe study will be conduct in two parts:1) A systematic review based on multidomain interventions.2) AU ARROW Intervention.A comprehensive search of electronic databases (EMBASE, MEDLINE, CINAHL, Cochrane, and Scopus) will be performed to retrieve publications and alerts were set to identify publications until 31 august 2021.ResultsAn expected positive outcome would give more evidence that lifestyle changes and if a single nutrient itself or a whole pattern as MIND DIET that are relatively easy to adopt, can help to prevent or delay brain function decline and dementia, such as Alzheimer’s disease dementia in an Australian populationConclusiona multidomain intervention focused on cognitive training, and nutritional and physical activity counselling seems decrease cognitive decline in older adults.

Developments in systemic therapies for the management of lung cancer.

Lung cancer accounts for approximately 1 in 10 new cancer diagnoses annually and is responsible for the most cancer-associated deaths in Australia. Despite such figures, there is reason for optimism with many practice-changing developments to report for the management of patients with thoracic malignancies over the last few years. We outline such changes, including the emerging role of immunotherapy in the neoadjuvant and adjuvant setting for patients with localised non-small-cell lung cancer, as well as the established standard of consolidation immunotherapy following definitive chemoradiotherapy for those with locally advanced disease. In the metastatic setting, combination chemotherapy-immunotherapy approaches have become the new paradigm for most patients in the absence of a recognised driver mutation. A range of novel targeted therapies now exist and are Pharmaceutical Benefits Scheme (PBS)-subsidised for targets such as EGFR, ALK and ROS1, with many others, such as KRAS G12C, NTRK, MET, RET and HER2, also with therapies rapidly being developed. Even among patients with small-cell lung cancer, who account for the worst prognoses and until recently have received a chemotherapy regimen that has remained unchanged in over 20 years, there is a new standard-of-care in combination chemotherapy-immunotherapy. Furthermore, immunotherapy and potentially anti-vascular endothelial growth factor agents now also play a role in mesothelioma treatment. Last, given recent developments in immunotherapy, targeted therapy and combination approaches in the non-small-cell lung cancer space, there is an increasing recognition of the diversity of lived experience for such patients and need for survivorship programmes to acknowledge such nuances.

Exercise‐induced metabolic changes in astrocytes in the 5xFAD mouse model of Alzheimer’s Disease

AbstractBackgroundAlzheimer’s Disease (AD), a progressive neurodegenerative disease and the second most common cause of death in Australia (ABS 2019), is an increasingly prominent societal issue, exacerbated by an ageing population and the absence of effective disease modifying treatments. Focus has shifted to targeting modifiable risk factors to slow or prevent AD onset and progression, such as exercise, diet and other lifestyle factors. Adiponectin, an anti‐inflammatory adipokine, regulates energy metabolism and is associated with metabolic pathways potentiated following exercise. Animal and human studies involving both healthy individuals and those with metabolic dysfunction, have consistently demonstrated increased serum adiponectin levels following various exercise regimes. The ability of adiponectin to cross the blood brain barrier and thus mediate neuronal metabolism is contentious. However, the expression of adiponectin receptors within neuronal cells implies adiponectin holds an important function within the brain.MethodsWe investigated the cortical expression of adiponectin receptors, AdipoR1 and AdipoR2, in the aged 5XFAD mouse model of AD following an exercise intervention. Immunohistochemical techniques were applied to double stain brain tissue for adiponectin receptor and astrocyte expression.ResultsWe observed neuronal AdipoR1 and AdipoR2 expression throughout the cortex of both exercised and sedentary control mice, as well as extensive expression of activated astrocytes.ConclusionsColocalisation analysis suggests astrocytes may utilise adiponectin receptors to fuel their metabolic activity in degrading toxic amyloid plaques within the AD brain.

Abstract 1122‐000242: Effect of Covid‐19 on Stroke Treatment in Australia and New Zealand

Introduction : In general, compared to the rest of the world, the impact of Covid‐19 in the Australia and New Zealand regions has been minimal and this may be attributed to their early adoption of social distancing, stable governments, national wealth and geographic isolation. However, this research was designed to validate this perception amongst the stakeholders. Methods : This research included: primary and secondary research. First, secondary research about Covid‐19 and stroke treatment and Australia and New Zealand in particular was conducted and compiled in a Google spreadsheet. Research sources include Stroke Foundation, Brain Foundation, and World Meters. Data collected included the number of stroke and Covid‐19 cases in Australia and New Zealand as well as a list of stakeholders with their contact information. The stakeholders included neurosurgeons, hospitals, neurologists, interventionists, and vascular surgeons. A survey tool and an interview questions were prepared next. The survey request was emailed to stakeholders, requesting the stakeholders for an interview and survey response. Over the following weeks, survey results came in and interviews were conducted. Since only a small subset of stakeholders responded to the survey (6 survey responses and 4 interviews), this study must be considered to be primarily qualitative in nature. The interviews were conducted online using Zoom. After the interviews, I replayed the interviews and took notes of important details. Results : The survey showed that 83% of the doctors worked in a hospital that had a separate stroke unit and that they perform mechanical thrombectomies most often as a treatment for stroke. Most of the doctors suggested that the stroke numbers have not changed significantly since Covid‐19. Yet, 50% of the doctors said that there had been delays in admitting stroke patients. One third believed Covid‐19 may have made an impact on mortality of stroke patients. One of the interviewees revealed that the main barriers to access to stroke care are the time it takes to treat the patient, fewer locations that treat strokes or perform mechanical thrombectomy, and patients’ reluctance to go to the hospital during the pandemic. Another confirmed that she did think there had been delays due to Covid‐19. Conclusions : Counter to widespread perception, Covid‐19 pandemic DID worsen many barriers for stroke treatment in Australia and New Zealand. These regions have insufficient stroke centers and these are not spread out widely enough for accessibility. Stroke deaths have increased during the Covid‐19 pandemic. Barriers such as time, accessibility, and the patient’s fear of hospitals have affected stroke treatment during the pandemic. Several measures can alleviate the impact: stroke awareness is critical. Every hospital needs to have the ability to assess and treat stroke. Hospitals must run simulations to practice and prepare for different scenarios that they could encounter when dealing with stroke patients. In conclusion, stroke treatment has been affected by the Covid‐19 pandemic and it is critical to minimize and overcome these barriers as stroke is one of the leading causes of death in Australia and New Zealand.

Barbiturate-related hospitalisations, drug treatment episodes, and deaths in Australia, 2000-2018.

To determine the characteristics and population rates of barbiturate-related hospitalisations, treatment episodes, and deaths in Australia, 2000-2018. Analysis of national data on barbiturate-related hospitalisations (National Hospital Morbidity Database, 1999-2000 to 2017-18), drug treatment episodes (Alcohol and Other Drug Treatment Services National Minimum Data Set, 2002-03 to 2017-18), and deaths (National Coronial Information System, 2000-01 to 2016-17). Population rates directly age-standardised to the 2001 Australian standard population; average annual percentage change (AAPC) in rates estimated by Joinpoint regression. We identified 1250 barbiturate-related hospitalisations (791 cases of deliberate self-harm [63%]), 993 drug treatment episodes (195 cases with barbiturates as the principal drug of concern [20%]), and 511 deaths during the respective analysis periods. The barbiturate-related hospitalisation rate declined from 0.56 in 1999-2000 to 0.14 per 100000 population in 2017-18 (AAPC, -6.0%; 95% CI, -7.2% to -4.8%); the declines in hospitalisations related to accidental poisoning (AAPC, -5.8%; 95% CI, -9.1% to -2.4%) and intentional self-harm (AAPC, -5.6%; 95% CI, -6.9% to -4.2%) were each statistically significant. Despite a drop from 0.67 in 2002-03 to 0.23 per 100000 in 2003-04, the drug treatment episode rate did not decline significantly (AAPC, -6.7%; 95% CI, -16% to +4.0%). The population rate of barbiturate-related deaths increased from 0.07 in 2000-01 to 0.19 per 100000 population in 2016-17 (AAPC, +9.3%; 95% CI, +6.2-12%); the rate of intentional self-harm deaths increased (AAPC, +11%; 95% CI, +7.4-15%), but not that of accidental deaths (AAPC, -0.3%; 95% CI, -4.1% to +3.8%). While prescribing and community use of barbiturates has declined, the population rate of intentional self-harm using barbiturates has increased. The major harm associated with these drugs is now suicide.

Demon Monsters or Misunderstood Casualties?

Demon Monsters or Misunderstood Casualties?

Increased ratio of summer to winter deaths due to climate warming in Australia, 1968–2018

ObjectiveTo determine if global warming has changed the balance of summer and winter deaths in Australia. MethodsCounts of summer and winter cause‐specific deaths of subjects aged 55 and over for the years 1968–2018 were entered into a Poisson time‐series regression. Analysis was stratified by states and territories of Australia, by sex, age and cause of death (respiratory, cardiovascular, and renal diseases). The warmest and coldest subsets of seasons were compared. ResultsWarming over 51 years was associated with a long‐term increase in the ratio of summer to winter mortality from 0.73 in the summer of 1969 to 0.83 in the summer of 2018. The increase occurred faster in years that were warmer than average. ConclusionsMortality in the warmest and coldest times of the year is converging as annual average temperatures rise. Implications for public healthIf climate change continues, deaths in the hottest months will come to dominate the burden of mortality in Australia.

Boxing-related fatalities in Australia: A retrospective analysis of news media reports

ObjectiveTo quantify and describe boxing-related deaths in Australia. DesignRetrospective analysis of news media reports of all boxing-related fatalities in Australia during 1832 to 2020. MethodsAustralia and New Zealand Newsstream, Factiva, Informit, Google News, Fairfax Media Archive, and Trove were searched from inception to December 31, 2020. News media articles reporting all-cause boxing-related mortality were included for analysis. ResultsThere were 163 boxing-related fatalities in Australia during 1832 to 2020, including 122 (74.8%) professional and 40 (24.5%) amateur athletes. The most common causes of death were traumatic brain injury (n = 121; 74.2%) and cardiac arrest (n = 11; 6.7%). Boxing-related deaths occurred most frequently during the decades from 1910 to 1930. The fatality rate remained relatively steady from the 1870s through the 1930s, and then declined precipitously until the 1980s. Since legislation to regulate boxing started being introduced in the mid-1970s, there were a total of eleven deaths, of which all but one were caused by traumatic brain injury. ConclusionsParticipation in boxing is associated with risk of death, in particular death caused by traumatic brain injury. The boxing-related fatality rate declined precipitously prior to government legislation to regulate boxing started being introduced, with no discernible further reduction in fatalities since. Given that a main purpose of government regulation of boxing is to protect the health and safety of athletes, the findings herein suggest that current regulations are either inadequate or not effectively implemented.

Weather Trumps Festivity? More Cardiovascular Disease Events Occur in Winter than in December Holidays in Queensland, Australia.

Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270; p < 0.01) excess hospitalisations and 774 (CI: 35, 1513; p < 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (−20 (CI: −29, −9; p < 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.

Understanding the healthcare journey from a patient's perspective

According to Australian Institute of Health and Welfare (2014) chronic conditions are the leading cause of illness, disability and death in Australia. Tackling chronic conditions and their causes is the biggest challenge facing Australia’s health system. Through interaction with patients and their families it has revealed that they often experience:• a fragmented system, with providers and services working in isolation from each other rather than as a team; service duplication or absent / delayed services;• difficulty in accessing services due to lack of mobility, transport, language, financial barriers and remoteness; and feelings of disempowerment, frustration and disengagement.Our service intend to focus on developing our Integrated Care program to be patient centered, to work with patients, families and carers to deliver individualized care that is led by the patient for the patient. Consumer engagement has shaped and driven the planning and delivery of this project.The project aims to work in partnership with patients, families and carers to capture their perception and their healthcare experience. This involved collecting responses through a validated questionnaire known as Patient Reported Experience Measures (PREMs) provided by the Agency of Clinical Innovation (ACI).The PREMs questionnaire captured most accurately patient's healthcare perspective and generated valuable data on intervention effectiveness and service delivery.We have worked on interventions based on the identified barriers and challenges from the PREMs data results.Patients and especially families and carers identified that they were often at a loss with “Is there any support from community if I have chronic condition or terminal illness?"Part of the many outcomes from this project is the development of 3 information brochures for clinicians, general practitioners and patients outlining essential information. These brochures aims to provide streamlined processes which would hopefully improve access to appropriate interventions and support services in the community.Of the 31 patients from the survey, 75% have identified that, by NOT being able to get access to community health care services is the main reason they experience difficulty in managing their chronic conditions and this is often accompanied by a feeling of despair. Key to our project is the patient’s voice. We engaged consumer representation and learnt how treating families with dignity, compassion and respect promotes autonomy and health-seeking behavior.Feedback in particular from patients has been positive and particularly valuing the holistic and integrated approach to their care:“ Great resource, in easy to read format, basic information to help us navigate the services available in the community”“Don’t like hospitals, I’d rather be in the comfort of my home, pleased to know that help is available”Integrated care has wide reaching impacts, our project has improved connections between patients and community services. This is as much a preventive health initiative that seeks to reduce hospital admissions and negative engagement for patients with chronic conditions.We believe that this project will continue to keep patients with chronic conditions out of hospital, by engaging their families in support and early intervention, thus improving their health and wellbeing.

1457Aboriginal and/or Torres Strait Islander deaths by suicide in Australia

Abstract Background The fifth leading cause of death for Aboriginal people in Australia is suicide. These deaths are preventable, and their impact is significant for family and the wider community. This work aims to increase understanding of suicide deaths among Aboriginal people by describing these deaths by a range of factors, and identifying similarities and differences between Aboriginal and non-Aboriginal deaths by suicide. Methods Suicide deaths in Australia from 2001 to 2019 will be identified from the National Coronial Information System database. Demographic factors, details of the deaths and geographic factors will be described, and comparisons will be made between Aboriginal and non-Aboriginal deaths by suicide. Overall suicide rates by Aboriginal status and age- and sex-standardised rates per 100,000 person-years will be calculated using mid-year estimated resident population and death counts stratified by year, age, sex, and Aboriginal status from the Australian Bureau of Statistics. Results The analysis for this work is currently underway and will be finalised prior to the conference. Conclusions The results of this research will provide information about sub-groups of the Aboriginal population and areas of Australia with heightened and reduced risks and rates of suicide. The findings will be interpreted with guidance from the Aboriginal Advisory Committee involved in this work. Findings will be shared with service providers, policymakers, communities, and researchers to enable improved targeting of interventions. Key messages Better understanding of Aboriginal deaths by suicide is critical to inform and improve the much-needed targeting of services and interventions.

892Quantification of mortality incorporating multiple causes of death: Application of weighting strategies to Australian data

Abstract Background Mortality statistics are typically based on a single underlying cause of death (UCoD). Although UCoD provides a useful construct, the relevance of assuming that a single disease caused the death is diminishing, especially with increased life expectancy and high proportions of deaths in older ages from chronic/degenerative diseases. Focussing on common underlying causes of death in Australia, we quantified mortality incorporating weighting strategies for multiple causes of death (MCoD). Methods All deaths registered in Australia from 2015-2017 (478,396 deaths) and coded using International Classification of Diseases Version 10 were classified using an extended cause list (n = 136 causes) based on a World Health Organization short list. Age-standardised rates (ASR) were estimated using three weighting methods: (1) traditional approach using UCoD alone; (2) UCoD and associated causes of death (ACoDs) equally weighted and (3) UCoD weighted 0.5 arbitrarily and remaining 0.5 apportioned to the remaining ACoDs. Results Common UCoD were ischaemic heart diseases, cerebrovascular diseases, dementia; 57671, 31515 and 27377 deaths respectively. There were substantial changes in ASR depending on the weighting method used. Variation in mortality patterns estimated using the three weighting methods and challenges to further refinement of the weighting strategy will be discussed. Conclusions Mortality indicators incorporating MCoD enhance traditional measures of mortality and provide a means to reassess the role of diseases in causing death. Further disease specific methods are required to refine current weighting strategies. Key messages Weighting strategies for are useful for quantifying mortality incorporating MCoD, but methodological challenges exist.