Disease In Australia Research Articles

Economic burden of sickle cell disease in Australia.

Sickle cell disease (SCD) is an inherited condition that impairs red blood cell function, posing a substantial health burden on patients. As the prevalence of SCD in Australia rises due to migration, discussions surrounding treatment and management strategies are becoming more prominent. Australia lacks a dedicated study on the prevalence and economic implications of SCD. In this study, we estimate the economic burden of SCD in Australia from the perspective of the Australian healthcare system. We performed a cost-of-illness study by using a bottom-up approach to estimate resource use per patient from a national registry with unit costs from national sources, and a top-down estimate of the prevalence of SCD in Australia using stratification by ancestry. We estimated the prevalence of SCD in Australia in 2021 to be 8485 patients, the cost per patient per year to be AU$13 975 and the total cost to the Australian healthcare system to be approximately AU$119 million per year. Factors influencing costs were age, interventions and frequency of hospital visits for vaso-occlusive crises. Prevalence had the greatest influence on results in the sensitivity analysis. While the estimated prevalence of SCD in Australia resulted in a relatively small total cost, the per patient annual cost of SCD remains high. This cost of SCD is anticipated to increase alongside migration and improved treatment. There are policies that could enhance patients' quality of life, thereby mitigating both economic and health burdens.

Age, period and cohort trends in hospital admissions for alcohol-related liver disease in Australia, 1993-2020.

This study examines trends in admissions for alcohol-related liver disease (ALD) for Australian men and women between 1993 and 2020 and disaggregates these trends into age, period and cohort components. Retrospective age-period-cohort analysis of hospital admissions with a primary diagnosis of ALD. Australia. 133,705 hospital admissions - 97,755 men (73%); 35,950 women (27%). Hospital admissions for ALD were grouped into five-year age groups (15-19, 20-24 up to 85 and over) for each financial year between 1992/93 and 2020/21. ALD admission rates were substantially higher for men than women. Rates for men increased up to 2005 and subsequently declined before an uptick in 2020. For women, rates increased steadily over the period. In age-period-cohort models, male admission rates were relatively stable over both period and cohort. For women, period effects increased steadily - compared to the period reference year of 2006, the RR for women's admission rates was 0.69 (0.65, 0.74) in 1993, increasing to 1.23 (1.18, 1.29) in 2020. Recent cohorts had significantly higher rates of hospital admission for ALD than those born earlier (e.g., women born in the 1996 cohort had an RR of 2.2 (1.8, 2.7) relative to those born in the reference year 1956). Increases in hospital admissions for ALD, especially since the COVID-19 pandemic, point to the need for effective identification and interventions for people with alcohol-use disorders at risk of chronic disease outcomes.

Cost-effectiveness of population-based expanded reproductive carrier screening for genetic diseases in Australia: a microsimulation analysis.

Using the Australian Census survey 2021 as base population, a microsimulation model, PreconMOD was developed to evaluate the cost-effectiveness of population-based expanded reproductive carrier screening (RCS) for 569 recessive conditions from the health service and societal perspectives. The model simulated the effect of expanded RCS including the downstream interventions for at-risk couples on cost and outcomes. The comparators were (i) no population screening (ii) limited screening for cystic fibrosis, spinal muscular atrophy, and fragile X syndrome and (iii) a 300 conditions screening panel. Averted affected births and health service cost with expanded RCS were projected to year 2061. At a 50% uptake, our model predicts that expanded RCS is cost saving (i.e., higher quality-adjusted life-years and lower costs) compared with other screening strategies in the model from the health service and societal perspectives. The number of affected births averted in a single cohort would increase from 84 [95% confidence interval (CI) 60-116] with limited screening to 2067 (95%CI 1808-2376) with expanded RCS. Expanded RCS was cost-saving compared to the 300-conditions screening panel. Indirect cost accounted for about one-third of the total costs associated with recessive disorders. Our model predicts that the direct treatment cost associated with current limited 3 genes screening would increase by 20% each year to A$73.4 billion to the health system by 2061. Our findings contribute insights on the cost burden of genetic diseases and the economic benefits of expanded RCS to better informed resource allocation decisions.

Adult obesity management in Australia: How can we bridge the gap between guidelines and current general practice?

Obesity is still recognised as a risk factor rather than a chronic disease in Australia. General practitioners (GPs) have reported a lack of confidence and support in the management of obesity. In this study, we explored GPs' current definitions and treatment of obesity and their attitudes towards proposed clinician educational and billing strategies. In this cross-sectional study, an online survey was distributed to GPs across Australia. Of the 189 GPs who completed the survey, 82% defined obesity, with and/or without comorbidities, as a chronic disease. There is a significant gap between current practice and clinical guidelines, particularly in screening and prevention. The overall attitude towards proposed solutions was very positive. Descriptive analysis was used to present the characteristics of the participants. Chi-squared tests or Fisher's exact test were used to evaluate the relationship between categorical variables. Australia's outdated definition of obesity likely hinders management and contributes to the observed gap between clinical guidelines and current practice. Clinician education on behaviour change and long-term weight management, funding for more enhanced primary care referrals and Pharmaceutical Benefits Scheme listing of pharmacotherapy for weight loss might be possible solutions.

High temperature and cardiovascular disease in Australia under different climatic, demographic, and adaptive scenarios.

Cardiovascular disease (CVD), the leading cause of death globally and in Australia, is sensitive to heat exposure. This study assesses the burden of CVD attributable to high temperatures across Australia and projects future burden in the context of climate change. Disability-adjusted life years for CVD, including years of life lost and years lived with disability, were sourced from the Australian Burden of Disease database. A meta-regression model was constructed using location-specific predictors and relative risks from prior literature to estimate relative risks of CVD mortality and morbidity due to high temperatures in the Australian context. The baseline CVD burden attributable to high temperatures in Australia for 2003-18 was calculated, and future burdens under two greenhouse gas emissions scenarios [Representative Concentration Pathways (RCP4.5 and RCP8.5)] for the 2030s and 2050s were projected, considering demographic changes and human adaptation. During the baseline period, high temperatures accounted for 7.3% (95% confidence interval: 7.0%-7.6%) of the CVD burden in Australia, equivalent to 223.8 Disability-adjusted life years (95% confidence interval: 221.0-226.6) per 100 000 population. Future projections suggest a steady increase in the CVD burden across all scenarios examined. By the 2050s, under the RCP8.5 scenario that considers population growth and no adaptation, the total attributable burden of CVD is projected to more than double compared with the baseline, with the Northern Territory facing the most significant increase. These impacts could be mitigated with effective human adaptation to the warming climate. Higher temperatures are expected to exacerbate the burden of CVD. This study highlights the need for urgent adaptation and mitigation efforts to minimize the negative health impacts of a warming climate on CVD.

Assessing the impact of non-pharmaceutical interventions against COVID-19 on 64 notifiable infectious diseases in Australia: A Bayesian Structural Time Series model.

Assessing the impact of non-pharmaceutical interventions against COVID-19 on 64 notifiable infectious diseases in Australia: A Bayesian Structural Time Series model.

Identifying Gaps in Detection of Heart Valve Disease in Australia: A Population Survey

Identifying Gaps in Detection of Heart Valve Disease in Australia: A Population Survey

Suboptimal care and inappropriate opioid use in chronic pain: A critical analysis of two case studies and healthcare expenditure burden.

Chronic pain is a leading cause of chronic disease in Australia, with a 2020 report indicating that one in five Australians aged over 45 experience chronic pain. The high prevalence of chronic pain accounts for significant healthcare utilization and associated costs, with the economic impact of chronic pain estimated to be AUD$139 billion in 2018. This paper uses two exemplar cases to demonstrate inadequacies within the current systems supporting those with chronic pain and the associated impacts these inadequacies have on patient outcomes and healthcare costs. An analysis of these cases demonstrated a combined healthcare cost of AUD$312,705 throughout their inpatient admissions, with no apparent benefit to either patient's pain experience. These cases highlight a multitude of opportunities to improve current pain management systems and their detrimental effects on patient well-being, healthcare utilization, and associated costs. Despite massive expenditures for the management of chronic pain, patients often continue to experience ongoing pain and reduced quality of life. This indicates that the available funds could be better utilized through reallocation to support a proactive, biopsychosocial model of care for the prevention and management of chronic pain.

P1327 Microbial signatures associated with Inflammatory Bowel Disease in Australia: baseline data from the Australian IBD Microbiome study

Abstract Background Microbial dysbiosis is associated with Crohn’s disease (CD) and ulcerative colitis (UC) onset and disease activity, however, large-scale data pertaining to Australian patients are limited1. This study aimed to describe the differences in gut microbiota composition between patients with IBD and healthy controls within the Australian IBD Microbiome (AIM) study2. Methods Paired faecal and oral samples alongside participant demographics and disease characteristics were collected at baseline from all healthy controls (HC) and IBD patients enrolled in the Australian IBD Microbiome (AIM) study from June 2019 to November 2023. Faecal and oral samples were self-collected in DNA stabilising buffer, aliquoted and stored at -80oC until extraction. Samples underwent 16S rRNA sequencing with annotation of DNA sequences to operational taxonomic units at the genus level. Differences in alpha diversity (Chao1) between groups were assessed using Mann-Whitney U tests. Beta diversity (weighted UniFrac dissimilarity) in bacterial communities were shown using Principal Coordinate Analysis (PCoA), and significance of variance was tested using ADONIS in R. Results 751 participants (305 HC, 232 CD, 214 UC) returned baseline faecal (n = 697) and/or oral samples (n = 737) and were included in the analysis, with patient group characteristics presented in Table 1. Most IBD patients were in clinical remission (Table 1). However, CD and UC patients had comparably lower faecal alpha diversity than the HC group (Figure 1A). Faecal beta diversity differed between CD, UC, and HC groups (Figure 1B). Five phyla were significantly different between the three groups in faecal samples (Figure 1C). No significant inter-group differences were seen with oral microbial analysis. Conclusion Compared to healthy adults, patients with IBD in Australia have distinct gut microbial profiles. Faecal rather than oral microbial sampling demonstrated a difference in community structure between IBD and healthy groups. Incorporating longitudinal microbial sampling and increasing sequencing resolution may elucidate a pathogenic relationship between gut microbiota and IBD.

A discrete choice experiment to elicit preferences for a chronic disease screening programme in Queensland, Australia: designing the choice sets for the final survey

Background Chronic diseases are a significant health concern in Australia. Understanding community preferences for health screening services is vital for enhancing service delivery. We conducted a study to determine community preferences for health screening services for chronic diseases in Australia using a discrete choice experiment (DCE). This paper aims to present the development of the final DCE design using priors estimated from a survey. Methods A DCE was conducted in Australia. An online survey was administered to a general Australian population over 18. The final attribute list of five attributes with three levels each was designed. A D-efficient design with 30 pair-wise choice tasks was developed using a fractional factorial design. A pre-test was conducted to assess comprehension and understanding of the online DCE survey. The pilot survey aimed to compute priors (i.e. coefficients) associated with attributes. A multinomial logit model was used to analyse the pilot DCE data. Results The survey included 30 choice tasks in three blocks, with 119 participants responding. The best DCE design was selected based on D-error, with a lower D-error indicating the most efficient design. The pilot survey results indicated a strong preference for highly accurate screening tests, with coefficients for 85% and 95% accuracy being positive. Coefficients estimated from the pilot survey were used as priors to design the DCE choice tasks for the main survey. The final DCE design showed a notable improvement in the attribute level overlap compared to the design used for the pilot survey. Conclusions A rigorous approach was taken to develop a DCE survey that could effectively determine the preferences of the community for health screening services. The resulting DCE design consisted of 30 choice tasks presented in pairs and was deemed efficient enough to gather comprehensive information in the final survey.

Policy in practice: Cystic Fibrosis Australia and Phage Australia surveys: understanding clinical needs and attitudes towards phage therapy in the cystic fibrosis community

Abstract Cystic fibrosis (CF) is the most prevalent serious inherited disease in Australia, imposing significant health risks. CF is characterized by chronic lung inflammation and recurrent pulmonary infections that increase morbidity and premature mortality rates. The emergence of antimicrobial resistance (AMR) places further challenges on the treatment and management of CF, necessitating research into alternative strategies for treatment of bacterial infections. Bacteriophage therapy, involving bacterial-specific viruses, is a potential avenue for AMR infections in patients with CF. Existing literature supports the feasibility of phage therapy in CF but there has been a gap in investigating attitudes of the CF community including affected individuals and their caregivers, regarding phage therapy. Understanding perspectives and needs of the CF community is essential for successful implementation and acceptance of novel therapies including phage therapy. We conducted a survey that encompasses responses from 112 consumers from across Australia, comprising people living with CF (38.4%), parents of affected children (49.6%), carers (6.4%), and family members (3%). The findings showed a significant reliance on antibiotics with 51.4% requiring oral, 43.4% nebulized, and 11.4% intravenous antibiotics within the preceding 2 weeks. Respondents highlighted the availability of new treatments, duration of hospitalizations and costs associated with treatment as important priorities to address. Despite an awareness of phage therapy among 62.4% of respondents, 86.4% expressed interest in obtaining more information, primarily from medical staff (66.7%). Notably, 96.0% of respondents expressed willingness to participate in phage therapy trials. The results of this survey highlighted the CF community’s strong interest in advanced therapeutic approaches, specifically phage therapy. The findings reveal a notable recognition and acceptance of phage therapy as a viable treatment option for pulmonary infections associated with CF. This study addresses UN Sustainable Development Goal 3: Good Health and Wellbeing by advancing knowledge on alternative therapeutic strategies for managing AMR in CF. By exploring community attitudes towards bacteriophage therapy, the research promotes informed development and implementation of innovative, targeted treatments for CF-associated infections. These findings support the sustainable management of AMR, fostering better health outcomes and reducing reliance on traditional antibiotics, thereby contributing to long-term health resilience.

Current approaches to the surgical management of Crohn’s disease in Australia and New Zealand

PurposeGiven the evolving literature regarding the optimal surgical approach to mitigate post-operative recurrence of Crohn’s disease (CD), this survey study aimed to elucidate the practices and preferences of colorectal surgeons in Australia and New Zealand (ANZ) in their surgical management of CD.MethodsColorectal surgical consultants and fellows (n = 337) registered with the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) were invited by email in April 2022 to participate in a cross-sectional survey consisting of basic demographics and 12 questions relating to their usual surgical practice and preferred operative strategy.ResultsA total of 135 responses were received (39.9%). Regarding anastomotic configuration, 47% (n = 68) preferred the side-to-side anastomosis (STSA), 19% (n = 28) the end-to-end anastomosis (ETEA), and 15% (n = 21) the Kono S anastomosis. Most respondents preferred to resect at the proximal junction of the abnormal mesentery (75%, n = 97), while radical resection of the mesentery was preferred in 10% (n = 13) and close intestinal resection through abnormal mesentery in 15% (n = 20). The preferred surgical approach was by far laparoscopic (93%, n = 125) with extraction from the midline peri-umbilical port (80%, n = 108).ConclusionAmongst participating colorectal surgeons, there was a clear consensus on the approach, where the dominant practice was laparoscopy with a midline peri-umbilical extraction. Similarly, most respondents preferred some degree of mesenteric resection. However, anastomotic configuration and technique were domains of resection in CD lacking unanimity despite clear guidelines, highlighting an area requiring further attention.

Estimating the cost of chronic kidney disease in Australia

IntroductionChronic kidney disease (CKD) is a significant burden on health systems globally, with limited up-to-date information on health system costs, particularly for non-dialysis patients. This study estimates the direct healthcare costs of CKD within Australia.MethodsThe study utilised the CKD.WA dataset, a linked repository for the state of Western Australia, containing public and private pathology, hospital, emergency and mortality data for over 2 million people, along with a secondary dataset of general practice records. Costs were calculated for individuals with CKD in 2019 and compared to controls without CKD to identify costs attributable to CKD. Cost items included hospital, emergency, medication, general practice, pathology, dialysis and outpatient services. Costs were expressed in 2023 AUD.ResultsThere were 114,899 individuals with CKD in 2019. Average yearly costs attributable to CKD were $3,367 for Stage 1, $4,114 for Stage 2, $3,607 for Stage 3a, $6,572 for Stage 3b, $11,456 for Stage 4 and $62,558 for Stage 5. Non-dialysis hospital costs were the biggest contributor, followed by dialysis costs. The estimated total cost of CKD to Australia was $8.3 billion for 2019.ConclusionThese findings highlight the significant cost burden of CKD. While CKD costs per individual are highest in later stages, the greater number of early-stage CKD cases means the majority of the cost burden is located among early-stage cases. Primary and secondary prevention strategies are likely key to reducing costs.

Effects of seasonal, geographical and demographic factors on otitis externa microbiota in Queensland, Australia.

Otitis externa (OE) is a very common disease in Australia. It is associated with swimming and exposure to water. Typically, treatment consists of aural toileting and the use of topical antimicrobial drops. Antimicrobial treatment is empiric, and most Australian guidelines advise the use of dexamethasone/framycetin/gramicidin as first-line therapy. This study aimed to identify the most prevalent pathogens implicated in OE in Queensland, Australia, and determine if there was any variability with the season, proximity to a coastline, age, gender and First Nations status. The primary pathogen cultured, the specimen type, thedate of collection and the patient demographics were retrieved from microbiology swabs sent from hospitals toPathology Queensland. Multivariate analysis was performed on the swabs. Pseudomonas aeruginosa was the most prevalent pathogen cultured in the external ear in Queensland, at37.9%. In inland regions, Staphylococcus aureus was themost prevalent organism. Children were three-fold less likely to have OE resulting from a fungal pathogen. The use of targeted antimicrobials against Pseudomonas aeruginosa in coastal regions during summer is sensible. Due to the low burden of fungal disease in children, there should be a high threshold for the commencement of antifungal ear drops.

Hospitalisation patterns for respiratory diseases in Australia: an ecological study

ObjectivesThe objective of this study is to examine the hospitalisation profile for respiratory diseases in Australia between 1998 and 2019.DesignAn ecological study.SettingA population study that involved all private and public...

Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study

Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study

Validation of serum non-invasive tests of liver fibrosis as prognostic markers of clinical outcomes in people with fatty liver disease in Australia.

The validity of non-invasive tests (NITs) of liver fibrosis for the prediction of liver and mortality outcomes in an Australian cohort is unknown. We aimed to verify the utility of available NITs to predict overall and cause-specific mortality and major adverse liver outcome (MALO). This was an analysis from the Crossroads 1 clinic sub-study of a randomly sampled adult cohort from regional Australia between 2001 and 2003. Baseline variables included demographic details, anthropometry, health and lifestyle data, and laboratory tests. Non-alcoholic fatty liver disease (NAFLD) and metabolic-(dysfunction) associated fatty liver disease (MAFLD) were defined by fatty liver index≥60 and other accepted criteria. Outcomes were defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision codes for linked hospitalization and death registry data. Available serum-based NITs were analyzed as predictors of overall, cardiovascular disease-related, and cancer-related mortality and MALO in those with fatty liver disease (FLD). In total, 1324 and 1444 participants were included for NAFLD and MAFLD analysis (prevalence 35.4% and 40.7%, respectively). There were 298 deaths (89 cardiovascular disease-related and 98 cancer-related) and 24 MALO over a median 19.7years of follow-up time. In both forms of FLD, fibrosis-4 index, Steatosis-Associated Fibrosis Estimator score, and Forns fibrosis score consistently had the highest area under the receiver operating characteristic curve (AUROC) for overall and cause-specific mortality, with AUROC>0.70 for each outcome. However, all had poor discriminatory ability for determining MALO in each FLD. Several liver fibrosis NITs perform similarly reasonably well in predicting the risk of mortality outcomes in those with FLD but are poorly discriminatory for MALO prediction.

Identifying factors that influence the use of pathogen genomics in Australia and New Zealand: a protocol.

Pathogen genomics, where whole genome sequencing technologies are used to produce complete genomic sequences of pathogens, is being increasingly used for infectious disease surveillance and outbreak response. Although proof-of-concept studies have highlighted the viability of using pathogen genomics in public health, few studies have investigated how end-users utilize pathogen genomics in public health. We describe a protocol for a study that aims to identify key factors that influence the use of pathogen genomics to inform public health responses against infectious diseases in Australia and New Zealand. We will use qualitative comparative analysis (QCA), a case-oriented methodology that systematically compares and analyses multiple cases (or 'units of analysis'), to identify multiple pathways leading to the use of pathogen genomics results in public health actions. As part of the process, we will develop a rubric to identify and define the use of pathogen genomics and individual factors affecting this process. Simultaneously, we will identify cases where pathogen genomics has been used in public health across Australia and New Zealand. Data for these cases will be collected from document review of publicly available and confidential documents and semi-structured interviews with technicians and end-users and summarized in a case report. These case reports will form the basis for scoring each case on the extent of the use of pathogen genomics data and the presence or absence of specific factors such as the ease of extracting essential information from pathogen genomics reports and perceptions toward pathogen genomics. Using the scores, cases will be analyzed using QCA techniques to identify pathways leading to the use of pathogen genomics data. These pathways will be interpreted alongside the cases to provide rich explanations of the use of pathogen genomics in public health. This study will improve our understanding of the key factors that facilitate or hinder the use of pathogen genomics to inform public health authorities and end-users. These findings may inform ways to enhance the use of pathogen genomics data in public health.

An overview of the challenges and methods for defining the wildlife-disease interface in the context of disease spread modelling, including concepts of infectious diseases epidemiology

ABSTRACT The wildlife-domestic interface is a key concept helping us to understand how diseases affect both wild and domestic animal populations, yet how to define and measure it remains a challenge. One tool which can contribute to our understanding of the wildlife-domestic interface is disease spread modelling. This can provide insight into how diseases spread within and between populations, and guide decision-making for disease control, response and surveillance programs. Specifically, quantitative estimation of contact rates permits such disease spread models to be developed and used confidently. Here we present a case study of the potential spread of rabies (an exotic disease in Australia) within the wild dog-domestic dog (Canis familiaris) ecosystem of northern Australia to illustrate the concept of the wildlife-domestic interface and disease transmission. We summarise a decade of research conducted to understand one such interface, the wild-domestic dog interface at one site in northern Australia, for the purposes of exploring the impact of one specific disease, rabies. Over a period of 10 years, free-roaming domestic dogs and wild dogs in the Northern Peninsula Area (NPA) of Cape York, Queensland were studied. Key findings included identification of a small but important group of domestic dogs which regularly roam in bushland areas; peri-urban wild dog activity, particularly in the dry season, likely driven by the availability of food sources; and the potential for interaction between hunting dogs and wild dogs in remote areas, particularly during the wet season. These observations can be used to inform disease spread models and identify strategies to mitigate the risks of disease transmission. However, the collection and incorporation of data into such models needs more consideration regarding what information is usable (such as contact rates) and the best ways to collect it. The scarcity of such models incorporating the wildlife-domestic interface suggests that integrated epidemiological-ecological studies are needed to fill this gap.

NEARER SCAN (LENO BESIK) evaluation of a task-sharing echocardiographic active case finding programme for rheumatic heart disease in Australia and Timor-Leste: protocol for a hybrid type II effectiveness-implementation study

IntroductionRheumatic heart disease (RHD) is underdiagnosed globally resulting in missed treatment opportunities and adverse clinical outcomes. We describe the protocol for a study which aims to co-design, implement and conduct...