Melbourne Population Research Articles

Bridging the education gap: A comprehensive analysis of travel distance and education quality based spatial accessibility of early childhood education in Metropolitan Melbourne

In Australia, Melbourne's population is growing rapidly and will soon overtake Sydney, fuelled by a COVID-19 baby boom that has increased demand for early childhood education (ECE). In response, the Victorian Government has announced transformational reforms to improve the accessibility and quality of ECE for the growing urban population. This study aims to addresses the evolution and effectiveness of ECE reforms in Melbourne from 2021 to 2036 by proposing an innovative approach that integrates spatial accessibility and educational quality into ECE evaluations. Using the distance decay function, the Floating Catchment Area (FCA) method and the Huff model, it extends traditional geographical analyses by highlighting the importance of educational quality in parental choice and providing a refined technique for simulating local demand based on educational quality and travel distance. Overall, inequalities in educational resources have been identified, with a concentration of ECE services near the CBD, despite high population density, while peripheral areas have significant service deficits. Furthermore, the projected poor accessibility scores for 2026, 2031 and 2036 highlight the urgent need for educational infrastructure development, even in areas rated as having better accessibility in 2021.

Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study

ObjectiveThe Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme...

Shifting car travel to active modes to improve population health and achieve transport goals: A simulation study

IntroductionBeing physically active has multiple health benefits and contributes to the reduction of co-morbidities and mortality from chronic diseases. Active transport (walking and cycling) contributes to population health by enabling physical activity. We developed a simulation model to measure health impacts of transport scenarios for Melbourne, Australia. Our aim was to demonstrate active transport health impacts and support the materialization of policies for healthy cities and people. The model measures health impacts of increased physical activity from replacing short car trips for any purpose or for commuting under 5 km by walking and cycling. MethodsWe developed a micro-simulation model of physical activity and disease risk in combination with the well-established proportional multi-state life table model. We quantified life course health including health adjusted-life years, life years, new cases of diseases prevented, and deaths prevented for 14 chronic diseases associated with physical inactivity for the adult population of people from Melbourne, Australia in 2017. ResultsOver the life course of the Melbourne adult population of 3.6 million people in 2017, gains in health-adjusted life years ranged from 5,100 (95% Uncertainty Interval (UI) 3,700 to 6,500) for the scenario replacing commute trips by car under 1 km with walking up to 738,800 (95% UI 546,000 to 935,000) when replacing car trips under 2 km with walking and between 2 km and 5 km with cycling. We also estimated benefits in terms of reductions of new cases of diseases and deaths prevented, with the greatest gains for ischemic heart disease, stroke, Alzheimer's and other dementias and type 2 diabetes. ConclusionsWe found that shifting car travel to active modes would accrue important health benefits for the 2017 Melbourne population. Our results support policies and strategies for sustainable transport planning to contribute to reduce the burden from chronic diseases and environmental impact of car-oriented cities.

Melbourne's Advanced Rail Transportation

Melbourne's commuter rail transportation is ageing and outdated. As Melbourne's population is ever-increasing, its rail transportation infrastructure planning also needs to be developed, based on long-term technological advancements. Subsequently, Melbourne's rail network and its systems need to be continuously scrutinized. This study thus reviews Melbourne's advanced rail transportation systems, and determines its future perspectives. This research initially found that, for Melbourne, one of the important aspects of long-term technological innovation is the inclusion of the three specific automation measures of; moderate intrusion control systems; revamp signaling technologies; and new rail lines and systems. Further examination recommended that advanced rail transportation systems including enhanced communications systems, be carefully integrated. Such outcomes will in turn boost Melbourne's rail performance through, a) increase safety and passenger satisfaction; b) enhance system reliability; c) intensify train frequency and capacity; d) improve operational flexibility; and e) reduce the overall operating costs. It is expected that these findings will ultimately assist the relevant rail transportation planners, to make optimal decisions when deciding on the selection of the most advanced rail transportation strategies.

Tubercular landscape: land use change and Mycobacterium in Melbourne, Australia, 1837–1900

In the late nineteenth century, the city of Melbourne, Australia, experienced unusually high tuberculosis mortality. Dr. William Thomson, whose statistical methods uncovered the epidemiological trend, argued that at least one in three of the adult population of Melbourne between the ages of twenty and forty-five died of tuberculosis. While Thomson’s research challenged existing epistemologies of medicine, advocating sanitary rather than climatological aetiology, he was ultimately incapable of identifying the major factors in the spread of tuberculosis. Drawing on recent public health scholarship, which suggests a firm link between land use change and emerging infectious diseases, this paper examines the role of cultural, political, economic, and ecological activities of nineteenth-century Melbournians in constructing a niche suited to the success of Mycobacterium tuberculosis. Using epidemiological techniques, GIS, and historical records, this paper analyzes the city’s ability to handle waste, stagnant water, and other vectors of disease, and considers how manipulations of the landscape to accommodate the growing city’s sanitary and commercial needs exacerbated transmissibility of tuberculosis. It concludes that the imported characteristics of the British colonial city fostered land use change uniquely suited to the perpetuation of one of the most prolific diseases of the modern era.

Better transport accessibility, better health: a health economic impact assessment study for Melbourne, Australia

BackgroundPhysical inactivity is a global public health problem, partly due to urbanization and increased use of passive modes of transport such as private motor vehicles. Improving accessibility to public transport could be an effective policy for Governments to promote equity and efficiency within transportation systems, increase population levels of physical activity and reduce the negative externalities of motor vehicle use. Quantitative estimates of the health impacts of improvements to public transport accessibility may be useful for resource allocation and priority-setting, however few studies have been published to inform this decision-making. This paper aims to estimate the physical activity, obesity, injury, health and healthcare cost-saving outcomes of scenario-based improvements to public transport accessibility in Melbourne, Australia.MethodsBaseline and two hypothetical future scenario estimates of improved public transport accessibility for Melbourne, Australia, were derived using a spatial planning and decision tool designed to simulate accessibility performance (the Spatial Network Analysis for Multimodal Urban Transport Systems (SNAMUTS)). Public transport related physical activity was quantified by strata of age group and sex from Melbourne travel survey data (VISTA survey) and used with the SNAMUTS Composite Index to estimate input data for health impact modelling for the Melbourne population aged 20–74 years. A proportional multi-state, multiple cohort lifetable Markov model quantified the potential health gains and healthcare cost-savings from estimated changes in physical activity, body weight and injuries related to walking to access/egress public transport under two scenarios: (S1) public transport accessibility under current policy directions, and (S2) multi-directional, high-frequency network improvements.ResultsMulti-directional, high-frequency improvements to the public transport network (S2) resulted in significantly greater health and economic gains than current policy directions (S1) in relation to physical activity (mean 6.4 more MET minutes/week), body weight (mean 0.05 kg differential), health-adjusted life years gained (absolute difference of 4878 HALYs gained) and healthcare cost-savings (absolute difference of AUD43M), as compared to business as usual under both scenarios (n = 2,832,241 adults, over the lifecourse).ConclusionsBased on our conservative analyses, improving accessibility to public transport will improve population health by facilitating physical activity and lead to healthcare cost savings compared with business-as-usual. These wider health benefits should be better considered in transport planning and policy decisions.

The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors

A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions. Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74-2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28-16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died. Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma. None.

Emergency demand, repeat and frequent presentations by older patients in metropolitan Melbourne: A retrospective cohort study using routinely collected hospital data.

To describe patterns for potentially avoidable general practice (PAGP)-type and non-PAGP-type ED presentations by older patients during 2008 and 2012. Retrospective analysis of ED presentations by patients ≥70 years for 2008 and 2012. Metropolitan Melbourne public hospital data were obtained from the Victorian Emergency Minimum Dataset. Outcomes were characteristics of PAGP-type and non-PAGP-type presentations as defined by the Australian Institute of Health and Welfare; numbers and rates per 1000 population ≥70 years of repeat (×2-3/year) and frequent (≥ ×4/year) PAGP-type and non-PAGP-type presentations. The older metropolitan Melbourne population increased by 10.3% between 2008 and 2012, whereas the number of ED presentations increased by 12.7%. The volume of PAGP-type presentations decreased by 2.6%, with declining rates per 1000 population ≥70 years of repeat (7.2-6.2) and frequent (0.7-0.4) presentation. In contrast, the volume of non-PAGP-type presentations grew by 15.4%, with increasing repeat (57.6-60.7) and frequent (13.1-14.2) presentation rates per 1000 population ≥70 years. The majority (39%) of non-PAGP-type presentations by frequent ED attenders were due to cardiovascular or respiratory problems. The rate of repeat and frequent PAGP-type presentations by older people decreased in 2012 compared with 2008, suggesting that initiatives implemented to reduce avoidable presentations may have had an effect. However, an increase in the rate of frequent non-PAGP-type presentations, predominately for acute exacerbation of cardiovascular and respiratory conditions, has important implications for planning future healthcare delivery; hence, the importance of initiatives such as the Health Care Home.

Cryptosporidium viatorum from the native Australian swamp rat Rattus lutreolus - An emerging zoonotic pathogen?

Cryptosporidium viatorum is a globally distributed pathogenic species of Cryptosporidium that has only ever been recorded from humans, until now. For the first time, we molecularly characterised a novel subtype of C. viatorum (subtype XVbA2G1) from the endemic Australian swamp rat (Rattus lutreolus) using the small subunit of nuclear ribosomal RNA (SSU) gene and then subtyped it using the 60-kilodalton glycoprotein (gp60) gene. In total, faecal samples from 21 swamp rats (three were positive for C. viatorum), three broad toothed rats (Mastacomys fuscus) and two bush rats (Rattus fuscipes) were tested for Cryptosporidium. The long-term, isolated nature of the swamp rat population in Melbourne's drinking water catchment system (where public access is prohibited), the lack of C. viatorum from other mammals and birds living within the vicinity of this system and its genetic distinctiveness in both the SSU and gp60 gene sequences from other species of Cryptosporidium collectively suggest that C. viatorum might be endemic to native rats in Australia. The current state of knowledge of epidemiological surveys of Cryptosporidium of rats and the zoonotic potential are further discussed in light of the finding of C. viatorum. Long-term studies, with the capacity to repetitively sample a variety of hosts in multiple localities, in different seasons and years, will allow for greater insight into the epidemiological patterns and zoonotic potential of rare Cryptosporidium species such as C. viatorum.

Physical activity and the use of standard and complementary therapies in Duchenne and Becker muscular dystrophies.

To record the use and perceived benefits of mainstream allied health services, complementary therapies, nutritional supplements and structured physical activity in a paediatric population of males with Duchenne or Becker muscular dystrophy. A questionnaire was distributed to 125 parents of males with a dystrophinopathy within a tertiary neuromuscular clinic population in Melbourne, Australia. Response rate to the survey was 41%. Most families (73%) reported use of allied health services: physiotherapy (65%), occupational therapy (47%), and psychology (25%). The most commonly used complementary therapy was massage (31%). Sixty-five percent of families reported using nutritional supplements. Fifty-one and 38% of families reported participation in swimming and other organised sports, respectively. Physical and psychological benefits of sporting activities were identified by families. Participation in physical activity was lowest in those transitioning to full-time wheelchair use. Access to allied health services by boys with dystrophinopathies is variable and inconsistent with published international standards of care. There is frequent use of complementary therapies, despite a lack of proven efficacy. Studies of the effects of such therapies would support provision of evidence-based advice to families. Continued involvement in physical activity for those boys with declining function should be supported by clinicians.

Novel population-based study finding higher than reported hepatocellular carcinoma incidence suggests an updated approach is needed.

Hepatocellular carcinoma (HCC) incidence is rising rapidly in many developed countries. Primary epidemiological data have invariably been derived from cancer registries that are heterogeneous in data quality and registration methodology; many registries have not adopted current clinical diagnostic criteria for HCC and still rely on histology for classification. We performed the first population-based study in Australia using current diagnostic criteria, hypothesizing that HCC incidence may be higher than reported. Incident cases of HCC (defined by American Association for the Study of Liver Diseases diagnostic criteria or histology) were prospectively identified over a 12-month period (2012-2013) from the population of Melbourne, Australia. Cases were captured from multiple sources: admissions to any of Melbourne's seven tertiary hospitals; attendances at outpatients; and radiology, pathology, and pharmacy services. Our cohort was compared to the Victorian Cancer Registry (VCR) cohort (mandatory notified cases) for the same population and period, and incidence rates were compared for both cohorts. There were 272 incident cases (79% male; median age: 65 years) identified. Cirrhosis was present in 83% of patients, with hepatitis C virus infection (41%), alcohol (39%), and hepatitis B virus infection (22%) the commonest etiologies present. Age-standardized HCC incidence (per 100,000, Australian Standard Population) was 10.3 (95% confidence interval [CI]: 9.0-11.7) for males and 2.3 (95% CI: 1.8 to 3.0) for females. The VCR reported significantly lower rates of HCC: 5.3 (95% CI: 4.4 to 6.4) and 1.0 (95% CI: 0.7 to 1.5) per 100,000 males and females respectively (P < 0.0001). HCC incidence in Melbourne is 2-fold higher than reported by cancer registry data owing to under-reporting of clinical diagnoses. Adoption of current diagnostic criteria and additional capture sources will improve registry completeness. Chronic viral hepatitis and alcohol remain leading causes of cirrhosis and HCC.

Decreased varicella and increased herpes zoster incidence at a sentinel medical deputising service in a setting of increasing varicella vaccine coverage in Victoria, Australia, 1998 to 2012.

We performed an ecological study using sentinel consultation data from a medical deputising service to assess the impact of increasing coverage with childhood varicella vaccine on the incidence risk of varicella and zoster in the population served by the deputising service in Victoria, Australia from 1998 to 2012. Following a successful vaccination programme, the incidence of varicella in Australia was modelled to decrease and the incidence of zoster to increase, based on a theoretical decrease in boosting of zoster immunity following a decrease in wild varicella virus circulation due to vaccination. Incidence risks (consultation proportions for varicella and zoster) were directly age-standardised to the Melbourne population in 2000, when varicella vaccine was first available. Age-standardised varicella incidence risk peaked in 2000 and halved by 2012. Age-standardised zoster incidence risk remained constant from 1998 to 2002, but had almost doubled by 2012. The increase in zoster consultations largely reflected increases in people younger than 50 years-old. Although causality cannot be inferred from ecological studies, it is generally agreed that the decrease in varicella incidence is due to increasing varicella vaccine coverage. The possible indirect effect of the vaccine on zoster incidence is less clear and ongoing monitoring of zoster is required.

Increased endometrial vascularity and intraoperative haemorrhage among women undergoing surgical evacuation for retained product of conception.

The aim of this study was to ascertain the incidence of “increased endometrial vascularity” recorded in the ultrasound scan reports, in the context of RPOC and correlate this finding with the incidence of life threatening intra‐operative bleeding.Ultrasound scan reports sometimes mention the presence of increased endometrial / sub‐endometrial vascularity in the context of retained products of conception or secondary post partum haemorrhage. This raises the possibility of serious intra‐operative haemorrhage in the minds of the junior doctors because of the possibility of arterio‐venous malformation. This retrospective case series was designed to find the incidences of increased endometrial vascularity and severe intra‐operative haemorrhage in the patients with RPOC in the south eastern part of Melbourne population. The study found that the incidence of increased endometrial vascularity was 7.57% and none of these patients suffered severe intra‐operative haemorrhage. A literature survey revealed that there were few studies on this topic.

Pat Bingham: Changing Bird Population of Melbourne over past 150 years

Pat Bingham: Changing Bird Population of Melbourne over past 150 years

Population and age-group trends in weekend sun protection and sunburn over two decades of the SunSmart programme in Melbourne, Australia

In response to the high skin cancer burden in Australia, the multicomponent, community-wide SunSmart programme has worked since 1988 to reduce excessive sun exposure. To examine trends in key sun-protection behaviours and sunburn for the Melbourne population from 1987 to 2007, and examine for the first time patterns of change among age groups. Representative cross-sectional weekly telephone surveys of weekend sun protection and sunburn were conducted over 11 of the summers in the period 1987-88 to 2006-07. Trends were analysed for the population and for age groups, adjusting for ambient temperature and ultraviolet radiation, which are environmental determinants of sun-related behaviour and sunburn. The general pattern of trends suggests two distinct periods, one with rapid improvement in behaviours (more sunscreen use, less unprotected body exposure and less sunburn) from 1987-88 to 1994-95, and the second from 1997-98 to 2006-07 with fewer changes in behaviours noted. The age-group analyses showed a similar pattern of change over time across groups, with a few notable exceptions. The similarity of the pattern of trends among age groups suggests that external influences including the SunSmart programme's activity had a relatively similar impact across the population. Sun-related behaviours continue to be amenable to change. More recent relative stability with some declines in sun protection suggests further intensive campaigns and other strategies may be needed to maintain previous successes and to achieve more universal use of sun protection.

Alcohol intoxication in the context of major public holidays, sporting and social events: a time–series analysis in Melbourne, Australia, 2000–2009

To assess the relationship between ambulance attendances, emergency department (ED) presentations and hospital admissions for acute alcohol intoxication and the timing of public holidays, sporting and social events. Time-series analysis was used to explore trends in intoxication in the context of major events. Population of Melbourne, Victoria, Australia between 2000 and 2009. All patients attended by ambulance, presenting to hospital EDs, or admitted to hospital who were classified as acutely alcohol intoxicated. Analysis of daily numbers of presentations for acute alcohol intoxication associated with major events were undertaken, including lead and lag effects. Analyses controlled for day of week and month of year to address temporal and seasonal variations. Alcohol intoxication presentations were significantly elevated the day before all public holidays, with intoxication cases on the day of public holidays only higher on New Year's Day (ambulance 6.57, 95% confidence intervals (CI): 3.4-9.74; ED 3.34, 95% CI: 1.28-5.4) and ANZAC Day (ambulance 3.71, 95% CI: 0.68-6.75). The Australian Football League (AFL) Grand Final (ED 2.37, 95% CI: 0.55-4.19), Commonwealth Games (ED 2.45, 95% CI: 0.6-4.3) and Melbourne Cup Day (ambulance 6.14, 95% CI: 2.42-9.85) represented the sporting events with significant elevations in acute intoxication requiring medical attention. The last working day before Christmas was the only social event where a significant increase in acute intoxication occurred (ambulance 8.98, 95% CI: 6.8-11.15). Acute alcohol intoxication cases requiring ambulance, emergency department and hospital in-patient treatment increase substantially on the day preceding public holidays and other major social events.

Diagnosis of tuberculous lymphadenitis using fine needle aspiration biopsy

Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. However, the optimal approach to diagnosis, employing biopsy by either fine needle aspiration (FNA) or surgical excision, remains uncertain. To evaluate the diagnostic value of biopsy using each of the component diagnostic modalities of FNA (microscopy, cytology and culture), and compare these with excision biopsy in the diagnosis of tuberculous lymphadenitis in a predominantly migrant population in Melbourne. A retrospective examination of tuberculous lymphadenitis cases presenting to Western Health over 12 years was conducted. Using a reference method of positive culture of Mycobacterium tuberculosis, the diagnostic sensitivities of each modality employed in FNA were determined. Forty-two subjects having FNA and 30 having excision biopsy as the initial investigation were compared. Among specimens obtained by FNA, sensitivity of microscopy was 18% (95% confidence interval (CI): 5–40%) and sensitivity of cytology was 38% (95% CI: 20–59%). For specimens obtained by excision biopsies, sensitivities for microscopy and histology were 17% (95% CI: 2–32%) and 96% (95% CI: 88–100%) respectively. Sensitivity of culture performed on FNA specimens was 86% (95% CI: 65–97%). Given the relatively high sensitivity of mycobacterial cultures from FNA, this study supports its routine use as the initial investigation in most patients with suspected tuberculous lymphadenitis. Microscopy and cytology add relatively little to the clinical utility of FNA

Isolation and characterisation via 454 sequencing of microsatellites from the tawny frogmouth, Podargus strigoides (Class Aves, Family Podargidae)

We isolated 24 novel polymorphic microsatellite markers from the tawny frogmouth, a nocturnal bird endemic to Australia, which has successfully adapted to urban environments. Initially, 454 shotgun sequencing was used to identify 733 loci with primers designed. Of these, we trialled 30 in the target species of which all amplified a product of expected size. Subsequently, all 30 of these loci were screened for variation in 25 individuals, from a single population in Melbourne, Victoria, Australia. Twenty-eight loci were polymorphic with observed heterozygosity ranging from 0.03 to 0.96 (mean 0.58) and the number of alleles per locus ranged from 2 to 18 (average of 6.5); we confirmed that 24 loci conformed to Hardy–Weinberg expectations. The 24 loci identified here will be sufficient to unequivocally identify individuals and will be useful in understanding the reproductive ecology, population genetics and the gene flow amongst localities in urban environments where this bird thrives.

Genetic structure and diversity of introduced eastern mosquitofish (Gambusia holbrooki) in south-eastern Australia

The closely related eastern mosquitofish (Gambusia holbrooki) and western mosquitofish (Gambusia affinis) have been introduced into many countries and collectively represent the most widely distributed freshwater fish in the world. We investigated genetic patterns associated with the spread of G. holbrooki in its introduced range in south-eastern Australia, by sampling 60 G. holbrooki populations (n = 1771) from major regions where G. holbrooki was initially introduced into Australia, and characterising the genetic diversity and population structure of G. holbrooki, using five polymorphic nuclear microsatellite loci and sequences from two mitochondrial genetic markers. Results were compared with published data on American and European Gambusia samples and historical records. Low microsatellite diversity and strong population genetic structuring were found within G. holbrooki in south-eastern Australia. Observed heterozygosity and allelic richness declined regionally in the order Sydney, Brisbane, Canberra, Melbourne and Adelaide. Microsatellite variation in Australia was reduced compared with native populations. Two mitochondrial DNA haplotypes of G. holbrooki were found; one was common, whereas the other was detected in one Sydney population and one Melbourne population. Cytochrome b sequence diversity was reduced compared with native and European ranges, and sequences were identical to two haplotypes previously identified. Microsatellite diversity of G. holbrooki in south-eastern Australia validates historical records of its spread, beginning north and moving south. Mitochondrial sequencing confirms that G. holbrooki is present in Australia, but the origins of Australian G. holbrooki populations remain unclear.

SOCIOECONOMIC STATUS AND ACUTE MYOCARDIAL INFARCT ADMISSIONS TO HOSPITAL IN MELBOURNE, AUSTRALIA

Background and Aims: Explanatory studies of the relationship between area deprivation and health have highlighted urbanisation and inequality as an emerging theme. Socioeconomic influences on health have been reported at both the individual and area levels of analysis. Acute myocardial infarction (AMI) morbidity in Melbourne and socioeconomic status was mapped to demonstrate spatial associations within the data. Methods: Age standardised rate ratios are calculated by determining the age specific rates for each age group, the expected and observed AMI were calculated. The observed AMI divided by the expected AMI provided a ratio of observed to expected AMI admissions controlling for differences in age structure. The standard Melbourne population was the baseline population. The measure of socioeconomic status used to examine health inequalities was the 2001 area-based Socio-Economic Index for Areas (SEIFA). AMI admissions to hospital were classified into SEIFA quintiles according to SEIFA value for place of residence. Each quintile contained approximately 668,000 adult persons. Quintile 1 includes the most disadvantaged areas and quintile 5 the least disadvantaged areas. Results: The absolute and relative differences in AMI admissions to hospital for SEIFA quintiles 1-5 indicate that rates of AMI admissions are higher in the most disadvantaged areas in the western suburbs, the urban fringe and industrial areas. The rate ratio suggests there were twice as many AMI admissions in quintile 1 (most disadvantage) than in quintile 5 (least disadvantage). Conclusions: The analysis indicates that socioeconomic inequality contributes to AMI admissions to hospital in Melbourne. Regional differences in AMI admissions were quantified and described. Spatial analysis was used to identify spatial clusters of AMI admissions in Melbourne metropolitan region. Quintile maps highlighted the differences in AMI admissions rates per quintile. AMI risk was presented in a spatial framework capable of informing policy and addressing disease prevention.