Remoteness Of Residence Research Articles

Multimorbidity, health-related quality of life and health service use among individuals with mental health problems: Urban-rural differences in South Australia.

To investigate urban-rural differences in the relationship between the coexistence of multiple physical health conditions, health-related quality of life and health service use among individuals with mental health problems. Cross-sectional. Population-based. Random sample of 2977 South Australians aged 15+years. Analyses restricted to 535 individuals self-reporting a "current" mental health problem (anxiety, depression, another mental condition). Number of physical health conditions (none, 1-2, 3+ conditions) based on a list of 16 self-reported chronic diseases. Physical and mental health-related quality of life, frequently visited a GP (3+ times), visited a mental health specialist, visited an emergency department, was hospitalised in the last 3months. The mean age of the participants was 57.3± 13.9 years (51.9% females) with 10.6% of them living ininner regional and 14.9% in outer/remote locations.Mental health problems had similar prevalence in major cities (15.4%; 95% confidence intervals [CI]: 13.5-17.4), inner regional (19.3%; 95% CI: 14.8-24.7) and outer/remote areas (16.8%; 95% CI: 14.4-17.7). The remoteness of residence did not affect the relationship between the number of physical health conditions with health-related quality of life or visits to the emergency department/hospitalisations. Individuals without a physical health condition living in major cities were five times more likely to have frequently visited a GP than their counterparts in outer/remote South Australia (35% and 7%, respectively), but these differences were less marked among those with multiple co-morbidities. The coexistence of multiple physical health conditions among patients with a mental health problem is associated with less urban-rural disparities in terms of visiting a GP.

Incidence and Associations of Chronic Kidney Disease in Community Participants With Diabetes: A 5-Year Prospective Analysis of the EXTEND45 Study.

To determine the incidence of and factors associated with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in people with diabetes. We identified people with diabetes in the EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45), a population-based cohort study (2006-2014) that linked the Sax Institute's 45 and Up Study cohort to community laboratory and administrative data in New South Wales, Australia. The study outcome was the first eGFR measurement <60 mL/min/1.73 m2 recorded during the follow-up period. Participants with eGFR < 60 mL/min/1.73 m2 at baseline were excluded. We used Poisson regression to estimate the incidence of eGFR <60 mL/min/1.73 m2 and multivariable Cox regression to examine factors associated with the study outcome. Of 9,313 participants with diabetes, 2,106 (22.6%) developed incident eGFR <60 mL/min/1.73 m2 over a median follow-up time of 5.7 years (interquartile range, 3.0-5.9 years). The eGFR <60 mL/min/1.73 m2 incidence rate per 100 person-years was 6.0 (95% CI 5.7-6.3) overall, 1.5 (1.3-1.9) in participants aged 45-54 years, 3.7 (3.4-4.0) for 55-64 year olds, 7.6 (7.1-8.1) for 65-74 year olds, 15.0 (13.0-16.0) for 75-84 year olds, and 26.0 (22.0-32.0) for those aged 85 years and over. In a fully adjusted multivariable model incidence was independently associated with age (hazard ratio 1.23 per 5-year increase; 95% CI 1.19-1.26), geography (outer regional and remote versus major city: 1.36; 1.17-1.58), obesity (obese class III versus normal: 1.44; 1.16-1.80), and the presence of hypertension (1.52; 1.33-1.73), coronary heart disease (1.13; 1.02-1.24), cancer (1.30; 1.14-1.50), and depression/anxiety (1.14; 1.01-1.27). In participants with diabetes, the incidence of an eGFR <60 mL/min/1.73 m2 was high. Older age, remoteness of residence, and the presence of various comorbid conditions were associated with higher incidence.

Abstract P2-10-16: Breast cancer treatment patterns and outcomes for Australian women by indigenous status and remoteness of residence

Abstract In Australia, incidence of breast cancer is lower but mortality risk is substantially higher in Indigenous relative to non-Indigenous women. Substantial detriment has been found to remain even after compensating for social class and stage of disease with risk of dying still being more than double. At almost one million square miles many patients in Western Australia have to travel for several days for single cycles of treatment in the capital Perth. Indigenous patients on average live in significantly more remote locations than non-Indigenous patients. We have also identified greater incidences of higher risk breast cancer sub-types in the Indigenous population including luminal B and HER2-enriched cancers which require more frequent and longer IV treatment schedules. Research is entirely lacking on systemic treatment disparities in adjuvant and metastatic settings, differences in follow-up and secondary screening protocols by Indigenous status in Australia. Here we set out to define patterns of offered, accepted, and completed treatment with a view to addressing service gaps for disadvantaged populations. An initial cohort of 100 patients comprising 1:1 matched Indigenous and non-Indigenous patients from across WA was obtained from the WA Cancer Registry. Registry data was supplemented with data from the Death Registry, individual medical records from hospitals and family practitioners, state results systems and pharmacy records. Initial surgery performed, radiotherapy delivered and rates of offering, accepting, commencing and completing chemotherapy, HER2-targeted and endocrine therapy were collated by sub-type and stage. Here initial results on treatment of early disease are presented. At the time of writing, data for 37 Indigenous and 33 non-Indigenous breast cancer patients are available. 46% of the cohort are deceased with a median follow-up of 13.2 years. 10-year survival was higher for patients in the metro area than regional or remote patients (79 v 58%, p=0.03) and for non-Indigenous relative to Indigenous patients (84 v 53%, p=0.003). Considering treatment pattern by Indigenous status, no significant differences were observed. Proportionally more Indigenous patients underwent mastectomy relative to conservative surgery (44 v 29 %), a difference observed across tumour sizes. Rate of axillary clearance relative to lymph node (LN) biopsy was similar (48 v 44%) but interestingly was numerically higher for Indigenous women where LNs were involved (99 v 88%). Post-operative radiotherapy was delivered in cases of conservative surgery or locally advanced disease in 87 and 93% of Indigenous and non-Indigenous cases with 9 and 7% of patients declining radiotherapy. For chemotherapy similar proportions of Indigenous and non-Indigenous patients declined offered adjuvant treatment (17 v 19%). Once commenced chemotherapy was completed in similar proportions (89 v 92%). 96% of both groups with estrogen receptor positive tumours were offered adjuvant endocrine therapy. However, the rate of declining or stopping endocrine therapy was numerically higher in Indigenous women (33 v 16%, p=0.12). To conclude, in this small cohort outcomes were significantly inferior, both for Indigenous women and for women living in regional and remote areas. Rates of delivery of local and adjuvant systemic therapy were similar. Rates of offering endocrine treatment were not different but a trend to lower acceptance or compliance with endocrine treatment was seen in Indigenous women that could potentially be addressed by improved patient information, expanded follow-up and toxicity management. Citation Format: Andrew David Redfern, Azim Khan, Lisa J Spalding, Hilary Martin. Breast cancer treatment patterns and outcomes for Australian women by indigenous status and remoteness of residence [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-16.

Abstract P5-04-18: Unfavourable tumour stromal immune cell infiltrates but not circulating immune cell profiles in Aboriginal women with breast cancer

Abstract Breast cancer (BrCa) in Aboriginal Australian women carries more than double the risk of death relative to non-Aboriginal Patients. This higher death is partially explained by factors such as higher stage at diagnosis, younger age, increased co-morbidities, remoteness, socioeconomic disadvantage, and access to culturally sensitive health services. Aboriginal women in a Western Australian cohort also more frequently had tumours with adverse biological features including high grade and luminal B or HER2-enriched phenotype. However, an unexplained detriment remained relative to non-Aboriginal women after accounting for these factors. The immune environment of a tumour as well as of the patient in general can impact on native tumour behaviour as well as response to treatment. Studies in many tumour types including meta-analyses in breast cancer correlate higher circulating neutrophil: lymphocyte ratios (NLR) and neutrophil:platelet ratios (NPR) with poorer outcome. Further to this, tumour infiltrating lymphocyte (TIL) levels also have prognostic significance, associating with improved outcome in triple negative and HER2 positive cancers receiving chemotherapy but with adverse outcomes in estrogen receptor positive (ER+) cancers, potentially through to links to anti-estrogen resistance. To further explore drivers of poor outcome in Aboriginal women we studied circulating NLRs and NPRs in a cohort of Indigenous women matched by remoteness of residence and age to non-Indigenous women in Western Australia. Considering the impact of incidental inflammatory conditions over time only levels from counts taken within 90 days either side of diagnosis were considered. Tissue sections where available were assessed for TILs by standard published methods. NLR was available on 214 patients. The median ratio for Indigenous patients (2.46) was not different to non-Indigenous patients (2.13). Considering patients with NLR &amp;gt; 3.0, a cut-off noted to have poorer prognosis in meta-analysis (ref), there was a stronger trend to higher relapse in non-Indigenous (HR 2.14, p=0.07) than Indigenous patients (HR =1.38, p=0.43) for higher NLR. High NLR was not more common in Indigenous relative to non-Indigenous patients (32% v 25%, p=0.37). Considering very high NLR, significantly more Indigenous women had NLRs &amp;gt;5.0 (4.8 v 6.3%, p=0.04). PLR was available on 225 patients. The median for Indigenous patients (126) was not different to non-Indigenous patients (130). Considering patients with PLR &amp;gt; 185, a cut-off noted to have poorer prognosis in meta-analysis (ref), there were non-significant trends to higher relapse in both Indigenous (HR 1.94, p=0.1) and non-Indigenous patients (HR =1.67, p=0.26) for higher PLR. However, high PLR was not more common in Indigenous relative to non-Indigenous patients (15.4 v 21.6%, p=0.24). Stromal TILs were available on 86 patients. Mean % TIL count was significantly higher in Indigenous women (10.7 v 6.6%, p=0.003). This difference was significant for ER+ (9.6 v 3.5%, p=0.004) but not ER- tumours (20.0 v 21.6%, p=0.79). Significantly more Aboriginal patients with ER positive tumours had &amp;gt;=10% TIL infiltrates (41.7 v 9.8%, p=0.0025) but not those with ER- cancers (70 v 40%, p=0.18). In summary, measured circulating immune or inflammatory profiles did not substantially differ between Aboriginal and non-Aboriginal breast cancer patients. In contrast, although numbers are small, ER+ tumours in Aboriginal women had a higher incidence of significant TIL infiltrates which may both contribute to poorer prognosis and predict for higher utility from immunotherapy. An expansion of the cohort is underway along with immune cell sub-typing and immune checkpoint molecule assessments. Citation Format: Andrew David Redfern, Jacinta J Fong, Lisa J Spalding, Sherene Loi, Benjamin Dessauvagie, Jennet Harvey, Katie Meehan. Unfavourable tumour stromal immune cell infiltrates but not circulating immune cell profiles in Aboriginal women with breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-04-18.

Abstract P2-10-09: Aggressive tumour biology contributes to poor breast cancer outcomes for indigenous Australians

Abstract Breast cancer (BrCa) incidence is lower in Aboriginal Australian women but carries more than double the risk of death. However, rates of Aboriginal BrCa diagnosis are increasing, hypothesized to be due to lifestyle changes. Thus, with rising incidence and higher mortality, deaths due to BrCa are rising in absolute terms in Aboriginal women. Studies of this higher death rate thus far have been epidemiological, exploring factors such as higher stage at diagnosis, younger age, increased co-morbidities, remoteness, socioeconomic disadvantage, and access to culturally sensitive health services. Collectively, these factors do not fully explain this higher rate of death. However, no study has explored any aspect of tumour or host biology in Aboriginal BrCa. We have studied a cohort of 262 Aboriginal women identified from the WA Cancer Registry comprising all cases diagnosed with BrCa in Western Australia for the period 2001-2016. Remoteness, in the form of an Accessibility/Remoteness Index of Australia (ARIA) score, was calculated from address at the time of diagnosis for each patient. All participants were then matched 2:3 by remoteness of residence and age with non-Aboriginal patients. Mortality data including cause was collected through state Death Registry linkage. Basic tumour parameters as well as receptor expressions were extracted from routine pathology assessment data with extra sections scored for missing values when tissue was available. A BrCa sub-type was assigned to each participant based on a modified IHC4 method using tumour grade, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2) status. A significant detriment was found for Indigenous BrCa mortality, univariate hazard ratio (HR)=4.19 (95% confidence interval (CI) 2.42 - 7.25, p&amp;lt;0.001) after matching for remoteness and age, multivariate HR=2.55 (95% CI 1.39 - 4.67, p=0.003) after further adjustment for lymph involvement and size.Supporting the hypothesis that Indigenous BrCa is more likely to be aggressive, substantially more tumours in Aboriginal women were greater than 2cm (51 v 23%, p&amp;lt;0.0001), grade 3 (45 v 26%, p&amp;lt;0.0001) and lymph node positive (56 v 33%, p=0.011). Considering individual receptors, HER2 positivity was substantially more common (21 v 12%, p=0.009) although ER and PR did not differ. Combining grade and receptor status revealed substantially higher proportions of the higher risk sub-types luminal B (29 v 16%) and HER2-enriched (11 v 5%), but no difference in triple negative cancers (15 v 15%), overall p=0.001 for sub-type differences. These biological differences explained part but not all of the survival detriment observed for Aboriginal women with attenuated survival detriment seen within each biological sub-type. Further studies on more detailed aspects of tumour biology are ongoing. Citation Format: Andrew David Redfern, Lisa J Spalding, Edward YC Lee, Connor F Redfern, Leanne Pilkington, Max Bulsara, Richard Trevithick, Katie Meehan. Aggressive tumour biology contributes to poor breast cancer outcomes for indigenous Australians [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-09.

The Importance of Place of Residence on Hospitalized Outcomes for Severely Injured Trauma Patients: A Trauma Registry Analysis.

Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality. A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality. We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07-1.71), head injury (RR 1.39, 95% CI: 1.19-1.62), extremity injuries (RR 1.82, 95% CI: 1.55-2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29-1.76). Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural-based traumatic injuries.

The changing patterns and correlates of population-level polysubstance use in Australian youth: a multi-group latent class analysis of nationally representative samples spanning 12 years.

To (1) identify population-level classes of polysubstance use among young Australians between 2004 and 2016, (2) test if these classes changed over the same period, in terms of class prevalence and probabilities of substance use within each class, and (3) identify demographic and health-related correlates of polysubstance use. Repeated cross-sectional nationally representative household surveys. All Australian states/territories. Young adult samples (aged 18-30years; 58% females) from the National Drug Strategy Household Surveys (n=20 350) MEASUREMENTS: Outcomes were the extent of past-year use of 10 licit (e.g. alcohol), and illicit substances (e.g. cannabis) were used to derive polysubstance use classes. The correlates were gender, age, psychological distress, general health, language background, personal income, education level, remoteness of residence and socio-economic index for area of residence. Three polysubstance use classes were consistently identified between 2004 and 2016 (SSABIC: 188349): minimal users (MU, ~60%), mainly tobacco, alcohol and cannabis users (TAC, ~30%) and extended range polysubstance users (POLY, ~10%). There were substantial changes in use of different substances within each class over the study period. For example, smoking decreased in all classes (P<0.05), while harmful alcohol use only decreased in the first two classes (P<0.05). Factors associated with TAC and POLY were similar over the study period. These included: being male and having an English-speaking background, a high level of psychological distress, suboptimal health and high personal income. Living in an affluent area was associated with reduced likelihood of being TAC, but an increased likelihood of being POLY. At the population-level among young Australians between 2004 and 2016, six in 10 did not engage in polysubstance use; four in 10 used a limited range of substances (mainly alcohol, tobacco and cannabis) and one in 10 used an extended range of substances. Over time, the types of substance within the extended polysubstance use class changed substantially.

The Australian Aboriginal Birth Cohort study: socio‐economic status at birth and cardiovascular risk factors to 25 years of age

To determine whether socio-economic status at birth is associated with differences in risk factors for cardiovascular disease - body mass index (BMI), blood pressure, blood lipid levels - during the first 25 years of life. Analysis of prospectively collected data. 570 of 686 children born to Aboriginal mothers at the Royal Darwin Hospital during 1987-1990 and recruited for the Aboriginal Birth Cohort Study in the Northern Territory. Participants resided in 46 urban and remote communities across the NT. The analysed data were collected at three follow-ups: Wave 2 in 1998-2001 (570 participants; mean age, 11 years), Wave 3 in 2006-2008 (442 participants; mean age, 18 years), and Wave 4 in 2014-2016 (423 participants; mean age, 25 years). Cardiovascular disease risk factors by study wave and three socio-economic measures at the time of birth: area-level Indigenous Relative Socioeconomic Outcomes (IRSEO) index score and location (urban, remote) of residence, and parity of mother. Area-level IRSEO of residence at birth influenced BMI (P<0.001), systolic blood pressure (P=0.024), LDL-cholesterol (P=0.010), and HDL-cholesterol levels (P<0.001). Remoteness of residence at birth influenced BMI (P<0.001), HDL-cholesterol (P<0.001), and triglyceride levels (P=0.043). Mother's parity at birth influenced BMI (P=0.039). Our longitudinal life course analyses indicate that area-level socio-economic factors at birth influence the prevalence of major cardiovascular disease risk factors among Indigenous Australians during childhood and early adulthood.

Patterns of prostate-specific antigen testing by remoteness of residence and socio-economic status: An Australian population-based study.

Describes the variation in prostate cancer testing by the remoteness of residence and socio-economic status groups in Australia. A national population-based descriptive study using Medicare data extracted by the Department of Health (formerly the Department of Health and Ageing). Australia. All men, with a Medicare-reimbursed prostate-specific antigen test conducted in Australia between 2002 and 2017, were included. We focused on "screening and case finding" tests (Medicare Benefits Schedule item number 66655) from 1 April 2005 to 31 December 2009, to describe testing differences in subgroups. Groups were categorised into State and Territory, socio-economic status and region of residence. A negative binomial regression model was fitted to measure the incidence rate ratios of those who had a screening prostate-specific antigen test by group. Age-standardised testing rates and incidence rate ratios. Between 2002 and 2017, 11588775 screening prostate-specific antigen tests were reimbursed by the Department of Human Services. During 2005-2009, 52% of all Australian men, aged 40years and over, had a screening test. The incidence rate ratios differed by State and Territory. Men aged 40years and over, living in very remote areas, were 43% less likely to have had a screening test than residents of major cities. Prostate-specific antigen testing rates fell in all age groups between 2007 and 2009 and 2017. The prostate-specific antigen testing behaviour differs between community groups in Australia. Men were less likely to have had a screening prostate-specific antigen test the farther they lived from the major cities. This highlights the need for a more targeted approach to achieve an equitable and evidence-based prostate cancer care across all sectors of the community.

Predictors of Discharge Against Medical Advice in a Tertiary Paediatric Hospital.

Background: Patients who discharge against medical advice (DAMA) from hospital carry a significant risk of readmission and have increased rates of morbidity and mortality. We sought to identify the demographic and clinical characteristics of DAMA patients from a tertiary paediatric hospital. Methods: Data were extracted retrospectively from electronic medical records for all inpatient admissions over a 5-year period. Demographic characteristics (age, sex, Aboriginality, socioeconomic status and remoteness of residence) and clinical characteristics (admitting hospital site, level of urgency on admission, diagnosis and previous DAMA) were extracted and logistic regression models were used to identify predictors of DAMA with 95% confidence intervals. Results: There were 246,359 admissions for 124,757 patients, of which 1871 (0.8%) admissions and 1730 patients (1.4%) DAMA. Predictors of DAMA in a given admission were hospital site (OR 4.8, CI 4.2–5.7, p < 0.01), a mental health/behavioural diagnosis (OR 3.3, CI 2.2–4.8, p < 0.01), Aboriginality (OR 1.6, CI 1.3–2.1, p < 0.01), emergency rather than elective admissions (OR 0.7ha, CI 0.6–0.8, p < 0.01), a gastrointestinal diagnosis (OR 1.5, CI 1.1–2.0, p = 0.04) and a history of previous DAMA (OR 2.0, CI 1.2–3.2, p = 0.05). Conclusions: There are clear predictors of DAMA in this tertiary hospital admission cohort and identification of these provides opportunities for intervention at a practice and policy level in order to prevent adverse outcomes.

The distribution and determinants of mammographic density measures in Western Australian aboriginal women

BackgroundMammographic density (MD) is an established risk factor for breast cancer. There are significant ethnic differences in MD measures which are consistent with those for corresponding breast cancer risk. This is the first study investigating the distribution and determinants of MD measures within Aboriginal women of Western Australia (WA).MethodsEpidemiological data and mammographic images were obtained from 628 Aboriginal women and 624 age-, year of screen-, and screening location-matched non-Aboriginal women randomly selected from the BreastScreen Western Australia database. Women were cancer free at the time of their mammogram between 1989 and 2014. MD was measured using the Cumulus software. Kolmogorov-Smirnov tests were used to compare distributions of absolute dense area (DA), precent dense area (PDA), non-dense area (NDA) and total breast area between Aboriginal and non-Aboriginal women. General linear regression was used to estimate the determinants of MD, adjusting for age, NDA, hormone therapy use, family history, measures of socio-economic status and remoteness of residence for Aboriginal and non-Aboriginal women separately.ResultsAboriginal women were found to have lower DA and PDA and higher NDA than non-Aboriginal women. Age (p < 0.001) was negatively associated and several socio-economic indices (p < 0.001) were positively associated with DA and PDA in Aboriginal and non-Aboriginal women. Remoteness of residence was associated with both mammographic measures but for non-Aboriginal women only.ConclusionsAboriginal women have, on average, less MD than non-Aboriginal women but the factors associated with MD are similar for both sample populations. Since reduced MD is associated with improved sensitivity of mammography, this study suggests that mammographic screening is a particularly good test for Australian Indigenous women, a population that suffers from high breast cancer mortality.

Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006\u20132014

BackgroundWhile a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning.MethodsData were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006–2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed (p < 0.05).ResultsThe crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4–2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6–30.0), 4.1 times (CI: 0.6–29.9), and 4.0 times (CI: 0.6–28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas.ConclusionsThis study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.

Iodine status of Indigenous and non-Indigenous young adults in the Top End, before and after mandatory fortification.

To assess the median urine iodine concentration (UIC) of young adults in the Top End of Northern Territory, before and after fortification of bread with iodised salt became mandatory. Analysis of cross-sectional data from two longitudinal studies, the Aboriginal Birth Cohort and the non-Indigenous Top End Cohort, pre- (Indigenous participants: 2006-2007; non-Indigenous participants: 2007-2009) and post-fortification (2013-15). Indigenous and non-Indigenous Australian young adults (mean age: pre-fortification, 17.9 years (standard deviation [SD], 1.20 years); post-fortification, 24.9 years (SD, 1.34 years). Median UIC (spot urine samples analysed by a reference laboratory), by Indigenous status, remoteness of residence, and sex. Among the 368 participants assessed both pre- and post-fortification, the median UIC increased from 58μg/L (interquartile range [IQR], 35-83μg/L) pre-fortification to 101μg/L (IQR, 66-163μg/L) post-fortification (P<0.001). Urban Indigenous (median IUC, 127μg/L; IQR, 94-203μg/L) and non-Indigenous adults (117μg/L; IQR, 65-160μg/L) were both iodine-replete post-fortification. The median UIC of remote Indigenous residents increased from 53μg/L (IQR, 28-75μg/L) to 94μg/L (IQR, 63-152μg/L; p<0.001); that is, still mildly iodine-deficient. The pre-fortification median UIC for 22 pregnant women was 48μg/L (IQR, 36-67μg/L), the post-fortification median UIC for 24 pregnant women 93μg/L (IQR, 62-171μg/L); both values were considerably lower than the recommended minimum of 150μg/L for pregnant women. The median UIC of young NT adults increased following mandatory fortification of bread with iodised salt. The median UIC of pregnant Indigenous women in remote locations, however, remains low, and targeted interventions are needed to ensure healthy fetal development.

Race-Related Attitudes Associated with Poor Adult Oral Health: A Nationwide Population-Based Australian Study

Summary: We identified pervasive and negative impacts of intolerance towards racial diversity on objective and subjective oral health. Background: Race-related attitudes reflect the views that individuals hold with regard to groups with various racial or ethnic backgrounds. While there is some evidence that those who are more positive about other groups may enjoy better health and well-being, there are clear gaps around the effects of such attitudes on oral health. Our aim was to examine the prevalence of specific race-related attitudes and to investigate the association between such attitudes and both subjective and objective oral health conditions among Australian adults. Methods: Data was from the 2013 National Dental Telephone Interview Survey (NDTIS) (N=2,936), a biannual population-based cross-sectional study in Australia. Race-related attitudes were assessed by a 12-item scale based on the Multi-Response Racial Attitude Measure. Poor race-related attitude scores were considered to be responses to six or more items demonstrating negative race-related attitudes. Fair/poor self-rated oral health and lack of functional dentition (<21 teeth) were the outcomes. Multivariable logistic regression analyses accounting for age, sex, household income, level of education, remoteness of residence, country of birth, dental fear and dental visiting behaviors were estimated to test associations between race-related attitudes and oral health conditions. Findings: Over half (52 percent) of the sample had negative race-related attitudes. The multivariable models revealed that, after adjustment, Australians with negative race-related attitudes had 1.7 (95% CI 1.1, 2.6) times the odds of reporting fair/poor self-rated oral health and 1.5 (95% CI 1.0, 2.4) times the odds of a non-functional dentition. Interpretation: Poor race-related attitudes were associated with negative oral health outcomes in a representative sample of the Australian adult population. Our findings are an important contribution to the literature in suggesting that the impact of race-based attitudes may extend beyond general health. Funding Statement: Australian Government (Department of Health), and the Australian Institute of Health and Welfare. Declaration of Interests: The authors declare no conflict of interests. Ethics Approval Statement: Ethical approval for the study was granted by the University of Adelaide’s Human Research Ethics Committee (approval number HS-2013-036).

Comorbidities contribute to the risk of cancer death among Aboriginal and non-Aboriginal South Australians: Analysis of a matched cohort study

BackgroundAboriginal Australians have poorer cancer survival than other Australians. Diagnoses at later stages and correlates of remote area living influence, but do not fully explain, these disparities. Little is known of the prevalence and influence of comorbid conditions experienced by Aboriginal people, including their effect on cancer survival. This study quantifies hospital recorded comorbidities using the Elixhauser Comorbidity Index (ECI), examines their influence on risk of cancer death, then considers effect variation by Aboriginality. MethodsCancers diagnosed among Aboriginal South Australians in 1990–2010 (N = 777) were matched with randomly selected non-Aboriginal cases by birth year, diagnostic year, sex, and primary site, then linked to administrative hospital records to the time of diagnosis. Competing risk regression summarised associations of Aboriginal status, stage, geographic attributes and comorbidities with risk of cancer death. ResultsA threshold of four or more ECI conditions was associated with increased risk of cancer death (sub-hazard ratio SHR 1.66, 95%CI 1.11-2.46). Alternatively, the presence of any one of a subset of ECI conditions was associated with similarly increased risk (SHR = 1.62, 95%CI 1.23-2.14). The observed effects did not differ between Aboriginal and matched non-Aboriginal cases. However, Aboriginal cases experienced three times higher exposure than non-Aboriginal to four or more ECI conditions (14.2% versus 4.5%) and greater exposure to the subset of ECI conditions (20.7% versus 8.0%). ConclusionComorbidities at diagnosis increased the risk of cancer death in addition to risks associated with Aboriginality, remoteness of residence and disease stage at diagnosis. The Aboriginal cohort experienced comparatively greater exposure to comorbidities which adds to disparities in cancer outcomes.

Breast cancer patients' willingness to travel to participate in a clinical trial.

e14031 Background: The option of clinical trial participation is an important component of high quality care for oncology patients. Despite a recognised need for generalizable research results to guide future practice, and the desire of current oncology patients to participate in trials, only 2-5% of oncology patients in developed nations enroll in a clinical trial. We aimed to determine the willingness of patients to travel, change location and/or clinician to participate in a clinical trial. Methods: Members of a national breast cancer consumer organization were invited by email to respond to an online cross-sectional survey. Questions included demographics, remoteness of residence, prior involvement in clinical trials and location of usual care. This was followed by a Discrete Choice Experiment (DCE) comprising an introduction and 10 hypothetical scenarios to test the effect of variation in travel time, clinician, treating centre, travel cost and type of trial. Results: Between July and August 2016, 288 responses were received, mean age 58. 86% had early stage disease, 51% were currently receiving treatment, 21% had prior clinical trial involvement. Ninety percent were willing to participate in a clinical trial in at least one scenario. Factors that decreased the likelihood of interest in clinical trial participation were increasing travel time, change in oncologist and out of pocket expenses. Type of trial (randomised placebo controlled; randomised open label; single arm) did not influence the decision. If the oncologist remained the same and there were no costs, respondents were willing to travel a mean extra 127 minutes, however if the oncologist changed and there were additional costs, they were willing to travel a mean of 30 minutes. If the oncologist changed and there was no cost, they were willing to travel a mean of 82 minutes. Conclusions: This group of respondents with a past history of breast cancer expressed interest in clinical trial participation, however willingness to travel in the most likely scenario (change oncologist and pay no additional cost) was 82 minutes. To facilitate optimal access to clinical trials, clinicians should consider referral within and between institutions.

Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data

Australia is a high-income country with a well established and largely publicly funded health-care system. However, some populations within Australia have shorter life expectancy and worse health outcomes than others. We explored geographical variations and sociodemographic inequities in infectious disease notifications in Australia. In this retrospective study, we analysed National Notifiable Diseases Surveillance System (NNDSS) notifications from 1991-2011 (n=2·4 million). We assessed the effect of socioeconomic disadvantage and remoteness of residence on national notification incidence. We calculated Gini coefficients, adjusted relative risks (aRRs), population attributable fractions (PAFs), and attributable notifications. We reported aRRs for Indigenous status in three jurisdictions with more than 75% completeness of Indigenous status reporting from the Northern Territory, South Australia, and Western Australia. Of the eight most commonly notified diseases from Jan 1, 1991, to Dec 31, 2011, gonococcal infection was the most geographically unequal and campylobacteriosis was the most evenly distributed across the country. Overall, notification incidence was higher in remote and very remote areas than in major cities (aRR 3·37), and higher in the most socioeconomically disadvantaged quintiles compared with less disadvantaged quintiles (aRR 1·15). The PAF for socioeconomic disadvantage was high for blood-borne viral hepatitis but decreased in other disease groups. In 2011, sexually transmitted infections had 11 093 notifications attributed to remoteness and 5597 notifications attributable to socioeconomic disadvantage. Notification incidence was higher in Indigenous than in non-Indigenous Australians (aRR 5·3). All diseases had differing geographical concentration and sociodemographic risk. Overall, sociodemographic inequities in infectious disease notifications have decreased, but remain unacceptably high. National communicable disease control is complex, requiring both targeted and population-wide interventions. None.

Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence—A population-based cohort study in Australia

BackgroundAboriginal and Torres Strait Islander people (referred to in this paper as “Aboriginal people”) generally have lower cancer survivals and more advanced stages at diagnosis than non-Aboriginal people. There is conflicting evidence on whether these disparities vary by socio-economic disadvantage and geographic remoteness. This study examines variations in these disparities in New South Wales (NSW), Australia. MethodsData for cancers diagnosed in 2000–2008 were extracted from the NSW Cancer Registry (n=264,219). Missing Aboriginal status (13.3%) was multiply imputed. Logistic regression and competing risk regression models were used to examine likelihood of advanced summary stage and risk of cancer death among Aboriginal compared with non-Aboriginal people by socio-economic disadvantage (categorised into quintiles 1: least disadvantaged—5: most disadvantaged) and remoteness. ResultsAboriginal people showed a general pattern of more advanced stage at diagnosis compared with non-Aboriginal people across socio-economic disadvantage and remoteness categories. After adjusting for demographic factors, year of diagnosis, summary stage and cancer site, Aboriginal people living outside the least disadvantaged areas had an increased risk of cancer death compared with non-Aboriginal people living in similar areas (sub-hazard ratio SHR 1.41, 95% confidence interval CI 1.09–1.81; SHR 1.59, 95%CI 1.31–1.93; SHR 1.42, 95%CI 1.22–1.64 and SHR 1.34, 95%CI 1.22–1.48 for quintiles 2–5, respectively). Compared with non-Aboriginal people, Aboriginal people had an elevation in the risk of cancer death irrespective of the remoteness, with the most pronounced elevations detected in remote/very remote areas (SHR 1.56, 95%CI 1.10–2.21). ConclusionCompared with non-Aboriginal people, Aboriginal people had a higher risk of cancer death and higher likelihood of more advanced stage across socio-economic disadvantage and remoteness categories. All areas appear to require attention in endeavours to improve cancer survival outcomes for Aboriginal people.

How calls from carers, friends and family members of someone affected by cancer differ from those made by people diagnosed with cancer; analysis of 4years of South Australian Cancer Council Helpline data.

The purpose of this study is to determine how people diagnosed with cancer who call the Cancer Council Helpline in South Australia differ from carers/family/friends (caregivers) who call. Descriptive, retrospective audit of calls from people who contacted Cancer Council Helpline in South Australia between 16 April 2009 and 16 April 2013 who were diagnosed with cancer (n=5766) or were the caregivers (n=5174) of a person with cancer. Caregivers were more likely to be female (p<0.001); younger in age (p<0.001); call regarding cancer that was metastasised/widespread/advanced, terminal or at an unknown stage (p<0.001) and phone requesting general cancer information or emotional support (p<0.001). This group was more distressed (p<0.001) but less likely (p=0.02) to be offered and/or accept referrals to counselling than people diagnosed with cancer who called. Follow-up care was required by 63.5% of caregivers and 73.1% of people with cancer according to distress management guidelines; 8.5 and 15.3%, respectively, accepted referrals to internal services. The most frequently discussed topic for both groups was emotional/psychological concerns. There were no differences in remoteness of residence or call length between groups. Caregivers represented different demographic groups than people diagnosed with cancer who called this helpline. The two groups phoned for different issues, at different stages of disease progression, displayed different levels of distress and, therefore, may benefit from services being tailored to meet their unique needs. These results also demonstrate the capacity of helplines to complement other health services and confirm that callers to cancer helplines exhibit high levels of distress.

Association of Continuity of Primary Care and Statin Adherence.

PurposeDeficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.Research DesignWe linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.Results36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04–1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15–1.54).ConclusionsGreater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.