Western Australian Hospital Morbidity Data Research Articles

Epilepsy in children exposed to family and domestic violence in the first 5 years of life.

To investigate childhood (0-18 years) hospitalisation and emergency department (ED) contacts for epilepsy in Western Australian (WA) children exposed to family and domestic violence (FDV) pre 5 years of age compared to children with no FDV exposure. A retrospective, population-based cohort study included children born 1987-2010 who were identified as being exposed to FDV (n=7018) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n=41 996). Epilepsy contact was identified in HMDC and ED Data Collection records. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval (CI) for epilepsy contact; adjustment was made for a range of demographic characteristics known to impact health outcomes. Analyses were stratified by Aboriginal and Torres Strait Islander status to account for higher rates of FDV and epilepsy hospital admissions in Aboriginal and Torres Strait Islander children. Children exposed to FDV had a 62% (HR 1.62, 95% CI: 1.33-1.98) increased risk of epilepsy contact than non-exposed counterparts. Furthermore, the children exposed to FDV had a 50% longer average hospital stay for epilepsy than non-exposed children (4.7 days vs. 3 days, P=0.006). When stratified by Aboriginal status, we found that Aboriginal children exposed to FDV stayed (on average) 2 days longer in hospital for epilepsy than their non-exposed counterparts (5.1 days vs. 3.1 days, P=0.018). FDV exposure in early childhood is associated with increased risk of requiring secondary health care and longer hospital stays for childhood epilepsy.

What matters to short interpregnancy intervals between pregnancies in Western Australia?

ObjectivesStudies showed that short interpregnancy interval - time between birth of the previous (index) child to the conception of the next - is associated with adverse perinatal and maternal outcomes, impacting sibling relations, parenting, and couple relations. This study aims to investigate the demographic and obstetric determinants of short interpregnancy interval in Western Australia.
 ApproachWe used a longitudinal study using data linkage obtained from Western Australian Midwives Notification System and Hospital Morbidity Data System for 150,712 women who gave births between 2006 and 2010. We estimated unadjusted and adjusted hazard ratio (aHR) and 95% CI using Gompertz gamma shared frailty model. In the study, event was deemed when women conceived within 18 months after index (previous) births. Otherwise, we considered as censored when women conceived after 18 months of the index births or if they did not conceive until the last date of the follow up period (31st December 2015).
 ResultsWe found that 20% (n=30,916) of births in WA conceived within 18 months after the index pregnancy. We found that women aged <20 years (aHR=1.46, 95% CI: 1.37, 1.54), 20-34 years (aHR=1.75, 95% CI: 1.69, 1.81), women with stillbirths (HR=3.31, 95% CI: 3.00, 3.65) and women in the lowest socioeconomic status (HR=1.14, 95% CI: 1.10, 1.19) had a greater hazard of having short interpregnancy intervals. However, women with previous gestational diabetes mellitus (aHR=0,90, 95% CI: 0.85, 0.95), women with previous preeclampsia (aHR=0,92 95% CI: 0.87, 0.90), women with more than one previous birth ((aHR=0,41; 95% CI: 0.40, 0.42), women with multiple births (aHR=0,65, 95% CI: 0.60, 0.71) had less hazards than their counterparts to have short interpregnancy intervals.
 ConclusionOne in five Western Australian women conceived within the sub-optimal range of interpregnancy interval. Demographic and obstetric factors play a significant role in determining short interpregnancy intervals.

The Hospital Frailty Risk Score Identifies Fewer Cases of Frailty in a Community-Based Cohort of Older Men Than the FRAIL Scale and Frailty Index.

The recently developed Hospital Frailty Risk Score (HFRS) allows ascertainment of frailty from administrative data. We aimed to compare the HFRS against the widely used FRAIL Scale and Frailty Index. Population-based cohort study linked to Western Australian Hospital Morbidity Data Collection and Death Registrations. The Health in Men Study with frailty determined at Wave 2 (2001/2004), mortality in the 1-year period following Wave 2, and disability at Wave 3 (2008). Participants were 4228 community-based men aged ≥75years, followed untilWave 3. We used multivariable regression to determine the association between each frailty measure and outcomes of length of stay (LOS), death, and disability. We also determined if the additional cases of frailty identified by one measure over the other was associated with these outcomes. Of 4228 men studied, the HFRS (n= 689) identified fewer men as frail than the FRAIL Scale (n=1648) and Frailty Index (n= 1820). In the fully adjusted models, all 3 frailty measures were associated with longer LOS and mortality, whereas only the FRAIL Scale and Frailty Index were significantly associated with disability. The additional cases of frailty identified by the FRAIL Scale and Frailty Index had longer LOS and greater risks of death and disability. The fully adjusted hazard ratio for death among the additional cases of frailty identified by the FRAIL Scale (compared to being not frail on both HFRS and FRAIL Scale) was 2.14 (95% CI 1.48-3.08). The HFRS is associated with adverse outcomes. However, it identified approximately 60% fewer men who were frail than the FRAIL Scale and Frailty Index, and the additional cases identified were also at high risks of adverse outcomes. Users of the HFRS should be aware of the differences with other frailty measures.

A blinded evaluation of privacy preserving record linkage with Bloom filters

BackgroundPrivacy preserving record linkage (PPRL) methods using Bloom filters have shown promise for use in operational linkage settings. However real-world evaluations are required to confirm their suitability in practice.MethodsAn extract of records from the Western Australian (WA) Hospital Morbidity Data Collection 2011–2015 and WA Death Registrations 2011–2015 were encoded to Bloom filters, and then linked using privacy-preserving methods. Results were compared to a traditional, un-encoded linkage of the same datasets using the same blocking criteria to enable direct investigation of the comparison step. The encoded linkage was carried out in a blinded setting, where there was no access to un-encoded data or a ‘truth set’.ResultsThe PPRL method using Bloom filters provided similar linkage quality to the traditional un-encoded linkage, with 99.3% of ‘groupings’ identical between privacy preserving and clear-text linkage.ConclusionThe Bloom filter method appears suitable for use in situations where clear-text identifiers cannot be provided for linkage.

Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study

Purpose This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Methods Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated. Results There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0–6, >6–12, and >12–18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged. Conclusions There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation. Implications for rehabilitation Little is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not. Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care. Dental practitioners at all levels need training and confidence in treating children with ID.

Validation of intellectual disability coding through hospital morbidity records using an intellectual disability population-based database in Western Australia

ObjectivesTo investigate how well intellectual disability (ID) can be ascertained using hospital morbidity data compared with a population-based data source.Design, setting and participantsAll children born in 1983–2010 with a hospital...

Risk factors for recurrent injurious falls that require hospitalization for older adults with dementia: a population based study.

BackgroundOlder adults with dementia are at an increased risk of falls, however, little is known about risk factors for recurrent injurious falls (a subsequent fall after the first fall has occurred) among this group. This study aimed to identify risk factors for recurrent injurious falls requiring hospitalization among adults aged 60+ years with dementia.MethodsThis retrospective, whole-population cohort study was conducted using the Western Australian Hospital Morbidity Data System and Western Australian Death Registrations from 2001 to 2013. Survival analysis using a stratified conditional Cox model (type 1) was undertaken to identify risk factors for recurrent injurious falls requiring hospitalization.ResultsThere were 32,519 participants with an index hospital admission with dementia during the study period. Over 27 % (n = 8970) of the cohort experienced a total of 11,073 injurious falls requiring hospitalization during follow up with 7297 individuals experiencing a single fall, 1330 experiencing two falls and 343 experiencing three or more falls. The median follow-up time for each individual was 2.49 years. Females were at a significantly increased risk of 7 % for recurrent injurious falls resulting in hospitalization (adjusted hazard ratio 1.07, 95 % CI 1.01–1.12), compared to males. Increasing age, living in rural areas, and having an injurious fall in the year prior to the index hospital admission with dementia also increased the risk of recurrent injurious falls resulting in hospitalization.ConclusionsScreening those with dementia for injurious falls history could help to identify those most at risk of recurrent injurious falls. Improvement of heath care and falls prevention services for those with dementia who live in rural areas may also reduce recurrent injurious falls.

Motor Vehicle Crashes and Dementia: A Population-Based Study.

To compare the frequency of motor vehicle crashes of drivers aged 50 and older with a diagnosis of dementia with that of a group without dementia in the 3 years before and 3 years after an index hospital admission using the Western Australian Data Linkage System (WADLS). Retrospective population-based study. De-identified data were obtained from Western Australian Hospital Morbidity Data System and the Western Australian Death Registrations using the WADLS from 2004 to 2010. The Integrated Road Information System was used to identify individuals involved in a crash as the driver from 2001 to 2013. Individuals with dementia with an index hospital admission (n = 1,666, 34%) and individuals without dementia (n = 3,636, 66%) who had been involved in at least one motor vehicle crash as the driver from 2001 to 2013. Involvement in a police-reported crash as the driver. The occurrence of one or more crashes as the driver in the dementia group (43% had a crash as the driver) was higher in the 3 years before the index hospitalization than in the comparison group (30% had a crash as the driver). The risk of a crash was 93% less for those with dementia in the 3 years after an index hospital admission with dementia than for those without dementia (incidence rate ratio = 0.07, 95% confidence interval = 0.06-0.09) compared to the previous 3 years, after adjusting for relevant confounders. Although older drivers may give up driving after a diagnosis of dementia, they may be at greater risk of crashing before diagnosis or in the early stages of dementia. Better methods are needed to identify at-risk drivers with early dementia and prevent crashes.

Fractures of the mandible and maxilla: A 10-year analysis.

Previous analysis of jaw fracture hospitalisations in Western Australia (WA) indicated disproportionately high rates of hospitalisations for Aboriginal people. This study was to follow-up on the earlier analysis to determine if inequalities in terms of jaw fracture hospitalisation rates between Aboriginal and non-Aboriginal people have changed. This study, done over a 10-year period from 1999/2000 to 2008/2009, aimed to determine rates of hospitalisations for jaw fractures in WA, trends over the 10-year period, and direct costs associated with these hospital admissions. Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System (HMDS). Episodes were selected on the basis of an ICD10-AM code being S02.4 (Fracture of the malar and maxillary bones) and S02.6 (Fracture of the mandible). Self-reported Aboriginality were used to compare Aboriginal to non-Aboriginal populations. Estimated cost of care was determined for each episode using the national standard diagnostic-related group (DRG) average price. Our findings indicate that inequalities between Aboriginal and non-Aboriginal people in terms of hospital admissions for jaw fractures exist in WA, and continued over a decade-long period. Higher fracture rates occurred amongst males, Aboriginal people, younger adult age-groups, those from low socioeconomic areas, and those from remote and very remote areas. The DRG cost per person for jaw fractures ranged between AUD $842 and $109,002, with a median cost of $4,965. Hospital admission rates for the treatment of maxillary and mandibular fractures is very strongly divided along racial and socioeconomic lines in WA.

Apple intake is inversely associated with all-cause and disease-specific mortality in elderly women

Higher fruit intake is associated with lower risk of all-cause and disease-specific mortality. However, data on individual fruits are limited, and the generalisability of these findings to the elderly remains uncertain. The objective of this study was to examine the association of apple intake with all-cause and disease-specific mortality over 15 years in a cohort of women aged over 70 years. Secondary analyses explored relationships of other fruits with mortality outcomes. Usual fruit intake was assessed in 1456 women using a FFQ. Incidence of all-cause and disease-specific mortality over 15 years was determined through the Western Australian Hospital Morbidity Data system. Cox regression was used to determine the hazard ratios (HR) for mortality. During 15 years of follow-up, 607 (41·7%) women died from any cause. In the multivariable-adjusted analysis, the HR for all-cause mortality was 0·89 (95% CI 0·81, 0·97) per sd (53 g/d) increase in apple intake, HR 0·80 (95% CI 0·65, 0·98) for consumption of 5-100 g/d and HR 0·65 (95% CI 0·48, 0·89) for consumption of >100 g/d (an apple a day), compared with apple intake of <5 g/d (P for trend=0·03). Our analysis also found that higher apple intake was associated with lower risk for cancer mortality, and that higher total fruit and banana intakes were associated lower risk of CVD mortality (P<0·05). Our results support the view that regular apple consumption may contribute to lower risk of mortality.

Tea and flavonoid intake predict osteoporotic fracture risk in elderly Australian women: a prospective study

Observational studies have linked tea drinking, a major source of dietary flavonoids, with higher bone density. However, there is a paucity of prospective studies examining the association of tea drinking and flavonoid intake with fracture risk. The objective of this study was to examine the associations of black tea drinking and flavonoid intake with fracture risk in a prospective cohort of women aged >75 y. A total of 1188 women were assessed for habitual dietary intake with a food-frequency and beverage questionnaire. Incidence of osteoporotic fracture requiring hospitalization was determined through the Western Australian Hospital Morbidity Data system. Multivariable adjusted Cox regression was used to examine the HRs for incident fracture. Over 10 y of follow-up, osteoporotic fractures were identified in 288 (24.2%) women; 212 (17.8%) were identified as a major osteoporotic fracture, and of these, 129 (10.9%) were a hip fracture. In comparison with the lowest tea intake category (≤1 cup/wk), consumption of ≥3 cups/d was associated with a 30% decrease in the risk of any osteoporotic fracture (HR: 0.70; 95% CI: 0.50, 0.96). Compared with women in the lowest tertile of total flavonoid intake (from tea and diet), women in the highest tertile had a lower risk of any osteoporotic fracture (HR: 0.65; 95% CI: 0.47, 0.88), major osteoporotic fracture (HR: 0.66; 95% CI: 0.45, 0.95), and hip fracture (HR: 0.58; 95% CI: 0.36, 0.95). For specific classes of flavonoids, statistically significant reductions in fracture risk were observed for higher intake of flavonols for any osteoporotic fracture and major osteoporotic fracture, as well as flavones for hip fracture (P < 0.05). Higher intake of black tea and particular classes of flavonoids were associated with lower risk of fracture-related hospitalizations in elderly women at high risk of fracture.

Long term mortality in a population-based cohort of adolescents, and young and middle-aged adults with burn injury in Western Australia: A 33-year study

BackgroundAdvances in the treatment and management of burn patients over the past decades have resulted in a decline of in-hospital mortality rates. Current estimates of burn-related mortality are usually in the context of deaths occurring during the admission or within a short time period after the incident burn. Limited data are available that examine long term mortality after burn injury. This study aimed to assess the impact of burn injury on long-term mortality and quantify any increased risk of death attributable to burn injury. MethodsA population-based cohort study of persons 15–44 years of age hospitalised for burn injury (n=14,559) in Western Australia (1980–2012) and a matched non-injured comparison group (n=56,822) using linked health administrative data was used. Hospital morbidity and death data were obtained from the Western Australian Hospital Morbidity Data System and Death Register. De-identified extraction of all linked hospital morbidity and death records for the period 1980–2012 were provided by the Western Australian Data Linkage System. Survival analysis was conducted using the Kaplan–Meier method and Cox proportional hazards modelling. ResultsThe adjusted all-cause Mortality Rate Ratio (MRR) for burn injury was 1.8 (95%CI: 1.7–2.0); those with burn injury had a 1.8 times greater rate of mortality than those with no injury. The index burn injury was estimated to account for 44% of all recorded deaths in the burn injury cohort during the study period after discharge. Increased risk of mortality was observed for both severe (MRR, 95%CI: 1.9, 1.3–2.9) and minor (MRR, 95%CI: 2.5, 2.2–3.0) burns. ConclusionsAn increased risk of long-term all-cause mortality is associated with both minor and severe burn injury. Estimates of total mortality burden based on the early in-patient period alone, significantly underestimates the true burden of burn injury in adolescents, and young and middle aged adults. These results have significant implications for burn injury prevention.

Evidence‐based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non‐Aboriginal patients admitted to Western Australian hospitals

To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11% vs 7%, P < 0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95% CI 1.39-2.42) and diabetes (OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals.

The Western Australian Family Connections Genealogical Project: Detection of Familial Occurrences of Single Gene and Chromosomal Disorders

To investigate using a Western Australian (WA) genealogical database for the identification of single gene and chromosome disorders among families. Hospital admissions for single gene and chromosome disorders recorded during 2000-2006 were identified from the WA Hospital Morbidity Data System. The proportion of these conditions occurring in family groups was then identified using genealogical links created through the WA Family Connections Genealogical Project. There were 216 family clusters among 11,303 people who were recorded as having a genetic or chromosomal disorder on their hospital admission record. The most common single gene conditions found to occur in multiple family members included blood clotting disorders such as Factor VIII deficiency and Von Willebrand's disease, followed by cystic fibrosis, myotonic dystrophies, neurofibromatosis, tuberous sclerosis, and osteogenesis imperfecta. Single gene disorders most commonly occurring in multiple family members have been identified using the WA Family Connections Genealogical Project. These disorders reflect the most common single gene disorders requiring hospital admission, but which are not fatal before reproductive age and do not result in a loss of fertility. They are also restricted to disorders with earlier onset, as the WA Family Connections Genealogical Project currently covers 2-3 of the most recent generations. This study demonstrates the utility of record linkage genealogies to identify kindred with genetic disorders, offering a rich resource of information for focused genetic epidemiological research.

The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study

cataract is a leading cause of reversible vision impairment and may increase falls in older adults. to assess the risk of an injury due to a fall among adults aged 60+, 2 years before first-eye cataract surgery, between first-eye surgery and second-eye surgery and 2 years after second-eye surgery. a retrospective cohort study. Western Australian Hospital Morbidity Data System and the Western Australian Death Registry. there were 28,396 individuals aged 60+ years who underwent bilateral cataract surgery in Western Australia between 2001 and 2008. Poisson regression analysis based on generalised estimating equations compared the frequency of falls 2 years before first-eye cataract surgery, between first- and second-eye surgery and 2 years after second-eye cataract surgery after accounting for potential confounders. the risk of an injurious fall that required hospitalisation doubled (risk ratio: 2.14, 95% confidence interval: 1.82 to 2.51) between first- and second-eye cataract surgery compared with the 2 years before first-eye surgery. There was a 34% increase in the number of injurious falls that required hospitalisation in the 2 years after second-eye cataract surgery compared with the 2 years before first-eye surgery (risk ratio: 1.34, 95% confidence interval: 1.16-1.55). there was an increased risk of injurious falls after first- and second-eye cataract surgery which has implications for the timely provision of second-eye surgery as well as appropriate refractive management between surgeries.

The impact of first eye cataract surgery on mental health contacts for depression and/or anxiety: a population-based study using linked data

Cataract is the leading cause of reversible blindness worldwide, and the incidence of cataract surgery is projected to increase as the population ages. Gaining an understanding of the effects of cataract surgery on a range of health outcomes is important for maintaining the health and safety of older adults. A before and after cohort study was conducted using the Western Australian Hospital Morbidity Data System, Mental Health Information System and the Western Australian Death Registry. Of the 21 110 patients who underwent cataract surgery in one eye only, 295 had mental health contacts for depression and/or anxiety 1 year before (n = 158) or 1 year after (n = 137) surgery. Results from Poisson generalized estimating equations showed a significant decrease of 18.80% (p ≤ 0.001) in the number of mental health contacts for depression and/or anxiety the year after cataract surgery after accounting for potential confounding factors. A 27.46% increase in mental health contacts the year after cataract surgery was reported by women compared with men (95% CI: 1.08-1.50). Those living in remote areas had less contact with mental health services compared with those living in metropolitan areas (adjusted risk ratio 0.62, 95% CI: 0.46-0.84). The corresponding reduction in health care costs for treatment of depression and/or anxiety was 28%. Further research should be conducted to collect information on the utilization of health care resources not captured in this study, namely community-based services, visits to general practitioners and/or emergency departments as well as medication usage such as antidepressants.

Hospitalisations for removal of impacted teeth in Australia: A national geographic modeling approach

The aim of the study was to project hospitalisation rates for the surgical removal of impacted teeth across Australia, based on Western Australian statistics. Population data were obtained from the Australian Bureau of Statistics and were divided across Australia by statistical local area and related to a validated socioeconomic index. Every episode of discharge from all hospitals in Western Australia for the financial years 1999/2000 to 2008/2009 indicating an impacted/embedded tooth removal as the principle oral condition, as classified by the International Classification of Disease (ICD-10AM), was included in the study. Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System. Variables of age, place of residence and health insurance status were utilised for projecting the Western Australian rates across Australia. The results of the study showed a definite rural-urban divide and the estimated age-adjusted rates were almost three times greater in the higher socioeconomic areas when compared to their poorer counterparts. The costs of the procedure were estimated to be approximately $60 million per annum across Australia. The findings of this study can be used to inform health policy to guide proper allocation of resources and target services for the benefit of the community especially those residing in rural and remote areas in a vast country like Australia.

FIRST EYE CATARACT SURGERY AND HOSPITALISATION FOR A FALL

BackgroundWith an increasing ageing population, the burden from both visual impairment and falls is expected to increase substantially. Cataract surgery is known to improve vision as well as enhancing quality...

First Eye Cataract Surgery and Hospitalization from Injuries Due to a Fall: A Population‐Based Study

To assess the association between first eye cataract surgery and hospitalization from injuries due to a fall in older adults at the population level. Retrospective population-based study. Western Australian Hospital Morbidity Data System and Western Australian mortality data. Six hundred individuals aged 60 and older hospitalized from injuries due to a fall between 2004 and 2008 in Western Australia. Hospital admission from injuries due to a fall. Of the 15,295 individuals who underwent cataract surgery in one eye only, 600 (3.9%) were involved in 625 hospital admissions from injuries due to a fall 1 year before (n = 273) or 1 year after (n = 352) first eye cataract surgery; 30% of these hospitalizations were for femoral neck fractures. Poisson generalized estimating equations confirmed 27% more (adjusted risk ratio = 1.27, 95% confidence interval = 1.04-1.56 P = .02) hospitalizations from injuries due to a fall in the year after first eye cataract surgery than in the year before. First eye cataract surgery was associated with more hospital admissions from injuries due to a fall in the year after cataract surgery than in the year before. Further research is needed to determine the underlying causes and reasons.

Hospitalisation for the surgical removal of impacted teeth: Has Australia followed international trends?

The aim of the study was to undertake a six-year analysis from 1999/00 to 2004/05, of the demographic characteristics of hospitalisations for the surgical removal of impacted teeth in Western Australia under general anaesthesia. Data for the current analysis was obtained from the Western Australian Hospital Morbidity Data System (HMDS). Gender, age, indigenous status, place of residence, type of hospital admitted, insurance status, and Diagnostic Related Group (DRG) cost estimates for the procedure were analysed. A total of 37.6% of all oral health-related hospitalisations in Western Australia over the six years were for the removal of impacted teeth. Admitted patients were predominantly females (58.8%) and very few Indigenous people were hospitalised (0.2%). The average age of patients was 21.4 years (sd=9.9). Metropolitan patients were hospitalised 1.5 times more than rural patients for this condition. The majority of patients were hospitalised at a private metropolitan hospital and were insured. The total cost of hospitalisation for this condition contributes to 27% of all the oral health condition-related hospitalisation costs. This study suggests that the hospital-based removal of impacted teeth in Western Australia is associated with factors such as indigenous status, age, gender and private hospital access along with insurance status raising interesting questions over the equity of provision of this service.