An AIHW framework for assessing data sources for population health monitoring: working paper

This paper outlines the Australian Institute of Health and Welfare\u27s (AIHW) assessment framework for determining the suitability of specific data sources for population health monitoring. AIHW\u27s Assessment Framework When identifying potential data sources for population health monitoring, it is important to ensure they are \u27fit-for-purpose\u27. The AIHW has developed a 3-step process to assess potential data sources for population health monitoring: Step 1 collects information about the data source Step 2 identifies the potential to inform key monitoring areas Step 3 assesses the quality of the data, using a modified version of the Australian Bureau of Statistics (ABS) Data Quality Framework (ABS 2009), to determine its \u27fitness-for-purpose\u27 by establishing its utility, strengths and limitations. The assessment framework has been designed for use by the AIHW and others with an interest in assessing new data sources for use in population health monitoring. With adaptation, it may also have wider applications in other sectors or subject areas. For an example of the application of the assessment framework, see the AIHW working paper Assessment of the Australian Rheumatology Association Database for national population health monitoring (AIHW 2014a)

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare

BACKGROUND Good quality spatial data on Family Physicians or General Practitioners (GPs) are key to accurately measuring geographic access to primary health care. The validity of computed associations between health outcomes and measures of GP access such as GP density is contingent on geographical data quality. This is especially true in rural and remote areas, where GPs are often small in number and geographically dispersed. However, there has been limited effort in assessing the quality of nationally comprehensive, geographically explicit, GP datasets in Australia or elsewhere.Our objective is to assess the extent of association or agreement between different spatially explicit nationwide GP workforce datasets in Australia. This is important since disagreement would imply differential relationships with primary healthcare relevant outcomes with different datasets. We also seek to enumerate these associations across categories of rurality or remoteness. METHOD We compute correlations of GP headcounts and workload contributions between four different datasets at two different geographical scales, across varying levels of rurality and remoteness. RESULTS The datasets are in general agreement with each other at two different scales. Small numbers of absolute headcounts, with relatively larger fractions of locum GPs in rural areas cause unstable statistical estimates and divergences between datasets. CONCLUSION In the Australian context, many of the available geographic GP workforce datasets may be used for evaluating valid associations with health outcomes. However, caution must be exercised in interpreting associations between GP headcounts or workloads and outcomes in rural and remote areas. The methods used in these analyses may be replicated in other locales with multiple GP or physician datasets

Expenditure and resource utilisation for cervical screening in Australia

BACKGROUND The National Cervical Screening Program in Australia currently recommends that women aged 18-69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. METHODS A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. RESULTS The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing$96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing$21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that$20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. CONCLUSIONS Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new technologies, increasing the interval and changing the age range of screening is expected to have a substantial impact on this expenditure, as well as having some impact on follow-up and management costs. These estimates provide a benchmark for future assessment of the impact of changes to screening program recommendations to the costs of cervical screening in Australia

Disability support services: services provided under the National Disability Agreement 2013–14

In 2013–14, an estimated 321,531 people used disability support services under the National Disability Agreement, including 4,200 who transitioned to the National Disability Insurance Scheme during the year. Summary In 2013-14, an estimated 321,531 people used disability support services under the National Disability Agreement (NDA)-a 9% increase since 2009-10, and a 3% increase since 2012-13. Of those who used NDA services in 2013-14: 44% used community support services, 41% used employment services, 18% used community access services, 14% used accommodation  support services, and 12% used respite services around three-quarters  (74%) were aged under 50, with an average age of 34 most (59%) were male majority (87%) were Australian-born 6% were Aboriginal and Torres Strait Islander people more than half (55%) had an intellectual or learning disability (44% as their primary disability) many needed at least some assistance with activities of daily living (68%), activities of independent living (82%), and activities of work, education and community living (86%) more than half (54%) lived with their families close to one-third (32%) of those aged 15 and over were not in the labour force 70% of those aged 15 and over who were in the labour force were unemployed an estimated 4,200 transitioned to the National Disability Insurance Scheme during the year

Mortality inequalities in Australia 2009–2011

Australia is one of the healthiest countries in the world. However, despite relatively high standards of health and health care in Australia, not all Australians fare equally well in terms of their health and longevity. Males have a mortality rate that is 1.5 times as high as the rate for females. There would have been 71,400 fewer male deaths over the 2009-2011 period if males had the same mortality rate as females. People living in Remote and Very remote areas had mortality rates 1.4 times as high as those for people living in Major cities, and higher rates of death due to diabetes and land transport accidents. People living in the lowest socioeconomic status (SES) areas had a mortality rate that was 1.3 times as high as the rate among people living in the highest SES areas, and higher rates of death due to diabetes and chronic obstructive pulmonary disease (COPD). Overseas-born Australian residents on average had lower mortality rates than Australian-born residents. Asian-born Australian residents had a mortality rate that was 36% lower than the rate for Australian-born residents. The overall mortality rate among Indigenous Australians was nearly twice that of non-Indigenous Australians, and five times as high among Indigenous people aged 35-44. Australians that fared the worst in terms of mortality rates tended to do so for causes of death that in many cases can be considered either preventable or treatable-these are often referred to as potentially avoidable deaths. Many of the patterns in mortality inequalities for 2009-2011 were similar to results from 10 years earlier. While we did not examine in depth the extent to which differences between population groups have changed over time, it is clear that mortality inequalities are long-standing. It is also clear that the greatest inequalities exist for what are considered to be avoidable causes of death

BreastScreen Australia monitoring report 2011-2012

Presents the latest national statistics on BreastScreen, which aims to reduce illness and death resulting from breast cancer through organised screening to detect cases of unsuspected breast cancer in women, thus enabling early intervention. Summary BreastScreen Australia aims to reduce illness and death resulting from breast cancer through organised screening to detect cases of unsuspected breast cancer in women, thus enabling early intervention. Women aged 40 and over are eligible for free 2-yearly mammograms. This report is the latest in the BreastScreen Australia monitoring report series, which is published annually to provide regular monitoring of national participation and performance for BreastScreen Australia. The report provides data for the 2011-2012 period of participation in BreastScreen Australia, as well as the latest available data on incidence and mortality. The following statistics refer to the latest data available for women aged 50-69*. *As part of the 2013-14 Federal Budget, the Australian Government committed $55.7 million over 4 years to expand BreastScreen Australia\u27s target age range from 50-69 to 50-74. This report includes data from women screened when BreastScreen Australia actively targeted women aged 50-69. How many women were diagnosed with, or died from, breast cancer? In 2010, there were 7,449 new cases of invasive breast cancer diagnosed in Australian women aged 50-69. This is equivalent to 300 new cases per 100,000 women, and makes breast cancer the most common cancer affecting Australian women. Incidence has remained steady at around 300 per 100,000 women for over a decade. In 2011, a total of 1,130 women aged 50-69 died from breast cancer, equivalent to 44 deaths per 100,000 women. This is similar to the rate for 2010, and makes breast cancer the second most common cause of cancer-related death for Australian women. Breast cancer mortality fell from 68 deaths per 100,000 women in the target age range in 1991 (when BreastScreen Australia began) to 44 per 100,000 women in 2011. Incidence of breast cancer was lower for Aboriginal and Torres Strait Islander women than for non-Indigenous women (221 compared with 266 new cases per 100,000 women), but mortality from breast cancer was higher (52 compared with 44 deaths per 100,000 women). How many women participated in BreastScreen Australia? In 2011-2012, more than 1.4 million women aged 50-69 had a screening mammogram through BreastScreen Australia, a participation rate of 55% for the target age group. This was unchanged from participation rates in 2009-2010 and 2010-2011. Participation of Indigenous women was lower-38% of Aboriginal and Torres Strait Islander women in the population participated compared with 54% of non-Indigenous women. How many women were recalled for further investigation? In 2012, 11% of women screening for the first time were recalled for further investigation; 3% of women attending subsequent screens were recalled. These are similar to rates for 2011. How many women had a small breast cancer detected? Small breast cancers (≤15 mm in diameter) are associated with better treatment options and improved survival. A high proportion of invasive breast cancers detected were small in 2012: 47% of invasive breast cancers detected in those attending their first screen, and 61% in those attending subsequent screens. These are similar to the figures for 2011

Adult oral health and dental visiting in Australia: results from the National Dental Telephone Interview Survey 2010

This publication reports on the oral health, dental visiting and dental treatment needs of Australian adults as self-reported in the National Dental Telephone Interview Survey (NDTIS) 2010. Time series data across all NDTISs conducted since 1994 are also presented to provide a picture of how key measures have changed over this period. International comparisons are also included.Oral health In 2010, the majority of Australian adults reported good oral health. However, 37% reported that they had experienced an oral health issue in the previous 12 months, including 15% who experienced toothache, 25% who felt uncomfortable with their dental appearance and 17% who had avoided certain foods. Adults who were from low-income households or held an Australian Government concession card were more likely to report having \u27fair\u27 or \u27poor\u27 oral health and to have experienced toothache than adults from high-income households or non-cardholders. There was no significant change over time in these measures.Dental visiting Around 60% of adults made a dental visit in the previous 12 months and the majority of these visited for a check-up (60%). Adults in the lowest income group (51%) and cardholders (those who hold an Australian Government concession card) (53%) were less likely than those in the highest household income group (65%) and non-cardholders (64%) to have made a dental visit in the previous 12 months. Adults from Major cities were more likely than those from all other areas to have made a dental visit and to have visited for a check-up.Barriers to dental care use Around 38% of adults experienced a financial barrier or hardship associated with dental visits. Overall, 31% avoided or delayed making a dental visit due to cost. Of those who did visit, around 11% of adults reported that dental visits in the previous 12 months were a large financial burden. Adults from the lowest income households were seven times as likely to report difficulty paying a $150 dental bill than those from high-income households.International comparisons Australian adults reported oral health similar to their Canadian counterparts but generally better than that of New Zealanders. Fewer Australians than New Zealanders had no natural teeth. However, Australians were more likely than their New Zealand counterparts to have made a dental visit in the previous 12 months but less likely than those in Canada to do so. Australian adults were more likely at all ages than Canadian adults to report that they had avoided or delayed visiting due to cost. However, they were less likely to have avoided or delayed due to cost than New Zealanders in all age groups up to 45-54 years and less likely to report that they currently needed dental care

Indigenous child safety

Indigenous children are over represented in areas where child safety and security are compromised, argues this report. Summary National data show that Aboriginal and Torres Strait Islander children are over-represented in various aspects of child safety compared with their non-Indigenous counterparts. In particular, Indigenous children have higher rates of hospitalisations and deaths due to injury, and more frequently come into contact with child protection and youth justice systems. Indigenous children have higher hospitalisation and mortality rates for injury The rate of injury hospitalisations among Indigenous children aged 0-17 was 1.3 times that for non-Indigenous children between July 2010 and June 2012. The most common cause of these hospitalisations were accidental falls, followed by transport accidents and assault. The hospitalisation rate for assault for Indigenous children was more than 5 times the rate for non-Indigenous children. In 2007-2011, more than one-quarter (26%) of all deaths among Indigenous children aged 0-17 were due to external causes of injury. The death rate due to external causes of injury for Indigenous children was more than twice the rate for non-Indigenous children (80 deaths per 100,000 children compared with 34 per 100,000). They are more likely to be victims of child abuse, neglect and sexual assault During 2011-12, Indigenous children aged 0-17 were nearly 8 times as likely as non-Indigenous children to be the subject of substantiated child abuse or neglect (42 per 1,000 children compared with 5 per 1,000). In 2012, rates of sexual assault reported to police among Indigenous children aged 0-9 in New South Wales, Queensland, South Australia and the Northern Territory were 2 to 4 times higher than rates among non-Indigenous children in these jurisdictions. They are over-represented among specialist homelessness services clients and in the youth justice system In 2012-13, almost 1 in 3 (31%) children aged 0-17 who received assistance from a specialist homelessness agency was Indigenous; by comparison, Indigenous children comprise 5.5% of the total Australian child population. On an average day in 2012-13, 39% of all males and 45% of all females aged 10-17 under youth justice supervision were Indigenous. Over-representation was highest in younger age groups; of all children aged 10-13 under supervision, 61% were Indigenous. Indigenous young people aged 10-17 were 17 times as likely to be under youth justice supervision as non-Indigenous young people. This over-representation was even higher for those in detention-Indigenous young people were 28 times as likely to be detained as non-Indigenous young people. However, their rate of youth justice supervision has fallen over time In 2012-13, Indigenous young people aged 10-17 were supervised at a rate of 225 per 10,000, down from 233 per 10,000 in 2008-09

Asthma hospitalisations in Australia 2010-11

This report provides an overview of asthma hospitalisation patterns over time and across population groups.SummaryAsthma is a common chronic condition of the airways, associated with episodes of wheezing, breathlessness, chest tightness and cough. Hospitalisation for asthma is rarely required as most symptoms are managed in the community through medication use and primary health care interventions. However, in cases where asthma exacerbations cannot be managed at home, hospitalisation may be required. This report provides an overview of these asthma hospitalisation patterns over time and across population groups. In 2010-11 there were 37,830 hospitalisations where asthma was the principal diagnosis. The asthma hospitalisation rate (175 per 100,000 population) is low compared with other countries. Hospitalisation for asthma decreased between 1998-99 and 2010-11. There was an overall reduction in the rate of hospitalisation for asthma among both children (33%) and adults (45%). Asthma hospitalisation rates varied across population groups in 2010-11: The rate for Indigenous Australians was 2.1 times the rate for Other Australians.Among adults, rates were higher in areas that were more remote (83 per 100,000 population in Major cities and 214 per 100,000 in Very remote regions). This pattern was reversed among children, where rates were lower in areas that were more remote (511 per 100,000 in Major cities and 404 per 100,000 in Very remote regions).Rates were higher among people living in areas with the lowest socioeconomic status (209 per 100,000 population) than for those living in areas with the highest socioeconomic status (134 per 100,000 population).Rates for people born in a non-English-speaking country were lower than for those born in an English-speaking country, with the exception of those aged over 65, where the rates were higher. Children had higher rates of hospitalisation for asthma than adults (495 compared with 92 per 100,000 population) although adults tended to stay in hospital for asthma longer than children: on average, 2.9 days compared with 1.5 days. One in four people hospitalised with a principal diagnosis of asthma in 2010-11 had an acute respiratory infection recorded as an additional diagnosis. Direct health expenditure for asthma was $655 million in 2008-09. The pattern of expenditure on asthma differs somewhat from the pattern for diseases overall. Half (50%) of all asthma expenditure in 2008-09 was attributed to prescription pharmaceuticals, (compared to 14% across all diseases) and a substantially lower proportion of asthma expenditure was attributed to admitted patient hospital care (20%), compared with total recurrent health expenditure across all diseases (52%)