Estimating the economic burden of low health literacy in the Blacktown community in Sydney, Australia : a population-based study

Evidence shows that inadequate or low health literacy (LHL) levels are significantly associated with economic ramifications at the individual, employer, and health care system levels. Therefore, this study aims to estimate the economic burden of LHL among a culturally and linguistically diverse (CALD) community in Blacktown: a local government area (LGA) in Sydney, Australia. This study is a secondary analysis of cross-sectional data from publicly available datasets, including 2011 and 2016 census data and National Health Survey (NHS) data (2017–2018) from the Australian Bureau of Statistics (ABS), and figures on Disease Expenditure in Australia for 2015–2016 provided by the Australian Institute of Health and Welfare (AIHW). This study found that 20% of Blacktown residents reported low levels of active engagement with health care providers (Domain 6 of the Health Literacy Questionnaire (HLQ)), with 14% reporting a limited understanding of the health information required to take action towards improving health or making health care decisions (Domain 9 of the HLQ). The overall extra/delta cost (direct and indirect health care costs) associated with LHL in the Blacktown LGA was estimated to be between $11,785,528 and$15,432,239 in 2020. This is projected to increase to between $18,922,844 and$24,191,911 in 2030. Additionally, the extra disability-adjusted life year (DALY) value in 2020, for all chronic diseases and age-groups—comprising the extra costs incurred due to years of life lost (YLL) and years lived with disability (YLD)—was estimated at $414,231,335. The findings of our study may enable policymakers to have a deeper understanding of the economic burden of LHL in terms of its impact on the health care system and the production economy

Prevalence and demographic, socioeconomic, and behavioral risk factors of self-reported symptoms of sexually transmitted infections (STIs) among ever-married women : evidence from nationally representative surveys in Bangladesh

Sexually transmitted infections (STI) symptoms (e.g., abnormal genital discharge and genital sores/ulcers) are a major public health concern in Bangladesh because the symptoms can indicate an STI and cause sexual and reproductive health complications in women of reproductive age. To our knowledge, no study examined the prevalence and risk factors of STI symptoms using a nationally representative sample. This study investigates the prevalence of STI symptoms among ever-married women in Bangladesh and the associations of STI symptoms with various demographic, socioeconomic, and behavioral risk factors using the most recent available data (2007, 2011, and 2014) of the Bangladesh Demographic and Health Surveys (BDHS). The BDHS employs a two stage stratified sampling technique. The analytic sample comprised 41,777 women of reproductive age (15–49 years). Outcome variables included STI symptoms: abnormal genital discharge and genital sores/ulcers. Multivariate logistic regression was employed to find the adjusted odds ratio with a 95% confidence interval to assess the associations of outcome measures with explanatory variables. The study found that the prevalence of abnormal genital discharge and genital sores/ulcers among ever-married women aged 15–49 years was 10% and 6%, respectively. Multivariable analysis revealed that for women aged 25–34 years, those who used contraceptives and married earlier had an increased likelihood of STI symptoms. Furthermore, women from the wealthiest wealth quintile and couple’s joint decision-making were less likely to have STI symptoms. Findings have implications for interventions efforts aiming to improve women’s sexual and reproductive health in Bangladesh

Social determinants of diabetes-related foot disease among older adults in New South Wales, Australia : evidence from a population-based study

Background: Diabetes-related foot is the largest burden to the health sector compared to other diabetes-related complications in Australia, including New South Wales (NSW). Understanding of social determinants of diabetes-related foot disease has not been definitive in Australian studies. This study aimed to investigate the social determinants of diabetes-related foot disease in NSW. Methodology: The first wave of the 45 and Up Study survey data was linked with NSW Admitted Patient Data Collection, Emergency Department Data Collection, and Pharmaceutical Benefits Scheme data resulting in 28,210 individuals with diabetes aged 45 years and older in NSW, Australia. Three outcome variables were used: diabetes-related foot disease (DFD), diabetic foot ulcer (DFU), and diabetic foot infection (DFI). They were classified as binary, and survey logistic regression was used to determine the association between each outcome measure and associated factors after adjusting for sampling weights. Results: The prevalence of DFD, DFU and DFI were 10.8%, 5.4% and 5.2%, respectively, among people with diabetes. Multivariate analyses revealed that the common factors associated with DFD, DFU and DFI were older age (75 years or more), male, single status, background in English speaking countries, and coming from lower-income households (less than AUD 20,000 per year). Furthermore, common lifestyle and health factors associated with DFD, DFU, and DFI were low physical activity (< 150 min of moderate-to-vigorous physical activity per week), history of diabetes for over 15 years, and having cardiovascular disease. Conclusion: Our study showed that about 1 in 10 adults with diabetes aged 45 years and older in NSW reported DFD. Interventions, including the provision of related health services aimed at reducing all forms of DFD in NSW, are recommended to target older individuals with a long history of diabetes, and coming from lower-income households

Economic Cost of Health Illiteracy for Blacktown Hospital Blacktown-Mt Druitt Health Medical Staff Council: Final Report

Health literacy (HL) is defined as the skills, knowledge, motivation, and capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care and take appropriate action (Australian Commission on Safety and Quality in Health Care, 2014) (3). Patients with a greater level of HL report better clinical and hospital outcomes (19, 20). On the contrary, a low level of HL, in other words, ‘health illiteracy’ is not only associated with significant health burdens at the individual and community levels but also has economic ramifications at the practice and health-care system levels (23-26). At the health-care system level, a low HL is associated with increased economic burden. Evidence from the United States (US) suggests that the cost of low HL to the US economy was between $106 billion to$238 billion annually, which is almost 7 to 17% of all personal care expenditures. At the individual level, the cost of low HL ranged from $143 to$7798 per person per year, compared to individuals with adequate health literacy (40). Findings from the Health Literacy Questionnaire (HLQ) indicated that only one in four Australians strongly agreed to have sufficient information to manage their health. In terms of self-management of conditions, only 18% of Australians strongly agreed to actively managing their health (43). However, compared to those without a chronic illness, only 12% of Australians with multiple chronic conditions reported adequate levels of self-management behaviours and only 17% reported to actively engaging with a health care team (43). Findings of the study may provide policymakers with a deeper understanding of the economic burden of low HL in terms of health care and the production economy. It may also help determine who bears the burden of low HL, which may aid in efficient allocation of resources to alleviate the cost of low HL at individual and public health care provider, and government levels. With respect to future research, there is an opportunity to delve into all nine domains of the Health Literacy Questionnaire in order to obtain a deeper understanding and to evaluate the cost associated with the different aspects of HL. Once the data on PHN levels are available, future research could focus on comparing Western Sydney PHN population with that of the neighbouring PHNs (South Western and Nepean Blue Mountains PHNs) as well as with high performing and affluent PHNs (North Sydney PHN)

Economic Cost of Health Illiteracy for Blacktown Hospital Blacktown-Mt Druitt Health Medical Staff Council: Report 1

is the first report on the Economic Cost of Health Illiteracy for Blacktown Hospital. This document contains two sections: an introduction and a methods and analysis. Health literacy (HL) is defined as the skills, knowledge, motivation, and capacity of a person to access, understand, appraise and apply information to make effective decisions about health and health care and take appropriate action (Australian Commission on Safety and Quality in Health Care, 2014). Patients with a greater level of HL report better clinical and hospital outcomes. On the contrary, low level of HL, in other words, ‘health illiteracy’ is not only associated with significant health burden at individual and community level but also results in economic ramifications at practice and health care system levels. At health care system level, low HL is associated with increased economic burden. Evidence from the United States (US) estimated that the cost of low HL to US economy was between $106 billion to$238 billion annually, which is almost 7 to 17% of all personal care expenditures. At individual level, the cost of low HL ranged from $143 and$7798 per person per year, compared to individuals with adequate health literacy. Findings of the Health Literacy Survey indicated that only one in four Australians strongly agreed to have sufficient information to manage their health. In terms of self-management of conditions, only 18% of Australians strongly agreed to actively managing their health. However, compared to those without a chronic illness, only 12% of Australians with multiple chronic conditions reported adequate levels of self-management behaviours and only 17% reporting to actively engage with health care team. The overall hospital admission rates as well as admissions for specific chronic conditions were higher among Blacktown LGA compared to North Sydney LGA, NSW average, and Australian Capital Territory average, with exception of musculoskeletal conditions. The study will use different publicly available secondary data sets to calculate the economic costs of low health literacy. These data sets include Australian Bureau of Statistics (ABS) Census data of 2011 and 2016, ABS National Health Survey (NHS) 2017-18, New South Wales Population health survey 2019 and Public Health Information Development Unit (PHIDU) data, Independent Hospital Pricing Authority (IHPA) reports, the 45 and Up study data, the NSW Admitted Patient Data Collection (APDC) and NSW Emergency Department Data Collection (EDDC). Different perspectives will be considered while costing the impact of health illiteracy. These perspectives will be public healthcare provider, individual, employer and government. Costs will include the cost to health system, production economy, government, household and individual. Both total and average cost will be calculated. These costs will be adjusted for inflation

Economic Cost of Eating Disorder: Report

Eating disorders (EDs) are serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. These disorders range in complexity and severity but can be life-threatening without appropriate treatment. EDs are a major social and economic issue, both in Australia and around the world. There is a significant burden of disease associated with EDs and evidence indicates a large treatment gap for these people. This paper focuses on Bulimia Nervosa (BN) and Binge Eating Disorder (BED), disorders characterised by episodes of binge eating occurring at least once a week for 3 months, involving (1) the consumption of an objectively large amount of food in a discrete time frame (e.g. 2 hours) and (2) a sense of loss of control over the food consumption. Although BED was only introduced as a stand-alone disorder in 2013, there has been a six-fold increase in binge-eating behaviour since 1998. As yet, very few studies have been undertaken into the prevalence and health service utilisation patterns of people with these disorders in the community. To close this treatment gap, service planning and delivery strategies need to be underpinned by up-to-date population health information. In order to generate this information this study used questions in the 2017 Health Omnibus Survey (HOS) of South Australians to gather data on the community prevalence, distribution, socio-demographic features, disease burden and costs of EDs, as well as current levels of health service utilisation. This survey data provided a representative, population-level snapshot from which new econometric modelling of costs and disease burden could be undertaken. Costs are considered as: health system costs, productivity costs, transactional costs and out-of-pocket costs

Prevalence and burden of diabetes-related foot disease in New South Wales, Australia : evidence from the 45 and Up Study survey data linked with Health Services data

Diabetes-related foot disease (DFD) is a major public health concern due to the higher risks of hospitalisation. However, estimates of the prevalence of DFD in the general population are not available in Australia. This study aims to estimate the prevalence of DFD and diabetes-related lower-extremity amputation (DLEA) among people aged 45 years and over in New South Wales (NSW), Australia. The NSW 45 and Up Study baseline survey data of 267,086 persons aged 45 years and over, linked with health services’ administrative data from 2006 to 2012 were used in our study. Of these, 28,210 individuals had been diagnosed with diabetes, and our study identified 3035 individuals with DFD. The prevalence of DFD, diabetic foot ulcer (DFU), diabetic foot infection (DFI), diabetic gangrene (DG), and DLEA were 10.8% (95%CI: 10.3, 11.2), 5.4% (95% CI: 5.1, 5.8), 5.2% (95%CI: 4.9, 5.5), 0.4% (95%CI: 0.3, 0.5), and 0.9% (95%CI: 0.7, 1.0), respectively. DFD, DFU, DFI, DG, and DLEA were the most common among those who were older, born in Australia, from low-income households (<AUD 20,000), or were without private health insurance. Interventional messages to reduce all forms of DFD should target those who are from high-risk groups

[In Press] The economic cost of bulimia nervosa and binge eating disorder : a population-based study

Background - The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. Method - Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. Results - The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included$81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion,$1.6 billion and $0.6 billion, respectively. Conclusions - The YLD average cost in 2018 in South Australia was$296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits