Socio-demographic factors drive regional differences in participation in the National Bowel Cancer Screening Program – An ecological analysis

© 2017 The Authors Objective: To examine if geographic variations in the participation rates in the National Bowel Cancer Screening Program (NBCSP) are related to population-level socio-demographic characteristics. Methods: Data reflecting participation in the NBCSP for 504 Local Government Areas (LGAs) between July 2011 and June 2013 were extracted from the Social Health Atlas of Australia. Logistic regression models were used to examine independent associations (odds ratios [ORs]) between participation, Remoteness Area (RA) and selected socio-demographic variables. Results: Compared to the participation rate for major cities (33.4%), participation was significantly higher in inner regional areas (36.5%, OR=1.15), but was much lower in remote (27.9%, OR=0.77) or very remote areas (25.0%, OR=0.65). When controlling for study period, gender, proportion of persons aged 65 years and older, Indigenous status, cultural background and socioeconomic status, significantly higher rates were observed in all non-metropolitan areas than in major cities. Indigenous status was strongly related to the poorer participation in remote areas. Conclusions: Socio-demographic characteristics, particularly Indigenous status, cultural background and population ageing, seem to be more important drivers of regional disparities in NBCSP participation than geographic remoteness. Implications for public health: This study provides important evidence to understand the regional disparities in participating in the national screening program

Access to general practitioner services amongst underserved Australians: a microsimulation study

<p>Abstract</p> <p>Background</p> <p>One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia.</p> <p>Methods</p> <p>Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need.</p> <p>Results</p> <p>It was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities.</p> <p>Conclusion</p> <p>Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services.</p

Disparities in cataract surgery between Aboriginal and non-Aboriginal people in New South Wales, Australia

&lt;b&gt;Background:&lt;/b&gt; To investigate variation in rates of cataract surgery in New South Wales (NSW), Australia by area of residence for Aboriginal and non-Aboriginal adults.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Design:&lt;/b&gt; Observational data linkage study of hospital admissions.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Participants:&lt;/b&gt; 289 646 NSW residents aged 30 years and over admitted to NSW hospitals for 444 551 cataract surgery procedures between 2001 and 2008.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods:&lt;/b&gt; Analysis of linked routinely collected hospital data using direct standardisation and multilevel negative binomial regression models accounting for clustering of individuals within Statistical Local Areas (SLAs).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Main outcome measures:&lt;/b&gt; Age-standardised cataract surgery rates and adjusted rate ratios (ARRs).&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results:&lt;/b&gt; Aboriginal people had lower rates of cataract procedures than non-Aboriginal people of the same age and sex, living in the same SLA (ARR 0.71, 95% CI 0.68-0.75). There was significant variation in cataract surgery rates across SLAs for both Aboriginal and non-Aboriginal people, with the disparity higher in major cities and less disadvantaged areas. Rates of surgery were lower for Aboriginal than non-Aboriginal people in most SLAs, but in a few, the rates were similar or higher for Aboriginal people.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Aboriginal people in NSW received less cataract surgery than non-Aboriginal people, despite evidence of higher cataract rates. This disparity was greatest in urban and wealthier areas. Higher rates of surgery for Aboriginal people observed in some specific locations are likely to reflect the availability of public ophthalmology services, targeted services for Aboriginal people and higher demand for surgery in these populations.&lt;p&gt;&lt;/p&gt

National trends in Aboriginal and Torres Strait Islander smoking and quitting, 1994-2008

Objective: To describe the trends in the prevalence of smoking, quitting and initiation among Aboriginal and Torres Strait Islander men and women aged 18 years and over. Methods: Analysis of responses to smoking questions in national Indigenous surveys in 1994, 2002, 2004 and 2008. Results: Male Indigenous smoking prevalence fell significantly from 58.5% in 1994 to 52.6% in 2008, an absolute decrease of 0.4 (CI 0.1-0.7)% per year, with the same decline in remote and non- remote areas. Female smoking fell from 51.0% to 47.4%, with markedly different changes in remote and non-remote areas. In non-remote areas, there was an absolute decrease in female smoking of 0.5 (CI 0.2-0.9)% per year, but in remote areas, female smoking increased by 0.4 (CI 0.0-0.8)% per year. From 2002 to 2008, the percentage of ever-smokers who had quit (quit ratio) increased absolutely by 1% per year in both men and women, remote and non-remote areas. Results about trends in initiation were inconclusive. Conclusions and Implications: Health Minister Roxon has committed to halving the Indigenous smoking prevalence by 2018, and has dramatically increased Indigenous-specific funding and activity in tobacco control. The reported historical trends in this paper are encouraging as they occurred at a time when there was little such tobacco control activity focused on Aboriginal and Torres Strait Islander people. However, to meet the Minister’s goal, Indigenous smoking prevalence will need to fall more than six times as quickly as occurred from 1994 to 2008

Ageing medical workforce in Australia - where will the medical educators come from?

Background: As the general practitioner and specialist medical workforce ages there is likely to be a large number of retirees in the near future. However, few Australian studies have specifically examined medical practitioner retirement and projected retirement patterns, and the subsequent impact this may have on training future health care professionals.\ud \ud Methods: Extracts from the Australian Medicare database and Medical Labour Force Surveys are used to examine trends in attrition of general medical practitioners and specialists over the age of 45 years from the workforce and to predict their rate of retirement to 2025.\ud \ud Results: The general medical practitioner workforce has aged significantly (p<0.05). Between the years 2000 and 2025, it was projected that 43% of the year 2000 general practitioner workforce and 56% of the specialist workforce would have retired.\ud \ud Conclusion: The ageing of the baby boomer and older cohorts of the general practitioner and specialist workforce will lead to a significant number of retirements over the next 20 years. Increasing the numbers of students and new medical schools has been heralded as a means of alleviating service shortages from about 2015 onwards; however, the retirement of a large proportion of experienced health care professionals may lead to shortages of educators for these students

Suicide in the Northern Territory, 1981-2002

Objective: To examine trends in suicide in the Northern Territory between 1981 and 2002, and demographic and other characteristics of people completing suicide in the Top End region in 2000-2002. Design: Retrospective descriptive analysis of Australian Bureau of Statistics death registration data and data from the NT Coroner's Office. Setting and participants: All residents of the NT who completed suicide between 1981 and 2002. Main outcome measures: Changes in the age-adjusted and age- and sex-specific rates of suicide in Indigenous and non-Indigenous NT residents over time; prior diagnosis of mental illness and use of alcohol or other drugs by those completing suicide. Results: The age-adjusted suicide rate in the NT increased significantly between 1981 and 2002 (P 0.05), respectively. Indigenous males aged under 45 years and non-Indigenous males aged 65 years and over were most at risk. In the Top End, a history of diagnosed mental illness was present in 49% of suicide cases, and misuse of alcohol or other drugs around the time of death was associated with 72% of suicide cases. Conclusion: Our study highlights the rising rate of suicide in the NT and suggests that suicide prevention initiatives need to specifically target Indigenous and non-Indigenous males in the age groups most at risk

Growth in Western Australian emergency department demand during 2007–2013 is due to people with urgent and complex care needs

Objectives: To determine the magnitude and characteristics of the increase in ED demand in Western Australia (WA) from 2007 to 2013. Methods: We conducted a population-based longitudinal study examining trends in ED demand, stratified by area of residence, age group, sex, Australasian Triage Scale category and discharge disposition. The outcome measures were annual number and rate of ED presentations. We calculated average annual growth, and age-specific and age-standardised rates. We assessed the statistical significance of trends, overall and within each category, using the Mann–Kendall trend test and analysis of variance ANOVA. We also calculated the proportions of growth in ED demand that were attributable to changes in population and utilisation rate. Results: From 2007 to 2013, ED presentations increased by an average 4.6% annually from 739 742 to 945 244. The rate increased 1.4% from 354.1 to 382.6 per 1000 WA population (P = 0.02 for the trend). The main increase occurred in metropolitan WA, age 45+ years, triage category 2 and 3 and admitted cohorts. Approximately three-quarters of this increase was due to population change (growth and ageing) and one-quarter due to increase in utilisation. Conclusion: Our study reveals a 4.6% annual increase in ED demand in WA in 2007–2013, mostly because of an increase in people with urgent and complex care needs, and not a shift (demand transfer) from primary care. This indicates that a system-wide integrated approach is required for demand management

Decisions to consent for autopsy after stillbirth: Aboriginal and Torres Strait Islander women’s experiences

Abstract Background: The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants is twice that for non-Indigenous infants. Autopsy is the gold standard for fetal investigation, however, parental consent is low. There is little research investigating the drivers of parents’ decision-making for autopsy after stillbirth. Aims: The current study explored the reasons why Aboriginal and Torres Strait Islander women did or did not give permission to autopsy after stillbirth. Materials and Methods: Five Aboriginal and/or Torres Strait Islander women participated in semi-structured interviews. Thematic analysis was conducted within a phenomenological framework. Results: Five themes were identified as reasons for giving permission – to find out why baby died; confirm diagnosis; understand future risk; help others; and doubt about maternal causes. Four themes were identified as reasons for declining permission – not asked in a sensitive manner; not enough time to think; distress about the autopsy procedure; and unwilling to agree. There was a lack of acceptability of the lengthy timeframe for the availability of autopsy results as families usually wait between three and nine months. This lengthy waiting period negatively impacted upon families’ health and wellbeing. Conclusions: It is important for health professionals to understand the factors that parents consider when giving permission for autopsy after stillbirth. It is hoped that an increase in autopsy rate will enhance the understanding of the causes of stillbirth and ultimately decrease the stillbirth rate for Aboriginal and Torres Strait Islander families

Cigarette availability and price in low and high socioeconomic areas

Objective: To determine whether tobacco retailer density and cigarette prices differ between low and high socioeconomic status suburbs in South-East Queensland. Methods: A survey of retail outlets selling cigarettes was conducted in selected suburbs over a two-day period. The suburbs were identified by geographical cluster sampling based on their Index of Relative Socio-economic Advantage and Disadvantage score and size of retail complex within the suburb. All retail outlets within the suburb were visited and the retail prices for the highest ranking Australian brands were recorded at each outlet. Results: A significant relationship was found between Index of Relative Socioeconomic Advantage and Disadvantage score (in deciles) and the number of tobacco retail outlets (r=0.93, p=0.003), with the most disadvantaged suburbs having a greater number of tobacco retailers. Results also demonstrate that cigarettes were sold in a broader range of outlets in suburbs of low SES. The average price of the packs studied was significantly lower in the most disadvantaged suburbs compared to the most advantaged. While cigarettes were still generally cheaper in the most disadvantaged suburbs, the difference was no longer statistically significant when the average price of cigarette packs was compared according to outlet type (supermarket, newsagent, etc). Conclusions: In South-East Queensland, cigarettes are more widely available in the most disadvantaged suburbs and at lower prices than in the most advantaged suburbs