The impact of health care on mortality: time trends in avoidable mortality in Australia 1968-2001

We investigate the extent to which health care has contributed to the decline in mortality rates in Australia over recent decades by examining trends in avoidable mortality between 1968 and 2001. Avoidable mortality refers to deaths from certain conditions that are considered to be largely avoidable given timely and effective health care. Using unit record mortality data, we classified deaths into three avoidable categories: conditions amenable to medical care (‘medical care indicators’ (MCI)), conditions responsive to health policy but that are considered to lack effective treatment once the condition has developed (‘health policy indicators’ (HPI)), and ischaemic heart disease(IHD). ‘Nonavoidable’ deaths included the remaining causes of death. Our findings suggest that the Australian health care system has made substantial contributions to the reduction in mortality over the past three decades. This is shown in the steady decline in avoidable mortality rates with slower declines in nonavoidable mortality rates. Between 1968 and 2001, total avoidable death rates fell around 70% (68.4% in females, 72.2% in males) and nonavoidable rates fell around 34% (34.6% in females, 33.2% in males). Using Poisson regression, the annual declines in avoidable mortality rates were as follows (95% CIs in parentheses): 3.47% (3.44-3.50%) in females and 3.89% (3.86-3.91%) in males. For nonavoidable mortality rates, the annual declines were 1.09% (1.05-1.13%) in females and 0.95% (0.92-0.98%) in males. The trends in avoidable mortality in Australia were similar to those of other European countries, with Australia improving it’s ranking between 1980 and 1998, performing particularly well with respect to MCI. In females, declines in MCI death rates made the largest contribution to the decline in avoidable mortality rates (54%) with the IHD contribution being 45%. In males, reductions in IHD death rates made the largest contribution (57%), with the MCI contribution being 32%. For both sexes, most of this decline occurred in only a small number of the thirty-five MCI causes – cerebrovascular disease, cancer of the breast (females), cancer of the colon and rectum, perinatal deaths and pneumonia. Declines in HPI death rates made a negligible contribution in females (1%) and only a modest contribution in males (11%). While the observed declines in avoidable mortality rates may also reflect changes in other factors that influence mortality such as environment and socioeconomic conditions, they are consistent with, and suggestive of, the health care system being an important determinant of health improvements in Australia in recent decades

Attributes and weights in health care priority setting: a systematic review of what counts and to what extent

In most societies resources are insufficient to provide everyone with all the health care they want. In practice, this means that some people are given priority over others. On what basis should priority be given? In this paper we are interested in the general public's views on this question. We set out to synthesis what the literature has found as a whole regarding which attributes or factors the general public think should count in priority setting and what weight they should receive. A systematic review was undertaken (in August 2014) to address these questions based on empirical studies that elicited stated preferences from the general public. Sixty four studies, applying eight methods, spanning five continents met the inclusion criteria. Discrete Choice Experiment (DCE) and Person Trade-off (PTO) were the most popular standard methods for preference elicitation, but only 34% of all studies calculated distributional weights, mainly using PTO. While there is heterogeneity, results suggest the young are favoured over the old, the more severely ill are favoured over the less severely ill, and people with self-induced illness or high socioeconomic status tend to receive lower priority. In those studies that considered health gain, larger gain is universally preferred, but at a diminishing rate. Evidence from the small number of studies that explored preferences over different components of health gain suggests life extension is favoured over quality of life enhancement; however this may be reversed at the end of life. The majority of studies that investigated end of life care found weak/no support for providing a premium for such care. The review highlights considerable heterogeneity in both methods and results. Further methodological work is needed to achieve the goal of deriving robust distributional weights for use in health care priority setting.12 page(s

Inequalities in bariatric surgery in Australia: findings from 49,364 obese participants in a prospective cohort study

OBJECTIVES: To investigate variation, and quantify socioeconomic inequalities, in receipt of primary bariatric surgery in an obese population. DESIGN, SETTING AND PARTICIPANTS: Prospective population-based cohort study of 49,364 individuals aged 45-74 with body mass index (BMI) ≥30kg/m2, with questionnaire (2006-09) linked to hospital and death data to July 2010. Sample drawn from the 45 and Up Study (~10% of NSW population aged ≥45 included, response rate ~18%). MAIN OUTCOME MEASURES: Rates of bariatric surgery and adjusted rate ratios (RR) in relation to health and sociodemographic characteristics. RESULTS: Over 111,757 person-years (py) of follow-up, 312 participants underwent bariatric surgery, a rate of 27.92/10,000 py (95%CI: 24.91-31.19). Rates were highest in women, people living in major cities and those with diabetes, and increased significantly with increasing body-mass-index and number of chronic health conditions. Adjusted RRs were: 5.27 (3.18-8.73) for annual household-income ≥$70,000 versus <$20,000; and 4.01 (2.41-6.67) for those living in areas in the least- versus most-disadvantaged quintile. Private health insurance (PHI) coverage (age-sex adjusted RR: 9.25; 5.70-15.00) partially explained the observed socioeconomic inequalities. CONCLUSIONS: Bariatric surgery has been shown to be cost-effective in treating severe obesity and associated illnesses. While bariatric surgery rates in Australia are higher in those with health problems, large socioeconomic inequalities are apparent. Our findings suggest these procedures are largely available to those who can afford PHI and associated out-of-pocket costs, with poor access in populations who are most in need. Continuing inequalities in access are likely to exacerbate existing inequalities in obesity and related health problems.National Health and Medical Research Council (NHMRC

Unmet medical needs and health care accessibility in seven countries of Eastern Europe

The study investigated the magnitude and structure of health care access barriers and utilisation inequalities in seven countries of Eastern Europe. Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, and Slovakia were examined over the period 2005-2009. The dataset containing 574,390 observations was derived from the European Union Statistics on Income and Living Conditions (EU-SILC). Logit and multinomial logit models were estimated for each country-year combination to inspect the relationship between respondents’ socio-economic characteristics, the probability of reporting unmet needs for examination or treatment, and the reason for the need not being met. We found that health care was most easily accessible in the Czech Republic and Slovakia. Affordability issues and prohibitive waiting times were prevalent in Poland and the Baltic States. Mobility and information represented minor access barriers. The poorest households, the unemployed, working age cohorts and women were more exposed to problems in accessing health care than the population at large. Access conditions improved over the analysed period. Substantial differences exist among countries that constitute an arguably homogenous group of post-communist, new EU member states. The nature of access barriers is indicative of coverage gaps and inadequacy of public sector resources relative to need, which call for systemic solutions

Unmet medical needs and health care accessibility in seven countries of Eastern Europe

The study investigated the magnitude and structure of health care access barriers and utilisation inequalities in seven countries of Eastern Europe. Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, and Slovakia were examined over the period 2005-2009. The dataset containing 574,390 observations was derived from the European Union Statistics on Income and Living Conditions (EU-SILC). Logit and multinomial logit models were estimated for each country-year combination to inspect the relationship between respondents’ socio-economic characteristics, the probability of reporting unmet needs for examination or treatment, and the reason for the need not being met. We found that health care was most easily accessible in the Czech Republic and Slovakia. Affordability issues and prohibitive waiting times were prevalent in Poland and the Baltic States. Mobility and information represented minor access barriers. The poorest households, the unemployed, working age cohorts and women were more exposed to problems in accessing health care than the population at large. Access conditions improved over the analysed period. Substantial differences exist among countries that constitute an arguably homogenous group of post-communist, new EU member states. The nature of access barriers is indicative of coverage gaps and inadequacy of public sector resources relative to need, which call for systemic solutions

The Theory of Brown Dwarfs and Extrasolar Giant Planets

Straddling the traditional realms of the planets and the stars, objects below the edge of the main sequence have such unique properties, and are being discovered in such quantities, that one can rightly claim that a new field at the interface of planetary science and and astronomy is being born. In this review, we explore the essential elements of the theory of brown dwarfs and giant planets, as well as of the new spectroscopic classes L and T. To this end, we describe their evolution, spectra, atmospheric compositions, chemistry, physics, and nuclear phases and explain the basic systematics of substellar-mass objects across three orders of magnitude in both mass and age and a factor of 30 in effective temperature. Moreover, we discuss the distinctive features of those extrasolar giant planets that are irradiated by a central primary, in particular their reflection spectra, albedos, and transits. Aspects of the latest theory of Jupiter and Saturn are also presented. Throughout, we highlight the effects of condensates, clouds, molecular abundances, and molecular/atomic opacities in brown dwarf and giant planet atmospheres and summarize the resulting spectral diagnostics. Where possible, the theory is put in its current observational context.Comment: 67 pages (including 36 figures), RMP RevTeX LaTeX, accepted for publication in the Reviews of Modern Physics. 30 figures are color. Most of the figures are in GIF format to reduce the overall size. The full version with figures can also be found at: http://jupiter.as.arizona.edu/~burrows/papers/rm

Measurements of differential production cross sections for a Z boson in association with jets in pp collisions at root s=8 TeV

Peer reviewe

Search for leptophobic Z ' bosons decaying into four-lepton final states in proton-proton collisions at root s=8 TeV

Peer reviewe

Search for black holes and other new phenomena in high-multiplicity final states in proton-proton collisions at root s=13 TeV

Peer reviewe