28 research outputs found
School-level variation in coverage of co-administered dtpa and hpv dose 1 in three Australian states
Background:Australian adolescents are routinely offered HPV and dTpa (diphtheria, tetanus, pertussis) vaccines simultaneously in the secondary school vaccination program. We identified schools where HPV initiation was lower than dTpa coverage and associated school-level factors across three states.Methods:HPV vaccination initiation rates and dTpa vaccination coverage in 2016 were calculated using vaccine databases and school enrolment data. A multivariate analysis assessed sociodemographic and school-level factors associated with HPV initiation being >5% absolute lower than dTpa coverage.Results:Of 1280 schools included, the median school-level HPV initiation rate was 85% (interquartile range (IQR):75-90%) and the median dTpa coverage was 86% (IQR:75-92%). Nearly a quarter (24%) of all schools had HPV vaccination initiation >5% lower than dTpa coverage and 11 % had >10% difference. School-level factors independently associated with >5% difference were remote schools (aOR:3.5, 95% CI = 1.7-7.2) and schools in major cities (aOR:1.8, 95% CI = 1.0-3.0), small schools (aOR:3.3, 95% CI = 2.3-5.7), higher socioeconomic advantage (aOR:1.7, 95% CI = 1.1-2.6), and lower proportions of Language-background-other-than-English (aOR:1.9, 95% CI = 1.2-3.0).Conclusion:The results identified a quarter of schools had lower HPV than dTpa initiation coverage, which may indicate HPV vaccine hesitancy, and the difference was more likely in socioeconomically advantaged schools. As hesitancy is context specific, it is important to understand the potential drivers of hesitancy and future research needs to understand the reasons driving differential uptake
What Matters 2 Adults: a study protocol to develop a new preference-based wellbeing measure with Aboriginal and Torres Strait Islander adults (WM2Adults).
BackgroundUnderstandings of health and wellbeing are culturally bound. Many Aboriginal and Torres Strait Islander people perceive wellbeing and quality of life (QOL) differently from the Western biomedical models of health underpinning existing QOL instruments. Any instrument to measure the wellbeing of Aboriginal and Torres Strait Islander people should be culturally appropriate and safe, include relevant dimensions, and be informed by their own values and preferences. Existing QOL instruments do not meet these standards. This study will generate a new preference-based wellbeing measure, WM2Adults, for Aboriginal and Torres Strait Islander adults, underpinned by their values and preferences.MethodsA mixed methods approach will be used; we will employ decolonising methodologies, privilege Aboriginal and Torres Strait Islander voices and perspectives, and adopt a strengths-based approach rather than a deficit lens. Yarning Circles will be conducted with Aboriginal and Torres Strait Islander people across Australia. A candidate item pool will be developed from these data, on which psychometric analysis and validity testing will be undertaken to develop a descriptive system. Following finalisation of the descriptive system, wellbeing states will be valued using a quantitative preference-based approach (best-worst scaling) with a diverse sample of Aboriginal and Torres Strait Islander adults (nâ=â1000). A multinomial (conditional) logit framework will be used to analyse responses and generate a scoring algorithm for the new preference-based WM2Adults measure.DiscussionThe new wellbeing measure will have wide applicability in assessing the effectiveness and cost-effectiveness of new programs and services for Aboriginal and Torres Strait Islander people. Results will be disseminated through journals, conferences and policy forums, and will be shared with Aboriginal and Torres Strait Islander communities, organisations and research participants
Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project
Objective To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. Setting/participants A linked data set of women aged 20â69 in the Queensland Pap Smear Register (PSR; 1999â2011) and Queensland Cancer Registry (QCR; 1997â2010) formed the Initial Study Cohort. Two extracts (1995â2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20â69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. Outcome measures The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. Results There were 28â
872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76â
831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1â
372â
823 women (PSR n=1â
374â
401; QCR n=1955), and 5â
062â
118 records. Conclusions Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australi
Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project.
OBJECTIVE: To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. SETTING/PARTICIPANTS: A linked data set of women aged 20-69 in the Queensland Pap Smear Register (PSR; 1999-2011) and Queensland Cancer Registry (QCR; 1997-2010) formed the Initial Study Cohort. Two extracts (1995-2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20-69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. OUTCOME MEASURES: The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. RESULTS: There were 28â
872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76â
831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1â
372â
823 women (PSR n=1â
374â
401; QCR n=1955), and 5â
062â
118 records. CONCLUSIONS: Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australia
Using probabilistic record linkage methods to identify Australian Indigenous women on the Queensland Pap Smear Register: the National Indigenous Cervical Screening Project
OBJECTIVE: To evaluate the feasibility and reliability of record linkage of existing population-based data sets to determine Indigenous status among women receiving Pap smears. This method may allow for the first ever population measure of Australian Indigenous women's cervical screening participation rates. SETTING/PARTICIPANTS: A linked data set of women aged 20-69 in the Queensland Pap Smear Register (PSR; 1999-2011) and Queensland Cancer Registry (QCR; 1997-2010) formed the Initial Study Cohort. Two extracts (1995-2011) were taken from Queensland public hospitals data (Queensland Hospital Admitted Patient Data Collection, QHAPDC) for women, aged 20-69, who had ever been identified as Indigenous (extract 1) and had a diagnosis or procedure code relating to cervical cancer (extract 2). The Initial Study Cohort was linked to extract 1, and women with cervical cancer in the initial cohort were linked to extract 2. OUTCOME MEASURES: The proportion of women in the Initial Cohort who linked with the extracts (true -pairs) is reported, as well as the proportion of potential pairs that required clerical review. After assigning Indigenous status from QHAPDC to the PSR, the proportion of women identified as Indigenous was calculated using 4 algorithms, and compared. RESULTS: There were 28,872 women (2.1%) from the Initial Study Cohort who matched to an ever Indigenous record in extract 1 (n=76,831). Women with cervical cancer in the Initial Study Cohort linked to 1385 (71%) records in extract 2. The proportion of Indigenous women ranged from 2.00% to 2.08% when using different algorithms to define Indigenous status. The Final Study Cohort included 1,372,823 women (PSR n=1,374,401; QCR n=1955), and 5,062,118 records. CONCLUSIONS: Indigenous status in Queensland cervical screening data was successfully ascertained through record linkage, allowing for the crucial assessment of the current cervical screening programme for Indigenous women. Our study highlights the need to include Indigenous status on Pap smear request and report forms in any renewed and redesigned cervical screening programme in Australia
Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap
Despite the âbest of intentionsâ, Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non-Aboriginal Australians. We examined 2150 original research articles published over the 12-year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases. The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%). This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. We anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health
Spatial variation in cervical cancer screening participation and outcomes among Indigenous and non-Indigenous Australians in Queensland
Indigenous women continue to experience a disproportionately higher burden of cervical cancer than nonâIndigenous women in Australia. The National Indigenous Cervical Screening Project used probabilistic record linkage to combine populationâbased administrative databases and identify Indigenous women on Pap Smear Registers. This study aimed to quantify the spatial variation by local government areas (LGAs) for Indigenous and nonâIndigenous women in Queensland in cervical screening participation rates and related outcomes. Empirical Bayes local geostatistical smoothing was performed to reduce the likelihood of spurious variation between small areas. The cohort included 1,091,260 women (2 per cent Indigenous) aged 20 to 69 with 2,393,708 Pap smears between 2006 and 2011. Indigenous women had smoothed LGAâspecific 5âyear participation rates (interquartile range (IQR) 38.9â53.3 per 100 eligible women) consistently lower than nonâIndigenous women (IQR 80.7â85.3). The nonâoverlapping confidence intervals of these rates suggest that the Indigenous differential was significant. Compared with Indigenous women, nonâIndigenous women had consistently lower and more stable prevalence rates of histologically confirmed high grade abnormalities (IQR 8.0â10.1 versus 15.0â21.3 per 1,000 screened women). Although the LGAâspecific rates also suggest that a higher proportion of nonâIndigenous women were followedâup within two months of an abnormal screening result, the wide confidence intervals for these estimates limit our ability to draw definitive conclusions about spatial patterns for this outcome. These findings highlight the importance of continued monitoring and ongoing efforts to identify drivers of these patterns and develop effective strategies to improve participation and potentially reduce the cervical cancer burden among Indigenous women
The first comprehensive report on Indigenous Australian women's inequalities in cervical screening: A retrospective registry cohort study in Queensland, Australia (2000â2011)
BACKGROUND The Australian National Cervical Screening Program, introduced more than 20 years ago, does not record the Indigenous status of screening participants. This article reports the first populationâbased estimates of participation in cervical screening for Indigenous and nonâIndigenous Australian women. METHODS This was a retrospective, populationâbased study of 1,334,795 female Queensland residents, aged 20 to 69 years, who participated in cervical screening from 2000 to 2011; 26,829 were identified as Indigenous through linkage to hospitalization records. Participation rates were calculated as the number of women screened divided by the average estimated resident population, with adjustments made for hysterectomies, for each 2â, 3â, and 5âyear screening period. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), which were adjusted for age group, place of residence, and socioeconomic disadvantage. RESULTS In 2010â2011, the 2âyear participation rate was 55.7% (95% CI, 55.6%â55.9%) for nonâIndigenous women and 33.5% (95% CI, 32.9%â34.1%) for Indigenous women; this represented a decrease from 2000â2001 (57.7% [95% CI, 57.6%â57.9%] and 35.3% [95% CI, 34.5%â36.1%], respectively). The difference between Indigenous and nonâIndigenous women was greatest for those aged 45 to 49 years. The 3â and 5âyear participation rates were higher within both groups, and the absolute differences between the 2 groups were larger. Significant interactions between the Indigenous status and the place of residence and socioeconomic disadvantage highlight that the Indigenous/nonâIndigenous differential was evident in all places of residence except for very remote areas (OR, 0.99; 95% CI, 0.95â1.02) and was greatest in the most affluent areas (OR, 0.26; 95% CI, 0.24â0.27). CONCLUSIONS Indigenous Australian women participate less than nonâIndigenous women, and this gap has not closed. These results provide important benchmarks for the new Australian cervical screening program commencing in 2017, which will provide opportunities to reduce inequities for Indigenous women and address longstanding data deficiencies in the collection of the Indigenous status. Cancer 2016;122:1560â9. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.The National Indigenous Cervical Screening Project is funded by a National Health and Medical Research Council (NHMRC) Project Grant (#104559). This project is part of a NHMRC Centre of Research Excellence in Discovering Indigenous Strategies to improve Cancer Outcomes via Engagement, Research Translation and Training (DISCOVERâTT CRE) (#1041111) and Cancer Council NSW (#SRP13â01) Strategic Research Partnership to Improve Cancer Control for Indigenous Australians (STREP CaâCIndA). The authors also acknowledge the ongoing support of the Lowitja Institute, Australia's National Institute for Aboriginal and Torres Strait Islander Health Research. Lisa J. Whop was supported by a Sidney Myer Health scholarship, a Menzies Enhanced Living scholarship, and a Lowitja Institute scholarship. Abbey Diaz was supported by a National Health and Medical Research Council postgraduate scholarship (1055587) and a DISCOVERâTTCREâfunded Menzies Enhanced Living scholarship. The National Health and Medical Research Council supported Joan Cunningham with a research fellowship (1058244), Patricia C. Valery with a career development fellowship (1083090), and Karen Canfell with a career development award (1082989). The views expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies. The funding bodies did not have any role in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the article for publication