Katrina Spilsbury

Falling rates of hospitalization and mortality from abdominal aortic aneurysms in Australia

BACKGROUND Studies of the population trends for abdominal aortic aneurysms (AAAs) in the period 1970 to 2000 all indicated that the incidence of AAAs was increasing. It is not known whether this increase has continued. We hypothesized that the incidence of AAAs has begun to fall in Australia. METHODS Age-standardized national trends in mortality from AAAs were estimated for the period 1999 to 2006, and hospital separations (deaths or discharges) for AAAs were estimated for the period 1999 to 2008. Poisson regression models were constructed to estimate the relative change over time. RESULTS The age-standardized mortality rate from AAAs fell by an average of 6.0% (95% confidence interval [CI], 4.7-7.3) per annum in men and 2.9% (95% CI, 1.0-4.7) in women. After adjusting for age, hospital separations for men decreased by an average of 2.3% (95% CI, 1.4-2.7) per annum for nonruptured AAAs, and 5.9% (95% CI, 5.0-6.6) for ruptured AAAs and for women decreased by an average of 2.2% (95% CI, 1.4-3.0) per annum for nonruptured AAAs, and 5.1% (95% CI, 3.7-6.5) for ruptured AAAs. Ruptured, compared with nonruptured, AAAs were proportionally more common in women compared with men. The age-specific trends in separations from hospital were all downward apart from nonruptured AAAs in individuals aged 80 years and over. CONCLUSIONS The rates of separation from hospital and mortality for AAAs in Australia have fallen since 1999. This suggests a true fall in incidence of AAAs. Although the reasons for this are unknown, it has implications for policy decisions about screening.

Persistent high rates of hysterectomy in Western Australia: a population‐based study of 83 000 procedures over 23 years

Objective  To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies.

Adenoidectomy for Middle Ear Effusion: A Study of 50,000 Children Over 24 Years†

Objective: To compare the incidence and outcomes of myringotomy plus ventilation tube insertion (MVTI) alone and that concurrent with pharyngeal surgery (adenoidectomy, adenotonsillectomy, or tonsillectomy) at a population level.

A 26-Year Population-Based Study of Burn Injury Hospital Admissions in Western Australia

The aim of the study was to use state-wide health administrative data to assess the incidence, temporal trends, and external cause of burn injury-related hospital admissions and mortality in Western Australia from 1983 to 2008. Linked hospital morbidity and death data for all persons hospitalized with an index burn injury in Western Australia for the period 1983–2008 were identified. Annual age-specific incidence and age standardized rates were estimated. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero-truncated negative binomial regression analysis was used to identify factors associated with hospital length of stay. From 1983 to 2008, there were 23,450 hospitalizations for an index burn injury. Hospital admission rates declined by an average annual rate of 2% (incidence rate ratio [IRR], 95% confidence interval [CI] = 0.983, 0.981–0.984), and burn-related mortality declined by an average annual rate of 2% (IRR, 95% CI = 0.98, 0.96–1.01). Aboriginal people while having significantly higher hospitalization rates than non-Aboriginal people experienced a greater 26-year decline in hospitalizations of 58% (IRR, 95% CI = 0.42, 0.37–0.48) compared with 32% (IRR, 95% CI = 0.68, 0.65–0.71) for non-Aboriginal people. Children younger than 5 years, 20- to 24-year-old men, and adults older than 65 years remain at high risk for burn injury, and males continue to be hospitalized twice as frequently as females. The results demonstrate declines in burn injury hospitalizations and mortality in both Aboriginal and non-Aboriginal populations. Continued research is required of the impacts of medical interventions and the burn pathway of identified high-risk populations.

Unequal Access To Breast-Conserving Surgery In Western Australia 1982–;2000

Background:  The purpose of the present study was to examine the effects of demographic, locational and social disadvantage and the possession of private health insurance in Western Australia on the likelihood of women with breast cancer receiving breast‐conserving surgery rather than mastectomy.

A study of burn hospitalizations for children younger than 5 years of age: 1983-2008

OBJECTIVE: Burn injury is a leading cause of emergency department visits and hospitalizations for young children. We aimed to use statewide linked health administrative data to evaluate the incidence, temporal trends, and cause of burn injuries for children younger than 5 years hospitalized for burn injuries in Western Australia for the period 1983–2008. METHODS: Epidemiologic analysis of linked hospital morbidity and death data of children younger than 5 years hospitalized with an index burn injury in Western Australia for the period 1983–2008. Poisson regression analyses were used to estimate temporal trends in hospital admissions and the external cause of the burn injury. RESULTS: From 1983 to 2008, there were 5398 hospitalizations for an index burn injury and 3 burn-related deaths. Hospital admission rates declined by an average annual rate of 2.3% (incidence rate ratio: 0.977 [95% confidence interval: 0.974–0.981]). More than half of the admissions were for scald burns. Hospitalizations declined for injury caused by scald, flame, contact, and electrical burns; however, the number of hospital admissions increased for chemical burns during the study period. CONCLUSIONS: The burn-injury hospitalizations reported in this study were preventable. Most burns occurred in the home and resulted from exposure to a household hazard. Further effort needs to be devoted to burn prevention and safety strategies, particularly in relation to scalds, to further reduce the incidence of burn injury in young children.

Severe psychiatric disorders in mid-life and risk of dementia in late-life (age 65-84 years): A population based case-control study

Objective: To examine the association of mid-life exposure to several psychiatric disorders with the development of late-life dementia. Methods: A matched case-control study using Western Australian state-wide hospital inpatient, outpatient mental health and emergency records linked to death records. Incident dementia cases (2000-2009) aged 65 to 84 years were sex- and age-matched to an electoral roll control. Records as far back as 1970 were used to assess exposure to medical risk factors before age 65 years. Candidate psychiatric risk factors were required to be present at least 10 years before dementia onset to ensure direction of potential causality. Odds ratios were estimated using conditional logistic regression. Results: 13, 568 dementia cases (median age 78.7 years, 43.4% male) were matched to a control. Depression, bipolar disorder, schizophrenia, anxiety disorder and alcohol dependence were found to be significant and independent risk factors for late-life dementia after adjusting for diabetes, heart disease, cerebrovascular disease and smoking risk factors. The effect of a history of depression, schizophrenia and alcohol dependency on dementia risk varied with age, being strongest for earlier onset late-life dementia and waning at older ages. Conclusion: Severe depression, anxiety disorder, bipolar disorder, schizophrenia and alcoholic dependency disorder treated by specialists in psychiatric facilities in mid-life are important risk factors for late-life dementia. These psychiatric conditions need to be considered in future studies of the risk and prevention of late-life dementia.

Morbidity outcomes of 78 577 hysterectomies for benign reasons over 23 years

Objective  To investigate the association of the method of hysterectomy for benign reasons with morbidity outcomes in Western Australia after taking other demographic, social and health‐related factors into account.

Long-term survival following laparoscopic and open colectomy for colon cancer: a meta-analysis of randomized controlled trials

Large randomized clinical trials comparing long‐term survival after laparoscopic and open colectomy for large bowel cancer show equivalence, but meaningful analysis of data by stage has not been possible due to the small numbers of patients in individual trials. The aim of this meta‐analysis was to improve statistical power by combining data to enable assessment of survival for individual stages.

Factors associated with developing Cholesteatoma: a study of 45,980 children with middle ear disease

To identify factors associated with the rate of developing cholesteatoma following ventilation tube insertion (VTI).