Lee Taylor

Cohort profile: the 45 and up study.

In common with virtually all industrialized countries and many less developed nations, Australia is facing rapid population ageing. Historical patterns of fertility and migration, along with changes in life expectancy, mean that the over 65 age group is likely to increase by around 50% in the next 15–20 years. The further increase in the proportion of people in the very old age groups will result in the ‘ageing of the aged’. The challenges presented by the ageing of the population are far reaching. Discussions have tended to focus on its likely health and economic consequences; however, few aspects of society will remain unaffected by the issue. There is an urgent need for reliable evidence to inform policy to support healthy ageing. The concept of healthy ageing encompasses traditional ideas relating to freedom from disease, as well as broader considerations including independence, quality of life, management of disability, participation in society and the workforce and productivity. A wide range of factors are likely to affect health in later life, including socioeconomic, environmental and cultural variables, cigarette smoking, alcohol consumption, diet, physical activity, reproductive and hormonal factors, infections, availability of healthcare and use of pharmaceutical agents, as well as individuals’ susceptibility to disease. A comprehensive investigation of the determinants of healthy ageing must incorporate assessment of disease risk, quality of life and other indices, in relation to a very wide range of possible exposures, and with consideration of how these exposures might interact with one another. Research needs to be of a sufficient scale to provide specific information on the major diseases and health problems experienced in later life. This is because reliable assessments of risk factor–disease relationships require a substantial degree of pathological homogeneity of outcome and appropriate consideration of confounding. At the same time, research needs to be able to assess the broad risks and benefits of particular exposures, to allow meaningful conclusions to be reached about suitable public health interventions. Finally, it needs to be large and long term enough to track the impact of health interventions and policies at the population level. Australia has some unique characteristics that will impact on healthy ageing and provide particular challenges in delivering health care. For example, it has: a relatively heterogenous population with a large migrant community; an indigenous population with an average life expectancy 17 years less than for nonindigenous Australians; some remote and sparsely populated regions and a mixed health care system with responsibility shared between the national and state governments and delivery in both the public and private sectors. Excellent population-level databases relating to use of health services and medications, and registers of cancers and deaths, are available for statistical linkage with research data sets. There is therefore a need for research that addresses issues specific to the Australian population and makes use of the unique features of the Australian setting, giving the opportunity to provide insights of international relevance. The 45 and Up Study was conceived as a long-term collaborative resource to investigate healthy ageing, in response to the gaps in existing knowledge and the needs of researchers. Initial discussions among interested researchers resulted in the formation of a Scientific Steering Group in 2003 to oversee the development of the Study. The Study is auspiced by the Sax Institute, which also provided funding for its development. The Sax Institute is an independent organization with core funding from the state government of New South Wales, Australia’s most populous state. Its mission is to improve health through facilitating high-quality research and increasing the impact of this research on health policy and services; it has membership from y The Writing Committee is listed at the end of the report. For a list of the 45 and Up Study Collaborators please go to www.45andUp.org.au.

How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period

Background:  There is currently no published information on the full range of morbid conditions affecting mothers and newborns in Australia. Hospital morbidity data collections are a possible source of this information, but have not been widely utilised due to concerns about data quality.

Investigating linkage rates among probabilistically linked birth and hospitalization records

BackgroundWith the increasing use of probabilistically linked administrative data in health research, it is important to understand whether systematic differences occur between the populations with linked and unlinked records. While probabilistic linkage involves combining records for individuals, population perinatal health research requires a combination of information from both the mother and her infant(s). The aims of this study were to (i) describe probabilistic linkage for perinatal records in New South Wales (NSW) Australia, (ii) determine linkage proportions for these perinatal records, and (iii) assess records with linked mother and infant hospital-birth record, and unlinked records for systematic differences.MethodsThis is a population-based study of probabilistically linked statutory birth and hospital records from New South Wales, Australia, 2001-2008. Linkage groups were created where the birth record had complete linkage with hospital admission records for both the mother and infant(s), partial linkage (the mother only or the infant(s) only) or neither. Unlinked hospital records for mothers and infants were also examined. Rates of linkage as a percentage of birth records and descriptive statistics for maternal and infant characteristics by linkage groups were determined.ResultsComplete linkage (mother hospital record – birth record – infant hospital record) was available for 95.9% of birth records, partial linkage for 3.6%, and 0.5% with no linked hospital records (unlinked). Among live born singletons (complete linkage = 96.5%) the mothers without linked infant records (1.6%) had slightly higher proportions of young, non-Australian born, socially disadvantaged women with adverse pregnancy outcomes. The unlinked birth records (0.4%) had slightly higher proportions of nulliparous, older, Australian born women giving birth in private hospitals by caesarean section. Stillbirths had the highest rate of unlinked records (3-4%).ConclusionsThis study shows that probabilistic linkage of perinatal records can achieve high, representative levels of complete linkage. Records for mother’s that did not link to infant records and unlinked records had slightly different characteristics to fully linked records. However, these groups were small and unlikely to bias results and conclusions in a substantive way. Stillbirths present additional challenges to the linkage process due to lower rates of linkage for lower gestational ages, where most stillbirths occur.

The Centre for Health Record Linkage: A New Resource for Health Services Research and Evaluation:

The Centre for Health Record Linkage (CHeReL) was established in 2006 to support health and health services research in New South Wales (NSW) and the Australian Capital Territory (ACT). It is the second dedicated health record linkage unit to be established in Australia. The CHeReL carries out record linkage using best practice privacy preserving procedures (Kelman, Bass & Holman 2002). All record linkage projects must have the approval of a Human Research Ethics Committee and the owners of the relevant databases. To facilitate access to linked health data, the CHeReL is creating a Master Linkage Key to link records for individuals across in a number of health-related datasets including hospital inpatient data, cancer registry data, and birth and death registration data.Introduction The Centre for Health Record Linkage (CHeReL) was established in 2006 to support health and health services research in New South Wales (NSW) and the Australian Capital Territory (ACT). It is the second dedicated health record linkage unit to be established in Australia. The first, Data Linkage WA, located within the Western Australian Department of Health, was established in 1995 (Western Australia Data Linkage Branch 2008). The CHeReL is jointly funded by the NSW Department of Health, ACT Health, the Cancer Institute NSW, the Clinical Excellence Commission, the Sax Institute, the University of Newcastle, the University of New South Wales and the University of Sydney. The Cancer Institute NSW is the host organisation for the CHeReL. There are 17 staff at the CHeReL, including the Manager and Deputy Manager, two Data Managers and 13 Record Linkage Officers. The CHeReL Management Committee, which comprises representatives of each of the eight funding organisations, oversees the strategic directions, operational and business plans, and policies and procedures of the CHeReL. A Community Advisory Committee provides advice to the CHeReL Manager and the Management Committee on issues of interest to the community related to linkage of health records.

Trends in births at and beyond term: evidence of a change?

Objective To examine trends in the distribution of births at and beyond term in New South Wales and in particular, to determine whether any changes are associated with changes in the obstetric practices of induction and elective caesarean section.

5. Area Health Services

Continuing the pattern of recent years, the largest numbers of confinements in 2001 were among mothers resident in the South Western Sydney (12,161, 14.4 per cent) and Western Sydney Health Areas (10,818, 12.8 per cent). These two health areas contributed over one quarter of the States births. Eighty per cent of confinements were to mothers resident in the metropolitan health areas (including the Central Coast, Hunter and Illawarra Health Areas), and 19.4 per cent were to mothers resident in rural health areas (Table 20).

Demographic and socio-economic factors associated with dental health among older people in NSW

Objective: To investigate the association between oral health status and social, economic and demographic factors in community‐dwelling older people in New South Wales (NSW).

Using linkage between hospital and ABS mortality data to enhance reporting of deaths among Aboriginal and Torres Strait Islander peoples

Objective: To investigate the potential of record linkage between the Australian Bureau of Statistics (ABS) mortality data and the NSW Admitted Patient Data Collection (APDC) to improve reporting of deaths among Aboriginal and Torres Strait Islander peoples.

Reporting of Aboriginal and Torres Strait Islander peoples on the NSW Admitted Patient Data Collection: the 2010 Data Quality Survey

The reporting of Aboriginal and Torres Strait Islander peoples on the NSW Admitted Patient Data Collection was ascertained using a stratified purposive sample of NSW public hospital patients in 2010. Information was collected by interviewing patients and compared with patient information obtained on admission. The study used the methods used in the national survey by the AIHW in 2007 and the study results were compared to the AIHW survey results. The level of correct reporting was 90.7% (95% CI 84.6-94.2). These results, while indicative, should be interpreted with caution as some people may not have identified themselves as Aboriginal or Torres Strait Islander either on hospital admission or in the survey, and non-random sampling can produce non-representative samples.

Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data

AIM To assess reporting characteristics of commonly dichotomised pregnancy outcomes (e.g. preterm/term birth); and to investigate whether behaviours (e.g. smoking), medical conditions (e.g. diabetes) or interventions (e.g. induction) were reported differently by pregnancy outcomes. METHODS Further analysis of a previous validation study was undertaken, in which 1680 perinatal records were compared with data extracted from medical records. Continuous and polytomous variables were dichotomised, and risk factor reporting was assessed within the dichotomised outcome groups. Agreement, kappa, sensitivity and positive predictive value calculations were undertaken. RESULTS Gestational age, birthweight, Apgar scores, perineal trauma, regional analgesia and baby discharge status (live birth/stillbirth) were reported with high accuracy and reliability when dichotomised (kappa values 0.95-1.00, sensitivities 94.7-100.0%). Although not statistically significant, there were trends for hypertension, infant resuscitation and instrumental birth to be more accurately reported among births with adverse outcomes. In contrast, smoking ascertainment tended to be poorer among preterm births and when babies were <2500 g. CONCLUSION Dichotomising variables collected as continuous or polytomous variables in birth data results in accurate and well ascertained data items. There is no evidence of systematic differential reporting of risk factors.