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Balabanski AH, Dos Santos A, Woods JA, Mutimer CA, Thrift AG, Kleinig TJ, Suchy-Dicey AM, Siri SRA, Boden-Albala B, Krishnamurthi RV, Feigin VL, Buchwald D, Ranta A, Mienna CS, Zavaleta-Cortijo C, Churilov L, Burchill L, Zion D, Longstreth WT, Tirschwell DL, Anand SS, Parsons MW, Brown A, Warne DK, Harwood M, Barber PA, Katzenellenbogen JM. Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review. Neurology 2024; 102:e209138. [PMID: 38354325 DOI: 10.1212/wnl.0000000000209138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health. METHODS We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study. RESULTS From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations. DISCUSSION In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building. REGISTRATION INFORMATION PROSPERO registration: CRD42021242367.
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Affiliation(s)
- Anna H Balabanski
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Angela Dos Santos
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - John A Woods
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Chloe A Mutimer
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Amanda G Thrift
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Timothy J Kleinig
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Astrid M Suchy-Dicey
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Susanna Ragnhild A Siri
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Bernadette Boden-Albala
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Rita V Krishnamurthi
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Valery L Feigin
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Dedra Buchwald
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Annemarei Ranta
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Christina S Mienna
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Carol Zavaleta-Cortijo
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Leonid Churilov
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Luke Burchill
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Deborah Zion
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - W T Longstreth
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - David L Tirschwell
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Sonia S Anand
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Mark W Parsons
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Alex Brown
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Donald K Warne
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Matire Harwood
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - P Alan Barber
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Judith M Katzenellenbogen
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
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2
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Henson C, Rambaldini B, Freedman B, Carlson B, Parter C, Christie V, Skinner J, Meharg D, Kirwan M, Ward K, Speier SN'Ḵ', Gwynne K. Wearables for early detection of atrial fibrillation and timely referral for Indigenous people ≥55 years: mixed-methods protocol. BMJ Open 2024; 14:e077820. [PMID: 38199631 PMCID: PMC10806615 DOI: 10.1136/bmjopen-2023-077820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Digital health technologies have the potential to provide cost-effective care to remote and underserved populations. To realise this potential, research must involve people not traditionally included. No research focuses on the acceptability and feasibility of older Indigenous people using wearables for early atrial fibrillation (AF) detection. This protocol compares digital augmentation against standard practice to detect AF, evaluate heart health self-efficacy and health literacy changes and identify barriers in collaboration with Aboriginal Community Controlled Health Organisations. It will establish a framework for implementing culturally safe and acceptable wearable programmes for detecting and managing AF in Indigenous adults ≥55 years and older. METHODS This mixed-methods research will use the Rambaldini model of collective impact, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology to assess the cultural safety, acceptability, feasibility and efficacy of incorporating wearables into standard care for early AF detection. ANALYSIS Qualitative data will be analysed to create composite descriptions of participants' experiences and perspectives related to comfort, cultural safety, convenience, confidence, family reactions and concerns. Quantitative device data will be extracted and analysed via Statistical Product and Service Solutions (SPSS). CONCLUSION Prioritising perspectives of older Indigenous adults on using wearables for detecting and monitoring cardiovascular disease will ensure that the findings are effective, relevant and acceptable to those impacted. ETHICS AND DISSEMINATION Findings will be published in open-source peer-reviewed journals, shared at professional conferences, described in lay terms and made available to the public. The AHMRC HREC Reference Number approved 1135/15.
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Affiliation(s)
- Connie Henson
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Boe Rambaldini
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Ben Freedman
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Dept of Cardiology, Concord Clinical School, Concord Hospital, Sydney, NSW, Australia
| | - Bronwyn Carlson
- Indigenous Studies, Macquarie University Faculty of Arts, North Ryde, New South Wales, Australia
- Centre for Global Indigenous Futures, Macquarie University Faculty of Arts, North Ryde, New South Wales, Australia
| | - Carmen Parter
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Vita Christie
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - John Skinner
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - David Meharg
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Morwenna Kirwan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Katrina Ward
- Brewarrina Aboriginal Medical Service, Brewarrina, New South Wales, Australia
| | | | - Kylie Gwynne
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- Djurali Centre for Aboriginal and Torres Strait Islander Research and Education, Sydney, NSW, Australia
- Indigenous Studies, Division of Vice Chancellor & President, University of New South Wales (UNSW), Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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3
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Dawson LP, Nehme E, Burchill LJ, Nehme Z, O’Brien J, Bloom J, Cox S, Anderson D, Stephenson M, Lefkovits J, Taylor AJ, Kaye D, Smith K, Stub D. Chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander peoples in Victoria, Australia: a population-based cohort study from 2015 to 2019. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100839. [PMID: 37790074 PMCID: PMC10544300 DOI: 10.1016/j.lanwpc.2023.100839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 10/05/2023]
Abstract
Background This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain. Methods State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes. Findings From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre. Interpretation Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified. Funding National Health and Medical Research Council, National Heart Foundation.
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Affiliation(s)
- Luke P. Dawson
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Luke J. Burchill
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Aboriginal Cardiovascular Health Equity Research Group, Department of Medicine, The University of Melbourne, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica O’Brien
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
| | - Shelley Cox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - David Anderson
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Michael Stephenson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrew J. Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
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4
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Kapral MK. Kenton Award Lecture-Stroke Disparities Research: Learning From the Past, Planning for the Future. Stroke 2023; 54:379-385. [PMID: 36689593 DOI: 10.1161/strokeaha.122.039562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/15/2022] [Indexed: 01/24/2023]
Abstract
Inequities in stroke care and outcomes have been documented both within and among countries based on factors, such as race, geography, and socioeconomic status. Research can help us to identify, understand, and address inequities, and this article offers considerations for scientists working in this area. These include designing research aimed at identifying the underlying causes of inequities, recognizing the importance of the social determinants of health, considering interventions that go beyond the individual patient and provider to include policies and systems, acknowledging the role of structural racism, performing community-engaged participatory research, considering intersecting social identities, learning from cross-national comparisons, maintaining the data sources needed for inequities research, using terminology that advances health equity, and improving diversity across the research enterprise.
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Affiliation(s)
- Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada (M.K.K.)
- ICES, Toronto, Canada (M.K.K.)
- Toronto General Hospital Research Institute, Canada (M.K.K.)
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McGee M, Shephard L, Sugito S, Baker D, Brienesse S, Al-Omary M, Nathan-Marsh R, Ngo DTM, Oakley P, Boyle AJ, Garvey G, Sverdlov AL. Mind The Gap, Aboriginal and Torres Strait Islander Cardiovascular Health: A Narrative Review. Heart Lung Circ 2023; 32:136-142. [PMID: 36336616 DOI: 10.1016/j.hlc.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
Australia's First Nations Peoples, Aboriginal and Torres Strait Islanders, have reduced life expectancy compared to the wider community. Cardiovascular diseases, mainly driven by ischaemic heart disease, are the leading contributors to this disparity. Despite over a third of First Nations Peoples living in New South Wales, the bulk of the peer-reviewed literature is from Central Australia and Far North Queensland. Regardless of the site of publication, First Nations Peoples are significantly younger at disease onset and have higher rates of comorbidities, in turn driving adverse health events. On top of this, very few First Nations Peoples specific cardiovascular interventions or programs have been shown to improve outcomes. The traditional biomedical model of care is less efficacious and non-traditional models of communication such as clinical yarning may benefit both clinicians and patients. The key purpose of this review is to highlight the deficiencies of our knowledge of cardiovascular burden of disease for First Nations Peoples; and to serve as a catalyst for more dedicated research. We need to have relationships with communities and concentrate on community improvement and partnerships. By involving First Nations Peoples researchers in collaboration with local communities in all levels of health care design and intervention will improve outcomes.
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Affiliation(s)
- Michael McGee
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Shephard
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Stuart Sugito
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - David Baker
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Stephen Brienesse
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Mohammed Al-Omary
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Rhian Nathan-Marsh
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/DoanNgo4
| | - Patrick Oakley
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia; Aboriginal Health Unit, Hunter New England Health, Wallsend Health Campus, Newcastle, NSW, Australia; General Medicine Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew J Boyle
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Gail Garvey
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Aaron L Sverdlov
- College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia; Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Weber C, Hobday M, Sun W, Kirkland L, Nedkoff L, Katzenellenbogen JM. Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease. AUST HEALTH REV 2022; 46:756-764. [PMID: 36395787 DOI: 10.1071/ah22149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022]
Abstract
Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, WA, Australia; and Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia; and Western Australian Department of Health, East Perth, WA, Australia
| | - Michelle Hobday
- Western Australian Department of Health, East Perth, WA, Australia
| | - Wendy Sun
- Western Australian Department of Health, East Perth, WA, Australia
| | - Laura Kirkland
- Western Australian Department of Health, East Perth, WA, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, WA, Australia; and Cardiology Population Health Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
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Armstrong E, Rai T, Hersh D, Thompson S, Coffin J, Ciccone N, Flicker L, Cadilhac D, Godecke E, Woods D, Hayward C, Hankey GJ, McAllister M, Katzenellenbogen J. Statistical analysis plan for the stepped wedge clinical trial Healing Right Way-enhancing rehabilitation services for Aboriginal Australians after brain injury. Trials 2022; 23:886. [PMID: 36273182 PMCID: PMC9587581 DOI: 10.1186/s13063-022-06800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. METHODS: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL-5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care. DISCUSSION The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018.
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Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Broadway, Australia
| | - Deborah Hersh
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Australia.,Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Broome, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia
| | | | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University and Sir Charles Gairdner and Osborne Park Healthcare Group, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - Colleen Hayward
- Centre for Indigenous Australian Education and Research, Kurongkurl Katitjin, Australia Edith Cowan University, Perth, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Medical and Health Sciences, University of Western Australia, Perth, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
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Armstrong E, Coffin J, Hersh D, Katzenellenbogen JM, Thompson S, Flicker L, McAllister M, Cadilhac DA, Rai T, Godecke E, Hayward C, Hankey GJ, Drew N, Lin I, Woods D, Ciccone N. Healing Right Way: study protocol for a stepped wedge cluster randomised controlled trial to enhance rehabilitation services and improve quality of life in Aboriginal Australians after brain injury. BMJ Open 2021; 11:e045898. [PMID: 34588230 PMCID: PMC8479943 DOI: 10.1136/bmjopen-2020-045898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 08/31/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. METHODS AND ANALYSIS: Design: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals.Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury.Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants.Primary outcome: Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference.Secondary outcome measures: Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role.Evaluations: An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks. ETHICS AND DISSEMINATION The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers. TRIAL REGISTRATION NUMBER ACTRN12618000139279.
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Affiliation(s)
- Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome, Western Australia, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Meaghan McAllister
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Tapan Rai
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Colleen Hayward
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia
| | - Neil Drew
- School of Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Western Australia, Australia
| | - Ivan Lin
- Western Australian Centre for Rural Health, University of Western Australia - Geraldton Campus, Geraldton, Western Australia, Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Western Australia, Australia
| | - Natalie Ciccone
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Mann G, Troeung L, Wagland J, Martini A. Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991-2020. BMJ Open 2021; 11:e052728. [PMID: 34475189 PMCID: PMC8413932 DOI: 10.1136/bmjopen-2021-052728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Transition back into the community following acute management of acquired brain injury (ABI) is a critical part of recovery. Post-acute rehabilitation and transitional care can significantly improve outcomes. The Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT) is a novel whole-population cohort formed to better understand the needs of individuals with ABI receiving post-acute rehabilitation and disability services in Western Australia (WA), and to improve their outcomes. To do this a unique combination of (1) internal clinical/rehabilitation data, and (2) externally linked health data from the WA Data Linkage System was used, including hospitalisations, emergency department presentations, mental health service use and death records, to measure longitudinal needs and outcomes of individuals with ABI over 29 years, making this the largest, most diverse post-acute ABI cohort in Australia to date. PARTICIPANTS Whole-population cohort of individuals (n=1011) with an ABI who received post-acute community-based neurorehabilitation or disability support services through Brightwater Care Group from 1991 to 2020. FINDINGS TO DATE Comprehensive baseline demographic, clinical and rehabilitation data, outcome measures and linked health data have been collected and analysed. Non-traumatic brain injury (eg, stroke, hypoxia) was the main diagnostic group (54.9%, n=555), followed by traumatic brain injury (34.9%, n=353) and eligible neurological conditions (10.2%, n=103). Mean age at admission was 45.4 years, and 67.5% were men (n=682). The cohort demonstrated significant heterogeneity, socially and clinically, with differences between ABI groups across a number of domains. FUTURE PLANS ABI-RESTaRT is a dynamic whole-population cohort that will be updated over time as individuals enrol in the service. Future analyses will assess longitudinal brain injury outcomes, the changing health and social needs of individuals with ABI and evaluate and inform post-acute services to best support these individuals. REGISTRATION This cohort is not linked to a clinical trial, and is not registered.
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Affiliation(s)
- Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
- School of Social Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Kelly J, Dowling A, Hillier S, Brown A, Kleinig T, Goldsmith K, McBride K, Pandian J, Castle S, Thrift AG. Perspectives on rehabilitation for Aboriginal people with stroke: a qualitative study. Top Stroke Rehabil 2021; 29:295-309. [PMID: 34180366 DOI: 10.1080/10749357.2021.1911771] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (hereinafter respectfully termed Aboriginal) people have a greater incidence of stroke at a younger age than non-Indigenous people in Australia. The needs and preferences of Aboriginal people for rehabilitation and longer-term support remain largely unknown. OBJECTIVES To identify the long-term rehabilitation needs of Aboriginal people who have a stroke, from the perspectives of Aboriginal persons with stroke and health care providers. METHODS Aboriginal people who had experienced stroke in the previous three years were interviewed to obtain their experiences of rehabilitation care. Health professionals who provided care in each of six designated hospitals and nearby community health sites were involved in focus groups and individual interviews. Information obtained was thematically analyzed separately for Aboriginal people with stroke and health professionals, and compared using Nvivo. RESULTS Among six Aboriginal people with stroke and 78 healthcare providers, four main themes emerged: the importance of family; variable access to services; the impact of stroke on Aboriginal peoples' lives; and making positive choices. Communication and involvement of family was highlighted as essential for a shared understanding, particularly when making decisions about participating in short and long-term rehabilitation. Co-morbidities, conflicting priorities, and inadequate or inflexible services and transport compounded issues with changing life roles. Stories of resilience were also shared. CONCLUSIONS Aboriginal people report making positive lifestyle changes, but experience significant unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery should improve some of the shortfalls in service provision, particularly in regional and remote areas.
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Affiliation(s)
- Janet Kelly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Adelaide Nursing School, The University of Adelaide,Australia
| | - Anna Dowling
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University
| | - Susan Hillier
- Allied Health & Human Performance,University of South Australia, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Aboriginal Health, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Timothy Kleinig
- Department of Neurology, SA Health, Adelaide, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | | | - Katharine McBride
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health & Human Performance,University of South Australia, Adelaide, Australia
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Sally Castle
- Department of Neurology, SA Health, Adelaide, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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11
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Paige E, Doyle K, Jorm L, Banks E, Hsu MP, Nedkoff L, Briffa T, Cadilhac DA, Mahoney R, Verjans JW, Dwivedi G, Inouye M, Figtree GA. A Versatile Big Data Health System for Australia: Driving Improvements in Cardiovascular Health. Heart Lung Circ 2021; 30:1467-1476. [PMID: 34092503 DOI: 10.1016/j.hlc.2021.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/21/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases (CVD) are leading causes of death and morbidity in Australia and worldwide. Despite improvements in treatment, there remain large gaps in our understanding to prevent, treat and manage CVD events and associated morbidities. This article lays out a vision for enhancing CVD research in Australia through the development of a Big Data system, bringing together the multitude of rich administrative and health datasets available. The article describes the different types of Big Data available for CVD research in Australia and presents an overview of the potential benefits of a Big Data system for CVD research and some of the major challenges in establishing the system for Australia. The steps for progressing this vision are outlined.
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Affiliation(s)
- Ellie Paige
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia
| | - Kerry Doyle
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia; National Institute of Complementary Medicines, Sydney, NSW, Australia; Ausbiotech, Melbourne, Vic, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT, Australia; Sax Institute, Sydney, NSW, Australia
| | - Meng-Ping Hsu
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia; Stroke Theme, the Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Melbourne, Vic, Australia
| | - Ray Mahoney
- Australian e Health Research Centre, CSIRO, Brisbane, Qld, Australia
| | - Johan W Verjans
- Australian Institute for Machine Learning/Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia; Vascular Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Girish Dwivedi
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA, Australia
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; The Alan Turing Institute, London, UK
| | - Gemma A Figtree
- Australian Cardiovascular Alliance, Chittaway Bay, NSW, Australia; Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
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Hung J, Kelty E, Nedkoff L, Thompson SC, Katzenellenbogen JM. Can the CHA 2 DS 2 -VA schema be used to decide on anticoagulant therapy in Aboriginal and other Australians with non-valvular atrial fibrillation? Intern Med J 2021; 51:600-603. [PMID: 33890375 DOI: 10.1111/imj.15282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
The Australasian guidelines recommend use of the CHA2 DS2 -VA schema to stratify ischaemic stroke risk in patients with non-valvular atrial fibrillation (N-VAF) and determine risk thresholds for recommending oral anticoagulant (OAC) therapy. However, the CHA2 DS2 -VA score has not been validated in a representative Australian population cohort with N-VAF, including in Aboriginal people who are known to have a higher age-adjusted stroke risk than other Australians. In a retrospective data-linkage study of 49 114 patients aged 24-84 years with N-VAF, 40.0% women and 2.5% Aboriginal, we found that patients with a CHA2 DS2 -VA score >2 had high annual stroke rates (>2%) that would justify OAC therapy. This occurred regardless of Aboriginal status. Non-Aboriginal patients with a CHA2 DS2 -VA score of 0 had a mean annual stroke rate of 0.4%, and hence were not likely to benefit from antithrombotic therapy. However, Aboriginal patients with a zero CHA2 DS2 -VA score had a significantly higher annual stroke rate of 0.9%, and could potentially obtain net clinical benefit from anticoagulation, primarily with the safer non-vitamin K antagonist OAC. We conclude that clinicians can confidently use the CHA2 DS2 -VA score to make decisions regarding anticoagulation in accordance with stroke risk in patients with N-VAF, except in Aboriginal people in whom the risk score was unable to identify those at truly low risk of stroke.
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Affiliation(s)
- Joseph Hung
- Medical School, Faculty of Medicine and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Erin Kelty
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Lee Nedkoff
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Perth, Western Australia, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, University of Western Australia and Telethon Kids Institute, UWA, Perth, Western Australia, Australia
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Atrial Fibrillation in Remote Indigenous and Non-Indigenous Individuals Hospitalised in Central Australia. Heart Lung Circ 2021; 30:1174-1183. [PMID: 33722491 DOI: 10.1016/j.hlc.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The epidemiology of atrial fibrillation (AF) amongst Indigenous populations remains poorly characterised. We studied hospitalisations for AF in Central Australia, the most populous Indigenous region in the country. METHODS Patients with a diagnosis of AF admitted to Alice Springs Hospital, the only secondary health care facility and provider of cardiac care in remote Central Australia, were identified from 2006 to 2016. Age and gender-specific hospitalised AF prevalence, comorbidities, and CHA2DS2-VASc scores were ascertained. RESULTS Of 57,056 admitted patients over the study period, 1,210 (2.1%; 46% Indigenous) had a diagnosis of AF. For Indigenous and non-Indigenous individuals <45 years, hospitalised AF prevalence per 10,000 population was 105 (CI 84-131) and 50 (CI 36-68) in males (ratio=2.10), and 98 (CI 77-123) and 12 (CI 6-23) in females (ratio=7.92), respectively. For Indigenous and non-Indigenous individuals ≥65 years, hospitalised AF prevalence per 10,000 was 1,577 (CI 1,194-2,026) and 2,326 (CI 2,047-2,623) in males (ratio=0.68), and 1,713 (CI 1,395-2,069) and 1,897 (1,623-2,195) in females (ratio=0.90). Indigenous individuals had higher rates of cardiometabolic comorbidities, particularly at younger ages. CHA2DS2-VASc scores were greater in Indigenous individuals, particularly those <45 years (2.5±1.5 versus 0.7±1.1, p<0.001). CONCLUSIONS The prevalence of hospitalised AF amongst Indigenous people in remote Central Australia was significantly higher than in non-Indigenous individuals, particularly in younger age groups and females. Indigenous individuals with hospitalised AF also had a markedly greater prevalence of cardiometabolic comorbidities and elevated stroke risk. These data suggest that AF may be contributing to the gap in morbidity and mortality experienced by Indigenous Australians.
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Clinical profile of Aboriginal and Torres Strait Islander adults with stroke and traumatic brain injury at a regional Australian hospital: a retrospective chart audit. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:The clinical profile of Aboriginal and Torres Strait Islander adults admitted to hospital with neurological injury is not well documented. Understanding these profiles may enable health professionals to provide more culturally responsive health care for this patient group. This study aimed to report the clinical profile of Aboriginal and Torres Strait Islander adults admitted to a regional Queensland hospital due to stroke or traumatic brain injury (TBI).Method:A 2-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years) admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI.Results:There were 132 Aboriginal and Torres Strait Islander adult stroke (51.5%) or TBI (48.5%) admissions. The mean ages were 56.7 years for stroke and 42.7 years for TBI. The majority of patients (83.3%) were of Aboriginal descent with others identifying as Torres Strait Islander only, or both Aboriginal and Torres Strait Islander. Patients were from 26 diverse home locations across northern Australia, primarily Outer Regional or Remote/Very Remote geographical locations. All patients’ language backgrounds were documented as English only. Over 90% of stroke and 50% of TBI patients presented with medical co-morbidities.Conclusions:Patients had diverse geographical locations and cultural backgrounds, with many likely impacted by dislocation from home and country, as well as potential delays in receiving treatment. Despite this diversity, English was documented in patients’ medical records as their only language. The majority of patients also presented with multiple medical co-morbidities. Health professionals should consider these factors to ensure patients receive optimum and culturally responsive health care.
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Thompson F, Cysique LA, Harriss LR, Taylor S, Savage G, Maruff P, Mcdermott R. Acceptability and Usability of Computerized Cognitive Assessment Among Australian Indigenous Residents of the Torres Strait Islands. Arch Clin Neuropsychol 2020; 35:1288-1302. [PMID: 32647858 DOI: 10.1093/arclin/acaa037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This cross-sectional study aimed to investigate the acceptability and usability of the Cogstate Brief Battery (CBB) in a community-based sample of Australian Indigenous people from the Torres Strait region, based on a user experience framework of human-computer interaction. METHODS Two-hundred community participants completed the four subtests of the CBB on an iPad platform, during a free adult health check on two islands in the region, between October and December 2016. Acceptability was defined as completing the learning trial of a task and usability as continuing a task through to completion, determined by examiner acumen and internal Cogstate completion and integrity criteria. These were combined into a single dichotomous completion measure for logistic regression analyses. Performance-measured as reaction times and accuracy of responses-was analyzed using linear regression analyses. RESULTS CBB completion ranged from 82.0% to 91.5% across the four tasks and the odds of completing decreased with age. After adjusting for age, iPad/tablet familiarity increased the odds of completion for all tasks while level of education and employment increased the odds for some tasks only. These variables accounted for 18.0%-23.8% of the variance in reaction times on speeded tasks. Age and education had the most effect, although semipartial correlations were modest. CONCLUSIONS When administered in a health-screening context, the acceptability and usability of the CBB were greatest in young- to middle-aged participants with some education and iPad/tablet experience. Older and more vulnerable participants may have benefited from additional time and practice on the CBB prior to administration.
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Affiliation(s)
- Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Lucette A Cysique
- Neurosciences Research Australia, Psychology Department, University of New South Wales, Sydney, New South Wales, Australia
| | - Linton R Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Sean Taylor
- Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Greg Savage
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | | | - Robyn Mcdermott
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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Rocheleau S, Gallagher C, Pitman BM, Tu SJ, Hanna-Rivero N, Clarke N, Linz D, Hendriks JM, Middeldorp ME, Mahajan R, Lau DH, Roberts-Thomson KC, Sanders P, Wong CX. Predictors of Anticoagulation Use in Indigenous and Non-Indigenous Australians With Atrial Fibrillation. Heart Lung Circ 2020; 30:707-713. [PMID: 33132053 DOI: 10.1016/j.hlc.2020.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/05/2020] [Accepted: 08/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Prior studies have demonstrated that anticoagulation underutilisation for atrial fibrillation (AF) and elevated stroke risk is common. However, there is little data on factors associated with appropriate anticoagulation, particularly in Indigenous Australians who face a disproportionate burden of AF and stroke. We thus sought to determine factors associated with anticoagulation use in Australians with AF. DESIGN Administrative, clinical, prescriptive and laboratory data were linked and aggregated over a 12-year period. SETTING Single tertiary teaching hospital. PARTICIPANTS 19,305 (98%) and 308 (2%) consecutive non-Indigenous and Indigenous Australians with AF identified from administrative databases. MAIN OUTCOME MEASURES Associations of anticoagulation use according to ethnicity. RESULTS Significant independent predictors of anticoagulation use included hypertension (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.17-1.34; p<0.001), diabetes (OR 1.14, 95% CI 1.05-1.24; p=0.002), heart failure (OR 1.54 95% CI 1.43-1.66; p<0.001) and prior stroke or transient ischaemic attack (OR 2.07, 95% CI 1.84-2.33; p<0.001). In contrast, increasing age (OR 0.99, 95% CI 0.98-0.99; p<0.001), female gender (OR 0.88, 95% CI 0.82-0.93; p<0.001), and vascular disease (OR 0.72, 95% CI 0.64-0.80; p<0.001) were significant predictors of no anticoagulation. Hypertension was associated with less anticoagulation use in Indigenous compared to non-Indigenous Australians (p=0.02). CONCLUSIONS Anticoagulation for AF was suboptimal in both Indigenous and non-Indigenous Australians. Older age, female gender, and comorbid vascular disease were found to be negatively associated with anticoagulation. Importantly, hypertension may also be under-recognised as a stroke risk factor in Indigenous Australians. Future efforts to encourage anticoagulation use in accordance with guideline recommendations is likely to reduce the burden of AF-related stroke in both Indigenous and non-Indigenous populations.
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Affiliation(s)
- Simon Rocheleau
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Bradley M Pitman
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nicole Hanna-Rivero
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nicholas Clarke
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Rajiv Mahajan
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
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Balabanski AH, Goldsmith K, Giarola B, Buxton D, Castle S, McBride K, Brady S, Thrift AG, Katzenellenbogen J, Brown A, Burrow J, Donnan GA, Koblar S, Kleinig TJ. Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study. BMJ Open 2020; 10:e039533. [PMID: 33033097 PMCID: PMC7545633 DOI: 10.1136/bmjopen-2020-039533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities. DESIGN A retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014. SETTING Alice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2. PARTICIPANTS 161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of first-ever stroke, overall (all events) stroke and in-hospital death. RESULTS Of 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p<0.001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged <55 years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p<0.001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients. CONCLUSIONS Stroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged <55 years.
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Affiliation(s)
- Anna H Balabanski
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kendall Goldsmith
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Blake Giarola
- Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Buxton
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sally Castle
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Katharine McBride
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephen Brady
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Judith Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Alex Brown
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Burrow
- Department of Neurology, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Geoffrey A Donnan
- Department of Medicine and Neurology, Melbourne Brain Centre at Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Simon Koblar
- Stroke Research Programme, The University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Stroke Research Programme, The University of Adelaide, Adelaide, South Australia, Australia
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Stolwyk RJ, Evans L, O'Halloran C, Evans J, Gooden JR. Comparing cognitive assessment service provision between Aboriginal and Torres Strait Islanders and non-Indigenous Australians at a metropolitan health service. Health Promot J Austr 2020; 32:541-547. [PMID: 32686249 DOI: 10.1002/hpja.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/14/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Aboriginal and Torres Strait Islander populations are at a significantly higher risk of neurological and cognitive impairment from a range of aetiologies. In order to better identify and support Indigenous Australians with cognitive impairment, culturally appropriate screening, management and referral processes are critical. The primary aim of this study was to investigate the frequency of presentations and type of cognitive screening conducted with Indigenous Australians presenting to health services. METHODS Hospital data for 30 Indigenous Australians presenting with neurological symptoms to Emergency Departments within a large metropolitan health service were compared with a group of 30 non-Indigenous, Australian-born, English-speaking, age-, gender- and diagnosis-matched individuals. RESULTS Only two individuals, one from each group, received cognitive screening. This was likely related to a surprisingly large proportion of Indigenous Australians presenting to hospital with headache and migraine. Significantly more Indigenous Australians (36.7%) were consulted by a member of the multidisciplinary team compared to 10% of the non-Indigenous group. No differences in follow-up referrals were observed. CONCLUSIONS Results indicated a lack of cognitive screening practices being undertaken in both groups. It was encouraging to see Indigenous Australians receiving consultations from multidisciplinary team members at a higher rate, with a similar follow-up pathway being observed. This study further highlights the need for adoption of screening practices in primary health care settings and the development and use of culturally appropriate cognitive screening measures. SO WHAT?: This study investigates the cognitive screening practices of a metropolitan health service and highlights the need for culturally appropriate cognitive screening methods to be developed and implemented to facilitate the identification of cognitive impairment in Indigenous Australians presenting for treatment.
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Affiliation(s)
- Renerus J Stolwyk
- Turner Institute for Brain and Mental, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia
| | | | | | | | - James R Gooden
- Turner Institute for Brain and Mental, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, VIC, Australia.,Eastern Health, Box Hill, VIC, Australia
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19
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Gattellari M, Goumas C, Jalaludin B, Worthington JM. Population-based stroke surveillance using big data: state-wide epidemiological trends in admissions and mortality in New South Wales, Australia. Neurol Res 2020; 42:587-596. [PMID: 32449879 DOI: 10.1080/01616412.2020.1766860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery. METHODS We calculated admissions rates for ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage between 1 January 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to 31 December 2014 for patients aged 15 years or older from New South Wales, Australia. Annual Average Percentage Change in rates was estimated using negative binomial regression. RESULTS Of 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval = -3.5% to -0.9%) (p < 0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change -2.9%, 95% Confidence Interval = -5.2% to -1.0%) (p = 0.004) and subarachnoid haemorrhage (Average Percentage Change = -2.6%, 95% Confidence Interval = -4.8% to -0.2%) (p = 0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval = -0.1% to 12.8%), although not significantly (p = 0.05). DISCUSSION Improved prevention may have underpinned declining intracerebral haemorrhage rates while survival gains suggest that innovations in care are being successfully translated. Mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.
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Affiliation(s)
- Melina Gattellari
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Department of Neurology, Royal Prince Alfred Hospital , Camperdown (Sydney), Australia
| | - Chris Goumas
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,School of Public Health, the University of Sydney , Sydney, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District , Liverpool, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - John M Worthington
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Department of Neurology, Royal Prince Alfred Hospital , Camperdown (Sydney), Australia.,School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia.,South Western Sydney Clinical School, The University of New South Wales , Liverpool, Sydney, Australia
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20
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Nedkoff L, Kelty EA, Hung J, Thompson SC, Katzenellenbogen JM. Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation. Med J Aust 2020; 212:215-221. [DOI: 10.5694/mja2.50496] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/02/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Sandra C Thompson
- Western Australia Centre for Rural HealthUniversity of Western Australia Geraldton WA
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21
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Ung D, Kim J, Thrift AG, Cadilhac DA, Andrew NE, Sundararajan V, Kapral MK, Reeves M, Kilkenny MF. Promising Use of Big Data to Increase the Efficiency and Comprehensiveness of Stroke Outcomes Research. Stroke 2020; 50:1302-1309. [PMID: 31009352 DOI: 10.1161/strokeaha.118.020372] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Ung
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.)
| | - Joosup Kim
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.).,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - Amanda G Thrift
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.)
| | - Dominique A Cadilhac
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.).,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - Nadine E Andrew
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.).,Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia (N.E.A.)
| | - Vijaya Sundararajan
- La Trobe University, Melbourne, VIC, Australia (V.S.).,Department of Public Health, School of Psychology and Public Health, College of Science Health and Engineering, La Trobe University, Bundoora, VIC, Australia (V.S.)
| | - Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, ON, Canada (M.K.K.)
| | - Mathew Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI (M.R.)
| | - Monique F Kilkenny
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.U., J.K., A.G.T., D.A.C., N.E.A., M.F.K.).,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
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22
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Kapral MK, Shah BR, Green ME, Porter J, Griffiths R, Frymire E, Slater M, Jacklin K, Sutherland R, Walker JD. Hospital admission for stroke or transient ischemic attack among First Nations people with diabetes in Ontario: a population-based cohort study. CMAJ Open 2020; 8:E156-E162. [PMID: 32184279 PMCID: PMC7082109 DOI: 10.9778/cmajo.20190199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND First Nations people have high rates of diabetes mellitus, which is a risk factor for stroke. We studied the rates of hospital admission, processes of care and outcomes of stroke and transient ischemic attack (TIA) in First Nations people in Ontario. METHODS Using linked administrative databases, we identified annual cohorts of people aged 20-105 years in Ontario with prevalent diabetes between Apr. 1, 1995, and Mar. 31, 2015. We identified Status First Nations people in Ontario from the Indian Register. We compared age- and sex-standardized rates of hospital admission for stroke or TIA, processes of care and case fatality among First Nations versus other people in Ontario with diabetes. RESULTS Overall, 28 874 people with diabetes (of whom 536 were First Nations people) were admitted to hospital with a stroke or TIA between Apr. 1, 2011, and Mar. 31, 2016. Admission rates for stroke or TIA declined over the study period but were higher among First Nations people than other Ontarians in most years after 2005/06. First Nations people admitted with stroke or TIA were as likely as other Ontarians to undergo neuroimaging within 24 hours (94.6% v. 96.0%), be discharged to inpatient rehabilitation (31.8% v. 34.8%) and receive carotid revascularization (1.4% v. 2.7%), but were less likely to receive thrombolysis (6.3% v. 11.0%). Age- and sex-standardized stroke case fatality was similar in First Nations people and other Ontarians at 7 days (12.0% v. 8.5%), 30 days (19.2% v. 16.0%) and 1 year (33.8% v. 28.1%). INTERPRETATION Rates of hospital admission for stroke or TIA were higher among First Nations people than other people with diabetes in Ontario. Future work should focus on determining Indigenous-specific determinants of health related to this disparity and implementing appropriate interventions to mitigate the risks and sequelae of stroke in First Nations people.
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Affiliation(s)
- Moira K Kapral
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
| | - Baiju R Shah
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Michael E Green
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Joan Porter
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Rebecca Griffiths
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Eliot Frymire
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Morgan Slater
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Kristen Jacklin
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Roseanne Sutherland
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Medicine (Kapral, Shah), University of Toronto; ICES (Kapral, Shah, Porter, Walker), Toronto, Ont.; Department of Family Medicine (Green, Frymire, Slater), Queen's University; ICES Queen's (Green, Griffiths, Frymire, Slater), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School Duluth, Duluth, Minn.; Chiefs of Ontario (Sutherland); School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
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23
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Hersh D, Armstrong E, McAllister M, Ciccone N, Katzenellenbogen J, Coffin J, Thompson S, Hayward C, Flicker L, Woods D. General practitioners' perceptions of their communication with Australian Aboriginal patients with acquired neurogenic communication disorders. PATIENT EDUCATION AND COUNSELING 2019; 102:2310-2317. [PMID: 31427169 DOI: 10.1016/j.pec.2019.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners' (GPs') perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context. METHODS A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically. RESULTS GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations. CONCLUSION GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people. PRACTICE IMPLICATIONS GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial.
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Affiliation(s)
- Deborah Hersh
- Speech Pathology, Edith Cowan University, Perth, Australia.
| | | | | | | | - Judith Katzenellenbogen
- Telethon Kids Institute, Broome and Perth, Australia; WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | - Juli Coffin
- Telethon Kids Institute, Broome and Perth, Australia
| | - Sandra Thompson
- WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | | | - Leon Flicker
- WA Centre for Rural Health, University of Western Australia, Perth, Australia; Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Deborah Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
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24
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Tew M, Dalziel KM, Petrie DJ, Clarke PM. Growth of linked hospital data use in Australia: a systematic review. AUST HEALTH REV 2019; 41:394-400. [PMID: 27444270 DOI: 10.1071/ah16034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and understand the utilisation of linked hospital data for research purposes across Australia over the past two decades. Methods A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Medline OVID, PsycINFO, Embase, EconLit and Scopus were searched to identify articles published from 1946 to December 2014. Information on publication year, state(s) involved, type of data linkage, disease area and purpose was extracted. Results The search identified 3314 articles, of which 606 were included; these generated 629 records of hospital data linkage use across all Australian states and territories. The major contributions were from Western Australia (WA; 51%) and New South Wales (NSW; 32%) with the remaining states and territories having significantly fewer publications (total contribution only 17%). WA's contribution resulted from a steady increase from the late 1990s, whereas NSW's contribution is mostly from a rapid increase from 2010. Current data linkage is primarily used in epidemiological research (73%). Conclusion More than 80% of publications were from WA and NSW, whereas other states significantly lag behind. The observable growth in these two states clearly demonstrates the underutilised opportunities for data linkage to add value in health services research in the other states. What is known about the topic? Linking administrative hospital data to other data has the potential to be a cost-effective method to significantly improve health policy. Over the past two decades, Australia has made significant investments in improving its data linkage capabilities. However, several articles have highlighted the many barriers involved in using linked hospital data. What does this paper add? This paper quantitatively evaluates the performance across all Australian states in terms of the use of their administrative hospital data for research purposes. The performance of states varies considerably, with WA and NSW the clear stand-out performers and limited outputs currently seen for the other Australian states and territories. What are the implications for practitioners? Given the significant investments made into data linkage, it is important to continue to evaluate and monitor the performance of the states in terms of translating this investment into outputs. Where the outputs do not match the investment, it is important to identify and overcome those barriers limiting the gains from this investment. More generally, there is a need to think about how we improve the effective and efficient use of data linkage investments in Australia.
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Affiliation(s)
- Michelle Tew
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Kim M Dalziel
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Dennis J Petrie
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Philip M Clarke
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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25
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Ciccone N, Armstrong E, Hersh D, Adams M, MCAllister M. The Wangi (talking) project: A feasibility study of a rehabilitation model for aboriginal people with acquired communication disorders after stroke. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:305-316. [PMID: 31096803 DOI: 10.1080/17549507.2019.1595146] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 06/09/2023]
Abstract
Purpose: Aboriginal Australians are under-represented in stroke rehabilitation services and rehabilitation practices that are sensitive to the needs of Aboriginal people are not currently available. This project tested the feasibility and acceptability of a rehabilitation model and approach to therapy with Aboriginal people with acquired communication disorders post-stroke. Method: Eight Aboriginal people with acquired communication disorders post-stroke were recruited to this study. Sixteen treatment sessions were provided twice weekly at the person's place of residence by a speech-language pathologist and Aboriginal co-worker. Feasibility was measured by analysing the number of sessions conducted jointly by the speech-language pathologist and Aboriginal co-worker and participant attendance. Participant acceptability was measured through the analysis of a post-therapy questionnaire. The Aboriginal co-worker's and speech-language pathologists' perceptions of the acceptability were collected through semi structured interviews. Result: Across all sessions 84.2% were attended by the Aboriginal co-worker and speech-language pathologist and seven of the eight participants completed all prescribed sessions. Positive feedback was provided by participants, the Aboriginal co-worker and speech-language pathologist on the key components of the programme. Conclusion: The rehabilitation model used within Wangi appears to be feasible and acceptable to participants and therapists. It provides direction to improve the quality of care for Aboriginal stroke survivors.
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Affiliation(s)
- Natalie Ciccone
- a School of Medical and Health Sciences, Edith Cowan University
| | | | - Deborah Hersh
- a School of Medical and Health Sciences, Edith Cowan University
| | - Mick Adams
- b Kurongkurl Katitjin, Edith Cowan University
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Tiedeman C, Suthers B, Julien B, Hackett A, Oakley P. Management of stroke in the Australian Indigenous population: from hospitals to communities. Intern Med J 2019; 49:962-968. [PMID: 30907045 DOI: 10.1111/imj.14303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ischaemic strokes lead to significant morbidity and mortality within the Australian Indigenous population, with known variances in the management of strokes between indigenous and non-indigenous populations. AIMS To compare investigations and management of indigenous and non-indigenous patients presenting to a New South Wales rural referral hospital with an ischaemic stroke to the national stroke standards across inpatient and outpatient settings. METHODS Historical cohort study of 43 indigenous and 167 non-indigenous patients admitted to Tamworth Rural Referral Hospital with an ischaemic cerebrovascular accident. RESULTS Indigenous patients were significantly less likely to have investigations completed, including carotid imaging (93.8% vs 100%, P = 0.012) and echocardiography (73.3% vs 97.7%, P = 0.004). Discharge follow up was significantly lower for the indigenous population (74.4% vs 87.4%, P = 0.034). Indigenous stroke patients were 15.8 years younger than non-indigenous subjects (56.8 vs 72.6 years old; P < 0.001). Indigenous patients were more likely to have stroke risk factors, including smoking (51.2% vs 15.0%; P < 0.001), diabetes mellitus (37.2% vs 16.8%, P = 0.003) and past history of cerebrovascular accident or transient ischaemic attack (50.2% vs 31.1%, P = 0.032). CONCLUSIONS The investigation and post-discharge care of indigenous ischaemic stroke patients is inferior to non-indigenous patients. Indigenous patients within rural NSW have a higher prevalence of preventable disease, including those that confer a higher stroke risk. Further research is needed to investigate the cause of these discrepancies and to improving indigenous stroke care between hospitals and primary care providers.
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Affiliation(s)
- Clare Tiedeman
- General Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Belinda Suthers
- General Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Respiratory and Sleep Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Benjamin Julien
- General Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Anna Hackett
- Department of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Clinical Governance Hunter New England Health, Newcastle, New South Wales, Australia
| | - Patrick Oakley
- General Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.,Department of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Research Medical Institute, Newcastle, New South Wales, Australia
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, Zwar N. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2019; 27:1209-1266. [PMID: 30077228 DOI: 10.1016/j.hlc.2018.06.1043] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - John Amerena
- Geelong Cardiology Research Unit, University Hospital Geelong, Geelong, Australia
| | - John Attia
- University of Newcastle, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney & Department of Pharmacy, Royal North Shore Hospital, Australia
| | - Kim H Chan
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cia Connell
- The National Heart Foundation of Australia, Melbourne, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Caleb Ferguson
- Western Sydney University, Western Sydney Local Health District, Blacktown Clinical and Research School, Blacktown Hospital, Sydney, Australia
| | | | - Haris Haqqani
- University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Jeroen Hendriks
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia
| | - Jonathan M Kalman
- University of Melbourne, Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John Worthington
- RPA Comprehensive Stroke Service, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Nicholas Zwar
- Graduate Medicine, University of Wollongong, Wollongong, Australia
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28
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Cochrane F, Siyambalapitiya S, Cornwell P. Speech-language pathology services for Indigenous Australian adults with acquired communication disorders: a systematic quantitative literature review. SPEECH LANGUAGE AND HEARING 2018. [DOI: 10.1080/2050571x.2018.1544729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Frances Cochrane
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Samantha Siyambalapitiya
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Petrea Cornwell
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
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Hussain MA, Katzenellenbogen JM, Sanfilippo FM, Murray K, Thompson SC. Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia. PLoS One 2018; 13:e0201496. [PMID: 30106971 PMCID: PMC6091927 DOI: 10.1371/journal.pone.0201496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospitalisation for atherothrombotic disease (ATD) is expected to rise in coming decades. However, increasingly, associated comorbidities impose challenges in managing patients and deciding appropriate secondary prevention. We investigated the prevalence and pattern of multimorbidity (presence of two or more chronic conditions) in Aboriginal and non-Aboriginal Western Australian residents with ATDs. METHODS AND FINDINGS We used population-based de-identified linked administrative health data from 1 January 2000 to 30 June 2014 to identify a cohort of patients aged 25-59 years admitted to Western Australian hospitals with a discharge diagnosis of ATD. The prevalence of common chronic diseases in these patients was estimated and the patterns of comorbidities and multimorbidities empirically explored using two different approaches: identification of the most commonly occurring pairs and triplets of comorbid diseases, and through latent class analysis (LCA). Half of the cohort had multimorbidity, although this was much higher in Aboriginal people (Aboriginal: 79.2% vs. non-Aboriginal: 39.3%). Only a quarter were without any documented comorbidities. Hypertension, diabetes, alcohol abuse disorders and acid peptic diseases were the leading comorbidities in the major comorbid combinations across both Aboriginal and non-Aboriginal cohorts. The LCA identified four and six distinct clinically meaningful classes of multimorbidity for Aboriginal and non-Aboriginal patients, respectively. Out of the six groups in non-Aboriginal patients, four were similar to the groups identified in Aboriginal patients. The largest proportion of patients (33% in Aboriginal and 66% in non-Aboriginal) was assigned to the "minimally diseased" (or relatively healthy) group, with most patients having less than two conditions. Other groups showed variability in degree and pattern of multimorbidity. CONCLUSION Multimorbidity is common in ATD patients and the comorbidities tend to interact and cluster together. Physicians need to consider these in their clinical practice. Different treatment and secondary prevention strategies are likely to be useful for management in these cluster groups.
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Affiliation(s)
- Mohammad Akhtar Hussain
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
| | - Judith M. Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M. Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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30
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Balabanski AH, Newbury J, Leyden JM, Arima H, Anderson CS, Castle S, Cranefield J, Paterson T, Thrift AG, Katzenellenbogen J, Brown A, Kleinig TJ. Excess stroke incidence in young Aboriginal people in South Australia: Pooled results from two population-based studies. Int J Stroke 2018; 13:811-814. [PMID: 29767602 DOI: 10.1177/1747493018778113] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Retrospective data indicate increased stroke incidence in Aboriginal/Torres Strait Islander (Indigenous) Australians, possibly with poorer outcomes. We present the first prospective population-based stroke incidence study in Indigenous Australians. Methods We pooled data from ASCEND and SEARCH, two prospective "ideal" South Australian stroke incidence studies, ASCEND conducted in urban Northwestern Adelaide (2009-2010) and SEARCH in five South Australian rural centers (2009-2011). We calculated age-standardized incidence for Aboriginal and non-Aboriginal people. Results The study population comprised 261,403 inhabitants. Among 432 first-ever strokes, 13 were in Aboriginal people (median age 51 vs. 78 years for non-Aboriginal people, p < 0.001). Age-standardized stroke incidence per 100,000 in Aboriginal patients (116, 95% CI: 95-137) was nearly two-fold that of non-Aboriginal patients (67, 95% CI: 51-84). Age-stratified excess incidence in Aboriginal people was restricted to those aged < 55 years (incidence rate ratio (IRR) 3.5, 95% CI: 2-7), particularly for intracerebral hemorrhage (IRR: 16, 95% CI: 4-61). Conclusion The excess stroke incidence in Aboriginal South Australians appears substantial, especially in those aged <55 years. Further work is required to delineate and address disparities.
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Affiliation(s)
- Anna H Balabanski
- 1 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,2 Department of Neurology, Royal Adelaide Hospital, SA Health, Adelaide, South Australia, Australia
| | - Jonathan Newbury
- 3 Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - James M Leyden
- 4 Lyell McEwin Hospital, SA Health, Elizabeth Vale, Australia
| | - Hisatomi Arima
- 5 Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, Australia.,6 Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Craig S Anderson
- 5 Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, Australia.,7 The George Institute China at Peking University Health Sciences Center, Beijing, China.,8 Royal Prince Alfred Hospital, Sydney, Australia
| | - Sally Castle
- 9 South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jennifer Cranefield
- 2 Department of Neurology, Royal Adelaide Hospital, SA Health, Adelaide, South Australia, Australia
| | - Tracey Paterson
- 3 Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amanda G Thrift
- 1 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Judith Katzenellenbogen
- 10 School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Alex Brown
- 9 South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Timothy J Kleinig
- 2 Department of Neurology, Royal Adelaide Hospital, SA Health, Adelaide, South Australia, Australia.,11 Telethon Kids Institute, Subiaco, Australia
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31
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Gauld S, Kendall M. Exploring the impact of sharing personal narratives of brain injury through film in Australian Indigenous communities. ACTA ACUST UNITED AC 2018. [DOI: 10.5348/100037d05sg2018oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zhao Y, Guthridge S, Falhammar H, Flavell H, Cadilhac DA. Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia. BMJ Open 2017; 7:e015033. [PMID: 28982808 PMCID: PMC5640075 DOI: 10.1136/bmjopen-2016-015033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. DESIGN Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. SETTING Public hospitals in the NT from 1992 to 2013. PARTICIPANTS Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. RESULTS 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). CONCLUSIONS Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Howard Flavell
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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33
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Thrift AG, Howard G, Cadilhac DA, Howard VJ, Rothwell PM, Thayabaranathan T, Feigin VL, Norrving B, Donnan GA. Global stroke statistics: An update of mortality data from countries using a broad code of "cerebrovascular diseases". Int J Stroke 2017; 12:796-801. [PMID: 28895807 DOI: 10.1177/1747493017730782] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Current information on mortality attributed to stroke among different countries is important for policy development and monitoring prevention strategies. Unfortunately, mortality data reported to the World Health Organization by different countries are inconsistent. Aims and/or hypothesis To update the repository of the most recent country-specific data on mortality from stroke for countries that provide data using a broad code for "cerebrovascular disease." Methods Data on mortality from stroke were obtained from the World Health Organization mortality database. We searched for countries that provided data, since 1999, on a combined category of "cerebrovascular disease" (code 1609) that incorporated International Classification of Diseases (10th edition) codes I60-I69. Using population denominators provided by the World Health Organization for the same year when available, or alternatively estimates obtained from the United Nations, we calculated crude mortality from "cerebrovascular disease" and mortality adjusted to the World Health Organization world population. We used the most recent year reported to the World Health Organization, as well as comparing changes over time. Results Since 1999, seven countries have provided these mortality data. Among these countries, crude mortality was greatest in the Russian Federation (in 2011), Ukraine (2012), and Belarus (2011) and was greater in women than men in these countries. Crude mortality was positively correlated with the proportion of the population aged ≥65 years but not with time. Age-adjusted mortality was greatest in the Russian Federation and Turkmenistan, and greater in men than women. Over time, mortality declined, with the greatest decline per annum evident in Kazakhstan (8.7%) and the Russian Federation (7.0%). Conclusions Among countries that provided data to the World Health Organization using a broad category of "cerebrovascular disease," there was a decline in mortality in two of the countries that previously had some of the largest mortality rates for stroke.
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Affiliation(s)
- Amanda G Thrift
- 1 Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - George Howard
- 2 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Dominique A Cadilhac
- 1 Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,3 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Virginia J Howard
- 4 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Peter M Rothwell
- 5 Nuffield Department of Clinical Neurosciences (Clinical Neurology), Stroke Prevention Research Unit, University of Oxford, Oxford, UK
| | - Tharshanah Thayabaranathan
- 1 Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Valery L Feigin
- 6 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- 7 Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Geoffrey A Donnan
- 2 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, USA.,8 The University of Melbourne, Parkville, Australia
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Boden-Albala B, Allen J, Roberts ET, Bulkow L, Trimble B. Ascertainment of Alaska Native Stroke Incidence, 2005-2009: Lessons for Assessing the Global Burden of Stroke. J Stroke Cerebrovasc Dis 2017; 26:2019-2026. [PMID: 28716585 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/16/2017] [Accepted: 06/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke is a critical public health issue in the United States and globally. System models to optimally capture stroke incidence in rural and culturally diverse communities are needed. The epidemiological transition to a western lifestyle has been associated with an increased burden of vascular risk factors among Alaska Native (AN) people. The burden of stroke in AN communities remains understudied. METHODS The Alaska Native Stroke Registry (ANSR) was designed to screen and capture all stroke cases between 2005 and 2009 through its integration into the existing single-payer Alaska Tribal Health System infrastructure. Registry staff received notification each time stroke International Classification of Diseases, Ninth Revision codes (430-436) were initiated anywhere in the system. Trained chart abstractors reviewed medical records to document incident strokes among AN patients, which were adjudicated. RESULTS Between October 2005 and October 2009, over 2100 alerts were screened identifying 514 unique stroke cases, of which 372 were incident strokes. The average annual incidence of stroke (per 100,000) among AN adults was 190.6: 219.2 in men and 164.7 in women. Overall, the ischemic stroke incidence rate was 148.5 per 100,000 with men (184.6) having higher ischemic rates per 100,000 than women (118.3). Men have higher rates of ischemic stroke at all ages, whereas older women experienced higher rates of hemorrhagic strokes over the age of 75 years. CONCLUSIONS We report a high rate of overall stroke, 190.6 per 100,000. The ANSR methods and findings have implications for other indigenous populations and for global health populations currently undergoing similar epidemiological transitions.
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Affiliation(s)
- Bernadette Boden-Albala
- Division of Social Epidemiology, College of Global Public Health, New York University, New York, New York; Department of Neurology, New York University, New York, New York; College of Dentistry, New York University, New York, New York.
| | - James Allen
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth, Minnesota; Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Eric T Roberts
- Division of Social Epidemiology, College of Global Public Health, New York University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lisa Bulkow
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Brian Trimble
- Department of Neurology, Alaska Native Medical Center, Anchorage, Alaska
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35
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Armstrong EM, Ciccone N, Hersh D, Katzenellebogen J, Coffin J, Thompson S, Flicker L, Hayward C, Woods D, McAllister M. Development of the Aboriginal Communication Assessment After Brain Injury (ACAABI): A screening tool for identifying acquired communication disorders in Aboriginal Australians. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:297-308. [PMID: 28425776 DOI: 10.1080/17549507.2017.1290136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/30/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations. METHOD A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments. RESULT The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature. CONCLUSIONS There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.
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Affiliation(s)
| | - Natalie Ciccone
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
| | - Deborah Hersh
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
| | - Judith Katzenellebogen
- b University of Western Australia, Telethon Institute for Child Health Research , Perth , Australia
| | - Juli Coffin
- c Office of the Dean, University of Notre Dame , Broome , Australia
| | - Sandra Thompson
- d Western Australian Centre for Rural Health, University of Western Australia , Geraldton , Australia
| | - Leon Flicker
- e Western Australian Centre for Health & Ageing , Centre for Medical Research, University of Western Australia , Perth , Australia
| | - Colleen Hayward
- f Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University , Joondalup , Australia , and
| | - Deborah Woods
- g Geraldton Regional Aboriginal Medical Service , Geraldton , Austarlia
| | - Meaghan McAllister
- a School of Medical & Health Sciences , Edith Cowan University , Perth , Australia
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36
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Cadilhac DA, Kilkenny MF, Levi CR, Lannin NA, Thrift AG, Kim J, Grabsch B, Churilov L, Dewey HM, Hill K, Faux SG, Grimley R, Castley H, Hand PJ, Wong A, Herkes GK, Gill M, Crompton D, Middleton S, Donnan GA, Anderson CS. Risk‐adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust 2017; 206:345-350. [DOI: 10.5694/mja16.00525] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Dominique A Cadilhac
- Monash University, Melbourne, VIC
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | - Monique F Kilkenny
- Monash University, Melbourne, VIC
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | | | | | | | - Joosup Kim
- Monash University, Melbourne, VIC
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | - Brenda Grabsch
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | - Helen M Dewey
- Eastern Health Clinical School, Monash University, Melbourne, VIC
| | | | - Steven G Faux
- St Vincent's Hospital, Sydney, NSW
- Sunshine Coast Clinical School, University of Queensland, Birtinya, QLD
| | - Rohan Grimley
- Sunshine Coast Clinical School, University of Queensland, Birtinya, QLD
| | | | | | - Andrew Wong
- Royal Brisbane and Women's Hospital, Brisbane, QLD
- University of Queensland, Brisbane, QLD
| | | | - Melissa Gill
- Armidale Rural Referral Hospital, Hunter New England Local Health District, Armidale, NSW
| | | | - Sandy Middleton
- St Vincent's Health Australia (Sydney), Sydney, NSW
- Australian Catholic University, Sydney, NSW
| | | | - Craig S Anderson
- The George Institute for Global Health, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
- The George Institute China at Peking University Health Science Center, Beijing, China
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37
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Keel S, Foreman J, Xie J, Taylor HR, Dirani M. The Prevalence of Self-Reported Stroke in the Australian National Eye Health Survey. J Stroke Cerebrovasc Dis 2017; 26:1433-1439. [PMID: 28411039 DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE The study aimed to determine the prevalence of and risk factors for self-reported stroke in Indigenous and non-Indigenous Australians. RESEARCH DESIGN AND METHODS In this national eye study, 1738 Indigenous Australians (41.1% male) aged 40-92 years and 3098 non-Indigenous Australians (46.4% male) aged 50-98 years from 30 randomly selected sites, stratified by remoteness, were recruited and examined. Sociodemographic information and a history of stroke, diabetes, and ocular health were obtained using an interviewer-administered questionnaire. RESULTS The crude prevalence of self-reported stroke was 5.04% (156 of 3098, 95% confidence interval: 4.29%-5.87%) for non-Indigenous Australians and 8.75% (152 of 1738, 95% confidence interval: 7.46%-10.17%) for Indigenous Australians (P < .0001). The age-adjusted prevalence of self-reported stroke for non-Indigenous and Indigenous Australians was 4.23% and 12.72%, respectively. The prevalence of stroke increased significantly with age for both Indigenous (odds ratio = 1.06 per year, P ≤ .001) and non-Indigenous Australians (odds ratio = 1.04 per year, P ≤ .001), with the Indigenous prevalence being higher than that of the non-Indigenous group at every age. CONCLUSIONS The prevalence of self-reported stroke was 3 times higher in Indigenous Australians than in non-Indigenous Australians. This disparity is consistent with previous reports, highlighting the need for intensified prevention and support services to reduce the burden of stroke on Indigenous Australians.
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia
| | - Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Victoria, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Gwynne K, Flaskas Y, O'Brien C, Jeffries TL, McCowen D, Finlayson H, Martin T, Neubeck L, Freedman B. Opportunistic screening to detect atrial fibrillation in Aboriginal adults in Australia. BMJ Open 2016; 6:e013576. [PMID: 27852724 PMCID: PMC5129009 DOI: 10.1136/bmjopen-2016-013576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a 10-year gap in life expectancy between Aboriginal and non-Aboriginal Australians. The leading cause of death for Aboriginal Australians is cardiovascular disease, including myocardial infarction and stroke. Although atrial fibrillation (AF) is a known precursor to stroke there are no published studies about the prevalence of AF for Aboriginal people and limited evidence about AF in indigenous populations globally. METHODS AND ANALYSIS This mixed methods study will recruit and train Aboriginal health workers to use an iECG device attached to a smartphone to consecutively screen 1500 Aboriginal people aged 45 years and older. The study will quantify the proportion of people who presented for follow-up assessment and/or treatment following a non-normal screening and then estimate the prevalence and age distribution of AF of the Australian Aboriginal population. The study includes semistructured interviews with the Aboriginal health workers about the effectiveness of the iECG device in their practice as well as their perceptions of the acceptability of the device for their patients. Thematic analysis will be undertaken on the qualitative data collected in the study. If the device and approach are acceptable to the Aboriginal people and widely adopted, it may help prevent the effects of untreated AF including ischaemic stroke and early deaths or impairment in Aboriginal people. ETHICS AND DISSEMINATION This mixed methods study received ethics approval from the Aboriginal Health and Medical Research Council (1135/15) and the Australian Health Council of Western Australia (HREC706). Ethics approval is being sought in the Northern Territory. The findings of this study will be shared with Aboriginal communities, in peer reviewed publications and at conferences. There are Aboriginal investigators in each state/territory where the study is being conducted who have been actively involved in the study. They will also be involved in data analysis, dissemination and research translation. TRIAL REGISTRATION NUMBER ACTRN12616000459426.
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Affiliation(s)
- Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney,Camperdown, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney,Camperdown, New South Wales, Australia
| | - Yvonne Flaskas
- Poche Centre for Indigenous Health, The University of Sydney,Camperdown, New South Wales, Australia
- Faculty of Dentistry, The University of Sydney,Westmead, New South Wales, Australia
| | - Ciaran O'Brien
- Poche Centre for Indigenous Health, The University of Sydney,Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney,Camperdown, New South Wales, Australia
| | - Thomas Lee Jeffries
- Poche Centre for Indigenous Health, The University of Sydney,Camperdown, New South Wales, Australia
- Sydney Medical School, The University of Sydney,Camperdown, New South Wales, Australia
| | - Debbie McCowen
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
| | - Heather Finlayson
- Brewarrina Multipurpose Service,Brewarrina, New South Wales, Australia
| | - Tanya Martin
- Poche Centre for Indigenous Health, The University of Sydney,Camperdown, New South Wales, Australia
- Sydney Nursing School, The University of Sydney,Camperdown, New South Wales, Australia
| | - Lis Neubeck
- Sydney Nursing School, The University of Sydney,Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney,Sydney, New South Wales, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney,Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney,Sydney, New South Wales, Australia
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Cochrane FC, Brown L, Siyambalapitiya S, Plant C. "… Trial and error …": Speech-language pathologists' perspectives of working with Indigenous Australian adults with acquired communication disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 18:420-431. [PMID: 27063675 DOI: 10.3109/17549507.2015.1101157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study explored speech-language pathologists' (SLPs) perspectives about factors that influence clinical management of Aboriginal and Torres Strait Islander adults with acquired communication disorders (e.g. aphasia, motor speech disorders). METHOD Using a qualitative phenomenological approach, seven SLPs working in North Queensland, Australia with experience working with this population participated in semi-structured in-depth interviews. Qualitative content analysis was used to identify categories and overarching themes within the data. RESULT Four categories, in relation to barriers and facilitators, were identified from participants' responses: (1) The Practice Context; (2) Working Together; (3) Client Factors; and (4) Speech-Language Pathologist Factors. Three overarching themes were also found to influence effective speech pathology services: (1) Aboriginal and Torres Strait Islander Cultural Practices; (2) Information and Communication; and (3) Time. CONCLUSION This study identified many complex and inter-related factors which influenced SLPs' effective clinical management of this caseload. The findings suggest that SLPs should employ a flexible, holistic and collaborative approach in order to facilitate effective clinical management with Aboriginal and Torres Strait Islander people with acquired communication disorders.
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Affiliation(s)
- Frances Clare Cochrane
- a Townsville Hospital and Health Service , Speech Pathology Department , The Townsville Hospital , Townsville , Australia
| | - Louise Brown
- b James Cook University, Speech Pathology , Townsville , Australia
| | | | - Christopher Plant
- d Central QLD University, School of Human, Health and Social Sciences , Rockhampton , Australia
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Andrew NE, Sundararajan V, Thrift AG, Kilkenny MF, Katzenellenbogen J, Flack F, Gattellari M, Boyd JH, Anderson P, Grabsch B, Lannin NA, Johnston T, Chen Y, Cadilhac DA. Addressing the challenges of cross-jurisdictional data linkage between a national clinical quality registry and government-held health data. Aust N Z J Public Health 2016; 40:436-442. [DOI: 10.1111/1753-6405.12576] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 04/01/2016] [Accepted: 05/01/2016] [Indexed: 01/12/2023] Open
Affiliation(s)
- Nadine E. Andrew
- Stroke & Ageing Research, School of Clinical Sciences at Monash Health; Monash University; Victoria
| | - Vijaya Sundararajan
- Department of Medicine, St. Vincent's Hospital; Melbourne University; Victoria
| | - Amanda G. Thrift
- Stroke & Ageing Research, School of Clinical Sciences at Monash Health; Monash University; Victoria
| | - Monique F. Kilkenny
- Stroke & Ageing Research, School of Clinical Sciences at Monash Health; Monash University; Victoria
- Florey Institute of Neuroscience and Mental Health; Heidelberg Victoria
| | - Judith Katzenellenbogen
- Western Australian Centre for Rural Health; The University of Western Australia
- Telethon Kids Institute; The University of Western Australia
| | - Felicity Flack
- Telethon Kids Institute; The University of Western Australia
| | - Melina Gattellari
- South Western Sydney Clinical School; University of New South Wales
- Ingham Institute for Applied Medical Research; New South Wales
| | - James H. Boyd
- Population Health Research Network Centre for Data Linkage, Centre for Population Health Research; Curtin University; Western Australia
| | - Phil Anderson
- Data Linkage Unit, Australian Institute of Health and Welfare; Australian Capital Territory
- Faculty of Health; University of Canberra, Australian Capital Territory
| | - Brenda Grabsch
- Florey Institute of Neuroscience and Mental Health; Heidelberg Victoria
| | - Natasha A. Lannin
- School of Allied Health, College of Science, Health and Engineering; La Trobe University; Victoria
| | | | - Ying Chen
- Victorian Data Linkages; Department of Health and Human Services; Victoria
| | - Dominique A. Cadilhac
- Stroke & Ageing Research, School of Clinical Sciences at Monash Health; Monash University; Victoria
- Florey Institute of Neuroscience and Mental Health; Heidelberg Victoria
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Zhao Y, Condon J, You J, Guthridge S, He V. Assessing improvements in survival for stroke patients in the Northern Territory 1992-2013: a marginal structural analysis. AUST HEALTH REV 2016; 39:437-443. [PMID: 25701881 DOI: 10.1071/ah14146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/25/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate changes in stroke survival among Indigenous and non-Indigenous patients in the Northern Territory (NT). METHODS A longitudinal study was undertaken of stroke patients admitted to NT public hospitals between 1992 and 2013. The Kaplan-Meier method and proportional hazards regression were used for survival analysis. A marginal structural model was applied to adjust for time-dependent confounders and informative censoring. RESULTS; There were 4754 stroke in-patients over the period, with 3540 new cases and 837 stroke deaths. Mean age of onset for Indigenous patients (51.7 years) was 12.3 years younger than that for non-Indigenous patients. After adjustments for confounders and loss to follow-up, in-hospital deaths were more likely among Indigenous patients (hazard ratio (HR) = 1.56; P < 0.01) and less likely among males (HR = 0.86; P < 0.05) and patients from remote areas (HR = 0.72; P < 0.01). There was a 3% decrease annually in mortality hazard from 1992 to 2013. Renal disease, cancer and chronic obstructive pulmonary disease had deleterious effects on stroke survival. CONCLUSIONS Stroke survival has improved in the NT over the past two decades. The marginal structural models provide a powerful methodological tool that can be applied to hospital administrative data to assess changes in quality of care and the impact of interventions.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, NT Department of Health, PO Box 40596, Casuarina, NT 0811, Australia. Email
| | - John Condon
- Health Gains Planning, NT Department of Health, PO Box 40596, Casuarina, NT 0811, Australia. Email
| | - Jiqiong You
- Health Gains Planning, NT Department of Health, PO Box 40596, Casuarina, NT 0811, Australia. Email
| | - Steven Guthridge
- Health Gains Planning, NT Department of Health, PO Box 40596, Casuarina, NT 0811, Australia. Email
| | - Vincent He
- Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia. Email
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Katzenellenbogen JM, Atkins ER, Thompson SC, Hersh D, Coffin J, Flicker L, Hayward C, Ciccone N, Woods D, McAllister M, Armstrong EM. Missing voices: Profile and extent of acquired communication disorders in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia using linked administrative records. Int J Stroke 2015; 11:103-16. [DOI: 10.1177/1747493015607521] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Limited data exist on the extent of specific functional sequelae, including acquired communication disorder, among Aboriginal stroke survivors, making planning of multidisciplinary services difficult. Aims To obtain estimates of the extent and profile of acquired communication disorder in Aboriginal and non-Aboriginal adult stroke survivors in Western Australia and investigate potential disparities in receiving in-hospital speech pathology services among survivors with acquired communication disorder. Methods Stroke cases surviving their first stroke episode during 2002–2011 were identified using Western Australia-wide person-based linked hospital and mortality data, and their five-year comorbidity profiles determined. The mid-year prevalence of stroke cases with acquired communication disorder was estimated for 2011. Regression methods were used to investigate determinants of receiving speech pathology services among acquired communication disorder cases. Results Of 14,757 stroke survivors aged 15–79 years admitted in 2002–2011, 33% had acquired communication disorder (22% aphasia/dysphasia) and 777 (5.3%) were Aboriginal. Aboriginal patients were more likely to be younger, live remotely, and have comorbidities. A diagnosis of aphasia was more common in Aboriginal than non-Aboriginal patients 15–44 years (p = 0.003). A minimum of 107 Aboriginal and 2324 non-Aboriginal stroke patients with acquired communication disorder lived in Western Australia in 2011. Aboriginal status was not associated with receiving in-hospital speech services among acquired communication disorder patients in unadjusted or adjusted models. Conclusions The relative youth, geographical distribution, high comorbidity prevalence, and cultural needs of Aboriginal stroke patients with acquired communication disorder should inform appropriate service design for speech pathology and rehabilitation. Innovative models are required to address workforce issues, given low patient volumes.
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Affiliation(s)
- JM Katzenellenbogen
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - ER Atkins
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
- The George Institute for Global Health, Sydney, Australia
| | - SC Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Australia
| | - D Hersh
- School of Psychology & Social Science, Edith Cowan University, Perth, Australia
| | - J Coffin
- Telethon Institute for Child Health Research, University of Western Australia, Perth, Australia
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - L Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
| | - C Hayward
- Kurongkurl Katitjin, Centre for Indigenous Australian Education and Research, Edith Cowan University, Perth, Australia
| | - N Ciccone
- School of Psychology & Social Science, Edith Cowan University, Perth, Australia
| | - D Woods
- Geraldton Regional Aboriginal Medical Service, Geraldton, Australia
| | - M McAllister
- School of Psychology & Social Science, Edith Cowan University, Perth, Australia
| | - EM Armstrong
- School of Psychology & Social Science, Edith Cowan University, Perth, Australia
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He VYF, Condon JR, You J, Zhao Y, Burrow JN. Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory. Int J Stroke 2015; 10 Suppl A100:89-95. [PMID: 26352280 DOI: 10.1111/ijs.12600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival. AIMS This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians. METHODS A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes). RESULTS Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88-1·78) and long-term death (standard hazard ratio: 1·27, 1·01-1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence. CONCLUSION Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.
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Affiliation(s)
- Vincent Y F He
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - John R Condon
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jiqiong You
- Department of Health, Northern Territory Government, Darwin, NT, Australia
| | - Yuejen Zhao
- Department of Health, Northern Territory Government, Darwin, NT, Australia
| | - James N Burrow
- Royal Darwin Hospital, NT Department of Health, Darwin, NT, Australia
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Study Protocol:Missing Voices– Communication Difficulties after Stroke and Traumatic Brain Injury in Aboriginal Australians. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background:Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.Method/Design:The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.Discussion:This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
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Wong CX, Lee SW, Gan SW, Mahajan R, Rangnekar G, Pathak RK, Twomey D, Schultz C, Ganesan AN, Brooks AG, Roberts-Thomson KC, Brown A, Lau DH, Sanders P. Underuse and overuse of anticoagulation for atrial fibrillation: A study in Indigenous and non-Indigenous Australians. Int J Cardiol 2015; 191:20-4. [DOI: 10.1016/j.ijcard.2015.03.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 11/29/2022]
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Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
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Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Katzenellenbogen JM, Teng THK, Lopez D, Hung J, Knuiman MW, Sanfilippo FM, Hobbs MST, Thompson SC. Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia. Heart 2015; 101:712-9. [DOI: 10.1136/heartjnl-2014-306678] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/29/2015] [Indexed: 11/04/2022] Open
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Hersh D, Armstrong E, Panak V, Coombes J. Speech-language pathology practices with Indigenous Australians with acquired communication disorders. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:74-85. [PMID: 25112423 DOI: 10.3109/17549507.2014.923510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Little is known about the needs of Indigenous Australian adults with acquired communication disorders (ACD) following stroke or brain injury and how these needs are met by speech-language pathology (SLP) services. In order for the profession to respond to the challenges of providing culturally appropriate, well-tailored and accessible services, more information on current practice and SLPs' concerns and attitudes is required. METHOD This paper reports on a national survey with completed responses from 112 SLPs, who worked with adult neurological populations, about their levels of contact with Indigenous clients, cultural competency training and potential sources of support. RESULT. Of the total respondents, 63 SLPs reported clinical contact with Indigenous clients and :they also answered questions on their assessment, intervention and discharge practices; liaison with family; and involvement with Aboriginal Health Professionals and interpreters. This group reported insufficient knowledge about Indigenous culture, lack of support and lower levels of confidence overall in working with these clients as compared to non-Indigenous clients. They wanted more flexible services for their Indigenous clients, good access to interpreters and culturally appropriate assessments and treatments delivered in culturally appropriate settings. CONCLUSION This research provides a useful starting point towards understanding SLPs' perspectives and practice at a national level.
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Affiliation(s)
- Deborah Hersh
- Speech Pathology, School of Psychology and Social Science, Edith Cowan University , Joondalup, Perth, WA , Australia
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You J, Condon JR, Zhao Y, Guthridge SL. Stroke incidence and case-fatality among Indigenous and non-Indigenous populations in the Northern Territory of Australia, 1999-2011. Int J Stroke 2015; 10:716-22. [PMID: 25588511 DOI: 10.1111/ijs.12429] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and disability in Australia. The impact of stroke on the Australia Indigenous people is, however, unclear. AIM This study describes hospital-based stroke incidence and case fatality in the Northern Territory population in Australia. METHODS Retrospective study of Northern Territory residents with a first-ever stroke episode and case fatality among Northern Territory residents in 1999-2011. RESULTS The rate ratio of age-adjusted stroke incidence between Indigenous and non-Indigenous populations was 2·8 for men and 2·7 for women, similar to those reported elsewhere in Australia. The rate ratio increased to 3·8 (95% confidence interval: 3·4-4·3) after adjusting for multiple risk factors. There was no change in annual incidence between 1999 and 2011 for either non-Indigenous (incidence rate ratio per year 1·01, 95% confidence interval: 1·00-1·03) or Indigenous people (incidence rate ratio: 1·00, 95% confidence interval: 0·98-1·02), although incidence did increase for non-Indigenous people in the 15-39 year age group (incidence rate ratio: 1·09, 95% confidence interval: 1·02-1·17) and for Indigenous people in the 40-64 year age group (incidence rate ratio: 1·03, 95% confidence interva1·00-1·06). The case fatality rate decreased from 22% in 1999 to 12% in 2011. In-hospital deaths were more common among; older and Indigenous people, for those with other chronic diseases, and from haemorrhagic stroke compared with ischemic stroke. CONCLUSIONS In the Northern Territory, as elsewhere in Australia, Indigenous Australians are more likely than other Australians to suffer a stroke. Lack of falling in incidence in the Northern Territory population highlights the importance for ongoing comprehensive primary and acute care in reducing risk factors and managing stroke patients.
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Affiliation(s)
- Jiqiong You
- Department of Health, Northen Territory Government, Darwin, NT, Australia
| | - John R Condon
- Menzies School of Health Research, Darwin, NT, Australia
| | - Yuejen Zhao
- Department of Health, Northen Territory Government, Darwin, NT, Australia
| | - Steven L Guthridge
- Department of Health, Northen Territory Government, Darwin, NT, Australia
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Gattellari M, Goumas C, Worthington J. Declining rates of fatal and nonfatal intracerebral hemorrhage: epidemiological trends in Australia. J Am Heart Assoc 2014; 3:e001161. [PMID: 25488294 PMCID: PMC4338703 DOI: 10.1161/jaha.114.001161] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background A recent systematic review of epidemiological studies reported intracerebral hemorrhage (ICH) incidence and mortality as unchanged over time; however, comparisons between studies conducted in different health services obscure assessment of trends. We explored trends in ICH rates in a large, representative population in New South Wales, Australia's most populous state (≈7.3 million). Methods and Results Adult hospitalizations with a principal ICH diagnosis from 2001 to 2009 were linked to death registrations through to June 30, 2010. Trends for overall, fatal, and nonfatal ICH rates within 30 days and fatal rates for 30‐day survivors at 365 days were calculated. There were 11 332 ICH patient admissions meeting eligibility criteria, yielding a crude hospitalization rate of 25.2 per 100 000 (age‐standardized rate: 17.2). Age‐ and sex‐adjusted overall rates significantly declined by an average of 1.6% per year (P=0.03). Fatal ICH declined by an average of 2.6% per year (P=0.004). For 30‐day survivors, a nonsignificant decline of 2.3% per year in fatal ICH at 365 days was estimated (P=0.17). Male sex and birth in the Oceania region and Asia were associated with an increased ICH risk, although this depended on age. Approximately 12% of ICH admissions would be prevented if the socioeconomic circumstances of the population equated with those of the least disadvantaged. Conclusions Overall and fatal ICH rates have fallen in this large Australian population. Improvements in cardiovascular prevention and acute care may explain declining rates. There was no evidence of an increase in devastated survivors because the longer term mortality of 30‐day survivors has not increased over time.
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Affiliation(s)
- Melina Gattellari
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia (M.G., C.G., J.W.) School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia (M.G.)
| | - Chris Goumas
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia (M.G., C.G., J.W.) South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia (C.G., J.W.)
| | - John Worthington
- Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia (M.G., C.G., J.W.) South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia (C.G., J.W.)
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