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Khan JR, Lingam R, Owens L, Chen K, Shanthikumar S, Oo S, Schultz A, Widger J, Bakar KS, Jaffe A, Homaira N. Social deprivation and spatial clustering of childhood asthma in Australia. Glob Health Res Policy 2024; 9:22. [PMID: 38910250 PMCID: PMC11194868 DOI: 10.1186/s41256-024-00361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia. METHODS Data on self-reported (by parent/carer) asthma prevalence in children aged 0-14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level. RESULTS Data were analysed from 4,621,716 children aged 0-14 years from 2,321 SA2s across the whole country. Overall, children's asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06-1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10-1.17). CONCLUSIONS We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
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Affiliation(s)
- Jahidur Rahman Khan
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Louisa Owens
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Katherine Chen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shivanthan Shanthikumar
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Steve Oo
- Perth Children's Hospital, Perth, WA, Australia
| | - Andre Schultz
- Perth Children's Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - John Widger
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - K Shuvo Bakar
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adam Jaffe
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Nusrat Homaira
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Terry D, Peck B, Kloot K. Paediatric Emergency Asthma Presentations: Temporal Trends and Representations in Rural Australia. Healthcare (Basel) 2023; 11:3113. [PMID: 38132002 PMCID: PMC10742987 DOI: 10.3390/healthcare11243113] [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: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is a key illness driving children to present to emergency departments, and although paediatric emergency asthma presentations have been examined, the temporal trends remain somewhat elusive. The aim is to highlight, describe, and model the temporal trends of emergency paediatric asthma presentations, using comprehensive hospital emergency presentation data. A retrospective cross-sectional study examined de-identified paediatric (0 to 14 years) emergency asthma presentation data over a three-year period. Data were obtained from nine healthcare facilities in Victoria, Australia. Episode-level data were collected through RAHDaR, a comprehensive emergency data register which includes missing data (35.0%) among rural health facilities not currently captured elsewhere. Monthly presentation rates demonstrate a significant difference in presentations between fall/autumn and spring, and males had higher presentation rates in February and June-August. Emergency presentations were more likely to occur Sunday-Tuesday, peaking in the time periods of 8-9 a.m., 11 a.m.-12 p.m., and 8-9 p.m. Significant differences were noted between all age groups. Examining previously unavailable rural data has highlighted patterns among emergency asthma presentations for children 0-14 years of age. Knowledge of these by season, month, and day of the week, in combination with time of day, offers scope for more focused workforce education and planning, and nuanced referral pathways, particularly in resource-limited settings.
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Affiliation(s)
- Daniel Terry
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD 4305, Australia;
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Blake Peck
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, VIC 3280, Australia
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Håkansson KEJ, Backer V, Suppli Ulrik C. Socioeconomic biases in asthma control and specialist referral of possible severe asthma. Eur Respir J 2021; 58:13993003.00741-2021. [PMID: 33986027 DOI: 10.1183/13993003.00741-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS). METHODS Asthma patients fulfilling the following: aged 18-45 and redeeming ≥2 prescriptions of ICS during 2014-18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals). RESULTS Of 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51-0.85)), 36-45 versus 18-25 years), male sex (OR 0.75 (0.64-0.87)), residence outside the Capital Region (OR 0.70 (0.59-0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59-0.95)).Having completed higher education increased odds of specialist referral (OR 1.28 (1.03-1.59)), when compared to patients with basic education. CONCLUSION Even in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.
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Affiliation(s)
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Terry D, Peck B, Kloot K, Hutchins T. Pediatric emergency asthma presentations in Southwest Victoria: a retrospective cross-sectional study 2017 to 2020. J Asthma 2020; 59:264-272. [PMID: 33143500 DOI: 10.1080/02770903.2020.1845725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Australia has one of the highest prevalence of asthma globally, and accessible emergency asthma presentation data remains vital, however, is currently underreported in regional and rural areas. Utilizing the Rural Acute Hospital Data Register (RAHDaR) which includes previously non-reported data, the aim of the study is to provide a more accurate understanding of asthma emergency presentation events, while investigating the factors associated with these presentations. METHODS A retrospective cross-sectional study collected de-identified emergency asthma presentation data from nine health services in regional Victoria for children aged 0 to 14 years between 2017 and 2020. Demographic and presentation data were collated along with government datasets. Asthma emergency presentations incidence rates and predictor variables were analyzed using hierarchical multiple regression after adjusting for smoking and sex. Significance was determined at p < 0.05. RESULTS Of the 1090 emergency asthma presentations, n = 369 occurred at health services who did not previously report data. This represents a 33.86% increase in our understanding of emergency asthma presentations and demonstrating a rate of 16.06 presentations per 1000 children per year. Key factors such as age, population density, and private health insurance were associated with asthma emergency presentation events among both sexes, while socioeconomic status and rurality were not predictive. CONCLUSIONS Although some findings are consistent with current research, the study highlights previously unrecognized specific factors that are predictive of asthma among 0-14-year-old children. These findings provide more accurate insights for healthcare workers and policymakers as they seek to support people with asthma and accurately address health inequities.
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Affiliation(s)
- Daniel Terry
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Blake Peck
- School of Health, Federation University, Ballarat, Victoria, Australia
| | - Kate Kloot
- Center for Rural Emergency Medicine, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
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Zolaly M, Al-Mohammadi G, Al-Saadi G, Qasim D. Vaso-occlusive crises in patients with sickle cell disease: Parents' perspectives and association with disease outcomes. J Taibah Univ Med Sci 2019; 14:515-522. [PMID: 31908639 PMCID: PMC6940674 DOI: 10.1016/j.jtumed.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES KSA has been reported to have a high prevalence of sickle cell disease (SCD). The most common complication of SCD in children is pain due to vaso-occlusion crises (VOCs) that ensue when sickle-shaped red blood cells are entrapped in small vessels, leading to infarcts. This study aimed to determine the level of awareness about VOCs among parents of patients with SCD and its correlation with the disease outcomes. METHODS A cross-sectional study was conducted including 123 parents of children with SCD, aged 2-18 years old. All recruited participants were residents of Almadinah Almunawwarah. A structured and validated questionnaire was used for data collection. RESULTS The mean total knowledge score was 30 ± 4. The majority of parents (74%) had a good level of knowledge about SCD. There was a significant association between the total knowledge score and the outcome of VOCs during the year prior (p < 0.05). There was no association between the total knowledge score and the parents' education and family income. Regarding methods of increasing awareness of VOCs, 60.97% of parents thought that the best method was by direct meetings about health education, while 30.89% preferred to have written information about the disease. Only 21.13% argued that the internet was a better choice for raising awareness. CONCLUSION In this study, the parents of SCD patients had a good level of knowledge about VOCs. There was a significant association between the parents' awareness of VOCs and a better disease outcome in their children, as they had fewer attacks and hospital admissions.
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Affiliation(s)
- Mohammed Zolaly
- Pediatrics and Pediatric Hematology Oncology, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | | | - Ghadi Al-Saadi
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | - Danya Qasim
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
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Terry DR, Nguyen H, Kim JA, Islam MR. Factors contributing to COPD hospitalisations from 2010 to 2015: Variation among rural and metropolitan Australians. CLINICAL RESPIRATORY JOURNAL 2019; 13:306-313. [PMID: 30816003 DOI: 10.1111/crj.13012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/21/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. OBJECTIVES To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. METHODS Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. RESULTS The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. CONCLUSION This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.
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Affiliation(s)
- Daniel R Terry
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Hoang Nguyen
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Jeong-Ah Kim
- School of Nursing and Healthcare Professions, Federation University Australia, Ballarat, Victoria, Australia
| | - Md Rafiqul Islam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia.,Goulburn Valley Health, Shepparton, Victoria, Australia.,School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
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Gardiner S, Robins S, Terry D. Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria. Aust J Rural Health 2019; 27:49-56. [PMID: 30693995 DOI: 10.1111/ajr.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN Retrospective study. SETTING All Victorian hospitals. PARTICIPANTS State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.
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Affiliation(s)
- Samantha Gardiner
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Shalley Robins
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniel Terry
- School of Nursing, Midwifery and Healthcare, Federation University, Ballarat, Victoria, Australia
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El-Heneidy A, Abdel-Rahman ME, Mihala G, Ross LJ, Comans TA. Milk Other Than Breast Milk and the Development of Asthma in Children 3 Years of Age. A Birth Cohort Study (2006⁻2011). Nutrients 2018; 10:E1798. [PMID: 30463252 PMCID: PMC6267177 DOI: 10.3390/nu10111798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 01/04/2023] Open
Abstract
Prevalence of asthma in Australian children is amongst the highest in the world. Although breastfeeding positively influences infant immunity, early introduction of Milk Other than Breast Milk (MOTBM) may also play an important role in the development of Asthma. The aim of this study was to investigate the association between the introduction of MOTBM in the first six months after birth and the development of reported persistent asthma in 3-year olds. A sample of 1121 children was extracted from the Environments for Healthy Living longitudinal birth cohort study. Introduction of MOTBM during the first six months after birth increased almost two-fold the risk of development of persistent asthma after adjusting for other covariates (Adjusted Relative Risk (ARR): 1.71, 95% CI: 1.03⁻2.83, p = 0.038). This study indicates that the introduction of MOTBM in the first six months of life is a risk factor for asthma incidence among 3-year old children. This result is important in explaining the benefits of breastfeeding as part of public health interventions to encourage mothers to increase breastfeeding initiation and duration, and avoid the introduction of MOTBM in the first six months after childbirth.
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Affiliation(s)
- Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Gabor Mihala
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Lynda J Ross
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia.
| | - Tracy A Comans
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
- Centre for Health Services Research, University of Queensland, Brisbane QLD 4072, Australia.
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