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Fishan N, Towers K, Haurat J, Zimmermann A, Radhakutty A. Tolerability and efficacy of sodium-glucose co-transporter-2 inhibitors in Australian Aboriginal and Torres Strait Islanders with type 2 diabetes mellitus: an observational study. Intern Med J 2023; 53:1916-1918. [PMID: 37792407 DOI: 10.1111/imj.16245] [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: 03/16/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023]
Abstract
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have renal and cardiovascular benefits in addition to their glucose-lowering potential. Data on the efficacy and safety of SGLT2i in Australian Aboriginal and Torres-Strait Islanders are lacking. We conducted a single-centre retrospective study assessing the safety and effects on glycaemic control and albuminuria of SGLT2i in Aboriginal and Torres Strait Islander patients with type 2 diabetes mellitus.
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Affiliation(s)
- Noor Fishan
- Department of Diabetes and Endocrinology, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kurt Towers
- Watto Purrunna Aboriginal Health Service, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Javier Haurat
- Department of Project and Data Services, BioGrid Australia, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anthony Zimmermann
- Department of Diabetes and Endocrinology, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anjana Radhakutty
- Department of Diabetes and Endocrinology, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
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2
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Atkinson-Briggs S, Ryan C, Keech A, Jenkins A, Brazionis L. Nurse-led vascular risk assessment in a regional Victorian Indigenous primary care diabetes clinic: An integrated Diabetes Education and Eye disease Screening [iDEES] study. J Adv Nurs 2022; 78:3652-3661. [PMID: 35441731 DOI: 10.1111/jan.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/06/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022]
Abstract
AIM The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse-led diabetes clinic. DESIGN This was a cross-sectional descriptive single-site study. METHODS Vascular risk factor data were extracted from the electronic health records of participants in the nurse-led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health-care clinic between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46-67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2-12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2 , 7.0 mg/L and 32.4 kg/m2 . Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3-5) for women and 3 (2-5) for men, pχ2 = 0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. CONCLUSION A nurse-led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. IMPACT A nurse-led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse-managed iDEES primary-care model of care can assist. TRIAL REGISTRATION This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235).
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Affiliation(s)
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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3
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Rebuli MA, Hendrie GA, Baird DL, Mahoney R, Riley MD. Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012–2013. Nutrients 2022; 14:nu14030507. [PMID: 35276866 PMCID: PMC8839560 DOI: 10.3390/nu14030507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.
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Affiliation(s)
- Megan A. Rebuli
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
- Correspondence:
| | - Gilly A. Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
| | - Danielle L. Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Surgical, Treatment and Rehabilitation Service (STARS) Level 7, Herston 4029, Australia;
| | - Malcolm D. Riley
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, South Australian Health and Medical Research Institute Level 7, Adelaide 5000, Australia; (G.A.H.); (D.L.B.); (M.D.R.)
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4
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Raymond WD, Lester S, Preen DB, Keen HI, Inderjeeth CA, Furfaro M, Nossent JC. Hospitalisation for systemic lupus erythematosus associates with an increased risk of mortality in Australian patients from 1980 to 2014: a longitudinal, population-level, data linkage, cohort study. Lupus Sci Med 2021; 8:8/1/e000539. [PMID: 34667085 PMCID: PMC8527118 DOI: 10.1136/lupus-2021-000539] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022]
Abstract
Objective Mortality rates for patients with SLE have not been reported in Australia. This study determined the association between a hospitalisation for SLE with mortality. Methods Population-level cohort study of patients with SLE (n=2112; 25 710 person-years) and general population comparators (controls) (n=21, 120; 280 637 person-years) identified from hospital records contained within the WA Rheumatic Disease Epidemiological Registry from 1980 to 2013. SLE was identified by ICD-9-CM: 695.4, 710.0, ICD-10-AM: L93.0, M32.0. Controls were nearest matched (10:1) for age, sex, Aboriginality and temporality. Using longitudinal linked health data, we assessed the association between a hospitalisation for SLE mortality and mortality with univariate and multivariate Cox proportional hazards and competing risks regression models. Results At timezero, patients with SLE were similar in age (43.96 years), with higher representation of females (85.1% vs 83.4%, p=0.038), Aboriginal Australians (7.8% vs 6.0%) and smokers (20.5% vs 13.2%). Before study entry, patients with SLE (mean lookback 9 years) had higher comorbidity accrual (Charlson Comorbidity Index ≥1 item (42.0% vs 20.5%)), especially cardiovascular disease (CVD) (44.7% vs 21.0%) and nephritis (16.4% vs 0.5%), all p<0.001. During follow-up (mean 12.5 years), 548 (26.0%) patients with SLE and 2450 (11.6%) comparators died. A hospitalisation for SLE increased the unadjusted (HR 2.42, 95% CI 2.20 to 2.65) and multivariate-adjusted risk of mortality (aHR 2.03, 95% CI 1.84 to 2.23), which reduced from 1980 to 1999 (aHR 1.42) to 2000–2014 (aHR 1.27). Females (aHR 2.11), Aboriginal Australians (aHR 3.32), socioeconomically disadvantaged (aHR 2.49), and those <40 years old (aHR 7.46) were most vulnerable. At death, patients with SLE had a higher burden of infection (aHR 4.38), CVD (aHR 2.09) and renal disease (aHR 3.43), all p<0.001. Conclusions A hospitalisation for SLE associated with an increased risk of mortality over the 1980–2014 period compared with the general population. The risk was especially high in younger (<40 years old), socioeconomically disadvantaged and Aboriginal Australians.
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Affiliation(s)
- Warren David Raymond
- Rheumatology Section, School of Medicine, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Crawley, Western Australia, Australia
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - David Brian Preen
- School of Population & Global Health, The University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Perth, Western Australia, Australia
| | - Helen Isobel Keen
- Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Charles Anoopkumar Inderjeeth
- Rheumatology Section, School of Medicine, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Crawley, Western Australia, Australia.,Rheumatology, Sir Charles Gairdner & Osborne Park Healthcare Group, Nedlands, Western Australia, Australia
| | - Michael Furfaro
- Rheumatology Section, School of Medicine, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Crawley, Western Australia, Australia
| | - Johannes Cornelis Nossent
- Rheumatology Section, School of Medicine, University of Western Australia Faculty of Medicine Dentistry and Health Sciences, Crawley, Western Australia, Australia.,Rheumatology, Sir Charles Gairdner & Osborne Park Healthcare Group, Nedlands, Western Australia, Australia
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5
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Barak Y, Neehoff S, Glue P. Ageing badly: indicators of old-age structure in Australia and New Zealand. J Prim Health Care 2021; 12:272-276. [PMID: 32988449 DOI: 10.1071/hc19095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Until 2050, Australia and New Zealand will experience continuing increase in the population aged >65 years. Studying differences in indicators of old-age structure between these countries can inform policymakers. AIM To calculate and analyse indicators of old-age structure for Australia and New Zealand. METHODS Five indicators of old-age structure were calculated: centenarian ratio (number of centenarians per 100,000 people), longevity index (proportion of people aged ≥90 and ≥65 years in the population), longevity level (proportion of 80+/60+ years population), ageing tendency (proportion of people aged ≥60 years in the population) and centenarity index (ratio between the centenarians and the total population ≥90 years). RESULTS All indicators of old-age structure demonstrated an advantageous ageing structure in Australia compared with New Zealand. In addition, the New Zealand Māori and Australian Aboriginal indicators of old-age structure demonstrated a significant disadvantage to these ethnic groups compared with the general population. DISCUSSION Public health policy needs to target ageing in New Zealand as a major goal in advancing the 'Ageing Well' policy advocated by the government.
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Affiliation(s)
- Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand; and Corresponding author.
| | - Shona Neehoff
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, Otago University Dunedin, New Zealand
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6
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Waller M, Buckley RF, Masters CL, Nona FR, Eades SJ, Dobson AJ. Deaths with Dementia in Indigenous and Non-Indigenous Australians: A Nationwide Study. J Alzheimers Dis 2021; 81:1589-1599. [PMID: 33967039 DOI: 10.3233/jad-201175] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of dementia is generally reported to be higher among Indigenous peoples. OBJECTIVE The rates and coding of dementia mortality were compared between Indigenous and non-Indigenous Australians. METHODS De-identified individual records on causes of death for all people aged 40 years or more who died in Australia between 2006 and 2014 (n = 1,233,084) were used. There were 185,237 records with International Classification of Diseases, Tenth Revision, codes for dementia (Alzheimer's Disease, vascular dementia, or unspecified dementia) as the underlying cause of death or mentioned elsewhere on the death certificate. Death rates were compared using Poisson regression. Logistic regression was used to assess whether dementia was more likely to be classified as 'unspecified' type in Indigenous Australians. RESULTS The rates of death with dementia were 57% higher in Indigenous Australians, compared to non-Indigenous, relative rate (RR) 1.57, 95% confidence interval (CI) (1.48, 1.66), p < 0.0001. This excess of deaths was highest at ages below 75 (RRs > 2, test for interaction p < 0.0001), and among men (test for interaction p < 0.0001). When the underreporting of Indigenous status on the death certificate was taken into account the relative rate increased to 2.17, 95% CI (2.07, 2.29). Indigenous Australians were also more likely to have their dementia coded as 'unspecified' on their death certificate (Odds Ratio 1.92, 95% CI (1.66, 2.21), p < 0.0001), compared to the non-Indigenous group. CONCLUSION This epidemiological analysis based on population level mortality data demonstrates the higher dementia-related mortality rate for Indigenous Australians especially at younger ages.
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Affiliation(s)
- Michael Waller
- University of Queensland, School of Public Health, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Rachel F Buckley
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colin L Masters
- The Florey Institute of Neuroscience, The University of Melbourne, Melbourne, Victoria, Australia
| | - Francis R Nona
- University of Queensland, School of Public Health, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Sandra J Eades
- Curtin Medical School, Curtin University, Western Australia, Australia
| | - Annette J Dobson
- University of Queensland, School of Public Health, Faculty of Medicine, Brisbane, Queensland, Australia
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7
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Gardiner FW, Bishop L, Gale L, Harwood A, Teoh N, Lucas RM, Jones M, Laverty M. Poor access to kidney disease management services in susceptible patient populations in rural Australia is associated with increased aeromedical retrievals for acute renal care. Intern Med J 2021; 50:951-959. [PMID: 31821680 DOI: 10.1111/imj.14716] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inequalities in access to renal services and acute care for rural and remote populations in Australia have been described but not quantified. AIM To describe: the coverage of renal disease management services in rural and remote Australia; and the characteristics of patients who had an aeromedical retrieval for renal disease by Australia's Royal Flying Doctor Service (RFDS). METHODS Data from the RFDS, the Australian Bureau of Statistics, and Health Direct were used to estimate provision of renal disease management services by geographic area. RFDS patient diagnostic data were prospectively collected from 2014 to 2018. RESULTS Many rural and remote areas have limited access to regular renal disease management services. Most RFDS retrievals for renal disease are from regions without such services. The RFDS conducted 1636 aeromedical retrievals for renal disease, which represented 1.6% of all retrievals. Among retrieved patients, there was a higher proportion of men than women (54.6% vs 45.4%, P < 0.01), while indigenous patients (n = 546, 33.4%) were significantly younger than non-indigenous patients (40.9 vs 58.5, P < 0.01). There were significant differences in underlying diagnoses triggering retrievals between genders, with males being more likely than females to be transferred with acute renal failure, calculus of the kidney and ureter, renal colic, obstructive uropathy, and kidney failure (all P < 0.01). Conversely, females were more likely to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo-interstitial nephritis, and nephrotic syndrome (all P < 0.01). CONCLUSION Aeromedical retrievals for acute care were from rural areas without regular access to renal disease prevention or management services.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Australia.,National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia
| | | | | | | | - Narci Teoh
- Medicine and Surgery Program, The Australian National University Medical School at The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Robyn M Lucas
- National Centre for Epidemiology and Population Health and The Australian National University Medical School, The Australian National University, Canberra, Australia
| | - Martin Jones
- University of South Australia Department of Rural Health, Whyalla, South Australia, Australia
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8
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Rennie C, Fernandez R, Donnelly S, McGrath KCY. The Impact of Helminth Infection on the Incidence of Metabolic Syndrome: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:728396. [PMID: 34456879 PMCID: PMC8397462 DOI: 10.3389/fendo.2021.728396] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are a growing number of publications that report an absence of inflammatory based disease among populations that are endemic to parasitic worms (helminths) demonstrating the ability of these parasites to potentially regulate human immune responses. The aim of this systematic review and meta-analysis was to determine the impact of helminth infection on metabolic outcomes in human populations. METHODS Using PRISMA guidelines, six databases were searched for studies published up to August 2020. Random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals using the Review Manager Software version 5.4.1. RESULTS Fourteen studies were included in the review. Fasting blood glucose was significantly lower in persons with infection (MD -0.22, 95% CI -0.40- -0.04, P=0.02), HbA1c levels were lower, although not significantly, and prevalence of the metabolic syndrome (P=0.001) and type 2 diabetes was lower (OR 1.03, 95% CI 0.34-3.09, P<0.0001). Infection was negatively associated with type 2 diabetes when comparing person with diabetes to the group without diabetes (OR 0.44, 95% CI 0.29-0.67, P=0.0001). CONCLUSIONS While infection with helminths was generally associated with improved metabolic function, there were notable differences in efficacy between parasite species. Based on the data assessed, live infection with S. mansoni resulted in the most significant positive changes to metabolic outcomes. SYSTEMATIC REVIEW REGISTRATION Website: PROSPERO Identified: CRD42021227619.
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Affiliation(s)
- Claire Rennie
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
| | - Ritin Fernandez
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
- Centre for Research in Nursing and Health, St George Hospital, Sydney, NSW, Australia
- Centre for Evidence Based Initiatives in Health Care a JBI Centre of Excellence, Sydney, NSW, Australia
| | - Sheila Donnelly
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
- *Correspondence: Kristine CY McGrath, ; Sheila Donnelly,
| | - Kristine CY McGrath
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia
- *Correspondence: Kristine CY McGrath, ; Sheila Donnelly,
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9
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Mitchell WG, Deane A, Brown A, Bihari S, Wong H, Ramadoss R, Finnis M. Long term outcomes for Aboriginal and Torres Strait Islander Australians after hospital intensive care. Med J Aust 2020; 213:16-21. [PMID: 32484925 DOI: 10.5694/mja2.50649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess long term outcomes for Aboriginal and Torres Strait Islander (Indigenous) Australians admitted non-electively to intensive care units (ICUs). DESIGN Data linkage cohort study; analysis of ICU patient data (Australian and New Zealand Intensive Care Society Adult Patient Database), prospectively collected during 2007-2016. SETTING All four university-affiliated level 3 ICUs in South Australia. MAIN OUTCOMES Mortality (in-hospital, and 12 months and 8 years after admission to ICU), by Indigenous status. RESULTS 2035 of 39 784 non-elective index ICU admissions (5.1%) were of Indigenous Australians, including 1461 of 37 661 patients with South Australian residential postcodes. The median age of Indigenous patients (45 years; IQR, 34-57 years) was lower than for non-Indigenous ICU patients (64 years; IQR, 47-76 years). For patients with South Australian postcodes, unadjusted mortality at discharge and 12 months and 8 years after admission was lower for Indigenous patients; after adjusting for age, sex, diabetes, severity of illness, and diagnostic group, mortality was similar for both groups at discharge (adjusted odds ratio [aOR], 0.95; 95% CI, 0.81-1.10), but greater for Indigenous patients at 12 months (aOR, 1.14; 95% CI, 1.03-1.26) and 8 years (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.35). The number of potential years of life lost was greater for Indigenous patients (median, 24.0; IQR, 15.8-31.8 v 12.5; IQR, 0-22.3), but, referenced to respective population life expectancies, relative survival at 8 years was similar (proportions: Indigenous, 0.78; 95% CI, 0.75-0.80; non-Indigenous, 0.77; 95% CI, 0.76-0.78). CONCLUSIONS Adjusted long term mortality and median number of potential life years lost are higher for Indigenous than non-Indigenous patients after intensive care in hospital. These differences reflect underlying population survival patterns rather than the effects of ICU admission.
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Affiliation(s)
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA.,University of Adelaide, Adelaide, SA
| | - Shailesh Bihari
- Flinders Medical Centre, Adelaide, SA.,College of Medicine and Public Health, Flinders University, Adelaide, SA
| | - Hao Wong
- University of Adelaide, Adelaide, SA.,Queen Elizabeth Hospital, Adelaide, SA
| | | | - Mark Finnis
- University of Adelaide, Adelaide, SA.,Royal Adelaide Hospital, Adelaide, SA
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10
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Smith K, Sutherland A, Hyde Z, Crawford R, Dwyer A, Malay R, Skeaf L, Flicker L, Atkinson D, LoGiudice D. Assessment, incidence and factors associated with urinary incontinence in older Aboriginal Australians. Intern Med J 2018; 49:1111-1118. [PMID: 30548387 DOI: 10.1111/imj.14192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about urinary incontinence in older Aboriginal Australians. AIM To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. METHODS Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. RESULTS Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self-report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow-up of 6.7 years was 33 (23.6%), higher than estimates of 5-20% in other populations. Cross-sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98-15.57), stroke (OR = 3.55; 95% CI 1.43-8.77), head injury (OR = 3.15; 95% CI 1.54-6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01-1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01-1.09) and female sex (OR = 2.37; 95% CI 0.99-5.67). Sensitivity (81.5%) and specificity (93.5%) of self-report were high. CONCLUSION The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self-report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required.
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Affiliation(s)
- Kate Smith
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.,Centre for Aboriginal Medical and Dental Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ailsa Sutherland
- Kimberley Aged and Community Services, Broome, Western Australia, Australia
| | - Zoë Hyde
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Ruth Crawford
- Kimberley Aged and Community Services, Broome, Western Australia, Australia
| | - Anna Dwyer
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.,Nulungu Research Institute, University of Notre Dame, Broome, Western Australia, Australia
| | - Roslyn Malay
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Linda Skeaf
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - David Atkinson
- Rural Clinical School of WA, University of Western Australia, Perth, Western Australia, Australia.,Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Dina LoGiudice
- Aged Care, Melbourne Health and The University of Melbourne, Melbourne, Victoria, Australia
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