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Summary: Hip fractures are substantial problem worldwide. The increase in rate with age does not continue into very old age. Rates decline in successive birth cohorts. If the increasing trend in period effect continues, there will be a substantial increase in hip fracture incidence. Introduction: The purpose of this study is to (1) determine incidence rates for fracture neck of femur (FNF) for the period 1974-2007, (2) estimate age, cohort, and period effects, and (3) predict the burden of FNF in 2025. Methods: Age adjusted incidence rates were estimated using New Zealand hospital discharge data for 1974-2007. Age-period-cohort modeling was used to estimate individual effects of these factors after adjusting for the other two factors. Future fracture burden was estimated under two scenarios. Results: Age-adjusted rates for women increased from 1974 to 1987 whereas rates for men have increased from 1974 until 2007. Risk increased from 70 years of age but dropped among the very elderly. Period effects showed a steady increase in risk throughout 1974-2007. In contrast, the risk was lower in later cohorts. If there is no change in the period effect from 2007 we estimate a reduction in the burden of illness from FNF, especially for women. However if the period effect continues to increase, there will be substantial increases in FNF incidence, especially for men. Conclusions: The effect of population aging on FNF incidence is predictable because projections are based on an existing population. The increasing health and improvement in measures of physical status of older people through the last century, explain the decline in FNF incidence in later cohorts. The steady increase in period effect may be due to increased survival of the very frail. This burden of illness resulting from FNFs must be addressed by population based, research proven approaches to fall and fracture prevention. [ABSTRACT FROM AUTHOR]

Research question Is length of stay (LoS) in hospital a stable proxy for severity of injury when monitoring time trends in serious injury incidence? Objective To investigate whether LoS metrics (mean, median and proportion exceeding several LoS thresholds) have changed over time for injury diagnoses with known severity. Design Time series investigation. Subjects and setting New Zealand population admitted to hospital for injury and discharged during the period 1989 to 1998. Main outcome measures Interpolated median and geometric mean lengths of stay, as well as the proportion of cases that have an LoS greater than or equal to 3, 4, 7 and 14 days in hospital. Methods ICD-9-CM diagnoses that are approximately homogeneous in regard to severity of injury (ICD-HS diagnoses) were identified. Trends were investigated in the LoS statistics for: injury and non-injury diagnoses combined; all injury diagnoses; major body sites of injury; severity strata; and ICD-HS diagnoses. Results Almost without exception, there was a decline in the LoS statistics over time for all diagnoses, all injury diagnoses, each body site of injury investigated, severity strata, and the ICD-HS diagnoses. Conclusions Reductions in median and geometric mean LoS over time, as well as reductions in the proportion exceeding selected LoS thresholds, were due to factors other than reductions in the incidence of serious injury; for example, changes in service delivery over time. An LoS threshold should not be used as a proxy for severity of injury if the goal is to monitor time trends in injury incidence. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy in coding for principal injury diagnosis (PDx), external cause, place of occurrence, and activity codes under the Australian Modification of the International Classification of Disease, 10th Revision (ICD-10-AM) for public hospital discharges in New Zealand.Method: A simple random sample of 1800 injury discharges was selected from the National Minimum Dataset (NMDS) of hospital discharges from July 2001 to June 2004. Records were obtained and coded by the Senior Advisor in Clinical Coding (SACC) independently of the codes already recorded in the NMDS.Results: Of injury discharges selected from the NMDS, 2% were not coded with a PDx of injury by the SACC. Fourteen percent of the PDxs and 26% of the external cause codes (E-codes V01-Y89) had inaccuracies in the first, second, or third characters. Variation in the accuracy of the PDxs and E-codes was obvious by diagnostic and E-code groupings; 22% of the place of occurrence codes (Y92) and 29% of the activity codes (Y93) were incorrect. Accuracy of the PDxs and E-codes was related to the clarity of the documentation in the medical records.Conclusions: For countries that are considering implementing ICD-10 or one of its variants, these findings provide insight into possible limitations of the classification and offer guidance on where the focus of training should be placed. For countries that have historical data coded according to ICD-10-AM, these results suggest that some specific estimates of injury and external-cause incidence may need to be treated with caution. [ABSTRACT FROM AUTHOR]

Objective: To determine the accuracy in coding for principal injury diagnosis (PDx), external cause, place of occurrence, and activity codes under the Australian Modification of the International Classification of Disease, 10th Revision (lCD-10-AM) for public hospital discharges in New Zealand. Method: A simple random sample of 1800 injury discharges was selected from the National Minimum Dataset (NMDS) of hospital discharges from July 2001 to June 2004. Records were obtained and coded by the Senior Advisor in Clinical Coding (SACC) independently of the codes already recorded in the NMDS. Results: Of injury discharges selected from the NMDS, 2% were not coded with a PDx of injury by the SACC. Fourteen percent of the PDxs and 26% of the external cause codes (E-codes V01-Y89) had inaccuracies in the first, second, or third characters. Variation in the accuracy of the PDxs and E-codes was obvious by diagnostic and Ecode groupings; 22% of the place of occurrence codes (Y92) and 29% of the activity codes (Y93) were incorrect. Accuracy of the PDxs and E-codes was related to the clarity of the documentation in the medical records. Conclusions: For countries that are considering implementing lCD-10 or one of its variants, these findings provide insight into possible limitations of the classification and offer guidance on where the focus of training should be placed. For countries that have historical data coded according to lCD-10-AM, these results suggest that some specific estimates of injury and external-cause incidence may need to be treated with caution. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the use of integrated hospitalization and mortality data sources and/or the inclusion of comorbidity improve the predictive ability of the International Classification of Disease (ICD)-based Injury Severity Score (ICISS).Design: Models using either the ICISS based solely on hospital discharge data or one of nine modified ICISSs as the predictor variable were assessed on their ability to predict survival using logistic regression modeling.Setting: New Zealand.Patients or subjects: Inpatients, with an S00DST89 ICD-10-AM principal diagnosis, and fatalities, with any S00DST89 ICD-10-AM diagnosis, occurring in 2000DS2003.Interventions: None.Main outcome measures: Models were compared in terms of their discrimination (concordance), calibration, and goodness-of-fit.Results: 186 835 cases including 9968 deaths met the inclusion criterion. The modified ICISS that included both mortality data and Charlson comorbid conditions at the ICD-10-AM level had the best concordance and high calibration. Calibration curves indicated that scores using hospital discharge data only to calculate survival risk ratios underestimated mortality, whereas scores using hospital discharge and mortality data overestimated mortality.Conclusions: Valid measurement of injury severity is important for both meaningful research and surveillance and to assist in classifying information to meet specific injury policy, prevention, and control needs. This study suggests that the predictive ability of ICISS would be improved if both mortality and comorbidity data were included in its calculation. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the use of integrated hospitalization and mortality data sources and/or the inclusion of comorbidity improve the predictive ability of the International Classification of Disease (ICD)-based Injury Severity Score (ICISS). Design: Models using either the ICISS based solely on hospital discharge data or one of nine modified lClSSs as the predictor variable were assessed on their ability to predict survival using logistic regression modeling. Setting: New Zealand. Patients or subjects: Inpatients, with an S00-T89 CD-10-AM principal diagnosis, and fatalities, with any 500-T89 lCD-10-AM diagnosis, occurring in 2000-2003. Interventions: None. Main outcome measures: Models were compared in terms of their discrimination (concordance), calibration, and goodness-of-fit. Results: 186 835 cases including 9968 deaths met the inclusion criterion. The modified ICISS that included both mortality data and Charlson comorbid conditions at the lCD-b-AM level had the best concordance and high calibration. Calibration curves indicated that scores using hospital discharge data only to calculate survival risk ratios underestimated mortality, whereas scores using hospital discharge and mortality data overestimated mortality. Conclusions: Valid measurement of injury severity is important for both meaningful research and surveillance and to assist in classifying information to meet specific injury policy, prevention, and control needs. This study suggests that the predictive ability of ICISS would be improved if both mortality and comorbidity data were included in its calculation. [ABSTRACT FROM AUTHOR]

Objective: To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size. Method: A simple random sample of 1800 discharges was selected from the period 1996–98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database. Results: Five percent of the principal diagnoses, 18% of the first four digits of the E-codes, and 8% of the location codes (5th digit of the E-code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals. Conclusions: Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD-9-CM-A. A similar degree of confidence is warranted for E-coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD-9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD-9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitic carriage is common in East African populations with a wide spectrum of clinical severity. There are scant data on the rates of carriage in East African immigrants to Australia. This study describes the prevalence of and risk factors for intestinal parasite carriage among children recently arrived from East African countries.Methods: Children aged 0-17 years, who attended an outpatient clinic, were born in East Africa and had immigrated since 1998 were eligible to participate. A single preserved stool specimen was collected for faecal microscopy, and blood tests were conducted for Strongyloides and Schistosoma serology, full blood examination and serum ferritin.Results: One hundred and thirty-five children (median age 8.1 years, range 1.0-17.5) participated, of whom 133 (99%) provided a stool specimen. Parasites were detected in 50% of samples, and 18% of children carried a possibly pathogenic species. No child was symptomatic at diagnosis. Positive or equivocal serology occurred in 11% of children for Strongyloides and 2% for Schistosoma. Anaemia and iron deficiency were detected in 16% of all children. Those carrying an intestinal parasite were older (mean age 9.8 vs 7.4 years, P= 0.002) and less likely to be anaemic (odds ratio 0.37, 95% confidence interval 0.14-0.96) than those who were not carriers.Conclusions: Carriage of intestinal parasites is common among children from East Africa. Those carrying pathogenic organisms require treatment and follow up to ensure eradication. The results of this survey support the need for routine assessment of newly arrived immigrants from East Africa for intestinal parasites, anaemia and iron deficiency. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To identify the age of adiposity rebound and the value of its associated BMI and examine their association with BMI at ages 18 and 21 y for males and females. DESIGN:A longitudinal study of a large cohort of people born in Dunedin, New Zealand between 1972–1973. SUBJECTS:Four hundred and seventy-four males and 448 females aged between birth and 21 y. MEASUREMENTS:BMI was derived from measurements of weight and height made when the participants were born and at intervals from age 3–21 y. RESULTS:When a random coefficients model was fitted to the data for those who had five or more measures of BMI between age 3 and age 18 y, adiposity rebound occurred at 6.0 y of age for boys and 5.6 y for girls. The values of BMI associated with these were 15.7 kg/m2 for boys and 15.5 kg/m2 for girls. The correlations between age at adiposity rebound and BMI at ages 18 and 21 y were between -0.72 and -0.65 for boys and -0.59 and -0.47 for girls. These were higher than those derived from fitting individual curves or from deriving the adiposity rebound from data collected up to age 11 y. The correlation between BMI at age 7 y and BMI at ages 18 and 21 y were 0.70 and 0.61 for boys and 0.56 and 0.52 for girls. The correlations between measures of skeletal maturity at age 7 y and adiposity rebound were statistically significant for boys but not for girls. CONCLUSIONS:BMI in early adulthood was associated with both age of adiposity rebound and BMI at that age. As the correlations between BMI at age 7 y and BMI at ages 18 and 21 y were similar in magnitude, BMI at age 7 y may be a more practical way of predicting BMI in early adulthood. [ABSTRACT FROM AUTHOR]

Background As in other countries, many of the New Zealand (NZ) national fatal injury indicators are derived from the underlying cause of death (UCoD) as captured in the national Mortality Collection (MC). Recent work in NZ, similar to work in Sweden and Australia, has exposed apparent contradictions between hospital data and the MC: for many of the injury cases that died in hospital, the UCoD recorded on the MC was a medical cause. Aim To investigate the current and alternative methods of identifying injury deaths. Methods NZ hospital discharges, with a principal diagnosis (PDx) of injury, were linked to the MC. Gross mismatches between PDx and the UCoD were described for people injured in the period 2000–2004, by selected variables (eg, age, sex, external cause, intent, PDx). Taking cognisance of (1) WHO coding rules for mortality, (2) definitions of injury death used by injury epidemiologists and (3) identified mismatches, alternative definitions of injury death were proposed. Results Of the 1713 people discharged from hospital with an injury PDx who died within 7 days of their injury, 39% did not have an injury UCoD. Of the 5900 who died within 3 months of their injury, the corresponding figure was 66%. There was variation in the percentage with non-injury UCoD by age, sex, external cause, intent and PDx. Conclusion Alternative theoretical and operational definitions of injury death are clearly needed. Definitions that capture relevant cases for epidemiologists, prevention practitioners and policy makers have been proposed. [ABSTRACT FROM PUBLISHER]

Background Similar to other countries, in New Zealand (NZ) a case of non-fatal injury is captured if the principal diagnosis (PDx) on the hospital discharge record is coded to the injury chapter of International Classification of Diseases (ICD). There has been recent debate in NZ about whether this operational definition captures all cases that are of interest to injury prevention practitioners and policy makers. Research question: Does the case definition of serious non-fatal injury, used in the specifications of the NZ serious injury indicators, miss a material number of serious injury cases of interest? Methods Empirical methods were used to investigate an alternative definition of serious non-fatal injury. The alternative definition involved relaxing the criteria for PDx to be within the ICD injury chapter, provided there exists an injury diagnosis on the hospital discharge record, and the severity of the injuries recorded on the record exceed a pre-existing agreed threshold. Results, including case scenarios, were presented to a stakeholder group, where agreement on the most appropriate case definition was sought. Results Relaxing the requirement for the PDx to be an injury resulted in 7% more serious non-fatal injury cases. The largest percentage increase in cases was found for self-harm, which showed a 17% increase. Conclusion The current NZ case definition potentially misses a material number of serious non-fatal injury cases of interest to the stakeholder community. There is evidence, and agreement with stakeholders, to support the adoption of the more inclusive case definition. [ABSTRACT FROM PUBLISHER]

Background When making international comparisons of non-fatal injury, they are often based on hospital data, and are contaminated by health service effects. One way to reduce this contamination is to make comparisons using a case definition based on diagnoses that have high probabilities of admission. Aim To identify International Classification of Diseases (ICD) diagnoses associated with a high probability of admission. Method We identified international collaborators who had access to Emergency Department data whose diagnoses were coded to the ICD. A protocol for data provision was agreed with our collaborators. The submitted data was checked by the New Zealand team and then via liaison with the collaborators. Country-specific results were presented at the ICD 4- character level. Results were also contrasted between countries. Results The results show that the only injuries with strong evidence for high probabilities of admission, consistently across all collaborating countries, were fractured neck of femur and other femoral fractures (S720, S721, S722 and S723). Other injuries that were potentially consistent with high probabilities, but for which the estimates had wide CIs due to small numbers in some of the collaborators data, included: focal brain injury (S063), traumatic haemopneumothorax (S272), injury of the spleen (S360), liver or gall bladder (S361). Outcome The information generated by this project will inform all high income countries of those diagnoses that almost always get admitted to hospital. It will also suggest a case definition suitable for making international comparisons. [ABSTRACT FROM PUBLISHER]

Background Return to work and work ability are considered major markers of rehabilitation following injury. Prolonged work absence and work disability result in significant personal and social costs, therefore improvements in return to work and work ability will have benefits for injured workers and society. The Prospective Outcomes of Injury Study (POIS) is a cohort study following the outcomes of injured New Zealanders. Aim This work-related component of the study aims to determine preinjury predictors of return to work and work ability for 2850 New Zealanders recruited into the POIS cohort. Methods The 2850 participants for this study comprise a sample of individuals aged 18–65 years referred to the national injury compensation scheme (ACC) for an entitlement claim (ie, injury severe enough to warrant 1 week off work or home/transportation assistance) during the period December 2007 to August 2009. Quantitative data are collected by questionnaire at 3, 5, 12 & 24 months after injury. Results and Conclusion This presentation will discuss results from 3 and 5 month interviews describing the injury outcomes relevant to return to work and return to work ability in the cohort. Of the 2850 participants, 2618 were workforce active. Presentation of analyses examining the impact of preinjury work factors, including psychosocial and physical working conditions and employment conditions on prospective return to work and work ability following injury will be made. [ABSTRACT FROM PUBLISHER]

Aim There are gaps understanding outcomes following injury. The Prospective Outcomes of Injury cohort Study (POIS) aims to determine factors (discussed below) influencing the risk of disability up to 2 years after injury. Study Design Participants from five regions, aged 18–65, were randomly selected from New Zealand's Accident Compensation Corporation (ACC) entitlement claims register. ACC provides no-fault personal injury cover to all residents. Entitlement claims are ones where the injury is severe enough to require 1 week off work or equivalent. The POIS study is at Phase One, with data having been collected about outcomes 3 months after injury. Results 2850 people have been recruited; 24% were hospitalised as a consequence of their injury. Preliminary analysis reveals age, gender, comorbidity, hospitalisation, perceived threat, expectations and pain predicted recovery. Potential predictors to report in September include pre-injury variables (age, gender, comorbidity, satisfaction with social relationships, financial and psychological status) and postinjury variables (health and social services, injury anatomical region and type, pain and expectations of recovery). Outcomes, 3 months after injury, include: health status (EQ-5D and general overall global health rating), participation (in usual activities) and disability (measured by the WHODAS II). Conclusion Understanding factors that lead to disability will contribute to better targeting of people at risk of poor outcomes and ultimately to service and policy initiatives. [ABSTRACT FROM PUBLISHER]