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Objective: To describe recent trends in opioid prescribing and prescription opioid poisoning resulting in hospitalisation or death in Victoria, Australia. Method: This is a population-based ecological study of residents of Victoria, 2006 – 14. Australian Bureau of Statistics residential population data were combined with Pharmaceutical Benefits Scheme (PBS) opioid prescription data, Victorian Admitted Episodes Data (VAED) and cause of death data. Results: Annual opioid dispensings increased by 78% in 2006 – 13, from 0.33 to 0.58 per population. Opioid use increased with age: in 2013, 14% of Victorian residents aged ≥65 years filled at least one oxycodone prescription. In 2006 – 14, prescription opioid related hospital admissions increased by 6.8% per year, from 107 to 187 /1,000,000 person-years; 56% were due to intentional self-poisoning. Annual deaths increased from 21 to 28 /1,000,000 persons, in 2007 – 11. Admissions and deaths peaked at 25–44 years. Conclusions: Although both opioid prescribing and poisoning have increased, there is discrepancy between the exposed group (dispensings increased with age) and those with adverse consequences (rates peaked at ages 25–44 years). Implications: A better understanding is needed of drivers of prescribing and adverse consequences. Together with monitoring of prescribing and poisoning, this will facilitate early detection and prevention of a public health problem.

OBJECTIVE: To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. METHOD: A random sample of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across four states in Australia. From this sample, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder; (ii) an independent auditor, blinded to the original code; or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. RESULTS: Of the 4,373 cases sampled, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. CONCLUSIONS AND IMPLICATIONS: The best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries. Language: en

Objective: The Australian National Collaborative Research Infrastructure Strategy supports development of a national research capability in population health and clinical data linkage. This paper illustrates the importance of incorporating a population registry within such a system using an example provided by the Manitoba Injury Outcome Study (MIOS) that quantified the long-term burden of mortality attributable to injury in working-age adults. Methods: MIOS is a population-based matched cohort study that used administrative health data from Manitoba, Canada. An inception cohort of injured cases (ICD-9-CM 800–995) aged 18–64 years was identified from all Manitoba hospital admissions between 1988 and 1991. A matched non-injured comparison group was randomly selected from the total provincial population using the Manitoba Population Registry. Mortality outcomes were obtained by linking the two cohorts with the deaths data over 10 years. Mortality rate ratios (MRRs) were calculated to compare the injured and non-injured cohorts. Results: A total of 21,032 matched pairs were identified. Using the population registry, the 10-year adjusted all-cause MRR comparing injured and non-injured cohort was 1.80 (95% CI 1.65–1.98). Without the registry, the unadjusted standardised morality ratio was 2.76 (95% CI 2.52–3.02). Conclusions: The effect of injury on mortality outcomes was over-estimated using only the injured cases, without use of the population registry. Use of the population registry enabled the selection of a matched non-injured group for comparison purposes, ensured comprehensive follow-up of almost all participants, and provided more accurate estimates of exposure time, incidence of mortality and relative risk.

Objective: Childhood injury remains the single most important cause of mortality in children aged between 1-14 years in many countries. It has been proposed that lower socio-economic status (SES) and poorer housing contribute to potential hazards in the home environment. This study sought to establish whether the prevalence of observed hazards in and around the home was differentially distributed by SES, in order to identify opportunities for injury prevention. Methods: This study was a cross-sectional, random sample survey of primary school children from 32 schools in Brisbane. Interviews and house audits were conducted between July 2000 and April 2003 to collect information on SES (income, employment and education) and previously identified household hazards. Results: There was evidence of a relationship between prevalence of household environmental hazards and household SES; however, the magnitude and direction of this relationship appeared to be hazard-specific. Household income was related to play equipment characteristics, with higher SES groups being more likely to be exposed to risk. All three SES indicators were associated with differences in the home safety characteristics, with the lower SES groups more likely to be exposed to risk. Conclusion:The differential distribution of environmental risk factors by SES of household may help explain the SES differential in the burden of injury and provides opportunities for focusing efforts to address the problem.

Objective: To quantify the extent that alcohol related injuries are adequately identified in hospitalisation data using ICD-10-AM codes indicative of alcohol involvement. Method: A random sample of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across four states in Australia. From this sample, cases were identified as involving alcohol if they contained an ICD-10-AM diagnosis or external cause code referring to alcohol, or if the text description extracted from the medical records mentioned alcohol involvement. Results: Overall, identification of alcohol involvement using ICD codes detected 38% of the alcohol-related sample, while almost 94% of alcohol-related cases were identified through a search of the text extracted from the medical records. The resultant estimate of alcohol involvement in injury-related hospitalisations in this sample was 10%. Emergency department records were the most likely to identify whether the injury was alcohol-related with almost three-quarters of alcohol-related cases mentioning alcohol in the text abstracted from these records. Conclusions and Implications: The current best estimates of the frequency of hospital admissions where alcohol is involved prior to the injury underestimate the burden by around 62%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine administrative data sources for identification of alcohol-related injuries.

The public health approach to injury control is now widely accepted. Since the development of this approach, there has been a shift in the perspective of public health programs to include broader definitions of health. There have also been increasing efforts to evaluate public health interventions in terms of health outcomes at the population level. In this context, it might be appropriate to broaden the focus of injury prevention to target more specifically injuries that are not life-threatening. Although they are not responsible for major morbidity at an individual level, they probably account for the greatest decrement in the health of the population as a whole.