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Background: Long-term childhood asthma studies that investigate adult outcomes other than lung function are lacking. This study examines the associations of childhood asthma and the occurrence of respiratory events and all-cause mortality in adulthood., Methods: A cohort of 4430 school children (aged to 17 years) who attended the Busselton Health Study between 1967 and 1983 were analysed. Self-reported history of asthma was determined using questionnaires. Participants were followed until 2014 for respiratory disease-related events (hospital admissions or death) and all-cause mortality using the Western Australia Data Linkage System. Cox regression models were used to investigate the impact of childhood asthma on respiratory events and all-cause mortality in adulthood. A subgroup of 2153 participants who re-attended a survey in young adulthood was also analysed., Results: A total of 462 (10%) of the cohort had childhood asthma. During follow-up 791 participants experienced a respiratory event and 140 participants died. Childhood asthma was associated with an increased risk of respiratory events in adulthood (unadjusted HR 1.84, 95% CI 1.52 to 2.23; P < 0.0001). The result remained significant after adjusting for adult-onset asthma, FEV 1 , body mass index, smoking, dusty job, hay fever, and respiratory symptoms (adjusted HR 1.68, 95% CI 1.07 to 2.64; P = 0.0247). Childhood asthma was not associated with all-cause mortality in adulthood (unadjusted HR 1.08, 95% CI 0.63 to 1.84; P = 0.7821)., Conclusion: Childhood asthma is associated with increased risk of respiratory disease-related hospital admissions and death but not all-cause mortality in adulthood., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Few studies have investigated the association of childhood obesity with respiratory disease-related outcomes in adulthood and findings are inconsistent. The aim of this study was to examine the associations of body mass index (BMI) in childhood with the occurrence of respiratory events in adulthood., Methods: We analyzed a cohort of 4537 school-aged children who attended the Busselton Health Study. Height and weight were measured and generated BMI z-scores were categorized into four groups. Participants were followed for respiratory disease-related hospital admissions or death using the Western Australia Data Linkage System. The associations between childhood BMI and respiratory events in adulthood were investigated using Cox regression models. A subgroup of 2196 that reattended a survey in young adulthood was also analyzed., Results: During the 122,781 person-years of follow-up, 810 participants experienced a respiratory event. Childhood BMI group was not associated with risk of respiratory event in adulthood (hazard ratio for BMI z ≥ 1 vs. < -1 = 0.90; 95% CI, 0.70-1.17; P = .295) and this persisted after adjustment for selected confounders in the subgroup (hazard ratio 0.80; 95% CI, 0.43-1.48; P = .476)., Conclusions: Childhood BMI is not associated with risk of respiratory events in adulthood., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's "Liveable Neighbourhoods Community Design Guidelines" policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The prevalence of warehouse-style liquor stores has prompted alarm from local communities and public health advocates. To increase local government control over liquor stores, one proposed planning response is to distinguish between 'small' (i.e., ≤ 300 m 2 ) and 'large' (i.e., > 300 m 2 ) liquor stores. We mapped the size and location of liquor stores in Perth, Western Australia, and tested associations between liquor store exposure and alcohol consumption (grams ethanol/day) in young adults (n = 990). The count of liquor stores of any size within 1600 m and 1601-5000 m of home were significantly associated with increased alcohol intake, whereas larger stores (i.e., > 300 m 2 and > 600 m 2 ) were not associated with alcohol intake. Young adults' alcohol consumption appears to be impacted by liquor store density and convenience, rather than outlet size. However, the presence of multiple stores close to home increases market competition, driving alcohol prices down, and plausibly results in alcohol prices similar to those at liquor superstores., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease., Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies., Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively., Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines., Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Few longitudinal studies have examined the impact of liquor licences on alcohol consumption, and none in young adults, the life stage when alcohol intake is at its highest. We examined associations between liquor licences (i.e., general licences, on-premise licences, liquor stores, and club licences) and alcohol consumption at 20-years (n=988) and 22-years (n=893), and whether changes in the licences between time-points influenced alcohol consumption (n=665). Only general licences were associated with alcohol consumption at 20-years (p=0.037), but by 22-years, all licences types were positively associated with alcohol consumption (p<0.05). Longitudinal analyses showed that for each increase in liquor stores over time, alcohol consumption increased by 1.22g/day or 8% (p=0.030), and for each additional club licence, consumption increased by 0.90g/day or 6% (p=0.007). Limiting liquor licences could contribute to a reduction in young adults' alcohol intake., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Although the carcinogenic potential of iron has been shown, evidence from observational studies that have linked serum iron variables and cancer outcomes has been inconsistent., Objective: We investigated whether higher iron concentrations increased risk of cancer outcomes., Design: A prospective examination of iron biomarkers as independent risk factors for cancer was assessed in 1597 men and 1795 women aged 25-79 y who participated in the 1994/1995 Busselton Health Survey and had relevant data, no history of cancer before the survey, and serum ferritin concentrations ≥20 μg/L. Follow-up for incident cancers and death from cancer was available to 2010. Proportional hazards regression modeling was performed to investigate if iron status predicted cancer incidence and mortality., Results: After adjustments for age, smoking, drinking, anthropometric and biochemical variables, or menopausal status (breast cancer), higher serum iron concentrations and transferrin saturation were associated with increased risks of incident nonskin cancer [HR for iron: 1.83 (95% CI: 1.21, 2.76; P < 0.01); HR for transferrin saturation: 1.68 (95% CI: 1.18, 2.38; P < 0.01)] including breast cancer [HR for iron: 2.45 (95% CI:1.12, 5.34; P < 0.05); HR for transferrin saturation: 1.90 (95% CI:1.02, 3.56; P < 0.05)] in women. Transferrin saturation was also associated with a greater risk of cancer death (HR: 2.48; 95% CI: 1.28, 4.82; P < 0.01). In men, higher iron concentrations were associated with reduced risks of incident nonskin cancer (HR: 0.65; 95% CI: 0.42, 0.99; P < 0.05) including colorectal cancer (HR: 0.34; 95% CI: 0.12, 0.95; P < 0.05). There was no association between serum iron and colorectal cancer risk in women. Serum ferritin was not associated with cancer risk or cancer death., Conclusions: Higher transferrin saturation or serum iron concentrations were associated with increased nonskin cancer risk and increased risk of cancer death. Conversely, in men, higher serum iron concentrations were associated with decreased risk of nonskin cancer. The molecular basis for the observed differences in the association between serum iron and nonskin cancer risk is unclear., (© 2016 American Society for Nutrition.)

Objective: To investigate the effect of sibling age, gender and dog ownership on children's independent mobility and how this varies according to the destination visited., Methods: Parents reported whether their child had an older sibling; if the child and older sibling were of the same gender; the number of older siblings; if they owned a dog; and whether their child was allowed to independently travel to school, friends' or family house, park/oval/sporting field and local shop. Data were analysed for 181 children aged 8-15 years., Results: The strongest significant sibling effect for independently mobility to school, local shop and ≥3 destinations was for having an older sibling of the same gender (p≤0.05). For independent mobility to a friend's house and park, the strongest significant sibling effect was for having one older sibling (p≤0.05). Dog ownership was associated with increased odds of being independently mobile to ≥3 destinations (OR=2.43; 95%CI=1.03-5.74)., Conclusions: Parents may be more likely to grant children licence to travel to local places if they are accompanied by an older sibling or the family dog., Implications: Understanding the effects of siblings and dog ownership on children's independent mobility will assist in identifying strategies through which independent mobility can be encouraged., (© 2016 Public Health Association of Australia.)

Objective: Hospitalization for atrial fibrillation (AF) is a large and growing public health problem. We examined current trends in the incidence, prevalence, and associated mortality of first-ever hospitalization for AF., Methods: Linked hospital admission data were used to identify all Western Australia residents aged 35-84 years with prevalent AF and incident (first-ever) hospitalization for AF as a principal or secondary diagnosis during 1995-2010., Results: There were 57,552 incident hospitalizations, mean age 69.8 years, with 41.4% women. Over the calendar periods, age- and sex-standardized incidence of hospitalization for AF as any diagnosis declined annually by 1.1% (95% CI; 0.93, 1.29), while incident AF as a principal diagnosis increased annually by 1.2% (95% CI; 0.84, 1.50). Incident AF hospitalization was higher among men than women, and 15-fold higher in the 75-84 compared with 35-64 year age group. The age- and sex-standardized prevalence of AF increased annually by 2.0% (95% CI; 1.88, 2.03) over the same period. Comorbidity trends were mixed with diabetes and valvular heart disease increasing, and hypertension, coronary artery disease, heart failure, cerebrovascular disease, and chronic kidney disease decreasing. The 1-year all-cause mortality after incident AF hospitalization declined from 17.6% to 14.6% (trend P<0.001), with an adjusted hazard ratio of 0.86 (95% CI; 0.81, 0.91)., Conclusion: This contemporary study shows that incident AF hospitalization is not increasing except for AF as a principal diagnosis, while population prevalence of hospitalized AF has risen substantially. The high 1-year mortality following incident AF hospitalization has improved only modestly over the recent period., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

This study examined whether the association of psychological distress with area-level socio-economic status (SES) was moderated by the area and attractiveness of local green space. As expected, the odds of higher psychological distress was higher in residents in lower SES areas than those in higher SES areas. However, our results were inconclusive with regard to the moderating role of green space in the relationship between psychological distress and SES. Further investigations incorporating safety and maintenance features of green space and street-level greenery are warranted., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Planning policy makers are requesting clearer guidance on the key design features required to build neighbourhoods that promote active living. Using a backwards stepwise elimination procedure (logistic regression with generalised estimating equations adjusting for demographic characteristics, self-selection factors, stage of construction and scale of development) this study identified specific design features (n=16) from an operational planning policy ("Liveable Neighbourhoods") that showed the strongest associations with walking behaviours (measured using the Neighbourhood Physical Activity Questionnaire). The interacting effects of design features on walking behaviours were also investigated. The urban design features identified were grouped into the "building blocks of a Liveable Neighbourhood", reflecting the scale, importance and sequencing of the design and implementation phases required to create walkable, pedestrian friendly developments., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: OSA is a common condition that has been associated with atrial fibrillation (AF), but there is a paucity of data from large longitudinal cohorts to establish whether OSA is a risk factor for AF independent of obesity and other established risk factors., Methods: We studied patients attending a sleep clinic referred for in-laboratory polysomnography for possible OSA between 1989 and 2001. Whole-population hospital data in Western Australia for 1970 to 2009 were linked to sleep study cases to determine incident AF hospitalization to 2009. Cox regression analyses were used to assess the independent association of OSA with incident AF., Results: Study case subjects (6,841) were predominantly middle aged (48.3 ± 12.5 years old) and men (77%), and 455 developed AF during a median 11.9 years of follow-up. Univariate predictors of AF included age, BMI, hypertension, diabetes, valvular heart disease, coronary or peripheral artery disease, heart failure, and COPD (all P < .001). After multivariable adjustment, independent predictors of incident AF were an apnea/hypopnea index (AHI) > 5/h (hazard ratio [HR], 1.55; 95% CI, 1.21-2.00), log (AHI + 1) (HR, 1.15; 95% CI, 1.06-1.26), and log (time with oxygen saturation < 90% + 1) (HR, 1.12; 95% CI, 1.06-1.19). There were no interactions between age, sex, or BMI and AHI for AF development., Conclusions: OSA diagnosis and severity are independently associated with incident AF. Clinical trials are required to determine if treatment of OSA will reduce the burden of AF.

This review examines evidence of the association between the neighborhood built environment, green spaces and outdoor home area, and early (0-7 years) child health and development. There was evidence that the presence of child relevant neighborhood destinations and services were positively associated with early child development domains of physical health and wellbeing and social competence. Parents׳ perceptions of neighborhood safety were positively associated with children׳s social-emotional development and general health. Population representative studies using objective measures of the built environment and valid measures of early child development are warranted to understand the impact of the built environment on early child health and development., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: Research suggests that survival among the recipients of a cardiac permanent pacemaker (PPM) matches the age- and sex-matched general population in the absence of cardiovascular disease. We used linked administrative data to examine life expectancy-based outcomes for adults requiring a cardiac PPM., Methods: Population-level hospital admissions data were used to identify all recipients of an initial PPM during 1995-2008. Expected years of additional life remaining at the time of implantation were calculated for each patient from population life tables. Observed years were calculated using linked mortality data to end 2011. Cox regression was used to determine demographic and clinical predictors of survival., Results: In 8757 patients age-adjusted risk of death to 5 years was associated with male sex, higher Charlson Comorbidity Index score (excluding cardiac disease), a history of heart failure, cardiomyopathy or atrial fibrillation and emergency admission. Coronary revascularisation surgery reduced long-term risk. The observed/expected ratio of additional years of life was 0.80 for men and 0.84 for women overall, varying from 0.92 for women without significant comorbidity to 0.40 for patients with the highest Charlson score and cardiomyopathy. The oldest patients (80-99 years) did relatively well, probably reflecting patient selection. Heart disease was the most frequent cause of death., Conclusions: Life expectancy among PPM recipients without significant comorbidity approached that of the general population. Greater non-cardiac comorbidity, heart failure, atrial fibrillation and, in particular, cardiomyopathy, contributed most to the loss of expected years of life in all age groups. The oldest patients and women did relatively well., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Objectives: To compare the incidence of first heart failure (HF) hospitalisation, antecedent risk factors and 1-year mortality between Aboriginal and non-Aboriginal populations in Western Australia (2000-2009)., Methods: A population-based cohort aged 20-84 years comprising Aboriginal (n=1013; mean 54±14 years) and non-Aboriginal patients (n=16,366; mean 71±11 years) with first HF hospitalisation was evaluated. Age and sex-specific incidence rates and HF antecedents were compared between subpopulations. Regression models were used to examine 30-day and 1-year (in 30-day survivors) mortality., Results: Aboriginal patients were younger, more likely to reside in rural/remote areas (76% vs 23%) and to be women (50.6% vs 41.7%, all p<0.001). Aboriginal (versus non-Aboriginal) HF incidence rates were 11-fold higher in men and 23-fold in women aged 20-39 years, declining to about 2-fold in patients aged 70-84 years. Ischaemic and rheumatic heart diseases were more common antecedents of HF in younger (<55 years) Aboriginal versus non-Aboriginal patients (p<0.001). Hypertension, diabetes, chronic kidney disease, renal failure, chronic obstructive pulmonary disease, and a high Charlson comorbidity index (>=3) were also more prevalent in younger and older Aboriginal patients (p<0.001). Although 30-day mortality was similar in both subpopulations, Aboriginal patients aged<55 years had a 1.9 risk-adjusted hazard ratio (HR) for 1-year mortality (p=0.015)., Conclusions: Aboriginal people had substantially higher age and sex-specific HF incidence rate and prevalence of HF antecedents than their non-Aboriginal counterparts. HR for 1-year mortality was also significantly worse at younger ages, highlighting the urgent need for enhanced primary and secondary prevention of HF in this population., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

We explored the impact of neighborhood walkability on young adults, early-middle adults, middle-aged adults, and older adults' walking across different neighborhood buffers. Participants completed the Western Australian Health and Wellbeing Surveillance System Survey (2003-2009) and were allocated a neighborhood walkability score at 200m, 400m, 800m, and 1600m around their home. We found little difference in strength of associations across neighborhood size buffers for all life stages. We conclude that neighborhood walkability supports more walking regardless of adult life stage and is relevant for small (e.g., 200m) and larger (e.g., 1600m) neighborhood buffers., (© 2013 The Authors. Published by Elsevier Ltd All rights reserved.)

Background: The prevalence of hospitalised atherothrombotic disease affecting the coronary, cerebrovascular and peripheral vasculature is expected to increase due to improving survival, ageing and changing risk factor profiles. This study determined sex, age-standardised and age-specific (35-54, 55-69, 70-84years) prevalence of atherothrombotic disease and its association with diabetes and chronic kidney disease in Western Australian residents from 2000 to 2007., Methods: In a cross-sectional and longitudinal study, person-linked hospitalisations for atherothrombotic disease were obtained using records from 1985. From 2000 to 2007, total and vasculature-specific prevalence of atherothrombotic disease (as a principal diagnosis) was calculated using a 15-year lead-in to determine prior disease and comorbidity., Results: In 2007, 45,916 (8.6%) men and 22,782 (4.3%) women in Western Australia had established atherothrombotic disease and about 25% had diabetes, 10% had chronic kidney disease, and 5% had both. From 2000 to 2007 the estimated average annual change in age-standardised atherothrombotic disease prevalence was -0.6%/year (95% CI -0.8, -0.4) in men and -0.7%/year (95% CI -1.0, -0.4) in women. Similar modest declines were seen in age-standardised prevalence of monovascular and polyvascular atherothrombotic disease. The proportion of cases with diabetes increased by about 5%/year, the proportion having chronic kidney disease increased slowly in women (1.5%/year) and was stable in men, and the proportion with both comorbidities increased at about 9%/year., Conclusion: The age-standardised prevalence of atherothrombotic disease requiring hospitalisation has been in marginal decline in Western Australia this decade, despite the proportion of affected persons with diabetes and/or chronic kidney disease steadily rising., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: It is uncertain if improvements in long-term cardiovascular (CV) mortality have occurred in both men and women with ischemic and non-ischemic forms of heart failure (HF)., Methods: The Western Australia Hospital Morbidity Database was used to identify all index (first-ever) hospitalizations for HF between 1990 and 2005. Patients were followed until death attributed to cardiovascular causes or censored on December 31, 2006 to determine 5-year survival. Cox proportional hazards models were used to compare the adjusted mortality hazard ratio (HR) during the study follow-up (4-year periods)., Results: A total of 21,507 patients (mean age 73.9 years, 49.1% women) were identified. Women were significantly older than men, and less likely to have ischemic HF (38.8% versus 46.1%). Over the period, age-standardized incidence of first HF hospitalization declined but with the least decline in women with non-ischemic HF (-13.3%) compared to other subgroups. Risk-adjusted 5-year CV mortality declined over the study period, with HR 0.64 (95% CI 0.60-0.68) for patients admitted in 1998-2001 compared to 1990-1993, with significant improvement in both forms of HF, and in both sexes and across age groups. However, overall total HF hospitalizations increased (+26.7%) over the period, particularly for non-ischemic HF (+43.7%), of which elderly women formed the predominant group., Conclusions: Risk-adjusted long-term survival improved similarly in men and women, including the elderly, with ischemic and non-ischemic forms of HF during 1990-2005 in Western Australia. However, there was a growing burden of HF hospitalizations particularly for HF of non-ischemic aetiology., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

This study examines the relationship between weather conditions and overall and domain-specific physical activity in adults living in a city with a temperate, stable climate. Objective and self-reported physical activity levels were measured in 1754 adults participating in RESIDE, a longitudinal study undertaken in Perth, Australia. Steps per week and self-reported minutes of domain-specific physical activity were compared with date-stamped weather data. Weather conditions were relatively constant across all seasons, showing little impact on physical activity behaviour. Variation in weather conditions had modest explanatory power (<6%) for predicting overall and domain-specific physical activity engagement in this sample. Weather variations observed in this study were of insufficient magnitude to impact on physical activity levels. This has implications for study designs and exploration of other factors associated with physical activity in these settings., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: To investigate the impact of prevalence correction of population denominators on myocardial infarction (MI) incidence rates, rate ratios, and rate differences in Aboriginal vs. non-Aboriginal Western Australians aged 25-74 years during the study period 2000-2004., Study Design and Setting: Person-based linked hospital and mortality data sets were used to estimate the number of prevalent and first-ever MI cases each year from 2000 to 2004 using a 15-year look-back period. Age-specific and -standardized MI incidence rates were calculated using both prevalence-corrected and -uncorrected population denominators, by sex and Aboriginality., Results: The impact of prevalence correction on rates increased with age, was higher for men than women, and substantially greater for Aboriginal than non-Aboriginal people. Despite the systematic underestimation of incidence, prevalence correction had little impact on the Aboriginal to non-Aboriginal age-standardized rate ratios (6% and 4% underestimate in men and women, respectively), although the impact on rate differences was more marked (12% and 6%, respectively). The percentage underestimate of differentials was greater at older ages., Conclusion: Prevalence correction of denominators, while more accurate, is difficult to apply and may add modestly to the quantification of relative disparities in MI incidence between populations. Absolute incidence disparities using uncorrected denominators may have an error >10%., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This study explored the relationship between neighbourhood design and residents' fear of crime in new suburban housing developments. Self-report and objective data were collected as part of the RESIDential Environments (RESIDE) Project. A neighbourhood form index based on the planning and land-use characteristics that draw people into public space, facilitate pedestrian movement and ensure the presence of 'territorial guardians' was developed for each participant (n=1059) from objective environmental data. With each additional index attribute, the odds of being fearful reduced (trend test p value=0.001), and this persisted even after progressive adjustment for demographics, victimisation, collective efficacy and perceived problems. The findings support the notion that a more walkable neighbourhood is also a place, where residents feel safer, and provides further evidence endorsing a shift away from low density, curvilinear suburban developments towards more walkable communities with access to shops, parks and transit., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Purpose: A Markov chain Monte Carlo simulation model was developed to analyze and forecast the numbers of coronary artery bypass graftings, percutaneous coronary interventions (PCIs) , incident coronary heart disease (CHD) events, and CHD deaths for different age and sex groups in the population of Western Australia (population approximately 1.7 million)., Methods: The Western Australian health information system contains linked records of all hospital admissions and deaths for individuals from 1980 to the present. This system allows the separation of the population into groups according to CHD/coronary artery revascularization procedure history and also allows the estimation of event probabilities directly from population-level data., Results and Conclusions: The results for the 1990 Western Australian population over the period 1990 to 1994 and the 1995 population over the period 1995 to 1999 indicated that the Markov model fits well and produces good forecasts under "stable" conditions. The model can also be useful in ascertaining the impact of system changes, such as the widespread introduction of stents in PCI operations in 1995.

Objective: To test the effectiveness of a minimal nutrition intervention to increase dietary intake of folate., Method: Randomised controlled trial in the general practice setting of personalized, face-to-face feedback with educational materials to increase dietary intake of folate., Results: One hundred and nine intervention and 94 control subjects completed baseline and follow-up assessments within the study period. At baseline (August-October 2004), there were no significant differences in folate intake scores between the intervention and control groups. At the eight-week follow-up, the mean folate intake score in the intervention group was significantly higher than in the control group, indicating that the nutrition intervention significantly increased reported dietary intake of folate., Conclusion: Presenting individual dietary feedback in conjunction with educational materials in the general practice setting is an effective way of changing dietary behaviour., Implications: The present study suggests a way in which health-related dietary change may be encouraged on a large scale without incurring a large cost.

This review examines the association between dog ownership and adult physical activity levels. While there is evidence to suggest that dog ownership produces considerable health benefit and provides an important form of social support that encourages dog owners to walk, there is limited evidence on the physical environmental and policy-related factors that affect dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further exploration of the relationship between dog ownership and physical activity levels may be important for preventing declining levels of physical activity and the associated detrimental health effects.

Background: The aim of this longitudinal study was to identify body size, behavioral, and respiratory risk factors for the development of habitual snoring in a general adult population., Methods: The sample for this study comprised 967 adults aged 25 to 74 years who reported not snoring in the 1981 Busselton Health Survey and who also attended the 1994-1995 follow-up survey. Logistic regression was used to identify and quantify the effect of baseline and change risk factors for the development of habitual snoring., Results: A total of 13% had become habitual snorers by 1994-1995. Male gender (odds ratio [OR], 3.5) and baseline body mass index (OR, 1.4 per 3.4 kg/m(2)) were significant predictors of habitual snoring; after accounting for these variables, no other baseline body size, behavioral, or respiratory/allergy variables were significantly related to the development of habitual snoring. However, change in body mass index over the 14-year follow-up period (OR, 1.55 per 2.3 kg/m(2)), development of asthma (OR, 2.8), and commencement of smoking (OR, 2.2) were additional significant independent risk factors for development of habitual snoring., Conclusions: This study has confirmed male gender, obesity, and weight gain as key determinants of habitual snoring, and has indicated that development of asthma and taking up smoking also play a role. Maintaining a healthy weight and not smoking are recommended lifestyle preventive strategies to reduce the risk of sleep-disordered breathing and its sequelae.

Purpose: To test a community population for the hypothesis that carcinogenesis is related to blood folate levels., Methods: Prospective analysis of cancer mortality data for a cohort of 964 men (person-time follow up: 20,254 years) and 1024 women (person-time follow up: 24,970 years) and morbidity data for a subcohort, all of whom participated in the 1969 Busselton (Western Australia) Health survey. Outcome measures were adjusted hazard ratios according to baseline folate levels for total cancer mortality and morbidity and site specific mortality and morbidity for colorectal, lung, breast, and prostate cancers., Results: In total, there were 278 cancer deaths--45 from colorectal cancer, 44 from lung cancer, 15 from breast cancer, and 31 from prostate cancer. Decreased serum folate levels showed an independent association with increased prostate cancer mortality risk, the adjusted hazard ratio per decrease of 2 microg/L was 1.56 (CI: 1.05, 2.38), men whose levels were in the lowest quartile had an adjusted hazard ratio of 4.79 (CI: 1.56, 14.43) for subsequent death from prostate cancer. The morbidity subcohort data showed that decreased red blood-cell folate was significantly associated with increased events due to breast cancer, the adjusted hazard ratio per decrease of 100 mug/L was 1.96 (CI: 1.22, 3.12), women in the lowest quartile of red cell folate levels had an adjusted hazard ratio of 6.46 (CI: 1.19, 35.07) for a subsequent breast cancer event. Mortality and morbidity from colorectal or lung cancers were not associated with folate levels., Conclusions: Independent associations, assessed over periods greater than 20 years, were demonstrated between decreased folate levels and increased risks of prostate cancer mortality and breast cancer morbidity.

Objective: The aim of this study was to identify potential body size, behavioural and respiratory risk factors for habitual snoring and witnessed apnoeas in a general population., Methods: Correlates of these conditions were studied in a sample of 3,577 adults aged 25-74 years who participated in a comprehensive health survey in Busselton, Western Australia, during 1994/95. Logistic regression was used to assess associations after age and gender adjustment and also in multivariate models., Results: The prevalence of both conditions was higher in men and rose with age. After controlling for age, gender and body mass index no additional body size variable remained significantly associated with witnessed apnoeas, whereas both waist-hip ratio and neck-height ratio remained significantly associated with habitual snoring. Among behavioural variables, smoking showed the strongest association, and among respiratory symptoms, asthma for habitual snoring and bronchitis for witnessed apnoeas had significant independent associations., Conclusions and Implications: This study has confirmed obesity and smoking as key determinants of habitual snoring and witnessed apnoeas. It has also shown that a number of measures of obesity are independently related to habitual snoring and that asthma and bronchitis may also play a role, independently of obesity.

Background and Objective: Estimates of dietary folate intake are currently of considerable interest, but no rapid tools are available to assess dietary intake of folate that are well suited to everyday health promotion activities. We developed and tested the reliability and validity of two prototypes of a rapid dietary assessment tool (a folate intake tool, FIT) to determine dietary intake of folate., Study Design and Setting: Five hundred and sixty eight men and women aged 33-83 years from Perth, Western Australia, completed one of the two prototypes of the tool and gave a fasting blood sample for measurement of serum folate. A subset (n=277) of participants completed the same tool on a second occasion 3-6 weeks later., Results: The Pearson correlations (r) between folate score from the tool and serum folate were moderately high for both prototypes (FIT-A r=0.54; FIT-B r=0.49). The folate scores for the two prototypes were similar on repeat testing and correlated strongly (FIT-A r=0.75; FIT-B r=0.68)., Conclusions: The rapid dietary assessment tool described here, FIT, provides a valid and reliable measurement of dietary intake of folate for both men and women.

Purpose: Concordance between spouses may be due to partner selection factors and/or the effects of marriage/environment. The extent to which partner selection factors contribute to spouse concordance has important implications for heritability studies. The aim of this study was to examine the magnitude of spouse correlation in lung function measures and its relationship to duration of marriage., Methods: Cross-sectional and longitudinal data collected over the period 1969 to 1995 for 2615 couples from the Busselton Health Study have been analyzed using the program FISHER., Results: Unadjusted correlations were around 0.45 for forced expiratory volume in 1 second (FEV1) and 0.25 for FEV1/FVC (forced vital capacity) and were reduced to 0.05 and 0.10, respectively, after adjustment for age, height, and smoking. No trend with marriage duration was apparent in both cross-sectional and longitudinal analyses but there was a significant downward trend in the correlations with age at marriage., Conclusions: The findings indicate that observed correlations in lung function measures are mostly due to partner selection factors and that partner selection factors have greater influence for couples that marry at younger ages. Family studies that aim to identify and separate genetic from other influences on lung function measures should not regard the mother-father correlation as due to common environment effects.

Purpose: To investigate the relationship between serum sialic acid level and risk of coronary heart disease (CHD) and stroke in men and women without diagnosed cardiovascular disease., Methods: A prospective case-cohort study over the period 1981 to 1998 involving 151 CHD cases, 87 stroke cases, and a random sub-cohort of 340 was used. Sialic acid levels were determined by enzymatic method from frozen serum. Cox proportional hazards regression was used to estimate the relative risks of CHD and stroke for sialic acid tertiles and for continuous sialic acid level after adjustment for age, blood pressure, body mass index, cholesterol, triglycerides, diabetes, and smoking., Results: The multivariate-adjusted relative risk of CHD associated with a 25 mg/dl increase in sialic acid was 1.22 (95% CI: 1.02-1.45) overall, 1.40 (95% CI: 1.11-1.76) in women, and 1.06 (95% CI: 0.82-1.37) in men. The overall relative risk for stroke was 1.13 (95% CI: 0.87-1.46) and for CHD and stroke combined it was 1.17 (95% CI: 0.99-1.37), Conclusions: Serum sialic acid may be a long-term predictor of CHD events in adults (especially women) who are currently clinically free of cardiovascular disease. Further studies are needed to determine whether this association can be explained by sialic acid being a marker of accelerated atherosclerosis or inflammation.

Objective: To evaluate the impact of repeated community-wide mass health examinations on cardiovascular mortality and hospital morbidity trends in Busselton., Method: Population census, hospital admission and death data were used to calculate and compare cardiovascular mortality rates from 1965 to 1998 and hospital morbidity rates from 1971 to 1998 in Busselton residents aged 40 to 84 years with the remainder of the south-west region of Western Australia., Results: Among men aged 40-69 years, the calendar year trends in standardised cardiovascular mortality and morbidity ratios were relatively flat and non-significant. Among women aged 40-69 years, the mortality ratio declined significantly up to 1989 (p = 0.03) but not over the whole period (p = 0.12), and the downward trend in the morbidity ratio did not reach statistical significance (p = 0.21). Among men aged 70-84 years, both the mortality and morbidity ratios rose significantly over time, whereas among women aged 70-84 years the mortality ratios showed a flat trend and the morbidity ratios a rising trend. These increasing trends were opposite to what was expected if the surveys had a beneficial impact., Conclusion: This analysis of trends, while failing to demonstrate a clear benefit of repeated mass health screenings on cardiovascular event rates, also highlights the difficulties in evaluating the longer-term impact on event rates of such programs and suggests that negative conclusions should be made with caution.

Background and Objectives: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth., Methods: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow-up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non-consecutive days to determine screening, follow-up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer., Result: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow-up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow-up meant that the sensitivity, specificity and cost-effectiveness of the test could not be assessed., Conclusions and Implications: The reasons for poor follow-up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.

Objective: To use the Busselton study to estimate the impact of smoking on hospital use in Australia., Methods: People on the electoral roll in Busselton in 1978 were invited to attend a survey where smoking habits were measured. 3,230 people aged 25 to 79 at the survey were followed until 1994 by record linkage to death records and to the Western Australian Hospital Morbidity Data System. Hyper Poisson regression was used to estimate ratios of hospital separation rates and mean bed day usage according to the 1978 smoking status., Results: Compared with never smokers, current smokers had hospital separation rates that were 1.32 (95% confidence interval 1.16-1.49) times higher and used 1.40 (1.20-1.65) times as many hospital bed days. Former smokers had rates midway between never and current smokers. Separations due to neoplasms, circulatory disorders and respiratory disorders were all more frequent in current than in never smokers. Estimates of hospital use in Australia due to smoking were about two times higher than those previously published using different methods., Conclusions: Smoking is a major contributor to hospital use in Australia. People who stop smoking reduce their risk of hospitalisation., Implications: Smoking has a major impact on hospital use, which can be reduced by successful smoking cessation programs.