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Background: Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney., Method: Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity., Result: Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years., Conclusion: For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Ltd.)

A growing literature has supported a relationship between greenspace and health. Various greenspace metrics exist; some are based on subjective measures while others are based on an objective assessment of the landscape. While subjective measures may better reflect individual feelings about surrounding greenspace and the resulting positive benefits thereof, they are expensive and difficult to collect. In contrast, objective measures can be derived with relative ease, in a timely fashion, and for large regions and populations. While there have been some attempts to compare objective and subjective measures of greenspace, what is lacking is a comprehensive assessment of a wide range of greenspace metrics against subjective measures of greenspace. We performed such an assessment using a set of three objective greenspace metrics and a survey of residents in Liverpool, New South Wales, Australia. Our study supported existing findings in that overall, there is very little agreement between perceived and objective greenspace metrics. We also found that tree canopy in 10 min walking buffers around residences was the objective greenspace measure in best agreement with perceived greenspace.

Background: At the end of life, cancer survivors often experience exacerbations of complex comorbidities requiring acute hospital care. Few studies consider comorbidity patterns in cancer survivors receiving palliative care., Aim: To identify patterns of comorbidities in cancer patients receiving palliative care and factors associated with in-hospital mortality risk., Design, Setting/participants: New South Wales Admitted Patient Data Collection data were used for this retrospective cohort study with 47,265 cancer patients receiving palliative care during the period financial year 2001-2013. A latent class analysis was used to identify complex comorbidity patterns. A regression mixture model was used to identify risk factors in relation to in-hospital mortality in different latent classes., Results: Five comorbidity patterns were identified: 'multiple comorbidities and symptoms' (comprising 9.1% of the study population), 'more symptoms' (27.1%), 'few comorbidities' (39.4%), 'genitourinary and infection' (8.7%), and 'circulatory and endocrine' (15.6%). In-hospital mortality was the highest for 'few comorbidities' group and the lowest for 'more symptoms' group. Severe comorbidities were associated with elevated mortality in patients from 'multiple comorbidities and symptoms', 'more symptoms', and 'genitourinary and infection' groups. Intensive care was associated with a 37% increased risk of in-hospital deaths in those presenting with more 'multiple comorbidities and symptoms', but with a 22% risk reduction in those presenting with 'more symptoms'., Conclusion: Identification of comorbidity patterns and risk factors for in-hospital deaths in cancer patients provides an avenue to further develop appropriate palliative care strategies aimed at improving outcomes in cancer survivors.

Objectives: Greenspace is one of the important factors that can promote an active lifestyle. Thus, greener surroundings may be a motivating factor for people with newly diagnosed diabetes to engage in more physical activity. Given that diagnosis of type 2 diabetes (T2D) may serve as a window opportunity for behavioural modification, we hypothesise that the association between neighbourhood greenspace and physical activity among people with newly diagnosed T2D may be greater than those not diagnosed with T2D. The aim of this study was to investigate the association between access to greenspace and changes in physical activity and sedentary behaviour, and whether these associations differed by T2D., Design: Prospective cohort., Setting: New South Wales, Australia., Methods: We used self-reported information from the New South Wales 45 and Up Study (baseline) and a follow-up study. Information on sitting, walking and moderate to vigorous physical activity was used as outcomes. The proportion of greenspace within 500 m, 1 km and 2 km road network buffers around participant's residential address was generated as a proxy measure for access to greenspace. The association between the access to greenspace and the outcomes were explored among the newly diagnosed T2D group and those without T2D., Results: Among New T2D, although no significant changes were found in the amount of walking with the percentage of greenspace, increasing trends were apparent. There was no significant association between the percentage of greenspace and changes in amount of moderate to vigorous physical activity (MVPA). Among No T2D, there were no significant associations between the amount of MVPA and walking, and percentage of greenspace. For changes in sitting time, there were no significant associations with percentage of greenspace regardless of buffer size., Conclusions: In this study, there was no association between access to greenspace at baseline and change in walking, MVPA and sitting time, regardless of T2D status., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pharmaceutical opioid analgesic use continues to rise and is associated with potentially preventable harm including hospitalisation for adverse drug reactions (ADRs). Spatial detection of opioid-related ADRs can inform future intervention strategies. We aimed to investigate the geographical disparity in hospitalised ADRs related to opioid analgesic use, and to evaluate the difference in patient characteristics between areas inside and outside the geographic clusters., Methods: We used the all-inclusive Admitted Patient Dataset for an Australian state (New South Wales, NSW) to identify patients admitted for opioid-related ADRs over a 10-year period (July 2004 to June 2014). A space-time analysis was conducted using Kulldroff's scan statistics to identify statistically significant spatial clusters over time. Relative risk (RR) was computed with p-value based on Monte Carlo Simulation. Chi-square test was used to compare proportional difference in patient clustering., Results: During the study period, we identified four statistically significant geographic clusters (RRs: 1.63-2.17) during 2004-08; and seven clusters (RRs: 1.23-1.69) during the period 2009-14. While identified high-risk clusters primarily covered areas with easier access to health services, those associated with socioeconomically disadvantaged areas and individuals with mental health disorders experienced more unmet healthcare needs for opioid analgesic safety than those from the rest of the State. Older people (≥65 years and over) accounted for 62.7% of the total study population and were more susceptible to opioid-related ADRs than younger people,. In the first five-year period the clusters included a greater proportion of people with cancer in contrast to the second five-year period in which there was a lesser proportion of people with cancer., Conclusions: These results suggest that there is significant spatial-temporal variation in opioid-related ADRs and future interventions should target vulnerable populations and high-risk geographical areas to improve safer use of pharmaceutical opioid analgesics.

Background: Adverse drug reactions (ADR) are severe problems in global public health, and result in high mortality and morbidity. Various trends of ADR-related hospitalisations have been studied in many countries, while estimates of the trends in Australia are limited., Aim: To examine trends in ADR-related hospitalisations in New South Wales (NSW)., Methods: Data were extracted from the Admitted Patient Data Collection, a census of hospital separations in NSW. We estimated age-adjusted rates of ADR-related hospitalisation between 1 July 2001 and 30 June 2014 and rates by patient characteristics, main therapeutic medication groups and clinical condition groups that warranted the hospitalisation. We used the percentage change annualised estimator to evaluate rates over time., Results: A total of 315 274 NSW residents admitted for urgent care of ADR was identified. The age-adjusted rates of ADR-related hospitalisations nearly doubled and increased by 5.8% (95% CI: 5.0-6.6%) per annum, with an in-hospital death rate increase of 2.4% (1.6-3.3%). Agranulocytosis (2.7%), nausea and vomiting (2.4%) and heart failure (2.4%) were the most common conditions that led to ADR-related hospitalisations over 13 years, with acute renal failure (1.4%) recently emerging as the leading adverse condition. Participants aged between 65 and 84 years accounted for nearly half of ADR hospitalisations (45.6%), with age-adjusted rate increasing from 103.9 in 2001-2002 to 189.0 per 100 000 NSW residents in 2013-2014. Anticoagulants (13.5%) were the most common medications contributing to ADR-related hospitalisation, followed by opioid analgesics (9.6%)., Conclusion: ADR-related hospitalisation remains a population health burden, with significant increase over time. The findings call for continuing efforts to prevent ADR, especially among high-risk populations, such as older people., (© 2018 Royal Australasian College of Physicians.)

Studies in the United States and United Kingdom have demonstrated ethnic variations in breast cancer receptor status, histology, and treatment access. This study aimed to investigate whether ethnicity variation similarly exists in Australia. Patients diagnosed with breast cancer between 2006 and 2011 across all public hospitals in the South Western Sydney Local Health District were identified and patient data collected retrospectively. Logistic regression analysis was used to measure the association between various biologic and treatment parameters and ethnicity. Ethnicity was found to have an influence on age of diagnosis, histology, treatment utilization, and recurrence in breast cancer patients., (© 2017 Wiley Periodicals, Inc.)

Background: The aim of this study was to investigate how perceived neighbourhood safety and area deprivation influenced the relationship between parklands and mental health., Methods: Information about psychological distress, perceptions of safety, demographic and socio-economic background at the individual level was extracted from New South Wales Population Health Survey. The proportion of a postcode that was parkland was used as a proxy measure for access to parklands and was calculated for each individual. Generalized Estimating Equations logistic regression analyses were performed to account for correlation between participants within postcodes, and with controls for socio-demographic characteristics and socio-economic status at the area level., Results: In areas where the residents reported perceiving their neighbourhood to be "safe" and controlling for area levels of socio-economic deprivation, there were no statistically significant associations between the proportion of parkland and high or very high psychological distress. In the most disadvantaged neighbourhoods which were perceived as unsafe by residents, those with greater proportions of parkland, over 20%, there was greater psychological distress, this association was statistically significant (20-40% parkland: OR=2.27, 95% CI=1.45-3.55; >40% parkland: OR=2.53, 95% CI=1.53-4.19)., Conclusion: Our study indicates that perceptions of neighbourhood safety and area deprivation were statistically significant effect modifiers of the association between parkland and psychological distress.

Paediatric trauma centres seek to optimise the care of injured children. Trends in state-wide paediatric care and outcomes have not been examined in detail in Australia. This study examines temporal trends in paediatric trauma outcomes and factors influencing survival and length of stay. A retrospective review was conducted using data from the NSW Trauma Registry during 2003-2008 for children aged 15 years and younger who were severely injured (injury severity score >15). To examine trauma outcomes descriptive statistics and multivariable logistic and linear regression were conducted. There were 1138 children severely injured. Two-thirds were male. Road trauma and falls were the most common injury mechanisms and over one-third of incidents occurred in the home. Forty-eight percent of violence-related injuries were experienced by infants aged less than 1 year. For the majority of children definitive care was provided at a paediatric trauma centre, but less than one-third of children were taken directly to a paediatric trauma centre post-injury. Children who received definitive treatment at a paediatric trauma centre had between 3 and 6 times higher odds of having a survival advantage than if treated at an adult trauma centre. The number of severe injury presentations to the 14 major trauma centres in NSW remains constant. It is possible that injury prevention measures are having a limited effect on severe injury in NSW. This research provides stimulus for change in the provision and co-ordination in the delivery of trauma care for injured children., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Studies have been conducted to determine 30-day and 365-day mortality rates after surgical procedures in different regions; however, there is a lack of data for mortality rates in New South Wales (NSW), Australia. The aim of this study was to determine 30-day and 365-day post-operative mortality rates after selected common operations performed in NSW., Methods: Using the Centre for Health Record Linkage, we linked the NSW Admitted Patient Data Collection with the NSW Registry of Births, Deaths and Marriages and Australian Bureau of Statistics to retrospectively calculate 30-day and 365-day post-operative mortality rates for 21 selected surgical procedures between 2000 and 2009. One year (365 days) standardized mortality ratios, and proportion of public and private hospital admissions and mortality, were calculated for each procedure., Results: Thirty-day mortality was lower than in previous studies for femur fracture fixation (3.7%), cervical spine fusion (0.8%), prostatectomy (0.2%), coronary valve replacement (4.2%), pulmonary resection (2.5%), bariatric surgery (0.07%) and pancreaticoduodenectomy (6.2%). Thirty-day mortality was higher than previously reported for abdominal aortic aneurysm (12.6%) and tonsillectomy (0.02%). One-year mortality rates ranged from 0.2% for tonsillectomy and bariatric surgery, to 24.6% for hip fracture fixation., Conclusions: Thirty-day mortality rates in NSW are similar, if not lower for most procedures when compared with rates reported in other studies. The reported mortality rates for each procedure allow clinicians and patients to be more informed of surgical risks., (© 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.)

Objective: To describe changes in the incidence of hospitalised injury for New South Wales residents involved in non-traffic crashes for the period 1 July 1998 to 30 June 2007., Design, Setting and Participants: This study identified 37 480 NSW residents admitted to hospitals for injuries resulting from non-traffic crashes from the NSW Admitted Patients Data Collection during the study period. Injury rates were calculated by applying 2001 census-derived estimates of NSW population figures as the denominator, and directly adjusting to the age distribution of the 2001 Australian population. The significance of trends in rates was assessed by the per cent change annualised estimator., Main Outcome Measures: Age-standardised rates of hospitalisation for injuries, and trends by inpatient demographics, travel mode and severity of injuries., Results: The annual rate of hospitalisation for injury showed a significant increase of 0.7% per annum (95% CI, 0.2% to 1.2%) for NSW residents involved in non-traffic crashes over 10 years. Annual hospitalisation rates for serious injuries increased by 2.2% (95% CI, 0.9% to 3.6%). The hospitalised injury rate for motorcyclists and pedal cyclists increased significantly by 3.3% per annum (95% CI, 2.4% to 4.2%) and 3.7% (95% CI, 2.6% to 4.9%), respectively, but the rate declined significantly for car occupants and pedestrians by - 8.3% per annum (95% CI, - 9.5% to - 7.0%) and - 2.2% (95% CI, - 4.2% to - 0.2%) respectively., Conclusions: The rate of hospitalisation for injury from non-traffic crashes increased significantly over time for NSW residents from 1998-99 to 2007-08, especially for serious injuries and injuries to motorcyclists and pedal cyclists. These findings call for continuing and specific effort to prevent road non-traffic injuries.

With the expansion of bicycle usage and limited funding and/or space for segregated pedestrian and bicycle paths, there is a need for traffic, road design and local government engineers to decide if it is more appropriate for space to be shared between either cyclists and pedestrians, or between cars and cyclists, and what restrictions need to be applied in such circumstances. To provide knowledge to aid engineers and policy makers in making these decisions, this study explored death and morbidity data for the state of New South Wales, Australia to examine rates and severity of injury arising from collisions between pedestrians and cyclists, and between cyclists and motor vehicles (MVs). An analysis of the severity of hospitalised injuries was conducted using International Classification of Diseases, Version 10, Australian Modification (ICD-10-AM) diagnosis-based Injury Severity Score (ICISS) and the Disability Adjusted Life Year (DALY) was used to measure burden of injury arising from collisions resulting in death or hospitalisation. The greatest burden of injury in NSW, for the studied collision mechanisms, is for cyclists who are injured in collisions with motor vehicles. Collisions between cyclists and pedestrians also result in significant injuries. For all collision mechanisms, the odds of serious injury on admission are greater for the elderly than for those in other age groups. The significant burden of injury arising from collisions of cyclists and MVs needs to be addressed. However in the absence of appropriate controls, increasing the opportunity for conflict between cyclists and pedestrians (through an increase in shared spaces for these users) may shift the burden of injury from cyclists to pedestrians, in particular, older pedestrians.

Geographical information system (GIS) technology is a potentially useful tool for policy makers to identify priority areas for the prevention of injuries in the home environment. An analysis of hospitalised injuries in New South Wales (NSW), Australia, that occurred in the home environment was conducted using Bayesian methods to calculate the expected relative home injury risk for common injury mechanisms. The results show geographic differences in the mechanism of home injuries. The risk of hospitalised fall-related injuries for people aged 75 years and over and poisoning of children four years of age or less was spread over NSW, while cut/pierce and struck by/struck against injuries showed less extensive areas of risk. This study shows that the use of geographic mapping and spatial statistics can provide a useful means of estimating home injury risk, eliminating the instability of estimates, while showing overall geographic patterns. In the future, geographical mapping of injury locations, coupled with satellite imagery, are likely to provide an additional level of detail for injury surveillance within a defined area.