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Background: TNF inhibiting drugs (TNFi) provide symptomatic relief for patients with ankylosing spondylitis (AS), but uncertainty remains about long-term benefits. We compared hospital admissions, emergency department (ED) presentations, and direct health care costs before and after the availability of subsidized TNFi therapy for AS patients. Methods: State-specific dispensing and cost data for TNFi therapy for AS in Western Australia (WA) were obtained from Pharmaceutical Benefits Scheme (PBS) and expressed as the number of defined daily doses (DDD)/1000 population/day. Linked admission and ED data for 1783 AS patients followed for 14,257 person-years between 1990 and 2015 were extracted. Pre- and post-2005 admission rates/100,000 population were compared by rate ratio (RR). Results: TNFi uptake in WA reached a DDD/1000 population/day 0.45 at an annual cost of AU$17.7 million in 2020. Hospital admission rates remained unchanged (RR: 0.95, CI 0.71–1.27, p = 0.66) but increased slightly in female patients (RR 1.22; CI 0.91–1.64, p = 0.20). While there was no change in cardiovascular admissions (6.3 vs. 6.2%, p = 0.6) or ED visit rates since 2005, frequency for cancer (2.7 vs. 3.8%, p < 0.01), infection (1.1 vs. 1.7%, p < 0.01) and mental health (4.0 vs. 4.5%, p < 0.02) admissions increased. Associated direct health care costs (2020 values) averaged AU$14.7 million before and AU$ 24.7 million per year after 2005. Conclusions: The introduction of subsidized TNFi therapy did not change all-cause hospital admission or ED visit rates for existing AS patients. Whether the significantly increased direct health care costs are offset by reductions in other health care costs remains to be determined. [ABSTRACT FROM AUTHOR]

Objectives With sparse data available, we investigated mortality and risk factors in adults with IgA vasculitis (IgAV). Methods This was an observational population-based cohort study using state-wide linked longitudinal health data for hospitalized adults with IgAV (n  = 267) and matched comparators (n  = 1080) between 1980 and 2015. Charlson comorbidity index (CCI) and serious infections (SIs) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from the Western Australia Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRRs) and hazard ratio (HR) for survival were assessed. Results During 9.9 (9.8) years lookback patients with IgAV accrued higher CCI scores (2.60 vs 1.50, P  < 0.001) and had higher risk of SI (OR = 8.4, P  < 0.001), not fully explained by CCI scores. During 19 years' follow-up, the rate of death in patients with IgAV (n  = 137) was higher than in comparators (n  = 397) (MRR = 2.06, 95% CI: 1.70–2.50; P  < 0.01) and the general population (standardized mortality rate ratio = 5.64, 95% CI: 4.25, 7.53; P  < 0.001). Survival in IgAV was reduced at 5 (72.7 vs 89.7%) and 20 years (45.2% vs 65.6%) (both P  < 0.05). CCI (HR = 1.88, 95% CI: 1.25, 2.73; P  = 0.001), renal failure (HR = 1.48, 95% CI: 1.04, 2.22; P  = 0.03) and prior SI (HR = 1.48, 95% CI: 1.01, 2.16; P  = 0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, P  = 0.02) was significantly more frequent in patients with IgAV. Conclusion Premorbid comorbidity accrual appears increased in hospitalized patients with IgAV and predicts premature death. As comorbidity does not fully explain the increased risk of premorbid infections or the increased mortality due to infections in IgAV, prospective studies are needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the key sociodemographic characteristics of Australian mothers and their children who were victims of family and domestic violence (FDV) that resulted in the male perpetrator being criminally charged for the offense or the mother being hospitalized. A population-based retrospective cohort study using de-identified linked health and police data of mothers with children born 1987–2010 who were victims of FDV 2004–2008 was utilized. Results indicate that mothers who were identified in police data are different demographically from those identified in health data and differed again from mothers identified in both health and police data. Within Western Australia, 3% of the population identify as Aboriginal; however, 44% of mothers identified as victims in police data and 73% within the health data were Aboriginal. Of the mothers identified in police data, 30% were under 25 years of age at their first assault recorded in police data compared with 21% in those identified in both police and hospital data. Most mothers identified as victims of FDV in police data had children present at their assault (60.6%). Prevalence of FDV exposure, identified in police data, was significantly different in Aboriginal children compared with non-Aboriginal children. Aboriginal children had a 19-fold (p <.0001) increased difference in prevalence of exposure compared with their non-Aboriginal counterparts. The study reveals the challenges in identifying victims of FDV when relying on a single data source for research and highlights the need for multiple datasets when investigating FDV. The overrepresentation of Aboriginal mothers and children should be taken in the context of the long-lasting impact of colonization. As such, prevention and early intervention strategies need to be underpinned by Aboriginal communities' cultural authority. [ABSTRACT FROM AUTHOR]

Summary: Rheumatoid arthritis (RA) is a potentially devastating disorder associated with increased risk of fractures, but current studies do not completely evaluate the RA fracture risk profile. This study estimates fracture incidence by site of fracture and makes comparisons between RA and controls using the key variables gender, age, and comorbidities. Background: Rheumatoid arthritis RA is a potentially devastating osteoimmunological disorder, predisposing to osteoporosis (OP), fragility fracture (FF), and major osteoporotic fractures (MOF). As few studies incorporate statistical matching, comorbidity and non-MOF sites, we compared the incidence of first FF, MOF, and non-MOF in RA patients with a matched control cohort adjusting for comorbidities. Methods: This longitudinal cohort study uses routinely collected administrative data from the West Australian Rheumatic Disease Epidemiological Registry (WARDER) between 1980 and 2015. RA patients, as defined using International Classification of Disease (ICD) codes, were compared to hospitalised patients free of rheumatic disease. Case–control matching adjusted for age, gender, and comorbidities (Charlson Comorbidity Index). Incidence rates (IR) per 1000 person years (PY) with 95% confidence intervals (CI) were compared by incidence rate ratios (IRR). Findings: In RA patients from 2000 to 2010, the first fracture IR was 18.3 (15.7–21.2) for an IRR of 1.32 (1.10–1.60). Upper limb, lower limb, and axial IR were 5.56 (95% CI 4.18–7.26), 10.60 (95% CI 8.66–12.87), and 2.47 (95% CI 2.58–3.68) with IRR of 1.18 (95% CI 0.84–1.65), 1.44 (95% CI 1.19–1.86), and 1.01 (95% CI 0.61–1.63) respectively. The first fracture IR increased 6 years before first RA hospital record (RR 1.58, CI 1.05–2.39). Conclusions: After age, gender, and comorbidity adjustment, RA is associated with a 32% higher incidence of first fracture, increased MOF, and a fracture incidence that is already increased before a first recorded RA diagnosis. This suggests a need for early attention to prevention of all fractures in RA patients. [ABSTRACT FROM AUTHOR]

Objectives: Patient contributions (co-payments) for one months' supply of a publicly-subsidised medicine in Australia were increased by 21% in January 2005 (US$2.73-$3.31 for social security recipients and $17.05-$20.58 for others). This study investigates the relationship between patients' use of statin medication and hospitalisation for acute coronary syndrome and stroke, following this large increase in co-payments.Methods: We designed a retrospective cohort study of all patients in Western Australia who were dispensed statin medication between 2004 and 05. Data for the cohort was obtained from State and Federal linked databases. We divided the cohort into those who discontinued, reduced or continued statin therapy in the first six months after the co-payment increase. The primary outcome was two-year hospitalisation for acute coronary syndrome or stroke-related event. Analysis was conducted using Fine and Gray competing risk methods, with death as the competing risk.Results: There were 207,066 patients using statins prior to the co-payment increase. Following the increase, 12.5% of patients reduced their use of statin medication, 3.3% of patients discontinued therapy, and 84.2% continued therapy. There were 4343 acute coronary syndrome and stroke-related hospitalisations in the two-year follow-up period. Multivariate analysis demonstrated that discontinuing statins increased the risk of hospitalisation for acute coronary syndrome or stroke-related events by 18% (95%CI = 0.1%-40%) compared to continuing therapy. Subgroup analysis showed that men aged <70 years were at increased risk of 54-63% after discontinuing statins compared to those continuing, but that women and older men were not.Conclusion: Discontinuing statin medication after a large increase patient cost contribution was associated with higher rates of acute coronary syndrome and stroke-related hospitalisation in men under 70 years. The findings highlight the importance of continued adherence to prescribed statin medication, and that discontinuing therapy for non-clinical reasons (such as cost) can possibly have negative consequences particularly for younger men. [ABSTRACT FROM AUTHOR]

Objective: To develop and apply a tool for measuring hospital discharge readiness of mothers practicing continuous kangaroo mother care (KMC) in a tertiary setting. Methods: A 22-item questionnaire was adapted from an existing tool. After a pilot (n=20), the survey was administered to 200 mothers in the KMC unit, Kalafong Hospital, South Africa from 20172018. Two items which asked participants how confident and ready they felt overall were used to categorize women as 'ready' or 'less ready' for discharge. Results: Most women (n=168, 88.0%) were categorized as ready for discharge. The mean (SD) score for all 22 questions was 9.4 (0.7). Women categorized as 'less ready' scored lower overall (mean difference: 1.3) and within all four questionnaire categories compared to women who were discharge ready (P<0.05). Conclusions: Although most women in this study reported high levels of discharge readiness, further research is needed to see if results are comparable across settings. [ABSTRACT FROM AUTHOR]

Abstract Background Increasing incidence and lack of survival improvement in adolescents and young adults (AYAs) with cancer have led to increased awareness of the cancer burden in this population. The objective of this study was to describe overall and type-specific cancer incidence and mortality trends among AYAs in Western Australia from 1982–2007. Methods Age–adjusted incidence and mortality rates were calculated for all malignancies combined and for each of the most common diagnostic groups, using five-year age–specific rates. Joinpoint regression analysis was used to derive annual percentage changes (APC) for incidence and mortality rates. Results The annual incidence rate for all cancers combined increased in males from 1982 until 2000 (APC = 1.5%, 95%CI: 0.9%; 2.1%) and then plateaued, whilst rates for females remained stable across the study period (APC = −0.1%; 95%CI: −0.2%; 0.4%) across the study period. For males, significant incidence rate increases were observed for germ cell tumors, lymphoblastic leukemia and thyroid cancer. In females, the incidence of Hodgkin’s lymphoma, colorectal and breast cancers increased. Significant incidence rate reductions were noted for cervical, central nervous system and lung cancers. Mortality rates for all cancers combined decreased from 1982 to 2005 for both males (APC = −2.6%, 95%CI:−3.3%;−2.0%) and females (APC = −4.6%, 95%CI:−5.1%;−4.1%). With the exception of bone sarcoma and lung cancer in females, mortality rates for specific cancer types decreased significantly for both sexes during the study period. Conclusions Incidence of certain AYA cancers increased, whilst it decreased for others. Mortality rates decreased for most cancers, with the largest improvement observed for breast carcinomas. Further research is needed to identify the reasons for the increasing incidence of certain cancers.