Medicine (RMH) - Research Publications
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ItemLifetime Risk of Primary Total Hip Replacement Surgery for Osteoarthritis From 2003 to 2013: A Multinational Analysis Using National Registry Data(WILEY, 2017-11)OBJECTIVE: To compare the lifetime risk of total hip replacement (THR) surgery for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, Norway, and Sweden. Life tables and population data were also obtained for each country. Lifetime risk of THR was calculated for 2003 and 2013 using registry, life table, and population data. RESULTS: In 2003, lifetime risk of THR ranged from 8.7% (Denmark) to 15.9% (Norway) for females, and from 6.3% (Denmark) to 8.6% (Finland) for males. With the exception of females in Norway (where lifetime risk started and remained high), lifetime risk of THR increased significantly for both sexes in all countries from 2003 to 2013. In 2013, lifetime risk of THR was as high as 1 in 7 women in Norway, and 1 in 10 men in Finland. Females consistently demonstrated the highest lifetime risk of THR at both time points. Notably, lifetime risk for females in Norway was approximately double the risk for males in 2003 (females 15.9% [95% confidence interval (95% CI) 15.6-16.1], males 6.9% [95% CI 6.7-7.1]), and 2013 (females 16.0% [95% CI 15.8-16.3], males 8.3% [95% CI 8.1-8.5]). CONCLUSION: Using representative, population-based data, this study found statistically significant increases in the lifetime risk of THR in 5 countries over a 10-year period, and substantial between-sex differences. These multinational risk estimates can inform resource planning for OA service delivery.
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ItemIncreased 30-day and 1-year mortality rates and lower coronary revascularisation rates following acute myocardial infarction in patients with autoimmune rheumatic disease(BMC, 2015-02-27)INTRODUCTION: It is now well-recognised that patients with autoimmune rheumatic disease (AIRD) have a predisposition to cardiovascular disease that results in increased morbidity and mortality. Following myocardial infarction (MI), patients with rheumatoid arthritis have been shown to have an increased case fatality rate; however, this has not been demonstrated in other forms of AIRD. The aim of this study was to compare case fatality rates following a first MI in patients with AIRD versus the general population. The secondary aim was to compare revascularisation treatment following MI in patients with AIRD versus the general population. METHODS: A retrospective cohort study using two population-based linked databases was undertaken. Cases of first MI from July 2001 to June 2007 were identified based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, codes. Thirty-day and one-year mortality rates were calculated (all-cause and cardiovascular causes of death). Logistic regression models were fitted to calculate the odds of mortality by AIRD status with adjustment for relevant characteristics. RESULTS: There were 79,390 individuals with a first MI, of whom 1,409 (1.8%) had AIRD. After adjusting for relevant covariates, the odds ratio (OR) for 30-day cardiovascular mortality in patients with AIRD was 1.44 (95% confidence interval (CI): 1.25 to 1.66), and the OR for 12-month cardiovascular mortality was 1.71 (95% CI: 1.51 to 1.94). The 90-day adjusted odds of percutaneous transluminal coronary angioplasty and coronary artery bypass graft were significantly lower in the AIRD group compared with controls (OR: 0.81, 95% CI: 0.70 to 0.94, and OR: 0.52, 95% CI: 0.39 to 0.69, respectively). CONCLUSIONS: We identified a higher risk-adjusted mortality rate for the majority of patients with AIRD at 30 days and 12 months after first MI. We also identified lower post-MI revascularisation rates in the AIRD group, suggesting there may be current gaps in cardiovascular treatment for patients with AIRD.
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ItemStatin initiation and treatment non-adherence following a first acute myocardial infarction in patients with inflammatory rheumatic disease versus the general population(BIOMED CENTRAL LTD, 2014)INTRODUCTION: To compare statin initiation and treatment non-adherence following a first acute myocardial infarction (MI) in patients with inflammatory rheumatic disease (IRD) and the general population. METHODS: We conducted a retrospective cohort study using a population-based linked database. Cases of first MI from July 2001 to June 2009 were identified based on International Classification of Diseases (ICD-10-AM) codes. Statin initiation and adherence was identified based on pharmaceutical claims records. Logistic regression was used to assess the odds of statin initiation by IRD status. Non-adherence was assessed as the time to first treatment gap using a Cox proportional hazards model. RESULTS: There were 18,518 individuals with an index MI over the time period surviving longer than 30 days, of whom 415 (2.2%) were IRD patients. The adjusted odds of receiving a statin by IRD status was significantly lower (OR =0.69, 95% CI: 0.55 to 0.86) compared to the general population. No association between IRD status and statin non-adherence was identified (hazard ratio (HR) =1.12, 95% CI: 0.82 to 1.52). CONCLUSIONS: Statin initiation was significantly lower for people with IRD conditions compared to the general population. Once initiated on statins, the proportion of IRD patients who adhered to treatment was similar to the general population. Given the burden of cardiovascular disease and excess mortality in IRD patients, encouraging the use of evidence-based therapies is critical for ensuring the best outcomes in this high risk group.
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ItemThe projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030(BMC, 2019-02-23)BACKGROUND: Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden. METHODS: De-identified TKR and THR data for 2003-2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003-2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1-5% of the overweight or obese population attained a normal body mass index. RESULTS: Based on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million. CONCLUSIONS: If surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings.
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ItemClinical presentation and patterns of care for short-term survivors of malignant glioma(SPRINGER, 2014-09)Palliative care provision for patients with high-grade malignant glioma is often under-utilised. Difficulties in prognostication and inter-patient variability in survival may limit timely referral. This study sought to (1) describe the clinical presentation of short-term survivors of malignant glioma (survival time <120 days); (2) map their hospital utilisation, including palliative and supportive care service use, and place of death; (3) identify factors which may be important to serve as a prompt for palliative care referral. A retrospective cohort study of incident malignant glioma cases between 2003-2009 surviving <120 days in Victoria, Australia was undertaken (n = 482). Cases were stratified according to the patient's survival status (dead vs. alive) at the end of the diagnosis admission, and at 120 days from diagnosis. Palliative care was received by 78 % of patients who died during the diagnosis admission. Only 12 % of patients who survived the admission and then deteriorated rapidly dying in the following 120 days were referred to palliative care in their hospital admission, suggesting an important clinical subgroup that may miss out on being linked into palliative care services. The strongest predictor of death during the diagnosis admission was the presence of cognitive or behavioural symptoms, which may be an important prompt for early palliative care referral.
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ItemMyocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study(BIOMED CENTRAL LTD, 2016-03-28)BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction (MI) and post-MI fatality compared with the general population. In a previous study examining post-MI treatment in RA compared with controls we noted that a higher proportion of the RA patients had experienced MI following a surgical procedure. The aim of this study was to compare the risk of MI and mortality at 6 weeks and 12 months following joint surgery in patients with RA compared with the general population. METHODS: Individuals who had undergone joint surgery in Victoria, Australia between 1 July 2000 and 30 June 2007 were identified from routinely collected hospital administrative data. Logistic regression analysis was performed to examine odds of 6 week and 12 month MI and mortality in RA versus non-RA patients with adjustment for age, sex, comorbidities, socioeconomic status, patient type and admission type. Subgroup analysis of total hip and knee arthroplasty episodes was undertaken. RESULTS: A total of 308,589 episodes of joint surgery occurred among 240,571 individuals, with 3654 (1.2 %) occurring among patients with RA. At 6 weeks post joint surgery the adjusted odds ratio (OR) for MI was 1.50 (95 % CI 0.96-2.33), all-cause death was 1.85 (95 % CI 1.09-3.13) and cardiovascular death was 1.90 (95 % CI 1.07-3.37). At 12 months post joint surgery the adjusted OR of MI was 1.70 (95 % CI 1.27-2.28), all-cause death was 2.18 (95 % CI 1.66-2.86) and cardiovascular death was 2.30 (95 % CI 1.65-3.22). On analysis of joint surgeries other than hip or knee arthroplasty, people with RA were at greater risk of MI within 6 weeks (adjusted OR 2.32; 95 % CI 1.24-4.34) and 12 months (adjusted OR 2.20; 95 % CI 1.47-3.30) compared to those without RA, but no difference in odds of short term mortality were found. CONCLUSIONS: Following an episode of joint surgery RA patients have a significantly increased risk of death at 6 weeks, and MI and death at 12 months, compared to the general population. The reasons for this remain to be elucidated but in the meantime RA patients should be considered at higher risk in the perioperative period.
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ItemPerformance of the Assessment of Quality of Life Measure in People With Hip and Knee Joint Disease and Implications for Research and Clinical Use(WILEY, 2014-03)OBJECTIVE: To comprehensively evaluate the performance of the Assessment of Quality of Life (AQoL) instrument for measuring health-related quality of life (HRQOL) in people with hip and knee joint disease (arthritis or osteoarthritis). METHODS: Data from 237 individuals were available for analysis from a national cross-sectional, population-based study of hip and knee joint disease in Australia. AQoL-4D data were evaluated using Rasch analysis. A range of measurement properties was explored, including model and item fit, threshold ordering, differential item functioning, and targeting. RESULTS: Good overall fit of the AQoL with the Rasch model was demonstrated across a range of tests, supporting internal validity. Only 1 item (relating to hearing) showed evidence of misfit. Most AQoL items showed logical sequencing of response option categories, with threshold disordering evident for only 2 of the 12 items (items 4 and 9). Minor issues with potential clinical and research implications include limited options for reporting pain and some evidence of measurement bias between demographic subgroups (including age and sex). Participants' HRQOL was generally better than that represented by the AQoL items (mean ± SD for person abilities -2.15 ± 1.39, mean ± SD for item difficulties 0.00 ± 0.67), indicating ceiling effects that could impact the instrument's ability to detect HRQOL improvement in population-based studies. CONCLUSION: The AQoL is a competent tool for assessing HRQOL in people with hip and knee joint disease, although researchers and clinicians should consider the caveats identified when selecting appropriate HRQOL measures for future outcome assessment involving this patient group.
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ItemLifetime Risk of Total Knee Replacement and Temporal Trends in Incidence by Health Care Setting, Socioeconomic Status, and Geographic Location(WILEY, 2014-03)OBJECTIVE: To estimate the lifetime risk of total knee replacement (TKR) and examine temporal trends in TKR incidence in the state of Victoria, Australia. METHODS: We performed a retrospective analysis of a population-based longitudinal cohort of patients (ages ≥40 years) who received a primary TKR in Victoria from 1999-2008. Hospital separations and life tables were used to estimate lifetime risk. Temporal changes in TKR incidence were examined according to health care setting (public versus private), socioeconomic status (SES), and geographic location (regional versus metropolitan). RESULTS: There were 43,570 incidents of primary TKRs identified over the study period. In 2008, the lifetime risk of surgery was 10.4% (95% confidence interval [95% CI] 10.13-10.64%) for men and 11.9% (95% CI 11.63-12.13%) for women. TKRs increased steadily over the study period in private hospitals (overall increase of 90%) with a smaller growth in procedure numbers for public hospitals (overall increase of 40%). From 2002-2003 onward, the low SES tertile showed a lower incidence of TKR compared to the middle and high SES groups, with incidence rates of 1.09 (95% CI 1.04-1.15), 1.22 (95% CI 1.17-1.28), and 1.20 (95% CI 1.16-1.25) per 1,000 population, respectively (based on 2007-2008 figures). Increased numbers of TKRs were also found to be occurring among people residing in regional areas of Victoria (from 1.12 [95% CI 1.04-1.31] to 1.84 [95% CI 1.72-2.02] per 1,000 population). CONCLUSION: Increases in lifetime risk of TKR were evident. Although improved access to TKR for those living in regional areas was observed, sustained disparities relating to health care setting and SES warrant further investigation.
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ItemNo Preview AvailableChronic Disease Management A Review of Current Performance Across Quality of Care Domains and Opportunities for Improving Osteoarthritis Care(W B SAUNDERS CO-ELSEVIER INC, 2013-02)Osteoarthritis is the most prevalent chronic joint disease worldwide. The incidence and prevalence are increasing as the population ages and lifestyle risk factors such as obesity increase. There are several evidence-based clinical practice guidelines available to guide clinician decision making, but there is evidence that care provided is suboptimal across all domains of quality: effectiveness, safety, timeliness and appropriateness, patient-centered care, and efficiency. System, clinician, and patient barriers to optimizing care need to be addressed. Innovative models designed to meet patient needs and those that harness social networks must be developed, especially to support those with mild to moderate disease.
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ItemLifetime Risk of Total Hip Replacement Surgery and Temporal Trends in Utilization: A Population-Based Analysis(WILEY, 2014-08)OBJECTIVE: To investigate lifetime risk of total hip replacement (THR) surgery in the state of Victoria, Australia and to describe temporal trends in THR incidence. METHODS: We analyzed a retrospective population-based longitudinal cohort of patients who received a primary THR in Victoria from 1998-2009. The factors potentially contributing to changes in lifetime risk were also examined, including temporal changes in THR incidence according to health care setting (public versus private), socioeconomic status, and geographic location (regional versus metropolitan). RESULTS: We identified 45,775 patients receiving THR over the time period. For a woman age 20-29 years, the mortality-adjusted lifetime risk rose significantly over time, from 8.49% (95% confidence interval [95% CI] 8.23-8.69%) in 1999-2000 to 10.30% (95% CI 10.07-10.49%) in 2007-2008. For a man age 20-29 years, the mortality-adjusted lifetime risk also increased significantly, from 9.29% (95% CI 8.97-9.58%) in 1999-2000 to 10.27% (95% CI 9.95-10.48%) in 2004-2005, but in contrast to the pattern observed for women, it decreased slightly in 2007-2008 (9.90% [95% CI 9.60-10.16%]). We also identified an increasing number of THRs in private hospitals, in people in middle and low socioeconomic groups, and in rural areas. CONCLUSION: The lifetime risk of THR for women was similar to men, despite a higher burden of hip osteoarthritis, and this warrants further investigation. However, increases in the number of THR procedures performed for patients in regional areas and in lower socioeconomic groups suggest some reductions over time in known disparities.