Suchergebnisse

ABSTRACTObjectivesAn accurate picture of infant mortality informs society of its social progress. It is a key indicator of how effective public health policies and programs are in caring for the most vulnerable in our society. Currently, at the population level, Victorian data on Aboriginal and Torres Strait Islander births and deaths are excluded from Australian vital statistics. The Victorian Aboriginal Mortality Study aimed to provide a more complete and accurate population profile of Aboriginal births in Victoria using population data linkage of Victorian statutory and administrative datasets. ApproachTwo population statutory datasets, the Victorian Perinatal Data Collection (VPDC) and Victorian Registry of Births, Deaths and Marriages (RBDM) were linked, using probabilistic matching with mother's name and surname, child's date of birth and sex, for all births that occurred in Victoria between 1988 and 2008, inclusive to more accurately ascertain births to mothers and fathers who identified as Aboriginal and/or Torres Strait Islander (hereafter respectfully 'Aboriginal').ResultsOver 1.34 million files, reporting births between 1988 and 2008, were linked. However, due to data integrity issues for Indigenous identification prior to 1998, the years between 1999 and 2008 only were used in the development of the birth cohort. Matching the VPDC with the RBDM resulted in identifying an additional 4,333 live births where mother and/or father identified as Aboriginal, representing an 87% increase in the number of births previously recorded as Aboriginal by the VPDC*. The largest increase (186%) in the number of births where mother and/or father identified as Aboriginal births was observed within the Victorian metropolitan areas. ConclusionThis is the first time that the VPDC and RBDM birth data were linked in Victoria. The matched birth information established a more complete population profile of Aboriginal and/or Torres Strait Islander births. These data will provide a more accurate baseline to enhance the Victorian and Australian governments' ability to plan services, allocate resources and evaluate funded activities aimed at eliminating disparity experienced by Aboriginal and/or Torres Strait Islander peoples. Importantly, it has established a more accurate denominator from which to calculate Aboriginal infant mortality rates for Victoria, Australia.
*Until 2009, the mother's Indigenous identification only was recorded in the VPDC

IntroductionNurse home visiting (NHV) is designed to redress child and maternal health inequities, but long-term evaluation is hampered by sample attrition. Evaluation using administrative data has the potential to overcome attrition through provision of a more complete outcome profile. Australia's "right@home" trial is the only long-running evaluation of NHV designed for a population with universal healthcare.
ObjectivesTo investigate the effects of the NHV program on children's health and development outcomes and service use, compared with usual care (comparator), using linked administrative data at school transition.
MethodsA screening survey identified pregnant women experiencing adversity from antenatal clinics across two states (Victoria, Tasmania). 722 were randomized: 363 to the right@home program (25 visits promoting parenting and home learning environment) and 359 to usual care. At children's first birthdays, 198/237 (83.5) Tasmanian and 420/485 (86.6) Victorian parents consented to data linkage with the Tasmanian Kindergarten Development Check (KDC, 4 years) and Victorian School Entrant Health Questionnaire (SEHQ, 5-6 years), respectively. Jurisdictional differences meant measures could not be harmonized, and variables varied in their interpretability. Following best-practice methods for managing missing data, outcomes were compared between groups (intention-to-treat) using regression models adjusted for stratification factors, baseline variables, and nurse/site cluster.
ResultsLinked data were obtained for n = 134/237 (56.5) Tasmanian and n = 252/485 (52.0) Victorian children. These children had substantially higher prevalence of negative life events and poorer health and development outcomes, and used similar or more services than children state-wide. Compared with usual care, the NHV program increased KDC achievement and SEHQ health service use. There was less evidence for program impacts on SEHQ outcomes.
ConclusionsBenefits of NHV were evident at school transition for child development outcomes and service use. This adds further evidence for NHV being an important component of universal health services that deliver support responsive to families' needs.
RegistrationISRCTN89962120

AbstractAustralian Governments are increasingly understanding the impacts of early adversity, evidenced by ongoing policy and investment in two of the most widely implemented early interventions: nurse home visiting (NHV) and early childhood education and care (ECEC). Neither intervention fully redresses the developmental inequities engendered by early adversity, yet their synergistic impacts ("dynamic complementarity") are unknown. In this research, we aimed to (1) inform evaluation of policy implementation by (2) experimentally testing the dynamic complementarity of NHV and ECEC. We capitalised on an opportunity afforded by the Australian "right@home" randomised trial, which involved 722 pregnant women experiencing adversity, randomised to receive NHV or usual care to child age 2 years. Detailed data describing family‐accessed ECEC were collected from parents at 3–4 years, and "quality ECEC" was categorised according to meeting quality recommendations defined by Australian policy and provision. Children's developmental outcomes (language, executive functioning, behaviour and well‐being) were parent‐reported or assessed directly at 4 years. At 4 years, 33 per cent of families had received neither intervention; 40 per cent NHV only; 14 per cent quality ECEC only; and 13 per cent had received both. We used linear regression to estimate differences in mean outcomes between exposure groups, including interaction between NHV and ECEC. Unadjusted analyses indicated modest effects of the combination of NHV and ECEC, which attenuated after adjustment for socioeconomic confounders. We present the design and preliminary findings as an approach that could be used to evaluate equitable implementation at scale and enable policymakers to determine the most effective evidence‐based policy.

ABSTRACTObjectivesThe disparity between the infant mortality rates of Aboriginal and Torres Strait Islander (forthwith respectfully 'Aboriginal') and non-Aboriginal populations in Australia is well documented. However, major public health initiatives and campaigns aimed particularly at halving the Aboriginal infant mortality rate are hindered by the lack of comprehensive and accurate data. To date, infant and child mortality rates for Victorian born Aboriginal children have not been reported in national statistics. The aim of Victorian Aboriginal Child Mortality Study was to accurately measure the patterns and trends of Aboriginal infant mortality and to report the disparities between Aboriginal and non-Aboriginal infants born in Victoria, Australia between 1999 and 2008 inclusive. ApproachWe used best practice methodologies to link total population data and comprehensive mortality case review to classify and code the deaths to determine, for the first time, all-cause and cause-specific mortality for Aboriginal and non- Aboriginal infants born in Victoria from 1999 to 2008.ResultsBetween 1999 and 2009, Aboriginal infants were twice as likely to die in in the first year of life as non-Aboriginal infants. Infant cumulative mortality rates (CMR) were higher among Aboriginal births (9.1/1000 livebirths in 1999-2003 and 9.4/1000 livebirths in 2004-2008) than non- Aboriginal births (4.7/1000 livebirths in 1999-2003 and 4.5/1000 livebirths in 2004-2008). For Aboriginal infants there was an observed decrease in the rate of neonatal deaths, and conversely an increase in the postneonatal CMR (from 2.2/1000 livebirths in 1999-2003 and 3.8/1000 livebirths in 2004-2008). Among Aboriginal infants there was an increase in deaths attributed to prematurity (3.1/1000 livebirths in 1999-2003 and 4.3/1000 livebirths in 2004-2008) and sudden infant death syndrome (SIDS) (1.0/1000 livebirths in 1999-2003 and 1.7/1000 livebirths in 2004-2008). There were significantly more potentially preventable deaths among Aboriginal infants than in non-Aboriginal infants [infection (0.6/1000 Aboriginal livebirths vs 0.2/1000 non-Aboriginal livebirths, RR 2.5 95%CI 1.1-5.6) injury (0.6/1000 Aboriginal livebirths vs 0.1/ 1000 non-Aboriginal livebirths, RR 5.8 95%CI 2.5-13.5), and SIDS (1.4/1000 Aboriginal livebirths vs 0.28/1000 non-Aboriginal livebirths, RR 5.0 95%CI 2.9-8.6)]. ConclusionThis is the first time that all-cause and cause-specific mortality rates for Victorian born Aboriginal and non-Indigenous infants have been reported. The observed increasing disparities between Aboriginal and non- Indigenous infants, especially due to preventative causes, such as infection, injury and SIDS, in the post neonatal period, demand immediate action in partnership with Aboriginal communities. Collaborative action must focus on both access to primary health care and better living conditions.

Aim We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medi

Aim: Children born low birthweight, preterm and/or small for gestational age (SGA) sustain substantially increased costs for hospital-based health care and additional educational support in the first few years of life. This is the first study internationally to investigate costs beyond hospital care, to community-based health care and prescription medicines across early and middle childhood with actual cost data, and to examine these costs according to the severity of perinatal risk. Method: In the prospective Longitudinal Study of Australian Children, we followed two cohorts of children from age of 0 to 5 years (no increased perinatal risk, n = 3973; mild risk, n = 442; and moderate-to-high risk, n = 297), and from age of 4 to 9 years (no increased perinatal risk, n = 3629; mild risk, n = 465; and moderate-to-high risk, n = 361). Children were defined as mild risk if born 32-36 weeks, with birthweight 1500-2499g, and/or SGA (<5-9th percentile), and moderate-to-high risk if born <32 weeks, birthweight <1500g and/or extremely SGA (<5th percentile). Federal government expenditure (2011 $AUD) on healthcare attendances and prescription medication from birth to 9 years were calculated via data linkage to the Australian Medicare records. Results: Mean costs per child were A$362 higher (95% CI $156; 568) from 0 to 5 years and A$306 higher (95% CI $137; 475) from 4 to 9 years, for children with any compared with no increased perinatal risk (P < 0.001). At the population level, an additional A$32m was spent per year for children 0-9 years with any relative to no increased perinatal risk. Conclusions: Perinatal risk is a major public health issue conferring considerable additional expense to community-based health care, most marked in the first year of life but persisting up to at least 10 years. Even without additionally considering burden, these findings add to the urgency of identifying effective mechanisms to reduce perinatal risk across its full spectrum.

Aim We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medi

Aim: Children born low birthweight, preterm and/or small for gestational age (SGA) sustain substantially increased costs for hospital-based health care and additional educational support in the first few years of life. This is the first study internationally to investigate costs beyond hospital care, to community-based health care and prescription medicines across early and middle childhood with actual cost data, and to examine these costs according to the severity of perinatal risk. Method: In the prospective Longitudinal Study of Australian Children, we followed two cohorts of children from age of 0 to 5 years (no increased perinatal risk, n = 3973; mild risk, n = 442; and moderate-to-high risk, n = 297), and from age of 4 to 9 years (no increased perinatal risk, n = 3629; mild risk, n = 465; and moderate-to-high risk, n = 361). Children were defined as mild risk if born 32-36 weeks, with birthweight 1500-2499g, and/or SGA (<5-9th percentile), and moderate-to-high risk if born <32 weeks, birthweight <1500g and/or extremely SGA (<5th percentile). Federal government expenditure (2011 $AUD) on healthcare attendances and prescription medication from birth to 9 years were calculated via data linkage to the Australian Medicare records. Results: Mean costs per child were A$362 higher (95% CI $156; 568) from 0 to 5 years and A$306 higher (95% CI $137; 475) from 4 to 9 years, for children with any compared with no increased perinatal risk (P < 0.001). At the population level, an additional A$32m was spent per year for children 0-9 years with any relative to no increased perinatal risk. Conclusions: Perinatal risk is a major public health issue conferring considerable additional expense to community-based health care, most marked in the first year of life but persisting up to at least 10 years. Even without additionally considering burden, these findings add to the urgency of identifying effective mechanisms to reduce perinatal risk across its full spectrum.

Aim: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Methods: Participants: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Outcome: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. Predictor: biennial BMI measurements over the same period. Results: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Conclusions: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Aim: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Methods: Participants: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Outcome: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. Predictor: biennial BMI measurements over the same period. Results: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Conclusions: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Purpose. This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. Method. Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. Result. It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $ AU206, 95% CI = $ 90, $ 321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $ AU1.2-$ AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $ 192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. Conclusion. Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Purpose. This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. Method. Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. Result. It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $ AU206, 95% CI = $ 90, $ 321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $ AU1.2-$ AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $ 192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. Conclusion. Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

IntroductionNewborn babies who require admission for specialist care can experience immediate and sometimes lasting impacts. For babies admitted to special care nurseries (SCN), there is no dataset comparable to that of the Australian and New Zealand Neonatal Network (ANZNN), which has helped improve the quality and consistency of neonatal intensive care through standardised data collection.
ObjectivesWe aim to establish a proof-of-concept, Victoria-wide registry of babies admitted to SCN, embedded within the whole-of-Victoria Generation Victoria (GenV) cohort.
MethodsThis prototype registry is a depth sub-cohort nested within GenV, targeting all babies born in Victoria from Oct-2021 to Oct-2023. Infants admitted to SCN are eligible. The minimum dataset will be harmonised with ANZNN for common constructs but also include SCN-only items, and will cover maternal, antenatal, newborn, respiratory/respiratory support, cardiac, infection, nutrition, feeding, cerebral and other items. As well as the dataset, this protocol outlines the anticipated cohort, timeline for this registry, and how this will serve as a resource for longitudinal research through its integration with the GenV longitudinal cohort and linked datasets.
ConclusionThe registry will provide the opportunity to better understand the health and future outcomes of the large and growing cohort of children that require specialist care after birth. The data would generate translatable evidence and could lay the groundwork for a stand-alone ongoing clinical quality registry post-GenV.