scholarly journals Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Rebecca Mitchell ◽  
Cate Cameron
Keyword(s):  
At Risk ◽  
Health Service ◽  
Mortality Risk ◽  
Service Use ◽  
Negative Binomial ◽  
Population Based ◽  
The Self ◽  
Health Service Use ◽  
Self Harm ◽  
Rate Ratios

IntroductionPrior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. Objectives and ApproachTo quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs. ResultsThere were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64). Conclusion/ImplicationsImproved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed.

Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design

2017 ◽  
Vol 52 (3) ◽  
pp. 262-270 ◽  
Author(s):  
Rebecca J Mitchell ◽  
Cate M Cameron
Keyword(s):  
At Risk ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Service Use ◽  
Population Based ◽  
Mortality Data ◽  
Post Discharge ◽  
Self Harm ◽  
Rate Ratios ◽  
Hospital Use

Objective: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. Method: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. Results: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55–64 years (3.96; 95% confidence interval: [2.79, 5.64]). Conclusion: Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.

scholarly journals Quantifying morbidity attributable to traumatic injury using a population-based matched cohort in Australia

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rebecca Mitchell ◽  
Cate Cameron ◽  
Rod McClure
Keyword(s):  
Health Service ◽  
Service Use ◽  
Injury Severity ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Traumatic Injury ◽  
South Australia ◽  
Population Based ◽  
Health Service Use ◽  
Matched Cohort

ABSTRACT ObjectiveThis study aims to quantify 12-month morbidity attributable to traumatic injury using a population-based matched cohort in Australia. ApproachA population-based matched cohort study of individuals ≥18 years using linked emergency department (ED) presentation, hospital separation and mortality records from three Australian states during 1 January 2008 to 31 December 2010. Injury admissions were identified using a principal diagnosis of injury (ICD-10-AM: S00-T75 or T79). The first injury-related hospital admission during 2009 was identified as the index injury admission and pre and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence at the date of the index injury admission of their matched counterpart. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. Injury severity was estimated using the International Classification of Injury Severity Score (ICISS): minor (≥0.99), moderate (0.942-<0.99) and serious (<0.942). Negative binomial and Poisson regression methods will be used to quantify associations between injury and counts of hospital admissions 12-month post-index injury health service use. ResultsThere were 166,032 individuals injured in 2009 and admitted to hospital in New South Wales, South Australia or Queensland with a matched comparison. Males represented 57% of those injured, 30.1% were aged 18-34 years, 37.9% were aged 35-64 years, 32.1% were aged ≥65 years and 65.1% resided in an urban location. Comorbidities were more common in the injured cohort (χ² =9384.5, df (2), p<0.0001). The most common injuries were fall-related (38.4%) and as a result of road trauma (12.4%). The majority of injuries were minor (43.9%) or moderate (37.2%), with 18.9% serious injuries. Attributable risk and adjusted rate ratios for injured versus matched non-injured comparison will be presented for pre and post health service use controlling for key confounding characteristics. ConclusionThrough the use of national data linkage, this study contributes to informing research efforts on better quantifying the attributable burden of injury-related disability in Australia.

scholarly journals Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population

2022 ◽  
Vol 12 ◽  
Author(s):  
Huah Shin Ng ◽  
Jonas Graf ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
Orhan Aktas ◽  
...  
Keyword(s):  
Health Service ◽  
Service Use ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Population Based ◽  
Drug Uptake ◽  
Health Service Use ◽  
Disease Modifying Drugs ◽  
Physician Visits ◽  
Disease Modifying

BackgroundEvidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (&lt;55 and ≥55 years), DMD exposure and health service use in the MS population.MethodsWe conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations.ResultsWe included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged &lt;55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the &lt;55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (&lt;55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs.ConclusionOur study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged &lt;55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.

scholarly journals Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study

2020 ◽  
Vol 12 ◽  
pp. 1759720X2092171
Author(s):  
Bindee Kuriya ◽  
Vivian Tia ◽  
Jin Luo ◽  
Jessica Widdifield ◽  
Simone Vigod ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mental Health ◽  
Ankylosing Spondylitis ◽  
Health Service ◽  
Service Use ◽  
Population Based ◽  
System Level ◽  
Health Service Use ◽  
Increased Risk ◽  
Ed Visits

Background: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. Whether acute mental health (MH) service utilization (i.e. emergency visits or hospitalizations) is increased in RA or AS is not known. Methods: Two population-based cohorts were created where individuals with RA ( n = 53,240) or AS ( n = 13,964) were each matched by age, sex, and year to unaffected comparators (2002–2016). Incidence rates per 1000 person-years (PY) were calculated for a first MH emergency department (ED) presentation or MH hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for demographic, clinical, and health service use variables. Results: Individuals with RA had higher rates of ED visits [6.59/1000 person-years (PY) versus 4.39/1000 PY in comparators] and hospitalizations for MH (3.11/1000 PY versus 1.80/1000 PY in comparators). Higher rates of ED visits (7.92/1000 PY versus 5.62/1000 PY in comparators) and hospitalizations (3.03/1000 PY versus 1.94/1000 PY in comparators) were also observed in AS. Overall, RA was associated with a 34% increased risk for MH hospitalization (HR 1.34, 95% CI 1.22–1.47) and AS was associated with a 36% increased risk of hospitalization (HR 1.36, 95% CI 1.12–1.63). The risk of ED presentation was attenuated, but remained significant, after adjustment in both RA (HR 1.08, 95% CI 1.01–1.15) and AS (HR 1.14, 95% CI 1.02–1.28). Conclusions: RA and AS are both independently associated with a higher rate and risk of acute ED presentations and hospitalizations for mental health conditions. These findings underscore the need for routine evaluation of MH as part of the management of chronic inflammatory arthritis. Additional research is needed to identify the underlying individual characteristics, as well as system-level variation, which may explain these differences, and to help plan interventions to make MH service use more responsive to the needs of individuals living with RA and AS.

scholarly journals Mental Health Service Use Among Children and Youth in Ontario: Population-Based Trends Over Time

2016 ◽  
Vol 61 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Sima Gandhi ◽  
Maria Chiu ◽  
Kelvin Lam ◽  
John C. Cairney ◽  
Astrid Guttmann ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Service Use ◽  
Population Based ◽  
Children And Youth ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Trends Over Time ◽  
Over Time

scholarly journals Patterns of Health Service Use Among Young People With Cerebral Palsy in England

2021 ◽  
Vol 12 ◽  
Author(s):  
Jennifer M. Ryan ◽  
Grace Lavelle ◽  
Nicola Theis ◽  
Cherry Kilbride ◽  
Marika Noorkoiv
Keyword(s):  
Cerebral Palsy ◽  
Young People ◽  
Health Service ◽  
Service Use ◽  
Negative Binomial ◽  
Occupational Therapists ◽  
Health Service Use ◽  
Service Development ◽  
Speech Impairment ◽  
Factors Associated

Background: Although the provision of healthcare for people with cerebral palsy (CP) is typically focussed on childhood, many people with CP require access to services periodically throughout their life. Few studies have examined patterns of health service use among young people with CP in England. Understanding patterns of use may inform future service development.Objective: To describe patterns of visits to rehabilitation and medical professionals among ambulatory young people with CP living in England, and identify factors associated with service use.Methods: Sixty-two young people with CP aged 10–19 years [mean (SD) age 13.7 (2.5) years] in Gross Motor Function Classification System (GMFCS) levels I-III reported visits to a range of health professionals, hospital admissions and visits to the emergency department over a median duration of 34 weeks (min–max: 12–34 weeks). Negative binomial models were used to examine factors associated with number of visits.Results: Physiotherapists were the most commonly used professional, with 67.7% of participants visiting a physiotherapist at least once, followed by dentists (66.1%), general practitioners (48.4%), occupational therapists (40.3%) and orthopaedic surgeons (40.3%). Physiotherapists were also the most frequently visited professional with a total of 473 visits (13.3 visits per person-year). Speech and language therapists (5.0 visits per person-year), occupational therapists (4.5 visits per person-year) and nurses (4.3 per person-year) were the next most frequently visited professionals. Age, GMFCS level, and speech impairment were associated with rate of visits to a physiotherapist.Conclusions: The proportion of young people who visited medical and rehabilitation professionals during the study period varied considerably depending on the profession. Generally, the proportion of young people using services was low. In the context of limited resources, data on service use in combination with data on unmet need, may support the reorganisation of services to maximise benefits to young people with CP.

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