Resource use and costs associated with epilepsy in the Queensland hospital system: protocol for a population-based data linkage study

IntroductionEpilepsy places a large burden on health systems, with hospitalisations for seizures alone occurring more frequently than those related to diabetes. However, the cost of epilepsy to the Australian health system is not well understood. The primary aim of this study is to quantify the health service use and cost of epilepsy in Queensland, Australia. Secondary aims are to identify differences in health service use and cost across population and disease subgroups, and to explore the associations between health service use and common comorbidities.Methods and analysisThis project will use data linkage to identify the health service utilisation and costs associated with epilepsy. A base cohort of patients will be identified from the Queensland Hospital Admitted Patient Data Collection. We will select all patients admitted between 2014 and 2018 with a diagnosis classification related to epilepsy. Two comparison cohorts will also be identified. Retrospective hospital admissions data will be linked with emergency department presentations, clinical costing data, specialist outpatient and allied health occasions of service data and mortality data. The level of health service use in Queensland, and costs associated with this, will be quantified using descriptive statistics. Difference in health service costs between groups will be explored using logistic regression. Linear regression will be used to model the associations of interest. The analysis will adjust for confounders including age, sex, comorbidities, indigenous status, and remoteness.Ethics and disseminationEthical approval has been obtained through the QUT University Human Research Ethics Committee (1900000333). Permission to waive consent has been granted under the Public Health Act 2005, with approval provided by all relevant data custodians. Findings of the proposed research will be communicated through presentations at national and international conferences, presentations to key stakeholders and decision-makers, and publications in international peer-reviewed journals.

The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic

Objectives The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation. Methods Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic. Results For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001). Conclusions Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.

COVID-19 vaccine hesitancy and refusal and associated factors in an adult population in Saskatchewan, Canada: Evidence from predictive modelling

Background A high population level of vaccination is required to control the COVID-19 pandemic, but not all Canadians are convinced of the value and safety of vaccination. Understanding more about these individuals can aid in developing strategies to increase their acceptance of a COVID-19 vaccine. The objectives of this study were to describe COVID-19 vaccine acceptance, hesitancy and refusal rates and associated factors in Saskatchewan, Canada. Methods This is a cross-sequential study that consisted of pooled responses from weighted samples of 9,252 Saskatchewan adults (≥18 years) across nine rounds of data collection between May 4, 2020 and April 3, 2021. The outcome variable was vaccine intention: vaccine acceptance, hesitancy, and refusal. The independent variables were layered into socio-demographic factors, risk of exposure to coronavirus, mitigating behaviours, and perceptions of COVID-19. Data were analyzed using multinomial logistic regression and a classification and regression tree. Results Seventy-six percent of the respondents indicated that they had been or were willing to be vaccinated, 13% had not yet decided, and the remaining 11% said they would not be vaccinated. Factors that increased the likelihood of vaccine refusal and hesitancy were lower education level, financial instability, Indigenous status, and not being concerned about spreading the coronavirus. Perceiving COVID-19 to be more of a threat to one’s community and believing that one had a higher risk of illness or death from COVID-19 decreased the likelihood of both vaccine refusal and hesitancy. Women and newcomers to Canada were more likely to be unsure about getting vaccinated. Respondents who did not plan to be vaccinated were less likely to wear face masks and practice physical distancing. Conclusion While many Canadians have voluntarily and eagerly become vaccinated already, reaching sufficient coverage of the population is likely to require targeted efforts to convince those who are resistant or unsure. Identifying and overcoming any barriers to vaccination that exist within the socio-demographic groups we found were least likely to be vaccinated is a crucial component.

Indigenous migration patterns in Brazil based on the 2010 national demographic census: analysis and critical reflection

Research in several Latin American countries points to violence, loss of traditional territories, and seeking education, health, and wage labor as key variables in triggering rural–urban migration among Indigenous people. This study presents an analysis of the migration patterns of Indigenous people in Brazil, compared to non-indigenous people, based on data from the most recent national census, conducted in 2010. Migration characteristics related to lifetime migration and recent migration were investigated by means of descriptive and multivariable logistic regression analyses. The findings pointed to complex mobility scenarios according to migrants’ Indigenous status and geographical regions of origin and destination. Indigenous people living in urban areas presented high levels of mobility (approximately 50% lived in different municipalities from those where they were born), which were more pronounced than those of non-Indigenous people. Indigenous people living in rural areas presented the lowest levels of migration (approximately 90% residing in their municipality of birth). Statistical modeling confirmed the patterns observed in descriptive analysis, highlighting the marked mobility of Indigenous subjects in urban areas. We emphasize the limitations of using census data for characterizing Indigenous mobility profiles, although no other nationally representative data are available. The finding that the Indigenous population living in urban areas presents rates of migration higher than their non-Indigenous counterparts is particularly important for the planning and implementation of a broad range of public policies aimed at ethnic minorities in the country, including health, education, and housing initiatives.

P098 Predicting delays in or failure to initiate CPAP therapy: A retrospective cohort study

Background Suboptimal CPAP usage is associated with negative outcomes and inefficient use of medical resources. Demographic and polysomnographic characteristics are well established predictors of poor adherence, however the literature regarding patients who fail to initiate treatment is limited. This audit aimed to identify features associated with the delayed commencement or failure to initiate CPAP therapy. Methods A single institution, retrospective cohort study was performed. The cohort comprised adults with obstructive sleep apnoea prescribed CPAP between 2017 and 2018. The demographic, clinical and polysomnographic features of this cohort were identified. Comparisons were conducted between patients who initiated therapy and those who did not, as well as between early and delayed initiators of treatment, which was defined as uptake after one month. Multiple logistic regression was performed with significance defined as a p&lt;0.05. Results 916 patients were identified. 38.2% of patients did not uptake prescribed CPAP, with male gender (p &lt; 0.001), younger age (p=0.007) and lower pressure (p=0.016) identified as prognostic factors. Socioeconomic disadvantage (p=0.774) and Epworth Sleepiness Scale (p=0.111) were not associated with failure to start treatment. Of the 61.8% of patients who initiated CPAP therapy, 33% exhibited a delayed start to therapy, with indigenous status a significant feature of this cohort (p=0.002). Discussion A large portion of patients displayed either delayed commencement or failure to initiate CPAP therapy. Younger age, male gender and lower prescribed pressures were identified as negative predictive factors. These characteristics, as well as delayed treatment experienced in the indigenous population, provide focus points for intervention.

The Impact of Offender–Victim Cultural Backgrounds on the Likelihood of Receiving Diversion

The extent to which both an alleged offender and victim’s cultural background influences how one is processed through the Australian criminal justice system is largely unknown. Such information would provide some insight into the extent of discrimination within the system. To address this question, this study aimed to ascertain whether offender/victim pairings across Indigenous and non-Indigenous cultural backgrounds predicted the likelihood of receiving diversion for first-time offenders. The sample comprised 5,616 young people aged between 10 and 17 years, from the state of New South Wales, charged with (a) an offense eligible for diversion, and (b) a crime against a person. Chi-square analyses and binary logistic regression were employed to determine proportions of inter- and intra-cultural offending and the likelihood of receiving diversion dependant on cultural grouping. Results demonstrated that charges for intra-cultural crime (within cultural group) were more likely to occur than charges for intercultural crime (between cultural groups). Indigenous subjects were more likely to receive a court summons. An Indigenous subject charged with an offense against an Indigenous victim was more than 2 times more likely to receive a court summons compared with a non-Indigenous offense against a non-Indigenous victim. An Indigenous suject charged with an offense against a non-Indigenous victim was also more likely to receive a court summons compared with a non-Indigenous/Indigenous offender/victim dyad. Findings indicate that Indigenous status is clearly impacting decisions to divert regardless of the victim’s cultural background. Further research is recommended to explore the situational reasons that underpin decisions to divert on the ground.

Associations Between Maternal Immunisation and Reduced Rates of Preterm Birth and Stillbirth: A Population Based Retrospective Cohort Study

Stillbirth and preterm birth (PTB) remain two of the most important, unresolved challenges in modern pregnancy care. Approximately 10% of all births are preterm with nearly one million children dying each year due to PTB. It remains the most common cause of death among children under five years of age. The numbers for stillbirth are no less shocking with 2.6 million babies stillborn each year. With minimal impact on the rate of these adverse birth outcomes over the past decade there is an urgent need to identify more effective interventions to tackle these problems. In this retrospective cohort study, we used whole-of-population data, to determine if maternal immunization during pregnancy against influenza and/or pertussis, is associated with a lower risk of PTB, delivering a small-for-gestational age (SGA) infant, developing preeclampsia or stillbirth. Women with a singleton pregnancy at 28 or more weeks’ gestation delivering in Victoria, Australia from July 2015 to December 2018 were included in the analysis. Log-binomial regression was used to measure the relationship between vaccination during pregnancy against influenza and against pertussis, with preterm birth, SGA, preeclampsia and stillbirth. Variables included in the adjusted model were maternal age, body mass index, first or subsequent birth, maternal Indigenous status, socio-economic quintile, smoking, public or private maternity care and metropolitan or rural location of the hospital. Women who received influenza vaccine were 75% less likely to have a stillbirth (aRR 025; 95% CI 0.20, 0.31), and 31% less likely to birth &lt;37 weeks (aRR 0.69; 95% CI 0.66, 0.72). Women who received pertussis vaccine were 77% less likely to have a stillbirth (aOR 0.23; 95% CI 0.18, 0.28) and 32% less likely to birth &lt;37 weeks gestation (aRR 0.68; 95% CI 0.66, 0.71). Vaccination also reduced the odds of small for gestational age by 13% and reduced the odds of pre-eclampsia when restricted to primiparous women. This association was seen over four different influenza seasons and independent of the time of year suggesting that any protective effect on obstetric outcomes afforded by maternal vaccination may not be due to a pathogen-specific response but rather due to pathogen-agnostic immune-modulatory effects.

The Mark Sheldon Remote Mental Health Team: an evaluation of patient demographics, diagnoses and clinical management in very remote Central Australia

Objective: The Mark Sheldon Remote Mental Health Team provides psychiatric services to 29 communities in very remote Central Australia. This study evaluated Mark Sheldon Remote Mental Health Team patient demographics, diagnoses and clinical management. Methods: A retrospective cross-sectional review was performed for January 2020. Variables included age, sex, Indigenous status, diagnosis, legal status, medication class and route of administration. Results: A total of 180 patients were identified (85.6% Indigenous, 53.3% male). Schizophrenia and delusional disorders were most common (41.1%). A small proportion of patients (2.8%) were involuntary. Psychotropic medication was commonly prescribed (77.4%) with a low threshold for anti-psychotic depot use (51.5%). Oral medication rates varied according to class. Conclusions: This study provided insights into the demographic and clinical profile of a unique population. The findings will help to optimise patient management in very remote Central Australia and serve as a foundation for similar evaluations and comparisons with other remote psychiatric services.

518Trajectories of offending in people with psychotic illness and other mental disorders: a population study

Background Trajectory analysis has been used to study long-term patterns of offending and identify offending groups. Only few studies have explored patterns in people with psychotic illness and these were restricted to adult offenders. This study examines offending trajectories, and identifies risk factors, for people aged 10-26 with psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental disorders (NMD). Methods This is a whole-population record-linkage study of 184,147 people born in Western Australia (WA) 1983-1991 using data from WA psychiatric case register, WA corrective services and other state-wide registers. Group-based trajectory modelling was used to identify offending trajectories. Results Four offender groups were identified for each mental health status (MHS) group: MHS groups had similar offending patterns, however PI had a lower proportion of individuals in the G1 group and later offending onset in the G3 group. Gender, indigenous status, substance use, childhood victimisation and parental offending were risk factors associated with group membership; for PI, childhood victimisation and parental offending were only significant in the G4 group. Conclusions Overall offending patterns and risk factors were similar for all MHS groups, however, some differences were observed for PI. Key messages To reduce offending in this population, interventions need to occur at an early age.

1543Gains in life expectancy in the Australian population due to reductions in smoking: comparisons between interventions targeting the population versus interventions in a specific high risk group

Background Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively. Methods Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014–15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011–13 Australian Health Survey. Results The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation. Conclusions Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.