Mortality, Morbidity And Income Inequality In Australia
Funder
National Health and Medical Research Council
Funding Amount
$232,175.00
Summary
Evidence has been accumulating for some time indicates that an individual's life expectancy is affected by their socioeconomic circumstances. In general, it appears that people with higher incomes tend to live longer. More recently, some evidence has suggested that life expectancy is affected not only by a person's income level but also by their relative position in the income distribution. Some studies have found that, when income is more unequally distributed, mortality rates tend to be higher ....Evidence has been accumulating for some time indicates that an individual's life expectancy is affected by their socioeconomic circumstances. In general, it appears that people with higher incomes tend to live longer. More recently, some evidence has suggested that life expectancy is affected not only by a person's income level but also by their relative position in the income distribution. Some studies have found that, when income is more unequally distributed, mortality rates tend to be higher and life expectancy lower. Several explanations for this association have been advanced. One is that the association is a statistical artifact. Another is social-psychological, arguing that a sense of relative deprivation and social exclusion increases susceptibility to a variety of conditions. A third explanation is couched in terms of social capital, a term that refers to various forms of participation in voluntary organisations which strengthen community life. A fourth argues that it is material deprivation that is the underlying cause - income inequality is found in communities characterised by lower levels of provision of social infrastructure such as schools, libraries, and health services. The main purpose of this research project is to investigate the association between morbidity, mortality, income, and income inequality in Australia. The project will attempt to find which of the several explanations just discussed are supported by Australian evidence. The results of the project will enhance our understanding of the relationship between socioeconomic status and health, and will have implications for the design of different policies aimed at ameliorating the effects of income inequality on health.Read moreRead less
Epidemiology Of Unexplained Antepartum Fetal Death In Australia
Funder
National Health and Medical Research Council
Funding Amount
$450,350.00
Summary
The death of a baby before birth is a devastating event for the parents and families. In the vast number of these deaths, no cause can be found leaving no clues for parents and care providers struggling with decisions about future pregnancies and how the risk may be reduced for all women in pregnancy. Fetal death before the onset of labour without an apparent cause (Unexplained Antepartum Fetal Death (UAFD) constitutes the most common cause of fetal death. In Australia, the rate of UAFD is appro ....The death of a baby before birth is a devastating event for the parents and families. In the vast number of these deaths, no cause can be found leaving no clues for parents and care providers struggling with decisions about future pregnancies and how the risk may be reduced for all women in pregnancy. Fetal death before the onset of labour without an apparent cause (Unexplained Antepartum Fetal Death (UAFD) constitutes the most common cause of fetal death. In Australia, the rate of UAFD is approximately 2 per 1 000 births, contributing 30% to all fetal deaths. The rate of UAFD is over three times the current rate of Sudden Infant Death Syndrome (SIDS) in Australia. Despite this, little research has been undertaken in this area. The research which has been undertaken suggests that factors which are present during pregnancy may identify women who are at risk. However, the results of these studies are not consistent, largely due to the problems with study design, and therefore the available information is not sufficiently reliable to assist in identification of women at risk. Well designed, large scale studies are urgently needed to determine, from the reported list of risk factors, those factors which truly identify a woman at increased risk in the antenatal period where appropriate care can be provided to decrease the likelihood of fetal death. Recently, a collaborative effort involving clinicians and consumers in Australia has commenced to support and undertake research and related activities and to collaborate with international groups in reducing the risk of UAFD (ANZ Fetal Death Collaborative Group). This study forms the basis for this work within Australia. This study is designed to identify women who are at risk of unexplained antepartum fetal death. The study involves a review of 800 unexplained antepartum fetal deaths in three States of Australia and an analysis of information on all births in Australia which is routinely collected by Health Departments.Read moreRead less
Mortality And Survival Among Clients Of The Aboriginal Medical Service At Redfern
Funder
National Health and Medical Research Council
Funding Amount
$483,290.00
Summary
The aims of the mortality study are to: (a) document current age-sex specific and cause-specific Indigenous mortality; (b) establish trends in age-sex specific and cause-specific Indigenous mortality over time; (c) compare age-sex-cause specific mortality in the AMS Redfern cohort with patterns documented in other Aboriginal populations, and in the general Australian population. The null hypotheses for general and cause-specific mortality (age-adjusted) are that: (a) there has been no decline in ....The aims of the mortality study are to: (a) document current age-sex specific and cause-specific Indigenous mortality; (b) establish trends in age-sex specific and cause-specific Indigenous mortality over time; (c) compare age-sex-cause specific mortality in the AMS Redfern cohort with patterns documented in other Aboriginal populations, and in the general Australian population. The null hypotheses for general and cause-specific mortality (age-adjusted) are that: (a) there has been no decline in mortality in Aboriginal people attending AMS Redfern over 30 years covering 1972-2001; (b) survival in the AMS cohort is similar to that recorded in Aboriginal people from NT and WA (mostly rural) for similar time periods; (c) comparisons of the AMS cohort mortality with overall NSW mortality are similar to previously published comparisons of NT-WA Aboriginal mortality compared to overall Australian mortality data. Major causes of mortality will centre on endocrine (mainly diabetes), cardio- and cerebro-vascular diseases, and on external causes, including suicide-violence and accidental death. The mortality study will be extended back to the inception of the AMS, and will rely on computerisation of name(s), sex, date of birth and date of first and last AMS attendance for the whole AMS patient data base, to provide information for matching of patient records with the National Death Index (for deaths from 1980) and for matching with the NSW mortality data for 1971-79 (as there is no nationwide mortality data available from a single source prior to 1980).Read moreRead less
ESTIMATION OF INDIGENOUS MORTALITY WHERE DESIGNATION OF INDIGENOUS STATUS ON DEATH CERTIFICATES IS UNRELIABLE
Funder
National Health and Medical Research Council
Funding Amount
$158,840.00
Summary
Mortality of indigenous Australians is regarded as unacceptably high compared to other Australians and compared to indigenous minorities in other similar countries. Indigenous mortality is based on data from WA, SA and NT, although some of the data are unreliable. There are few reliable data available in Qld, NSW, Vic or Tas because Indigenous status is significantly under-recorded on the death certificate. The objective of the research is to devise and validate indirect methods for estimating i ....Mortality of indigenous Australians is regarded as unacceptably high compared to other Australians and compared to indigenous minorities in other similar countries. Indigenous mortality is based on data from WA, SA and NT, although some of the data are unreliable. There are few reliable data available in Qld, NSW, Vic or Tas because Indigenous status is significantly under-recorded on the death certificate. The objective of the research is to devise and validate indirect methods for estimating indigenous mortality in sub-populations where there are significant proportions of indigenous people, and where designation of indigenous status on death certificate is unreliable. This would permit assessment of mortality differentials and trends in a significant number of Aboriginal and Torres Strait Islander communities in Qld, NSW, Vic and possibly Tas and provide new perspectives in the study of determinants of mortality in indigenous populations through comparisons of communities with relatively high and relatively low mortality, and allow population-based evaluation of the effectiveness of services and programs through surveillence of mortality trends and differentials. The methods rely on the basic premise that the total mortality of a population is contributed to by the mortality of its components in relation to their proportion of the total population. The units of analyses will be mainly municipalities. Mortality and proportion indigenous will be used in the comparison of municipalities with similar socio-economic and geographic characteristics, and mortality by municipality will be statistically modelled using various characteristics of these populations, including proportion indigenous (using ABS data). Methods will be validated by employing them on selected WA, SA and NT mortality data where designation of indigenous staus is considered reliable. Mortality estimates will then be made for indigenous communities in NSW, Qld, and other states.Read moreRead less
Functional Genomic Analysis Of The Role Of P53 In Early Embryo Death After Assisted Reproductive Technologies (ART).
Funder
National Health and Medical Research Council
Funding Amount
$227,036.00
Summary
Assisted reproductive technologies (ART, such as IVF and related techniques) are successful treatments for most forms of infertility. ART are expensive therapies and much of this cost is related to the relative inefficiency of the technology. Much of this is due to the high mortality of the resulting embryos. Typically, 45-80% of embryos produced by ART do not survive the first week. Consequently the chance of any individual embryo resulting in a successful birth is not high. There has been only ....Assisted reproductive technologies (ART, such as IVF and related techniques) are successful treatments for most forms of infertility. ART are expensive therapies and much of this cost is related to the relative inefficiency of the technology. Much of this is due to the high mortality of the resulting embryos. Typically, 45-80% of embryos produced by ART do not survive the first week. Consequently the chance of any individual embryo resulting in a successful birth is not high. There has been only modest increments in embryo survival in recent years. The low cahnce of individual embryos resulting in a baby means that: (1) generally several treatment cycles are required; (2) superovulation is used to maximise the number of embryos produced giving an accumulation of unwanted cryopreserved embryos; (3) more than one embryo is generally transferred resulting in a significant incidence of multiple pregancies. The high mortality of the early embryo seems to be a general feature of IVF but its causes and effectors are not known. It has recently been established that it largely occurs due to a form of cell 'suicide' known as apoptosis. This form of cell death has important normal functions: its activation allows for cells that are no longer required to be removed, allowing the remodelling of tissues and it also serves to remove cells that are irreversibly damaged. p53 is a protein that has the ability to 'sense' cell stress and damage and to direct the cell to undergo apoptosis if the stress is severe. This project will examine if ART cause increased expression of p53 and whether this elevation of p53 causes embryonic cell death. We will examine the factirs that control p53 expression in the embryo. using mice with mutations that stop the function of p53 and several of its regulatory proteins. Experiments will determine the susceptibility of embryos possessing these mutations and will therefore allow us to define the proteins causing apoptosis after ART.Read moreRead less
A small number of babies die unexpectedly while still in the womb: the numbers are much higher than those dying from Sudden Infant Death Syndrome (SIDS). Some of these babies slow their movements down in the days before death. It would be very helpful to be able to accurately monitor babies' movements in the womb so that we could help the few babies who need it, and so prevent poor outcomes. Mothers feel their babies moving, but it's often hard for them to pick up all the movements that do occur ....A small number of babies die unexpectedly while still in the womb: the numbers are much higher than those dying from Sudden Infant Death Syndrome (SIDS). Some of these babies slow their movements down in the days before death. It would be very helpful to be able to accurately monitor babies' movements in the womb so that we could help the few babies who need it, and so prevent poor outcomes. Mothers feel their babies moving, but it's often hard for them to pick up all the movements that do occur. The best way of measuring babies' movements is during an ultrasound. However, that's expensive and means that the pregnant mother needs to lie still for about half an hour to have this testing done. We are developing a way of recording babies' movements, which still lets the pregnant woman continue with her normal activities. We will do this using an AMBULATORY FETAL ACTIVITY MONITOR, which is an accelerometer, like an advanced pedometer. The ambulatory fetal activity monitor will measure the activity of the unborn baby during pregnancy, looking at the number of times s-he moves and how simple or complex the movements are. We expect that the unborn baby who is not getting enough nutrition during the pregnancy will have fewer movements than other unborn babies. This project involves checking that movements picked up by the ambulatory fetal activity monitor are the same as movements seen on an ultrasound. We will then monitor a large number of pregnant women with healthy and possibly unhealthy babies, to help identify the babies who need help. Once we have this information, we will be able to use it in the future to possibly prevent poor outcomes in those babies who do need help.Read moreRead less
Mortality Among Opioid Dependent Persons In Pharmacotherapy, NSW 1985-2006
Funder
National Health and Medical Research Council
Funding Amount
$148,757.00
Summary
Heroin dependence is a long term condition associated with high rates of death, illness and injury. Death rates are much higher than the general Australian population and the causes of death include drug intoxication or overdose, trauma, suicide, complications from blood born viruses such as Hepatitis C and HIV-AIDS and other medical complications of a chaotic drug-using lifestyle. As a part of a harm minimisation approach to heroin dependence, maintenance opioid pharmacotherapies seek to stabil ....Heroin dependence is a long term condition associated with high rates of death, illness and injury. Death rates are much higher than the general Australian population and the causes of death include drug intoxication or overdose, trauma, suicide, complications from blood born viruses such as Hepatitis C and HIV-AIDS and other medical complications of a chaotic drug-using lifestyle. As a part of a harm minimisation approach to heroin dependence, maintenance opioid pharmacotherapies seek to stabilise a chaotic heroin-using lifestyle by providing a regular dose of a legal, high quality opioid under medical supervision. Maintenance treatment uses long-acting opioids such as methadone and buprenorphine to provide consistent blood opioid levels so the client avoids the constant and disruptive cycles of opioid intoxication and withdrawal. Clients in regular maintenance treatments have lower death rates than untreated heroin dependent people and better outcomes with regards to drug use. However, death still occurs in methadone and buprenorphine treatment and minimising death rates is an important goal of treatment programs. This is a large longitudinal study looking at all NSW methadone and buprenorphine clients between 1985 and 2006, an estimated 44,000 people. In particular, the study looks at their mortality. It is a data linkage project, in that it uses two existing databases (a treatment database and a mortality database) and combines the information for each subject to get a better picture of how long methadone and buprenorphine clients survive, how much maintenance treatment they have received, and what the clients die of. This is the first time the mortality of all NSW methadone and buprenorphine recipients will be examined in a systematic way. It will allow us to compare the mortality of subjects receiving methadone and buprenorphine treatments and look at changes in mortality rates and causes of death over time. This will be an important policy resource.Read moreRead less
20 Year Study Of Skin Cancer In A Queensland Community
Funder
National Health and Medical Research Council
Funding Amount
$396,415.00
Summary
Skin cancers are by far the commonest cancers diagnosed in Australia. Even though it is known that sun exposure in excess causes skin cancers there are complexities about the causes, especially of basal cell carcinoma (BCC) -the major type of skin cancer- that are still not understood. Relative intensity of sun exposure and perhaps its timing with respect to age in life may well be critical factors. We aim to study these causes in very great detail by collating information that has been gathered ....Skin cancers are by far the commonest cancers diagnosed in Australia. Even though it is known that sun exposure in excess causes skin cancers there are complexities about the causes, especially of basal cell carcinoma (BCC) -the major type of skin cancer- that are still not understood. Relative intensity of sun exposure and perhaps its timing with respect to age in life may well be critical factors. We aim to study these causes in very great detail by collating information that has been gathered over a 20 year period in a community-based skin cancer study in Nambour, Qld as well as performing some laboratory tests on skin cancer tissue collected from participants. This 3-year project will enable the full realisation of the potential of this esource-20 years in the making- with its wealth of information for answering questions about skin cancer decelopment and preventability. It should finally provide us with a clearer rationale for 'prevention of skin cancer' than is currently available. In addition we shall assess the costs of treatment of skin cancer in general and for the individual, and how much preventive practices for skin cancer might save the health budget, by using the releavnt data collected from this community sample.Read moreRead less