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Objective: To examine associations between remoteness of region of residence and in‐hospital mortality for people admitted to hospital with heart failure in New South Wales during 2002–21.
Study design: Retrospective observational cohort study; analysis of New South Wales Admitted Patient Data Collection data.
Setting, participants: Adult (16 years or older) NSW residents admitted with heart failure to NSW public hospitals, 1 January 2002 – 30 September 2021. Only first admissions with heart failure during the study period were included.
Main outcome measures: In‐hospital mortality, by remoteness of residence (Australian Statistical Geography Standard), adjusted for age (with respect to median), sex, socio‐economic status (Index of Relative Socioeconomic Advantage and Disadvantage [IRSAD], with respect to median), other diagnoses, hospital length of stay, and calendar year of admission (by 4‐year group).
Results: We included 154 853 admissions with heart failure; 99 687 people lived in metropolitan areas (64.4%), 41 953 in inner regional areas (27.1%), and 13 213 in outer regional/remote/very remote areas (8.5%). The median age at admission was 80.3 years (interquartile range [IQR], 71.2–86.8 years), and 78 591 patients were men (50.8%). The median IRSAD score was highest for people from metropolitan areas (metropolitan: 1000; IQR, 940–1064; inner regional: 934; IQR, 924–981; outer regional/remote/very remote areas: 930; IQR, 905–936). During 2002–21, 9621 people (6.2%) died in hospital; the proportion was 8.0% in 2002, 4.9% in 2021. In‐hospital all‐cause mortality was lower during 2018–21 than during 2002–2005 (adjusted odds ratio [aOR], 0.52; 95% confidence interval [CI], 0.49–0.56); the decline was similar for all three remoteness categories. Compared with people from metropolitan areas, the odds of in‐hospital death during 2002–21 were higher for people from inner regional (aOR, 1.12; 95% CI, 1.07–1.17) or outer regional/remote/very remote areas (aOR, 1.35; 95% CI, 1.25–1.45).
Conclusion: In‐hospital mortality during heart failure admissions to public hospitals declined across NSW during 2002–21. However, it was higher among people living in regional and remote areas than for people from metropolitan areas. The reasons for the difference in in‐hospital mortality should be investigated.
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Correspondence: imants.rubenis@sydney.edu.au
Open access:
Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.
Data Sharing:
The NSW Population and Health Services Research Ethics Committee (PHSREC) prohibits authors from making the minimal data set publicly available. Interested researchers may contact the ethics coordinator (
No relevant disclosures.
Objectives: To investigate the frequency, timing, and characteristics of cardiovascular collapse after snakebite in Australia, and the complications of collapse following envenoming.
Study design: Observational study; analysis of prospectively collected demographic and clinical data.
Setting, participants: People with confirmed snake envenoming recruited to the Australian Snakebite Project at one of 200 participating Australian hospitals, 1 July 2005 – 30 June 2020.
Main outcome measures: Time from snakebite to collapse; post‐collapse complications (cardiac arrest, seizures, death).
Results: Of 1259 envenomed people, 157 (12%) collapsed within 24 hours of the snakebite; venom‐induced consumption coagulopathy (VICC) was determined in all 156 people for whom coagulation testing could be performed. The exact time between bite and collapse was known for 149 people (median, 20 min; interquartile range, 15–30 min; range, 5–115 min); the time exceeded 60 minutes for only two people, each after releasing tight bandages 60 minutes after the bite. The collapse preceded hospital arrival in 132 cases (84%). Brown snake (
Conclusion: Collapse after Australian snake envenoming almost always occurred within 60 minutes of the bite, was always accompanied by VICC, and most frequently followed brown snake bites. Poorer outcomes, including cardiac arrest, seizures, and death, were more frequent for people who collapsed than for those who did not. Outcomes for people who collapsed before medical care arrived were poorer than for those who collapsed in hospital or in an ambulance.
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We acknowledge Kylie Tape (University of Newcastle) for data collection and data entry for the Australian Snakebite Project.
No relevant disclosures.
Objectives: To assess the commitment of the ten largest pharmaceutical companies operating in Australia to achieving net zero emissions by evaluating their accountability metrics, ambitions, and quantifiable actions taken.
Study design: Cross‐sectional study; analysis of publicly available company reports published during 12 December 2015 – 31 December 2023.
Setting, participants: Ten largest pharmaceutical companies operating in Australia, defined by total pharmaceutical costs (to patients and Pharmaceutical Benefits Scheme) for PBS‐subsidised medications, as reported in PBS expenditure and prescriptions reports for 2020–21 and 2022–23.
Main outcome measures: Content analysis of publicly available documents for the ten companies using modified criteria from the PricewaterhouseCoopers
Results: Three groups could be defined by evidence of their commitment to emissions reductions. The first — companies leading emissions reduction efforts, with SBTi‐approved near term targets, consistent emissions monitoring, well defined commitments, and quantified evidence of action — includes AstraZeneca, Novartis, Johnson & Johnson, Bayer, and Merck & Co. The second group — companies that had made commitments to SBTi‐approved targets but their disclosure records are limited — includes AbbVie and Roche. The third group — without public commitments to achieving net zero emissions, minimal or no SBTi‐approved targets, and minimal disclosure or monitoring of emissions — includes Viatris, Vertex, and Arrotex.
Conclusions: The ten largest pharmaceutical companies in Australia are moving towards net zero greenhouse gas emissions at different rates. Gaps in standardised reporting processes should be closed, and further qualitative research on industry‐wide environmental sustainability policy and practice is needed.
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Data Sharing:
We confirm that the data supporting the findings of this study were derived from public domain sources and are available in the article and its supplementary materials.
Open access publishing facilitated by The University of Melbourne, as part of the Wiley – the University of Melbourne agreement via the Council of Australian University Librarians.
All authors are members of Doctors for the Environment Australia.
Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2
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We would like to acknowledge the Climate and Health Foundation for providing financial support for the development of this manuscript. The Climate and Health Foundation had no role in the planning, writing or publication of the work.
Philomena Colagiuri received funding from the Climate and Health Foundation for her role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for her to attend COP29 in Baku, Azerbaijan in 2024 (airfare, accommodation, daily stipend). Jake Williams received funding from the Climate and Health Foundation for his role as Lancet Countdown Oceania Fellow. The Climate and Health Foundation also provided funding for him to attend COP29 in Baku, Azerbaijan in 2024. Jake Williams received funding from the Wiser Healthcare Research Collaboration for the 2024 EMCR Seed Grant, and funding from HEAL (Healthy Environments And Lives) National Research Network (National Health and Medical Research Council Grant No. 2008937) for the 2024 Travel Award and 2023 Travel Award. Paul Beggs received funding from the Lancet Countdown for in‐kind support (payment of airfare, accommodation etc.) to attend the Lancet Countdown Annual Meeting, London, 2024. He also received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Paul Beggs is the Director of Oceania Regional Centre for the Lancet Countdown. Ying Zhang has received funding from the Climate and Health Foundation for in‐kind support (payment of airfare, accommodation etc.) to attend UNFCCC COP28, Dubai, 2023. Ying Zhang is a Co‐Director of Oceania Regional Centre for the Lancet Countdown and is on the Editorial Board for the Journal of Climate Change and Health.
To enable proactive decisions that promote a healthy start to life, our understanding of children's health and development at a population level is only as good as the data we collect and analyse.1 A decade ago, Olver called for improved access and capacity to link data in the Australian context, voiced in the Medical Journal of Australia.2 In the intervening years, there have been varying rates of progress across Australian states and territories. Victoria's routinely collected statewide data documenting children's health and development from pregnancy to school entry, the maternal and child health (MCH) service dataset, is the most comprehensive nationally with the highest population uptake, yet remains unlinked to key health and determinants data and longitudinal cohorts.3 The time to address this is now given increasing policy interest in the first 2000 days (conception to five years of age) demonstrated by the national Early Years Strategy 2024–2034 and the $14 billion rollout of Victoria's Best Start, Best Life reforms.4,5,6
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This perspective article was written as part of Ashleigh Shipton's PhD project “The effect of COVID‐19 pandemic and policies on maternal and child health outcomes in the Western Health region of Victoria: a mixed methods study” funded by the University of Melbourne, Royal Australasian College of Physicians and Murdoch Children's Research Institute. The Royal Children's Hospital Melbourne Human Research Ethics Committee approved Ashleigh Shipton's PhD project as above (reference number: 87751). Melissa Wake was funded by the Australian National Health and Medical Research Council (NHMRC) Principal Research Fellowship 1160906. Sharon Goldfeld was funded by NHMRC Practitioner Fellowship 2026263. Ashleigh Shipton, Meredith O'Connor, Melissa Wake, Sharon Goldfeld, Jatender Mohal and Fiona Mensah's research at the Murdoch Children's Research Institute is supported by the Victorian Government's Operational Infrastructure Support Program. Rhiannon Pilkington was supported by NHMRC CTCS (1187489). Leesa Hooker, Kristina Edvardsson, Helen Lees and Catina Adam's in‐kind support is funded by their teaching and research at La Trobe University. Helen Lees receives in‐kind support from the Municipal Association of Victoria as the maternal and child health policy and program lead. Authors acknowledge that project and salary support for projects unrelated to the present manuscript were received from funding bodies including the NHMRC, Medical Research Future Fund, Paul Ramsay Foundation, State Government of Tasmania, Victorian Government, right@home implementation licence, Australian National Research Organisation for Women's Safety, Victorian Department of Social Services, Family Safety Victoria, Channel 7 Children's Research Foundation, South Australian Department of Human Services, Uniting Communities, Junction Australia, and Commissioner for Aboriginal Children and Young People. Authors acknowledge that payment of honoraria unrelated to the present manuscript were received for lectures, presentations and manuscript peer review. The University of Melbourne had no role in planning or writing this article. The other funders had no role in the planning, writing or publication of this article.
In Australia, little prevalence data around vision impairment exist. However, self‐reported data from the Australian Bureau of Statistics 2017–18 National Health Survey1 suggest that around 800 000 people have a vision impairment or are blind (excluding uncorrected refractive errors).2 The leading cause of vision impairment in working‐age adults are inherited retinal diseases (IRDs)3 — a group of genetic conditions that primarily affect the retina. Other than one particular gene therapy for biallelic RPE65‐associated retinal dystrophy, there are no other clinically available treatments to safely prevent vision loss or restore vision for someone with an IRD.4
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Eden Robertson and Anai Gonzalez‐Cordero are supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Consumers (Meredith Prain, Leighton Boyd, Emily Shepard, Hollie Feller, Sally Karandrews, and Kanae Yamamoto) are also supported by a 2021 Medical Research Future Fund Stem Cell Therapies Mission (APP2016039). Kate Hetherington is supported by the Cancer Institute Translational Program Grant (2021/TPG2112) as well as Luminesce Alliance and the Zero Childhood Cancer National Personalised Medicine Program for children with high risk cancer, a joint initiative of Children's Cancer Institute and Kids Cancer Centre, Sydney Children's Hospital, Randwick.
No relevant disclosures.
Attacks on health care in conflict zones are increasing, depriving civilians of urgently needed care, putting the lives of patients and health care workers at risk, and contributing to the deterioration in the health of affected populations.1 Health care is protected under international humanitarian law but there are challenges faced with its enforcement. Consequently, we opine that physicians and medical societies have a moral imperative to advocate for the enduring protection of health care workers, patients, and health care infrastructure in conflict zones.
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Correspondence: lussier.sandra1@gmail.com
The statements and opinions in this manuscript reflect the authors’ views alone and do not represent the official policies or views of our institutions.
No relevant disclosures.
Culturally safe health care for all people is a requirement for medical practice in Australia and Aotearoa New Zealand.1,2 In both countries, legislation protects the rights of the lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) community. Despite progress toward equality, higher rates of discrimination towards LGBTQI+ communities contribute to double the risk of mental health disorders and increased inequities in health outcomes, such as cardiovascular disease and cancer survivorship, compared with their non‐LGBTQI+ counterparts.3,4,5
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Open access publishing facilitated by University of Otago, as part of the Wiley ‐ University of Otago agreement via the Council of Australian University Librarians.
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Objective: To examine the accuracy of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), the population‐based clinical quality registry for people with kidney failure, in identifying Aboriginal and/or Torres Strait Islander people.
Design: Population‐based cohort study of reporting accuracy.
Setting: New South Wales, 2006–2020.
Participants: Incident kidney failure patients.
Main outcome measures: Sensitivity and specificity of identification of Aboriginal and/or Torres Strait Islander people in ANZDATA compared with identification with Enhanced Reporting of Aboriginality (ERA) methods using linked health datasets.
Results: Of 11 708 patients, 693 (5.9%) were identified as Aboriginal and/or Torres Strait Islander people using ERA methods, with 484 recognised in ANZDATA. Overall ANZDATA sensitivity was 67.0% (95% CI, 63.3–70.5%), with high specificity (99.8%; 95% CI, 99.7–99.9%). Sensitivity was lowest for males (63.8%; 95% CI, 58.7–68.6), people aged under 18 years (45.0%; 95% CI, 23.1–68.5%) or over 65 years (61.7%; 95% CI, 53.8–69.2%), and those with greater socio‐economic advantage (56.6%; 95% CI, 46.6–66.2%), living in major cities (53.8%; 95% CI, 48.0–59.5%) and with no comorbidities (47.7%; 95% CI, 37.0–58.6%). Aboriginal and/or Torres Strait Islander people identified in ANZDATA had lower rates of waitlisting for kidney transplantation (17.8%
Conclusion: Aboriginal and/or Torres Strait Islander people were under‐reported in ANZDATA. There were multiple biases in characteristics and outcomes for people identified in ANZDATA compared with those identified by ERA using linked data. This highlights the importance of data integration as a quality improvement mechanism and identifying barriers to disclosure.
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Data sharing:
The data for this study will not be shared, as we do not have permission from the data custodians or ethics approval to do so. Data may be available upon request from the data custodians.
Angela Webster is supported by a National Health and Medical Research Council Leadership Fellowship (1177117). This study was supported by a University of Sydney External Research Collaboration Seed Funding Grant (CT34675). We thank ANZDATA and the NSW Ministry of Health for access to registry and population health data, and the Centre for Health Record Linkage for linking the datasets. We are grateful to the MHLL Aboriginal Sovereign Steering Committee, Samantha Bateman and the ANZDATA Aboriginal and Torres Strait Islander Health Working Group for helpful feedback and guidance.
No relevant disclosures.
Abstract
Objectives: To estimate and compare the costs and benefits of introducing a prison needle and syringe program in all Australian prisons.
Study design: Stochastic compartmental modelling study.
Setting: All Australian prisons, 1 January 2010 to 31 December 2030.
Intervention: Introduction of a prison needle and syringe program in all Australian prisons during 1 January 2025 – 1 January 2027, with the aim of covering 50% of people who inject drugs in prison by 1 January 2030.
Main outcome measures: Projected new hepatitis C virus (HCV) infections and hospitalisations with injection‐related bacterial and fungal infections in prisons, with and without the needle and syringe program; costs of the program; savings in treatment costs for HCV and injection‐related bacterial and fungal infections; benefit–cost ratio of the program.
Results: In the base scenario (no prison needle and syringe program), the projected number of new HCV infections during 2025–2030 was 2932 (uncertainty interval [UI], 2394–3507) and the projected number of hospitalisations with injection‐related bacterial and fungal infections was 3110 (UI, 2596–3654). With the prison needle and syringe program, it was projected that 894 (UI 880–912) new HCV infections (30%; UI, 26–37%) and 522 (UI, 509–532) hospitalisations with injection‐related bacterial and fungal infections (17%; UI, 15–20%) would be averted; the incidence of new HCV infections would be reduced from 3.1 (UI, 2.5–3.7) to 1.3 (UI, 1.0–1.7) per 100 person‐years among people who inject drugs in prison. The estimated cost of the program was $12.2 million (UI, $7.6–22.2 million), and the saved care costs for HCV and injection‐related infections were $31.7 million (UI, $29.3–34.6 million), yielding a benefit–cost ratio of 2.6 (UI, 1.4–4.1). The benefit–cost ratio was also greater than one for scenarios in which the assumptions and base values for several parameters were varied.
Conclusions: Each dollar spent on a needle and syringe program in Australian prisons could save $2.60 in treatment costs for HCV and other injection‐related infections.