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Objectives: To compare life expectancy at birth in Australia during 1980–2016 with that in other high income countries; to estimate the contributions of age at death and cause of death to differences between Australia and these countries.
Design, setting, participants: Data on deaths by age, sex, and cause in Australia and 26 other high income countries obtained from the Global Burden of Disease study.
Main outcome measures: Contributions of age, cause of death, and birth cohort to differences in life expectancy between Australia and other high income countries and to changes in the differences.
Results: From 1981 to 2003, life expectancy at birth increased rapidly in Australia, both in absolute terms and in comparison with other high income countries. The main contributor to greater increases for males in Australia than in western Europe was lower mortality from ischaemic heart disease; compared with the United States, mortality from ischaemic heart disease, cerebrovascular disease, and transport‐related injuries was lower. Since 2003, life expectancy has increased more slowly for both sexes than in most other high income countries, mainly because declines in mortality from cardiovascular disease and cancer have slowed. Age‐specific mortality for people born since the 1970s is higher in Australia than in most high income countries.
Conclusions: Recent declines in mortality in Australia have been relatively modest. Together with the high prevalence of obesity and the limited scope for further increasing life expectancy by reducing the prevalence of smoking, this suggests that future life expectancy increases will be smaller than in other high income countries. Improved control of health risk factors will be required if further substantial life expectancy increases in Australia are to be achieved.
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We acknowledge Mohsen Naghavi of the Institute of Health Metrics and Evaluation, University of Washington, for supplying the data analysed in our study.
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Prison‐based antiviral treatment for chronic hepatitis C is a critical element of the national elimination goal
In 2016, it was estimated 227 000 Australians had chronic hepatitis C virus (HCV) infection, with the majority infected through unsafe injecting drug use.1 The advent of direct‐acting antiviral (DAA) therapies for HCV infection, and their subsequent listing on the Pharmaceutical Benefits Scheme in March 2016, means that all Australians with chronic HCV, including prisoners, can access well tolerated, short course, highly curative treatments, regardless of how they acquire their infection or their disease stage. This universal access approach is supported by modelling that shows that increasing treatment uptake among people who inject drugs is an effective public health measure to reduce community prevalence due to the interruption of HCV transmissions.2 These elements underpin Australia's efforts to meet the World Health Organization goal to eliminate HCV as a public health threat by 2030, including key targets of a 90% decline in new infections, a reduction in HCV‐related mortality by 65%, and HCV treatment provision for 80% of those infected.3
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The manuscript of this article was prepared on behalf of the National Prisons Hepatitis Network and has been approved by the Network members. Margaret Hellard and Alexander Thompson are supported by National Health and Medical Research Council (NHMRC) Research Fellowships. Andrew Lloyd is supported by an NHMRC Practitioner Fellowship.
Timothy Papaluca has received speaker fees from MSD. Margaret Hellard has received investigator‐initiated support for hepatitis‐related research from Gilead Sciences, AbbVie and GSK. Alexander Thompson has received investigator‐initiated support for hepatitis‐related research from Gilead Sciences, AbbVie and Merck. He is a member of advisory boards for Gilead Sciences, AbbVie, MSD, Bristol‐Myers Squibb and Eisai, and has received speaker fees from Gilead Sciences, AbbVie, MSD and Bristol‐Myers Squibb. Andrew Lloyd has received investigator‐initiated support for prisons hepatitis‐related research from Gilead Sciences and MSD.
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No relevant disclosures.
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Bruce Campbell has received research support from the National Health and Medical Research Council (GNT1043242, GNT1035688), the Royal Australasian College of Physicians, the Royal Melbourne Hospital Foundation, the National Heart Foundation and the Stroke Foundation. He has received unrestricted grant funding for the EXTEND‐IA trial to the Florey Institute of Neuroscience and Mental Health from Medtronic. He co‐chaired the 2017 Australian Stroke Guidelines content working party.
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A 26‐year‐old refugee from Myanmar was referred to the infectious diseases unit of an Australian teaching hospital for assessment of suspected recurrent pulmonary tuberculosis (TB). He had arrived in Australia 3 months earlier, after spending the preceding 5 years in Malaysia. He was diagnosed with presumed pulmonary TB in Malaysia in 2013, in the context of a productive cough and suspicious chest x‐ray findings, without microbiological confirmation. He completed treatment with 6 months of first line anti‐TB therapy (2 months of rifampicin, isoniazid, pyrazinamide and ethambutol, followed by 4 months of rifampicin and isoniazid).
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David Griffin and Khai Huang contributed equally to the authorship of this manuscript. We would like to thank the staff in the Department of Microbiology at Melbourne Health.
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Objective: To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region.
Design: Retrospective population‐based study of AKI events confirmed by changes in serum creatinine levels.
Setting, participants: Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end‐stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels.
Main outcome measures: Age‐specific AKI rates; principal and other diagnoses.
Results: 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9–61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281–367) per 100 000 population; 92 events (28%) were in people aged 15–44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one‐third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis.
Conclusion: The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community‐acquired AKI; applying pathology‐based criteria could improve the detection of AKI.
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We thank Julia Marley (Kimberley Research, University of Western Australia) for critically reviewing our manuscript.
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Objective: To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10‐year period.
Design, setting, participants: Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007–2016.
Main outcomes and measures: Temporal trends in population‐based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more).
Results: There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17–1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99–1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4–15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in‐hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths).
Conclusions: Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post‐discharge care, and support.
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We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing Victorian State Trauma Registry data. We also thank Sue McLellan for her assistance with providing the data. The VSTR is funded by the Department of Health and Human Services, Victoria and the Transport Accident Commission. Ben Beck was supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE180100825). Peter Cameron was supported by a National Health and Medical Research Council Practitioner Fellowship (545926). Warwick Teague's role as director of trauma services was supported by a grant from the Royal Children's Hospital Foundation. Belinda Gabbe was supported by an Australian Research Council Future Fellowship (FT170100048).
No relevant disclosures.
Immunisation providers should offer annual influenza vaccination for children aged 6 months to 5 years and report it to the Australian Immunisation Register
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Summary