The impact of single gene and chromosomal disorders on hospital admissions of children and adolescents: a population-based study.

BACKGROUND: It is well recognized that genetic disease makes a significant contribution to childhood illness. Here, we present recent population data describing the impact of single gene and chromosomal disorders on hospital admissions of children and adolescents. METHODS: Hospital admissions for patients aged 0-19 years between 2000 and 2006, with a single gene or chromosomal disorder, were extracted from the Western Australian Hospital Morbidity Data System using 296 diagnosis codes identified from the International Statistical Classification of Diseases, Tenth Revision, Australian Modification. Data extracted for each patient included the number, length and cost of all admissions. RESULTS: Between 2000 and 2006, 14,197 admissions were identified for 3,271 patients aged 0-19 years with single gene and chromosomal disorders, representing 2.6% of admissions and 4.3% of total hospital costs in this age group. Patients with genetic disorders had more admissions and stayed longer in hospital than patients admitted for any reason. Specific disorders associated with a high demand on hospital services included cystic fibrosis, Down syndrome, osteogenesis imperfecta, thalassemia, and von Willebrand's disease. CONCLUSIONS: Children and adolescents with single gene and chromosomal disorders placed higher demands on hospital services than other patients in their age group, but were responsible for a relatively small proportion of hospital admissions and costs. These data will enable informed planning of health care services for patients with single gene and chromosomal disorders in Western Australia.

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long-term trends.

BACKGROUND: Exacerbations requiring hospital admission for chronic obstructive pulmonary disease (COPD) contribute to a decline in health status and are costly to the community. Long-term trends in admissions and associated outcomes are difficult to establish because of frequent readmissions, high case fatality and potential diagnostic transfer between COPD and asthma. The Western Australian Data Linkage System provides a unique opportunity to examine admissions for patients with COPD over the long term. METHOD: Nineteen years of hospital morbidity data, based on International Classification of Diseases-9 criteria were extracted from the Western Australian Data Linkage System (1980-1998) and merged with mortality records to examine trends in hospital admissions for COPD. RESULTS: The rate of hospital admissions for COPD has declined overall and the rate of first presentation declined in men and remained constant in women. The risk of readmission increased throughout the period (P < 0.0001) and more than half of all admissions were followed by readmission within a year. Median survival following first admission was 6 years (men 5 years; women 8 years). Age, sex and International Classification of Diseases subcategory each showed an independent effect on the risk of mortality (P < 0.0001). The poorest survival was in patients subcategorized as emphysema. For patients with multiple admissions, the likelihood of cross-over between COPD and asthma was high and increased with the total number of admissions. CONCLUSION: The rate of admission for COPD has declined in Western Australia; however, the resource burden will continue to increase because of the ageing population. This has policy implications for the development of acute care treatment programmes for COPD.

Health related migration: evidence of reduced "urban-drift".

The aim of this study was to determine if the onset of serious disease triggers a different intra-state migratory response from patterns observed in the healthy population. The analysis was carried out using linked administrative data. The onset of serious disease triggered a reduction in the rate of endocentric migration in remote and rural populations. Urban drift occurred only in people with mental illness in rural locations. Rural and remote communities appear to suffer from an unhealthy selection force, with persons unable to migrate centrally to access services due to the onset of the physical illness they require treatment for.

Validation of linked administrative data on end-stage renal failure: application of record linkage to a 'clinical base population'.

OBJECTIVE: To evaluate the use of record linkage to monitor the occurrence of end-stage renal failure in Western Australia in 1980-94. METHODS: A clinical base population of 1,046 patients was identified from the Western Australian (WA) Health Services Research Linked Database. To exclude acute renal failure, patients were selected if they received in-hospital renal dialysis on more than 10 occasions over more than 28 days in 1980-94. Estimates of annual incident and prevalent cases were validated against the ANZDATA dialysis and transplant register. Reasons for discrepancy were investigated by an ad hoc linkage between the two data sources. RESULTS: The WA Linked Database counted slightly fewer incident cases (-7%) and slightly more prevalent cases (+7%) than the ANZDATA Register. The Linked Database identified 97% of cases on the ANZDATA Register, but this fell to 83% post case definition, probably due to patients receiving home-based dialysis failing to meet our case definition. ANZDATA correctly identified 90% of cases in the linked file. CONCLUSION: Trends in end-stage renal failure from 1986 to 1994, based on the Linked Database, were the same as those reported from purpose-designed disease registers. IMPLICATIONS: Linked administrative data provide a valid and efficient means to plan and evaluate many of the routine aspects of renal dialysis and transplant services.

Hospitalisation of the elderly during the last year of life: an application of record linkage in Western Australia 1985-1994.

STUDY OBJECTIVE: To measure the trend, pattern, and cost of time spent in hospital during the last year of life in Western Australia and to identify trends in the place of death. The results were compared with those reported from the Oxford Record Linkage Study. DESIGN: Mortality records for those aged 65 years and over were linked to inpatient hospital morbidity records with a date of separation within one year before death. Comparative inpatient resource utilisation was estimated using ANDRG 3.0 cost weights for Australian public hospitals. SETTING: Western Australia. PARTICIPANTS: All 68,875 persons aged 65 years and over who died between 1 January 1985 and 31 December 1994. MAIN RESULTS: Increasing proportions of all age groups (65-74, 75-84, and 85+ years) were admitted to hospital at least once in the year before death during 1985-94, but the chance of admission decreased with age. There was a trend towards a greater number of shorter admissions per person. Total bed days per person showed no significant increase, except at ages 65-74 years. Total inpatient resource utilisation during the last year of life was lowest and remained constant in those aged 85 years and over, while increasing gradually (3.7% per annum) in the younger elderly. The Western Australian population spent more time in hospital in the last year of life at ages 65-74 years, but the advanced elderly spent less time in hospital, when compared with the Oxford Region. CONCLUSIONS: Recent gains in life expectancy and higher per capita health expenditure have not been accompanied by more time spent in hospital during the last year of life at ages 75+ years. International differences between Western Australia and Oxford can be explained by differences in aged care provision.