Socioeconomic status and heart failure in Sydney.

BACKGROUND: Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. METHODS: Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 1999-2003. Standardised rates were analysed according to patients' residential local government area and correlated with an index of socioeconomic disadvantage. RESULTS: Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. CONCLUSIONS: Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health.

General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population.

This paper aimed to examine the utilisation of and preferences related to health care services by residents of a disadvantaged area and to identify factors associated with levels of current and future use. Data were collected from face-to-face structured interviews of randomly selected residents of a disadvantaged local government area in 2003-04. Information about respondents' health and socioeconomic status and patterns of use and preferred features of health care was analysed in PASW Statistic 17. Chi-square statistics were used to examine differences in utilisation by sex and simple logistic regression provided sex specific age-adjusted odds ratios about frequent visits. Most respondents (95%) attended a 'usual' general practitioner (GP) service and about two-fifths had obtained other health care in the last 12 months. The median number of visits was four and most providers offered bulk billing (83%). Less common were visits to the dentist (32%), emergency department (14%), specialists (29%) and the hospital (5%). Providers' skills and traits, physical access and bulk billing were key considerations for men and women when choosing a health care provider. Disadvantaged communities want skilled practitioners who reflect their demographic mix and are located at convenient and accessible clinics, which preferably bulk bill. Apart from GP visits, this group appears to make only moderate use of specialists and emergency departments, and little routine use of other primary health services.

Who has regular mammograms? Effects of knowledge, beliefs, socioeconomic status, and health-related factors.

BACKGROUND: Breast cancer accounts for the largest proportion of female cancer deaths and new cases in New South Wales (NSW). Biennial screening is recommended for women aged 50-69 years. Objectives were to (1) identify associations between beliefs and knowledge about breast cancer and mammography, socioeconomic (SES) indicators, and health-related factors, and having a mammogram (a) ever and (b) within the last 2 years; and (2) describe utilization of mammography. METHODS: 2974 women aged 50-69 years selected from the BreastScreen NSW (BSNSW) database and the NSW Electoral Roll were administered a structured telephone survey. Associations were assessed using weighted Chi squares and age-adjusted odds ratios from logistic regression with 95% confidence intervals. RESULTS: Strong positive associations were found between age, married/de facto relationship, knowledge about and belief in the benefits of screening, indicators of health status and service utilization, and whether women had had a mammogram or had one within the recommended period. SES was weakly associated with regularity of mammography. Most respondents (97.4%) reported having had at least one mammogram. CONCLUSIONS: Specific aspects of knowledge and beliefs about mammograms and individual health-related factors would be important components of initiatives to encourage initial and repeat screening in the targeted age group.

An environmental intervention to promote walking and cycling--the impact of a newly constructed Rail Trail in Western Sydney.

BACKGROUND: Few studies have evaluated environmental changes to promote physical activity. The impact of a local promotional campaign around a newly constructed Rail Trail in western Sydney, Australia, was assessed. METHODS: Pre and post-campaign telephone surveys were used. Adults 18-55 years of age were randomly sampled from an "inner" area, residents within < or =1.5 km of the Trail, and an "outer" area, bike-owners only, 1.5-5 km from the Trail. Objective concurrent monitoring of daily bike counts was carried out. RESULTS: A cohort of 450 completed both interviews. A significant increase (+2.9%, McNemar P < 0.05) in unprompted Trail awareness was detected but post-campaign awareness was low (34%). Inner cyclists, males, and those recalling any baseline bike promotion messages were more likely to be aware of the Trail. Trail usage was higher among bike-owners than pedestrians (8.9 vs 3.3%, P = 0.014) and was moderated by proximity to the Trail. Inner cyclists increased mean cycling time by 0.19 h (SD = 1.5) while outer cyclists decreased cycling time (-0.24 h, SD = 1.6). Mean daily bike counts in the monitored areas increased significantly after the Trail launch (OR = 1.35, P = 0.0001, and OR = 1.23, P = 0.0004). CONCLUSIONS: The campaign reached and influenced cyclists in the inner area. For further increase in Trail usage promotional and educational programs focusing on walking for inner residents are needed.

Predictors of non-attendance from BreastScreen NSW in women who report current mammography screening.

OBJECTIVE: To identify among self-reported current screeners: (1) predictors of never attendance at BreastScreen NSW (BSNSW); (2) predictors of late or lapsed attendance to BSNSW (attendance to alternative providers). METHODS: Random samples of women aged 50-69 years were selected from the BSNSW database and NSW electoral roll as: current attenders to BSNSW (<27 months since last screen); late or lapsed attenders to BSNSW (>27 months since last screen); or women who had never attended BSNSW. The response rate was 71% (3,104) for a telephone interview that asked questions concerning demographics, medical status and health service usage, and opinions and behaviours related to mammography. RESULTS: Never attendance at BSNSW was predicted by higher income, advice from a doctor or nurse to have their last mammogram, recent clinical breast examination and belief that a referral letter is necessary. Late or lapsed attendance to BSNSW (and attendance to alternate providers) was associated with higher education, health insurance coverage, recent clinical breast examination and a family history of breast cancer. CONCLUSIONS: Currently screened women who do not attend BSNSW, or who are late or lapsed for a mammogram, appear to be influenced by referral patterns of their health care providers and their higher socio-economic status. IMPLICATIONS: BSNSW should be promoted to eligible women and general practitioners as a specialty mammography screening service that does not require a referral.

Vascular health risks in the Aboriginal community. A cultural approach.

BACKGROUND: Diabetes, heart disease and other vascular diseases are a great problem in Aboriginal communities and there are many reasons for this. As a health professional it is easy to feel overwhelmed by both the magnitude of the problem and the feeling that it is just too hard when patients don't seem to take charge of their own health. OBJECTIVE: This article aims to outline the increased vascular disease and vascular risk factors in the Aboriginal community and explore some of the historical, socio-economic, cultural and genetic reasons for this. The barriers to health care and self management are discussed and some positive developments in the area of Aboriginal vascular health are noted. DISCUSSION: To improve health outcomes we need to focus on two parts of the same problem. First, we need to tackle the vascular diseases at their roots--the vascular risk factors. Second, we need to look at ways to promote self management so that our patients can identify personal barriers to self care and be partners in their health care. There is evidence that better organised systems of care, such as recall systems and improved screening systems, are very beneficial. The most successful interventions are culturally appropriate and developed and implemented with Aboriginal community control.