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Methods for indicator: Immunised against influenza or pneumococcal disease
Because influenza immunisation significantly reduces morbidity and preventable mortality, it is recommended and funded for all people aged 65 years and over, Aboriginal and Torres Strait Islander people aged 15 years and over, pregnant women, and people aged 6 months or over with conditions predisposing to severe influenza.
The indicator includes those aged 65 years and over who have been immunised against influenza in the last 12 months. The questions used to define the indicator were: Were you vaccinated or immunised against flu in the last 12 months?
NSW Population Health Survey
The NSW Ministry of Health has conducted the Adult Population Health Survey (since 1997) and the Child Population Health Survey (since 2001) through the New South Wales Population Health Survey, an ongoing survey of the health of people in NSW using computer-assisted telephone interviewing (CATI). The main aims of the surveys are to provide detailed information on the health of adults and children in NSW and to support planning, implementation and evaluation of health services and programs in NSW.
The survey instruments include question modules on health behaviours, health status, and other associated factors. The methods and all questions are approved for use by the NSW Population and Health Services Research Ethics Committee. The instrument is translated into 5 languages: Arabic, Chinese, Greek, Italian and Vietnamese.
The target population for the survey is all state residents living in private households. The target sample was approximately 1,000 persons in each of the health administrative areas (total sample 8,000-16,000 depending on the number of administrative areas).
From 1997 to 2010 the random digit dialling (RDD) landline sampling frame was developed as follows. Records from the Australia on Disk electronic white pages (phone book) were geo-coded using MapInfo mapping software. The geo-coded telephone numbers were assigned to statistical local areas and area health services. The proportion of numbers for each telephone prefix was calculated by area health service. All prefixes were expanded with suffixes ranging from 0000 to 9999. The resulting list was then matched back to the electronic phone book. All numbers that matched numbers in the electronic phone book were flagged and the number was assigned to the relevant geo-coded area health service. Unlisted numbers were assigned to the area health service containing the greatest proportion of numbers with that prefix. Numbers were then filtered to eliminate continuous non-listed blocks of greater than 10 numbers. The remaining numbers were then checked against the business numbers in the electronic phone book to eliminate business numbers.
From 2011 onwards the RDD landline sampling frame was developed as follows: Australian Communications and Media Authority exchange district and charge zone prefixes were generated for each of the strata (that is Local Health Districts introduced in January 2011) using “best fit” postcode (ACMA 2011). All prefixes were expanded with suffixes ranging from 0000 to 9999. The sample was then randomly ordered within each stratum. The estimated numbers required for each stratum was then forwarded to Sampleworx, who used proprietary software to test each numbers current status (valid, invalid or unknown and business, non-business or unknown). The resulting valid non-business and valid unknown numbers were used for the survey.
From 2012 onwards mobile only phone users were included into the surveys using an overlapping dual-frame design, which incorporates three groups of respondents: landline only users, mobile only users and landline and mobile users.
The RDD mobile sampling frame was developed by Sampleworx and included using all known Australian mobile prefixes. Sampleworx used proprietary software to test each number to identify valid and invalid numbers. A random sample of valid mobile numbers was then provided for use for the survey.
The introduction of this design was prompted by the increasing numbers of mobile-only phone users in the general population. Because this design increases the representativeness of the survey sample the production of unbiased estimates over time is also improved. The improvement has been confirmed by an analysis of unweighted estimates, which indicated that a greater proportion of younger people, of males, and of people born overseas participated in the mobile sample compared with the landline sample. Further, comparison of the demographic characteristics of the survey sample for the first quarter of 2012 with the NSW population showed that the NSW Population Health Survey was more representative of the NSW population than the previous sample (Barr et al. 2012).
Due to this change in design, the 2012 NSW PHS estimates reflect both changes that have occurred in the population over time and changes due to the improved design of the survey.
When considering significant differences over time excluding the 2010 and 2011 data points ensures that all of the estimates are from sampling frames that had adequate coverage of the population, that is 85% or more.
When the Australia on Disk electronic white pages became available, reliable introductory letters were sent to the selected households (1997 to 2008). Households were contacted using random digit dialling. Depending on the frame either one person from the household was randomly selected or the mobile phone holder was selected for inclusion in the survey.
Interviews are carried out continuously between February and December each year. An 1800 freecall contact number and website details are provided to potential respondents, so they can verify the authenticity of the survey and ask any questions regarding the survey. Trained interviewers at the Health Survey Program CATI facility carried out interviews. Up to 7 calls were made to establish initial contact with a household, and up to 5 calls were made in order to contact a selected respondent.
For analysis, the survey sample was weighted to adjust for differences in the probabilities of selection among respondents. Post-stratification weights were used to reduce the effect of differing non-response rates among males and females and different age groups on the survey estimates. These weights were adjusted for differences between the age and sex structure of the survey sample and the Australian Bureau of Statistics latest mid-year population estimates (excluding residents of institutions) for each health administrative area.
Call and interview data were manipulated and analysed using SAS version 9.2 (SAS). The Taylor expansion method was used to estimate sampling errors of estimators based on the stratified random sample. The 95 per cent confidence interval provides a range of values that should contain the actual value 95 per cent of the time.
Estimates were smoothed using least-squares spline transformation (CEE, Adult survey methods: web page).
Further information on the methods and weighting process is provided elsewhere (CEE, Child survey methods: web page).
Australian Communications and Media Authority (ACMA). Communications report 2010-11 series: Report 2 – Converging communications channels: Preferences and behaviours of Australian communications users. Commonwealth of Australia, 2011. Available at www.acma.gov.au/webwr/_assets/main/lib410148/report2-convergent_comms.pdf
Barr ML, Ritten JJ, Steel DG, Thackway SV. ‘Inclusion of mobile phone numbers into an ongoing population health survey in New South Wales, Australia: design, methods, call outcomes, costs and sample representativeness’. BioMed Central: Medical Research Methodology 2012, 12:177 (22 November, 2012). Available at www.biomedcentral.com/1471-2288/12/177.
Centre for Epidemiology and Evidence. NSW Adult Population Health Survey Methods. CEE, NSW Ministry of Health. http://www.health.nsw.gov.au/surveys/adult/Pages/default.aspx
Centre for Epidemiology and Evidence. NSW Child Population Health Survey Methods. CEE, NSW Ministry of Health. http://www.health.nsw.gov.au/surveys/child/Pages/default.aspx
PitneyBowes Software. MapInfo (software). PBS as MapInfo Corporation: version 1997. Available at www.pbinsight.com.au
Sampleworx Pty Ltd. Available at www.sampleworx.com.au.html
SAS Institute. The SAS System for Windows version 9.2 (software). Cary, NC: SAS Institute Inc., 2009. Available at www.sas.com
United Directory Systems. Australia on Disk (software). UDS: version 2004. Available at www.uniteddirectorysystems.com
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Key points: Influenza and pneumonia
Influenza and pneumonia are a group of acute respiratory infections that can be very severe and, in persons at high risk, lead to death. They are usually presented together as influenza can lead to pneumonia and, in most cases of hospitalisation and death from pneumonia, the responsible organism is not identified. Each year, 75-85 % of all hospitalisations for influenza and pneumonia are due to 'unspecified pneumonia'.
Severe virus-related complications of influenza require hospitalisation and threaten life most frequently in the very young and elderly (children under 1 year old and persons over 65) and among persons with chronic heart or, especially, lung conditions. Appropriate antibacterial therapy decreases the mortality rate from secondary bacterial pneumonia.
In 2009, the WHO recommended that ICD-10-AM J09 code be used to cover influenza A/H1N1 (initially called ‘swine flu’) responsible for the pandemic 2009 and the code has been added to the set of codes relevant here.
There were 25,302 hospitalisations due to influenza and pneumonia in 2011-12 (313.0 per 100,000 population), of which 14,013 were patients aged 65 years and older (1,262.9 per 100,000 population in that age group). Males accounted for almost 53% of all influenza and pneumonia hospitalisations.
There were 788 deaths from influenza and pneumonia in 2011 (8.4 deaths per 100,000 population) and almost 92% of these were in persons aged 65 years and over (60.4 deaths per 100,000 population in that age group). Death rates from influenza or pneumonia are very low in all other age groups. The death rate in 2009 was the lowest since 1993 for all ages and for people aged 65 years and older. A slight increase was subsequently observed in years 2010 and 2011.
Introduction: Respiratory disease
Respiratory diseases include acute diseases, such as influenza and pneumonia, and chronic respiratory diseases (specifically asthma, chronic obstructive pulmonary disease, asbestosis, and respiratory tuberculosis), where preventive measures and better management of conditions can reduce the burden of disease and reduce associated healthcare costs. Respiratory diseases, including lung cancer, were together responsible for around 14% of all deaths in NSW in the period 2003 to 2007, and about 5% of hospital separations in 2008-09.
Chronic respiratory diseases were responsible for 7.1% of total burden of disease and injury in Australia in 2003, with chronic obstructive pulmonary disease and asthma accounting for 46% and 34% of this burden, respectively (Begg et al. 2007).
Influenza and pneumonia
Influenza and pneumonia are acute respiratory diseases that can be very severe and, in persons at high risk, can lead to death. Influenza and pneumonia cause around 1.8% of all deaths and around 0.9% of hospital separations and are an important cause of hospitalisations in the very young, and of death and hospitalisations among older age groups.
Asthma is a significant public health problem in Australia and it is estimated that Australian prevalence rates are among the highest in the world. Fortunately, recent studies in children show no further increase in prevalence. The overall prevalence of asthma reported in Australia was 9.9%, down from 11.6% in the 2001 ((ABS Cat. no. 4364.0 2009). Among children asthma is the most prevalent long term condition in Australia. In Australia in 2003, asthma was estimated to account for 2.3% of the disease burden (Begg et al. 2007).
Chronic obstructive pulmonary disease
Chronic bronchitis and emphysema are the two main conditions comprising chronic obstructive pulmonary disease (COPD). In Australia in 2003, COPD was estimated to account for 2.9% of the disease burden.
Tuberculosis (TB) is caused by the bacterial organism Mycobacterium tuberculosis. Despite the increasing burden from respiratory tuberculosis globally, it is not a major public health problem in NSW. In fact the mortality and morbidity from all types of tuberculosis in NSW is one of the lowest in the world.
Lung cancer is excluded from analyses of respiratory diseases, as it is classified with cancers, and not with respiratory diseases, in the International Classification of Diseases (the coding system used for health data in NSW). However, some indicators analysing respiratory diseases explicitly include lung cancer to provide a more appropriate measure of the burden of respiratory disease from a clinical and health services planning perspective.
Cigarette smoking is the main risk factor for both COPD and lung cancer and the current incidence rates of these conditions reflect smoking rates 20 years and more in the past. Lung cancer is one of the leading causes of death in Australia.
Australian Bureau of Statistics. National Health Survey: Summary of Results, 2007-2008 (Reissue). Cat. no. 4364.0. Canberra: ABS, 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0/
Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. http://www.aihw.gov.au/publication-detail/?id=6442467990
Interventions: Respiratory diseases
Potentially preventable hospitalisations for chronic conditions
The most common chronic conditions defined as potentially preventable hospitalisations or ambulatory care sensitive hospitalisations are included in the NSW Chronic Disease Management Program (MoH, 2014).
In response to the Garling Report 2008, the NSW Department of Health implemented the NSW Severe Chronic Disease Management Program. The continuation of this program, the Chronic Disease Management Program, is being overseen by the NSW Ministry of Health and NSW Agency for Clinical Innovation. The program provides care coordination and self-management support to help people with chronic disease to better manage their condition and access appropriate services in order to improve health outcomes, prevent complications and reduce the need for hospitalisation.
The Chronic Diseases Management Program targets five major chronic diseases of interest that are recognised as having a major impact on the burden of disease in NSW. Furthermore, these conditions have been demonstrated to have improved outcomes through CDM approaches. The diseases of interest are Chronic Obstructive Pulmonary Disease (mainly emphysema and chronic bronchitis); Coronary Heart Disease (also known as coronary or ischaemic heart disease); Diabetes; Hypertension (high blood pressure); and Congestive Heart Failure.
People who are diagnosed with these diseases and who are experiencing repeated episodes in hospitalisation are offered enrolment to the program. People with these conditions, who are not being admitted to hospital frequently but experience difficulties in managing their conditions, are also eligible for enrolment. The focus is on prevention of deterioration, recognising that people suffering from these diseases often have comorbidities such as depression, arthritis and dementia.
Written asthma management plans are recommended as part of the national guidelines for the management of asthma: Asthma handbook (NACA 2014). They enable people with asthma to recognise a deterioration in their condition and initiate appropriate treatment, thereby reducing the severity of acute episodes.
The Asthma handbook promotes preventive care activities, proper inhaler technique and adherence and stepped medical management where the use of medicines can be increased or decreased depending on circumstances and the therapy combinations.
The NSW Tuberculosis Program is successful as the incidence of tuberculosis in NSW remained stable over the last decade despite large-scale migration from high-prevalence countries and the treatment success rates have been high, with the absence of treatment failures and low rates of relapse of cases initially treated in Australia.
The main challenges to the NSW Tuberculosis Program are similar to those that face tuberculosis control globally. They include control of multi-drug resistant and extreme drug-resistant tuberculosis and identification and management of tuberculosis-HIV coinfection (O'Connor et al. 2009).
Influenza and Pneumonia
Influenza and pneumococcal disease are covered by the National Immunisation Programs in NSW.
Influenza has been a notifiable disease by all laboratories under the Public Health Act in NSW since 2001. Surveillance is enhanced in winter months when the NSW Department of Health collects and reports weekly on influenza-like illness presentations to Emergency Departments , through the Public Health Real-time Emergency Department Surveillance System (PHREDSS), and laboratory confirmed diagnoses of influenza virus infections.
Emergency Departments in NSW are prepared for influenza epidemics with peak visit plans and similar measures in winter months.
NSW Ministry of Health. Chronic Disease Management Program. Sydney: NSW Ministry of Health, 2014. http://www.health.nsw.gov.au/cdm/pages/default.aspx
National Asthma Council Australia. Asthma handbook. NACA, 2014 http://www.nationalasthma.org.au/news-media/d/2014-03-04/new-national-asthma-management-guidelines-released
O'Connor B, Fritsche L, Christensen A, McAnulty J. EpiReview: Tuberculosis in New South Wales, 2003-2007. 2009. Available at www.publish.csiro.au/index.cfm?act=view_file&file_id=NB09001.pdf
For more information: Respiratory diseases
Useful websites include:
Australian Centre for Asthma Monitoring at http://www.asthmamonitoring.org
National Asthma Council Australia at http://www.nationalasthma.org.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au