Australias Health: vital statistics, vital signs weighing up our health and health system

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Australias Health vital statistics, vital signs
weighing up our health and health system

• Cardiovascular disease and diabetes concerns and
  considerations

Annette Dobson, School of Population Health,
University of Queensland
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National Centre for Monitoring Cardiovascular
Disease at AIHW

• Not a disease registry (c.f. cancer, diabetes)
• Alternative, more cost effective way of
  monitoring major chronic disease using routinely
  collected data (e.g. death and hospital data)
  and national surveys
• Focus on specific conditions allows
• development of content expertise
• key partnerships, e.g Heart Foundation

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What can AIHW data tells us about CVD in
Australia at beginning of 21st century?

• Compare CVD experience of men and women using
• national mortality data
• hospital separations by principal diagnosis
  (ICD)
• hospital separations by DRG (including
  procedures)

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Death rates from CHD and stroke, 19502002
Number per 100,000 population age standardised
to Australian population
Source Australian Institute of Health and
Welfare, Heart, stroke and vascular diseases,
Australian facts 2004.
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Numbers of deaths, Australia, 2001
CVD is no longer a major cause of death except in
people aged 75
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Death rates, Australia, 2001
Men
Women
Death rates from CVD are not very different
between men and women aged 75
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Numbers of hospital separations by ICD codes,
Australia, 2001-2
Men
Women
Most hospital separations for IHD (ACS and
related procedures) are for men aged 55-79
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Numbers of procedures by DRG, Australia, 2001-02
Men
Women
Similar numbers of PTCA and CABG, but more
procedures in men than women
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Numbers of separations by DRG, Australia, 2001-02
Men
Women
Heart failure is the most common cause of
hospitalisation for CVD in people aged 70,
especially women
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Emerging picture

• In Australia CVD is now a disease of the elderly
• Diverging patterns for men and women
• Men develop ACS and undergo procedures
• Women develop heart failure

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What do these patterns mean for monitoring CVD ?

• Need to understand better
• development and progression of CVD in the elderly
• impact of changing epidemiology of CVD on people
  and on the health system

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How can this be done cost effectively ?

• Record linkage
• Within and between hospitals - readmissions
• Within and between doctors e.g. using Medicare
  data
• Between doctors and hospitals
• Pharmaceuticals using PBS

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What are the threats to continued monitoring CVD
in Australia ?

• Unwillingness of governments to support this cost
  effective monitoring system
• Broad-banding with other chronic conditions
  potentially leading to
• Loss of focus
• Loss of content expertise
• Weakening of partnerships, e.g., Heart Foundation
• Lack of public confidence in record linkage
• Turf warfare between agencies over record linkage

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Wish list for continued monitoring of CVD in
Australia

• Secure funding for the National Monitoring Centre
  at AIHW
• Agreed uniform approach to health record linkage
  to improve individual patient care and to improve
  understanding evolving epidemiological patterns
  of disease