Topics

Abstract

Objectives: To estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale.

Design: Health impact assessment (excess annual mortality and financial costs) based upon atmospheric PM_2.5 measurements.

Setting: Armidale, a regional Australian city (population, 24 504) with high levels of air pollution in winter caused by domestic wood heaters, 1 May 2018 – 30 April 2019.

Main outcome measures: Estimated population exposure to PM_2.5 from wood heaters; estimated numbers of premature deaths and years of life lost.

Results: Fourteen premature deaths (95% CI, 12–17 deaths) per year, corresponding to 210 (95% CI, 172–249) years of life lost, are attributable to long term exposure to wood heater PM_2.5 pollution in Armidale. The estimated financial cost is $32.8 million (95% CI, $27.0–38.5 million), or $10 930 (95% CI, $9004–12 822) per wood heater per year.

Conclusions: The substantial mortality and financial cost attributable to wood heating in Armidale indicates that effective policies are needed to reduce wood heater pollution, including public education about the effects of wood smoke on health, subsidies that encourage residents to switch to less polluting home heating (perhaps as part of an economic recovery package), assistance for those affected by wood smoke from other people, and regulations that reduce wood heater use (eg, by not permitting new wood heaters and requiring existing units to be removed when houses are sold).

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1 University of New England, Armidale, NSW
2 Sydney Medical School, University of Sydney, Sydney, NSW
3 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
4 University Centre for Rural Health, Lismore, NSW

Correspondence: drobin27@une.edu.au

Acknowledgements:

We thank the NSW Office of Environment and Heritage for installing an air pollution monitoring station in Armidale and assisting with the installation of PurpleAir units (for checking and calibration) on the roof of the monitoring station, and the Armidale Regional Council for purchasing and installing further PurpleAir units.

Competing interests:

No relevant disclosures.

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Editorials

Opioid prescribing in Australia: too much and not enough

Adrian J Dunlop, Buddhima Lokuge and Nicholas Lintzeris

Med J Aust 2021; 215 (3): . || doi: 10.5694/mja2.51180
Published online: 2 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Pharmaceutical preparations

Substance-related disorders

Mental disorders

A comprehensive and coordinated approach to overdose prevention by national and state governments and professional groups is needed

Opioid prescribing in Australia has increased steadily over the past three decades.1,2 Each time a new opioid formulation becomes available, it is enthusiastically prescribed. Ten opioids are currently approved by the Therapeutic Goods Administration for pain management, and there are more than 126 different formulations.3

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1 Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW
2 University of Newcastle, Newcastle, NSW
3 University of Sydney, Sydney, NSW
4 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW

Correspondence: Adrian.Dunlop@health.nsw.gov.au

Acknowledgements:

Buddhima Lokuge holds a Hunter New England Local Health District/University of Newcastle General Research Fellowship.

Competing interests:

Nicholas Lintzeris has served on the advisory boards for GW Pharmaceuticals, Indivior, and Mundipharma, received speaker’s honoraria from Chiesi Pharmaceuticals and Mundipharma, and received research‐related funding from Braeburn Pharmaceuticals/Camurus.

Adrian Dunlop has served (in an honorary capacity) on the advisory board for Mundipharma; his organisation has received research‐related funding from Braeburn Pharmaceuticals/Camurus (manufacturers of buprenorphine), and he served as an honorary investigator in an Indivior‐funded study of buprenorphine‒naloxone products.

1. Karanges EA, Blanch B, Buckley NA, Pearson SA. Twenty-five years of prescription opioid use in Australia: a whole-of-population analysis using pharmaceutical claims. Br J Clin Pharmacol 2016; 82: 255–267.
2. Islam MM, McRae IS, Mazumdar S, et al. Prescription opioid analgesics for pain management in Australia: 20 years of dispensing. Intern Med J 2016; 46: 955–963.
3. NPS Medicinewise. Opioids: new and amended PBS listings. Updated 18 June 2020. https://www.nps.org.au/radar/articles/opioids-new-and-amended-pbs-listings#other-changes-and-information (viewed May 2021).
4. Adewumi AD, Maravilla JC, Alati R, et al. Opioid medication prescribing in Queensland, 1997–2018: a population study. Med J Aust 2021; 215: 137–138.
5. Roxburgh A, Hall WD, Gisev N, Degenhardt L. Characteristics and circumstances of heroin and pharmaceutical opioid overdose deaths: comparison across opioids. Drug Alcohol Depend 2019; 205: 107533.
6. Campbell G, Larance B, Gisev N, et al. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2019; 210: 6–8. https://www.mja.com.au/journal/2019/210/1/regulatory-and-other-responses-pharmaceutical-opioid-problem
7. Adewumi AD, Hollingworth SA, Maravilla JC, et al. Prescribed dose of opioids and overdose: a systematic review and meta-analysis of unintentional prescription opioid overdose. CNS Drugs 2018; 32: 101–116.
8. Penington Institute. Australia’s annual overdose report 2020. Melbourne: Penington Institute, 2020. https://www.penington.org.au/publications/2020-overdose-report (viewed May 2021).
9. International Narcotics Control Board. Narcotic drugs 2017. Estimated world requirements for 2018; statistics for 2016. New York: United Nations, 2018. https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2017/Narcotic_drugs_technical_publication_2017.pdf (viewed May 2021).
10. Lintzeris N, Wilson H. Take-home intranasal naloxone to prevent opioid overdose deaths. Medicine Today 2020; 21(4): 45–49.
11. Prathivadi P, Nielsen S. Should we be routinely co-prescribing naloxone for patients on long term opioids? Med J Aust 2021; 214: 403–404. https://www.mja.com.au/journal/2021/214/9/should-we-be-routinely-co-prescribing-naloxone-patients-long-term-opioids
12. Australian Department of Health. About the take home naloxone pilot. Updated 23 June 2021. https://www.health.gov.au/initiatives-and-programs/take-home-naloxone-pilot/about-the-take-home-naloxone-pilot (viewed June 2021).
13. Australian Department of Health. National real time prescription monitoring (RTPM). Updated 7 Jan 2021. https://www.health.gov.au/initiatives-and-programs/national-real-time-prescription-monitoring-rtpm (viewed June 2021).
14. Lee B, Zhao W, Yang KC, et al. Systematic evaluation of state policy interventions targeting the US opioid epidemic, 2007–2018. JAMA Netw Open 2021; 4: e2036687.
15. Pitt AL, Humphreys K, Brandeau ML. Modeling health benefits and harms of public policy responses to the US opioid epidemic. Am J Public Health 2018; 108: 1394–1400.

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Editorials

Update on voluntary assisted dying in Australia

Cameron J McLaren and Greg Mewett

Med J Aust 2021; 215 (3): . || doi: 10.5694/mja2.51152
Published online: 2 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

More research is needed to ensure safe and unimpeded access for eligible applicants and to inform practice

We now have two years’ experience in providing voluntary assisted dying to terminally ill patients in Victoria. Western Australian legislation will come into force on 1 July 2021; Tasmanian legislation has received Royal assent, and the early stages of implementation are underway. The South Australian Voluntary Assisted Dying Bill has been passed by both Houses and may have been sent for Royal assent by the time this article is published. The Queensland Law Reform Commission report and draft bill1 were tabled in parliament on 18 May 2021; a bill is expected to be tabled in the New South Wales parliament in late 2021. There have been calls for the Commonwealth to repeal the Euthanasia Laws Act 1997 to reinstate Australian territories’ rights to debate voluntary assisted dying legislation.

1 Monash University, Melbourne, VIC
2 Monash Health, Melbourne, VIC
3 Ballarat Health Services, Ballarat, VIC

Correspondence: cameron.mclaren@monash.edu

Competing interests:

No relevant disclosures.

1. Queensland Law Reform Commission. Voluntary assisted dying review. May 2021. https://www.qlrc.qld.gov.au/recently-completed-reviews#VAD (viewed May 2021).
2. National Health and Medical Research Council. Archived grant opportunity view: GO4309. GrantConnect, 2 Sept 2020. https://www.grants.gov.au/Go/Show?GoUuid=c4f4fb0a-d551-3d14-8c4c-64c88301fdd4 (viewed May 2021).
3. Willmott L, White BP, Sellars M, Yates PM. Participating doctors’ perspectives on the regulation of voluntary assisted dying in Victoria: a qualitative study. Med J Aust 2021; 215: 125–129.
4. Voluntary Assisted Dying Review Board. Report of operations July‒December 2020. Updated Mar 2021. https://www.bettersafercare.vic.gov.au/reports-and-publications/voluntary-assisted-dying-report-of-operations-july-to-december-2020 (viewed May 2021).
5. Parliament of Australia. Criminal Code Act 1995 [No. 12, 1995]; here: ss. 474.29A, 474.29B. https://www.legislation.gov.au/Details/C2021C00132/Html/Volume_2 (viewed May 2021).
6. Oliver P, Jonquiere R, Wilson M, McLaren C. Providing legal assisted dying and euthanasia in a global pandemic: provider experiences and lessons for the future. World Federation of Right to Die Societies, updated Mar 2021. https://wfrtds.org/covid19report (viewed May 2021).
7. Victorian Civil and Administrative Tribunal (Human Rights Division). NTJ v NTJ (Human Rights) [2020]; VCAT 547 [VCAT reference no. H121/2020]. Updated 6 May 2020. http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VCAT/2020/547.html?context=1;query=NTJ%20v%20NTJ%20(Human%20Rights);mask_path= (viewed May 2021).
8. Victorian Civil and Administrative Tribunal, YSB v YSB (Human Rights) [2020] VCAT 1396 [VCAT reference no. H424/2020]. Updated 10 Dec 2020. http://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VCAT/2020/1396.html (viewed May 2021).
9. Parliament of Victoria. Voluntary Assisted Dying Act 2017 [Act No. 61/2017]. https://www.legislation.vic.gov.au/in-force/acts/voluntary-assisted-dying-act-2017/004 (viewed May 2021).
10. Department of Health and Human Services (Victoria). Voluntary assisted dying model of care pathways for health services. Jan 2019. https://www2.health.vic.gov.au/Api/downloadmedia/%7B38D6AD67-02C1-4A97-A240-9D726C5D9D6A%7D#:~:text=This%20model%20of%20care%20resource,staff%20within%20the%20health%20service (viewed May 2021).
11. Voluntary Assisted Dying Review Board. Report of operations January‒June 2020. Updated Aug 2020. https://www.bettersafercare.vic.gov.au/publications/VADRB-january-to-june-2020 (viewed May 2021).
12. Waran E, Williams L. Navigating the complexities of voluntary assisted dying in palliative care. Med J Aust 2020; 213: 204–206.e1. https://www.mja.com.au/journal/2020/213/5/navigating-complexities-voluntary-assisted-dying-palliative-care
13. Cunningham M. “Discriminatory and unethical”: palliative care service criticised over failure to verify euthanasia deaths. Sydney Morning Herald, 17 April 2021. https://www.smh.com.au/national/discriminatory-and-unethical-palliative-care-service-criticised-over-failure-to-verify-euthanasia-deaths-20210415-p57jif.html#comments (viewed May 2021).

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Editorials

Diabetes care for hospital patients in Australia needs repair

Jeffrey D Zajac and Sofianos Andrikopoulos

Med J Aust 2021; 215 (3): . || doi: 10.5694/mja2.51160
Published online: 2 August 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Endocrine system diseases

Annual audits of practice, national guidelines, specialist diabetes care teams, and increased patient participation are all needed

Diabetes inpatient care is broken and, given the disease burden, it requires urgent attention. The Queensland Impatient Diabetes Survey reported by Donovan and colleagues in this issue of the Journal1 found that care for hospital patients with diabetes is suboptimal. The authors report that rates of medication error and hospital‐acquired diabetic ketoacidosis are high and that peri‐operative planning is inadequate. This is a major problem, as many hospital inpatients have diabetes.

1 Austin Hospital, Melbourne, VIC
2 The University of Melbourne, Melbourne, VIC

Correspondence: j.zajac@unimelb.edu.au

Competing interests:

No relevant disclosures.

1. Donovan P, Eccles‐Smith J, Hinton N, et al. The Queensland Inpatient Diabetes Survey (QuIDS) 2019: the bedside audit of practice. Med J Aust 2021; 215: 119–124.
2. National Diabetes Services Scheme. Diabetes data snapshots. Updated Mar 2021. https://www.ndss.com.au/about-the-ndss/diabetes-facts-and-figures/diabetes-data-snapshots (viewed June 2021).
3. Australian Institute of Health and Welfare. Diabetes. Updated June 2020. https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/diabetes/overview (viewed June 2021).
4. Andrikopoulos S, Johnson G. The Australian response to the COVID‐19 pandemic and diabetes: lessons learned. Diabetes Res Clin Pract 2020; 165: 108246.
5. Nanayakkara N, Nguyen H, Churilov L, et al. Inpatient HbA1c testing: a prospective observational study. BMJ Open Diabetes Res Care 2015; 3: e000113.
6. Yong PH, Weinberg L, Torkamani N, et al. The presence of diabetes and higher HbA1c are independently associated with adverse outcomes after surgery. Diabetes Care 2018; 41: 1172–1179.
7. Kyi M, Wang J, Fourlanos S. Increased hyperglycemia and hospital‐acquired infections following withdrawal of the RAPIDS early intervention model of diabetes care in medical and surgical inpatients. Diabetes Care 2021; 44: e25–e26.
8. Australian Diabetes Society. Guidelines for routine glucose control in hospital. 2012. https://diabetessociety.com.au/documents/ADSGuidelinesforRoutineGlucoseControlinHospitalFinal2012.pdf (viewed June 2021).
9. Bach LA, Ekinci EI, Engler D, et al. The high burden of inpatient diabetes mellitus: the Melbourne Public Hospitals Diabetes Inpatient Audit. Med J Aust 2014; 201: 334–338. https://www.mja.com.au/journal/2014/201/6/high-burden-inpatient-diabetes-mellitus-melbourne-public-hospitals-diabetes
10. American Diabetes Association. Diabetes care in the hospital: Standards of Medical Care in Diabetes, 2019. Diabetes Care 2019; 42 (Suppl 1): S173–S181.
11. Kyi M, Gorelik A, Reid J, et al. Clinical prediction tool to identify adults with type 2 diabetes at risk for persistent adverse glycemia in hospital. Can J Diabetes 2021; 45: 114–121.e3.

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Research letters

The impact of the COVID‐19 pandemic on routine vaccinations in Victoria

Brynley P Hull, Alexandra J Hendry, Aditi Dey, Kerin Bryant, Catherine Radkowski, Stephen Pellissier, Kristine Macartney and Frank H Beard

Med J Aust 2021; 215 (2): . || doi: 10.5694/mja2.51145
Published online: 19 July 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

The coronavirus disease 2019 (COVID‐19) pandemic reduced routine vaccination activity in many countries.1,2,3 Strict physical distancing and movement restrictions (stage 3 lockdown measures) were implemented in Australia from 23 March 2020, with many health care providers moving to telehealth‐based models of care. Earlier analyses found the first pandemic wave did not affect childhood vaccination activity at the national or state/territory levels to July 2020.4 But vaccination activity has not been assessed during the more stringent stage 4 lockdowns during the second epidemic wave in Victoria (early August ‒ late October 2020). Further, the effects of the shift to remote learning on the vaccination of adolescents, usually delivered in schools, have not been assessed, nor the impact of the epidemic on vaccinations for older adults. We therefore compared vaccination activity in Victoria in 2019 and 2020 by analysing de‐identified Australian Immunisation Register (AIR) surveillance data (status: 28 February 2021). The Sydney Children’s Hospitals Network Human Research Ethics Committee exempted our analysis of AIR data, approved by the Australian Department of Health, from formal ethics approval.

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1 National Centre for Immunisation Research and Surveillance (NCIRS), Children’s Hospital Westmead, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Victorian Department of Health and Human Services, Melbourne, VIC

Correspondence: brynley.hull@health.nsw.gov.au

Competing interests:

No relevant disclosures.

1. World Health Organization. WHO and UNICEF warn of a decline in vaccinations during COVID‐19 [media release]. 15 July 2020. https://www.who.int/news/item/15-07-2020-who-and-unicef-warn-of-a-decline-in-vaccinations-during-covid-19 (viewed Dec 2020).
2. Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID‐19 pandemic on routine pediatric vaccine ordering and administration: United States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 591–593.
3. Public Health England. Impact of COVID‐19 on childhood vaccination counts to week 43, and vaccine coverage to September 2020 in England: interim analyses [Health Protection Report 14/21]. 10 Nov 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/933545/hpr2120_chldhd-vc_wk43.pdf (viewed Nov 2020).
4. National Centre for Immunisation Research and Surveillance. COVID‐19: impact on routine childhood vaccination uptake in Australia. 10 Nov 2020. https://www.ncirs.org.au/sites/default/files/2020-11/COVID-19_Impact_Analysis_Final%20Report.pdf (viewed Dec 2020).
5. Hull B, Hendry A, Dey A, et al. Immunisation coverage annual report 2019. Commun Dis Intell (2018); 2021: 45.
6. Hull B, Hendry A, Dey A, et al. Exploratory analysis of the first 2 years of adult vaccination data recorded on AIR. Nov 2019. http://ncirs.org.au/sites/default/files/2019-12/Analysis%20of%20adult%20vaccination%20data%20on%20AIR_Nov%202019.pdf (viewed Dec 2020).
7. Victorian Department of Health and Human Services. Secondary school immunisation program 2020 during COVID: advice for parents and guardians. 3 Aug 2020. https://www2.health.vic.gov.au/about/publications/factsheets/sec-school-immunisation-2020-covid-fs-parents (viewed Dec 2020).

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Editorial

Non‐alcoholic fatty liver disease: raising awareness of a looming public health problem

Lucy Gracen and Elizabeth E Powell

Med J Aust 2021; 215 (2): . || doi: 10.5694/mja2.51109
Published online: 19 July 2021

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Environment and public health

Endocrine system diseases

Nutritional and metabolic diseases

Neoplasms

In Australia, there is a paucity of coordinated strategies for preventing, detecting, and managing NAFLD

Despite being the most frequent cause of chronic liver disease in Australia, the prevalence and clinical consequences of non‐alcoholic fatty liver disease (NAFLD) remain uncertain.1 Accurate population‐based data on the burden of NAFLD are crucial for guiding public health strategies and directing health care resources to reducing the incidence of NAFLD and associated metabolic conditions.

1 Centre for Liver Disease Research, Translational Research Institute Australia, Brisbane, QLD
2 Princess Alexandra Hospital, Brisbane, QLD

Correspondence: e.powell@uq.edu.au

Acknowledgements:

Lucy Gracen is supported by a PA Research Foundation research award (2021).

Competing interests:

Elizabeth Powell has received an unrestricted grant from Siemens Healthineers.

1. Mahady SE, Adams LA. Burden of non‐alcoholic fatty liver disease in Australia. J Gastroenterol Hepatol 2018; 33 (Suppl 1): 1–11.
2. Roberts SK, Majeed A, Glenister K, et al. High prevalence of non‐alcoholic fatty liver disease in regional Victoria: a prospective population‐based study. Med J Aust 2021; 215: 77–82.
3. Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018; 15: 11–20.
4. European Association for the Study of the Liver; European Association for the Study of Diabetes; European Association for the Study of Obesity. EASL‐EASD-EASO clinical practice guidelines for the management of non‐alcoholic fatty liver disease. J Hepatol 2016; 64: 1388–1402.
5. Cuthbertson DJ, Weickert MO, Lythgoe D, et al. External validation of the fatty liver index and lipid accumulation product indices, using ¹H‐magnetic resonance spectroscopy, to identify hepatic steatosis in healthy controls and obese, insulin‐resistant individuals. Eur J Endocrinol 2014; 171: 561–569.
6. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease: meta‐analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64: 73–84.
7. Angulo P, Kleiner DE, Dam‐Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long‐term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology 2015; 149: 389–397.e10.
8. Anstee QM, Lawitz EJ, Alkhouri N, et al. Noninvasive tests accurately identify advanced fibrosis due to NASH: baseline data from the STELLAR trials. Hepatology 2019; 70: 1521–1530.
9. Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology 2019; 156: 1717–1730.
10. Eslam M, Sarin SK, Wong VWS, et al. The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease. Hepatol Int 2020; 14: 889–919.
11. McPherson S, Stewart SF, Henderson E, et al. Simple non‐invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non‐alcoholic fatty liver disease. Gut 2010; 59: 1265–1269.

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Perspectives

Australia needs a prioritised national research strategy for clinical trials in a pandemic: lessons learned from COVID‐19

Asha C Bowen, Steven YC Tong and Joshua S Davis

Med J Aust 2021; 215 (2): . || doi: 10.5694/mja2.51143
Published online: 19 July 2021

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Infectious diseases

Statistics, epidemiology and research design

Environment and public health

Developing a pathway to prioritise clinical research and prepare for future pandemics remains an urgent need

The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), sparking a global pandemic,1 has driven an imperative to quickly design and conduct treatment studies. We strongly propose a national, coordinated approach for randomised controlled trials (RCTs) for coronavirus disease 2019 (COVID‐19), future pandemics and inter‐pandemic periods in Australia. Our reflections represent those of the Australasian COVID‐19 Trial (ASCOT)2 steering committee, as we have considered the challenges of conducting a clinical trial during the COVID‐19 pandemic in Australia.

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1 Perth Children’s Hospital, Perth, WA
2 Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
3 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Doherty Institute, Melbourne, VIC
4 University of Melbourne, Melbourne, VIC
5 Menzies School of Health Research, Darwin, NT
6 John Hunter Hospital, Newcastle, NSW

Correspondence: asha.bowen@health.wa.gov.au

Competing interests:

All authors are members of the ASCOT steering committee.

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Research

Increasing incidence of invasive group A streptococcal disease in Western Australia, particularly among Indigenous people

Cameron M Wright, Rachael Moorin, Glenn Pearson, John R Dyer, Jonathan R Carapetis and Laurens Manning

Med J Aust 2021; 215 (1): . || doi: 10.5694/mja2.51117
Published online: 5 July 2021

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AUTHORS
REFERENCES

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Environment and public health

Indigenous health

Infectious diseases

Statistics, epidemiology and research design

Abstract

Objective: To quantify the burden of invasive group A Streptococcus (GAS) disease in Western Australia during 2000–2018.

Design, setting: Population‐based data linkage study: Hospital Morbidity Data Collection (HMDC; all WA public and private hospital records), PathWest pathology data (government‐owned pathology services provider), and death registrations.

Participants: People with invasive GAS disease, defined by an isolate from a normally sterile site (PathWest) or a hospital‐based principal ICD‐10‐AM diagnosis code (HMDC).

Main outcome measures: Incidence of invasive GAS disease; median length of hospital stay; all‐cause mortality.

Results: We identified 2237 cases of GAS disease during 2000‒2018; 1283 were in male patients (57%). 1950 cases had been confirmed by GAS isolates from normally sterile tissues (87%; including 1089 from blood [56% of cases] and 750 from tissue [38%]). The age‐standardised incidence increased from 2.0 (95% CI, 1.4–2.7) cases per 100 000 population in 2000 to 9.1 (95% CI, 7.9–10.2) cases per 100 000 in 2017 (by year, adjusted for age group and sex: incidence rate ratio [IRR], 1.09; 95% CI, 1.08–1.10). Incidence was consistently higher among Indigenous than non‐Indigenous Australians (year‐adjusted IRR, 13.1; 95% CI, 11.3–15.1). All‐cause 30‐day mortality was 5% (116 deaths), and 90‐day mortality 7% (156 deaths); 30‐day mortality, adjusted for age group and sex, was not statistically significantly different for cases involving Indigenous or non‐Indigenous patients (adjusted odds ratio, 0.8; 95% CI, 0.6–1.1).

Conclusions: The incidence of invasive GAS disease in WA increased between 2000 and 2018, particularly among Indigenous Australians. Mandatory notification of invasive GAS disease would therefore be appropriate. The social determinants of differences in incidence should be addressed, and other relevant host, pathogen, and health system factors investigated.

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1 The University of Western Australia, Perth, WA
2 The Fiona Stanley Fremantle Hospitals Group, Perth, WA
3 Curtin University, Perth, WA
4 University of Tasmania, Hobart, TAS
5 Centre for Health Services Research, University of Western Australia, Perth, WA
6 Telethon Kids Institute, University of Western Australia, Perth, WA
7 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
8 Perth Children’s Hospital, Perth, WA

Correspondence: cameron.wright@curtin.edu.au

Acknowledgements:

Data acquisition costs for this study were jointly funded by the Telethon Kids Institute and the Department of Infectious Diseases, the Fiona Stanley Fremantle Hospitals Group. We acknowledge the WA Data Linkage Branch for providing the linked data, Ryan Shave (WA Department of Health) for assistance with research governance approvals, Brett Cawley (PathWest) for assisting with identifying PathWest cases, Susan Benson (Curtin University, University of Western Australia) for assisting with blood culture results interpretation, and the people whose data were analysed in this study. Cameron Wright completed this work as part of scholarly activity for his Doctor of Medicine degree from the University of Western Australia.

Competing interests:

No relevant disclosures.

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The effects on mortality and the associated financial costs of wood heater pollution in a regional Australian city

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Opioid prescribing in Australia: too much and not enough

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Update on voluntary assisted dying in Australia

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Diabetes care for hospital patients in Australia needs repair

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The impact of the COVID‐19 pandemic on routine vaccinations in Victoria

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Non‐alcoholic fatty liver disease: raising awareness of a looming public health problem

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Australia needs a prioritised national research strategy for clinical trials in a pandemic: lessons learned from COVID‐19

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Increasing incidence of invasive group A streptococcal disease in Western Australia, particularly among Indigenous people

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The road less travelled: supporting physicians to practice rurally

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Improving access to community care for people with intellectual disability is needed to avert unnecessary hospitalisations

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