Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes.

BACKGROUND: Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. METHODS: Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). RESULTS: From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. CONCLUSION: Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes.

OBJECTIVE: To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. DESIGN: Population-based retrospective descriptive study. SETTING: Not applicable. PATIENT(S): All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). INTERVENTION(S): Records from statutory statewide data collections of hospitals separations and births were extracted and linked. MAIN OUTCOME MEASURE(S): Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. RESULT(S): The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81). CONCLUSION(S): Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.

Influence of offence type and prior imprisonment on risk of death following release from prison: a whole-population linked data study.

PURPOSE: The purpose of this paper is to examine the influence of offence type, prior imprisonment and various socio-demographic characteristics on mortality at 28 and 365 days following prison release. DESIGN/METHODOLOGY/APPROACH: Using whole-population linked, routinely collected administrative state-based imprisonment and mortality data, the authors conducted a retrospective study of 12,677 offenders released from Western Australian prisons in the period 1994-2003. Cox proportional hazards regression was used to examine the association between mortality at 28 and 365 days post-release and offence type, prior imprisonment, and a range of socio-demographic characteristics (age, gender, social disadvantage and Indigenous status). FINDINGS: Overall, 135 (1.1 per cent) died during the 365 days follow-up period, of these, 17.8 per cent (n=24) died within the first 28 days (four weeks) of their index release. Ex-prisoners who had committed drug-related offences had significantly higher risk of 28-day post-release mortality (HR=28.4; 95 per cent CI: 1.3-615.3, p=0.033), than those who had committed violent (non-sexual) offences. A significant association was also found between the number of previous incarcerations and post-release mortality at 28 days post-release, with three prior prison terms carrying the highest mortality risk (HR=73.8; 95 per cent CI: 1.8-3,092.5, p=0.024). No association between mortality and either offence type or prior imprisonment was seen at 365 days post-release. ORIGINALITY/VALUE: Post-release mortality at 28 days was significantly associated with offence type (with drug-related offences carrying the greatest risk) and with prior imprisonment, but associations did not persist to 365 days after release. Targeting of short-term transitional programmes to reduce preventable deaths after return to the community could be tailored to these high-risk ex-prisoners.

Effectiveness of in vitro fertilization in women with previous tubal sterilization.

OBJECTIVE: The objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization. STUDY DESIGN: We examined first IVF live deliveries for women aged 20-44 years at their first embryo transfer (ET) with history of hospital admission for tubal sterilization in Western Australia (WA). The ET cycles (n=178) were ascertained over the period of 1996 to 2010 using WA hospital records. A control group of subfertile women matched by age was randomly selected (n=178). We used Kaplan-Meier curves and life-table analysis to evaluate the cumulative live-delivery rates. RESULTS: An overall cumulative live-delivery rate in women who had undergone previous tubal sterilization (31%) was comparable to that of subfertile controls (34%) within the first 24 months. Younger women (aged 20-34 years) with previous sterilization (34%) were slightly more likely to deliver an IVF live baby than older women (aged 35-39 and 40-44 years) (33% and 22%, respectively), although this difference was not statistically significant (p=.449). CONCLUSION: Women who desire fertility after a tubal sterilization procedure and undergo IVF have rates of pregnancy similar to age-matched subfertile IVF control patients. IMPLICATIONS: In vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.

Morbidity due to acute lower respiratory infection in children with birth defects: a total population-based linked data study.

BACKGROUND: Acute lower respiratory infections (ALRIs) are leading causes of hospitalisation in children. Birth defects occur in 5% of live births in Western Australia (WA). The association between birth defects and ALRI hospitalisation is unknown. METHODS: We conducted a retrospective cohort study of 245,249 singleton births in WA (1996-2005). Population-based hospitalisation data were linked to the WA Register of Developmental Anomalies to investigate ALRI hospitalisations in children with and without birth defects. We used negative binomial regression to estimate associations between birth defects and number of ALRI hospitalisations before age 2 years, adjusting for known risk factors. RESULTS: Overall, 9% of non-Aboriginal children and 37% of Aboriginal children with birth defects had at least one ALRI admission before age 2 years. Aboriginal children (IRR 2.3, 95% CI: 1.9-2.8) and non-Aboriginal children (IRR 2.0, 95% CI: 1.8-2.2) with birth defects had higher rates of hospitalisation for an ALRI than children with no birth defects. Rates of ALRI hospitalisation varied by type of defect but were increased for all major birth defects categories, the highest rate being for children with Down syndrome (IRR 8.0, 95% CI: 5.6-11.5). The rate of ALRI hospitalisation was 3 times greater in children with multiple birth defects than in those with isolated defects. CONCLUSIONS: Children with birth defects experience higher rates of hospitalisation for ALRIs before age 2 years than children with no birth defects. Optimal vaccination coverage and immunoprophylaxis for specific categories of birth defects would assist in reducing hospitalisation rates for ALRI.

Long-term risk of ectopic pregnancy varies by method of tubal sterilization: a whole-population study.

OBJECTIVE: To evaluate the risk of ectopic pregnancy (EP) associated with different methods of tubal sterilization. DESIGN: Population-based retrospective cohort study. SETTING: Hospitals in Western Australia. PATIENT(S): All women aged 18-44 years undergoing tubal sterilization between 1990 and 2010 at Western Australian hospitals (n = 44,829). INTERVENTION(S): Data on tubal sterilization were extracted from hospital records. MAIN OUTCOME MEASURE(S): Long-term risk of EP. RESULT(S): There were 89 EPs recorded during the observation period in women previously sterilized. The 10-year and 15-year cumulative probability of EP for all methods of tubal sterilization were 2.4/1,000 and 2.9/1,000 procedures, respectively. The 10-year cumulative probability of EP was 3.5 times higher in women sterilized before the age of 28 years than in those sterilized after the age of 33 years. An increased risk of EP existed in women who received laparoscopic partial salpingectomy (adjusted hazard ratio = 14.57, 95% confidence interval 3.50-60.60) and electrodestruction (adjusted hazard ratio = 5.65, 95% confidence interval 2.38-13.40), compared with those who had laparoscopic unspecified destruction of fallopian tubes. CONCLUSION(S): Women undergoing tubal sterilization at a young age are at particular risk for subsequent EP. The risk among younger women doubled between 5 and 15 years after sterilization. Laparoscopic electrodestruction and partial salpingectomy carried the highest risk of EP.