Trend and change analysis in an Australian surveillance system Associate Professor Anne Taylor South...

Trend and change analysis in an Australian

surveillance system

Associate Professor Anne TaylorSouth Australian Department of Health

University of Adelaide

Eleonora Dal Grande, Tiffany Gill, Zumin Shi Population Research & Outcome Studies, SA Health

Michele HerriotHealth Promotion, SA Health

Background

• The importance of evidence to Health Promotion– Range of sources– Health surveys ► risk factor surveillance

• Flexibility• Addition of time• Seasonal trends• Trends over time

• Difference between surveys and surveillance - The ways things were vs the way things are changing

Outline of presentation

• Surveillance in Australia• Examples/results from South

Australia• What challenges we face

History of surveillance in Australia

South Australia

Northern Territory

Western Australia

Queensland

New South Wales

← Victoria

TasmaniaSurveillance systemNo surveillance systemAdaptation

Surveillance in Australia

• COAG (Council of Australian Governments)– “Laying the foundations for healthy

behaviours in the daily lives of Australians”– ($A448.1m over 4 yrs) – reward payments

• National Partnership Agreement on Preventive Health

Surveillance in Australia

• CATI infrastructure ($A10m over 4 yrs)– National consistency

• Questions• Measurement• Sampling frame

– Minimum sample sizes

• Indicators (adults & children)- Fruit & vegetables- Physical activity- Healthy weight- Smoking

South Australian Monitoring & Surveillance System (SAMSS)

• Commenced July 2002– Continuous chronic disease and risk

factor surveillance system– CATI (Computer Assisted Telephone

Interviews)

– n = 600 per month– Random selection of South Australians

of all ages (0+ years)

Sampling

• Australia– Electronic White Pages

• 2004 privacy legislation

– Random Digit Dialling

• All telephone numbers included in IPND (Integrated Public Number Database)– (fixed line, mobile, public/private payphone,

freecall) included in 1 database (listed and unlisted)

Data use

•Prevalence, change in estimates, trends

•Description of at risk populations•Geographic distribution of

illness/risk factors•Detecting epidemics•Generating hypotheses•Facilitating planning

Data use

•Importance of continuous data collection– Provide trends– Timeliness– Aggregation over time

Fruit and vegetable consumption

Mean Serves of Mean serves of fruit per day – Adults aged 18 years and over

Data Source: SAMSS 2003-2009

Mean serves of fruit per day – Children aged 5 to 17 years

Mean Serves of Mean serves of vegetables per day – Adults aged 18 years and over

Mean serves of vegetables per day – Children aged 5 to 17 years

Fruit and vegetable consumption campaign

• Go for 2&5 Campaign®

– Awareness raising and educating– Comprehensive media campaign May-

June 2005 – National and State based activities – $A100,000 in SA; Nationally $A4.75

million– “Go for 2&5 Fruit and Vegetable man”

events

Fruit & vegetable consumption campaign

Proportion eating 5+ serves vegetables/day (pre and post

campaign)

Proportion eating 5+ serves vegetables/day

(pre and post campaign) by gender

Male Female

MonthGraphs by sex

Proportion eating 5+ serves vegetables/day

(pre and post campaign) by BMI

Underweight/normal Overweight/obesity

Proportion eating 2+ serves fruit/day(pre and post campaign)

Proportion eating 2+ serves fruit/day(pre and post campaign) by gender

Male Female

MonthGraphs by sex

Proportion eating 2+ serves fruit/day(pre and post campaign) by BMI

Physical Activity

Sufficient physical activity – Adults 18 years and over

Data source: SAMSS, age 18 years and over 2003 - 2009

60 minutes of physical activity per day –

Children 5 to 15 years

Data source: SAMSS, age 15 - 15 years 2003 - 2009

Proportion undertaking sufficient physical activity (adults)

Proportion undertaking sufficient physical activity by BMI (adults)

Proportion undertaking sufficient physical activity by gender (adults)

Male Female

Proportion undertaking sufficient physical activity by SEIFA (adults)

lowest/low/middle high/highest

Proportion undertaking sufficient physical activity by overall health

status (adults)

Fair/Poor Good/Very good/Excellent

Proportion undertaking sufficient physical activity by smoking status

(adults)

Non-/Ex-smoker Current smoker

Smoking

Data source: SAMSS, age 16 years and over

Smoking – Adults aged 16 years and over

Proportion of adults smoking

Proportion of adult smokers by gender

Data source: SAMSS, age 16 years and over 2002 to 2010

Male Female

MonthGraphs by sex

Smoking policy and legislation

• Dec 2004– Smoke-free workplaces and public areas

except licensed hospitality venues

• May 2007 – Ban on smoking in cars with children under

16 years

• Nov 2007 – All public areas smoke-free, including

hospitality venues– Current policy targeting retail sales displays

Proportion of adults reporting smoking undertaken in the home

Healthy Weight

Unhealthy weight – Adults aged 18 years and over

Unhealthy weight – Children aged 5 -17 years

Data source: SAMSS, age 5-17 years

Proportion of adults reporting overweight/obese (BMI >25)

Actual Predicted 95% CI

Proportion of adults reporting overweight/obese (BMI > 25) by

gender

Male Female

Graphs by sex

Proportion of adults reporting overweight/obese (BMI > 25) by age

<40 40-59 >=60

Graphs by age

Proportion of adults reporting overweight/obese (BMI > 25) by

income

High Low Not stated

Graphs by income

What challenges do we face?

• In Australia - continued harmonization– State-based system– Conflicting goals

• Aim of all surveillance systems– Improvement on health outcomes– Value for money– Use of data

An effective risk factor surveillance system will provide the evidence for change

Challenges - Sampling

•Scientific•Known probability of selection•Random•Power•System approach•Population framework

•Limited by:– Needs/resources available

Challenges - Questions

•Standards•Best practice guidelines•Question development

– Cognitive testing– Field testing

•Use of modules

•Flexibility but consistency•Reliability/validity

Challenges

•In Australia -Too many different systems

•Harmonization-Questions (SNAPS)

•No national conference

•No governing committee-Informal vs formal

Challenges - Data collection

•Telephones•Mixed mode•Regular & sustained•Issues

– Response rates– Cultural differences

•Importance of quality assurance in all aspects

Challenges

•Dissemination– We have room for improvement– The use of the media & relationship

with media– Explore more options

•The power of collaboration– Partners

Challenges - Sustainability/continuity

•Long term commitment - cost•Show a difference/make a

difference•Be useful as an evidence provider

Contact Details

Anne Taylor

Population Research & Outcome Studies (PROS)

South Australian Department of Health

University of Adelaide

PROS Website:

http://www.health.sa.gov.au/PROS/

Trend and change analysis in an Australian surveillance system Associate Professor Anne Taylor South...

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