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Epidemiology profile of neurological conditions in Western Australia 2015

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DISCLAIMER STATEMENT

Important Disclaimer:

All information and content in this Material is provided in good faith by the Western Australian (WA) Department of Health, and is based on sources believed to be reliable and accurate at the time of development. The State of Western Australia, the WA Department of Health and their respective officers, employees and agents, do not accept legal liability or responsibility for the Material, or any consequences arising from its use.

ACKNOWLEDGEMENT Health Strategy and Networks Branch, WA Department of Health would like to sincerely thank the data providers across WA Department of Health, including the Epidemiology Branch, Emergency Data Collection and Data Integrity Directorate. Special acknowledgement also goes to all the organisations which provided information for the Community Neurological Services in WA – A Professional Resource. Joanne Cronin is acknowledged for the preparation of the report. SUGGESTED CITATION Western Australian Department of Health. (2015). Epidemiology profile of neurological conditions in Western Australia, Health Strategy and Networks Branch, Department of Health, Perth.

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Executive summary This report provides an overview of the number of people with neurological conditions who use public hospital and non-admitted outpatient services and/or community services in Western Australia (WA). It is an attempt to identify potential sources of data on the prevalence and incidence of neurological conditions. Currently there is no central collection of neurological data and a limited ability to identify how many people in WA have a neurological dysfunction or disease. The intention is to provide information that can be used by service planners and procurement agencies to ensure high quality, equitable and cost effective services can be provided for neurological patients across WA.

In this report, data is presented across a range of different areas such as burden of disease and disability, hospital separations and costs, emergency department (ED) presentations and non-admitted outpatients appointments. Estimates of client contacts and membership numbers have been accessed from community based organisations which provide services and support to people with neurological conditions.

There are a number of limitations with the available data, and this impacts on the reliability of the data and potentially underestimates the number of people with neurological conditions across WA1. For example, comprehensive data on neurological conditions is not currently available for people receiving services from primary care, private health care, aged care, community nursing and generalist home nursing organisations. Similarly there are limitations in the available data on rare neurological conditions (those which are chronically debilitating but with a prevalence of less than 1 in 2000 in the population). Additionally, the report does not include consideration of people indirectly affected by neurological conditions such as carers and family members.

The following data sources have been included in this report:

• Australian and international research • WA Burden of Disease Study 20102 • Hospitalisation rates for the WA Department of Health3 • hospital costs, length of stay and bed-days occupied3 • emergency department presentations4 • non-admitted outpatients5 • community neurological services in WA6 • consideration of other data sources: Home and Community Care minimum data set7,

Disability Services Commission8 and Impact of Rare Diseases on the WA Health System.

The report attempts to identify areas where data quality could be improved, where there are discrepancies between data sources and where there are gaps in the available data. Future efforts should focus on establishing a statewide linked data system for neurological conditions, with particular attention being given to improving the reliability and validity of the data across all systems of care.

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Contents

Executive summary 2

Summary of findings 5

Limitations in the data available 6

Australian and international research 7

WA burden of disease study 2010 10

Burden of disease by sex 10

Burden of disease WA 2006 for Aboriginals by sex 11

Projected disease burden 11

Burden of disability WA 2006 by sex 11

Burden of disability WA 2006 for Aboriginals by sex 12

Burden of disability WA 2006 for nervous system and senses organ disorder 13

Hospitalisation rates for nervous system diseases 15

Hospital costs 17

Emergency department attendance 18

Non-admitted outpatients clinics 20

Mortality 23

Community services and supports 25

Home and community care 27

Disability Services Commission 28

Impact of rare diseases study 30

Conclusion 31

Appendix 1: List of conditions serviced in WA 32

Appendix 2: Data summary for major conditions 34

Cerebral palsy 35

Dementia 39

Epilepsy 45

Huntington’s disease 50

Hydrocephalus 52

Migraine 57

Motor neurone disease 61

Multiple sclerosis 65

Muscular dystrophy 69

Parkinson’s disease 73

Spina bifida 77

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Stroke 82

Transient ischaemic attack 87

Traumatic acquired brain injury 92

Appendix 3: Additional emergency department codes 97

References 98

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Summary of findings • Disorders of the nervous system and senses organs were the third major cause of

disease burden in WA in 2006.9 • It is predicted that in 2016, disorders of the nervous system and senses organs will

continue to be third major cause of disease burden.9 • Dementia was the first leading cause of disease burden in WA for females and the

second for males in 2006.9 • In 2006, disorders of the nervous system and senses organs were the second leading

cause of disability burden in WA.2 • In WA in 2006, the leading causes of disability due to nervous system and senses organ

disorder for females were dementia (44.2%), adult onset hearing loss (10.2%) and migraine (8.4%). For males the leading causes of disability were dementia (27.1%), adult-onset hearing loss (29.8%) and Parkinson’s disease (7.3%).2

• For WA, nervous system diseases hospitalisations accounted for 2.4 % of all hospitalisations by principal diagnosis between 2008 and 2012.10

• Between 2001 and 2012, the rate of nervous system disease hospitalisations increased significantly.10

• The age group most affected by nervous system diseases is 45-64 year olds.10 • In 2012, there were 31,804 occasions of hospital admission for conditions due to nervous

system diseases.3 These admissions totalled 340,627 bed-days at an approximate cost of $307,114,587.3

• The percentage of Aboriginal people who were hospitalised for the following causes were; epilepsy (22%) cerebral palsy(13%), hydrocephalus (7%), spina bifada (11.5%) and traumatic brain injury (10%).3

• In 2013, 18 953 patients attended 30 608 appointments at public neurology non-admitted outpatient clinics in WA.5

• Between 2004-2014, there were 111 433 ED attendances across WA with a primary diagnosis of a neurological condition.4 The conditions with the highest frequency of ED attendance for specific neurological diagnosis were acquired brain injury (25%), epilepsy (24%), migraine (18%), transient ischaemic attacks (14%) and stroke (6%).4

• In WA, nervous system diseases accounted for 8.8% of all deaths between 2007 and 2011.11 The average number of deaths due to nervous system diseases in WA between 2007 and 2011 was 1107 per year.11

• It is estimated that there are over 19 800 people who are currently members of WA based community neurological organisations and/or receive services and supports from these agencies. Services provided may be of a clinical or non-clinical nature.6

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Limitations in the data available Interpretation of the data in this report must take into account the following:

• The report does not consider people receiving services from primary care, private health care, allied health outside of non-admitted outpatients clinics, aged care or residential nursing organisations as data specific to neurological conditions is largely unavailable from these services.

• Some neurological conditions progress slowly and may not require ongoing medical support. Therefore, people with these conditions may not be included in the data.

• People may not seek treatment or support for their condition. Therefore they are not included within the data.

• Some neurological conditions are rare and not adequately represented in health datasets such as hospital morbidity and ED data.

• Data on hospitalisation rates, length of stay and costs within the report, only relate to occasions where a neurological condition was the principal diagnosis.

• ED admissions data may only identify people who present with a complication from a diagnosed neurological condition and/or their presentation at ED results in a primary coding diagnosis of a neurological condition at the conclusion of a patient’s attendance at ED.

• Community based organisations use a number of different data systems to collect data on their client contacts and member numbers, therefore the figures should only be used as an indication of potential contacts and numbers.

• The impact of neurological conditions is not just restricted to the sufferer. Other people affected by neurological conditions include carers and family members. Data on these groups of people is limited and was not included in this report.

• Due to continuous quality improvement processes with data collection, historical comparisons may in some cases be misleading.

Estimates of prevalence (that is the total number of people with that condition per 100 000 of the population), provide the best indicator of the numbers of people with chronic neurological conditions. For other acute neurological conditions such as stroke or brain injury estimates of incidence (the numbers of new cases per year) provide a better indication of patient numbers.

We are unable at this stage to quantify the total cost of neurological conditions to the WA economy in terms of health system costs, lost productivity, lost quality of life, carer costs and premature mortality.

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Australian and international research There is considerable research which aims to estimate the incidence and prevalence of neurological conditions in Australia and internationally. Several key studies are summarised below.

Australia In Australia, diseases of the nervous system accounted for 6 884 deaths in 2012, representing 4.7% of all registered deaths.12 There has been an increase in deaths attributable to diseases of the nervous system from 2003 where there were 4 324 deaths recorded.12 Females (3 861) experienced a higher number of deaths due to diseases of the nervous system than males (3 023).12 The median age at death was 80.8 for males and 85.3 for females.12

Neurological conditions were the fourth highest ranked contributor to the fatal burden of disease in Australia in 2010.13 Neurological conditions accounted for 6% of the total fatal burden of disease, with females showing a higher contribution to this total (53% of the total for neurological conditions).13 The proportion of total years of life lost due to neurological conditions increased with age; this was more noticeable among females.13

Acquired Brain Injury (ABI) Over 700 000 Australians are estimated to have a brain injury, which limits their daily activities and restricts their participation.14 Between 2004–05, 22 000 Australians were hospitalised as a result of a traumatic brain injury.14 These hospitalisations resulted in over 26 000 episodes of inpatient care totalling nearly 206 000 days, and estimated direct costs of hospital care of $184 million.15 In 2003, 1 in 45 Australians (432 700 people) had an ABI with activity limitations or participation restrictions due to disability and almost 157 500 people had an ABI and a severe or profound core activity limitation.15 It was estimated that approximately 20 000 children aged under 15 years had an ABI.15 In WA, it was estimated that there was 21 800 people with an ABI in 2003.15

Dementia/Alzheimer’s disease Alzheimer's disease was identified to account for 44.2% (3 046) of all deaths in Australia due to diseases of the nervous system and 2.1% of all registered deaths in 2012.12 Females (2 128) experience a higher number of deaths due to Alzheimer's disease than for males (918).12 The median age at death due to Alzheimer's disease was 87.5 years.12

Alzheimer’s Australia commissioned a report to estimate the number of people with dementia in Australia in 2011, and future projections until 2050.16

Table 1: Dementia Prevalence Estimates in WA 2011-5 016

2011 2012 2015 2020 2030 2040 2050

23 931 25 177 29 041 36 500 46 332 57 781 68 708 It is estimated that in 2010, 1.2 million people were involved in the care of a person with dementia in Australia.16 In 2009-10, the total direct health and aged care system expenditure on people with dementia in Australia was $4.9 billion.16

Epilepsy Epilepsy Action Australia and the George Institute for International Health are currently undertaking a major epidemiological research project to measure the impact and incidence of

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epilepsy in Sydney. This study known as the Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) will explore the incidence, psychosocial impact and the household economic burden of epilepsy in a large population. The study was due for completion by the end of 2014 with the results yet to be released. The study estimates that there is an annual incidence of 50 per 100 000 in developed countries equating to approximately 10 750 people newly diagnosed with epilepsy in Australia last year.17

Migraine Headache Australia reports that the incidence of migraine is 9-10% of the Australian population, with 17% of females affected and 6% of the male population.18 This equates to about 2 million Australians who suffer from migraines.18 Studies show that 50% of migraine sufferers have not been diagnosed by a medical professional.18

Muscular dystrophy In Australia, it is estimated that there are more than 20 000 people who have some form of neuromuscular disease.18 There is an Australian registry for muscular dystrophy with more than 10 000 of these Australian and New Zealand patients currently registered.18

Multiple sclerosis In 2009, it was estimated that there are now 23 700 Australians living with multiple sclerosis and of these 11,400 (48%) had a profound or severe core activity limitation.19 66.7% or 15 800 Australians living with multiple sclerosis need assistance with at least one of the ten everyday activities.19 This figure has been used to determine that the cost of multiple sclerosis to individuals and the Australian community totals over $1 billion each year.20

Parkinson’s disease In 2011 it was estimated that 1 in 350 Australians are affected by Parkinson’s disease which is an increase of 17% since 2005.21 In 2011, over 64 000 Australians were living with Parkinson’s disease.21 The cost of Parkinson’s disease in Australia was valued at $775 million in 2011-12, with approximately $480 million in health system costs and $110 million in lost productivity.21 The estimated burden of disease is valued at $7.6 billion in terms of lost quality of life and premature mortality for people with Parkinson’s disease.21

Parkinson's Disease accounted for 20.2% of all nervous system deaths and 0.9% of all deaths registered in 2012 in Australia.12 The number of male deaths (788) from Parkinson's disease was higher than the number of female deaths (604).12 There were 1 392 deaths from Parkinson’s disease in 2012, with a median age at death of 83.5 years.12

Stroke The National Stroke Foundation regularly commissions reports regarding the prevalence and impact of stroke. A recent report released in November 2014 estimated that there will be around 90 000 stroke survivors living in WA by 2050.22 The number of strokes in WA is also predicted to rise from 4652 in 2014 to 11 889 in 2050. 22 The cost of stroke in Australia in 2012 was estimated to be $5 billion which includes $3 billion of productivity losses, $881 million in health system costs and $222 million in carer costs.22 The estimated burden of disease cost in 2012 for Australia was $49.3 billion.22 In 2009, an estimated 381 400 Australians (1.8% of the total population) reported they had suffered a stroke.19 Of this, 35% had at least one impairment which lasted for six months or longer as a result of a stroke.19

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Regional WA There is limited data on the prevalence and incidence of neurological conditions in regional WA. In 2008, a cohort of 160 patients were studied who attended clinics with a neurologist in the Geraldton and Midwest areas over a 12 month period. Parkinson’s disease was the most common condition with an estimated prevalence of 187.5 persons per 1000. Other conditions observed were epilepsy (16.87%), neuromuscular disorders (13.75%); multiple sclerosis (7.5%); cerebrovascular disease (6.25%); headaches (4.37%); neurodegenerative disorders (4.37%); dementia (3.75%); memory dysfunction (3.75%); gait disorders (2.5%); vestibular syndrome (1.87%); pain syndrome (1.87%); sensory syndrome (1.25%); brain injury (0.62%) and other various conditions (7.5%)23.

United Kingdom In the United Kingdon (UK), it is estimated that each year 600 000 people or 1% of the population are newly diagnosed with a neurological condition.24 Over 1 million people or 2% of the population in the UK have a disbility associated with their neurological condition.24 Another 8 million people are affected by a neurological condtion, although are able to manage with limited support.24 Approximately 350 000 people in the UK with neurological condtions require help for most of their daily activities.24 10% of the presentations to ED in the UK are for neurological problems.24

United States of America The incidence and prevalence for 12 neurological disorders experienced within the United States of America were published in 2007.25 The estimated prevalence for autism spectrum disorder in children was identified to be 5.8/1000 and 2.4/1000 for cerebral palsy.25 In the general population, the prevalence for migraine was estimated at 121/1000, 7.1/1000 for epilepsy, and 0.9/1000 for multiple sclerosis.25 Among the older population (65+ years) the prevalence of Alzheimer’s disease was estimated at 67/1000 and 9.5/1000 for Parkinson’s disease.25 The incidence, or number of new cases each year of stroke were 183/100 000, 101/100 000 for major traumatic brain injury, 4.5/100 000 for spinal cord injury, and 1.6/100 000 for amyotrophic lateral sclerosis.25

Canada An estimate of the prevalence of eight neurological conditions including Alzheimer's disease, Parkinson's disease, epilepsy, traumatic brain injury, multiple sclerosis, cerebral palsy, Huntington's disease, and amyotrophic lateral sclerosis was undertaken in non-acute health care settings in Canada. This included nursing homes, home care, complex continuing care and psychiatric hospitals. The conditions with the highest estimated prevalence in these care settings were Alzheimer's disease and related dementias, Parkinson's disease, epilepsy, and traumatic brain injury.1 It was noted that the proportion of people with neurological conditions in these settings were substantially higher than that reported for the general population.1

Additionally it was identified that prevalence estimates from acute hospital administrative data were comparatively lower for all conditions evaluated.1 The researchers concluded that the use of hospital or ED records alone, is likely to substantially underestimate the true prevalence of neurological conditions.1

#N.B.: Due to time constraints a comprehensive literature review was not included in this report.

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WA burden of disease study 2010 The WA Department of Health Epidemiology Branch conducted a Burden of Disease Study in 2010 based on 2006 hospital separations data. Burden of disease reflects the impact of an illness or disability on a population's life expectancy and quality of life. Disability Adjusted Life Year (DALY) is a measure of burden of disease in the population, which integrates both mortality (Years of Life Lost, YLL) and disability (Years Lost due to Disability, YLD). One DALY equates to one year of healthy life lost. The sum of DALYs in the population is a gap measure used to quantify the difference between current health and ideal health situations.

Burden of disease by sex Total disease burden is measured using DALYs, and to compare DALYs across different population groups (for example males vs females) age standardised rates (ASRs) have been created.

In WA in 2006, the leading causes of total disease burden in males were malignant neoplasms, cardiovascular disease and nervous system and senses organ disorders. In females, the leading causes of burden were malignant neoplasms, mental disorders and nervous system and senses organ disorders. While females had a higher burden of nervous system and senses organ disorders than males, this difference was not statistically significant.2

Figure 1: Burden of disease WA 2006 by sex 2

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Burden of disease WA 2006 for Aboriginals by sex Burden of disease for nervous system and senses organ disorders were ranked 7th in Aboriginal males, and 6th in Aboriginal females, although the difference between the sexes was not statistically significant. 2 While the burden of disease rates for nervous system and senses organ disorders were similar in Aboriginal males compared to non-Aboriginal males, and in Aboriginal females compared to non-Aboriginal females, the rankings were much lower in Aboriginal males and Aboriginal females.2 Therefore while nervous system and senses organ disorders accounted for a similar rate of DALYs per 100,000 population in both Aboriginal and non-Aboriginals, the relative ranking of these disorders compared to other diseases was higher in the non-Aboriginal population.2

Projected disease burden It is predicted that in 2016, nervous system and senses organ disorders will continue to be the third major cause of disease burden.9 For the top 15 specific conditions, it was projected that in 2016 Dementia will be the first leading cause of disease burden for females and the second for males.9

Burden of disability WA 2006 by sex In 2006 the leading causes of disability burden in WA males were mental disorders, nervous system and senses organ disorders and diabetes mellitus.2 The same pattern was observed in females.2 The disability rates for nervous system and senses organ disorders were very similar in males and females.2

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Figure 2: Burden of disability WA 2006 by sex 2

Burden of disability WA 2006 for Aboriginals by sex In WA in 2006 the leading causes of disability burden in Aboriginal males were mental disorders, diabetes mellitus and chronic respiratory disease.2 In Aboriginal females the leading causes were mental disorders, diabetes mellitus and cardiovascular disease.2 Nervous system and senses organ disorders were ranked 5th in both sexes, with similar rates of YLDs.2

In non-Aboriginal males the leading causes of disability were mental disorders, nervous system and senses organ disorders and diabetes mellitus.2 In non-Aboriginal females the leading causes of disability were mental disorders, nervous system and senses organ disorders and musculoskeletal diseases.2

Comparing the sexes by Aboriginality, non-Aboriginal males had a significantly higher burden of disability for nervous system and senses organ disorders compared to Aboriginal males.2 The same pattern was noted for females.2

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Burden of disability WA 2006 for nervous system and senses organ disorder In WA in 2006, the leading causes of disability due to nervous system and senses organs disorder for the total population were dementia (36.3%), adult onset hearing loss (19.3%) and Parkinson’s disease (7.1%).2 For females the leading causes of disability were dementia (44.2%), adult onset hearing loss (10.2%) and migraine (8.4%). For males the leading causes of disability were dementia (27.1%), adult-onset hearing loss (29.8%) and Parkinson’s disease (7.3%).2

Table 2: Number and percentage of total disability adjusted life years (DALYs) lost to nervous system and senses organ disorders in WA in 2006 by sex 2

Cause Male (N)

Male (%)

Female (N)

Female (%)

Total (N)

Total (%)

Dementia Male N

4082 Male percentage

27.1 Femal e N

7749 Femal e percentage

44.2 Total N

11 832 Dementi a T otal percentag e

36.3

Epilepsy Male N

911 Male percentage

6.1 Femal e N


3.6 Total N

1534 Epil epsy T otal percentage

4.7

Huntington’s chorea Male N

82 Male percentage

0.5 Femal e N


0.4 Total N

158 Huntington’s disease Total percentage

0.5

Migraine Male N

479 Male percentage

3.2 Femal e N


8.4 Total N

1951 Migraine T otal percentage

6.0

Motor neurone disease Male N

457 Male percentage

3.0 Femal e N


1.2 Total N

667 Motor neurone disease Total percentage

2.0

Multiple sclerosis Male N

186 Male percentage

1.2 Femal e N


2.5 Total N

618 Multipl e scl erosis Total percentage

1.9

Muscular dystrophy Male N

37 Male percentage

0.2 Femal e N


0.0 Total N

39 Muscular dystr ophy Total percentage

0.1

Parkinson’s disease Male N


7.3 Femal e N


6.9 Total N

2297 Par ki nson’s disease Total percentage

7.1

Senses organ disorders Male N


43.2 Femal e N


25.1 Total N

10 891 Senses organ disorders T otal percentage

33.5

Senses organ disorders • Glaucoma related

blindness

Male N

122

Male percentage

0.8 Femal e N


0.8 Total N

254 Glaucoma r elated blindness Total percentage

0.8

Senses organ disorders • Cataract related

blindness

Male N

96

Male percentage

0.6 Femal e N


0.9 Total N

248 Cataract rel ated bli ndness T otal percentag e

0.8

Senses organ disorders • Macular degeneration

Male N

407

Male percentage

2.7 Femal e N


4.0 Total N

1113 Macul ar degenerati on T otal percentage

3.4

Senses organ disorders • Adult-onset hearing

loss

Male N

4488

Male percentage

29.8 Femal e N


10.2 Total N

6279 Adult-onset heari ng loss Total percentage

19.3

Senses organ disorders • Refractive errors

Male N

848 Male percentage

5.6 Femal e N


5.9 Total N

1875 Refracti ve err ors T otal percentage

5.8

Senses organ disorders • Other vision loss

Male N

532 Male percentage

3.5 Femal e N


3.4 Total N

1123 Other visi on loss T otal percentage

3.4

Other nervous system and sense disorders

Male N


8.2 Femal e N


7.7 Total N

2573 Other ner vous system and sense disorders T otal percentag e

7.9

All nervous system and senses organ disorders

Male N

15 046 Male percentage

100 Femal e N

17 514 Femal e percentage

100 Total N

32 559 All ner vous system and senses organ disor ders Total percentage

100

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#N.B.: The burden of disease and disability studies are based on 2006 public hospital separations data. It would be useful to repeat these studies using more recent data. Additionally, it should be noted that the studies do not consider data from private hospitals. It is also likely to underrepresent the burden of nervous system and senses organ disorders, particularly rare conditions since data is limited regarding these conditions.

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Hospitalisation rates for nervous system diseases The data on hospitalisation rates covers the period from 2001-12, however the 2012 data should be considered as preliminary. All data is for the state of WA but only includes hospitalisations in public hospitals.

Disease specific data has been presented in Appendix 2 for prominent neurological conditions.

• For WA, nervous system disease hospitalisations accounted for 2.4% of all hospitalisations by principal diagnosis between 2008-12.10

• During the ten year period the male rate of nervous system disease hospitalisation increased significantly (p <0.0001). The average annual percentage change in the rate was 7.8%.10

• For females the rate of nervous system diseases hospitalisation also increased significantly (p< 0.0001).10 The average annual percentage change in the rate was 8.4%.10

• Hospitalisations decreased significantly for the total population for dementia, epilepsy, Huntington’s disease, muscular dystrophy, motor neurone disease and Parkinson’s disease. Hospitalisations also decreased for the total population for stroke and cerebral palsy however these were not significant. A significant increase was identified for the total population over the last five years for migraine and multiple sclerosis.3

Figure 3: Nervous diseases hospitalisations in WA a ge standardised rate by sex and year 10

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Figure 4: Age specific nervous system diseases hosp italisations rates in WA 2008-12 10

The age group most affected by nervous system diseases is the 65+ age group.10

#N.B.: The hospitalisation rates presented only include consideration where nervous system diseases were the principle diagnosis. The data only includes rates of hospitalisation from public hospitals.

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Hospital costs The Epidemiology Branch provided a report on the costs of hospitalisations in 2012 where nervous system conditions were listed as the major cause of hospitalisation. In 2012, there were 31 804 occasions of hospital admission for conditions due to nervous system diseases in WA.3 These admissions totalled 340 627 beddays at an approximate cost of $307,114,587.3

Table 3: Hospitalisations, length of stay and costs of neurological conditions in WA 3

Condition Average length of stay (days)

Number of separations Beddays Total cost

Epilepsy Aver age l ength of stay

10.49 Number of separ ati ons

2787 Beddays

29 224 Epil epsy T otal cost

$20,106,254

Cerebral palsy Aver age l ength of stay


1277 Beddays

5065 Cerebral palsy total cost

$7,586,833

Dementia Aver age l ength of stay


7955 Beddays

124 133 Dementi a total cost

$85,225,176

Huntington’s Aver age l ength of stay


35 Beddays

609 Huntington’s total cost

$291,408

Hydrocephalus Aver age l ength of stay


416 Beddays

6181 Hydrocephalus total cost

$11,735,562

Migraine Aver age l ength of stay


1742 Beddays

6022 Migraine total cos t

$6,942,465

Motor neurone disease

Aver age l ength of stay


217 Beddays

2185 Motor neurone disease total cost

$2,088,975

Multiple sclerosis Aver age l ength of stay


4037 Beddays

9175 Multipl e scl erosis total cost

$12,189,179

Muscular dystrophy



108 Beddays

853 Muscular dystr ophy total cost

$1,358,364

Parkinson’s Aver age l ength of stay


1870 Beddays

36 943 Par ki nson’s total cos t

$21,245,898

Spina bifida Aver age l ength of stay


143 Beddays

2168 Spi na bifi da total cost

$2,089,702

Stroke Aver age l ength of stay


5479 Beddays

80 820 Stroke total cos t

$78,107,937

Transient ischemic attack



1545 Beddays

8012 Transi ent ischemic attack total cos t

$9,669,957

Traumatic brain injury



4193 Beddays

29 237 Traumatic brai n i njur y total cos t

$48,476,877

*Costs are based on Australian National Diagnostic Related Groups (ANDRG) National Public costweights as published by Commonwealth Department of Ageing.

#N.B.: Table 3 only includes occasions where the “condition” was listed as the major cause of hospitalisation. It does not include less prevalent neurological conditions, although as a combined group ‘other disorders’ were identified to account for 7.9% of the total disability adjusted life years lost to nervous system and senses disorders.2 The contribution of nervous system diseases to overall hospitalisation costs would be expected to be considerably higher as it should include patients with neurological conditions who are admitted with a primary diagnosis for an alternative health condition and/or patients who have a less prevalent type of neurological condition than those listed in the table above.

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Emergency department attendance The following data relates to primary diagnosis of a neurological condition established at the conclusion of a patient's attendance in an ED. A code is provided following consideration of the clinical assessment of the patient.

Between 2004-14, there were 111 433 ED attendances across WA with a primary diagnosis of a neurological condition.4 The conditions with the highest frequency of ED attendance for specific neurological diagnosis were acquired brain injury (25%), epilepsy (24%), migraine (18%), transient ischaemic attack (TIA) (14%) and stroke (6%).4 Further data on ED attendance for prominent neurological conditions has been presented in Appendix 2.

In 2014 there were 13 033 presentations to ED with a primary diagnosis of a neurological condition compared to 10 364 presentations in 2010.4

The following table identifies the relative rank of the neurological principle diagnosis in comparison to all ED presentations coded between 2004–14 in WA. Intracranial injury, epilepsy and migraine were the highest ranked from the list of neurological diagnoses considered below.

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Table 4: Primary diagnosis of a neurological condit ion and relative rank in WA 2004–14

Primary diagnosis at character level Attendance Principal diagnosis rank

Primar y diagnosis at char acter level

(S06) Intracranial injury Attendance

25 772 Principal diag nosis rank

55 Primar y diagnosis at char acter level

(G40) Epilepsy Attendance



(G43) Migraine Attendance



(G45) Transient cerebral ischaemic attacks & related syndromes

Attendance


90


(F05) Delirium, not induced by alcohol and other psychoactive substances

Attendance

8488 Principal diag nosis rank

126


(F03) Unspecified dementia Attendance



(I61) Intracerebral haemorrhage Attendance



(G41) Status epilepticus Attendance



(I60) Subarachnoid haemorrhage Attendance



(I62) Other non-traumatic intracranial haemorrhage Attendance



(G20) Parkinson’s disease Attendance



(F07) Personality and behavioural disorders due to brain disease, damage and dysfunction

Attendance


382


(G35) Multiple sclerosis Attendance



(G93) Other disorders of brain Attendance



(G91) Hydrocephalus Attendance



(G12) Spinal muscular atrophy and related syndromes Attendance



(G80) Cerebral palsy Attendance



(Q03) Congenital hydrocephalus Attendance



(G21) Secondary parkinsonism Attendance



(G71) Primary disorders of muscles Attendance



(Q05) Spina bifida Attendance



(Q76) Congenital malformations of spine and bony thorax Attendance

<5 Principal diag nosis rank

930

#N.B. The codes used for the above data have not been approved by a clinical coder and therefore may not be an accurate representation of true number of ED attendances. Secondary diagnosis of patients attending an ED are not captured in this data. The International Classification of Diseases (ICD) codes used for the ED data are the same as those used for the hospital separations as listed in Appendix 2 as well as some additional codes listed in Appendix 3. ICD10-AM Primary Diagnosis is not captured in all WA EDs, so the counts above are predominantly based on Perth metropolitan hospitals. ICD10-AM Primary diagnosis has not been captured at all sites for the entire period 2004-14, so increased counts over time may be related to the capture of data from additional hospitals. ICD10-AM Version 2 has been captured at 8 metropolitan EDs since 2002 and at 1 metropolitan and 1 rural hospital since 2008. ICD10-AM V6/7 has been captured at 6 rural sites since November 2012 and 3 rural sites since September 2014. ICD10-AM primary diagnosis was not captured at one metropolitan site during the period 2004-14.

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Non-admitted outpatients clinics In 2013, 18 953 patients attended 30 608 appointments at public neurology non-admitted outpatient clinics in WA.5

From this:

• 11 335 patients accessed one neurology non-admitted outpatient clinic • 4330 patients accessed two clinics • 1789 patients accessed three clinics • 734 patients accessed four clinics • 765 patients accessed five or more clinics.5

Figure 5: The percentage of patients accessing publ ic neurology non-admitted outpatient clinics in WA in 2013. 5

The above figure highlights the percentage of patients accessing one (60%), two (23%), three (9%), four (4%) or five or more (4%) public neurology non-admitted outpatient clinics in WA in 2013.5 65% of the patients are identified to return to the same clinic for follow-up, with the remainder accessing a range of different types of clinics. The number of clinics attended each year by a patient has remained relatively consistent between 2008-12.5

One clinic60%

Two clinics23%

Three clinics9%

Four clinics4%

Five or more4%

21

The following table identifies the number of patients attending neurology non-admitted outpatient clinics across all public metropolitan hospitals in WA.

Table 5: Number of attendances at non-admitted neur ology outpatient clinics in WA by type of clinic in 2013 5

Clinic category 2013

Clinical Measurement 2013 N

2533

Epilepsy 2013 N

2555

Minor Medical Procedures 2013 N

208

Neurology 2013 N

15 312

Neuropsychology 2013 N

8

Neurosurgery 2013 N

6150

Nutrition/Dietetics 2013 N

48

Occupational Therapy 2013 N

22

Pain Management 2013 N

687

Physiotherapy 2013 N

941

Rehabilitation 2013 N

1814

Social Work 2013 N

56

Speech Pathology 2013 N

269

Total (all) 2013 N

30 608

Table 6: Number of attendances at WA non-admitted n eurology outpatient clinics by type of clinic in 2013 5

Clinic Number of attendances

Fremantle Hospital Number of attendances

3395

Hedland Health Campus Number of attendances

13

Osborne Park Hospital Number of attendances

396

Nickol Bay Hospital-Karratha Number of attendances

27

Princess Margaret Hospital Number of attendances

4704

Rockingham Hospital Number of attendances

404

Royal Perth Hospital, Shenton Park Campus Number of attendances

681

Royal Perth Hospital Number of attendances

7270

Sir Charles Gairdner Number of attendances

10 364

Swan District Hospital Number of attendances

3371

In addition, Royal Perth Hospital had a total of 402 telehealth neurology clinics in 2013 servicing a range of health districts across regional WA. It should be noted that the metropolitan figures would also include regional patients who travelled to the metropolitan area to attend a clinic.5

22

In Albany, Amity Health a non-government organisation primarily funded by the Australian Government Department of Health had 59 patients attend neurology clinics between June to December 2014.

Figure 6: Total number of patients accessing neurol ogy clinics 2008-12 in WA 5

The above graph highlights the numbers of patients attending non-admitted neurology outpatient clinics from 2008-12. There has been an increase in attendances from 17 752 in 2008 to 19 909 in 2012.5 There was a slight decline in the number of outpatient appointments attended in 2013 with 18 953 appointments.5

#N.B.: Clinics that had five or less attendances in one year were not included in the data summaries. The grouping of clinics in Table 5 was pre-determined using clinic identification and clinic category codes and in some instances the coding varied between hospitals.

17752

18607

1957919789 19909

18953

17000

18000

19000

20000

2008 2009 2010 2011 2012 2013

No.

of p

atie

nts

23

Mortality In WA, nervous system disease accounted for 8.8% of all deaths between 2007 and 2011.11 During the five year period, the male and female rates of mortality from nervous system diseases did not change significantly.11 The average number of deaths due to nervous system diseases in WA between 2007-11 was 1107 per year.11

Table 7: Total death rates for WA metropolitan and country residents by condition 2007–11

Condition Metro 26 Country 27 Total 11

Systemic atrophies primarily affecting the central nervous system

Metro

298 Countr y

74 Total

372

Parkinson’s disease Number of attendances

403 Countr y

95 Total

498

Dementia (including Alzheimer’s disease) Number of attendances

3311 Countr y

688 Total

3999

Episodic and paroxysmal disorders Number of attendances

91 Countr y

44 Total

135

Other disorders of the nervous system Number of attendances

401 Countr y

108 Total

509

All nervous system diseases Number of attendances

4505 Countr y

1009 Total

5514

1Systemic atrophies primarily affecting the central nervous system includes Huntington’s disease; hereditary ataxia; spinal muscular atrophy and related syndromes (including motor neurone disease), systemic atrophies primarily affecting central nervous system in diseases classified elsewhere and postpolio syndrome. 2Episodic and paroxysmal disorders includes epilepsy, status epilepticus, migraine, other headache syndromes, transient cerebral ischaemic attacks and related syndromes, vascular syndromes of brain in cerebrovascular diseases and sleep disorders. 3Other disorders of the nervous system include disorders of autonomic nervous system, hydrocephalus, toxic encephalopathy, other disorders of brain, other disorders of brain in diseases classified elsewhere, other diseases of spinal cord, other disorders of central nervous system, postprocedural disorders of nervous system, not elsewhere classified, other disorders of nervous system, not elsewhere classified and other disorders of nervous system in diseases classified elsewhere.

#N.B.: The mortality data is based on underlying cause of death as determined by the Australian Bureau of Statistics and doesn’t include additional causes of death.

24

A separate analysis of mortality data for more prevalent neurological conditions was undertaken. The following table identifies the numbers of deaths by neurological condition.

Table 8: Number of deaths in WA in 2011 by neurolog ical condition 3

Condition Number of deaths

Cerebral palsy Number of deaths

18

Dementia Number of deaths

1223

Epilepsy Number of deaths

99

Huntington’s disease Number of deaths

5

Hydrocephalus Number of deaths

24

Motor neurone disease Number of deaths

84

Multiple sclerosis Number of deaths

23

Muscular dystrophy Number of deaths

10

Parkinson’s disease Number of deaths

214

Stroke Number of deaths

1210

Transient ischemic attack Number of deaths

97

Traumatic brain injury Number of deaths

55

Further mortality trend data is provided in Appendix 2.

#N.B.: The data included above used both principal diagnosis plus additional diagnosis for each condition of interest.

25

Community services and supports It is estimated that there are more than 600 recognised neurological conditions which vary in the type of symptoms experienced and the acute, chronic, remissive or degenerative nature of the condition.28 There are over 130 different neurological conditions currently supported in WA. A list of these conditions has been provided in Appendix 1.

Table 9: Estimated membership numbers and prevalenc e in community based organisations in WA in 2014 6

Organisation Members/ clients supported

Prevalence estimate reported by the organisation

Data source

Alzheimer’s Australia WA

3500 members

Prevalence esti mate

30 700 living with dementia in WA

Data source

Australian Institute of Health and Welfare/ Australian Bureau of Statistics

Centre for Cerebral Palsy

Supporting 1720 people


2.4 per 1000 have cerebral palsy in WA

Data source

Cerebral Palsy Registry on 14/10/2014

Epilepsy Action 350 members 280 with Epilepsy 70 family/ carer


Australian figure: 230 000 Data source

Sydney Epilepsy Incidence Study. George’s Institute for Medical Research

Epilepsy Association

350 members Prevalence estimate unknown

Data source

N/A

Headwest 250 clients supported per year

Prevalence estimate unknown

Data source

N/A

Huntington’s WA 425 members 63 children 157 family


12-16 per 100 000 in WA 20% clustered in South West of WA

Data source

Estimate from WA Neurosciences Unit

Learning and Attention Disorders

400 members Prevalence estimate unknown

Data source

N/A

Myalgic Encephalomyelitis /Chronic Fatigue

80 members Prevalence esti mate

0.2–0.7% in Australia Data source

2004 Royal Australasian College of Physicians

Motor Neurone Disease

240 members 140 patients


1 in 13 000 in Australia Data source

Macquarie University Study

Multiple Sclerosis 2500 members 250 patients


71 per 100 000 in Australia Data source

MS Society national data

Muscular Dystrophy

100 members 400 people serviced


Data source

N/A

26

Organisation Members/ clients supported

Prevalence estimate reported by the organisation

Data source

Neurodegenerative Conditions Coordinated Care Program (NCCCP)

50 clients supported


Data source

N/A

Neurological Council of WA

1742 clients supported 2013-14


Data source

N/A

Neurosciences Unit

250-300 new clients supported per annum


Data source

N/A

Parkinson’s WA 3000 members 1800 patients


8000 in WA Data source

Pharmaceutical Benefits Scheme

Silver Chain 3129 clients supported with neurological condition


Data source

N/A

Trigeminal Neuralgia Support Group

100 members Prevalence esti mate

1 in 20 000 Internationally Data source

Mayo Clinic USA – Dr Zakrzewska

Spina Bifida and Hydrocephalus

151 members (54 sufferers)


Data source

N/A

State Head Injury Unit

Servicing 600–700 per year (ABI <2 years)


Data source

N/A

Stroke Foundation 500 members Prevalence esti mate

4652 suffering stroke 41 173 stroke survivors 999 Stroke deaths

Data source

National Stroke Foundation 2014 data

Using the data from the above table it can be estimated that there are over 19 800 people who are members of WA based community neurological organisations and/or receive services and supports from these agencies. Services provided may be of a clinical or non-clinical nature.6

#N.B.: The data from Table 9 is based on best estimates provided by community organisations. It is acknowledged that organisations use a number of different data systems to collect data on their client contacts and member numbers, therefore the figures should only be used as an indication of potential numbers. Future data collection could consider the numbers of members and clients serviced in regional and remote areas. There are also opportunities to improve data collection and linkages using data registries for specific conditions.

27

Home and community care A number of the community organisations providing in home services to people with a neurological condition are partially or fully funded by the Home and Community Care Program (HACC). All providers are required to provide data on the services they provided as required under the minimum data set and a report is produced annually based on this data. The minimum data set includes:

• characteristics of care recipients (for example sex, date of birth, Aboriginal status, functional status items)

• the circumstances of care recipients (i.e. where they live, whether they have a carer) • the characteristics of carers (for example, date of birth, sex, Aboriginal status) • information about the service episode (for example source of referral, data of entry, date

of last update) • the assistance received by recipients and carers from the HACC program (for example

amounts and types of assistance received)7

Unfortunately, the minimum data set does not include information on the health issues causing their need for services so without data linkage systems there is limited ability to determine how many HACC services are provided to people with a neurological condition. Some HACC funded organisations do collect this information separately however it is not linked to the HACC minimum data set.

The HACC client characteristic data for 2012-13 showed that the number of female HACC care recipients outnumbered male HACC care recipients across all regions in WA and in fact there were almost twice as many female care recipients (65.7% female vs 34.3% male).7

The leading number of service types provided under the HACC Program were:

1. assessment 2. domestic assistance 3. transport 4. home maintenance 5. social support 6. centre based day care 7. client care coordination7

The 2012–13 HACC report noted that the assessment volumes increased 17.9% over the previous year, despite a 9.4% decrease in the number of new clients.7 In terms of age of recipients, the highest number of care recipients in every service type falls in the 75-89 age group.7

Silver Chain Group, which receives HACC funding, collects additional data outside of the minimum dataset. In 2014, Silver Chain provided services for 3129 clients in WA with at least one of 36 different neurological conditions including Alzheimer's disease, cerebral palsy, Parkinson disease and multiple sclerosis.6 These clients have 3449 diagnosed neurological conditions between them and are receiving one of at least 44 services from Silver Chain including continence management and advice, home help, nursing and allied health.6

#N.B.: The HACC minimum dataset could be a useful and complementary source of data if it included information on the medical cause for a recipient’s access to services or if a data linkage system was developed.

28

Disability Services Commission There is also a minimum data set collected by the Disability Services Commission. Within the data fields the service user’s primary and other disability groups are identified. Table 10 identifies that there were 15 948 people with acquired brain injury and 39 140 people with neurological conditions who accessed disability services in 2012-13.8

Table 10: Disability service users in WA, by primar y or other significant disability group 2012–138

Primary disability group

Other disability group

Total disability group

Disability group Primar y disability group

Number Primar y disability group

% Other disability group

Number Other disability group

% Total disability group

Number Total disability group

% Disabil it y g roup

Intellectual/learning All Int ellectual /learning Pr imary disabil it y g roup nu mb er

134 005 All Int ellectual /learning Pr imary disabil it y g roup %

45.3 All Int ellectual /learning Oth er disabil it y group numb er

40 687 All Int ellectual /learning Oth er disabil it y group %

13.0 All Int ellectual /learning Total disabilit y g roup nu mber

174 692 All Int ellectual /learning Total disabilit y g roup %

55.9 Intellec tual/ l earning disability group

Intellectual Intellec tual Primar y disability group number

84 082 Intellec tual Primar y disability group %

28.4 Intellec tual Other disability group number

16 980 Intellec tual Other disability group %

5.4 Total Intellec tual disability group number

101 062 Total Intellec tual disability group %


Specific learning/ADD Specific l earni ng/ADD Pri mar y disability group number

12 808 Specific l earni ng/ADD Pri mar y disability group %

4.3 Specific l earni ng/ADD Other disability group number

11 463 Specific l earni ng/ADD Other disability group %

3.7 Total Specific l ear ning/ADD disability gr oup number

24 271 Total Specific l ear ning/ADD disability gr oup %


Autism Autism Pri mary disability group number

26 347 Autism Pri mary disability group %

8.9 Autism Other disability group number

10 288 Autism Other disability group %

3.3 Total Autism disability group number

36 635 Total Autism disability group %


Development delay Devel opment delay Pri mar y disability group number

10 768 Devel opment delay Pri mar y disability group %

3.6 Devel opment delay Other disability group number

1956 Devel opment delay Other disability group %

0.6 Total Devel opment delay disability group number

12 724 Total Devel opment delay disability group %

4.1 Disabil it y g roup

Physical/diverse All ph ysical /diverse Primary disab ilit y grou p number

78 935 All ph ysical /diverse Primary disab ilit y grou p %

26.7 All ph ysical /diverse Other disab ilit y group nu mber

70 044 All ph ysical /diverse Other disab ilit y group

%22.4 All ph ysical /diverse Tot al d isabi lit y group numb er

148 979 All ph ysical /diverse Tot al d isabi lit y group %

47.7 Physical/di verse disability group

Physical Physical Primar y disability group number

49 655 Physical Primar y disability group %

16.8 Physical Other disability group number

44 236 Physical Other disability group %

14.2 Total Physical disability gr oup number

93 981 Total Physical disability gr oup %


Acquired brain injury Acquired brai n i njur y Primar y disability group number

11 340 Acquired brai n i njur y Primar y disability group %

3.8 Acquired brai n i njur y Other disability group number

4608 Acquired brai n i njur y Other disability group %

1.5 Total Acquired brai n inj ur y disability group number

15 948 Total Acquired brai n inj ur y disability group %


Neurological Neur ological Pri mar y disability group number

17 940 Neur ological Pri mar y disability group %

6.1 Neur ological Other disability group number

21 200 Neur ological Other disability group %

6.8 Total Neur ological disability group number

39 140 Total Neur ological disability group %


Sensory/speech All sen sory/sp eech Primary disab ilit y group nu mber

26 341 All sen sory/sp eech Primary disab ilit y group %

8.9 All sen sory/sp eech Other disabil it y g roup nu mb er

39 630 All sen sory/sp eech Other disabil it y g roup %

12.7 All sen sory/sp eech Tot al disab ilit y grou p number

65 971 All sen sory/sp eech Tot al disab ilit y grou p %

21.1 Sensor y/speech disability group

Deaf-blind Deaf-blind Primar y disability group number

748 Deaf-blind Primar y disability group %

0.3 Deaf-blind Other disability group number

1281 Deaf-blind Other disability group %

0.4 Total Deaf- blind disability group number

2029 Total Deaf- blind disability group %


Vision Vision Primar y disability group number

12 721 Vision Primar y disability group %

4.3 Vision Other disability group number

11 385 Vision Other disability group %

3.6 Total Visi on di sability group number

24 106 Total Visi on di sability group %


Hearing Heari ng Pri mar y disability group number

8900 Heari ng Pri mar y disability group %

3.0 Heari ng Other disability group number

7897 Heari ng Other disability group %

2.5 Total Hearing disability group number

16 797 Total Hearing disability group %


Speech Speech Pri mar y disability group number

3972 Speech Pri mar y disability group %

1.3 Speech Other disability group number

19 067 Speech Other disability group %

6.1 Total Speech disability group number

23 039 Total Speech disability group %


Psychiatric All p sychiatric Primary disab ilit y group nu mber

56 391 All p sychiatric Primary disab ilit y group %

19.1 All p sychiatric Other disabil it y g roup nu mb er

27 994 All p sychiatric Other disabil it y g roup %

9.0 All p sychiatric Tot al disab ilit y grou p number

84 385 All p sychiatric Tot al disab ilit y grou p %

27.0

Psychiatric Psychiatric Pri mar y disability group number

56 391 Psychiatric Pri mar y disability group %

19.1 Psychiatric Other disability group number

27 994 Psychiatric Other disability group %

9.0 Total Psychiatric disability group number

84 385 Total Psychiatric disability group %

27.0 Disability group

Totalª Primar y disability group total Total all Pri mar y disability group number

295 672 Primar y disability group total Total all Pri mar y disability group %

100.0 Other disability group total Total all Other disability group number

312 539 Other disability group total Total all Other disability group %

100.0 Total disability group total Total all disability group number

312 539 Total disability group total Total disability group %

100.0

ª Primary disability group was ‘not stated/not collected’ for 16 867 service users (which includes service users who used only recreation/holiday programs (service type 3.02) and who did not provide a response). The total for ‘primary disability group’ excludes these records, while the total for ‘total disability group’ includes these records.

29

Notes

1. Service user data are estimates after use of a statistical linkage key to account for individuals who received services from more than one service type outlet during the 12 month period.

2. Service user data were not collected for all NDA service types. Refer to the appendix to this bulletin, separately published as Disability support services: Appendix 2012-13 (AIHW 2014).

3. Totals for ‘other significant disability’ and ‘total disability’ are not the sum of components because individuals may report multiple types of disability.

# N.B.: A linkage process was used by the Australian Institute of Health and Welfare to identify the extent of joint use of disability services and the HACC program29. The data could be further considered with additional breakdown by type of neurological condition.

30

Impact of rare diseases study Exploring the impact of rare diseases on the Wester n Australian health system The Office of Population Health Genomics (OPHG) is leading an international collaborative study investigating the impact of rare diseases on the WA health system. Rare diseases are those which occur in Australia in less than 1 in 2000 people. At present, there is limited data on the number of people affected by, and the burden of rare diseases on the WA health system. Collating data on rare diseases is significantly hampered by the inadequate coding specific for each disease within the ICD coding system. Orphanet is an international consortium that has developed a comprehensive coding system for rare diseases called Orpha number (www.orpha.net). Orphanet, in collaboration with the World Health Organisation, have expanded the ICD coding system such that the new release of ICD-11 will more adequately code rare diseases.

This epidemiological cohort study aims to measure the impact of rare diseases on the WA health system over a ten year period using linked data from the Hospital Morbidity Data Set (HMDS), the Western Australian Register of Developmental Anomalies (WARDA) which receives mandatory data of developmental anomalies (birth defects and cerebral palsy) for children aged 0-6 years, and death records supplied from the Registry of Births, Deaths and Marriages within the WA Department of the Attorney General. In addition, linked data from Emergency, Cancer Registry and Mental Health data sets will assist in identifying comorbidities of rare disease. Neurological diseases contribute to approximately 13% of the rare diseases coded in this study. This study is a collaborative study led by OPHG in partnership with the WA Health Data Linkage Branch. Expert advice is contributed by the WA Department of Health Directorates of Data Integrity, Health System Economic Modelling and Epidemiology Branch; Genetic Services WA, Telethon Kids Institute and Orphanet France. Information from this study will inform the state and national planning for improved management of rare diseases in Australia.

31

Conclusion This report has been able to demonstrate the range of data that is available to identify the significance of neurological conditions in WA. It has provided estimates of the number of people accessing public hospital and non-admitted outpatient services and/or community services, although often the figures under estimate the true rates. Future efforts should concentrate on the establishment of a reliable and valid linked dataset for neurological conditions.

This type of dataset could be used to identify:

• number of people with neurological conditions across WA • prevalence and/or incidence of different types of neurological conditions • prevalence and/or incidence trends over time to enable planning for future service needs • percentage of people that are currently being serviced and the type of services they

access • whether current levels of service provision are adequate and best utilised • impact of new initiatives which aim to reduce the severity of conditions and level of care

required.

It is important to continue to gain a better understanding of the epidemiological profile of neurological conditions to ensure that services in WA meet the need of the community both now and into the future.

32

Appendix 1: List of conditions serviced in WA

Acquired brain injury

Adem [acute disseminated encephalomyelitis]

Alexander disease

Angelman syndrome

Ankylosng spondylitis

Alzheimer's disease

Anaplastic astrocytoma

Autism

Ataxic disorder

Arteriovenous malformation

Brain aneurysm

Brain tumour

Blepharos spasm

Cadasil

Canavan disease

Cauda equine syndrome

Cerebellar ataxia

Cerebral palsy

Charcot-Marie-Tooth disease

Chiari malformation

Chorea

Cognitive dysfunction

Complex regional pain syndrome

Chronic fatigue syndrome

Chronic demyelinating inflammatory Polyneuropathy

Dementias

Down's syndrome

Diabetic neuropathy

Duchene muscular dystrophy

Dysautonomias

Dystonias

Encephalitis

Epilepsy

Essential tremor

Extrapyramidal syndrome

Fibromyagia

Focal cerebral palsy

Fragile x syndrome

Friedreich's ataxia

Frontotemporal dementia

Global development delay

Guillain barre' syndrome

Hashimoto encephalopathy

Hallervorden-spatz syndrome

Headache and migraine

Hemifacial spasm

Hereditary motor and sensory neuropathy

Hereditary spastic paraparesis

Holopresencepaly

Huntington’s disease

Hydrocephalus

Hypertrophic olivary degeneration

Hypoxic-ischaemic encephalopathy

Inclusion body myositis

Idiopathic intracranial hypertension

Intellectual disability

Intracranial bleed

Kennedy's disease

Lambert-eaton myasthenic syndrome

Lateral medullary syndrome

Labrynitis

Lewy body disease

Lissen cephaly

Limbic encephalitis

Locked-in syndrome

Lyme disease

Meniere's disease

Meningitis

Melas

Microcephaly

33

Motor neuron disease

Moya moya disease

Myalgic encephalomyelitis

Myasthenia gravis

Myelitis

Myelodysplasia

Myeloradiculopathy

Myopathy

Multisystem atrophy

Multiple sclerosis

Narcolepsy

Neuropathy, ataxia and retinitis pigmentosa [narp]

Neurofibromatosis

Neuromyelitis opticus

Normal pressure hydrocephalus

Oligodenroglioma

Oliviopontocerebellar degeneration

Paraplegia

Parkinsonism

Parkinson's disease

Peripheral neuropathies

Poem syndrome

Poliomyelitis

Post traumatic distress syndrome

Posterior fossa meningioma

Prader-willi syndrome

Progressive supranuclear palsy

Quadriplegia

Radiation myolitus

Rett syndrome

Restless leg syndrome

Schaltenbrand syndrome

Scoliosis

Seizure disorders

Smart syndrome

Soto syndrome

Spinal atrophy

Spinocerebllar degeneration

Spinocerebellar ataxia

Spina bifida

Spinal arachnoiditis

Spinal cord compression

Spinal cord injury

Spinal cord tumour

Spinal muscular atrophy

Spinal stenosis

Spontaneous cerebellar haemorrhage

Stereotypies

Stiffman syndrome

Stroke

Subacute sclerosing panencephalitis

Subarachnoid haemorrhage

Systemic lupus

Temporal arteritis

Tourette syndrome

Traumatic brain injury

Transient ischemic attack

Trigeminal neuralgia

Tuberous sclerosis

Vanishing white matter disease

Vascular dementia

Vertigo

West syndrome

William syndrome

34

Appendix 2: Data summary for major conditions Data summaries have been provided for the following conditions:

• cerebral palsy • dementia • epilepsy • Huntington’s disease • hydrocephalus • migraine • motor neurone disease • multiple sclerosis • muscular dystrophy • Parkinson’s disease • spina bifida • stroke • transient ischemic attack • traumatic brain injury

Considerations when interpreting the following data:

• The data on hospitalisations does not consider admissions from private hospitals. • Hospitalisation rates, length of stay and costs within the report, only considered

occasions where a neurological condition was the principal diagnosis. • Changes in hospitalisation rates across years is calculated using age standardised rates. • The ED data also included additional ICD codes listed in Appendix 3.

35

Cerebral palsy In 2012, cerebral palsy patients had an average length of stay in hospital of 3.97 days, an occupancy of 5065 beddays at a total cost of $ 7,586,833.3 Additionally in 2011 there were 18 deaths recorded in WA from cerebral palsy.3

The total combined number of hospital separations for cerebral palsy in WA between 2008-12 was 6021.3 For WA, the rate of cerebral palsy hospitalisations decreased between 2008-12, but it was not significant.3 The average annual percentage change in the rate was -0.97%.3

In 2012, there were a total of 1277 hospitalisations in WA for cerebral palsy; from this 55% were males and 45% females.3

Figure 7: Annual number of hospitalisations for cer ebral palsy in WA by gender for 2008–12.3

The above figure shows the WA annual hospital separations by gender for the years 2008–12 for cerebral palsy. During the five year period, both the male and female rate of hospitalisations decreased, but neither were significant.3

693 665 681 676707

496

539511

483

570

400

500

600

700

800

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

36

Figure 8: Total number of hospitalisations for cere bral palsy in WA by Aboriginality and gender for 2008–12. 3

The above figure shows the total number hospitalisations for cerebral palsy in WA by aboriginality and gender between 2008–12. Over the five year period, Aboriginal people accounted for 13% of hospitalisations for cerebral palsy in WA.3 This is significant as 3.1% of the population in WA are Aboriginal.30

Table 11: Number of hospitalisations for cerebral p alsy by key age groups and gender for 2008–12 in WA. 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender

Male Male 0–4 years (N)

600 Male 5–14 years (N)




180 Male 65+ years (N)

80 Gender

Female Femal e 0–4 years (N)

471 Femal e 5–14 years (N)




152 Femal e 65+ years (N)

47

All All 0–4 years (N)

1071 All 5–14 years (N)

3127 All 15–24 years (N)

841 All 25–44 years (N)

523 All 45–64 years (N)

332 All 65+ years (N)

127

The age group most hospitalised for cerebral palsy is the 5-14 year olds and accounted for 52% of the hospital admissions between 2008-12.3

0

500

1000

1500

2000

2500

3000

3500

4000

Male Female

No.

of h

ospi

talis

atio

ns

GenderNon-Aboriginal Aboriginal

37

Figure 9: Annual cerebral palsy hospitalisations in WA metropolitan and regional health service areas for 2003–13. 3

The above figure displays the number of annual hospitalisations for cerebral palsy in WA metropolitan and regional health service areas between 2003-13. On average, metropolitan health service areas recorded 911 hospitalisations annually for cerebral palsy, compared to regional service areas with an average of 263 hospitalisations annually.3

Figure 10: Annual cerebral palsy attendances in WA emergency departments for 2008–14.4

The above figure shows the number of ED attendances for cerebral palsy in WA have remained reasonably consistent between 2008–14.4

701774

918972 939 898 932 940 899

1032 1018

263 262 261 256 274 288 270 252 257 237 275

0

200

400

600

800

1000

1200

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns

YearMetropolitan Regional

11 11

9

12

109

12

0

5

10

15

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s

WA Health Services

38

Figure 11: Annual cerebral palsy mortality rate for all WA Department of Health services between 2001–11. 4

The above figure displays the annual cerebral palsy mortality rate for WA metropolitan and regional health service areas between 2001-11. On average, there is 13 deaths from cerebral palsy each year in WA.4

Table 12: Cerebral palsy ICD codes used

Cerebral palsy ICD codes

G80.00 Spastic cerebral palsy, unspecified

G80.01 Spastic diplegic cerebral palsy

G80.02 Spastic hemiplegic cerebral palsy

G80.03 Spastic quadriplegic cerebral palsy

G80.09 Other spastic cerebral palsy

G80.3 Dyskinetic cerebral palsy

G80.4 Ataxic cerebral palsy

G80.8 Other cerebral palsy

G80.9 Cerebral palsy, unspecified

1112 12

13

8

16

6

19

15

8

18

0

5

10

15

20

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s

YearAll WA Health Services

39

Dementia In 2012, dementia patients had an average length of stay in WA hospitals of 15.6 days, an occupancy of 124 133 beddays at a total cost of $ 85,225,176.3 Additionally, in 2011 there were 1223 deaths from dementia in WA.3

The total combined number of hospital separations for dementia in WA over the past five years from 2008-12 was 39 146, from this 45% were males and 55% females.3 In 2012, there were a total of 7955 hospitalisations for dementia.3

Dementia (including Alzheimer’s disease) hospitalisations accounted for 0.1% of all hospitalisations by principal diagnosis between 2008-12.3

For WA, the rate of dementia hospitalisations in WA between 2008–12 decreased and was significant (P<0.001). The average annual percentage change in the rate was -6.42%.3

Figure 12: Annual number of hospitalisations for de mentia in WA by gender for 2008–12. 3

The above figure shows the annual number of dementia hospital separations by gender in WA between 2008-12. During the five year period, both the male and female rates of dementia hospitalisation decreased, and was significant (P<0.001).3 The average annual percentage change in the rate for males was -4.99% and -7.55% for females.3

3629

33683190

3360

3592

4900

4577

4224

3943

4363

3000

3500

4000

4500

5000

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

40

Figure 13: Total number of hospitalisations for dem entia in WA by Aboriginality and gender for 2008–12. 3

The above figure shows the total number of dementia hospitalisations in WA by aboriginality and gender between 2008-12. Over the five year period, Aboriginal people accounted for 2% of hospitalisations for dementia.3

Table 13: Number of dementia hospitalisations by ke y age groups and gender 2008–12 in WA3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







16 105 Gender







21 352


0 All 5–14 years (N)



179 All 45–64 years (N)


37 457

The age group most hospitalised for dementia is the 65+ year olds and accounted for 96% of the hospital admissions between 2008-12 in WA.3

16670

21619

469

388

0

5000

10000

15000

20000

25000

Male Female

No.

of h

ospi

talis

atio

ns


41

Figure 14: Annual dementia hospitalisations for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the annual number of dementia hospitalisations for WA metropolitan and regional health service areas between 2003-13. On average, metropolitan health service areas recorded 6789 hospitalisations annually for dementia compared to regional service areas with an average of 1554 hospitalisations annually.3

Figure 15: Annual dementia attendances in WA metrop olitan and regional emergency departments for 2008–14. 4

6995 6957 7236 7507 7357 69406511

6049 59946460 6670

1634 1683 1642 1623 1714 1557 1421 1353 1283 1477 1709

0

1000

2000

3000

4000

5000

6000

7000

8000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


9541059 1065

12731370

1487 1505

47 32 54 64 89 76 84

0

200

400

600

800

1000

1200

1400

1600

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s

Metropolitan Regional

42

Figure 15 shows the number of ED attendances for dementia in WA have nearly doubled in country areas between 2008-14.4 There has also been a 37% increase in the number of ED admissions in the metropolitan areas between 2008-14.4

Figure 16: Annual dementia mortality rate for WA me tropolitan and regional health service areas between 2001–11. 3

The above figure displays the annual dementia mortality rate for WA metropolitan and regional health service areas between 2001–11. On average, metropolitan health service areas recorded 873 deaths annually compared with 180 deaths reported for regional service areas.3

472 501

765820

891 917 936

1081 1093 10971033

104 91166 159 177 173

224 213254 232

190

0

200

400

600

800

1000

1200

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


43

Table 14: Dementia ICD codes used for the above dat a

Dementia ICD Codes

F00.0 Dementia in Alzheimer's disease with early onset (G30.0+)

F00.1 Dementia in Alzheimer's disease with late onset (G30.1+)

F00.2 Dementia in Alzheimer's disease, atypical or mixed type (G30.8+)

F00.9 Dementia in Alzheimer's disease, unspecified (G30.9+)

F01.0 Vascular dementia of acute onset

F01.1 Multi-infarct dementia

F01.2 Subcortical vascular dementia

F01.3 Mixed cortical and subcortical vascular dementia

F01.8 Other vascular dementia

F01.9 Vascular dementia, unspecified

F02.0 Dementia in Pick's disease (G31.0+)

F02.1 Dementia in Creutzfeldt-Jakob disease (A81.0+)

F02.2 Dementia in Huntington's disease (G10+)

F02.3 Dementia in Parkinson's disease (G20+)

F02.4 Dementia in human immunodeficiency virus [HIV] disease (B22.0+)

F02.8 Dementia in other specified diseases classified elsewhere

F03. Unspecified dementia

F05.1 Delirium superimposed on dementia

F10.7 Mental and behavioural disorders due to use of alcohol, residual and late-onset psychotic disorder

F11.7 Mental and behavioural disorders due to use of opioids, residual and late-onset psychotic disorder

F12.7 Mental and behavioural disorders due to use of cannabinoids, residual and late-onset psychotic disorder

F13.70 Mental and behavioural disorders due to use of sedatives or hypnotics, residual and late-onset psychotic disorder – unspecified agent

F13.71 Mental and behavioural disorders due to use of sedatives or hypnotics, residual and late-onset psychotic disorder– gammahydroxybutyrate

F13.79 Mental and behavioural disorders due to use of sedatives or hypnotics, residual and late-onset psychotic disorder – other specified agent

F14.7 Mental and behavioural disorders due to use of cocaine, residual and late-onset psychotic disorder

F15.70 Mental and behavioural disorders due to use of other stimulants, including caffeine, residual and late-onset psychotic disorder, unspecified stimulants

F15.71 Mental and behavioural disorders due to use of other stimulants, including caffeine, residual and late-onset psychotic disorder, methylamphetamine

Mental and behavioural disorders due to use of other stimulants, including caffeine,

44

Dementia ICD Codes residual and late-onset psychotic disorder, mdma/ecstasy

F15.79 Mental and behavioural disorders due to use of other stimulants, including caffeine, residual and late-onset psychotic disorder, other specified stimulants

F16.70 Mental and behavioural disorders due to use of hallucinogens, residual and late-onset psychotic disorder – unspecified hallucinogen

F16.71 Mental and behavioural disorders due to use of hallucinogens, residual and late-onset psychotic disorder – ketamine

F16.79 Mental and behavioural disorders due to use of hallucinogens, residual and late-onset psychotic disorder – other specified hallucinogen

F17.7 Mental and behavioural disorders due to use of tobacco, residual and late-onset psychotic disorder

F18.7 Mental and behavioural disorders due to use of volatile solvents, residual and late-onset psychotic disorder

F19.7 Mental and behavioural disorders due to multiple drug use and use of psychoactive substances, residual and late-onset psychotic disorder

45

Epilepsy In 2012, epilepsy patients had an average length of stay in hospital of 10.49 days, an occupancy of 29 224 beddays at total cost of $20,106,254.3 Additionally, in 2011 there were 99 deaths from epilepsy in WA.3

The total combined number of hospital separation for epilepsy in WA over the past five years between 2008-12 was 13 426, from this 57% were males and 43% females.3 In 2012, there were a total of 2787 hospitalisations for epilepsy.3

For WA, the rate of epilepsy hospitalisation decreased over the five year period between 2008-12 and it was significant (P<0.001).3 The average annual percentage change in the rate was -2.28%.3

Figure 17: Annual number of hospitalisations for ep ilepsy in WA by gender for 2008–12. 3

The above figure shows the total number of epilepsy separations annually by gender for WA between 2008–12. During the five year period, the male rate of epilepsy hospitalisation decreased, but it was not significant (P<0.52).3 For females the rate of epilepsy hospitalisation also decreased, and it was significant (P<0.001). The average annual percentage change in the rate was -3.77%.3

1457 14591432

1495

1575

12501175

1229

1142

1212

1000

1100

1200

1300

1400

1500

1600

1700

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

46

Figure 18: Total number of hospitalisations for epi lepsy in WA by Aboriginality and gender for 2008–12. 3

The above figure shows the total number of epilepsy hospitalisations in WA by Aboriginality and gender from 2008–12. Over the five year period, Aboriginal people accounted for 22% of the hospitalisations for epilepsy. This is significant as Aboriginal people make up 3.1% of the population of WA.30

Table 15: Number of epilepsy hospitalisations by ke y age groups and gender 2008–12 in WA3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







1040 Gender







970


1109 All 5–14 years (N)

1399 All 15–24 years (N)

1775 All 25–44 years (N)

3918 All 45–64 years (N)


2010

Between 2008–12 the aged groups most hospitalised for epilepsy were; 24–44 year olds accounting for 29% of hospital admissions and 45-64 year olds accounting for 24% of the hospital admissions.3

5423 4994

1995

1014

0

2000

4000

6000

8000

Male Female

No.

of h

ospi

talis

atio

ns


47

Figure 19: Annual epilepsy hospitalisations for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the number of annual epilepsy hospitalisations for WA metropolitan and regional health service areas between 2003–13. For both health service areas there has been a steady decline in the number of hospitalisations for epilepsy.3

Figure 20: Annual epilepsy attendances in WA metrop olitan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for epilepsy in WA have nearly doubled in regional areas between 2008-14.4 There has also been a 18% increase in the number of ED admissions in the metropolitan areas between 2008-14.4

22232009 1965 2010 1930

1731 1682 1771 17421894 1855

13421177 1185

1087 1027 945 924 864 843 856 786

0

500

1000

1500

2000

2500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


2321 2428 2495 25242732 2717 2817

119 118 127 122 161 130 216

0

500

1000

1500

2000

2500

3000

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


48

Figure 21: Annual epilepsy mortality rate for metro politan and regional health service areas between 2001–11. 3

The above figure displays the annual epilepsy mortality rate for WA metropolitan and regional health service areas between 2001–11. On average, metropolitan health service areas had an annual mortality rate of 73 deaths with 20 deaths reported for regional service areas.3

6674

6469

80 77 7368

56

91

75

15 1520 20

11

2227

17 1625 24

0

25

50

75

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


49

Table 16: Epilepsy ICD codes used for the above dat a

Epilepsy ICD Codes

G40.00 Localisation-related (focal)(partial) idiopathic epilepsy and epileptic syndromes with seizures of localised onset, without mention of intractable epilepsy

G40.01 Localisation-related (focal)(partial) idiopathic epilepsy and epileptic syndromes with seizures of localised onset, with intractable epilepsy

G40.10 Localisation-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy

G40.11 Localisation-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy

G40.20 Localisation-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy

G40.21 Localisation-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy

G40.30 Generalised idiopathic epilepsy and epileptic syndromes, without mention of intractable epilepsy

G40.31 Generalised idiopathic epilepsy and epileptic syndromes, with intractable epilepsy

G40.40 Other generalised epilepsy and epileptic syndromes, without mention of intractable epilepsy

G40.41 Other generalised epilepsy and epileptic syndromes, with intractable epilepsy

G40.50 Special epileptic syndromes, without mention of intractable epilepsy

G40.51 Special epileptic syndromes, with intractable epilepsy

G40.60 Grand mal seizures, unspecified (with or without petit mal), without mention of intractable epilepsy

G40.61 Grand mal seizures, unspecified (with or without petit mal), with intractable epilepsy

G40.70 Petit mal, unspecified, without grand mal seizures, without mention of intractable epilepsy

G40.71 Petit mal, unspecified, without grand mal seizures, with intractable epilepsy

G40.80 Other epilepsy, without mention of intractable epilepsy

G40.81 Other epilepsy, with intractable epilepsy

G40.90 Epilepsy, unspecified, without mention of intractable epilepsy

G40.91 Epilepsy, unspecified, with intractable epilepsy

G41.0 Grand mal status epilepticus

G41.1 Petit mal status epilepticus

G41.2 Complex partial status epilepticus

G41.8 Other status epilepticus

G41.9 Status epilepticus, unspecified

50

Huntington’s disease In 2012, Huntington’s disease patients had an average length of stay in hospital of 17.4 days, an occupancy of 609 beddays at a total cost of $ 291,409.3

The total combined number of hospital separations for Huntington’s disease in WA over the past five years from 2008-12 was 227, from this 51% were males and 49% females.3 In 2012, there were a total of 35 hospitalisations for Huntington’s disease; from this 51% were males and 49% females.3

For WA, the rate of Huntington’s disease hospitalisations decreased over the past five years and it was significant (P<0.001). The average annual percentage change in the rate was -24.58%.3

Figure 22: Annual number of hospitalisations in WA for Huntington’s disease by gender from 2008–12. 3

The above figure displays the annual number of hospitalisations for Huntington’s disease in WA by gender from 2008-12. Since 2008, the number of hospitalisations for males has significantly decreased while hospitalisations for females has remained relatively stable. The average annual percentage change in the rate for males was -34.04% and -9.14% for females.3

The number of Aboriginal people hospitalised in WA for Huntington’s disease between 2008-12 was five.3

60

26

19

10

18

15

29

20

1317

0

10

20

30

40

50

60

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

51

Table 17: Number of Huntington’s disease hospitalis ations by key age groups and gender 2008–12 in WA 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







31 Gender







18





105 All 45–64 years (N)


49

The age group most hospitalised for Huntington’s disease was males aged 25-44 years and accounted for 46% of the total number of hospitalisations in WA between 2008-12.3

Figure 23: Annual Huntington’s disease hospitalisat ions for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the annual number of hospitalisations for Huntington’s disease in WA metropolitan and regional health service areas between 2003-13. The number of hospitalisations for Huntington’s disease has fluctuated for both metropolitan and regional health service areas during the past ten years. In 2008-09, hospitalisations at both health service areas were the highest with 48 at metropolitan and 44 at regional health service areas.3 Since that time, the number of hospitalisations has decreased and in 2013 there were 27 hospitalisations recorded at metropolitan and 11 at regional health service areas.3

The Huntington’s disease mortality rates and ED presentations for metropolitan and regional health service areas for WA have not been graphed as the numbers are too small. It is estimated that there were less than 78 deaths across the ten years.3

Table 18: Huntington’s disease ICD codes used for t he above data

Huntington’s disease ICD codes

G10. Huntington’s disease

4345

41

34

26

31

48

30

17

28 27

75

12

6 7

44

79

6 5

11

0

5

10

15

20

25

30

35

40

45

50

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

sopi

talis

atio

ns


52

Hydrocephalus In 2012, hydrocephalus patients had an average length of stay in hospital of 14.9 days, an occupancy of 6181 beddays at a total cost of $11,735,562.3

The total combined number of hospital separations for hydrocephalus in WA over the past five years from 2008-12 was 2086, from this 54% were males and 46% females.3 In 2012, there were a total of 416 hospitalisations for hydrocephalus.3

For WA, the rate of hydrocephalus hospitalisations decreased over the past five years and it was significant (P<0.001). The average annual percentage change in the rate was -5.48%.3

During the 5 year period, the male rate of hydrocephalus hospitalisation decreased, and it was significant (P<0.001). The average annual percentage change in the rate was -6.49%.3

Figure 24: Annual number of hospitalisations for hy drocephalus in WA by gender for 2008-12.3

The above figure displays the annual number of hospitalisations for hydrocephalus in WA by gender from 2008-12. The total number of hospitalisations for hydrocephalus has decreased since 2008.3 Since 2008, the number of hospitalisations for males has decreased and this was significant (P<0.001).3 The rate of hospitalisations for females also decreased however it was not significant (P<0.06). 3 Each year, on average 224 males are hospitalised for hydrocephalus compared to 194 females.3

218

265

220

201214

200192

208

166

202

150

200

250

300

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

53

Figure 25: Total number of hospitalisations for hyd rocephalus in WA by Aboriginality and gender for 2008-12. 3

The above figure shows the total number hospitalisations for hydrocephalus in WA by aboriginality and gender from 2008-12. In contrast to non-aboriginal people, higher numbers of Aboriginal females were hospitalised for hydrocephalus than males.3 Over the five year period, Aboriginal people accounted for 7% of the total hospitalisations for hydrocephalus in WA.3

Table 19: Number of hydrocephalus hospitalisations by key age groups and gender 2008–12 in WA 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







458 Gender







350



115 All 15–24 years (N)

116 All 25–44 years (N)

278 All 45–64 years (N)


808

The age group most hospitalised for hydrocephalus is the 65+ year olds who accounted for 39% of the hospital admissions between 2008-12.3

1053897

65

71

0

200

400

600

800

1000

1200

Male Female

No.

of h

ospi

talis

atio

ns


54

Figure 26: Annual number of hospitalisations for hy drocephalus for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the number of annual hydrocephalus hospitalisations for WA metropolitan and regional health service areas between 2003–13. Since 2003, hospitalisations in both metropolitan and regional health service areas have decreased.3 Since 2001, WA metropolitan health service areas account for, on average, 78% of the total hospitalisations for hydrocephalus each year.3

Figure 27: Annual hydrocephalus attendances in WA E Ds between 2008–14. 4

The above figure shows the number of ED attendances for hydrocephalus have remained relatively consistent between 2008–14.4

392371

328

394459

319358

324

260306 302

13997

76 78 85 96 95 99 97 104 108

0

100

200

300

400

500

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


3235

30

23 22

3732

0

10

20

30

40

50

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s

WA Health Services

55

Figure 28: Annual hydrocephalus mortality rate for all WA Department of Health services between 2001–11. 3

The above figure displays the annual number of deaths resulting from hydrocephalus in WA between 2001–11. Each year in WA, on average, 17 people die from hydrocephalus.3

16

11

1820

14

9

30

9

1820

24

0

10

20

30

40

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s

YearAll WA Health…

56

Table 20: Hydrocephalus ICD codes used for the abov e data

Hydrocephalus ICD codes

Congenital hydrocephalus

Q03.0 Malformations of aqueduct of Sylvius*

Q03.1 Atresia of foramina of Magendie and Luschka

Q03.8 Other congenital hydrocephalus**

Q03.9 Congenital hydrocephalus, unspecified

Acquired or unspecified hydrocephalus

G91.0 Communicating hydrocephalus

G91.1 Obstructive hydrocephalus

G91.2 Normal-pressure hydrocephalus

G91.3 Post-traumatic hydrocephalus, unspecified

G91.8 Other hydrocephalus

G91.9 Hydrocephalus, unspecified

G94.0 Hydrocephalus in infectious and parasitic diseases classified elsewhere (A00-B99+)

G94.1 Hydrocephalus in neoplastic disease (C00-D48+)

G94.2 Hydrocephalus in other diseases classified elsewhere

*Increased granularity from 1 July 2010 onwards

*Q03.01 Congenital stenosis and obstruction of aqueduct of sylvius

Q03.09 Other congenital malformations of aqueduct of sylvius

*Q03.81 Congenital communicating hydrocephalus

Q03.89 Other congenital hydrocephalus

57

Migraine In 2012, migraine patients had an average length of stay in hospitals in WA of 3.46 days, an occupancy of 6022 beddays at a total cost of $6,942,465.3

The total combined number of hospital separations for migraine in WA over the past five years from 2008-12 was 6698, from this 22% were males and 78% females.3 In 2012, there were a total of 1742 hospitalisations for migraine, from this 22% were males and 78% females.3

For WA, the rate of migraine hospitalisations in WA increased over the last five years, and it was significant (P<0.001). The average annual percentage change in the rate was 12.59%.3

Figure 29: Annual number of hospitalisations for mi graine in WA by gender for 2008–12. 3

The above figure displays the annual number of hospitalisations in WA for migraine by gender from 2008–12. Overall, hospitalisations for migraine are far greater in females than males with 1052 females hospitalised on average per year compared to 288 hospitalisations for males.3

203 228 269349 391

810 862975

1260 1351

0

200

400

600

800

1000

1200

1400

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

58

Figure 30: Total number of hospitalisations for mig raine in WA by Aboriginality and gender for 2008–12. 3

The above figure shows the total number hospitalisations for migraine in WA by aboriginality and gender from 2008-12. Over the five year period, Aboriginal people accounted for 3% of the hospitalisations for migraine.3

Table 21: Number of migraine hospitalisations by ke y age groups and gender 2008–12 in WA

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







143 Gender


<5 Femal e 5–14 years (N)





530



335 All 15–24 years (N)

770 All 25–44 years (N)

2684 All 45–64 years (N)


673

Between 2008-12 the aged groups most hospitalised for migraine were; 24-44 year olds accounting for 40% of hospital admissions and 45-64 year olds accounting for 33% of the hospital admissions.3

1380

5089

60

169

0

1000

2000

3000

4000

5000

6000

Male Female

No.

of h

ospi

talis

atio

ns


59

Figure 31: Annual number of hospitalisations for mi graine for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the number of annual migraine hospitalisations for WA metropolitan and regional health service areas between 2003–13. Since 2003, hospitalisations in the metropolitan area have increased and regional health service areas have seen a slight decline.3 In 2013, WA metropolitan health service areas represented 78% of the total hospitalisations for migraine in WA with1280 hospitalisations.3

Figure 32: Annual migraine attendances in WA metrop olitan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances in regional areas for migraine have increased from 159 attendances in 2008 to 188 attendances in 2014.4 There has also been a 28% increase in the number of ED admissions in the metropolitan areas between 2008–14.4

522599

741 698 722 692814

924

12441382 1280

471 474375 376 359

307 264 307 327 325 365

0

200

400

600

800

1000

1200

1400

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


15541709 1650

2011 2082 20082147

159 161 153 187 206 170 188

0

500

1000

1500

2000

2500

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


60

The migraine mortality rates for WA metropolitan and regional health service areas between 2001–11 have not been graphed as the numbers are too small. It is estimated that there were less than 50 deaths related to migraine across the ten years.3

Table 22: Migraine ICD codes used for the above dat a

Migraine ICD codes

G43.0 Migraine without aura [common migraine]

G43.1 Migraine with aura [classical migraine]

G43.2 Status migrainosus

G43.3 Complicated migraine

G43.8 Other migraine

G43.9 Migraine, unspecified

61

Motor neurone disease In 2012, motor neurone disease patients had an average length of stay in hospital of 10.7 days, an occupancy of 2185 beddays at a total cost of $2,088,975.3 Additionally in 2011, there were 84 deaths from motor neurone disease in WA.3

The total combined number of hospital separation of motor neurone disease in WA over the past five years from 2008-12 was 1367, from this 53.5% were males and 46.5% females.3 In 2012 there were a total of 217 hospitalisations for motor neurone disease.3

For WA between 2008–12, the rate of motor neurone disease hospitalisations in WA decreased, and it was significant (P<0.001). The average annual percentage change in the rate was -12.15%.3

Figure 33: Annual number of hospitalisations for mo tor neurone disease in WA by gender for 2008–12. 3

The above figure displays the annual number of hospitalisations for motor neurone disease by gender from 2008–12 in WA. Over the five year period, hospitalisations for both genders have declined. The average annual percentage change in the rate was -15.04%.3 For females the average annual percentage change in the rate was -7.12% and -15.04% for males.3 In 2012, there were 116 hospitalisations for males and 101 hospitalisations for females.3

190

225

171160

116120

90105

89 101

0

50

100

150

200

250

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

62

Figure 34: Total number of hospitalisations for mot or neurone disease in WA by Aboriginality and gender for 2008–12. 3

The above figure shows the total number of hospitalisations for motor neurone disease in WA by aboriginality and gender from 2008–12. Hospitalisations for Aboriginal people account for less than 2% of the total number of hospitalisations for motor neurone disease in WA.3 Hospitalisations for males was nearly double females, with 848 hospitalisations for males compared to 493 for females between 2008–12.3

Table 23: Number of motor neurone disease hospitali sations by key age groups and gender 2008–12 in WA. 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender


<5 Male 5–14 years (N)





798 Gender







339


<5 All 5–14 years (N)





837

The age group most hospitalised for motor neurone disease was the 65+ year olds and accounted for over 60% of the total number of the hospital admissions in WA between 2008–12.3

848

493

14

12

0

250

500

750

1000

Male Female

No.

of h

ospi

talis

atio

ns


63

Figure 35: Annual hospitalisations for motor neuron e disease at WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the annual number of hospitalisations for motor neurone disease at WA metropolitan and regional health service areas between 2003–13. Over the past ten years the number of hospitalisations has fluctuated at both metropolitan and regional health service areas, with the total number of hospitalisations in 2013 declining since 2003.3

Figure 36: Annual motor neurone disease attendances in WA emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for motor neurone disease across WA have decreased from 17 to 12 attendances between 2008–14.4

211186

204

249 253 254

214 221

189

153168

7153 59

36

125

54

101

55 59 62 65

0

100

200

300

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns

GenderMetropolitan Regional

17

13

16 16

13

16

12

0

5

10

15

20

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s

WA Health Services

64

Figure 37: Annual motor neurone disease mortality r ate for WA metropolitan and regional health service areas between 2001–11. 3

The above figure shows the number of deaths recorded annually for motor neurone disease at WA metropolitan and regional health service areas. Despite fluctuations, the total number of deaths has increased since 2001–13 mortality rates showing a 39% increase for metropolitan areas and just under 90% increase for regional health service areas.3

Table 24: Motor neurone disease ICD codes used for the above data

Motor neurone disease ICD codes*

G12.2 Motor neurone disease

4149

70

58

42

5559 62 64 63

67

9 11 1115 14

9 10

2012 13

17

0

10

20

30

40

50

60

70

80

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


65

Multiple sclerosis In 2012, multiple sclerosis patients had an average length of stay in hospital of 2.27 days, an occupancy of 9175 beddays at a total cost of $12,189,179.3 Additionally, in 2011 there were 23 deaths from multiple sclerosis in WA.3

The total combined number of hospital separations for multiple sclerosis in WA over the past five years from 2008-12 was 14 006; from this 29% were males and 71% females.3 In 2012, there were a total of 4037 hospitalisations for multiple sclerosis.3

For WA, the rate of multiple sclerosis hospitalisation increased over the five year period, and it was significant (P<0.001).3 The average annual percentage change in the rate was 22.54%.3

Figure 38: Annual number of hospitalisations in WA for multiple sclerosis by gender from 2008–12.3

The above figure displays the annual number of hospitalisations in WA for multiple sclerosis by gender from 2008–12. Over the five year period, the number of multiple sclerosis hospitalisations in WA has significantly increased for both males and females. During the five year period, the average percentage change annually was 18.87% for males and 24.15% for females.3 In 2012, 2868 females and 1169 males were hospitalised for multiple sclerosis.3

472693

810 9311169

1039

1464

1994

2566 2868

0

500

1000

1500

2000

2500

3000

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

66

Figure 39: Total number of hospitalisations in WA f or multiple sclerosis by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of hospitalisations for multiple sclerosis in WA by aboriginality and gender from 2008–12. Over the five year period, Aboriginal people accounted for 0.3% of the hospitalisations for multiple sclerosis.3

Table 25: Number of multiple sclerosis hospitalisat ions by key age groups and gender 2008–12 in WA 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







290 Gender







561




689 All 25–44 years (N)

6097 All 45–64 years (N)


851

Between 2008-12 the aged groups most hospitalised for multiple sclerosis were; 24–44 year olds accounting for 49% of hospital admissions and 45-64 year olds accounting for 50% of the hospital admissions in WA.3

Non-Aboriginal, 4065

Non-Aboriginal, 9898Aboriginal, 10

Aboriginal, 33

0

2500

5000

7500

10000

Males Females

No.

of h

ospi

talis

atio

ns


67

Figure 40: Annual multiple sclerosis hospitalisatio ns for WA metropolitan and regional health service areas between 2003–13. 3

The above figure displays the annual number of hospitalisations for multiple sclerosis at WA metropolitan and regional health service areas between 2003–13. Since 2007, hospitalisations at both health service areas have increased, although regional health service areas have seen a slight decline since 2012. In 2013, WA metropolitan health service areas represented 86% of the total hospitalisations in WA with 3543 hospitalisations.3

Figure 41: Annual multiple sclerosis attendances in WA metropolitan and regional EDs between 2008–14. 4

The above figure shows the number of ED attendances for motor neurone disease across WA have remained relatively consistent between 2008–14.4

683 702 669 647 701

1243

1730

2257

2831

3438 3543

134 125 96 137 166 264 414 541 664 587 585

0

1000

2000

3000

4000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


7684 80 77 79

73 77

6 9 7 7 10 8 6

0

25

50

75

100

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


68

The multiple sclerosis mortality rate for metropolitan and regional health service areas between 2001–11 for WA have not been graphed as the numbers are too small. It is estimated that there were approximately 243 deaths from multiple sclerosis across the ten years.3

Table 26: Multiple sclerosis ICD codes used for the above data

Multiple sclerosis ICD codes

G35. Multiple sclerosis

69

Muscular dystrophy In 2012 there were a total of 108 hospitalisations for muscular dystrophy in WA; from this 61% were males and 39% females.3 Additionally, in 2011 there were ten deaths from muscular dystrophy in WA.3

The total combined number of hospital separations for muscular dystrophy in WA over the five years from 2008–12 was 612; from this 67% were males and 33% females.3 In 2012 there were 108 separations for stroke compared to 136 in 2008.3

For WA, the total rate of muscular dystrophy hospitalisations decreased over the five year period and was significant (P<0.01).3 The average annual percentage change in the rate was -6.68%.3

Figure 42: Annual number of hospitalisations in WA for muscular dystrophy by gender from 2008–12. 3

The above figure shows the WA annual muscular dystrophy separations by gender for the years 2008–12. During the five year period, both the male and female rate of hospitalisations decreased, but neither were significant.3

92

73

85 91

66

44 4641

3242

0

25

50

75

100

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMales Females

70

Figure 43: Total number of hospitalisations for mus cular dystrophy by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of hospitalisations for muscular dystrophy in WA by aboriginality and gender from 2008-12. Hospitalisations for Aboriginal people account for less than 2% of the total number of hospitalisations for muscular dystrophy in WA.3 Hospitalisations for males nearly double female with 407 hospitalisations for males compared to 205 for females between 2008-12.3 As there were less than five cases, data for Aboriginal females is not displayed in the above figure.

Table 27: Number of muscular dystrophy hospitalisat ions by key age groups and gender 2008–12 in WA 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







31 Gender







12



114 All 15–24 years (N)

103 All 25–44 years (N)

104 All 45–64 years (N)


43

Table 27 shows the number of hospitalisations by key age groups and gender in WA. The age group most hospitalised was the 45–64 year old age group who accounted for 31% of all hospitalisations between 2008-12.3

Non-Aboriginal, 396

Non-Aboriginal, 204

Aboriginal, 11

0

50

100

150

200

250

300

350

400

450

Males Females

No.

of h

ospi

talis

atio

ns


71

Figure 44: Annual hospitalisations for muscular dys trophy at WA metropolitan and regional health service areas between 2003–13. 3

The above figure shows the number of hospitalisations annually for muscular dystrophy at both WA metropolitan and regional health service areas. The number of hospitalisations for muscular dystrophy has decreased since 2003 with the annual total for 2013 recorded at 65 for metropolitan and 24 for regional health service areas.3

Figure 45: Annual muscular dystrophy mortality rate for all WA Department of Health service areas between 2001–11. 3

The above figure displays the annual mortality rate for muscular dystrophy across all WA Department of Health service areas between 2001–11. Due to low numbers, no split can be provided for metropolitan and regional health service areas. During the ten year period, the mortality rate has remained relatively unchanged due to the small numbers.

95 94 9890

115 11297

103 103

82

65

40

2416 20

3123 22 21 20

26 24

0

20

40

60

80

100

120

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


9

65

6

11

5

12

10

6

8

10

0

2

4

6

8

10

12

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s

YearAll Health Services

72

Table 28: Muscular dystrophy ICD codes used

Muscular dystrophy ICD codes*

G71.0 Muscular dystrophy

G71.1 Myotonic disorders (myotonic congenital muscular dystrophy)

G71.2 Congenital myopathies (congenital muscular dystrophy, not otherwise specified)

73

Parkinson’s disease In 2012, Parkinson’s disease patients had an average length of stay in hospital of 19.76 days, an occupancy of 36 943 at a total cost of $21,245,8983. Additionally in 2011 there were 214 deaths from Parkinson’s disease in WA.3

The total combined number of hospital separation for Parkinson’s disease over the past five years from 2008-12 was 8631; from this 60% were males and 40% were females.3 In 2012 there were 1870 separations for Parkinson’s disease compared to 1773 in 2008.3 For WA, the total rate of Parkinson’s disease hospitalisations decreased over the five year period and was significant (P<0.01).3 The average annual percentage change in the rate was -1.92%.3

Figure 46: Annual number of hospitalisations in WA for Parkinson’s disease by gender from 2008–12. 3

The above figure displays the annual number of hospitalisations for Parkinson’s disease in WA by gender for 2008–12. Over the five year period, hospitalisations for males are higher than females.3 Each year on average, males accounted for 1063 hospitalisations compared to 663 hospitalisations for females.3

10961030 1016 1049

1126

677

549

659 685744

400

600

800

1000

1200

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

74

Figure 47: Total number of hospitalisations in WA f or Parkinson’s disease by Aboriginality and gender for 2008–12. 3

The above figure shows the total number of hospitalisations for Parkinson’s disease in WA by aboriginality and gender from 2008–12. Aboriginal people accounted for less than 2% of the hospitalisations for Parkinson’s’ disease.3

Table 29: Number of Parkinson’s disease hospitalisa tions by key age groups and gender 2008–12 in WA. 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







4646 Gender







2905





139 All 45–64 years (N)


7551

The age group most hospitalised for Parkinson’s disease between 2008–12, was the 65+ year olds and they accounted for 87% of the total number of hospitalisations in WA.3

5272

3258

45

56

0

1000

2000

3000

4000

5000

6000

Male Female

No.

of h

ospi

talis

atio

ns


75

Figure 48: Annual hospitalisations for Parkinson’s disease at WA metropolitan and regional health service areas in WA between 2003–13 .3

The above figure displays the annual number of Parkinson’s disease hospitalisations for WA metropolitan and regional health service areas between 2003–13. On average, metropolitan health service areas recorded 1479 hospitalisations annually and regional service areas an average of 353 hospitalisations annually.3

Figure 49: Annual Parkinson’s disease attendances i n WA metropolitan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for Parkinson’s disease in the metropolitan area saw an increase in 2012 from 79 attendances to 133 attendances in 2014.4

14601596 1592 1675 1601

14221271

1373 1425 14481647

346 353 369 359 439 345 302 297 304414

498

0

200

400

600

800

1000

1200

1400

1600

1800

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


88 89 88100

79

117

133

6 0 010 9 11

00

25

50

75

100

125

150

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


76

Figure 50: Annual Parkinson’s disease mortality rat e for metropolitan and regional health service areas in WA between 2001–11. 3

The above figure displays the annual Parkinson’s disease mortality rate for WA metropolitan and regional health service areas between 2001–11. On average, metropolitan health service areas record an average of 171 deaths per year for Parkinson’s disease compared to 36 deaths for regional service areas.3

Table 30: Parkinson’s disease ICD codes used for th e above data

Parkinson’s disease ICD codes*

G20. Parkinson's disease

G21.0 Malignant neuroleptic syndrome

G21.1 Other drug-induced secondary parkinsonism

G21.2 Secondary parkinsonism due to other external agents

G21.3 Postencephalitic parkinsonism

G21.4 Vascular parkinsonism

G21.8 Other secondary parkinsonism

G21.9 Secondary parkinsonism, unspecified

G22. Parkinsonism in diseases classified elsewhere

158 148 153 153170 175

188204

187165

185

34 2838 38 34 25

4837

4937

29

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


77

Spina bifida In 2012, spina bifida patients had an average length of stay in hospital of 15.16 days, an occupancy of 2168 beddays at a total cost of $2,089,701.3

The total combined number of hospital separation of spina bifida in WA over the past five years from 2008-12 was 750, from this 46% were males and 54% females.3 In 2012, there were 143 separations for spina bifida compared to 179 in 2008.3

For WA total, the rate of spinal bifida hospitalisation decreased, and it was significant (P<0.001). The average annual percentage change in the rate was -8.36%.3

Figure 51: Annual spina bifida hospitalisations in WA by gender from 2008–12. 3

The above figure shows the WA annual spina bifida separation by gender for the years 2008–12. During the five year period, the male rate of spina bifida hospitalisation decreased, and it was significant (P<0.001).3 The average annual percentage change in the rate was -20.72%.3 For females the rate of spina bifida hospitalisation increased, but it was not significant (P<0.50).3 The average annual percentage change in the rate was 3.57%.3

Male, 105

Male, 71

Male, 80

Male, 43 Male, 49

Female, 74

Female, 81

Female, 63

Female, 90 Female, 94

0

25

50

75

100

125

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

78

Figure 52: Total number of spina bifida hospitalisa tions in WA by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of hospitalisations for spina bifida in WA by aboriginality and gender from 2008–12. In WA, Aboriginal people accounted for 11.5% of the hospitalisations for spina bifida. This is significant as Aboriginal people make up 3.1% of the population of WA.30 Hospitalisations for females were greater than males in both Aboriginal and Non-Aboriginal people.3

Table 31: Number of spina bifida hospitalisations b y key age groups and gender 2008–12 in WA 3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







17 Gender







<5



122 All 15–24 years (N)

179 All 25–44 years (N)

221 All 45–64 years (N)


19

Between 2008–12 the aged groups most hospitalised for spina bifida were; 24-44 year olds accounting for 29% of hospital admissions and 15-24 year olds accounting for 24% of the hospital admissions in WA.3

314 350

34

52

0

100

200

300

400

500

Male FemaleNo.

of h

ospi

talis

atio

ns


79

Figure 53: Annual hospitalisations for spina bifida at WA metropolitan and regional health service areas in WA between 2003–13. 3

The above figure displays the annual number of spina bifida hospitalisations for WA metropolitan and regional health service areas between 2003–13. Since 2003, hospitalisations in both metropolitan and regional health service areas have decreased.3

The spina bifida mortality rates for metropolitan and regional health service areas for WA have not been graphed as the numbers are too small. It is estimated that there were less than 30 deaths related to spina bifida across the ten years.3

129

149164

134 136122

108 11093 100 106

38 4055

67 61 5743

33 39 4232

0

25

50

75

100

125

150

175

200

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


80

Table 32: Spina bifida disease ICD codes used for t he above data

Spina Bifida ICD Codes

Q05.00 Cervical spina bifida with hydrocephalus, unspecified whether lesion is open or closed

Q05.01 Cervical spina bifida with hydrocephalus, open, aperta, not covered with skin or membrane

Q05.02 Cervical spina bifida with hydrocephalus, closed, cystica, covered with skin or membrane

Q05.10 Thoracic spina bifida with hydrocephalus, unspecified whether lesion is open or closed

Q05.11 Thoracic spina bifida with hydrocephalus, open, aperta, not covered with skin or membrane

Q05.12 Thoracic spina bifida with hydrocephalus, closed, cystica, covered with skin or membrane

Q05.20 Lumbar spina bifida with hydrocephalus, unspecified whether lesion is open or closed

Q05.21 Lumbar spina bifida with hydrocephalus, open, aperta, not covered with skin or membrane

Q05.22 Lumbar spina bifida with hydrocephalus, closed, cystica, covered with skin or membrane

Q05.30 Sacral spina bifida with hydrocephalus, unspecified whether lesion is open or closed

Q05.31 Sacral spina bifida with hydrocephalus, open, aperta, not covered with skin or membrane

Q05.32 Sacral spina bifida with hydrocephalus, closed, cystica, covered with skin or membrane

Q05.40 Unspecified spina bifida with hydrocephalus, unspecified whether lesion is open or closed

Q05.41 Unspecified spina bifida with hydrocephalus, open, aperta, not covered with skin or membrane

Q05.42 Unspecified spina bifida with hydrocephalus, closed, cystica, covered with skin or membrane

Q05.50 Cervical spina bifida without hydrocephalus, unspecified whether lesion is open or closed

Q05.51 Cervical spina bifida without hydrocephalus, open, aperta, not covered with skin or membrane

Q05.52 Cervical spina bifida without hydrocephalus, closed, cystica, covered with skin or membrane

Q05.60 Thoracic spina bifida without hydrocephalus, unspecified whether lesion is open or closed

Q05.61 Thoracic spina bifida without hydrocephalus, open, aperta, not covered with skin or membrane

81

Spina Bifida ICD Codes

Q05.62 Thoracic spina bifida without hydrocephalus, closed, cystica, covered with skin or membrane

Q05.70 Lumbar spina bifida without hydrocephalus, unspecified whether lesion is open or closed

Q05.71 Lumbar spina bifida without hydrocephalus, open, aperta, not covered with skin or membrane

Q05.72 Lumbar spina bifida without hydrocephalus, closed, cystica, covered with skin or membrane

Q05.80 Sacral spina bifida without hydrocephalus, unspecified whether lesion is open or closed

Q05.81 Sacral spina bifida, open, aperta, not covered with skin or membrane

Q05.82 Sacral spina bifida, closed, cystica, covered with skin or membrane

Q05.90 Spina bifida, unspecified, unspecified whether lesion is open or closed

Q05.91 Spina bifida, unspecified, open, aperta, not covered with skin or membrane

Q05.92 Spina bifida, unspecified, closed, cystica, covered with skin or membrane

Q76.0 Spinalbifida occulta

82

Stroke In 2012, stroke patients had an average length of stay in hospital of 14.75 days, an occupancy of 80 820 beddays at a total cost of $78,107,937.3 Additionally in 2011, there were 1210 deaths from stroke in WA.3

The total combined number of hospital separations for strokes in WA over the five years from 2008-12 was 24 774; from this 54% were males and 46% females.3 In 2012 there were 5479 separations for stroke compared to 4813 in 2008.3 For WA, the total rate of stroke hospitalisations decreased over the five years period, however it was not significant (P<0.584). The average annual percentage change in the rate was -0.36%.3

Figure 54: Annual stroke hospitalisations in WA by gender from 2008–12. 3

The above figure shows the WA annual stroke separation by gender for the years 2008–12. During the five year period, both the male and female rate of hospitalisations decreased, but neither were significant.3

25612497

2671 26892958

22522139 2083

24032521

1500

2000

2500

3000

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

83

Figure 55: Total number of stroke hospitalisations in WA by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of stroke hospitalisations in WA by aboriginality and gender from 2008–12. Over the five year period, Aboriginal people accounted for 4% of the hospitalisations for stroke.3

Table 33: Number of stroke hospitalisations by key age groups and gender 2008–12 in WA3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







8799 Gender







8509




141 All 25–44 years (N)

1413 All 45–64 years (N)


17 308

The age group most hospitalised for stroke was the 65+ year olds and they accounted for 70% of the total number of strokes in WA between 2008–12.3

1279710923

579

475

0

2000

4000

6000

8000

10000

12000

14000

Male Female

No.

of h

ospi

talis

atio

ns


84

Figure 56: Annual stroke hospitalisations for WA me tropolitan and regional health service areas between 2003–13. 3

The above figure displays the number of annual stroke hospitalisations for WA metropolitan and regional health service areas between 2003–13. On average, metropolitan health service areas recorded 3679 stroke hospitalisations annually and regional service areas had an average of 1028 stroke hospitalisations annually.3

Figure 57: Annual stroke attendances in WA metropol itan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for stroke increased by 13% in the metropolitan areas and have remained reasonable consistent in country areas between 2008–14.4

3145 32413498 3630 3789 3723 3594 3639

39034189 4119

852 926 1037 984 991 1022 975 1033 1112 1170 1210

0

1000

2000

3000

4000

5000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


537 527565

597568

539

616

35 18 17 17 26 26 32

0

100

200

300

400

500

600

700

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


85

Figure 58: Annual stroke mortality rate for WA metr opolitan and regional health service areas between 2001–11. 3

The above figure displays the annual stroke mortality rate for WA metropolitan and regional health service areas between 2001–11. On average, metropolitan health service areas had an annual mortality rate for stroke of 1065 deaths with 273 deaths reported for regional service areas.3

1002 10261111 1137

10091081 1033

11541098 1108

959

261 276 274 281 260 263 282 266318 272 251

0

200

400

600

800

1000

1200

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


86

Table 34: Stroke ICD codes used for the above data

Stroke ICD Codes*

I60.0 Subarachnoid haemorrhage from carotid siphon and bifurcation

I60.1 Subarachnoid haemorrhage from middle cerebral artery

I60.2 Subarachnoid haemorrhage from anterior communicating artery

I60.3 Subarachnoid haemorrhage from posterior communicating artery

I60.4 Subarachnoid haemorrhage from basilar artery

I60.5 Subarachnoid haemorrhage from vertebral artery

I60.6 Subarachnoid haemorrhage from other intracranial arteries

I60.7 Subarachnoid haemorrhage from intracranial artery, unspecified

I60.8 Other subarachnoid haemorrhage

I60.9 Subarachnoid haemorrhage, unspecified

I61.0 Intracerebral haemorrhage in hemisphere, subcortical

I61.1 Intracerebral haemorrhage in hemisphere, cortical

I61.2 Intracerebral haemorrhage in hemisphere, unspecified

I61.3 Intracerebral haemorrhage in brain stem

I61.4 Intracerebral haemorrhage in cerebellum

I61.5 Intracerebral haemorrhage, intraventricular

I61.6 Intracerebral haemorrhage, multiple localised

I61.8 Other intracerebral haemorrhage

I61.9 Intracerebral haemorrhage, unspecified

I62.0 Subdural haemorrhage (acute)(nontraumatic)

I62.1 Nontraumatic extradural haemorrhage

I62.9 Intracranial haemorrhage (nontraumatic), unspecified

I63.0 Cerebral infarction due to thrombosis of precerebral arteries

I63.1 Cerebral infarction due to embolism of precerebral arteries

I63.2 Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries

I63.3 Cerebral infarction due to thrombosis of cerebral arteries

I63.4 Cerebral infarction due to embolism of cerebral arteries

I63.5 Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries

I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic

I63.8 Other cerebral infarction

I63.9 Cerebral infarction, unspecified

I64. Stroke, not specified as haemorrhage or infarction *Excludes: late effects of old stroke; cerebrovascular disease without infection or haemorrhage; TIA

87

Transient ischaemic attack In 2012, transient ischaemic attack (TIA) patients had an average length of stay in hospital in WA of 5.19 days, an occupancy of 8012 beddays at a total cost of $9,669,957.03.3

The total combined number of TIA hospital separation in WA over the past five years from 2008-12 was 7480; from this 49% were males and 51% females.3 In 2012 there were 1545 separations for TIA compared to 1370 in 2008.3

For WA total, the rate of TIA hospitalisation decreased, but it was not significant (P<0.50). The average annual percentage change in the rate was -0.66%.3

Figure 59: Annual transient ischaemic attack hospit alisations in WA by gender from 2008–12.3

The above figure displays the annual number of hospitalisations in WA for TIA by gender from 2008–12. Using age standardised rates for comparison, over the five year period, the number of TIA hospitalisations in WA has decreased in both males and females. Since 2008, TIA hospitalisations has decreased each year on average by -1.21% for males and -0.14% for females.3 However, the decreases for both genders were not significant.3

681

714

747

810

746

689

720

793781 799

650

700

750

800

850

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

88

Figure 60: Total number of transient ischaemic atta ck hospitalisations in WA by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of hospitalisations for TIA in WA by aboriginality and gender from 2008–12. Over the five year period, Aboriginal people accounted for 2.6% of the hospitalisations for TIA.3

Table 35: Number of hospitalisations for transient ischaemic attack by key age groups and gender 2008–12 in WA3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







2543 Gender







2848




<10 All 25–44 years (N)

338 All 45–64 years (N)


5397

The age group most hospitalised for TIA was the 65+ year olds and accounted for 72% of the total number of hospitalisations for TIA in WA between 2008–12.3

3617 3664

81 118

0

500

1000

1500

2000

2500

3000

3500

4000

Male Female

No.

of h

ospi

talis

atio

ns


89

Figure 61: Annual number of hospitalisations for tr ansient ischaemic attack at WA metropolitan and regional health service areas betw een 2003–13.3

The above figure displays the annual number of TIA hospitalisations at WA metropolitan and regional health service areas between 2003–13. There has been a gradual increase in the number of hospitalisations from 825 in 2003 to 1220 in 2013.

Figure 62: Annual transient ischaemic attack attend ances in WA metropolitan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for TIAs increased by 17% in the metropolitan areas and 28% in regional areas between 2008–14.4

825 790860

807 838

983 10321120

12191166

1220

386 347 371 335 362 370 383 393 352 348406

0

250

500

750

1000

1250

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


1331 1363 1370 1415 14181491

1604

88 108 118 104 147 115 123

0

200

400

600

800

1000

1200

1400

1600

1800

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


90

Figure 63: Annual transient ischaemic attack mortal ity rate for metropolitan and regional health service areas in WA between 2001–11. 3

The above figure displays the annual TIA mortality rate for WA metropolitan and regional health service areas between 2001–11. The number of TIA deaths has increased over the ten year period across WA.3

26

39 4151

5965

70 7277

88

71

11 8 7 16 11 15 17 16 1524 26

0

25

50

75

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s


91

Table 36: Transient ischaemic attack ICD codes used for the above data

Transient ischaemic attack IDC codes

G45.0 Vertebro-basilar artery syndrome

G45.1 Carotid artery syndrome (hemispheric)

G45.2 Multiple and bilateral precerebral artery syndromes

G45.3 Amaurosis fugax

G45.4 Transient global amnesia

G45.8 Other transient cerebral ischaemic attacks and related syndromes

G45.9 Transient cerebral ischaemic attack, unspecified

92

Traumatic acquired brain injury In 2012, traumatic acquired brain injury patients had an average length of stay in hospital of 6.97 days, an occupancy of 29 237 beddays at a total cost of $48,476,877.06.3

The total combined number of hospital separation of traumatic acquired brain injury in WA over the past five years from 2008-12 was 18 416; from this 67% were males and 33% females.3 In 2012 there were 4,193 separations for traumatic acquired brain injury compared to 3213 in 2008.3

For WA total, the rate of traumatic acquired brain injury hospitalisation increased, and it was significant (P<0.001). The average annual percentage change in the rate was 3.64%.3

Figure 64: Annual traumatic acquired brain injury h ospitalisations in WA by gender from 2008–12.3

The above figure displays the annual number of hospitalisations in WA for traumatic acquired brain injury by gender from 2008-12. Over the five year period, the number of traumatic acquired brain injury hospitalisations in WA has increased in both males and females. 3 Since 2008, each year traumatic acquired brain injury hospitalisations has increased on average by 2.72% for males and 5.55% for females.3

21972326

24472626 2754

1016 10941220 1297

1439

500

1000

1500

2000

2500

3000

2008 2009 2010 2011 2012

No.

of h

ospi

talis

atio

ns

YearMale Female

93

Figure 65: Total number of traumatic acquired brain injury hospitalisations in WA by Aboriginality and gender from 2008–12. 3

The above figure shows the total number of hospitalisations for traumatic acquired brain injury in WA by aboriginality and gender from 2008–12. Over the five year period, Aboriginal people accounted for 10% of the hospitalisations for traumatic acquired brain injury in WA.3 This is significant as Aboriginal people make up 3.1% of the population of WA.30

Table 37: Number of hospitalisations for traumatic acquired brain injury by key age groups and gender 2008–12 in WA3

Gender 0–4 years

(N) 5–14 years

(N) 15–24 years

(N) 25–44 years

(N) 45–64 years

(N) 65+ years

(N) Gender







2491 Gender







2332



1479 All 15–24 years (N)

3767 All 25–44 years (N)

4665 All 45–64 years (N)


4823

The age group most hospitalised for traumatic acquired brain injury between 2008–12, was the 65+ year olds and accounted for 26% of the total number of hospitalisations in WA.3

11250

5341

1100

725

0

2000

4000

6000

8000

10000

12000

14000

Male Female

No.

of h

ospi

talis

atio

ns


94

Figure 66: Annual number of hospitalisations for tr aumatic acquired brain injury at WA metropolitan and regional health service areas betw een 2003–13.3

The above figure displays the annual number of traumatic acquired brain injury hospitalisations at WA metropolitan and regional health service areas between 2003–13. Since 2008, the number of hospitalisations for traumatic acquired brain injury has been increasing on average by 3.64%.3

Figure 67: Annual traumatic acquired brain injury a ttendances in WA metropolitan and regional emergency departments between 2008–14. 4

The above figure shows the number of ED attendances for traumatic acquired brain injury increased by 26% in the metropolitan areas and 42% in regional areas between 2008–14.4

13401500

1683 1701 1792

2085

23322519

28062950 2986

1079 1110908 991 959 1042 996 1007 988

1087 1094

500

1000

1500

2000

2500

3000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No.

of h

ospi

talis

atio

ns


23022465 2341

2670 26302950

3119

178 189 170 207 193 246 305

0

500

1000

1500

2000

2500

3000

3500

2008 2009 2010 2011 2012 2013 2014

No.

of E

D a

ttend

ence

s


95

Figure 68: Annual mortality rate for traumatic acqu ired brain injury at metropolitan and regional health service areas in WA between 2001–11 .3

The above figure displays the annual mortality rate for traumatic acquired brain injury at WA metropolitan and regional health service areas between 2001–11. Due to low numbers for regional areas, the mortality rate is shown for all WA health services. Over the ten period, on average, 53 deaths are recorded as a result of traumatic acquired brain injury.3

34

61

4035

44

55 51 49

85

71

55

0

25

50

75

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.

of d

eath

s

YearAll WA Health Services

96

Table 38: Traumatic acquired brain injury ICD codes used for the above data

Traumatic acquired brain injury ICD codes

S06.00 Diag Concussion

S06.01 Diag Loss of consciousness of unspecified duration

S06.02 Diag Loss of consciousness of brief duration [less than 30 minutes]

S06.03 Diag Loss of consciousness of moderate duration [30 minutes to 24 hours]

S06.04 Diag Loss of consciousness of prolonged duration [more than 24 hours] with return to pre-existing conscious level

S06.05 Diag Loss of consciousness of prolonged duration [more than 24 hours] without return to pre-existing conscious level

S06.1 Diag Traumatic cerebral oedema

S06.20 Diag Diffuse cerebral and cerebellar brain injury, unspecified

S06.21 Diag Diffuse cerebral contusions

S06.22 Diag Diffuse cerebellar contusions

S06.23 Diag Multiple intracerebral and cerebellar haematomas

S06.28 Diag Other diffuse cerebral and cerebellar injury

S06.30 Diag Focal cerebral and cerebellar injury, unspecified

S06.31 Diag Focal cerebral contusion

S06.32 Diag Focal cerebellar contusion

S06.33 Diag Focal cerebral haematoma

S06.34 Diag Focal cerebellar haematoma

S06.38 Diag Other focal cerebral and cerebellar injury

S06.4 Diag Epidural haemorrhage

S06.5 Diag Traumatic subdural haemorrhage

S06.6 Diag Traumatic subarachnoid haemorrhage

S06.8 Diag Other intracranial injuries

S06.9 Diag Intracranial injury, unspecified

T06.0 Diag injuries of brain and cranial nerves with injuries of nerves and spinal cord and neck level

97

Appendix 3: Additional emergency department codes Table 39: Additional code included in emergency dep artment attendances 4

Additional code included in emergency department at tendances

F05.0 Delirium not superimposed on dementia, so described

F05.9 Delirium, unspecified

F050 Delirium not superimposed on dementia, so described

F07.0 Organic personality disorder

F07.1 Postencephalitic syndrome

F07.8 Postconcussional syndrome

F07.9 Other organic personality and behavioural disorders due to brain disease, damage and dysfunction

G45 Vertebro-basilar artery syndrome

G93.0 Cerebral cysts

G93.2 Benign intracranial hypertension

G93.3 Postviral fatigue syndrome

G93.4 Encephalopathy, unspecified

G93.5 Compression of brain

G93.6 Cerebral oedema

G93.7 Reye's syndrome

G93.9 Disorder of brain, unspecified

98

References 1. Danila O HJ, Maxwell CJ, Marrie RA, Pattern S, Pringsheim T, Jette N. Prevalence of

neurological conditions across the continuum of care based on interRAI assessments. BMC Health Services Research 2014;22:14-29.

2. Epidemiology Branch. WA Burden of Disease Study. Western Australia; 2010. 3. Epidemiology Branch. Mortality and Morbidity Data for Neurological Conditions 1999-

2013. Western Australia; 2014. 4. Emergency Department Data Collections. Significance of Neurological Conditions in

Regard to Emergency Department Presentations. WA Department of Health, ed. Western Australia; 2014.

5. Russell M. Non Admitted Patient Activity and Waitlist Data Collection (NAPAAWL). Data Integrity Directorate.; 2014.

6. Health Strategy and Networks Branch Department of Health. Community Neurological Services in WA- December 2014. Western Australia; 2014.

7. WA Aged Care Research and Evaluation Unit. Home and Community Care Program Western Australia - Minimum Data Set Report 2012-2013. Western Australia; 2013.

8. Australian Institute for Health and Welfare. Disability Support Services. Services Provided under the Natoinal Disability Agreement. . Canberra; 2014.

9. Somerford P KJ, Codde J. Projected Disease Burden for Western Australia 2016. WA Burden of Disease Study. Western Australia: Department of Health.

10. Epidemiology Branch and Cooperative Research Centre for Spatial Information. Health status report on Nervous system diseases hospitalisations by principal diagnosis for the Western Australia State. Western Australia: Department of Health; 2014.

11. Epidemiology Branch(Public Health and Clinical Services Division) and Cooperative Research Centre for Spatial Information. Specific Health Condtion Analysis. Nervous System Diseases Deaths- Western Australian State. Generated using data from the WA Death Registrations which includes data from the WA Register of Births Marriages and Deaths and Australian Bureau of Statistics (online) 2014 (cited 12/12/2014). Available from: http://wsep002app/htr/default.asp#6815.

12. Australian Bureau of Statistics. Causes of Death, Australia, 2012. Canberra; 2012. 13. Australian Institute of Health and Welfare. Australian Burden of Disease Study: Fatal

burden of disease 2010. Canberra: AIHW; 2015. 14. Brain Injury Australia. About Acquired Brain Injury (online); 2014 (cited 5 December

2014). Available from: http://www.braininjuryaustralia.org.au/. 15. Australian Institute for Health and Welfare. Disability in Australia: Acquired Brain Injury.

Australia; 2007. 16. Alzheimer's Australia. Summary of Dementia Statistics in Australia. (online); 2014 (cited

11 December 2014). Available from: https://fightdementia.org.au/about-dementia-and-memory-loss/statistics.

17. Institute TG. Sydney Epilepsy Incidence Study to Measure Illness Consequences. Sydney, Australia; 2015.

18. Headache Australia. Migraine- 'a common and distressing disorder' (online); 2014 (cited 11/12/2014). Available from: http://headacheaustralia.org.au/headache-types/17-migraine-a-common-and-distressing-disorder.

19. Australian Bureau of Statistics. Profiles of Disability Australia 2009. Australia; 2012. 20. MS Research Australia. Australian Bureau of Statistics Releases New Data on MS.

(online). Australia; 2012 (cited Available from: http://www.msra.org.au/australian-bureau-statistics-releases-new-data-ms1.

99

21. Deloitte Access Economics. Living with Parkinson's Disease- Update. Canberra; 2011. 22. National Stroke Foundation. Facing Up to the Australian Stroke Challenge 2014-2050.

Victoria.; 2014. 23. Panegyres P. Neurological disorders in a rural Western Australian Population. Internal

Medicine Journal 2008;40(3):209-13. 24. Neurological Alliance. Neuro Numbers: A brief review of the numbers of people in the UK

with a neurological condtion. London; 2003. 25. Hirtz D TD, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are

the more common neurologic disorders? Neurology 2007;68(5):326-7. 26. Epidemiology Branch (Public Health and Clinical Services Division) in collaboration with

the Cooperative Research Centre for Spatial Information. Overview of death due to nervous system diseases among residents of the Metropolitan area. Generated using data from the WA Death Registrations which includes data from the WA Register of Births Marriages and Deaths and Australian Bureau of Statistics (online) 2014 (cited 12/12/2014). Available from: http://wsep002app/htr/.

27. Epidemiology Branch (Public Health and Clinical Services Division) in collaboration with the Cooperative Research Centre for Spatial Information. Overview of Death Due to Nervous System Diseases Among Residents of the Country Area. Generated using data from the WA Death Registrations which includes data from the WA Register of Births Marriages and Deaths and Australian Bureau of Statistics (online) 2014 (cited 12/12/2014). Available from: http://wsep002app/htr/.

28. Neurological Council of WA. Types of Neurological Condtions (online). Western Australia; 2014 (cited 9 January 2015). Available from: http://www.ncwa.com.au/conditions/types-of-neurological-condition.

29. Australian Institute for Health and Welfare. People Using Both Disability Services and Home and Community Care in 2010-11:Technical Report. Data Linkage Series. Canberra; 2014.

30. Australian Bureau of Statistics. 2011 Census Count (online); 2011 (cited 2 January 2015). Available from: http://www.abs.gov.au/ausstats/[email protected]/Lookup/2076.0main+features1102011.

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