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On Our Selection: Australian Longitudinal Research Studies

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On Our Selection: Australian Longitudinal Research Studies RESEARCH ENTERPRISE On our selection: Australian longitudinal research studies Ann T Gregory, Ruth M Armstrong, Tanya D Grassi, Bronwyn Gaut and Martin B Van Der Weyden he association between smoking and lung cancer is now an not questions from ‘Trivial Pursuit’ nor is the answer to each of these accepted fact. Every day, doctors base management deci- questions readily available”, wrote Professor Paul Zimmet in the T sions on cardiovascular risk calculated using the Framing- Medical Journal of Australia in 1985.3 At that time, Zimmet was ham equation. It is because of such findings and practical frustrated that there had been little research into the growing implicationsThe Medical that theJournal British of Australia doctors ISSN:study 0025-and the Framingham problem of diabetes in Australia. Even Papua New Guinea, then one Heart729X Study 1/15 from December the United 2008 States189 11/12 are 650-657among the world’s best of the poorest countries in the world, had better diabetes data. known©The longitudinal Medical studies. Journal The of storiesAustralia of these 2008 landmark studies Zimmet’s involvement in the epidemiology of diabetes had begun in thewww.mja.com.au fields of epidemiology and public health have already been a decade earlier when, in 1975, he had gained funding from the US told;1,2Research but longitudinal enterprise researchers have also been at work in National Institutes of Health (NIH) to conduct a diabetes prevalence Australia, with implications for our particular population and the survey on Nauru, a Central Pacific island. The President of Nauru, wider world. We selected just a few of these (Box 1) — studies that Hammer DeRoburt, had invited Pincus Taft — his Australian have already demonstrated some longevity and which we judged physician and a colleague of Zimmet’s — to the island because he would be of particular interest to our readership — and inter- thought diabetes was a problem on Nauru; he was right! Zimmet viewed some of their key investigators. What are their stories? and Taft’s survey found the highest prevalence of diabetes in the How will they make their mark in medicine? world — about a third of the adult population were affected.4 With further NIH funding, Zimmet and his team were able to survey other Pacific countries and Mauritius, and also, in 1985, to set up the The Australian Diabetes, Obesity and International Diabetes Institute (IDI) in Melbourne as a World Lifestyle Study (AusDiab) Health Organization collaborating centre for the epidemiology of Interviewee: Professor Paul Zimmet diabetes. “It was really that NIH funding which allowed me to create “How many Australians suffer from diabetes? the institute and establish the framework and the infrastructure that How many new cases are diagnosed annually? … was then able to do AusDiab”, said Zimmet. How many people have complications of diabetes In 1996, Australia’s health ministers agreed that diabetes would that are threatening to their vision or even to their life? … These are become one of the national health priorities. Spearheaded by Dr 1 On our selection: characteristics of some Australian longitudinal studies No. in Funding* Year of baseline No. of Study title Location initiation cohort(s) Initial funding Total funding publications† Study website The Australian Diabetes, National 1999 11 247 $1 500 000 $2 600 000 80 http://www.diabetes.com.au/ Obesity and Lifestyle research.php?regionID=181 Study (AusDiab) Bettering the Evaluation National 1998 na $1 200 000 $11 000 000 53 http://www.fmrc.org.au/beach.htm And Care of Health (BEACH) The Blue Mountains Eye Blue 1992 3654 $163 819 $7 255 400 332 http://www.cvr.org.au/bmes.htm Study (BMES) Mountains, NSW The Busselton Health Busselton, 1966 5008 £6000 > $7 600 000 >250 http:// Study WA www.busseltonhealthstudy.com The Dubbo Study Dubbo, NSW 1988 2805 $250 000 $400 000 51 http://www.dubbostudy.org Tasmanian Longitudinal National 1968 45 900 nd $4 000 000‡ 30 — Health Study (TAHS) Wittenoom cohort Wittenoom, 1974 11 684 $50 000 > $4 000 000 100 http://www.sph.uwa.edu.au/go/ studies WA research-programs/oee/schools-and- centres/schools/school-of- population-health/projects#asb Women’s Health National 1995 41 616 $3 500 000 > $18 000 000 252 http://www.alswh.org.au Australia (WHA) na = not applicable. nd = data not available. NSW = New South Wales. WA = Western Australia. * Amounts shown are estimates and may not include institutional funding for costs such as investigator salaries or postgraduate students, and may comprise a mix of federal funding, support from trusts and industry, and in-kind support from various states and territories. Total funding is an estimate of funding received so far. † Number of published (or in press) articles in peer-reviewed journals only. See study websites for details of other publications. ‡ TAHS funding information is only available since 1992. ◆ 650 MJA • Volume 189 Number 11/12 • 1/15 December 2008 RESEARCH ENTERPRISE Michael Wooldridge, the then federal Minister for Health and Aged the University of Sydney and the Australian Institute of Health and Care, the National Diabetes Strategy was launched in 1998. Arising Welfare. Since its inception in 1998, 100 000 encounters between from (but only partly funded by) the Strategy, the Australian general practitioners and patients from a random, changing sample Diabetes, Obesity and Lifestyle Study (AusDiab) was commis- of 1000 GPs have been added to the BEACH database each year. The sioned, with Zimmet and Professor Timothy Welborn as the lead database now includes details of more than a million encounters. investigators. The BEACH program has provided independent data about a AusDiab was a population-based, cross-sectional survey of the range of often controversial topics, including consultation length, national prevalence of diabetes and associated risk factors in payment structures, doctors’ prescribing practices, and adverse people aged 25 years or older. The study involved an initial drug events, to various stakeholders, including researchers, educa- household interview, followed by a biomedical examination that tors, government departments and agencies, pharmaceutical com- included an oral glucose tolerance test, and questionnaires. It was panies and health care professional organisations. The program has conducted between May 1999 and December 2000 in 42 ran- produced 23 books (freely available for download from the domly selected districts in the six states and the Northern Territory BEACH website) and about 100 articles published in recognised of Australia. journals. Most recently, the group has reported on the prevalence “It was akin to an army exercise”, said Zimmet. Team members and patterns of chronic disease in Australia, finding that one in would go in advance to work out logistics of transport, motels and four Australians suffer from two or more chronic conditions.7 meals, as well as to identify suitable study centres, which might be When asked to comment on the program’s impressive produc- schools, town halls or local bowling clubs. Blood sugar-level tests tivity, Associate Professor Helena Britt was quick to point out that: were done immediately on site at a mini-lab, and blood samples “What makes the productivity level so high is a fantastic team of were then sent by car or plane to the main lab for other testing and excellent health services researchers”. There were also many years storage. of methodological development and validation before BEACH was In the initial cohort, 11 247 people attended the biomedical launched. “We didn’t land on the BEACH without preparation. It examination. The most alarming finding was that almost a million did take 20 years to get to that point … and some more from Australian adults had diabetes — equating to 7.4% of the adult [Emeritus Professor] Charles Bridges-Webb before that.” 5 population and a 300% increase since 1981. A further 16.3% had Between 1978 and 1990, Britt, a research psychologist by pre-diabetes, and there was a 60% prevalence of overweight and training, worked in the University of Sydney’s teaching and obesity and a high prevalence of untreated hypertension. research general practice. The practice, run by Bridges-Webb, used Further funding, now with Professor Jonathan Shaw from a continually evolving data collection system that was based on his Melbourne as co-investigator, allowed a 5-year follow-up study of work in the 1960s and 70s with patient-based data collection from 6537 participants in 2004–2005. This determined, among other all general practices in the Victorian town of Traralgon. things, that about 100 000 adults in Australia develop diabetes In 1990, the team successfully secured funding from the each year; that is, about 275 people every day. National Health and Medical Research Council (NHMRC) and the AusDiab is the largest national study of diabetes in the world. To General Practice Evaluation Program for the first national study of ease ongoing funding concerns and to provide critical infrastruc- general practice for more than two decades, and for a comparative ture, the IDI has recently merged with the Baker Heart Research study of rural and metropolitan general practice. These studies Institute in Melbourne. There is no longer any argument that were reported in supplements to the MJA. Thanks to their diabetes is a global epidemic with devastating human and socio- distinctive covers, they became known as the purple report economic effects. However, Zimmet says other questions related to (Morbidity and treatment
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