Objectives: To measure the acute burden of and to identify risk factors associated with notified Q fever in older adults in New South Wales.
Design, settings and participants: A prospective cohort of adults aged 45 years and over (the 45 and Up Study) recruited during 2006–2009 and followed using linked Q fever notifications, hospital records and death records during 2006–2012.
Main outcome measures: Incident cases of Q fever, based on a linked Q fever notification; proportion of cases with a Q fever‐coded hospitalisation.
Results: A total of 266 906 participants were followed up for 1 254 650 person‐years (mean, 4.7 ± 1.0 years per person). In our study population, the incidence of notified Q fever during follow‐up was 3.6 (95% CI, 2.7–4.8) per 100 000 person‐years. After adjustments, age (≥ 65 years v 45–54 years: hazard ratio [HR], 0.39; 95% CI, 0.16–0.96), sex (women v men: HR, 0.48; 95% CI, 0.26–0.88), and area and type of residence (P < 0.001 for trend) remained significantly associated with Q fever. Compared with those living in an inner regional area but not on a farm, the risk of notified Q fever was highest for those living on a farm in outer regional or remote areas (HR, 11.98; 95% CI, 5.47–26.21), followed by those living on a farm in inner regional areas (HR, 4.95; 95% CI, 1.79–13.65). Of notified Q fever cases, 15 of 39 (38%) had been hospitalised with a diagnosis consistent with Q fever.
Conclusions: Adults living on a farm in outer regional and remote areas are at a substantially greater risk of contracting Q fever. This suggests that, as well as targeting specific occupational groups for vaccination, there would be benefits in increasing public awareness of Q fever and vaccination among those living on and near farms in outer regional and remote areas of Australia.