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Methods: Aboriginal peoples
Recording of Aboriginality in data collections
Estimating the size and composition of the Aboriginal population is difficult for a range of reasons, in particular the incomplete and differential recording of Aboriginality in administrative data collections. The Aboriginality is generally under-reported in administrative data collections for reasons such as staff reluctance to ask about Aboriginality and Aboriginal people’s reluctance to identify as Aboriginal in some circumstances. Recording and reporting is usually better in rural and remote regions than in major cities.
Recording of Aboriginality in the Admitted Patient Data Collection
The quality of recording of Aboriginality in health administrative datasets in NSW varies and may affect the reported hospitalisation rates. The estimated level of enumeration of Aboriginal people in hospital data (Admitted Patient Data Collection) in NSW was 80% in 2011-12 (AHIW 2013).
Differences in population composition
The Aboriginal population is relatively young, with a median age of 21 years, compared with 36 years for the non-Aboriginal population. As age is closely related to health, care should be taken when comparing information for these two populations, except where rates have been age-standardised.
Standardisation by age allows comparing rates of disease in Aboriginal and non-Aboriginal populations. Comparisons are often limited, however, by very low numbers of Aboriginal persons in age groups of 55 years and older.
For example, in NSW in 2008 the proportion of Aboriginal young persons aged below 20 years was 47.6% while persons aged 55 years and older were 9.0% (estimated as 14,064 persons) of the total Aboriginal population. The corresponding proportions in non-Aboriginal population in NSW in 2008 were 25.3% and 34.3% (estimated as 1,733,605 persons). In NSW in 2008, there were estimated 1,613 Aboriginal persons and 458,987 non-Aboriginal persons aged 75 years and older.
These differences in age distribution result in a situation where chronic diseases of the old age may be relatively underrepresented in the Aboriginal older population and cases of rarer diseases may even be absent, leading to falsely favourable results in Aboriginal people when compared with non-Aboriginal people.
To ensure a substantial number of older people in the Aboriginal population for comparison, the older age groups in both Aboriginal and non-Aboriginal populations are often amalgamated from age 55 years. In this report, amalgamation from age 75 years is used for indicators that compare the Aboriginal and non-Aboriginal population data, while amalgamation from age 85 years is used for indicators that involve comparisons of the total population.
Amalgamating older ages allows results in Aboriginal and non-Aboriginal populations to be compared, however it is not suitable for analysis of a disease distribution in the total population, because information concerning older ages from 55 to 85 years and over is lost.
Australian Institute of Health and Welfare. Indigenous identification in hospital separations data - Quality report. Cat no IHW 90. Canberra: AIHW, 2013.
Australian Bureau of Statistics. Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians 1991-2021. Cat no 3238.0. Canberra: ABS, 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Products/946D4BC28DB92E1BCA25762A001CBF38?opendocument
1. Hospital statistics in NSW
All NSW public hospitals, public psychiatric hospitals, public multi-purpose services, private hospitals and private day procedure centres in NSW report data on patients admitted for care to the NSW Ministry of Health. Patient separations from developmental disability institutions and private nursing homes are not included. These reported data, from about 400 different facilities in NSW, are called the NSW Admitted Patient Data Collection (APDC).
The collection also includes data relating to NSW residents hospitalised interstate (see below in Imputation for more details) and in Commonwealth Department of Veterans’ Affairs facilities.
Each reporting facility has its own Patient Administration System (PAS), there are five types of these in NSW: HNMA Millenium (administered by Cerner), WinPAS, iPM (I-Soft), HOSPAS (legacy system being phased out and replaced with other systems) and ISCOS, which is the Inpatient Statistics Collection On-line System used by private hospitals. Data from the PAS systems are loaded into the Health Information Exchange (HIE) in a standard format. The HIE is the data warehouse for the whole NSW health system maintained by the NSW Ministry of Health which is accessed by authorised staff across the health system and in the NSW Ministry of Health. Data from the HIE are extracted and loaded onto the Secure Analytics for Population Health Research and Intelligence (SAPHaRI) warehouse, administered by the Centre for Epidemiology and Evidence and used for this report.
2. Hospitalisation rate definition
A hospitalisation rate is an estimate of the proportion of a population that was hospitalised during a specified period. It is expressed in this report as the number of hospitalisations per 100,000 population per year (person-years). Age and sex standardisation (also called ‘adjustment’) adjusts for differences in the age and sex structure of populations and is performed to make rates comparable between different sub-populations in the same geographic area; in the same population over time; or between different geographic areas at the same time (for example between different States and Territories or different Local Health Districts). This assists in interpreting variations in patterns of hospitalisations between groups and over time after controlling for factors such as age, which are commonly associated with increased disease rates.
Hospitalisation rates in this report are standardised to the 2001 Australian standard population.
3. The Admitted Patient Data Collection and this report
The Admitted Patient Data Collection (APDC) is a census of all inpatients treated in NSW and includes data on NSW residents treated in other states. The APDC was, up to 2002, known as the Inpatient Statistics Collection. The APDC contains approximately 70 variables and is based on a financial year cycle beginning on 1 July and ending on 30 June of the following year.
The APDC data used in this report are the SAPHaRI (Secure Analytics for Population Health Research and Intelligence) data warehouse, maintained by the Centre for Epidemiology and Evidence. The APDC data is extracted from the Health Information Exchange (HIE) and undergoes a quality assurance and standardisation process before being loaded onto SAPHaRI in a SAS dataset format.
Further information on the APDC and SAPHaRI is available in this report in Methods tab under The Admitted Patient Data Collection title.
4. Use of selected variables of APDC in this report
4.1 Principal diagnosis and additional diagnoses coded to the ICD-9-CM and ICD-10-AM
Each hospital episode in the APDC is described by a principal diagnosis and additional diagnoses, which are coded using the International Statistical Classification of Diseases and Related Health Problems: ICD-9-CM (up to June 1998) and ICD-10-AM (from July 1998 onwards). Please refer to a separate Methods section on Principal and additional diagnoses for a detailed discussion (this section accompanies selected indicators that include principal and additional diagnoses, for example diabetes hospitalisations).
In this report the count of hospitalisations for a condition is based mainly on principal diagnosis. If an indicator contains analysis of data in additional diagnosis fields as well ('comorbidities'), this is clearly stated in the title of an indicator and in the Notes. The Notes specify how many additional diagnosis fields were included in the analysis. Another exception is the topic of injury and poisoning where the count is based on ‘external cause of injury’. See Methods for injury and poisoning indicators.
The number of additional diagnoses that are included in the hospital records is restricted to conditions which fulfil several requirements, including direct relevance to the treatment and management of the principal diagnosis. This ensures that only the most resource intensive or clinically relevant conditions are listed for that hospitalisation rather than all comorbidities that a patient may have. Data on additional hospital diagnoses cannot therefore be used to estimate the prevalence of a condition in the community.
4.2 Procedures coded to Australian Classification of Health Interventions
Procedures performed in Australian hospitals are coded in medical records using the Australian Classification of Health Interventions (ACHI) published by the National Centre for Classification in Health. This classification is based on the Commonwealth Medicare Benefit Schedule and relates to anatomy rather than surgical specialty.
Up to 30 June 1998, the ICD-9-CM Procedure Classification was used in Australia. This was based on WHO Surgical procedures (edition 5) and was not revised and carried beyond 1998 by the WHO due to the rapid advancements in the field of procedures (National Coding Centre 1996).
On 1 July 1998, both the ACHI and the ICD-10-AM were introduced in NSW. They are revised every two years. The ICD-10 is the WHO classification but the AM suffix stands for Australian Modification, which adds detail necessary to describe practice in Australian hospitals. The ICD-10-AM is fully compatible with ICD-10 (NCCH 2006).
Up to the fourth edition of ICD-10-AM in 2004, the ACHI was published as a part of the ICD manuals (volume 3 and 4), from the fifth edition in 2006 the titles of the ACHI publication emphasise that this is a classification independent from the ICD.
Both ICD-9-CM Procedure Classification (up to and including 1997-98) and Australian Classification of Health Interventions (from 1998-99 onwards) are used in this report.
4.3 Episode of care based count of hospitalisations
The count of hospitalisations in this report is based on an episode of care from 1 July 1998 (ISC EOC datasets on SAPHaRI). A patient can have several episodes of care during one hospital stay, that is, between the formal admission and the formal discharge (separation) from hospital.
The episode of care is defined by a service category. An episode of care starts when the hospital stay starts or when the service category changes. There are ten service categories: acute care, rehabilitation care, palliative care, maintenance care, newborn care, other care, geriatric evaluation and management, psychogeriatric care, organ procurement-posthumous and hospital boarder.
A new episode of care starts also when a patient is on leave from hospital: more than 4 days away in any hospital and more than 10 days away in psychiatric hospitals.
4.4 Overnight and day-only hospital stays are included
Both overnight and day-only hospitalisations are included in this report, unlike in the national reporting on hospital statistics (AIHW Health services series no. 40. Cat. no. HSE 107 2011), where day-only hospitalisations are not included.
The only exceptions are the count and rate of hospitalisation for falls in elderly (persons aged 65 years and over) in NSW, where day-only hospitalisations are excluded from the key indicator reports in NSW. NSW performance reporting of hospitalisations for falls in elderly in NSW includes overnight (and longer) hospitalisations. However, in this report, an analysis of day-only hospitalisations and the total of overnight and day-only hospitalisations are also included in the relevant indicator for comparison and completeness.
4.5 Full census of hospitalisations from 1993-94 and sampling factor prior to 1993-94
In 1993-94 the APDC (then known as the Inpatient Statistics Collection) was a fully enumerated survey (that is a census) for the first time. Datasets containing financial years earlier than 1993-94 are based on estimates from a sample of all inpatient data in some hospitals, partiularly in rural areas, and their use in analysis requires the inclusion of a sampling factor weighting variable.
4.6 Separation date determines the year of hospitalisation
The main record file of the hospital stay for a patient is created or completed on separation from hospital when all relevant documentation is made available to hospital medical record departments. Consequently, the main reason for hospitalisation (principal diagnosis) completed at separation, may be different from the admitting diagnosis. The hospitalisation is counted in the year when the separation took place even if the hospitalisation period occurred predominantly in the previous financial year. For example a patient discharged on 1 July after a 4 week hospital stay would be counted as hospitalised in the new financial year.
4.7 Imputation of interstate hospitalisations in the last year of data
At the time when the NSW Ministry of Health completes the Admitted Patient Data Collection for the previous financial year, data on hospitalisations of NSW residents in other states are usually not available and so interstate hospitalisations for the latest year is always ‘imputed’ from the previous three years in this report. This imputation process estimates the number of hospitalisations occurring in other states for each diagnosis in previous years and adds these numbers to the latest year of data. When the actual data become available, the number and rates for the affected year are re-calculated.
4.8 Summary of major changes in the hospital data on SAPHaRI
1988-89: Hospital data included from the Inpatients Statistics Collection (ISC) counted on the basis of a "period of stay" in hospital (ie multiple episodes of care). ICD-9-CM used and sampling from some hospitals (requiring a sampling factor for weighting numbers in these hospitals).
1993-94: Admitted Patient Data Collection (APDC) is a fully enumerated census of hospitalisations.
1998-99 onwards: APDC starts to be counted as episodes of care. ICD-10-AM replaces ICD-9-CM; and Australian Classification of Health Interventions replaces ICD-9-CM Procedure Classification.
Imputation for interstate hospitalisations: The latest year of data (number and rates) are ‘imputed’ for missing interstate hospitalisations for NSW residents. The actual number of interstate hospitalisations is included when available.
5. Differences between figures published by the AIHW and the NSW Ministry of Health and other institutions
5.1 Differences in publication schedules
The APDC dataset is continuously updated because it is not uncommon to receive additional records or additional information on records already supplied well after the close of a financial year. Consequently data on hospitalisations in NSW from different sources, such as this report and the AIHW report, will always differ slightly due to different publication schedules.
5.2 Imputation of interstate hospitalisations in the latest year of data
In this report imputation methods are used to estimate the number of hospitalisations of NSW residents occurring elsewhere in Australia in the latest year due to a lag in receiving this information (see above). Over some periods of time two last years of data need to be imputed. Refer to Notes in the indicator for confirmation how many years are imputed at the time. Estimates may vary slightly from the estimates in other releases of this report or other reports because of the imputation. The actual number of interstate hospitalisations is included when relevant.
5.3 Definition of hospitalisation
Both overnight and day-only hospitalisations are included in this report, unlike in the national reporting on hospital statistics, where only overnight hospitalisations are included (AIHW Health services series no. 40. Cat. no. HSE 107 2011).
5.4 Different projected populations
For the calculation of rates, the NSW Ministry of Health uses population projections based on the NSW Health Population Projection Series, prepared by the Statewide Services Development Branch of the NSW Ministry of Health in collaboration with the NSW Department of Planning. Refer to Methods in Population-Demography topic for further information on projected populations and other issues mentioned here. The rates in this report are expressed as a number per 100,000 population.
Rates published by the Australian Institute of Health and Welfare may be expressed differently (per 1,000 or 10,000 population) and use different projected population estimates for NSW. The population estimates, which are not projected, are likely to be the same, as these are based on the estimated residential populations published by the ABS.
6. Other datasets holding data on activity in hospitals
The APDC datasets contain information on inpatient hospital activity. Emergency department data and Outpatient activity data are also available to report on hospital activity.
Australian Institute of Health and Welfare. Australian hospital statistics 2009–10. Health services series no. 40. Cat. no. HSE 107. Canberra: AIHW, 2011. Available at http://www.aihw.gov.au/publication-detail/?id=10737418863 (Cited on April 2011).
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Australian Coding Standards. Sydney: NCCH, 2006.
National Coding Centre. The Australian version of the International Classification of Diseases, 9th revision, clinical modification (ICD-9-CM). Sydney: University of Sydney, 1996.
The Admitted Patient Data Collection
The NSW Admitted Patient Data Collection (APDC) or Inpatient Statistics Collection (ISC) is a census of all services for admitted patients provided by public hospitals, public psychiatric hospitals, public multi-purpose services, private hospitals and private day procedure centres in NSW. The APDC is a financial year collection from 1 July through to 30 June of the following year. The information it contains is provided by patients, health service providers, and the hospital's administration. The information reported includes patient demographics, source of referral to the service, service referred to on separation, diagnoses, procedures, and external causes.
For this report, the APDC was accessed via SAPHaRI. The APDC data is still called the 'ISC' data on SAPHaRI to maintain consistency in naming of SAS datasets.
Imputation of interstate admissions in the last year of data
The APDC includes data on hospital admissions of NSW residents which occurred in hospitals interstate. The only exception to this is that data from interstate hospitals for the last year of data which are not yet available when the data is analysed for publication. This may affect analyses and has a greater effect on rates for areas closer to an interstate boundary. Analyses by Local Health Districts, Local Government Areas, Divisions of General Practice and analyses involving uncommon diagnoses or procedures are particularly affected. Therefore, an estimate is made of interstate admissions for the last year of hospitalisations. This estimate is based on admissions in the preceding three years. The first step is to determine the proportion of total admissions for NSW residents in the preceding three years which were at interstate hospitals. That proportion is then used to multiply the number of admissions at hospitals in NSW in the last year of data, to obtain the estimate of the number of admissions expected to have occurred at interstate hospitals. The estimates are calculated for each age-sex stratum. Where hospitalisations are further categorised, for example by diagnosis, geographical place of residence or country of birth, the imputation procedure is carried out separately for each category, thus accounting for the uneven distribution of interstate hospital admissions.
Episodes of care
From 1 July 1998, inpatient data on SAPHaRI (formerly HOIST) have been for episodes of care in hospital. Episodes of care end with the discharge, transfer, or death of a patient. A new episode of care may also start when the service category for an admitted patient is altered, as a result of a change in the on-going clinical care requirements for that patient during the one episode of accommodation in a single facility. APDC data on SAPHaRI up to 30 June 1998 were for periods of stay in hospital. A period of stay in hospital ends with the discharge, transfer, or death of a patient, and may consist of multiple episodes of care. The change from 'period of stay' to 'episode of care' causes a small increase in the apparent number of admissions.
ICD-9 and ICD-10 coding of diagnoses
The reason for a hospital admission is coded at the time of separation (discharge, transfer or death). Since 1 July 1998, coding has been according to the 10th revision of the International Classification of Diseases, Australian Modification ICD-10-AM. Updated ICD-10 coding manuals have been published by the National Centre for Classification in Health every two years since 1998. Prior to this, coding was according to the 9th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM), using the Australian version (National Coding Centre, 1996) from July 1995 and the US version prior to that.
Coding of procedures
Since 1 July 1998, procedures carried out during a patient's stay have been coded according to the MBS-Extended Procedure Classification, published as Volume 3 and Volume 4 of the 10th revision of the International Classification of Diseases, Australian Modification (ICD-10-AM). Updated ICD-10 coding manuals have been published by the National Centre for Classification in Health every two years since 1998. Prior to this, procedures were coded according to the 9th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM), using the Australian version (National Coding Centre, 1996) from July 1995 and the US version prior to that.
The numbers of diagnosis and procedure codes that may be recorded, at the time of separation, have varied over time, and are currently as follows:
· principal diagnosis (the principal reason for admission);
· up to 54 other diagnoses;
· up to 50 procedures and procedure blocks;
· up to eight external cause codes for injury and poisoning.
· up to three codes for place of occurrence injury or poisoning.
· up to three codes for activity at time of injury or poisoning.
Mapping tables between ICD-9-CM and ICD-10-AM disease codes, produced by the National Centre for Classification in Health, were used extensively to obtain the most appropriate match for individual codes between the two classification systems. The ICD-10-AM and ICD-9-CM codes used for each indicator are included in the Codes tab available with each indicator group in this report.
Select the rows below to view more detail on a code
Codes: Chronic obstructive pulmonary disease
The International Statistical Classification of Diseases and Related Health Problems
National Centre for Classification in Health, Australia; CM - Clinical Modification; AM - Australian Modification
Key points: Aboriginal peoples
• In 2011, around 172,624 Aboriginal people lived in NSW making up around 2.5% of the total population and 31.5% of the total Australian Aboriginal population, according to 2011 Census results.
• The relative socioeconomic disadvantage experienced by Aboriginal people in NSW continues to place them at a greater risk of exposure to behavioural and environmental health risk factors.
• The Aboriginal population is younger, with 37% of the population under 15 years of age, compared with 19%of the non-Aboriginal population. The proportion of the Aboriginal population over the age of 65 years is just over 3.5% compared with just over 14% of the non-Aboriginal population.
• Life expectancy at birth is calculated to be nearly 70 years in Aboriginal males and 75 years in Aboriginal females in NSW. These calculations estimate life expectancy as 8.8 and 7.5 years shorter than in non-Aboriginal males and females, respectively.
• Aboriginal people are more likely to die at younger ages. People aged less than 25 years make up around 10% of deaths of Aboriginal people, compared with 2% of deaths among non-Aboriginal people.
• The infant mortality rate among babies identified as Aboriginal on the death registration form was 3.8 per 1,000 live births in years 2010 to 2012. The infant mortality rate among non-Aboriginal babies was 3.5 per 1,000 live births.
• Non-communicable diseases explain 70% of the health disparity between Aboriginal and non-Aboriginal people in NSW. The main risk factors contributing to the health gap are:
High body mass (16%)
Physical Inactivity (12%)
High blood cholesterol (7%)
• Cardiovascular disease and cancer are the leading causes of death in both Aboriginal and non-Aboriginal people.
• Aboriginal people are admitted to hospital at about 1.7 times the rate of non-Aboriginal people. Renal dialysis accounts for the largest number of hospitalisations in Aboriginal people.
• Compared with rates in non-Aboriginal people, hospitalisation rates in Aboriginal people in NSW are (around):
150% higher for conditions for which hospitalisation can be avoided through prevention and early management
170% higher for diabetes
60% higher for cardiovascular diseases
250% higher for chronic respiratory diseases
50% higher for injury and poisoning
200% higher for alcohol-related conditions.
• Reported rates of current smoking in Aboriginal adults are around double those for the general population across all age groups; while reported rates of risk drinking are around 1.4 times the general population rates across all age groups.
Introduction: Aboriginal peoples
In 2011, Aboriginal and Torres Strait Islander people comprised 2.5% of the total NSW population. The NSW Aboriginal population is 94.4% Aboriginal only, 3.4% Torres Strait Islander only, and 2.2% both Aboriginal and Torres Strait Islander. In this report all these people are referred to as Aboriginal in recognition of the fact that Aboriginal people are the original inhabitants of NSW.
The Aboriginal population in Australia grew by 13% in the period between the 2001 and 2006 Censuses. Much of this intercensal increase is a 'natural' increase which can be explained by demographic factors (births and deaths). Non-demographic factors, such as improvements in Census collection methods and people identified as Aboriginal for the first time in the Census, also contribute to the growth.
Burden of disease and social and economic disadvantage among Aboriginal people
There are many and complex reasons for the health disparities between Aboriginal and non-Aboriginal people including:
• socio-economic factors such as low incomes, high unemployment, low educational levels, and poor nutrition
• environmental factors such as poor living environments, substandard and overcrowded housing, poor sewerage and water quality and access to affordable healthy food
• social and political factors including removal from land, separation from families, dislocation of communities, culturally inappropriate services, and poor cross cultural communication
• lack of access to primary health care and
• specific health risk factors such as poor nutrition, hazardous alcohol use, high tobacco use and low physical activity.
Interventions: Aboriginal peoples
NSW Health is committed to working in partnership with Aboriginal people and other government agencies to improve the health and wellbeing of Aboriginal people. This means that Aboriginal people must be involved in the process of identifying and deciding on their health priorities and participate in the planning and delivery of their health services.
The National Partnership Agreement - Indigenous Health
In 2008, the Council of Australian Governments (COAG) committed to closing the gap between Aboriginal and non-Aboriginal people’s health outcomes. The National Partnership Agreement-Indigenous Health commits NSW to closing the gap in life expectancy within a generation and to halving the gap in mortality rates for Indigenous children within a decade. These health improvements will be achieved by making Aboriginal health everybody’s business and by providing specific Aboriginal health initiatives.
The National Partnership Agreement – Indigenous Health commits the NSW and Commonwealth Governments to spending $180 million over 4 years on new Aboriginal specific health initiatives aimed at:
• reducing smoking and injuries in the Aboriginal population
• preventing and better managing chronic diseases for Aboriginal people
• improving Aboriginal oral health and adolescent health
• boosting the Aboriginal workforce and improving the cultural competence of the health workforce and
• improving the quality of Aboriginal health data.
The Agreement also provides additional funds to strengthen existing Aboriginal health programs such as Housing for Health and the Aboriginal Maternal and Infant Health Strategy.
These new and enhanced Aboriginal health initiatives build on existing Aboriginal health specific initiatives including:
• The Chronic Care for Aboriginal People program which focuses on an integrated approach to diabetes, heart disease, stroke, hypertension and kidney disease because of the shared risk conditions and common approaches needed to prevent and manage these conditions in Aboriginal communities.
• The NSW Aboriginal Mental Health and Well Being Policy 2006-2010 which guides the provision of culturally sensitive and appropriate mental health and social and emotional well being services to the Aboriginal community (NSW Department of Health, 2007).
• Implementation of SmokeCheck a project which increases the capacity of Aboriginal health workers to support Aboriginal people to quit smoking.
• Funding for Aboriginal Medical Services (AMSs) which provide primary health care services which are initiated and operated by the local Aboriginal community and deliver holistic, comprehensive, and culturally appropriate health care.
These initiatives are further supported by Two Ways Together, the NSW Aboriginal Affairs Plan 2003- 2012, which adopts a whole-of-government approach to improve the lives of Aboriginal people.
For more information: Aboriginal peoples
Key points: Respiratory disease
• In 2012 in NSW, around 9% of adult males and 13% of adult females had asthma, and in 2009 and 2010, around 15% of boys and 11.5% of girls aged 2-15 years had asthma. Asthma was responsible for 130 deaths in 2007 and around 12,000 hospitalisations in 2010-11.
• Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, was responsible for over 1,700 deaths in 2007 in NSW and almost 20,000 hospitalisations in 2010-11.
• In 2007, 75% of all deaths from chronic obstructive pulmonary disease in NSW and 91% of all lung cancer deaths were attributable to smoking. In 2009-10, smoking caused around 80% of all hospitalisations for chronic obstructive pulmonary disease and lung cancer.
• Asbestosis is a chronic lung disease that is associated with occupational exposure to asbestos. Total hospitalisations due to asbestos in NSW have decreased in the past five years.
• Death rates from respiratory tuberculosis have remained low and stable since 1994 in NSW.
• The rate of new cases of malignant mesothelioma (a cancer that is associated with past exposure to asbestos) more than doubled in NSW between 1986 and 2003. It has been slowly decreasing since then.
Introduction: Respiratory disease
Respiratory diseases include acute diseases, such as influenza and pneumonia, and chronic respiratory diseases (specifically asthma, chronic obstructive pulmonary disease, asbestosis, and respiratory tuberculosis), where preventive measures and better management of conditions can reduce the burden of disease and reduce associated healthcare costs. Respiratory diseases, including lung cancer, were together responsible for around 14% of all deaths in NSW in the period 2003 to 2007, and about 5% of hospital separations in 2008-09.
Chronic respiratory diseases were responsible for 7.1% of total burden of disease and injury in Australia in 2003, with chronic obstructive pulmonary disease and asthma accounting for 46% and 34% of this burden, respectively (Begg et al. 2007).
Influenza and pneumonia
Influenza and pneumonia are acute respiratory diseases that can be very severe and, in persons at high risk, can lead to death. Influenza and pneumonia cause around 1.8% of all deaths and around 0.9% of hospital separations and are an important cause of hospitalisations in the very young, and of death and hospitalisations among older age groups.
Asthma is a significant public health problem in Australia and it is estimated that Australian prevalence rates are among the highest in the world. Fortunately, recent studies in children show no further increase in prevalence. The overall prevalence of asthma reported in Australia was 9.9%, down from 11.6% in the 2001 ((ABS Cat. no. 4364.0 2009). Among children asthma is the most prevalent long term condition in Australia. In Australia in 2003, asthma was estimated to account for 2.3% of the disease burden (Begg et al. 2007).
Chronic obstructive pulmonary disease
Chronic bronchitis and emphysema are the two main conditions comprising chronic obstructive pulmonary disease (COPD). In Australia in 2003, COPD was estimated to account for 2.9% of the disease burden.
Tuberculosis (TB) is caused by the bacterial organism Mycobacterium tuberculosis. Despite the increasing burden from respiratory tuberculosis globally, it is not a major public health problem in NSW. In fact the mortality and morbidity from all types of tuberculosis in NSW is one of the lowest in the world.
Lung cancer is excluded from analyses of respiratory diseases, as it is classified with cancers, and not with respiratory diseases, in the International Classification of Diseases (the coding system used for health data in NSW). However, some indicators analysing respiratory diseases explicitly include lung cancer to provide a more appropriate measure of the burden of respiratory disease from a clinical and health services planning perspective.
Cigarette smoking is the main risk factor for both COPD and lung cancer and the current incidence rates of these conditions reflect smoking rates 20 years and more in the past. Lung cancer is one of the leading causes of death in Australia.
Australian Bureau of Statistics. National Health Survey: Summary of Results, 2007-2008 (Reissue). Cat. no. 4364.0. Canberra: ABS, 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0/
Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. Available at http://www.aihw.gov.au/publications/index.cfm/title/10317
Interventions: Respiratory diseases
Potentially preventable hospitalisations for chronic conditions
The most common chronic conditions defined as potentially preventable hospitalisations or ambulatory care sensitive hospitalisations are included in the NSW Severe Chronic Disease Management Program.
In response to the Garling Report 2008, the NSW Department of Health is implementing the NSW Severe Chronic Disease Management Program. This program is being overseen by the Chronic Disease Management Office to improve the quality of life of older people with chronic and complex conditions, their carers and families and to prevent unplanned and avoidable hospital admissions. It achieves this by coordinating a statewide chronic disease management approach.
The NSW Severe Chronic Diseases Management Program is focused on five major chronic diseases of interest that are recognised as having a major impact on the burden of disease in NSW. Furthermore, these conditions have been demonstrated to have improved outcomes through CDM approaches. The diseases of interest are Chronic Obstructive Pulmonary Disease (mainly emphysema and chronic bronchitis); Coronary Artery Disease (also known as coronary or ischaemic heart disease); Diabetes; Hypertension (high blood pressure); and Congestive Heart Failure.
People who are diagnosed with these diseases and who are experiencing repeated episodes in hospital are offered enrolment to the program. In the future the program will expand and be offered to people with these conditions even if they are not being admitted to hospital frequently to prevent their deterioration.
Written asthma management plans are recommended as part of the National Guidelines for the management of asthma (NAC, 2002). They enable people with asthma to recognise a deterioration in their condition and initiate appropriate treatment, thereby reducing the severity of acute episodes.
The National Asthma Campaign publicised the Six Step Plan for the identification and management of more severe cases of asthma, where preventive therapy is recommended.
The NSW Tuberculosis Program is successful as the incidence of tuberculosis in NSW remained stable over the last decade despite large-scale migration from high-prevalence countries and the treatment success rates have been high, with the absence of treatment failures and low rates of relapse of cases initially treated in Australia.
The main challenges to the NSW Tuberculosis Program are similar to those that face tuberculosis control globally. They include control of multi-drug resistant and extreme drug-resistant tuberculosis and identification and management of tuberculosis-HIV coinfection (O'Connor et al. 2009).
Influenza and Pneumonia
Influenza and pneumococcal disease are covered by the National Immunisation Programs in NSW.
Influenza has been a notifiable disease by all laboratories under the Public Health Act in NSW since 2001. Surveillance is enhanced in winter months when the NSW Department of Health collects and reports weekly on influenza-like illness presentations to Emergency Departments , through the Public Health Real-time Emergency Department Surveillance System (PHREDSS), and laboratory confirmed diagnoses of influenza virus infections.
Emergency Departments in NSW are prepared for influenza epidemics with peak visit plans and similar measures in winter months.
NSW Department of Health . NSW Chronic Care Program: Phase Three: 2006-2009, NSW Chronic Disease Strategy: Executive Summary. Sydney: NSW Department of Health, 2006.
NSW Premier's Department. A new direction for NSW. State Plan. Sydney: NSW Premier's Department, 2006. Available at http://www.nsw.gov.au/stateplan/index.aspx?id=8f782cbd-0528-4077-9f40-75af9e4cc3e5
O'Connor B, Fritsche L, Christensen A, McAnulty J. EpiReview: Tuberculosis in New South Wales, 2003-2007. 2009. Available at www.publish.csiro.au/index.cfm?act=view_file&file_id=NB09001.pdf
For more information: Respiratory diseases
Useful websites include:
Australian Centre for Asthma Monitoring at http://www.asthmamonitoring.org
National Asthma Council Australia at http://www.nationalasthma.org.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
HealthInsite at http://www.healthinsite.gov.au