Mortality estimates for years up to 2005 are based on Australian Bureau of Statistics death registration data. Data from 2006 onwards were provided by the Australian Coordinating Registry, Cause of Death Unit Record File; the data for the most 2 recent years are preliminary (SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health) Unpublished tables from Australian Burden of Disease Study, 2015. Australian Institute of Health and Welfare
Calculated using age and sex-specific aetiological fractions from the Australian Burden of Disease Study 2015: methods and supplementary information.
Only NSW residents are included. Deaths were classified using ICD-10. Rates were age-adjusted using the Australian population as at 30 June 2001.
Counts of deaths for the latest year of data include an estimate of the number of deaths occurring in that year but registered in the next year.
Direct age standardisation was used to calculate standardised rates and counts; Spatial adjustment methods were used to calculate the adjusted rates.
Local Government Area boundaries used were defined in 2016.
Estimates of the numbers and rates of deaths and hospitalisations attributable to the use of tobacco and alcohol, to overweight and obesity and other risk factors used age and sex-specific aetiologic fractions for NSW developed by the Australian Institute of Health and Welfare (AIHW) as part of the Australian Burden of Disease Study 2015 (ABDS 2015). The term "population attributable fraction" is a synonym for 'aetiological fraction'. An aetiological fraction is the estimated proportion of cases of the disease in a specific population that would be eliminated in the absence of the risk factor. Hospitalisations attributable to risk factors measure only the more severe outcomes of these risk factors and exclude less severe morbidity which may be captured elsewhere such as in primary health care data.
The ABDS 2015 identified 38 risk factor components that were combined, resulting in 18 individual risk factors which can broadly be grouped into categories (behavioural, metabolic, environmental and dietary risks). Details of the methods used in the ABDS 2015 to derive age and sex-specific aetiological fractions can be found in the report Australian Burden of Disease Study 2015: methods and supplementary information. Below is an overview of the methods from the report (p 111-12).
The burden attributable to selected risk factors is generally estimated using population attributable fractions (PAFs) applied to the disease burden estimated in the ABDS 2015. If PAFs appropriate to the disease and population in question are available from a comprehensive data source (such as a disease register), they are applied directly. If not, PAFs are estimated using the following process:
1. Select risk factors.
2. Identify linked disease based on best evidence in the literature that risk factor has a causal association with increased prevalence or mortality.
3. Define the risk factor exposure level not associated with increased risk of disease (i.e. theoretical minimum risk exposure - TMRED).
4. Estimate the PAFs by comparative risk assessment method (Lim et al. 2012).
5. Estimate the effect of risk factors on disease outcomes (relative risks).
6. Estimate the population-level distribution of risk factor exposure.
7. Calculate the population attributable fraction. This is done for each risk-outcome pair by sex and age group.
The AIHW provided the Australian fractions to NSW with mapping of diseases to ICD-10 codes. These were applied to death and hospital unit record files for these indicators.
Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2015—summary report. Australian Burden of Disease Study series no. 18. BOD 21. Canberra: AIHW; 2019.
Australian Institute of Health and Welfare. Australian Burden of Disease 2015: methods and supplementary material. Australian Burden of Disease Study series no. 20. Cat. no. BOD 23. Canberra: AIHW; 2019.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224–60.
The Local Government Area boundaries (LGAs) used in HealthStats NSW are an Australian Bureau of Statistics (ABS) approximation of officially gazetted LGAs as defined by the NSW Office of Local Government. The 2016 Australian Statistical Geography Standard (ASGS) edition of LGAs includes the 19 New South Wales councils announced on 12 May 2016 at https://www.strongercouncils.nsw.gov.au/. Based on the 2016 ASGS, there are 130 LGAs in NSW.
LGAs cover incorporated areas of Australia. Incorporated areas are legally designated parts of a State or Territory over which incorporated local governing bodies have responsibility. The major areas of NSW not administered by incorporated bodies include parts of far western NSW and Lord Howe Island. These regions are identified as ‘Unincorporated’ in the ABS Local Government Area structure.
Local Government Area population estimates used in HealthStats NSW
In HealthStats NSW, the total population used for each LGA in age-standardisation calculations is the Estimated Resident Population produced by the ABS and projections produced by the NSW Department of Planning, Industry, and Environment. As sub-state projections based on the 2016 Census are not yet available, population projections for LGAs (estimated population for 2017 and onwards) are based on Estimated Resident Populations produced by the ABS prior to the 2016 Census.
Methods used to adjust estimates for small areas
The term ‘small area’ refers to a small geographical area and a small population. Data from a small area are characterised by considerable variability. Smoothing is a general term for methods of minimising variability in data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of areas considered. In addition, statistical smoothing can be used to adjust raw estimates in small areas by taking into account information from adjacent areas (local or spatial variability) and from the whole state (global or non-spatial variability).
LGAs are the smallest level at which data are analysed in HealthStats NSW. 'Statistical smoothing' methods are used to control for random variability in the small area estimates and result in more conservative estimates for small areas. These methods are described in a paper in the HealthStatsPLUS Methods tab on this website.
The results of the spatial adjustment were used to determine whether the results obtained from individual areas are significantly different from NSW. The level of significance and the direction of difference from the NSW average is shown using plus and minus signs, as follows:
means more than 99.5% of the posterior distribution is above the unadjusted state rate. This indicates that the estimated LGA rate is significantly higher than the state average at the 1% level of significance.
means more than 97.5%, but less than 99.5%, of the posterior distribution is above the unadjusted state rate. This indicates that the estimated LGA rate is significantly higher than the state average at the 5% level of significance.
means that between 2.5 and 97.5% of the distribution is above the unadjusted state rate. This indicates that the LGA rate is not significantly different to the state average.
means less than 2.5% of the posterior distribution is above the unadjusted state rate. This indicates that the LGA rate is significantly lower than the state average at 5% level of significance.
means less than 0.5% of the posterior distribution is above the unadjusted state rate. This indicates that the LGA rate is significantly lower than the state average at the 1% level of significance.
Australian Bureau of Statistics. Regional population growth, Australia. Cat no. 3218.0. ABS Canberra, 2019. Accessed 28 February 2020 at https://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3218.0
NSW Office of Local Government website at: https://www.olg.nsw.gov.au/
Australian Bureau of Statistics. Local Government Areas. Australian Statistical Geography Standard. Cat no. 1270.0.55.003. ABS Canberra, 2016. Accessed 28 February 2020 at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1270.0.55.003~July%202016~Main%20Features~Local%20Government%20Areas%20(LGA)~7
NSW Department of Planning, Industry, and Environment website at: https://www.dpie.nsw.gov.au/
In order to complete a death registration in Australia, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. Natural causes are predominantly certified by doctors, whereas External and Unknown causes or unaccompanied deaths are usually certified by a Coroner. Approximately 85-90% of deaths each year are certified by a doctor and the remainder is reported to a Coroner. The death is registered in the state in which the death occurred, rather than the state in which the person resides. The Australian Cause of Death Statistics System is outlined by the Australian Bureau of Statistics (ABS) at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument
The ABS have implemented a revision process for Coroner certified deaths. Data are deemed preliminary when published for the first time, revised when published the following year and final when published two years after initial publication. This revision process, and the impact on specific causes are described at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument.
The ABS publishes two publications every September concerning deaths in the previous calendar year: Deaths, Australia (Catalogue Number 3302.0) and Causes of death, Australia (Catalogue Number 3303.0), which include breakdowns at the State and Territory level. These are usually published nine months following the most recent reported year.
Prior to 2008, the NSW Ministry of Health obtained data on causes of death of all NSW residents from the Australian Bureau of Statistics (ABS). This covers deaths registered from 1964 to 2005.
For deaths registered from 2006 onwards, the NSW Ministry of Health receives coded cause of death data from the Australian Coordinating Registry (ACR). The ACR is an agency appointed to coordinate access of coded cause of death unit record data on behalf of the Registrars of Births Deaths and Marriages in each state or territory as well as the Australian Bureau of Statistics and National Coronial Information System. The coordinating registry undertakes the coordination and management of the designated activity. The underlying legal responsibility is retained by the collective Registrars. The coding of the causes of death is still undertaken by the ABS but the process to obtain the data is administered by the ACR.
The ACR provides the NSW Ministry of Health with a unit record file of all deaths, either occurring in NSW or to NSW residents who died interstate, approximately sixteen to seventeen months following the most recent reported year to allow a detailed analysis of deaths data. This analysis includes comparisons of causes of death in NSW by sub-state geographies (e.g. by Local Health District or Local Government Area) and by other dimensions and sub-populations, such as remoteness categories and socioeconomic groups. Causes of death data are also used throughout the NSW public health system for a variety of health system planning, reporting, research and evaluation needs.
There are differences in how deaths data are reported in HealthStats NSW and by the ABS, including differences in how deaths are allocated to specific years and differences in the populations used for calculating rates.
1. Death count by year of registration and by year of occurrence
There is usually an interval between the occurrence and registration of a death which is related to the time of year or whether a death is referred to a Coroner. The registration of deaths which occur in November and December are likely to be delayed until the following year, for example, of all deaths in NSW registered in 2013, 6.9% had occurred in 2012 or earlier (ABS 3302.0).Deaths data reported by the ABS for the latest year are based on the year of registration therefore do not include deaths which occurred in that year but where registration was delayed.
Deaths data reported in HealthStats NSW are based on the year of occurrence of the death to provide a better match for the population denominator when calculating rates. Estimates of missing deaths for the latest year due to delayed registration (i.e. due to time of year or Coronial cases) are imputed for each cause and included in the count reported in HealthStats NSW. A small percentage of death registrations may be delayed for more than one year. All deaths figures reported in HealthStats NSW are updated historically (e.g. in trends) when new data becomes available.
2. Different population projection data
For the calculation of rates, the NSW Ministry of Health uses population projection estimates from the NSW Department of Planning, Industry, and Environment. The estimated residential populations which are not projected are the same as those published by the ABS and are currently based on the 2016 Census. See Methods associated with indicators in topics Demography (or Population) for further discussion of population estimates.
Australian Bureau of Statistics. Deaths, Australia, latest year. 3302.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0
Australian Bureau of Statistics. Causes of Deaths, Australia, latest year. 3303.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0
Australian Bureau of Statistics. Multiple Cause of Deaths, Australia, 1997-2001. 3319.0.55.001. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3319.0.55.001
Mortality: Alcohol attributable conditions
|WHOLLY ATTRIBUTABLE CONDITIONS|
|Alcohol use disorders||F10|
|PARTIALLY ATTRIBUTABLE CONDITIONS|
|Lip and oral cavity cancer||C00-C08|
|Other lip, oral cavity and pharynx cancers||C09-C10 C12-C14|
|Lower Respiratory Infections||J12,J14-J18, J20-J22, J85-J86|
|Hypertensive heart disease||I11|
|Coronary heart disease||I20-I25|
|Atrial fibrilation and flutter||I48|
|Chronic liver disease||B18, I85,K70-K76|
|Road traffic injuries - motorcyclists||V20-V29|
|Road traffic injuries - motor vehicle occupants||V30-V79, V89.2, Y85.0|
|Road traffic injuries - pedestrians||V01-V09|
|Road traffic injuries - pedal cyclists||V10-V19|
|Other land transport injuries||V01-V06, V09-V89,Y85.9|
|Fire, burns and scalds||X00-X06, X08-X19|
|Drowning||V90, V92, W65-W70, W73-74|
|Other unintentional injuries||V91, V93-V99, W20-W46, W49-W60, W64, W75-W81, W83-W94, W99, X20-X39, X50-X54, X57-X58, Y35-Y36, Y86, Y89|
|Suicide and self-inflicted injuries||X60-X84, Y87.0|
|Homicide and violence||X85-X99, Y00-Y09, Y87.1|
Note: ICD codes have been summarised. Numbers are calculated using age and sex-specific population attributable fractions from the Australian Burden of Disease Study 2015. For information on how these were applied in HealthStats NSW please see the Methods paper on Population Attributable Fractions.
The 2019 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI) estimated that:
• 32.8% of adults (41.2% of men and 22.8% of women) consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol.
• 48.7% of Aboriginal adults consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol
• 26.7% of adults (34.7% of men and 19.1% of women) consumed more than 4 drinks on a single occasion in the previous four weeks.
Latest available data for secondary school students in NSW
• 13.7% of students aged 12-17 years (15.1% of boys and 12.3% of girls) consumed alcohol in the last 7 days as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
Self-reported data on consuming more than 2 standard alcoholic drinks on a day have been collected for adults in NSW since 1997 through the NSW Population Health Survey, and since 1985 through the National Drug Strategy Household Survey. Data from an interviewer-administered questionnaire has been collected in the ABS National Health Survey (2017-18).
Self-reported data on alcohol drinking in the past 7 days have been collected for students in NSW since 1987 through the NSW School Students Health Behaviours Survey.
Prevalence estimates, although differing slightly between surveys because of different sampling frames, participation rates and modes of collection (telephone versus self-completed questionnaires versus face-to-face personal interview versus drop-and-collect) have remained constant over time for adults and fallen in school students.
In 2018-19 in NSW:
• There were around 15,800 unplanned presentations to 84 NSW public hospital emergency departments for alcohol.
• The rate of ED presentations among persons aged 18-24 years (402.5 per 100,000 population) was around 1.6 times that of persons aged 15 years and over (254.5 per 100,000 population).
• The rate of ED presentations among males aged over 15 years was around 1.8 times that of females aged over 15 years, however similar between males and females aged 15-17 years (326.9 and 321.5 per 100,000 respectively).
• There were 10,129 presentations for alcohol-related problems among all males aged over 15 years and 1,532 in males aged 18-24 years (15% of total for males) compared with 5,673 for all females aged over 15 years and 1,423 for females aged 18-24 years (25% of total for females).
Data are from 84 NSW public hospital emergency departments (EDs) that have reported continuously since 2009-10 and have collected reasonably complete diagnosis information since 2009-10. These EDs accounted for around 87% of all emergency department activity in NSW in 2018-19, consequently the presentations reported here are under-estimates of the actual NSW presentations. The under-estimation differs by geographical area, which precludes analysis by Local Health District, Primary Health Network, Local Government Area and remoteness from service centres. Data refer to all presentations to the included EDs regardless of patients' district or state of residence.
A total of 45,005 hospitalisations were attributed to alcohol in NSW in 2018-19, which was approximately 1.5% of all hospitalisations.
The rate of hospitalisations attributable to alcohol has been relatively stable in all persons in recent years. There is a consistent pattern over time of increasing rates with increasing rurality and geographic remoteness. There is also a consistent pattern of higher rates in higher socioeconomic areas compared with more disadvantaged areas. The rate in the Aboriginal population was 1.8 times higher than the rate in the non-Aboriginal population in 2018-19.
There was considerable variation in the rate of hospitalisations attributable to alcohol between Local Government Areas (LGAs), with 21 LGAs having a rate significantly higher than the state average and 38 significantly lower than the state average (at the 1% level of significance) in the period 2015/16-2016/17.
Deaths attributable to alcohol
A total of 1,929 deaths were attributed to alcohol in NSW in 2018, which was approximately 3.6% of all deaths in 2018.
The death rate attributable to alcohol has shown a slight decrease in recent years. The rates in males and females were 26.6 and 13.2 deaths per 100,000 population respectively in 2018.
Australian Institute of Health and Welfare. National Drug Strategy Household Survey report. Available at: https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-detailed/contents/table-of-contents
Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017-18. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/F6CE5715FE4AC1B1CA257AA30014C725?opendocument
Excessive alcohol consumption is one of the main preventable public health problems in Australia, with alcohol being second only to tobacco as a preventable cause of drug-related death and hospitalisation.
Long-term adverse effects of high consumption of alcohol on health include contribution to cardiovascular disease, some cancers, nutrition-related conditions, risks to unborn babies, cirrhosis of the liver, mental health conditions, tolerance and dependence, long term cognitive impairment, and self-harm.
The guidelines to reduce the health risks from drinking alcohol, published by the National Health and Medical Research Council in 2009, state that the lifetime risk of harm from alcohol-related disease or injury is reduced by drinking no more than two standard drinks on any day when drinking alcohol. These guidelines also state that drinking no more than four standard drinks on a single occasion reduces the immediate risk of alcohol-related injury arising from that occasion. In HealthStats NSW, the measure of lifetime risk of harm is defined as more than 2 standard drinks on a day when usually drinking, and is referred to as "long-term risk of harm" from alcohol consumption. As this definition is based on usual alcohol consumption, therefore representing an overall pattern of drinking, it reflects alcohol use related to health risk over the long-term.
Harm from alcohol-related accident or injury is experienced disproportionately by younger people; over half of all serious alcohol-related road injuries occur among 15–24-year-olds. However, harm from alcohol-related disease is more marked among older people.
National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC, 2009. Available at: https://nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol
NSW Ministry of Health. Reducing alcohol-related harm snapshot
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au
NSW Health: Alcohol and other drugs website at http://www.health.nsw.gov.au/aod/Pages/default.aspx
Your Room website at http://yourroom.com.au/
Get Healthy Information and Coaching Service at http://www.gethealthynsw.com.au/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
healthdirect at http://www.healthdirect.gov.au