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)
Calculated using age and sex-specific aetiological fractions from the Australian Burden of Disease Study 2011: 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 years of data include an estimate of the number of deaths occurring in that year but registered in the next year. Data on late registrations were unavailable at the time of production.LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
Estimates of the numbers and rates of deaths and hospitalisations attributable to the use of tobacco, alcohol, to high body mass 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 2011 (ABDS 2011).
The ABDS 2011 identified 30 risk factors for analysis, which were broadly grouped into categories (behavioural, metabolic, environmental and dietary risks). Details of the methods used in the ABDS 2011 to derive age and sex-specific aetiological fractions can be found in the report Australian Burden of Disease Study 2011: methods and supplementary information. This report provides the following overview of the methods (p 118):
The burden attributable to selected risk factors is generally estimated using population attributable fractions (PAFs) applied to the disease burden estimated in the ABDS 2011. 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 created using the comparative risk assessment method that has become standard practice in burden of disease risk factor analysis globally (Lim et al. 2012).
The comparative risk assessment method is a 5-step process:
1. Select risk–outcome pairs.
2. Estimate the population-level distribution of risk factor exposure.
3. Estimate the effect of risk factors on disease outcomes.
4. Define the counterfactual (theoretical minimum risk exposure distribution—TMRED).
5. Calculate the population attributable fraction.
The AIHW provided fractions for NSW mapped to ICD10 and ICD10-AM codes. These were applied to death and hospital unit record files for these reports.
Australian Institute of Health and Welfare 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011—summary report. Australian Burden of Disease Study series no. 4. BOD 5. Canberra: AIHW.
Australian Institute of Health and Welfare 2016. Australian Burden of Disease 2011: methods and supplementary material. Australian Burden of Disease Study series no. 5. Cat. no. BOD 6. Canberra: AIHW.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. 2012. 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 380(9859):2224–60.
The Australian Bureau of Statistics (ABS) has produced measures of socioeconomic disadvantage from the 1971 Census. The Socio-Economic Indexes for Areas (SEIFA), in their present form, were first produced in 1990 and consisted of five indexes formed from the 1986 Census data (ABS).
There are four SEIFA indexes currently used. In each census year, the ABS assigns index SEIFA scores to non-overlapping geographical areas covering all Australia calculated from the various socioeconomic characteristics from the Census of the people living in areas.
Each index is a summary of a different subset of Census variables and focuses on a different aspect of socioeconomic advantage and disadvantage (ABS). The reference value for the whole of Australia is set to 1,000. Lower values indicate lower socioeconomic status.
The indexes are:
• Index of Relative Socio-Economic Disadvantage (IRSD)
• Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD)
• Index of Economic Resources (IER)
• Index of Education and Occupation (IEO).
In the IRSD, the constituent characteristics relate to occupation, education, non-English speaking background and the economic resources of the household. The proportion of Aboriginal people is no longer a constituent variable of IRSD from 2011 (ABS).
The score for each index is an ordinal measure with a mean of 1000 and standard deviation of 100 for Australia, and from 2011, based on the index scores of all Statistical Areas Level 1 (SA1) in Australia. Scores for larger geographic areas such as Local Government Areas (LGAs) and Postal Areas (POA) are population-weighted averages of scores in constituent SA1.
The overall scores for states are not available because as the size of an area increases, it becomes correspondingly more heterogeneous and the socioeconomic index becomes less and less meaningful. For very large areas, it is more useful to look at the distribution of SA1 scores within each area. The distributions of SA1 scores within each state and territory are available at the ABS web site (ABS).
The ABS has released SEIFA scores after the last five censuses. The methods used to calculate scores were similar in 1986, 1991 and 1996, but changed in 2001, 2006 and 2011. The major change in 2006 was that the census data used in the calculation of the indexes was based on people's usual area of residence rather than their location on census night (place of enumeration) and in 2011 a new geography standard was used and the proportion of Aboriginal people was no longer a constituent variable of IRSD (ABS).
In the Index of Relative Socio-Economic Disadvantage (IRSD), the constituent characteristics relate to occupation, education, non-English speaking background and the economic resources of the household. There are currently 16 variables contributing to the index and the proportion of Aboriginal people is no longer a constituent variable of IRSD from 2011 (ABS). This is the most frequently used and quoted SEIFA index.
The Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) consists of 25 contributing variables. They summarise information about the economic and social conditions of people and households within an area, including both relative advantage and disadvantage measures.
A low score indicates relatively greater disadvantage and a lack of advantage in general. For example, an area could have a low score if there are (among other things) many households with low incomes, or many people in unskilled occupations. A high score indicates a relative lack of disadvantage and greater advantage in general. For example, an area may have a high score if there are (among other things) many households with high incomes, or many people in skilled occupations (ABS)
The Index of Economic Resources (IER) focuses on the financial aspects of relative socioeconomic advantage and disadvantage, by summarising variables related to income and wealth. This index excludes education and occupation variables because they are not direct measures of economic resources. It also misses some assets such as savings or equities which, although relevant, could not be included because this information was not collected in the 2011 Census. There are 14 contributing variables. (ABS)
The Index of Education and Occupation (IEO) is designed to reflect the educational and occupational level of communities. The education variables in this index show either the level of qualification achieved or whether further education is being undertaken. The occupation variables classify the workforce into the major groups and skill levels of the Australian and New Zealand Standard Classification of Occupations (ANZSCO) and the unemployed. This index does not include any income variables. There are 9 variables contributing to the total score. (ABS)
Socioeconomic disadvantage is associated with a higher prevalence of health risk factors and higher rates of hospitalisations, deaths and other adverse health outcomes. Maps of socioeconomic disadvantage by LGA viewed in conjunction with maps of health outcomes can assist in identifying factors which may be associated with poorer outcomes.
In this report, the NSW population was divided into five groups based on the IRSD scores of their SLA of residence. This means that SLAs were sorted by IRSD score and assigned to population-weighted quintiles, each containing close to one-fifth of the total population. In some charts and data tables on HealthStats NSW, the quintiles were divided into three groups: the lowest SES population-weighted quintile, the highest SES population-weighted quintile, and the rest of the population, comprising the remaining three population-weighted quintiles.
Postal Areas (POAs) were grouped into quintiles of socioeconomic status based on the IRSD.
Adhikari P. Socio-economic indexes for areas: Introduction, use and future directions. ABS Catalogue no. 1351.0.55.015. Canberra: ABS, 2006.
Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) - Technical Paper, 2011. SEIFA Cat no 2033.0.55.001. Canberra: ABS, 2013. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001
Australian Bureau of Statistics. 1996 Census of population and housing. Socioeconomic indexes for areas. 2039.0. Canberra: ABS, 1998. Available at http://www.ausstats.abs.gov.au/ausstats/free.nsf/0/C17E9A880591BB45CA256AE9001BCD57/$File/2039.0_1996.pdf
Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. Catalogue no 2033.0.55.001. Canberra: ABS, 2013. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2011~Main%20Features~Main%20Page~1
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 at http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/47E19CA15036B04BCA2577570014668B?opendocument.
The Australian Bureau of Statistics (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 http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12015?OpenDocument .
The Australian Bureau of Statistics publishes two publications every year: Deaths, Australia (Catalogue Number 3302.0) in November, eleven months after the end of the concerned year and Causes of death, Australia (Catalogue Number 3303.0), in March, fifteen months after the end of the year concerned.
The Australian Coordinating Registry (ACR) is an agency appointed coordinate access to 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 ACR provides the NSW Ministry of Health with a national cause of death unit record file to allow detailed anaylsis of deaths data.
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 refered 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% 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. Estimates of missing deaths for the latest year due to delayed registration (ie due to time of year or Coronial cases) are imputed for each cause and included in the count for the reports in HealthStats NSW. A small percentage of death registrations may be delayed for more than one year. All deaths figures are updated historically (eg in trends) in this report when new data becomes available.
For the calculation of rates, the NSW Ministry of Health uses population projection estimates from the NSW Department of Planning 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
|Condition||ICD10 (AM) codes|
|WHOLLY ATTRIBUTABLE CONDITIONS|
|Alcohol use disorders||F10|
|PARTIALLY ATTRIBUTABLE CONDITIONS|
|Mouth and pharyngeal cancer||C00-C14|
|Diabetes||E10-E14 , O24|
|Lower Respiratory Tract Infections||J12,J14-J22, J85-J86|
|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 vehcle occupants||V30-V79, V87, V89, Y85.0|
|Other road traffic injuries||V01-V19, Y87.9|
|Other land transport injuries||V01-V86, V88-V89,V85.9|
|Fire, burns and scalds||X00-X19|
|Drowning||V90, V92, W65-W74|
|Other unintentional injuries||V91, V93-V99, W20-W60, W64, W75-W99, X20-X39, X50-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 2011: methods and supplementary information. For information on how these were applied in HealthStats NSW please see the Methods paper on Population Attributable Fractions.
The 2018 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI) estimated that:
• 31.5% of adults (40.9% of men and 22.5% of women) consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol.
• 43.5% of Aboriginal adults consumed more than 2 standard alcoholic drinks on a day when they consumed alcohol
• 25.8% of adults (34.8% of men and 17.1% 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 86 NSW public hospital emergency departments for alcohol.
• The rate of ED presentations among persons aged 18-24 years (412.8 per 100,000 population) was around 1.6 times that of persons aged 15 years and over (259.3 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 (326.3. and 318.3 per 100,000 respectively).
• There were 10,126 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 86 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 49,356 hospitalisations were attributed to alcohol in NSW in 2017-18, which was approximately 1.7% 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 2.3 times higher than the rate in the non-Aboriginal population in 2016-17.
There was considerable variation in the rate of hospitalisations attributable to alcohol between Local Government Areas (LGAs), with 29 LGAs having a rate significantly higher than the state average and 35 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 1,759 deaths were attributed to alcohol in NSW in 2017, which was approximately 3.3% of all deaths in 2017.
The death rate attributable to alcohol has stabilised in recent years. The rates in males and females were 23.0 and 13.1 deaths per 100,000 population respectively in 2017.
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, 2014-15. 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