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)
Body Mass Index (BMI)= weight(kg)/height²(m).
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: High Body Mass Index (BMI) attributable conditions
|Condition||ICD10 (AM) codes|
|PARTIALLY ATTRIBUTABLE CONDITIONS|
|Diabetes||E10-E14 , O24|
|Coronary heart disease||I20-I25|
|Hypertensive heart disease||I11|
|Atrial fibrillation and flutter||I48|
|Inflammatory heart disease||I30-I33, I40-I41|
|Peripheral vascular disease||I70, I72-I74|
|Other cardiovascular diseases||G45, I00, I10, I13-I15, I26-I28, I44-I47, I49-I52, I70.9, I77-I84, I86-I89, I95-I99|
|Chronic kidney disease||E10-E14, I12, N02-N08, N11-N16, N18, N39, Q61|
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.
• 54.2% of adults aged 16 years and over (61.3% of men and 47.2% of women) were overweight or obese as estimated from the 2018 NSW Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 65.9% of persons aged 18 years and over (73.9% of males and 58.0% of females) in NSW were overweight or obese as estimated from the 2017-18 National Health Survey (interviewer-administered questionnaire and measured weight and height). This survey also showed that 59.7% of males and 63.8% of females were at either increased or substantially increased risk of health problems associated with overweight or obesity as measured by waist circumference.
• 20.6% of students aged 12-17 years (23.4% of boys and 17.7% of girls) were overweight or obese as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
• 24.5% of students in years K, 2, 4, 6 and 10 (22.9% of primary school students and 27.5% of secondary school students) were overweight or obese as estimated from the 2015 NSW Schools Physical Activity and Nutrition Survey (measured).
• 24.0% of children aged 5-16 years in NSW (26.5% of boys and 21.3% of girls) were overweight or obese as estimated from the 2018 NSW Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 25.6% of children aged 5-17 years in NSW (26.1% of boys and 26.2% of girls) were overweight or obese as estimated from the 2017-18 National Health Survey (measured).
• 72.7% of Aboriginal adults aged 16 years and over were overweight or obese compared with 53.8% of non-Aboriginal adults in NSW as estimated from the 2018 NSW Adult Population Health Survey (self-reported using CATI). The trend in rates of overweight and obesity are consistently higher for Aboriginal peoples. This appears to be driven by higher rates of obesity rather than overweight rates over time among Aboriginal compared with non-Aboriginal peoples.
Self-reported data on overweight and obesity have been collected for adults in NSW since 1997 through the NSW Population Health Survey and since 1977-78 through the Australian Health Surveys, National Health Surveys (from 1995). Measured data on overweight and obesity have been collected for adults in NSW through the National Nutrition Survey (1995) and the Australian and National Health Survey (2011-12 and 2007-08 respectively).
Self-reported data on overweight and obesity have been collected for students in NSW since 2005 through the NSW School Students Health Behaviours Survey and measured data on overweight and obesity have been collected for students in NSW since 1985 through the Australian Health and Fitness Survey and the Australian Health Survey and the NSW Schools Fitness and Physical Activity Survey (1997) and the NSW Schools Physical Activity and Nutrition Survey (SPANS) (2004, 2010 and 2015).
Parent-reported data on overweight and obesity have been collected for children in NSW since 2007 through the NSW Population Health Survey. Measured data on overweight and obesity have been collected for children in NSW since 2008 through the Australian Health 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 measured) have shown that rates have been stabilising in recent years.
A total of 66,869 hospitalisations were attributed to high body mass in NSW in 2017-18, which was approximately 2.2% of all hospitalisations. The rate of hospitalisation decreased by approximately 12.5% between 2010-11 and 2017-18.
A total of 3,758 deaths were estimated to be caused by high body mass in NSW in 2017, which was approximately 7.1% of all deaths. The rate of death attributed to high body mass decreased in the decade up to 2017.
Australian Bureau of Statistics. National Health Survey. Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0.55.001Main+Features100012017-18?OpenDocument
Centre for Epidemiology and Evidence. NSW Population Health Surveys. NSW Ministry of Health. Available at: http://www.health.nsw.gov.au/surveys/Pages/default.aspx
University of Sydney. NSW Schools Physical Activity and Nutrition Survey. Information available at: http://ses.library.usyd.edu.au/handle/2123/9091
There are health problems associated with being either underweight or overweight. Although underweight can be a serious risk to health (leading to malnutrition and other health problems such as osteoporosis), public health focus is on excess body weight, as this is a much greater problem in the Australian population.
Excess weight, especially obesity, is a risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic disorders.
Excess weight in children increases the risk of poor health, both during childhood and later in adulthood. Children who are overweight or obese are at greater risk of developing chronic conditions such as asthma and Type 2 diabetes and may experience negative social and mental wellbeing.
High and low body weight categories are determined using Body Mass Index (BMI). BMI is calculated by a person’s weight in kilograms divided by the square of their height in metres (kg/m2). A person considered overweight or obese has a BMI of at least 25 kg/m2. For more details on the BMI, see the Methods section.
For persons aged 18 years and over, the body weight categories are: underweight (BMI less than 18.5), healthy weight (BMI from 18.5 to 24.9), overweight (BMI from 25.0 to 29.9) and obese (BMI of 30.0 and over). Obesity was further classified into: Obesity Class I (BMI between 30.0 and 34.9), Obesity Class II (BMI between 35.0 and 39.9) and Obesity Class III (BMI of 40.0 or over).
For children and adolescents, while the same categories to describe body weight are used, the BMI range for each category varies by individual year of age of the child and is different for boys and girls. These category ranges comply with an international standard (Cole et al. 2000; Cole et al. 2007).
The NSW Healthy Eating and Active Living Strategy 2013-2018 provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease.
The Strategy has four key strategic directions:
• environments to support healthy eating and active living
• state-wide healthy eating and active living support programs
• healthy eating and active living advice as part of routine service delivery
• education and information to enable informed, healthy choices.
8700 Find Your Ideal Figure. Available at http://www.8700.com.au/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
Cole T, Bellizzi M, Flegal K, Dietz W. Establishing a standard definition for child overweight and obesity worldwide: International survey. British Medical Journal 2000; 320. Available at http://www.bmj.com/content/320/7244/1240 (accessed 12 January 2016).
Cole Y, Flegal K, Nicholls D, Jackson A. Body mass index cut offs to define thinness in children and adolescents: International survey. British Medical Journal 2007; 335(7612): 194. Available at http://www.bmj.com/content/335/7612/194 (accessed 12 January 2016).
Get Healthy Information and Coaching Service. Available at http://www.gethealthynsw.com.au/
Healthdirect at http://www.healthdirect.gov.au
Healthy Eating Active Living. Available at http://www.health.nsw.gov.au/heal/pages/default.aspx
Healthy Kids, a collaboration between the NSW Ministry of Health, Department of Eduction and Training and the Heart Foundation. Available at http://www.healthykids.nsw.gov.au/default.aspx
Make Healthy Normal. Available at https://www.makehealthynormal.nsw.gov.au/
National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council, 2013. Available at https://www.nhmrc.gov.au/guidelines-publications/n57
The Strategy has four key strategic directions:
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
National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council, 2013. Available at: https://www.nhmrc.gov.au/guidelines-publications/n57
NSW Department of Education and Training and NSW Ministry of Health. Live Life Well @ School. NSW Department of Education and Training & NSW Ministry of Health website. Available at: http://www.healthykids.nsw.gov.au/teachers-childcare/live-life-well-@-school.aspx/index.htm
NSW Government. Good for kids. Good for life. Available at: http://www.goodforkids.nsw.gov.au/parents-carers
NSW Government: NSW Ministry of Health, NSW Department of Education and Training, Sport and Recreation, a division of Communities NSW and the Heart Foundation. Munch and Move. NSW Government website. Available at: http://www.healthykids.nsw.gov.au/campaigns-programs/about-munch-move.aspx
NSW Ministry of Health. Healthy Eating Active Living. Available at: http://www.health.nsw.gov.au/heal/pages/default.aspx.