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for the most 2 recent years are preliminary (SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health) Unpublished tables from Australian Burden of Disease Study, 2015.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.
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
Tobacco smoking is the single most preventable cause of ill health and death in Australia, contributing to more drug-related hospitalisations and deaths than alcohol and illicit drug use combined. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions.
The data presented here were derived by applying aetiologic fractions (the probability that a particular case of illness or death was caused by smoking) to death and hospital morbidity data for NSW.
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.
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: Tobacco smoking attributable conditions
|PARTIALLY ATTRIBUTABLE CONDITIONS|
|Lip and oral cavity cancer||C00-C08|
|Acute lymphoblastic leukaemia||C91.0|
|Chronic lymphocytic leukaemia||C91.1|
|Chronic myeloid leukaemia||C92.1|
|Acute myeloid leukaemia||C92.0 C92.3-C92.8 C93.0 C94.0 C94.2-C94.5|
|Other leukaemias||C91.2-C91.9 C92.2 C92.7 C92.9 C93.1-C93.3 C93.7 C93.9 C94.1 C94.3 C94.6-C94.7 C95|
|Type 2 diabetes||E11 O24.1|
|Eye and ear diseases|
|Age-related macular degeneration||H35.3|
|Otitis media||H65-H66 H68 H70|
|Hypertensive heart disease||I11|
|Coronary heart disease||I20-I25|
|Atrial fibrillation and flutter||I48|
|Peripheral vascular disease||I70 I72-I74|
|Other cardiovascular diseases||G45 I26-I28 I44-I45 I47 I49 I51-I52 I77-I84 I86-I89 I95 I97-I99|
|Lower Respiratory Infections||J12 J14-J18 J20-J22 J85-J86|
|Other respiratory disease
||J47 J66-J68 J70 J80-J82 J90-J95 J98-J99
|Digestive system diseases|
|Gastroduodenal disorders||K22.1 K25-K27 K29|
|Gallbladder and bile duct disease||K80-K83|
|Muscle and connective tissue diseases|
|Rheumatoid arthritis||M05-M06 M08|
|Back pain and problems||M40-M41 M45-M51 M53-M54 M99|
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.
Data from the NSW Population Health Survey is used to measure the NSW State Government targets on reducing smoking in the population and is comparable with other sources of information on smoking in NSW.
• 11.2% of adults aged 16 years and over (12.1% of men and 10.2% of women) smoked daily in NSW in 2019 and 15.5% (18.0% of men and 13.1% of women) were current (daily or occasional) smokers. Estimates were produced from the NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI).
• 13.9% of NSW adults aged 18 years and over (17.0% of males and 10.9% of females) were daily smokers, as estimated from the 2017-18 National Health Survey (interviewer-administered questionnaire).
• 8.8% of mothers smoked during pregnancy in 2019, as reported to the NSW Perinatal Data Collection.
• 6.4% of students aged 12-17 years (7.0% of boys and 5.7% of girls) were current smokers, as estimated from the 2017 NSW School Students Health Behaviours Survey (self-completed questionnaire).
• 26.4% of Aboriginal adults aged 16 years and over smoked daily in NSW in 2018-2019 and 31.5% were current (daily or occasional) smokers. Estimates were produced from the NSW Adult Population Health Survey (self-reported using CATI).
• 43.2% of Aboriginal mothers smoked during pregnancy in 2019, as reported to the NSW Perinatal Data Collection.
Self-reported data on current smoking have been collected for adults in NSW since 1997 through the NSW Population Health Survey, since 1977-78 through the National Health Survey (from 1995), since 1985 through the National Drug Strategy Household Survey, and since 2011 through the Australian Health Survey.
Self-reported data on current smoking have been collected for students in NSW since 1984 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, self-completed questionnaires, face-to-face personal interview and drop-and-collect), have all been decreasing over time.
A total of 62,930 hospitalisations were attributed to smoking in NSW in 2018-19, which was approximately 2.0% of all hospitalisations.
The rate of hospitalisations attributable to smoking decreased in males by nearly 36%, compared to a 15% decrease among females in NSW between 2001-02 and 2018-19. Rates have stabilised in recent years.
The rate of hospitalisations attributable to smoking increased in both Aboriginal males and Aboriginal females by 32% aand 24% respectively in the period between 2009-10 and 2018-19.
A total of 6,702 deaths were attributed to smoking in NSW in 2018, which was 12.5% of all deaths in 2018. In 2018, the rate of deaths attributable to smoking in males and females was 84.2 and 50.3 deaths per 100,000 population, respectively.
Australian Institute of Health and Welfare. National Drug Strategy Household Survey report. Available at: https://www.aihw.gov.au/about-our-data/our-data-collections/national-drug-strategy-household-survey
Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~New%20South%20Wales~10002
Tobacco smoking is one of the biggest causes of premature death and is a leading preventable cause of chronic disease in New South Wales. It is a major risk factor for cardiovascular disease, a range of cancers, chronic obstructive pulmonary disease, coronary heart disease and a variety of other diseases and conditions. Approximately one in five of all cancer deaths are due to tobacco smoking.
There is a no safe level of exposure to second-hand tobacco smoke. In adults, breathing second-hand smoke can increase the risk of heart disease, lung cancer and other lung diseases. It can worsen the effects of existing illnesses such as asthma and bronchitis. For children, inhaling second-hand smoke is even more dangerous. Children are more likely to suffer health problems due to second-hand smoke such as bronchitis, pneumonia and asthma.
Australia has one of the most comprehensive tobacco control policies and programs in the world. The aim of the tobacco control programs in NSW is to contribute to a continuing reduction of smoking prevalence rates in the community.
Information on NSW Health tobacco and smoking control programs and policies is available at: http://www.health.nsw.gov.au/tobacco.
Cancer Institute at: https://www.cancerinstitute.org.au/
I Can Quit at http://www.icanquit.com.au
Information on NSW Health programs and policies is available at http://www.health.nsw.gov.au/tobacco.
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
I Can Quit at http://www.icanquit.com.au