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.
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.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.
The state rate used in the Local Government Area trend view differs from the state rate as it doesn't include cases who can not be assigned to a LGA.
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 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 nineteen New South Wales councils announced on the 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/latestProducts/3218.0Media%20Release12017-18
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
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 Unit Record File (URF) is required to enable the Ministry to report on causes of death in NSW by sub-state geographies (eg 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.
In 2013, the Australian Coordinating Registry (ACR) based at the Queensland government Department of Justice and Attorney-General provided the Centre for Epidemiology and Evidence (CEE) at the NSW Ministry of Health with a URF of all deaths registered in NSW between 2006 and 2011 and which included the cause of death (COD). This file will be referred to as the ACR CODURF. The coding of the causes of death is still undertaken by the ABS but the process for obtaining the data is conducted by the ACR.
The CEE carried out linkage of the ACR CODURF with records from the NSW Registry of Births, Deaths and Marriages (RBDM) death registration file for 2006-2013. The linkage relates the cause of death information from the ACR records to the death registration records which contain addresses of those who died in NSW. This allowed death records to be geocoded so that geographic boundaries such as Local Health Districts, Medicare Locals and Local Government Areas could be added to them. Statistical weights were developed using an imputation process to estimate the number of missing records of NSW residents who died interstate, which were not available for 2007 onwards, and deaths which occurred in the latest year but were registered in the following year. Estimates for the numbers of deaths for 2007 onwards include counts of interstate and late death registrations based on these imputations.
Mortality: Tobacco smoking attributable conditions
|Condition||ICD10 (AM) codes|
|PARTIALLY ATTRIBUTABLE CONDITIONS|
|Mouth and pharyngeal cancer||C00-C14|
|Diabetes||E10-E14 , O24|
|Interstitial lung disease||J84|
|Other respiratory disease||J47, J66-J68, J70-J82, J90-J95, J88-J99, M05.19|
|Coronary heart disease||I20-I25|
|Hypertensive heart disease||I11|
|Atrial fibrillation and flutter||I48|
|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|
|Tuberculosis||A15-A19, B90, N33.0, N74, O98.0, P37.0|
|Otitis media||H65-H68, H70|
|Lower Respiratory Tract Infections||J12,J14-J22, J85-J86|
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.
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).
• 14.8% of persons aged 15 years and over (18.3% of males and 11.5% of females) in NSW were current smokers (defined as daily, at least once a week or less than weekly), as estimated from the 2017-18 National Health Survey (interviewer-administered questionnaire).
• 9.1% of mothers smoked during pregnancy in 2018, 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 2018, 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 60,249 hospitalisations were attributed to smoking in NSW in 2017-18, which was approximately 2.0% of all hospitalisations.
The rate of hospitalisations attributable to smoking decreased in males by nearly 23%, compared to a 10% decrease among females in NSW between 2001-02 and 2017-18. Rates have stabilised in recent years.
The rate of hospitalisations attributable to smoking increased in both Aboriginal males and Aboriginal females in the period between 2001-02 and 2011-12. In recent years, the rates have remained stable.
A total of 6,631 deaths were attributed to smoking in NSW in 2017, which was 12.6% of all deaths in 2017. In 2017, the rate of deaths attributable to smoking in males and females was 86.7 and 50.0 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. Australian Health Survey. Available at: http://www.abs.gov.au/australianhealthsurvey
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