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 since the 1971 Census. The Socio-Economic Indexes for Areas (SEIFA) were first produced in 1990 and consisted of five indexes formed from the 1986 Census data (ABS).
There are four SEIFA indexes currently produced. 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, 2018). 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. From 2011, the proportion of Aboriginal people is no longer a constituent variable of IRSD (ABS, 2011).
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 2013). SEIFA 2016 broadly uses the same method that was used for SEIFA 2011, though there were updates to SA1 boundaries in many areas (ABS 2018).
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 (ABS 2018). 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 2016)
The Index of Economic Resources (IER) focuses on the financial aspects of relative socio-economic advantage and disadvantage, by summarising variables related to income and wealth. Education and occupation variables are excluded from this index because they are not direct measures of economic resources. Some relevant data on assets such as savings or equities are also not included because this information was not collected in the Census. There are 14 contributing variables. (ABS 2018)
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 10 variables contributing to the total score. (ABS 2018)
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.
The NSW population was divided into five groups based on the IRSD scores of their SA2 of residence. This means that SA2s 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.
Australian Bureau of Statistics. Socio-Economic Indexes for Areas (SEIFA) - Technical Paper, 2016. SEIFA Cat no 2033.0.55.001. Canberra: ABS, 2018.
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, 2016. Catalogue no 2033.0.55.001. Canberra: ABS, 2013. Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001~2016~Main%20Features~SOCIO-ECONOMIC%20INDEXES%20FOR%20AREAS%20(SEIFA)%202016~1
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
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