Smoking attributable hospitalisations by remoteness from service centres and year

Females, Total
420.2 (414, 426.5)Females, Very remote
988.6 (702.8, 1350.8)Females, Remote
897.3 (758.6, 1053.9)Females, Outer regional
541.5 (514.9, 569)Females, Inner regional
484.9 (470.4, 499.8)Females, Major cities
384.1 (377.1, 391.2)Males, Total
703.8 (695.5, 712.1)Males, Very remote
1241.7 (911.5, 1647.4)Males, Remote
1576.1 (1399.3, 1768.7)Males, Outer regional
897.8 (863.4, 933.2)Males, Inner regional
758.9 (740.5, 777.6)Males, Major cities
656.4 (646.8, 666.1)
 
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Notes

NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

Calculated using age and sex-specific aetiological fractions from the School of Population Health, University of Queensland and AIHW, 2007. Only NSW residents are included. Figures are based on where a person resides, not where they are treated. Hospital separations were classified using ICD-10-AM. Rates were age-adjusted using the Australian population as at 30 June 2001. Numbers for the two latest years include an estimate of the small number of hospitalisations of NSW residents in interstate public hospitals, data for which were unavailable at the time of production. LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate. Statistical Local Areas are grouped according to Australian Standard Geographical Classification (ASGC) remoteness categories on the basis of Accessibility/Remoteness Index for Australia (ARIA+ version) score.

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Methods: Deaths and hospitalisations attributable to health risks

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 developed by the School of Population Health, University of Queensland and the Australian Institute of Health and Welfare and published in The burden of disease and injury in Australia, 2003 report (BOD) (Begg et al. 2007).

The contribution of 14 health risks to the total burden of disease was assessed by the School of Population Health, using methods developed by the WHO Comparative Risk Assessment project (Ezzati et al. 2004). Earlier work by English and colleagues (English et al. 1995) was also used with reference to risks from the use of drugs and alcohol by the researchers from the School of Population Health. The main elements of the methodology are the prevalence of exposure to a health risk in a population and information on the risk of disease, injury or death from this exposure, which is derived from meta-analysis of published scientific literature. Calculations result in estimates of the proportions of cases of specific diseases and injuries that could be attributed to each risk factor.

For this report, electronic files of the aetiologic fractions developed by Begg and colleagues were obtained directly from the School of Population Health, University of Queensland by the Centre for Epidemiology and Evidence. The disease and injury groupings used in these files were defined using coding developed for The burden of disease study (BOD), but a mapping to ICD-10-AM codes was also provided.

There are two steps in applying the aetiologic fractions to a death or hospitalisation dataset:

(a) ill-defined categories (e.g. ICD-10-AM: heart failure, unspecified diabetes mellitus and injuries with unspecified intent) are redistributed into specific BOD categories based on other information in the record and/or on a pro rata basis;

(b) the aetiologic fractions are applied to categorised records.

 

References

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007.  http://www.aihw.gov.au/publication-detail/?id=6442467990

English DR, Holman CDJ, Milne MG. The quantification of drug caused morbidity and mortality in Australia. Canberra: Commonwealth Department of Human Services and Health, 1995.

Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds). Comparative quantification of health risks: Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization, 2004. Available at http://www.who.int/healthinfo/global_burden_disease/cra/en/

 


Methods: Accessibility/Remoteness Index of Australia Plus (ARIA+)

The Accessibility/Remoteness Index of Australia Plus (ARIA plus) is a remoteness index value (or score) based on road distance to major service centres (GISCA 2011). In 2001, the Australian Bureau of Statistics (ABS) applied ARIA  cut-off scores to define the Australian Standard Geographical Classification (ASGC) Remoteness Areas (ABS Census Paper No. 03/01 2003). 

The service centre categories are based on population size, with the smallest centres in ARIA having populations of 1,000-4,999. Localities with populations greater than 1000 persons are considered to contain at least some basic level of services (e.g. health, education, or retail) (GISCA, 2001). Service centres with larger populations are assumed to contain a greater level of service provision. ARIA scores are based on 11,879 such localities throughout Australia.

ARIA scores on a continuous scale range from 0 (high accessibility) to 15 (high remoteness), but have been grouped by the ABS into 5 distinct ASGC remotness categories: major cities, inner regional, outer regional, remote and very remote (AIHW, 2004). Census Collection Districts (CDs) are assigned ASGC remoteness categories based on the average ARIA score within the CD. Statistical Local Areas (SLAs) are then classified by the proportion of the population living in CDs in each ASGC remoteness category. In the report, remoteness areas are classified as Major cities; Inner regional or Outer regional areas (these two are referred to as regional when taken together); Remote and Very remote areas (remote when the last two are taken together). The term rural and remote is used when referring generally to areas outside Major Cities.

Remoteness Categories

The Australian Standard Geographical Classification (ASGC) classifies CDs into broad geographical regions called Remoteness Areas (RAs), based on their ARIA scores. The five ASGC Remoteness Areas are listed below. The sixth Remoteness Area defined by the ABS, Migratory Area, is not used in this report.  

• Major Cities of Australia: CDs with an average ARIA  score of 0 to 0.2

• Inner Regional Australia: CDs with an average ARIA score greater than 0.2 and less than or equal to 2.4

• Outer Regional Australia: CDs with an average ARIA score greater than 2.4 and less than or equal to 5.92

• Remote Australia: CDs with an average ARIA score greater than 5.92 and less than or equal to 10.53

• Very Remote Australia: CDs with an average ARIA score greater than 10.53

• Migratory: composed of off-shore, shipping and migratory CDs.

Australian Statistical Geography Standard (ASGS)

From July 2011 the ABS will progressively replace the current Australian Standard Geographical Classification (ASGC) with the new Australian Statistical Geography Standard (ASGS) as its geographical framework.

It is envisaged that ARIA will be recalculated after the 2011 Census and the results will be used to construct the 2011 Australian Statistical Geography Standard (ASGS) Remoteness Structure based on aggregations of Statistical Areas Level 1 (SA1s) instead of CDs. SA1s are the basic level of ASGS and the first level aggregate of the Mesh Blocks, a unit of the ASGS (ABS 1217.0.55.001 2011). The change to the new measurement will be introduced in this report after the ABS publishes the results.

Smoothing of estimates for small areas resulting from analysis by remoteness from service centres in this report

The term ‘small area’ refers to a small geographical area and a small population. Data from small areas are characterised by considerable variability. Smoothing is a general term for methods aimed at 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. Bayesian 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).

In this report, increasing the size of areas considered is used for estimates in analysis by remoteness from service centres. Very remote areas are often amalgamated with Remote areas and occasionally Very remote, Remote and Outer regional areas are amalgamated. Notes under the graphs confirm the extent of amalgamation. Extending the period of time in which cases are counted is also used in some indicators presenting health data by ARIA .

References

Australian Bureau of Statistics. Glossary of Statistical Geography Terminology. 1217.0.55.001. ABS, 2011. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/1217.0.55.001#PARALINK9

Australian Bureau of Statistics. ASGC Remoteness Classification: Purpose and Use . Census Paper No. 03/01. ABS, 2003. Available at http://www.abs.gov.au/websitedbs/D3110122.NSF/0/f9c96fb635cce780ca256d420005dc02

National Centre for Social Applications of Geographic Information Systems (GISCA). About ARIA (Accessibility/Remoteness Index of Australia). GISCA. Cited on 1 April, 2011). Available at http://gisca.adelaide.edu.au/projects/category/about_aria.html


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Codes: Aetiologic fractions

The disease and injury groupings used in the analysis of aetiologic fractions were defined using coding developed for the Burden of disease study (BOD) with a mapping to ICD-10-AM codes (Begg et al. 2007). These resources were provided by the School of Population Health, University of Queensland directly to the Centre for Epidemiology and Evidence.

Refer to the Methods tab for more information on aetiologic fractions methodology.

References

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. http://www.aihw.gov.au/publication-detail/?id=6442467990


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Smoking attributable deaths

Number and rate by sex, Local Health District, Medicare Local, Local Government Area, remoteness from service centres, socioeconomic status and year.
 
Key points: Smoking

Latest available information

Latest available data for adults in NSW:

• 16.4% of adults aged 16 years and over (20.5% of men and 12.4% of women) were current smokers, as estimated from the 2013 NSW Adult Population Health Survey (self reported using Computer Assisted Telephone Interviewing or CATI).

    • 15.5% of persons aged 15 years and over (17.9% of males and 13.2% of females) were current smokers, as estimated from the 2011-12 Australian Health Survey (Interviewer administered questionnaire).

    Latest available data for secondary school student in NSW:

• 7.5% of students aged 12-17 years (7.9% of boys and 7.1% of girls) were current smokers as estimated from the 2011 NSW School Students Health Behaviours Survey (self completed questionnaire).

Latest available data for adult Aboriginal persons in NSW

• 35.2% of Aboriginal adults aged 16 years and over were current smokers as estimated from the 2013 NSW Adult Population Health Survey (smoothed estimates, self reported using CATI).

 Overall trends in NSW

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.

Hospitalisations attributable to smoking

A total of 46,041 hospitalisations were attributed to smoking in NSW in 2012-13, which was approximately 1.6% of all hospitalisations.

The rate of hospitalisations attributable to smoking decreased in males by almost 24% but remained stable in females in NSW between 1998-99 and 2012-13. 

The rate hospitalisations attributable to smoking increased in both Aboriginal males and Aboriginal females in the period between 1998-99 and 2011-12. The rate of hospitalisation attributable to smoking increased in Aboriginal people by almost 40% in that period.

Deaths attributable to smoking

A total of 5,491 deaths were attributed to smoking in NSW in 2011, which was approximately 10.8% of all deaths in 2011.

The rate of death attributable to smoking has been declining in the decade up to 2011, the decline was much greater in males (about 25%) than in females (about 11%) but it ocurred from a much higher base in males. The rates in males and females were 91.1 and 42.8 deaths per 100,000 population respectively in 2011.

References

Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW Adult Population Health Survey (http://www.health.nsw.gov.au/publichealth/surveys/index.asp)

Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW. (available at: http://www.aihw.gov.au/publication-detail/?id=32212254712)

Australian Bureau of Statistics, National Health Survey: Summary of Results (4362.0); State Tables, 2007-2008 (available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0/)

Centre for Epidemiology and Evidence, NSW Ministry of Health. NSW School Students Health Behaviours Survey (available at: http://www.health.nsw.gov.au/publichealth/surveys/index.asp)

 


Introduction: Smoking

Smoking as a health risk factor

Tobacco smoking is the leading preventable cause of illness and premature death, particularly from cardiovascular disease; cancers of the lung, larynx, and mouth; and chronic obstructive pulmonary disease. It is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions . Smoking also contributes to the risk of sudden infant death syndrome (SIDS) and low birthweight (U.S. Department of Health and Human Services 2004). Tobacco smoking contributes more drug-related hospitalisations and deaths than alcohol and illicit drug use combined (AIHW Cat. no. AUS 122 2010) and is estimated to kill approximately half (Peto et al. 2004) to two-thirds (Doll et al. 2004 ) of all its long-term users.

The currently reviewed evidence on the mechanisms by which smoking causes disease indicates that there is no risk-free level of exposure to tobacco smoke, which causes adverse health outcomes, particularly cancer and cardiovascular and pulmonary diseases, through mechanisms that include DNA damage, inflammation, and oxidative stress (U.S. Department of Health and Human Services 2010).

Exposure to environmental tobacco smoke (ETS), particularly indoors, carries well documented health risks.

Burden of disease due to smoking and prevalence in Australia

Tobacco smoking was responsible for 7.8% of the total burden of disease in Australia in 2003 (Begg et al. 2007). In 2004-05, the total social costs of tobacco use in Australia were estimated to be $31.5 billion with tangible costs of $12.0 billion (Collins DJ et al. 2008).

In 2007, around 2.9 million Australians aged 14 years and over smoked daily. Males were more likely to be daily smokers (18.0%) than females (15.2%) (AHIW Cat No. PHE 98 2008).

References

Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376

Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: first results. Drug Statistics Series No 20. Cat No. PHE 98. Canberra: AHIW, 2008. Available at http://www.aihw.gov.au/publications/phe/ndshs07-fr/ndshs07-fr-no-questionnaire.pdf

Begg S, Vos T, Barker B. The burden of disease and injury in Australia, 2003. Cat. no. PHE 82 edition. Canberra: AIHW, 2007. http://www.aihw.gov.au/publication-detail/?id=6442467990

Collins DJ, Lapsley HM. The cost of tobacco, alcohol and illicit drug abuse to Australian society in 2004-05. National Drug Strategy Monograph Series no. 64. Canberra: Department of Health and Ageing, 2008. Available at http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono64

Doll R, Peto R, Boreham J and Sutherland I. "Mortality in relation to their smoking: 50 years' observations on male British doctors". British Medical Journal 2004. Vol328 1519-28.

Peto R, Lopez AD, Boreham J, Thun M, Heath JC. Mortality from smoking in developed countries 1950-2000. Oxford: Oxford University Press, 2004. Available at http://rum.ctsu.ox.ac.uk/~tobacco

U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta, GA: 2010. Available at http://www.surgeongeneral.gov/library/reports/tobaccosmoke/full_report.pdf

U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centres for Diseases Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm


Interventions: Smoking

Plain packaging

Australia has one of the most comprehensive tobacco control policies and programs in the world. The National Preventative Health Strategy recommended a range of actions aimed at reducing chronic disease burden associated with three lifestyle risk factors: obesity, tobacco and excessive alcohol consumption. The Strategy recommended ending all remaining forms of advertising and promotion of tobacco products, including eliminating promotion of tobacco products through the design of a package to reduce tobacco consumption and prevalence of smoking within Australian communities.  In April 2010, the Australian Government announced that it would introduce legislation to mandate plain packaging of tobacco products. The Tobacco Plain Packaging Act 2011 requires all tobacco products sold in Australia to be sold in plain packaging by 1 December 2012.

 NSW Tobacco Strategy 2012 – 2017

The NSW Tobacco Strategy 2012 - 2017, which was released in early 2012, sets out the actions that NSW Health will lead to reduce tobacco related harm in NSW.

The Strategy includes:

    •  A focus on addressing tobacco smoking in populations with high smoking rates, particularly Aboriginal communities, women smoking in pregnancy, mental health consumers and people in corrections facilities;

    •  Enhanced programs to help smokers quit; and  

    •  Measures to protect people from harmful second-hand smoke in outdoor areas.

Smoke-free Environment Act

The Smoke-free Environment Act 2000 protects the community from second-hand smoke by prohibiting smoking in all enclosed public places in NSW (with the exception of the private gaming areas in Star City Casino).

The Tobacco Legislation Amendment Act 2012 which was passed by the NSW Parliament on 15 August 2012, amends the Smoke-free Environment Act 2000 to make the following public outdoor places smoke-free areas from 7 January 2013:

    •  Within 10 metres of children’s play equipment;

    •  Swimming pool complexes;

    •  Spectator areas of sports grounds or other recreational areas while organised sporting events are being held;

    •  Railway platforms, light rail stations and ferry wharves;

    •  Bus stops, light rail stops and taxi ranks;

    •  Within 4 metres of a pedestrian access point to a public building; and

    •  from 6 July 2015 in commercial outdoor dining.

Public Health (Tobacco) Act

The Public Health (Tobacco) Act 2008 restricts the sale, advertising and display of tobacco products, non-tobacco smoking products and smoking accessories in NSW.  Key provisions of the Act include the introduction of a tobacco retailer notification scheme, restricting tobacco sales to a single point of sale in any retail outlet, a ban on smoking in cars with children present, the removal of tobacco products removed from shopper loyalty programs and the introduction of a total display ban for retailers (with the exception of approved specialist tobacconists).

The Quitline

The correct use of nicotine replacement therapies, such as gum, lozenge, patch, sublingual tablet or inhaler, doubles the chance of successfully quitting smoking (Stead et al. 2008). The Quitline (13 7848) provides expert smoking cessation advice and quitting smokers can enrol in the free callback service, where an advisor will provide ongoing support throughout the quit attempt. The Quitline is accessible for the cost of a local call throughout NSW. A fax referral system is in place for all health services in NSW to refer clients who want to quit smoking to the NSW Quitline.

NSW Health has published a guide to brief intervention for health professionals, titled 'Let's take a moment'. The document outlines clear and practical advice in the provision of smoking cessation interventions for health professionals, based on evidence for best practice (NSW Department of Health Let's take a moment 2005). This guide is currently in the process of being updated.

 

References

Fiore MC, Jaen CR, Baker TB et al. Treating tobacco use and dependence. 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/

Ministerial Council on Drug Strategy. National Tobacco Strategy 2004-2009. Canberra: Department of Health and Ageing, 2005. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm

NSW Department of Health . Let's take a moment. Quit smoking brief intervention - a guide for all health professionals. Sydney: NSW Department of Health, 2005. Available at http://www.health.nsw.gov.au/pubs/2005/lets_take_a_moment.pdf

Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Second edition. Cochrane Database of Systematic Reviews, 2008. Available at http://www.ncbi.nlm.nih.gov/pubmed/18253970

Tobacco Working Group. Australia: the healthiest country by 2020. Technical Report No 2. Tobacco control in Australia: making smoking history. Including addendum for October 2008 to June 2009. Canberra: National Preventative Health Taskforce, Commonwealth of Australia, 2009.

 


For more information: Smoking

Useful websites include:

Australian Bureau of Statistics at http://www.abs.gov.au

Australian Institute of Health and Welfare at http://www.aihw.gov.au

HealthInsite at http://www.healthinsite.gov.au