HealthStats NSW

Smoking attributable hospitalisations

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)
  • + Source

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

  • + Notes

    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
  • + Codes
    • 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

  • + Related Indicators
     

    Smoking attributable deaths

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

    Quality of reporting of Aboriginality in hospital data

    Number and proportion of observed and expected admissions to hospital by Network, Local Health District of hospital, hospital and year.
     
  • + Associated Information
    • 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).

        • 10.4% of mothers smoked during pregnancy in 2012, as reported to the NSW Perinatal Data Collection.

        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).

      • 49.9% of Aboriginal mothers smoked during pregnancy in 2012, as reported to the NSW Perinatal Data Collection.

       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

      healthdirect at http://www.healthdirect.gov.au