Local Health Districts (LHDs) are health administrative areas constituted under Section 17 of the NSW Health Services Act, 1997 which became effective from January 2011 and were initially called Local Health Networks.

There are 15 geographically-based LHDs (8 covering the Sydney metropolitan region and 7 rural and regional NSW) and two specialist networks focussing on Children's and Paediatric Services and Forensic Mental Health. A third network operates across the public health services provided by three Sydney facilities operated by St Vincent's Health: these include St Vincent's Hospital and the Sacred Heart Hospice at Darlinghurst and St Joseph’s at Auburn.

LHDs replaced the former Area Health Services. Each LHD has its own budget, management and accountabilities. Geographically-based LHDs are overseen by Governing Boards. Please refer to the NSW Health website for a list of Local Health Districts and the membership of Boards.

Local Health Districts are:

Metropolitan NSW: Central Coast, Illawarra Shoalhaven, Nepean Blue Mountains, Northern Sydney, South Eastern Sydney, South Western Sydney, Sydney, Western Sydney.

Rural & regional NSW:  Far West, Hunter New England, Mid North Coast, Murrumbidgee, Northern NSW, Southern NSW, Western NSW

Methods used to adjust estimates for rare conditions analysed by Local Health District in HealthStats NSW

The term ‘small area’ refers to a sub-state geographical area with a small population. Data analysed for small areas may result in estimates that display considerable variability from year to year, particularly for rare conditions or events. Smoothing is a general term for statistical methods used to reduce the random variability of data in small populations. Examples of smoothing include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. 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).

In HealthStats NSW, the most frequently used smoothing technique for data presented by Local Health District is the aggregation of several years of data together followed by the calculation of a rolling average across the aggregated years. For some indicators, data for particular Local Health Districts may be suppressed due to very low numbers and privacy concerns. Please refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.

Local Health District population estimates used in HealthStats NSW

In HealthStats NSW, the total population used for each Local Health District when calculating age-standardised rates are the Estimated Resident Populations produced by the Australian Bureau of Statistics (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 Local Health Districts (estimated population for 2017 and onwards) are based on Estimated Resident Populations produced by the ABS prior to the 2016 Census.

References

NSW Health. Local Health Districts and specialty networks. Available at https://www.health.nsw.gov.au/lhd/Pages/default.aspx

Death (or mortality) statistics

Death certification in Australia

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 http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/47E19CA15036B04BCA2577570014668B?opendocument.

Causes of death revision process

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 http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12015?OpenDocument .

Causes of death in NSW

The ABS publishes two publications every year: Deaths, Australia (Catalogue Number 3302.0) and Causes of death, Australia (Catalogue Number 3303.0) at the end of September, nine months after the end of the concerned year.

The Australian Coordinating Registry

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 a detailed analysis of deaths data (sixteen to seventeen months after the end of the concerned year).

Preliminary deaths data, Australian Coordinating Registry, 2006 - 2011

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.

Apparent differences between figures published by the ABS and the NSW Ministry of Health 

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% 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.

Different population projection data

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.

References

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

Potentially Avoidable Deaths (PAD) are based on National Healthcare Agreement: PI 16-Potentially avoidable deaths

Potentially avoidable deaths are those attributed to onditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care and which occur before age 75 years.