Potentially avoidable deaths with projections

• In 2007, more than one-third of premature deaths were classified as potentially avoidable. The potentially avoidable death rate has more than halved in the last 20 years.

• Aboriginal people die from premature and potentially avoidable deaths at the rate around 2.5 higher than non-Aboriginal people.

• Potentially avoidable death rates increase with increasing geographic remoteness.

• The difference in rates of potentially avoidable death between the highest and lowest socioeconomic status groups narrowed over the 20-year period. However, the relative decline was faster in the highest socioeconomic status group and the ‘gap’ between the least disadvantaged and the most disadvantaged and the rest of the population significantly increased.

Definitions

Potentially avoidable deaths refer to premature deaths (persons aged under 75 years) that, theoretically, could have been avoided given current understanding of causation, and available disease prevention and health care ((Tobias et al. 2001 ),(Page et al. 2006)(ABS 1370.0 2010)).

Potentially avoidable deaths can be further differentiated into conditions where death can be averted by prevention ('preventable') or by treatment ('amenable'). A previously used approach of classifying avoidable causes according to the level of intervention: primary, secondary and tertiary was discontinued in 2006 as it was considered to be too reliant on expert judgement (Page et al. 2006).

Amenable conditions are defined as those from which it is reasonable to expect death to be averted even after the condition has developed, for example, through early detection and effective treatment (such as for breast cancer).

Preventable conditions include those for which there are effective means of preventing the condition from occurring, for example, where the aetiology is to a considerable extent related to lifestyle factors (such as smoking) (Page et al. 2006).

Conditions within scope are either considered to be fully amenable to healthcare interventions or fully preventable, with the exception of diabetes, ischaemic (or coronary) heart disease and cerebrovascular disease (or strokes), which are divided 50%/50% between the two categories. While these weightings do not reflect the true level of the impact of interventions related to healthcare interventions and prevention programs on individual conditions, they do provide a simple and stable means of making comparisons between groups and over time.

See Codes tab for a list of causes of avoidable deaths and their codes.

Potentially avoidable deaths in NSW

The rate of potentially avoidable death was 153.7 per 100,000 population in NSW in 2007. There were 10,457 potentially avoidable deaths, which was 23.4% of all deaths and 66% of all premature deaths in NSW in 2007.

The overall potentially avoidable death rate decreased by 53% between 1998 and 2007. The death rate from preventable causes decreased by 52% and from causes amenable to health care by 56% in this period.

Specific causes of potentially avoidable deaths in NSW

In NSW in 2006 and 2007, malignant neoplasms (cancers) were the leading cause of potentially avoidable death. They were responsible for 37.5% of all potentially avoidable deaths in NSW residents (32.6% of male and 45.8% of female deaths). Cardiovascular disease, including ischaemic heart disease and stroke, was second (27.7%) and injury and poisoning third (13.6%).

The three leading causes of potentially avoidable death: malignant neoplasms (cancers), cardiovascular disease and injury and poisoning are the same and their rank is the same in males and females, but the proportional distribution of the leading causes of potentially avoidable death is very different between the sexes, with death rates in males for these causes being closer together. This distribution of potentialy avoidable causes of death reflects a long time trend of changing causes of death in males with decreasing death rates from cardiovascular causes, extending life expectancy and the resulting increased probability of death from cancer. Despite a considerable reduction of over 25% in injury death rates in males in the decade to 2007, the injuries are still more than twice as frequent a cause of death in males than in females. Injuries are by far the leading cause of death in males aged 5-44 years accounting for almost three quarters of all causes of death in males aged 15-24 years.

References

Australian Bureau of Statistics. Measures of Australia's progress, 2010: Potentially avoidable deaths. 1370.0. Web page. Canberra: ABS, 2010. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1370.02006%20(Reissue)?OpenDocument (Cited on 4 November 2010).

Page A, Tobias M, Glover J, Wright C, Hetzel D, Fisher E. Australian and New Zealand atlas of avoidable mortality. Adelaide: PHIDU, University of Adelaide, 2006. Available at http://www.publichealth.gov.au/publications/australian-and-new-zealand-atlas-of-avoidable-mortality.html

Tobias M and Jackson G. "Avoidable mortality in New Zealand, 1981-1997". Australian and New Zealand Journal of Public Health 2001. Vol25 (1): 12-20.

Interventions aimed at reducing potentially avoidable deaths in NSW are embedded in strategies dealing with specific health issues or specific disadvantaged populations. Variation in potentially avoidable death rates among health regions reflect the distribution of the underlying social and economic determinants of health which are associated with the geographic clustering of populations of lower socioeconomic status, high Aboriginal populations and populations with a high prevalence of disease risk factors. Other factors such as access to primary health care and other health services, particularly specialist treatment services may also contribute to this variation.

Health services are increasingly able to manage chronic diseases and prolong life and more conditions are regarded as amenable to health care. Because this trend should continue, the rate of potentially avoidable deaths is likely to continue to decrease in the short- to medium- term. Reductions in the longer term, however, depend upon sustainable declines in the risk factors which cause the greatest number of potentially avoidable deaths. Ongoing prevention programs are required to reduce the prevalence of these risk factors in the population, including smoking, obesity, inadequate physical activity and poor nutrition.  

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

Public Health Information Development Unit at the University of Adelaide at http://www.publichealth.gov.au

• The age standardised death rate in NSW has more than halved in the last 35 years. The male death rate was 48% higher than the female rate in 2007.

Definition

Death or mortality statistics are published at regular intervals in most countries and usually show numbers and rates of deaths by sex, age and other variables. A death rate is an estimate of the proportion of the population that dies during a specified period. (Last 2001). In this report it is expressed as the number of deaths per 100,000 population (person-years).

The proportion of older people varies between geographic areas and over time and can therefore influence death rate comparisons within these dimensions. Age-adjustment (also known as age-standardisation) allows for the comparison of death rates across geographic areas and over time after removing the effects of the different age structures in these dimensions.

Refer to the Methods tab for more information.

Death rates in NSW and in Australia

In NSW in 2007, the age-adjusted death rate was 589.1 deaths per 100,000 population. There were 46,341 deaths in NSW in 2007 - 23,615 men and 22,726 women died that year.

The ABS reported death rate for NSW for 2009 was 5.7 deaths per 1000 people, the same as in the whole of Australia, which was the lowest on record.  The rates in NSW in 2007 and 2008 were 5.9 and 6.0 respectively as reported by the ABS (ABS 3302.0 2010). The ABS reports deaths by the year of registration and this report uses the year of occurrence as the basis of reporting. Refer to the Methods tab for more information.

Death rates internationally

Death rates from all causes are low in Australia and NSW by international standards.  The WHO classifies Australia into an ‘A stratum’, with very low child and adult mortality (WHO 2003). Comparisons by country reveal that the probability of dying between 15 and 60 years per 1000 population (WHO calculated adult mortality rate) spans from low 50s to 600-700 in some African counties. Australia’s rate was 61 per 1000 in 2008 which placed it in the top five best results in the world (WHO 2010).

Causes of death in NSW by sex and age in 2007

The leading causes of all deaths in NSW (after averaging results from the last two years) were cardiovascular diseases followed by malignant neoplasms (or cancers), contributing around one third of all deaths each. Respiratory diseases and injury and poisonings were a distant third and fourth cause of all death, below 10% of all deaths each.

The results of analysis by sex and age reveal striking differences between males and females and different ages. One of the main differences is that injury and poisoning is of much greater importance as a cause of death in younger ages in both sexes, but especially in males. It constitutes over 70% of all deaths in males aged 15-24 years and over 50% in females of the same age.

References

Australian Bureau of Statistics. Deaths, Australia 2009. 3302.0. Canberra: ABS, 2010. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3302.02009?OpenDocument

Last JM (eds). A dictionary of epidemiology. Fourth edition. New York: Oxford University Press. Inc, 2001.

World Health Organisation. World health statistics 2010. Geneva: WHO, 2010. Available at http://www.who.int/whosis/whostat/en/index.html

World Health Organization. The world health report 2003 - shaping the future. Geneva: WHO, 2003. Available at http://www.who.int/whr/2003/en/

Interventions aiming to reduce deaths rates in NSW are embedded in strategies dealing with specific health issues or specific disadvantaged populations.

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