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Methods: Local Health Districts
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 and have their own budgets, 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
Smoothing of estimates for rare conditions analysed by Local Health District in this report
The term ‘small area’ refers to a small geographical area and a small population. Data from a small area are characterised by considerable variability. Smoothing is a general term for statistical methods used to reduce the random variability of data. Examples include rounding, moving averages, extending the period of time in which cases are counted or increasing the size of the areas. In addition, 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, extending the period of time, in which cases in the Local Health Districts are counted, was the most frequently used smoothing technique. Results for some Local Health Districts were completely suppressed in few indicators due to very low numbers and privacy concerns. Refer to Notes under the graphs or Methods tabs for confirmation of suppression and the smoothing technique used.
NSW Health. Home page. Last updated 1 July 2011. Available at http://www.health.nsw.gov.au/services/pages/default.aspx
Methods: Respiratory diseases
Inclusion of lung cancer with respiratory diseases
Lung cancer is excluded from some analyses of respiratory diseases (collectively) in this report, as it is classified with cancers, not with respiratory diseases, in the International Statistical Classification of Diseases and Related Health Problems (ICD-9-CM, ICD-10-AM), which is the coding system used for health data in NSW.
Lung cancer is included with respiratory diseases in selected analyses in this report. It is appropriate, from a clinical and health services planning perspective, to include lung cancer together with other respiratory diseases when considering the burden of respiratory disease. When lung cancer is included in the analysis it is always made explicit.
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Codes: Selected respiratory diseases
The International Statistical Classification of Diseases and Related Health Problems
National Centre for Classification in Health, Australia; CM - Clinical Modification; AM - Australian Modification
Key points: Respiratory disease
• In 2012 in NSW, around 9% of adult males and 13% of adult females had asthma, and in 2009 and 2010, around 15% of boys and 11.5% of girls aged 2-15 years had asthma. Asthma was responsible for 118 deaths in NSW in 2011 and around 12,750 hospitalisations in NSW in 2012-13.
• Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, was responsible for over 1,700 deaths in 2007 in NSW and almost 20,000 hospitalisations in 2010-11.
• In 2007, 75% of all deaths from chronic obstructive pulmonary disease in NSW and 91% of all lung cancer deaths were attributable to smoking. In 2009-10, smoking caused around 80% of all hospitalisations for chronic obstructive pulmonary disease and lung cancer.
• Asbestosis is a chronic lung disease that is associated with occupational exposure to asbestos. Total hospitalisations due to asbestos in NSW have decreased in the past five years.
• Death rates from respiratory tuberculosis have remained low and stable since 1994 in NSW.
• The rate of new cases of malignant mesothelioma (a cancer that is associated with past exposure to asbestos) more than doubled in NSW between 1986 and 2003. It has been slowly decreasing since then.
Introduction: Respiratory disease
Respiratory diseases include acute diseases, such as influenza and pneumonia, and chronic respiratory diseases (specifically asthma, chronic obstructive pulmonary disease, asbestosis, and respiratory tuberculosis), where preventive measures and better management of conditions can reduce the burden of disease and reduce associated healthcare costs. Respiratory diseases, including lung cancer, were together responsible for around 14% of all deaths in NSW in the period 2003 to 2007, and about 5% of hospital separations in 2008-09.
Chronic respiratory diseases were responsible for 7.1% of total burden of disease and injury in Australia in 2003, with chronic obstructive pulmonary disease and asthma accounting for 46% and 34% of this burden, respectively (Begg et al. 2007).
Influenza and pneumonia
Influenza and pneumonia are acute respiratory diseases that can be very severe and, in persons at high risk, can lead to death. Influenza and pneumonia cause around 1.8% of all deaths and around 0.9% of hospital separations and are an important cause of hospitalisations in the very young, and of death and hospitalisations among older age groups.
Asthma is a significant public health problem in Australia and it is estimated that Australian prevalence rates are among the highest in the world. Fortunately, recent studies in children show no further increase in prevalence. The overall prevalence of asthma reported in Australia was 9.9%, down from 11.6% in the 2001 ((ABS Cat. no. 4364.0 2009). Among children asthma is the most prevalent long term condition in Australia. In Australia in 2003, asthma was estimated to account for 2.3% of the disease burden (Begg et al. 2007).
Chronic obstructive pulmonary disease
Chronic bronchitis and emphysema are the two main conditions comprising chronic obstructive pulmonary disease (COPD). In Australia in 2003, COPD was estimated to account for 2.9% of the disease burden.
Tuberculosis (TB) is caused by the bacterial organism Mycobacterium tuberculosis. Despite the increasing burden from respiratory tuberculosis globally, it is not a major public health problem in NSW. In fact the mortality and morbidity from all types of tuberculosis in NSW is one of the lowest in the world.
Lung cancer is excluded from analyses of respiratory diseases, as it is classified with cancers, and not with respiratory diseases, in the International Classification of Diseases (the coding system used for health data in NSW). However, some indicators analysing respiratory diseases explicitly include lung cancer to provide a more appropriate measure of the burden of respiratory disease from a clinical and health services planning perspective.
Cigarette smoking is the main risk factor for both COPD and lung cancer and the current incidence rates of these conditions reflect smoking rates 20 years and more in the past. Lung cancer is one of the leading causes of death in Australia.
Australian Bureau of Statistics. National Health Survey: Summary of Results, 2007-2008 (Reissue). Cat. no. 4364.0. Canberra: ABS, 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0/
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
Interventions: Respiratory diseases
Potentially preventable hospitalisations for chronic conditions
The most common chronic conditions defined as potentially preventable hospitalisations or ambulatory care sensitive hospitalisations are included in the NSW Chronic Disease Management Program (MoH, 2014).
In response to the Garling Report 2008, the NSW Department of Health implemented the NSW Severe Chronic Disease Management Program. The continuation of this program, the Chronic Disease Management Program, is being overseen by the NSW Ministry of Health and NSW Agency for Clinical Innovation. The program provides care coordination and self-management support to help people with chronic disease to better manage their condition and access appropriate services in order to improve health outcomes, prevent complications and reduce the need for hospitalisation.
The Chronic Diseases Management Program targets five major chronic diseases of interest that are recognised as having a major impact on the burden of disease in NSW. Furthermore, these conditions have been demonstrated to have improved outcomes through CDM approaches. The diseases of interest are Chronic Obstructive Pulmonary Disease (mainly emphysema and chronic bronchitis); Coronary Heart Disease (also known as coronary or ischaemic heart disease); Diabetes; Hypertension (high blood pressure); and Congestive Heart Failure.
People who are diagnosed with these diseases and who are experiencing repeated episodes in hospitalisation are offered enrolment to the program. People with these conditions, who are not being admitted to hospital frequently but experience difficulties in managing their conditions, are also eligible for enrolment. The focus is on prevention of deterioration, recognising that people suffering from these diseases often have comorbidities such as depression, arthritis and dementia.
Written asthma management plans are recommended as part of the national guidelines for the management of asthma: Asthma handbook (NACA 2014). They enable people with asthma to recognise a deterioration in their condition and initiate appropriate treatment, thereby reducing the severity of acute episodes.
The Asthma handbook promotes preventive care activities, proper inhaler technique and adherence and stepped medical management where the use of medicines can be increased or decreased depending on circumstances and the therapy combinations.
The NSW Tuberculosis Program is successful as the incidence of tuberculosis in NSW remained stable over the last decade despite large-scale migration from high-prevalence countries and the treatment success rates have been high, with the absence of treatment failures and low rates of relapse of cases initially treated in Australia.
The main challenges to the NSW Tuberculosis Program are similar to those that face tuberculosis control globally. They include control of multi-drug resistant and extreme drug-resistant tuberculosis and identification and management of tuberculosis-HIV coinfection (O'Connor et al. 2009).
Influenza and Pneumonia
Influenza and pneumococcal disease are covered by the National Immunisation Programs in NSW.
Influenza has been a notifiable disease by all laboratories under the Public Health Act in NSW since 2001. Surveillance is enhanced in winter months when the NSW Department of Health collects and reports weekly on influenza-like illness presentations to Emergency Departments , through the Public Health Real-time Emergency Department Surveillance System (PHREDSS), and laboratory confirmed diagnoses of influenza virus infections.
Emergency Departments in NSW are prepared for influenza epidemics with peak visit plans and similar measures in winter months.
NSW Ministry of Health. Chronic Disease Management Program. Sydney: NSW Ministry of Health, 2014. http://www.health.nsw.gov.au/cdm/pages/default.aspx
National Asthma Council Australia. Asthma handbook. NACA, 2014 http://www.nationalasthma.org.au/news-media/d/2014-03-04/new-national-asthma-management-guidelines-released
O'Connor B, Fritsche L, Christensen A, McAnulty J. EpiReview: Tuberculosis in New South Wales, 2003-2007. 2009. Available at www.publish.csiro.au/index.cfm?act=view_file&file_id=NB09001.pdf
For more information: Respiratory diseases
Useful websites include:
Australian Centre for Asthma Monitoring at http://www.asthmamonitoring.org
National Asthma Council Australia at http://www.nationalasthma.org.au
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