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Murrumbidgee Local Health District
ABN 71 172 428 618
Locked Bag 10, Wagga Wagga NSW 2650
Tel 02 6933 9100 Fax 02 6933 9188
Website www.mlhd.health.nsw.gov.au
The Murrumbidgee Local Health District 2018
Summary Population and Health Profile
Population, Hospitalisation and Potentially Preventable Hospitalisations update, June 2018
Date: June 2018 revision
Author: Kim Gilchrist, Epidemiologist, Public Health Unit, MLHD [email protected]
Copies available: www.mlhd.health.nsw.gov.au/about/health-statistics/
Contents Contents ............................................................................................................. 2
Figures ............................................................................................................ 3
Tables .............................................................................................................. 3
The Murrumbidgee LHD ..................................................................................... 4
Facilities .............................................................................................................. 5
The population ................................................................................................... 6
The population now ....................................................................................... 6
The population in the future .......................................................................... 6
Summary from the Census ................................................................................. 8
Cultural and linguistic diversity ...................................................................... 8
Education ........................................................................................................ 8
The working population ................................................................................. 8
Socioeconomic disadvantage 2016 ................................................................ 8
Families ......................................................................................................... 11
Income support ............................................................................................ 11
Disability ....................................................................................................... 12
Burden of Disease ............................................................................................. 13
Mortality ....................................................................................................... 13
Life expectancy ......................................................................................... 13
Causes of death ........................................................................................ 14
Potentially avoidable deaths .................................................................... 14
Hospitalisations ............................................................................................ 15
Potentially Preventable Hospitalisations ................................................. 19
Health topics .................................................................................................... 22
Injury and poisoning .................................................................................... 22
Cardiovascular disease ................................................................................. 24
Blood pressure and cholesterol ............................................................... 27
Diabetes ....................................................................................................... 28
Respiratory disease ...................................................................................... 29
COPD ........................................................................................................ 29
Asthma ..................................................................................................... 29
Influenza and pneumonia ........................................................................ 30
Mental health (suicide and self-harm) ........................................................ 31
Cancer .......................................................................................................... 33
Breast cancer ........................................................................................... 34
Lung cancer .............................................................................................. 34
Bowel cancer ............................................................................................ 35
Skin Cancer ............................................................................................... 35
Prostate cancer ........................................................................................ 35
Cervical cancer ......................................................................................... 35
Risk Behaviours ............................................................................................ 37
Smoking.................................................................................................... 38
Alcohol ..................................................................................................... 39
Physical activity ........................................................................................ 40
Fruit and vegetable consumption ............................................................ 41
Obesity/ high BMI related illness ............................................................. 42
Food insecurity ......................................................................................... 43
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 3/49
Pregnancy and the newborn ........................................................................ 44
Antenatal care .......................................................................................... 44
Low birth weight ....................................................................................... 44
Smoking during pregnancy ....................................................................... 44
Summing up ...................................................................................................... 45
For 2018 ............................................................................................................ 46
Data sources ..................................................................................................... 47
Supporting information .................................................................................... 47
Infographics ...................................................................................................... 47
Figures Figure 1 – NSW Local Health Districts ............................................................................. 4 Figure 2 - MLHD Facility locations and Local Government Areas ................................... 5 Figure 3 – MLHD population projections (no Albury), NSW Department of Planning and Environment Projections 2016 ................................................................................ 7 Figure 4 - 2016 Australian Bureau of Statistics Census and PHIDU Social Health Atlas data. ................................................................................................................................ 9 Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local Government Area ......................................................................................................... 10 Figure 6 - Deaths by category of cause, MLHD, 2015 (HealthStats NSW 2018) ........... 14 Figure 7 - Hospitalisation all causes trend 2011-02 to 2016-17, MLHD (HealthStats NSW, 2018) ................................................................................................................... 15 Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018) ............ 16 Figure 9 - Potentially preventable Hospitalisations all conditions, MLHD and Total NSW, 2015-16 (HealthStats NSW, 2018) ...................................................................... 19 Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018) ....................... 20
Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW ...................................................................................................................................... 23 Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW 25 Figure 13 - Circulatory procedures, Murrumbidgee LHD 2001-02 to 2015-16 (Health Statistics NSW) .............................................................................................................. 27 Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW ...................................................................................................................................... 30 Figure 15 – Mental and behavioural disorders trend in deaths and hospitalisations, MLHD and NSW ............................................................................................................ 32 Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW .................. 34 Figure 17 - Trend in adult smoking prevalence, MLHD and NSW 2002 to 2017 ........... 38 Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 to 2017 .......................................................................................................................... 39 Figure 19- Trend in adult insufficient physical activity prevalence, MLHD and NSW 2002 to 2017 ................................................................................................................. 40 Figure 20 - Trend in adult adequate fruit and vegetable consumption prevalence, MLHD and NSW 2002 to 2017 ...................................................................................... 41 Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 to 2017 .............................................................................................................................. 42
Tables Table 1 - MLHD facilities by type and location ............................................................... 5 Table 2 - Income support recipients by type of benefit and eligible population, MLHD and NSW, June 2016 ..................................................................................................... 11 Table 3 - Hospitalisations by cause and sex, Murrumbidgee LHD and NSW, 2016-17 (Health Statistics NSW, 2018). ...................................................................................... 17 Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015-16 (Health Statistics NSW) ............................................................................................ 21 Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Statistics NSW, June 2018) ............................................................................................ 26
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 4/49
The Murrumbidgee LHD Murrumbidgee LHD is 123,233 sq/km in area and encompasses
21 Local Government Areas in the central south of NSW (Figure
1Figure 1 and Table 1) Berrigan, Bland, Carrathool, Coolamon,
Cootamundra, Deniliquin, Edward River, Federation, Greater
Hume, Griffith, Gundagai, Junee, Lake Cargelligo part of
Lachlan Shire, Leeton, Murray River, Murrumbidgee,
Narrandera, Snowy Valleys, Temora and Wagga Wagga and
also includes providing services to the Albury City population.
Most of the LHD is considered inner regional or outer regional
with only the north western LGA of Hay classified as remote.
Figure 1 – NSW Local Health Districts
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 5/49
Facilities The MLHD includes one Referral Base Hospital at Wagga Wagga and one Rural
Base Hospital at Griffith. There are currently fifteen District and Community
Hospitals and a further fourteen Multi Purpose Services (Table 1 and Figure
1).
Table 1 - MLHD facilities by type and location
Facility type Location
Major hospital (B) Wagga Wagga
District Hospital – group 1 (C1) Griffith
District Hospital – group 2 (C2) Deniliquin, Young
Community Hospitals with surgery (D1a)
Cootamundra, Corowa, Leeton, Narrandera, Temora, Tumut
Community Hospitals without surgery (D1b)
Finley, Hay, Holbrook, Harden, West Wyalong
Multi Purpose Services (F3) Barham, Batlow, Berrigan, Boorowa, Coolamon, Culcairn, Gundagai, Henty, Hillston, Jerilderie, Junee, Lake Cargelligo, Lockhart, Tocumwal, Tumbarumba, Urana
Affiliated Health Organisations (sub-acute F4)
Mercy Health Service Albury and Mercy Care Centre Young
Other Services
South West Brain Injury Rehabilitation Service, BreastScreen NSW and Public Health, Mental Health Accessline
Community Health Posts
Adelong, Ardlethan, Barellan, Barmedman, Coleambally, Darlington Point, Mathoura, Moama, Moulamein, Tarcutta, Tooleybuc, Ungarie, Weethalle
Figure 2 - MLHD Facility locations and Local Government Areas
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 6/49
The population
242,840
Estimated resident population (June 30, 2016) P
O P U L A T I O N
+ 1,922
Wagga Wagga LGA population increase (2012 to 2016)
+ 1,000 Annual growth In MLHD (2012 to 2016)
+ 5%
Junee and Carrathool LGAs % increase (2012 to 2016)
+ 1.8% Annual growth In MLHD (2012 to 2016)
- 2%
Narrandera LGA decrease (177 people) (2012 to 2016)
+ 1 % Projected growth (2011 to 2021)
+ 10,000
Projected increase in people aged 75+ years (2011 to 2026)
The population now The MLHD as of June 2016, had an estimated resident population (ERP) of
242,840 (Albury LGA of 52,165 is not included). The Murrumbidgee LHD has
grown by approximately one thousand people per year from 2012 to 2016 a
1.8 per cent increase over the five years. The largest population increase was
in Wagga Wagga with an extra 1,922 people since 2012, followed by Griffith
with an extra 784 (Albury LGA had an increase of 2,363 people). LGAs with the
largest percentage growth were: Junee (5.1% net increase of 315 people),
Carrathool (4.9% net increase of 132 people) and Murray River (4.4% net
increase of 496 people). The largest drop in population was experienced by
Narrandera (177 people), Snowy Valleys (109 people) and Federation (97
people). LGAs with the largest percentage decrease were, Narrandera (-1.9%
net decrease of 177 people), Hay (-1.8% net decrease of 53 people) and Lake
Cargelligo (-1.1% net decrease of 21 people).
The population in the future The population is projected to grow by just over 1 per cent from the ERP 2011
to 2021 to reach approximately 244,870 people then increase by 0.5% to
246,220 by 2026 with a projected decline from 2026 to 2031 (2016
Department of Planning and Environment New South Wales State and Local
Government Area Population Projections). This is slow to negative growth
compared to total NSW figures which increased by 6.8 per cent from 2011 to
2016 and are projected to increase by around 6 per cent for the next two five-
year forecast periods. The Albury LGA had a population of 49,451 in 2011 this
is projected to increase to 52,100 by 2016 (+5.1% increase from 2011) then to
56,550 by 2026.
While the overall MLHD population number is not projected to change
significantly, projections indicate growth in the older population (Figure 3).
People aged 75 years and over made up 8 per cent of the total population in
2011 (around 18,000 people), this is projected to increase to 12 per cent of
the total population in 2026 (around 29,000 people) an increase of more than
10,000 older people. The aged population in NSW was 7 per cent in 2011
increasing to 9 per cent in 2026. There were 3,547 people aged 75 years or
over in Albury in 2011 this is expected to increase to 4,000 in 2016 and to
5,800 in 2026.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 7/49
Figure 3 – MLHD population projections (no Albury), NSW Department of Planning and Environment Projections 2016
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 8/49
Summary from the Census
5.3% Non-English Speaking COB (21% NSW)
C E N S U S
4.8% Aboriginal people (2.9% NSW)
6.1%
Speak Language other than English at home (25.5% NSW)
< 1.5% Difficulty speaking English (4.5% NSW)
41% Post school qualifications 15+ years (50.4% NSW)
4.8% Unemployed (5.9% NSW)
66,000
Concession card holders (27% of the
population compared to 24% NSW)
13,019
People needing assistance with core activities (5.5% of the population compared to 5.4 % NSW)
A full report of Census statistics for Murrumbidgee LHD is available at:
www.mlhd.health.nsw.gov.au/about/health-
statistics/dem/MurrumbidgeeCensus2016profile_release2_Dec2017.pdf
Cultural and linguistic diversity The people of MLHD were mostly born in Australia (82.2%, 2016) or were from
English speaking overseas countries (3.2%, 2016). Only 5.3 per cent of the
MLHD population were born in a predominantly non-English speaking country
(NESB COB 2016) and 6.1 per cent stated speaking a language other than
English (LOTE) at home, compared to 21.0 per cent and 25.5 per cent in NSW
respectively. Just over one per cent of the MLHD population had difficulty
speaking English compared to 4.5 per cent in NSW. People of Aboriginal
background made up 4.8 per cent of the MLHD population compared to 2.9
per cent of all NSW. The majority of religious affiliations reported were
Christian-based (68% in MLHD and 55% in NSW, 2016).
Education Seventy-nine per cent of sixteen year olds in MLHD were full-time participants
in secondary school compared to eighty –four per cent in NSW (in 2016). Five
per cent of the MLHD population were enrolled in Tertiary education,
compared to seven per cent in NSW. The age standardised rate of people who
left school at Year 10 or who did not go to school in Murrumbidgee was 42 per
100 adults compared with 33 per 100 adults in NSW. Education to Year 12 (or
equivalent) was reported by 34 per cent of the adult population compared to
52 per cent of NSW. University education of Bachelor degree or higher were
reported by 11.4 per cent of the MLHD population compared to 23.4 per cent
in NSW. In 2016, 41 per cent of adults had attained some type of post school
qualification in MLHD compared to 50.4 per cent of NSW.
The working population In 2016 Census 4.8 per cent of the labour force of MLHD reported to be
unemployed compared to 5.9 per cent of the NSW labour force. In 2016
agriculture was the main industry employer followed by Health Care and
Social Assistance (11.8%), retail trades (9.7%) and manufacturing (9.3%). The
main occupations of employment in MLHD were Managers (17.8%) and
Professionals (14.6%). The NSW workforce had proportionally more people
classified as Professionals (23.6%) and Clerical workers (13.8%) than MLHD. In
2017 the unemployment rate for the September Quarter for MLHD LGAs
varied, with highest unemployment in Edward River (7.7%), Hilltops (6.9%)
and Narrandera (6.5%) and the lowest Lockhart (2.6%), information is not
available for Lake Cargelligo.
Socioeconomic disadvantage 2016 The Index of Relative Socio-economic Disadvantage (IRSD) is a general socio-
economic index that summarises a range of information about the economic
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 9/49
and social conditions of people and households within an area. Unlike the
other indexes, this index includes only measures of relative disadvantage. A
low score indicates relatively greater disadvantage in general. For example, an
area could have a low score if there are (among other things): - many
households with low income, many people with no qualifications, or many
people in low skill occupations. A high score indicates a relative lack of
disadvantage in general. For example, an area may have a high score if there
are (among other things):- few households with low incomes, few people with
no qualifications, and few people in low skilled occupations.
The SEIFA score of 1000 is the national mean, scores below 1000 show higher
disadvantage than the average and scores above 1000 show less
disadvantage. A score of 500 does not indicate twice as much disadvantage as
a score of 1000, a decile band of 1 indicates the top 10 per cent most
disadvantaged areas. Narrandera and Lachlan are the LGAs with the greatest
average disadvantage within MLHD (Figure 5). These LGAs are among the top
25 per cent of disadvantaged LGAs in Australia and rank 21st and 25th
respectively of the 129 LGAs in NSW. Averaging scores to LGA level may mask
pockets of disadvantage at the smaller SA1 level. Griffith and Wagga Wagga
have the widest range of scores indicating a broad social gradient of high levels
of disadvantage to relatively low levels
.
Figure 4 - 2016 Australian Bureau of Statistics Census and PHIDU Social Health Atlas data.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 10/49
Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local Government Area
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 11/49
Families There were approximately 94,500 occupied private dwellings in the MLHD in
2016, 60,451 family households (64% of households) and 24,378 lone person
households (26%). In MLHD 23,989 households (25.4% of all households) were
couple families with children, 26,206 (27.7%) couples with no children, and
9,427 (10.0%) one parent families. NSW had a similar proportion of one parent
families (10.7%) to MLHD and more couple families with children (31.5%),
most likely due to a younger age structure than MLHD. More families,
proportionally, reported incomes of less than $800 a week in MLHD compared
to NSW (20.0% and 16.8% respectively). The median household income in
NSW (2016) was $1780/week the approximate median for MLHD is
$1500/week with Gundagai, Berrigan and Hilltops LGAs having median family
incomes below $1000/week. Twenty per cent of families reported incomes of
over $4,000/week in NSW compared to 15% of families in MLHD. In 2011,
there were 6,523 children under 15 years in jobless families (or 14.6% of all
children under 15 years compared to 14.7% in NSW), this varied by LGA with
the highest percentage of children in jobless families in Hay (21.7%), Lake
Cargelligo (20.2%) and Narrandera (19.9%) and the lowest in Jerilderie (8.6%)
and Lockhart (10.1%) (PHIDU Social Health Atlas, Dec 2017).
Income support Murrumbidgee LHD had approximately 32,400 aged pensioners in June 2016,
71 per cent of the eligible population compared to 68 per cent in NSW. In June
2016 there were 14,000 Health Care Card holders in MLHD and 52,000
Pensioner Concession Card holders making a total of approximately 66,000
concession card holders or 27 per cent of the total population compared to 24
per cent in NSW. The percentage of concession card holders ranged from over
one third of the population in Federation (34.5%), Berrigan (34.1%) Gundagai
(33.9%) and Cootamundra (33.7%) to less than a quarter of the population in
Carrathool (21.6%), Griffith (23.5%) Junee (24.2%) and Wagga Wagga (24.4%)
(PHIDU Social Health Atlas, March 2018). Full income support details for the
MLHD population are in Table 2.
Table 2 - Income support recipients by type of benefit and eligible population, MLHD and NSW, June 2016
Income support benefits MLHD NSW
Age pensioners
Age pensioners 32410
Persons aged 65 years and over 45755
% age pensioners 70.8 67.6
Disability support pensioners
Disability support pensioners 9543
Persons aged 16 to 64 years 144530
% disability support pensioners 6.6 5.2
Female sole parent pensioners
Female sole parent pensioners 3271
Females aged 15 to 54 years 56976
% female sole parent pensioners 5.7 3.7
People receiving an unemployment benefit
People receiving an unemployment benefit 8219
Persons aged 16 to 64 years 144530
% people receiving an unemployment benefit 5.7 4.8
People receiving an unemployment benefit long-term
People receiving an unemployment benefit for longer than 6 months
6839
Persons aged 16 to 64 years 144530
% people receiving an unemployment benefit long-term 4.7 4.0
Young people aged 16 to 24 receiving an unemployment benefit
Young people (16 to 24 years) receiving an unemployment benefit
1132
Persons aged 16 to 24 years 27793
% young people receiving an unemployment benefit 4.1 3.0
Low income, welfare-dependent families (with children)
Low income, welfare-dependent families (with children) 6420
Total families 60540
% low income, welfare-dependent families (with children) 10.6 9.9
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 12/49
Income support benefits MLHD NSW
Children in low income, welfare-dependent families
Children in low income, welfare-dependent families 12570
Children under 16 years 51391
% children in low income, welfare-dependent families 24.5 22.3
Health Care Card holders
Health Care Card holders 14081
Persons 0 to 64 years 195921
% Health Care Card holders 7.2 6.4
Pensioner Concession Card holders
Pensioner Concession Card holders 52147
Persons aged 15 years and over 193705
% Pensioner Concession Card holders 26.9 21.9
Seniors Health Card holders
Seniors Health Card holders 3788
Persons aged 65 years and over 45755
% Seniors Health Card holders 8.3 8.3
Source: Compiled by PHIDU based on data from the Department of Human Services and Centrelink June
2016; and the ABS Estimated Resident Population, 30 June 2015 (accessed March 2018).
Disability On Census night August 2016, 13,019 people in MLHD reported needing
assistance with core activities, which made up 5.5 per cent of the population
compared to 5.4 per cent of NSW. For people aged 0 to 64 years
approximately 3.1 per cent reported needing help with core activities (5,874
people), this proportion increased for those aged 65 years and over to 15
percent (7154 people). In the 65 years and over group there were 4,470
people with a profound or severe disability living in the community and 5,176
people aged 0 to 64 years (MLHD 2011). There were 10,160 people aged 16
years or over in MLHD (June 2014) who were receiving a disability support
pension, making up 7.1 per cent of the eligible population, compared to 5.6
per cent in all NSW. Cootamundra (11.6%) and Urana (11.5%) had the highest
percentages of their eligible populations on disability pensions among MLHD
LGAs, and Conargo (2.5%) and Carrathool (4.2%) the lowest.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 13/49
Burden of Disease
79.5 years
Male Life expectancy at birth (NSW 80.9 yrs)
D I S E A S E
B U R D E N
127,143
Hospital admissions per year (significantly high rate compared to NSW)
83.9 years
Female Life expectancy at birth (NSW 85.0 yrs)
8,367
Potentially Preventable Hospital (PPH) admissions per year (close to 6.5% of all admissions)
2,409 Deaths per year In 2015 27,329
Hospital bed days a year for PPH (2015-16)
344
Potentially avoidable deaths per year (significantly higher rate in MLHD 129.0/100,000 compared to NSW 105.9/100,000)
10%
Of all hospital admissions in MLHD are for dialysis
Significantly higher death rate for all causes and potentially
avoidable causes
MLHD to
NSW
Significantly higher hospitalisation rate for all
causes and potentially preventable causes
Mortality
LIFE EXPECTANCY Life expectancy in NSW and MLHD continues to increase. In 2015 newborn
males could expect to live for 80.9 years in NSW and 79.5 years in MLHD, while
newborn females could expect to live for 85.0 years in NSW and 83.9 years in
MLHD. At age 65 years males could expect to live until age 85.0 years in NSW
and 84.5 years in MLHD and females until 87.6 in NSW and 87.4 years in MLHD.
Although females can still expect to live longer than males, the gap between
the sexes is narrowing. In NSW life expectancy increased by 10 years for
females since 1974, whereas there has been a 10 year increase for males since
1980.
Life expectancy at birth in 2015 by LGA differs by approximately four years
from the highest in Lockhart of 85.7 to the lowest in Narrandera of 81.2.
The median age at death for MLHD was 78 years for male; 84 years for females
(2010 to 2014), the same as for NSW (PHIDU 2018).
Aboriginal people have a much shorter life expectancy than non-Aboriginal
people. In 2010-12, life expectancy in NSW was estimated to be 70.5 years in
Aboriginal males and 74.6 years in Aboriginal females, almost 10 years lower
than in males and females in the general population (ABS 3302.0.55.003
2013).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 14/49
CAUSES OF DEATH The age-adjusted “all cause” death rate 2015 in MLHD was significantly higher
than expected based on NSW rates (603.1 per 100,000 population compared
to 546.0 per 100,000 in NSW). There were 2,409 deaths in MLHD 2015 and the
death rate has been decreasing steadily for both males and females since the
early 2000’s. The major causes of death for males and females are circulatory
diseases and cancers (Figure 6).
POTENTIALLY AVOIDABLE DEATHS Potentially avoidable deaths are those that occur before age 75 years and are
caused by conditions that are potentially preventable through individualised
care and/or treatable through existing primary or hospital care. Deaths are
defined as avoidable in the context of the present health system. MLHD in
2014-15 had an annual average of 344.0 avoidable deaths with an age-
adjusted rate significantly higher than NSW (MLHD: 129.0/100,000; NSW:
105.9/100,000). The avoidable death rate for males was significantly higher
than females in MLHD and significantly higher than the NSW rate for males.
Similar to NSW and other LHDs the avoidable death rates for males were
significantly higher than that of females. Given that in NSW approximately 35
per cent of all deaths occur before the age of 75 years from MLHD figures
approximately 840 deaths per year are for people aged less than 75 years
around 40 per cent of these are considered potentially avoidable. From a
significant drop in rates from 2001-2002 to 2004-05 the overall MLHD rate has
remained around 130 to 135 per 100,000. The male rate of avoidable deaths
is around double that of the female rate in MLHD and the gap between males
and females has only changed in recent years as the male rate has dropped
and female rate increased slightly, for NSW on the other hand there has been
a gradual decline in both male and female rates since the early 2000’s and a
slight decrease in the gap between male and female rates. In NSW death rates
for avoidable causes were seen to increase with geographic remoteness,
particularly in males, however in females the potentially avoidable death rate
for those in Very Remote areas is significantly higher than any other category
for females and is at a rate comparable with males in Very Remote NSW.
Figure 6 - Deaths by category of cause, MLHD, 2015 (HealthStats NSW 2018)
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 15/49
Hospitalisations In 2016-17 financial year there were 127,143 episodes of hospital care for
residents of the MLHD. The age-adjusted rates of hospitalisation were
significantly higher than the NSW averages for both sexes separately and
combined. In the past 20 years hospitalisation rates have steadily increased
with a slight drop in 2010-11 when a change of coding for diabetes made
significant changes to rates, since then the rates have continued to rise (Figure
7). The increase in rates over time is due to increases in hospitalisation rates
for the people aged over 65 years, the highest rates of hospitalisation are for
those aged 80 to 94 years (in NSW).
The most significant cause of hospitalisation in MLHD (2016-17) was “other
factors influencing health care” (ICD10 Z-codes*) (15,383 episodes, 12.1%);
followed by digestive system diseases (13,327, 10.5%), and then dialysis
(12,630 episodes, 9.9%). The pattern for most causes was similar for males
and females however the highest rate of hospitalisation for females was
maternal and neonatal related diagnoses.
Since the early 2000’s rate of separations for most major categories of cause
have been increasing slightly, however the major contributor to increased
separation rates overall for the MLHD is the increasing rate of dialysis
admissions which have doubled in 15 years. Dialysis has increased from
around 3% of admissions in 2001-02 to around 10% in 2016-17. For MLHD
residents the age-adjusted rates of hospitalisation by cause were significantly
higher than the NSW rates for a large number of causes (Table 3 and Figure
8).
Figure 7 - Hospitalisation all causes trend 2011-02 to 2016-17, MLHD (HealthStats NSW, 2018)
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 16/49
Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018)
International Classification of Disease (ICD) “Z” codes – “other factors
influencing health”
Categories Z00-Z99 are for occasions where situations other than a disease,
external or internal injury, or other external cause of which is classifiable to
categories A00-Y89 are recorded as one of the diagnoses or presenting
problems. Such situation can arise from one of two ways:
1. To receive limited care or service for an ongoing condition, to
donate an organ and/or tissue, to receive prophylactic
immunization, or to discuss a problem other than a disease or
injury.
2. for a situation or problem that influences the person's health
status, however, is not currently an illness or injury.
In 2016 in MLHD there were around 13,500 episodes with this coding
although specific reasons for hospital contact are varied, some of the major
reasons for these encounters were for chemotherapy (~4,000), newborns
(~2,000), surgical care follow up (~1000) and endoscopic examinations
(~500).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 17/49
Table 3 - Hospitalisations by cause and sex, Murrumbidgee LHD and NSW, 2016-17 (Health Statistics NSW, 2018). ^ Statistically significant difference from NSW age-standardised rates, based on 95% confidence limits.
Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of
hospitalisations Rate per 100,000
population LL 95% CI UL 95% CI Rate per 100,000
population LL 95% CI UL 95% CI Different from
state^
Infectious diseases Males 1,199 1.9 882.8 831.6 936.2 652.7 644.8 660.7 HIGH
Females 1,326 2.1 1006.7 950.4 1065.4 675.4 667.5 683.5 HIGH
Persons 2,525 2.0 943.0 904.9 982.2 661.6 656.0 667.2 HIGH
Malignant neoplasms Males 3,209 5.1 1928.3 1860.5 1997.8 1507.6 1496.0 1519.3 HIGH
Females 1,967 3.0 1180.9 1126.8 1236.9 1045.4 1035.9 1054.9 HIGH
Persons 5,176 4.1 1540.1 1496.9 1584.1 1258.8 1251.5 1266.3 HIGH
Other neoplasms Males 1,164 1.9 728.6 686.0 773.1 692.4 684.5 700.4
Females 1,158 1.8 832.5 782.8 884.5 814.6 806.0 823.4
Persons 2,323 1.8 775.1 742.4 808.8 749.9 744.1 755.8
Blood immune diseases Males 814 1.3 503.8 468.6 540.8 412.7 406.5 418.9 HIGH
Females 1,061 1.6 724.3 678.7 772.1 536.5 529.5 543.5 HIGH
Persons 1,875 1.5 608.4 579.7 638.0 473.3 468.6 477.9 HIGH
Endocrine diseases Males 880 1.4 616.0 574.1 660.1 455.1 448.5 461.7 HIGH
Females 1,210 1.9 913.5 859.9 969.4 636.3 628.5 644.2 HIGH
Persons 2,090 1.6 762.6 728.5 797.7 545.2 540.1 550.3 HIGH
Mental disorders Males 1,563 2.5 1397.8 1327.4 1470.9 1781.2 1767.7 1794.7 LOW
Females 1,386 2.1 1172.5 1109.0 1238.5 2039.5 2025.3 2053.8 LOW
Persons 2,949 2.3 1285.8 1238.3 1334.7 1909.4 1899.6 1919.2 LOW
Nervous sense disorders Males 3,910 6.2 2611.8 2527.4 2698.1 2516.2 2500.9 2531.6
Females 4,088 6.3 2695.4 2609.0 2783.7 2521.6 2506.8 2536.5 HIGH
Persons 7,998 6.3 2646.2 2585.9 2707.5 2514.9 2504.3 2525.6 HIGH
Circulatory diseases Males 5,132 8.2 3144.8 3056.7 3234.7 2217.6 2203.5 2231.8 HIGH
Females 3,590 5.6 2007.3 1938.7 2077.6 1352.1 1341.7 1362.7 HIGH
Persons 8,722 6.9 2568.9 2513.3 2625.5 1765.7 1757.0 1774.4 HIGH
Respiratory diseases Males 4,204 6.7 3006.8 2913.7 3102.1 1909.6 1896.1 1923.3 HIGH
Females 4,066 6.3 2943.1 2848.5 3039.8 1685.6 1673.0 1698.2 HIGH
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 18/49
Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of
hospitalisations Rate per 100,000
population LL 95% CI UL 95% CI Rate per 100,000
population LL 95% CI UL 95% CI Different from
state^
Persons 8,270 6.5 2965.2 2898.9 3032.5 1787.2 1778.0 1796.5 HIGH
Digestive system diseases Males 6,617 10.6 4802.0 4682.0 4924.2 3792.6 3773.4 3811.8 HIGH
Females 6,710 10.4 5030.5 4904.7 5158.5 3555.8 3537.4 3574.3 HIGH
Persons 13,327 10.5 4904.7 4817.8 4992.6 3665.2 3651.9 3678.5 HIGH
Skin diseases Males 1,129 1.8 837.3 787.2 889.8 687.0 678.8 695.3 HIGH
Females 921 1.4 656.0 611.7 702.5 532.3 525.2 539.4 HIGH
Persons 2,050 1.6 745.5 712.0 780.2 607.7 602.3 613.2 HIGH
Musculoskeletal diseases Males 3,197 5.1 2279.2 2197.2 2363.3 1839.7 1826.4 1853.0 HIGH
Females 3,137 4.9 2128.9 2051.0 2208.8 1724.7 1712.3 1737.1 HIGH
Persons 6,334 5.0 2205.5 2148.8 2263.2 1784.8 1775.7 1793.9 HIGH
Genitourinary diseases Males 2,790 4.5 1877.6 1805.8 1951.5 1447.5 1435.8 1459.2 HIGH
Females 3,610 5.6 2839.0 2742.2 2938.2 2156.8 2142.3 2171.4 HIGH
Persons 6,400 5.0 2351.2 2291.0 2412.5 1797.7 1788.4 1807.0 HIGH
Maternal, neon. congenital
Males 986 1.6 830.6 779.4 884.2 729.0 720.5 737.6 HIGH
Females 5,968 9.3 6144.6 5989.3 6302.9 4637.6 4615.6 4659.7 HIGH
Persons 6,954 5.5 3467.0 3385.6 3549.8 2686.8 2674.9 2698.6 HIGH
Symptoms abnormal findings
Males 5,996 9.6 4071.4 3964.8 4180.0 2894.0 2877.4 2910.6 HIGH
Females 5,730 8.9 4063.9 3953.0 4176.9 3059.5 3042.6 3076.4 HIGH
Persons 11,726 9.2 4051.0 3974.3 4128.7 2965.4 2953.6 2977.2 HIGH
Injury poisoning Males 5,897 9.4 4736.5 4612.3 4863.0 3002.5 2985.3 3019.9 HIGH
Females 4,494 7.0 3256.0 3155.4 3358.8 2184.8 2170.7 2199.1 HIGH
Persons 10,391 8.2 4008.7 3928.6 4090.1 2597.9 2586.8 2609.1 HIGH
Dialysis Males 6,249 10.0 4116.9 4011.7 4224.1 5616.2 5593.5 5639.0 LOW
Females 6,381 9.9 4048.3 3944.9 4153.8 3243.8 3227.1 3260.5 HIGH
Persons 12,630 9.9 4046.4 3973.1 4120.8 4363.9 4350.0 4377.8 LOW
Other factors infl. health Males 7,699 12.3 5290.1 5168.2 5414.1 3340.4 3322.7 3358.3 HIGH
Females 7,684 11.9 5551.0 5420.9 5683.2 4244.7 4224.4 4265.0 HIGH
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 19/49
Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of
hospitalisations Rate per 100,000
population LL 95% CI UL 95% CI Rate per 100,000
population LL 95% CI UL 95% CI Different from
state^
Persons 15,383 12.1 5414.4 5325.3 5504.6 3783.1 3769.7 3796.6 HIGH
Other Males 10 0.0 8.7 4.1 16.1 73.1 70.3 75.9 LOW
Females 10 0.0 9.6 4.5 17.9 27.5 25.9 29.2 LOW
Persons 20 0.0 9.1 5.5 14.1 50.3 48.7 51.9 LOW
Total Males 62,645 100.0 43670.9 43315.7 44028.1 35567.2 35509.0 35625.4 HIGH
Females 64,497 100.0 47204.0 46819.6 47590.6 36674.5 36615.7 36733.3 HIGH
Persons 127,143 100.0 45298.7 45037.7 45560.7 35968.8 35927.6 36009.9 HIGH
POTENTIALLY PREVENTABLE HOSPITALISATIONS Potentially preventable hospitalisations (PPH) are those which are considered
avoidable through prevention or appropriate primary care (also known as
Ambulatory Care Sensitive Conditions). In 2016, NSW Health applied two new
exclusion rules to the calculation of potentially preventable hospitalisations.
Hospital episodes with source of referral being a transfer from another
hospital or a type change admission are excluded in order to reduce multiple
counting of hospitalisation episodes relating to the same event. Hospital
episodes with bed/unit type being hospital in the home are also excluded.
These rules are applied to the whole period from 2001/02 onwards to allow
for comparisons over time. Rates of PPH in MLHD have remained significantly
higher than NSW in the last decade but have decreased slightly since 2001-02
(Figure 9).
Figure 9 - Potentially preventable Hospitalisations all conditions, MLHD and Total NSW, 2015-16 (HealthStats NSW, 2018)
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 20/49
In relation to PPH rates by condition type (2015-16) the most common in terms
of total bed days (Table 4) per year in MLHD were:
Chronic obstructive pulmonary disease (5,579 total bed days);
Congestive cardiac failure (4,228 total bed days);
Cellulitis (3,253 total bed days);
Urinary Tract Infections (2,847 total bed days);
Diabetes complications (2,216 total bed days);
The most frequent in terms of number of admissions (Figure 10, Table 4) in
2015-16 were:
COPD (1,250);
Urinary tract infections (1,022)
Cellulitis (838);
Congestive cardiac failure (807);
Iron deficiency anaemia (589)
Ear nose and throat infections (536)
Diabetes complications (527)
The causes with significant increasing trend in admission rates since 2001-02
were:
Urinary tract infections
Cellulitis and
Iron deficiency anaemia.
The age-adjusted rates of PPH by condition in MLHD were significantly higher
than the rates for NSW (Table 4) for the following: Angina
Asthma
Bronchiectasis
Cellulitis
Congestive cardiac failure
Convulsions and epilepsy
COPD
Diabetes complications
Ear, nose and throat infections
Gangrene
Hypertension
Iron deficiency anaemia
Urinary tract infections, including pyelonephritis
Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018)
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 21/49
Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015-16 (Health Statistics NSW)
Murrumbidgee LHD NSW
Rate in MLHD Compared to NSW
PPH Conditions Number Rate per 100,000 Average bed days Total bed days
Rate Average bed days
COPD 1250 359.9 4.5 5579 217.6 5.2 HIGH
Urinary tract infections, including pyelonephritis 1022 337.7 2.8 2847 230.1 3.7 HIGH
Cellulitis 838 309.3 3.9 3253 259.6 4.3 HIGH
Congestive cardiac failure 807 213.5 5.2 4228 154.9 6.2 HIGH
Iron deficiency anaemia 589 203.5 1.2 724 140.6 1.5 HIGH
Ear, nose and throat infections 563 243.3 1.5 825 158.7 1.6 HIGH
Dental conditions 536 227.2 1.2 635 219.2 1.2
Diabetes complications 527 191.2 4.2 2216 127.9 5.2 HIGH
Convulsions and epilepsy 482 205.3 1.9 909 141 2.7 HIGH
Angina 436 129.1 1.6 694 97.5 1.9 HIGH
Asthma 418 171.6 2.1 875 123.9 2.1 HIGH
Hypertension 205 62.1 2.3 477 29.9 2.4 HIGH
Pneumonia and influenza (vaccine-preventable) 187 66.7 6.2 1167 63.8 6.9
Bronchiectasis 183 52.8 4.5 815 20.3 6 HIGH
Gangrene 134 47.5 9.4 1255 21.3 11.8 HIGH
Other vaccine-preventable conditions 80 31.9 4.1 329 85.5 5
Perforated/bleeding ulcer 70 23.7 5.9 411 17.6 6.5
Rheumatic heart diseases 34 10.9 6.1 209 8.1 7.8
Pelvic inflammatory disease 31 15.2 1.9 60 13.5 2.7
Pneumonia (not vaccine-preventable) 21 8.8 4 85 12.8 6
Nutritional deficiencies 1 0.2 2 2 1.8 15.3 LOW
Eclampsia 0 0 0 0 0.2 4.6 LOW
Total 8367 2893.8 3.3 27329 2126.3 3.8 HIGH
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 22/49
Health topics
Injury and poisoning
128 Deaths per year
I N J U R Y
25 Male suicides per year (Average 2011-2015)
5.9% Of all deaths (6.6% for males, 5.1% females)
3 Female suicides per year (Average 2011-2015)
10,391 Admissions to hospital In 2016-17
2,405 Admissions to hospital for falls In 2015-16
28 Admissions per day across MLHD
7%
Of all injury hospital admissions in MLHD are for Motor Vehicle Crashes
Not significantly higher death rate
MLHD to
NSW
Significantly higher hospitalisation rate
There were 128 injury and poisoning deaths in 2015 (including suicide) in
MLHD making up 5.9 per cent of all deaths. The age-adjusted rate of 38.7 per
100,000 in MLHD was slightly higher than the NSW rate of 32.5 per 100,000,
but not significantly so. In previous years the overall rate in MLHD especially
for males was significantly higher than NSW rates. The leading causes of injury
death (2011-2015) varied for males and females with suicide making up 25 per
cent of male injury deaths followed by motor vehicle transport deaths (23%)
and falls (9.7%); for women falls accounted for 27 per cent of injury deaths,
motor vehicle transport 21.5 per cent and “exposure to unspecified factor” 19
per cent (studies have shown these are predominantly in the older age groups
and are due to death certificates lacking sufficient information to code from).
For the MLHD population injury and poisoning hospitalisations had been
increasing steadily from early 2000’s to around 2009 when they dropped
slightly for males and females and have since increased to 2016-17, NSW rates
have shown more of a gradual increase (Figure 11). Injury and poisoning was
recorded as the principal diagnosis in a total of 10,391 episodes of care in
2016-17 for MLHD residents (data for acute hospital transfer and “statistical
discharge” were excluded). MLHD had the highest rate of hospitalisation for
injury among all NSW LHDs at 4,009 per 100,000 population, significantly
higher than the NSW rate of 2,598 per 100,000 as well as all other LHDs in
NSW. Approximately 2,405 injury hospitalisations in 2015-16 in MLHD were
due to fall-related injury making up 26 per cent of all injury hospitalisations;
703 motor vehicle transport related (7%); and 437 self-harm related (5%).
Females were overrepresented in the self-harm hospitalisations with close to
two thirds the admissions being females, conversely males were
overrepresented in the motor vehicle injury hospitalisations with 75 per cent
of admissions in this category were for males. (Latest figures from HealthStats
NSW as of March 2018).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 23/49
Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 24/49
Cardiovascular disease
629 Deaths per year
C V D
24 Admissions per day across MLHD
28.9% Of all deaths (29.6% NSW) 662
Revascularisation procedures per year (MLHD 2015-16)
8,722 Admissions to hospital In 2016-17
33%
Of MLHD adults reported High Blood Pressure (NSW Health Survey 2013)
Not significantly higher death rate
MLHD to
NSW
Significantly higher hospitalisation rate
Cardiovascular (or circulatory) diseases comprise all diseases of the heart and
blood vessels. Among these diseases, the four types responsible for the most
deaths in NSW are: coronary heart disease (or ischaemic heart disease), stroke
(or cerebrovascular disease), heart failure, and peripheral vascular disease.
Other causes of death are cardiac arrhythmias (most notably atrial
fibrillation), heart valve disorders, non-ischaemic cardiomyopathies,
pulmonary embolism, and hypertensive renal and heart disease. Significant
causes of morbidity include hypertension, deep vein thrombosis,
haemorrhoids and varicose veins.
There were 629 deaths in MLHD from circulatory disease in 2015. The age-
adjusted death rate of 159.9 per 100,000 in MLHD was similar to the NSW rate
of 153.5/100,000. The rate of circulatory disease deaths has been decreasing
steadily since the early 2000’s and still dropped significantly from 2009-10 to
2012-13 and again in 2014-15 where the rate is no longer significantly higher
than the rest of NSW (Figure 12). The majority of deaths were due to coronary
heart disease (38%) followed by stroke (16%), heart failure (10%) and
peripheral vascular disease (4%); (“other circulatory diseases” made up 32%
of circulatory disease deaths). Rates of death for all causes have been
decreasing since 2000 except for “other circulatory diseases”.
In 2016-17 there were 8,722 hospitalisations in total for circulatory disease,
(27% for coronary heart disease, 11% heart failure, 11% atrial fibrillation and
flutter and 7% for stroke). Circulatory disease also comprises hospitalisation
for varicose veins and haemorrhoids which together make up 16 per cent of
these hospitalisations. The age-adjusted rate of hospitalisation for circulatory
disease in MLHD in 2016-17 of 2,568 per 100,000 was significantly higher than
NSW at 1,765 per 100,000. Overall Murrumbidgee LHD had the highest rates
of most categories of circulatory disease hospitalisation compared to other
LHDs in NSW and in fact was statistically significantly higher for almost all
categories from all LHDs – with the exception of tachycardia, varicose veins
and TIA (Table 5 and Figure 12).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 25/49
Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 26/49
Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Statistics NSW, June 2018)
Murrumbidgee LHD NSW Circulatory disease type
Number of separations
Rate per 100,000
population LL 95% CI UL 95% CI
Rate per 100,000
population LL 95% CI UL 95%
CI Comparison with NSW #
Coronary Heart Disease 2536 741.3 711.9 771.5 536.0 531.2 540.8 HIGHER
Remaining circulatory diseases 2277 715.0 684.6 746.4 453.5 449.0 458.0 HIGHER
Atrial fibrillation and flutter 1083 311.9 293.1 331.6 215.1 212.1 218.1 HIGHER
Heart failure 1016 259.6 243.6 276.3 186.0 183.3 188.8 HIGHER
Haemorrhoids 834 315.2 293.2 338.3 148.2 145.6 150.9 HIGHER
Stroke 694 196.0 181.1 211.7 144.4 141.9 146.9 HIGHER
Peripheral Vascular Disease 680 188.4 174.2 203.5 112.7 110.6 114.9 HIGHER
Varicose veins of lower extremities 206 78.8 67.9 90.9 65.6 63.8 67.4 HIGHER
Transient ischaemic attacks 192 55.4 47.5 64.2 57.5 56.0 59.1
Paroxysmal tachycardia 230 78.0 67.8 89.3 52.5 51.0 54.1 HIGHER
All Circulatory Disease* 8722 2568.9 2513.3 2625.5 1765.7 1757.0 1774.4 HIGHER
All circulatory (or cardiovascular) disease* does not include Transient ischaemic attacks (TIA) or Haemorrhoids. # 95% Confidence interval on age-adjusted rates
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 27/49
Figure 13 - Circulatory procedures, Murrumbidgee LHD 2001-02 to 2015-16 (Health Statistics NSW)
Hospitalisations for cardiovascular procedures (used to restore adequate
blood flow to blocked arteries) were highest for residents of the South Eastern
Sydney LHD and lowest in the Northern NSW LHD. Murrumbidgee LHD
residents had a CVD procedure rate of 203.8 per 100,000 (2015-16) which was
not significantly higher than NSW at 185.9 per 100,000. The combined
procedure rate had been increasing steadily since the early 1990’s due to
increases in angioplasty and stent surgery, but have remained fairly constant
since the early 2000’s in NSW, MLHD saw a peak around 2009-11 which has
dropped off in more recent years (Figure 13). Males have significantly higher
rates of these procedures than females.
BLOOD PRESSURE AND CHOLESTEROL The NSW Health Survey from 2002 to 2013 has shown an increase in the
prevalence of self-reported high blood pressure (Question: Have you ever
been told by a doctor or hospital you have high blood pressure?) in adults in
the MLHD* from 24 per cent to 33 per cent, a similar increase was seen in
NSW overall with 20 per cent in 2002 and 28 per cent 2013 of adults reporting
high blood pressure (MLHD* rates were not significantly higher than NSW).
High cholesterol in adults of MLHD* saw a rise from 23 per cent in 2002 to a
peak of 31 per cent in 2008 and has dropped to 22 per cent in 2013, a similar
trend was observed for all NSW (MLHD* rates were not significantly higher
than NSW). (MLHD* including Albury LGA population).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 28/49
Diabetes
62
Deaths with diabetes as underlying cause (MLHD 2015)
D I A B E T E S
10%
Of hospital episodes of care were for dialysis (MLHD 2016-17)
218
Deaths where underlying or associated cause is diabetes (MLHD 2015)
13.5%
Of adults reported being diagnosed with diabetes (MLHD 2017)
9%
Of all deaths were attributed to diabetes (MLHD 2015)
14.0% Aboriginal adults reported diabetes (NSW 2017)
Not significantly higher death rate
MLHD to
NSW
Significantly higher hospitalisation rate
There were 62 deaths in MLHD in 2015 where diabetes was the principal
cause, but a total of 218 where diabetes was an underlying or associated cause
making up 9 per cent of all deaths in 2015. The MLHD death rate in 2015 from
diabetes as a principal cause was 16.4 per 100,000 which was not significantly
higher than the NSW rate of 15.8 per 100,000.
In 2016-17 there were 710 hospitalisations where diabetes was the principal
diagnosis in MLHD at an age-adjusted rate of 255.7 per 100,000, the MLHD
rate was significantly higher than NSW at 151.8 per 100,000 and all other LHDs
except Far West. The female rate of hospitalisation in MLHD was higher than
the male rate, which was not the case in most LHDs except for Far West. A
serious complication of diabetes is chronic kidney disease leading to the need
for dialysis. Dialysis accounted for 12,630 hospital episodes of care in 2016-
17, 10 per cent of all hospitalisations.
In July 2010 the Australian Coding Standard for diabetes was revised resulting
in a major change affecting the coding of diabetes as a principal diagnosis or
an additional diagnosis (or comorbidity) in the hospital data. This change is
responsible for dramatic decreases in the number and rate of hospitalisation
for diabetes as a principal diagnosis in NSW between 2009-10 and 2010-11
(around a 60% drop), then in 2012 the coding changed again, this time to
include diabetes as a comorbidity if it is mentioned in the patients notes which
has resulted in a spike in comorbidity coding.
In the 2017 NSW Health Survey 13.5 per cent of adults in MLHD said they had
been diagnosed with diabetes or high blood glucose (not during pregnancy)
this was higher than NSW adults at 10.1 per cent (but not significantly so). The
prevalence of adult diabetes has been gradually increasing in MLHD since the
early 2000s to 2017 with some annual fluctuations. Diabetes prevalence
increases with age, increasing levels of disadvantage and is more prevalent
among Aboriginal people.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 29/49
Respiratory disease
228 Deaths from respiratory diseases (MLHD 2015)
R E S P I R A T O R Y
6.5%
Of hospitalisations were for respiratory disease (MLHD 2015)
10.5% Of all deaths were from respiratory diseases (MLHD 2015)
1,500+
COPD hospitalisations per year (MLHD 2015)
111 Deaths per year from COPD (MLHD 2013-2015)
21%
Of children reported to currently have asthma (MLHD 2014-2015)
6 People die per year from asthma (MLHD 2016)
19% Of adults reported to have asthma (MLHD 2017)
35
Deaths per years from influenza and pneumonia (MLHD 2014-2015)
1,670
Influenza and pneumonia hospitalisations (MLHD 2015-2016)
Not significantly higher death rate from suicide
MLHD to
NSW
Significantly higher hospitalisation rate for COPD,
asthma and influenza & pneumonia
Respiratory disease deaths made up 10.5 per cent of deaths in MLHD 2015,
the main contributor to respiratory disease deaths for 2013-2015 was chronic
obstructive pulmonary disease (COPD) making up 58 per cent of respiratory
deaths. There were 8,270 hospitalisations for respiratory disease in MLHD in
2016-17 making up 6.5 per cent of all hospitalisations at an age-adjusted rate
of 2,965 per 100,000 which was significantly higher than the rest of NSW at
1,787 per 100,000. The rates for death from respiratory disease fluctuate in
MLHD but have been decreasing in NSW since 2001, the hospitalisation rates
have been increasing slowly since 2001-02 (Figure 14).
COPD Chronic Obstructive Pulmonary Disease (COPD), which includes chronic
bronchitis and emphysema accounted for an average of 111 deaths per year
(2013 to 2015) in MLHD at an age adjusted rate of 30.5/100,000 which was
significantly higher than NSW rate of 24 per 100,000. Death rates from COPD
declined dramatically for males from the early 2000s to 2008-2010, but have
been increasing slightly since then for both men and women. There were
1,548 hospitalisations for COPD in MLHD in 2016-17 the rate was significantly
higher than NSW (MLHD: 436.8 per 100,000, NSW: 253/100,000). 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.
ASTHMA Approximately six people have died per year from asthma in MLHD from 2012
to 2015. The latest age-standardised death rate of 1.5 per 100,000 for 2014-
2015 was the same as the NSW rate. The death rate has been decreasing since
the early 2000s. There were 677 hospitalisations of Murrumbidgee LHD
residents of all ages in 2016-17 for asthma at a rate of 278.2 per 100,000
population, which was significantly higher than the NSW rate of 177.2 per
100,000. The hospitalisation rate for those aged 5-34 years, where asthma is
more clearly diagnosed and likely to be acute, was 261.1 per 100,000 which
was also significantly higher than the NSW rate for the same ages at 180.5 per
100,000 and has been gradually decreasing since the early 2000s. In the 2017
NSW Health Survey, 19.1 per cent of the adult MLHD population reported
having current asthma (symptoms or treatment for asthma in the past 12
months) which was significantly higher than NSW at 10.9 per cent. In 2015-16
21.4 per cent of children aged 2 to 15 years were reported to have current
asthma and 32 per cent had “ever had asthma”. MLHD had the highest rates
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 30/49
of childhood asthma among NSW LHDs but was only significantly higher than
Sydney and SE Sydney LHDs.
INFLUENZA AND PNEUMONIA Death rates from influenza and pneumonia have dropped significantly in
MLHD from 2003-2004 to 2014-15. There were approximately 35 deaths per
year in the 2014-2015 period at a rate of 9.6 per 100,000 which was slightly
higher than 8.6 per 100,000 for NSW. In 2015-16 there were 1,670
hospitalisations of Murrumbidgee LHD residents of all ages the age-adjusted
rate of 547.2 per 100,000 was significantly higher than the NSW rate of 349.9
per 100,000. There were 105 hospitalisations for those aged 0-4 years (age-
adjusted rate: 693.8/100,000) in MLHD and 955 for persons aged 65 years and
over (age-adjusted rate: 1971.8/100,000, 57% of total), the rate for the older
population was significantly higher than NSW at 1,236 per 100,000. In older
people in MLHD, the rate of influenza and pneumonia hospitalisations for
males was over 1.5 times that of females. Influenza and pneumonia
hospitalisations are considered to be partly preventable through
immunisation.
The number of potentially preventable hospitalisations due to influenza and
pneumonia (considered vaccine preventable) in Murrumbidgee LHD in 2015-
2016 was 187 at an age-standardised rate of 66.7 per 100,000 population, this
rate was similar to the NSW rate at 63.8 per 100,000 and accounted for a total
of 1,167 bed days and on average 6.2 bed days per admission in MLHD.
In 2015-16 the NSW Health Survey reported that 71.3 per cent of the MLHD
population aged 65 years or over had been immunised against flu in the
previous 12 months and 52.2 per cent had been vaccinated against
pneumococcal pneumonia in the past 5 years, immunisation rates for
influenza were slightly lower than NSW and slightly higher for pneumococcal,
but not significantly so. Influenza immunisation rates for the 65 plus age
group, reported by the NSW Health Survey, have mostly remained above 70
per cent since 2002-2003 in MLHD and in NSW, for pneumococcal
immunisation the rates reached a peak of close to 70 per cent in 2011-2012
and have since dropped to around 50 per cent.
Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 31/49
Mental health (suicide and self-harm)
107
Deaths from mental and behavioural disorders (non- suicide) (MLHD 2015)
M E N T A L
H E A L T H
2,949
Hospitalisations for mental disorders per year (MLHD 2016-17)
33 Deaths from suicide (MLHD 2015)
523 Hospitalisations for self-harm (MLHD 2016-17)
3 Female suicide deaths per years (MLHD 2011-2015)
15.7%
Of adults reported to have high psychological distress (MLHD 2017)
25 Male suicide deaths per years (MLHD 2011-2015)
13.4%
Of 12-17 year olds reported to have high psychological distress (MLHD 2014)
Significantly lower death rate from mental disorders
MLHD to
NSW
Significantly higher hospitalisation rate for self-
harm
There were 107 deaths due to mental and behavioural disorders in 2015 at a
rate of 25.0 per 100,000 population in MLHD this rate was significantly lower
than that of NSW at 32.2 per 100,000. In 2015 there were 33 deaths from
suicide registered in the MLHD population, with an average number per year
of 27.8 from 2011 to 2015. The age-adjusted rate of suicide for MLHD was 14.7
per 100,000 compared to 10.6 per 100,000 in NSW in 2015, it was not
significantly higher.
There were 523 (184 males, 339 females) hospital admissions where “self-
harm” was recorded as the external cause of injury or poisoning at a rate of
248.9 per 100,000 population for all ages and 722.2 per 100,000 for 15-24 year
olds in MLHD in 2016-17, both rates were significantly higher than NSW and
the rate for young males was the highest among all LHD and for young females
the second highest in NSW LHDs. There were 2,949 hospitalisations for mental
disorders (not suicide or self-harm related) in 2016-17 at a rate significantly
lower than NSW. The death rates and hospitalisations rates for mental and
behavioural disorders have been increasing since the early 2000’s in both NSW
and MLHD (Figure 15).
In the 2015-2017 NSW Health Survey 15.7 per cent of adults in MLHD had high
to very high psychological distress (assessed by the K10 10-item questionnaire
that measures the level of psychological distress in the most recent 4-week
period) a rate slightly higher than NSW at 13.4 per cent, there has been an
increase in the rate of “High distress” in MLHD in recent years (but not
significant).
Behavioural problem risk is a recent indicator included in the NSW Child
Health Survey which is a series of questions from the Strengths and Difficulties
Questionnaire (SDQ) (see methodology section of NSW Health Statistics for
more information). In 2013-14 it was determined by this survey that 8.0 per
cent of children (aged 2-15 years) in MLHD were at substantial risk of
developing a clinically significant behavioural problem, compared to 8.3 per
cent in NSW as a whole. Lower socioeconomic groups were more likely to be
at significant risk. In the NSW School Students Health Behaviours Survey 2014,
30.5 per cent of 12-17 year olds reported being unhappy, sad or depressed,
32.8 per cent were nervous, stressed or under pressure and 15.8 per cent had
been in trouble because of behaviour a further 13.4 per cent were rated as
having high psychological distress (this is for the combined MLHD and
Southern NSW LHDs).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 32/49
Figure 15 – Mental and behavioural disorders trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 33/49
Cancer
665 Deaths from cancer (MLHD 2015)
C A N C E R
1,686 New cases of cancer (MLHD 2013)
106 Deaths from lung cancer per year (MLHD 2009-2013)
149 New cases of lung cancer per year (MLHD 2009-2013)
69 Deaths from bowel cancer per year (MLHD 2009-2013)
135
New cases of colon cancer per year (MLHD 2009-2013)
43
Deaths from prostate cancer per year (MLHD 2009-2013)
352
New cases of prostate cancer per year (MLHD 2009-2013)
32
Deaths from pancreatic cancer per year (MLHD 2009-2013)
31 Deaths from breast cancer per year (MLHD 2009-2013)
169
New cases of breast cancer per year (MLHD 2009-2013)
18 Deaths from skin cancer per year (MLHD 2009-2013)
138
New cases of melanoma of skin per year (MLHD 2009-2013)
Significantly lower death rate for liver cancer
MLHD to
NSW
Significantly higher incidence of total cancers and deaths
from all cancers, prostate and bowel cancer (rectal in
particular)
Cancer is Australia's leading cause of disease burden. It accounts for almost
one-fifth of years of healthy life lost due to premature death, disease, and
injury. In 2013 in NSW the five leading types of new cases of cancer in
descending order were: prostate cancer; colorectal cancer; breast cancer;
melanoma and lung cancer accounting for 60.4 per cent of new cases. The rate
of diagnosis of new cases of cancer in NSW has increased steadily since 1990,
whereas the death rate has been decreasing. For MLHD it is projected that in
2026 there will be over 2,000 new cancers diagnosed, the majority of these
will be prostate (25%), bowel (13%), lung (10%) and breast (9%) (NSW Cancer
Registry data (population data are sourced from NSW Ministry of Health
Secure Analytics for Population Health Research and Intelligence (SAPHaRI)
and NSW Department of Planning and Environment).
There were 665 deaths reported as due to malignant neoplasms in 2015 for
MLHD residents, 264 females and 401 males. In 2015 cancer deaths made up
31 per cent of all causes of death in MLHD and 28 per cent in NSW. The MLHD
rate was significantly higher than NSW. Narrandera and Lachlan Shires had
higher death rates from cancer than expected based on NSW averages,
Murray, Wakool and Conargo Shires all had lower death rates than expected
based on NSW averages. Death rates and hospitalisation rates from cancer
have decreased slightly since the early 2000s in MLHD and NSW (Figure 16).
There were 1,686 new cancers diagnosed in MLHD in 2013 at an
overall incidence rate significantly higher than NSW.
Carrathool, Cootamundra, Gundagai and Lachlan Shires all had higher
than expected incidence rates of new cancers compared to NSW
averages.
MLHD is reported to have significantly higher incidence of bowel
cancer (includes rectal and colon cancers) than other LHD’s and
significantly higher incidence of urogenital cancers, but significantly
lower incidence of skin and thyroid cancers (Reporting for Better
Cancer Outcomes, 2015).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 34/49
Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW
BREAST CANCER From 2009 to 2013 there were on average 169 new cases of breast cancer
diagnosed in MLHD with an age/sex standardised rate of 59.2 per 100,000
population was slightly lower than the NSW rate of 62.4 per 100,000. There
were on average 31 breast cancer deaths per year in MLHD in 2009-2013 with
an age-standardised rate of 10.3 per 100,000 which was lower but not
significantly different from the NSW rate of death of 11.4 per 100,000
population.
Mammographic screening is seen as the best population-based method to
reduce mortality and morbidity attributable to breast cancer. BreastScreen
Australia aims to screen at least 55 per cent of women aged 50 to 74 years
every two years by 2018. The two-yearly screening rate for breast cancer in
women aged 50-74 years in MLHD for 2015-16 was 53.8 per cent. Lockhart
LGA had the highest screening rate among MLHD LGAs at 64.6 per cent of the
target women with Temora, Tumut, Murrumbidgee, Cootamundra, Gundagai
and Wagga Wagga all above 60 per cent. However Junee, Greater Hume,
Albury, Lachlan, Jerilderie, Carrathool, Corowa, Berrigan, Conargo, Wakool
and Murray were all below the 55 per cent target. Where residents may access
services outside NSW (primarily Victorian border areas) the rates of screening
then drop significantly below the NSW rate as only NSW based screening is
included in the data set. Wakool and Murray LGAs have rates of less than 10
per cent due to cross-border flows.
The screening rate for Aboriginal women in MLHD for 2015-16 was 34.1 per
cent which has been increasing since 2011-12. The rate for culturally and
linguistically diverse women was 29.3 per cent in 2015-16 which is significantly
below the rates for this group in all NSW.
LUNG CANCER In MLHD there were on average 149 new cases of lung cancer diagnosed
annually from 2009-2013 at an age-adjusted incidence of 47.5 per 100,000
population this was slightly higher than the NSW rate of 44.2 per 100,000
population. There were 106 lung cancer deaths on average per year in MLHD
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 35/49
2009-2013 at an age-adjusted rate of 33.3 per 100,000 which was similar to
the NSW rate of 33.2 per 100,000. The incidence of lung cancer for males in
MLHD has been decreasing since the late 1980’s as has the rate of death,
however for women the incidence and death rates have been increasing, this
is in-line with the general trend in NSW. The incidence of lung cancer was
significantly higher than NSW rates in Hay and Narrandera LGAs (2009-2013).
BOWEL CANCER In 2009-2013 in MLHD there were 213 new cases of bowel cancer (colon and
rectal cancers combined) diagnosed on average annually at an age-adjusted
incidence of 69 per 100,000 population, this rate was significantly higher than
the NSW rate of 61.5 per 100,000 population. There were on average 69
deaths annually in MLHD from bowel cancer at an age-adjusted rate of 21.4
per 100,000 which was similar to the NSW rate of 21.4 per 100,000. The
incidence of bowel cancer for males and females in MLHD had been increasing
since the early 2000s but has decreased since 2009. Death rates however have
been showing a downward trend for both sexes. The participation rate in
bowel cancer screening for 2016 in MLHD (including Albury LGA) was 40.8 per
cent of the 22,349 people who were eligible, which was significantly higher
than the NSW rate of 37.8 per cent. Bland, Greater Hume, Gundagai and
Tumbarumba LGAs all had significantly high incidence rates of bowel cancer
compared to NSW. Participation rates in the
SKIN CANCER In 2009-2013 in MLHD an average of 138 new cases of melanoma were
diagnosed at an age-adjusted incidence of 46.7 per 100,000 population, this
rate was significantly lower than the NSW rate of 54.6 per 100,000 population.
Approximately 18 people died annually in the 2009-2013 period in MLHD at
an age standardised rate of 6.0 per 100,000, the rate was similar to NSW at
6.3 per 100,000. In MLHD the incidence of melanoma for males and females
has increased since the early 2000s whereas the death rate for males and
females varies over the years due to small numbers. Coolamon and Lachlan
LGAs had a significantly high incidence of skin cancer in the 2009-2013 period.
PROSTATE CANCER In 2009-2013 in MLHD there were an average of 352 new cases of prostate
cancer diagnosed annually at an age-adjusted incidence of 112.4 per 100,000
population which was significantly higher than the NSW rate of 85.3 per
100,000 population and significantly higher than all other LHDs in NSW. There
were an average of 43 deaths per year in MLHD from prostate cancer in 2009-
2013 at a rate of 12.7 per 100,000 which was not significantly higher than the
NSW rate of 11.6 per 100,000. The incidence of prostate cancer for males in
MLHD and in NSW has increased significantly since the late 1980’s, due in part
to increased awareness, screening and detection, while the death rate has
decreased. Bland, Cootamundra, Griffith, Gundagai, Hay, Murrumbidgee,
Temora, Tumbarumba, Urana, Wagga Wagga and Young LGAs all had
incidence rates of prostate cancer significantly higher than expected based on
NSW rates.
CERVICAL CANCER In MLHD 2009-2013 there was an average of nine new cases of cervical cancer
diagnosed at an age-adjusted incidence of 4.0 per 100,000 compared to the
NSW rate of 3.7 per 100,000 population. There were on average 1.8 deaths
per year in MLHD at a rate of 0.3 per 100,000 population which was less than
the NSW rate of 1.0 per 100,000 but not significantly so. Both incidence of and
mortality from cervical cancer have decreased since the early 2000s.
The biennial cervical screening participation rate for 2015-2016 for MLHD was
54 per cent which was lower than the NSW rate of 56 percent. The screening
rate for MLHD has decreased slightly since 2013-14 but more so in the 25-34
year age group than others up to 69 years, however the screening rates in the
younger group are in line with NSW rates and in the age groups 35 to 69 years
are significantly lower (RBCO Performance Report 2017: Murrumbidgee).
The uptake of Human Papilloma Virus (HPV) vaccination for females in
secondary school was reported to be 86.3 per cent of 15 year olds fully
immunised in Murrumbidgee in 2014-2015, which was higher than the state
average of 81.5 per cent. For 15 year old males the uptake was 68.7 per cent
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 36/49
which was also higher than the NSW rate of 64.7 per cent. HPV has been
reported to account for more than 99 per cent of all cervical cancer.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 37/49
Risk Behaviours
22% Of adults smoke (MLHD 2017, 15% NSW)
H E A L T H
R I S K S
253
Deaths attributed to smoking per year (MLHD 2013, significantly higher rate than NSW)
5% Of 12-17 year olds smoke (MLHD/SNSW 2014, 6.7% NSW)
2,614
Hospitalisations attributed to smoking per year (MLHD 2014-15, significantly higher rate than NSW)
34%
Of adults drink alcohol at risk levels to health (MLHD 2017, 31% NSW)
51 Deaths attributed to alcohol per year (MLHD 2012-2013)
37%
Of 12-17 year olds had drunk alcohol in the last month (MLHD/SNSW 2014, 37.6% NSW)
1,860
Hospitalisations attributed to alcohol per year (MLHD 2014-15, significantly higher rate than NSW)
51% Of adults reported insufficient exercise (NSW 2017, 42% )
32%
Of children reported sedentary behaviour (5 to 15 yrs, NSW 2016-17, 44% )
6%
Of adults reported adequate vegetable consumption (NSW 2017, 7% )
8%
Of children reported adequate vegetable consumption (2 to 15 yrs, NSW 2016-17, 7% )
39%
Of adults reported adequate fruit consumption (NSW 2017, 46% )
63%
Of children reported adequate fruit consumption (2 to 15 yrs, NSW 2016-17, 67% )
62%
Of adults were overweight or obese (NSW 2017, 54% )
120
Deaths attributed to high body mass per year (MLHD 2013)
30% Of adults were obese (NSW 2017, 21% )
1,987
Hospitalisations attributed to high body mass (MLHD 2014-15, significantly higher rate than NSW)
7%
Of adults had experienced food insecurity in previous year (NSW 2014, 7% )
MLHD to
NSW
Significantly higher prevalence of overweight and obesity in
adults and higher rates of hospitalisations related to
smoking, alcohol and high body mass risk factors.
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SMOKING
Figure 17 - Trend in adult smoking prevalence, MLHD and NSW 2002 to 2017
Tobacco smoking is the single most preventable cause of ill health and death
in Australia, contributing to more drug-related hospitalisations and deaths
than alcohol and illicit drug use combined. It is a major risk factor for coronary
heart disease, stroke, peripheral vascular disease, cancer and a variety of
other diseases and conditions.
The per cent of the MLHD adult population reporting to be current smokers
has been declining since 2002 and has remained below 20 per cent since 2013,
however in 2017 the adult smoking prevalence was 21.9 per cent, which was
higher (not significantly) than the NSW rate of 15.2 per cent (Figure 17). For
school students in MLHD/Albury/Southern NSW LHD (combined) aged 12-17
years in 2014 the per cent of students who reported to be heavy, light or
occasional smokers was 4.9 per cent which was a significant decrease from
2005 where 13.9 per cent reported to be smokers. The equivalent rate for
NSW was 6.7 per cent of students.
Smoking was believed to have contributed to 2,614 hospitalisations in the
MLHD in 2014-15 at an age-adjusted rate of 830.1 per 100,000 population this
rate was significantly higher than NSW at 542.1 per 100,000. MLHD had the
highest rate of smoking attributable hospitalisations among NSW LHDs for
males and females. MLHD has seen a decrease in smoking attributable
hospitalisations since the early 2000s but only in males, for females the rate
has increased slightly. The number of deaths which could be attributed to
smoking in 2013 in MLHD was 253 at a rate of 75.3 per 100,000 population
which was significantly higher than the NSW rate of 60.8 per 100,000.
Smoking during pregnancy is reported in the Pregnancy and New born section
below.
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ALCOHOL
Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 to 2017
Long term adverse effects of high consumption of alcohol on health include
contribution to cardiovascular disease, some cancers, nutrition-related
conditions, risks to unborn babies, cirrhosis of the liver, mental health
conditions, tolerance and dependence, long term cognitive impairment, and
self- harm. Excessive alcohol consumption is one of the main preventable
public health problems in Australia.
In the 2017 NSW Health Survey risk consumption of alcohol was defined as:
consuming more than 2 standard drinks on a day when drinking alcohol.
Adults in MLHD had a slightly higher rate of risk consumption than NSW in
2017 at 33.5 per cent compared to 31.1 per cent. The prevalence in MLHD had
remained fairly steady from 2002 to 2013 when the rate was significantly
higher than NSW, the rate is no longer significantly higher as the rate in NSW
and MLHD have both increased from a low in 2014 (Figure 18). Another
category of risk consumption is the “immediate risk to health” defined as
consuming more than 4 standard drinks on a single occasion in the last 4
weeks. In the 2017 survey 30.7 per cent of adults in MLHD drank at this level
compared to 26.1 per cent in NSW. The frequency of consuming alcohol is
another measure of risk with 13.8 per cent of adult males in MLHD (2016-
2017) reporting drinking alcohol on a daily basis compared to 5.6 per cent of
females; weekly consumption was reported by 36.7 per cent of the adult
population; less than weekly consumption by 23.0 per cent of adults and 30.6
per cent reported never drinking alcohol (22.8% of males compared to 38.5%
of females). For school students aged 12 to 17 years 13.4 per cent reported to
have consumed alcohol in the 7 days, and 23.6 per cent in the month, prior to
survey in the MLHD/Albury/Southern NSW LHDs (combined) compared to
14.0 per cent and 23.6 per cent in NSW (2014 School Students Survey), the
rates for MLHD/Albury/Southern NSW LHD have dropped since 2008 as have
the rates for all NSW.
Alcohol attributable hospitalisations are those where the consumption of
alcohol is believed to make up a percentage of hospitalisations for certain
causes, such as injury and cardiovascular disease as well as liver disease and
mental health conditions. Alcohol consumption in MLHD contributed to 1,860
hospital admissions in 2014-15 at an age-adjusted rate of 882.8 per 100,000
males and 566.4 per 100,000 females, which was significantly higher than the
NSW rates for males of 797.8 per 100,000 but not for females (NSW: 544.7
per 100,000). The overall rate was 727.3 per 100,000 population in MLHD
which was significantly higher than 671.6 per 100,000 in NSW. The age-
adjusted rate of alcohol attributable hospitalisations in MLHD has been
increasing since the early 2000s for both males and females as is the same for
NSW. There were 51 deaths per year in the 2012 to 2013 period which could
have been attributed to alcohol in MLHD at rate of 18 deaths per 100,000
population this was slightly higher than the NSW rate of 16 per 100,000.
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PHYSICAL ACTIVITY
Figure 19- Trend in adult insufficient physical activity prevalence, MLHD and NSW 2002 to 2017
Physical activity is an important factor in maintaining good health at any age.
People with adequate physical activity have lower rates of preventable
morbidity and mortality than those who are physically inactive. To maintain
good health, the National physical activity guidelines for adults recommend at
least 30 minutes of moderate activity on most, and preferably all, days of the
week. Moderate intensity activity includes brisk walking, dancing, swimming,
or cycling, which can be undertaken in shorter bursts such as 3 lots of 10
minutes (AGDHA, 1999 and 2005).
In the 2017 NSW Health survey 50.5 per cent of adults reported insufficient
physical activity in MLHD, the prevalence has been between 45 to 52 per cent
since 2010. The rate of insufficient physical activity was 41.6 per cent for
adults in NSW in 2017 and the prevalence has been decreasing (i.e. more
adults are getting adequate exercise) (Figure 19). The NSW Population Health
Survey of 2016-17 reported that 34.8 per cent of children (5 to 15 years) in
MLHD were undertaking adequate physical activity and 32.4 per cent had
“sedentary behaviours” (spending 2+ hours per day in sedentary leisure
activities) compared to 24.2 per cent “active” and 44.0 per cent “sedentary”
in NSW. Sedentary behaviour levels had dropped in MLHD since 2006-2007,
however so had the rate of adequate physical activity, until 2016-2017. The
NSW School Student Survey of 2014 reported that 29.6 per cent of boys ages
12 to 17 years and 24.8 per cent of girls undertook adequate physical activity
in MLHD/Albury/Southern NSW LHDs (combined), this was a significant
increase on the 2011 rates and was reported across the state and in particular
among 12-15 year olds.
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FRUIT AND VEGETABLE CONSUMPTION
Figure 20 - Trend in adult adequate fruit and vegetable consumption prevalence, MLHD and NSW 2002 to 2017
Fruit and vegetable consumption is strongly linked to the prevention of
chronic diseases and to better health. Vegetables and fruits are sources of
antioxidants, fibre, folate and complex carbohydrates. The MLHD population
reported rate of adequate vegetable consumption (five or more serves per
day, a serve = ½ cup cooked or 1 cup salad vegetables) at 5.7 per cent of the
adult population was not significantly lower than the NSW rate in 2017 of 6.6
per cent of adults. Adequate fruit consumption in MLHD was lower than NSW
rates at 39.0 per cent compared to 46.4 per cent for NSW. In MLHD fruit and
vegetable consumption since 2002 had been increasing to a peak at around
2009-2010 and has since levelled off and dropped slightly. A similar trend has
been experienced by NSW as a whole (Figure 20). For adults in NSW the
consumption of fruit has dropped off from a high of 56.4 per cent in 2009 to
a low of 46.4 per cent in 2017 and for vegetables there was a high of 9.2 per
cent in 2007 decreasing to 6.6 per cent in 2017.
Recommended vegetable consumption for children aged 2 to 15 years was
reported to be 8.2 per cent of the MLHD population in 2016-2017 and
recommended levels of fruit was eaten by 62.6 per cent of children, neither
of these rates has changed significantly over time in MLHD. Since 2004-2005
in NSW the reported vegetable consumption for children had increased
slightly reaching a high of 7.7 per cent in 2014-2015 and fruit consumption
had risen to 69.2 per cent in 2012-2013 but dropped to 66.8 per cent in 2016-
2017.
The School Students Survey (2014) reported that MLHD/Albury/Southern
NSW LHDs (combined) students aged 12 to 17 years had an adequate fruit
consumption rate of 78.7 per cent and adequate vegetable consumption rate
of 10.7 per cent which were similar to the rates in NSW (77.7% fruit and 9.9%
vegetable). The trend for NSW students as a whole has been a plateau at
around 10 per cent for adequate vegetable consumption and 77 per cent for
fruit consumption between 2008 and 2014.
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OBESITY/ HIGH BMI RELATED ILLNESS
Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 to 2017
Excess weight, especially obesity, is a risk factor for cardiovascular disease,
Type 2 diabetes, some musculoskeletal conditions and some cancers. As the
level of excess weight increases, so does the risk of developing these
conditions. In addition, being overweight can hamper the ability to control or
manage chronic disorders (AIHW Cat. no. AUS 122 2010). The NSW Health
Survey 2017 reported that in MLHD more adults were overweight or obese (as
measured by self-reported height and weight used to calculate Body Mass
Index) when compared to NSW (MLHD: 62.1%, NSW 53.5%), but not
significantly so. In MLHD 30.2% of adults were classified as obese (significantly
higher than NSW at 21.0%) and 31.9% as overweight (not significantly lower
than NSW at 32.5%). In MLHD the proportion of adults who are obese has
been gradually increasing from 2002 to 2017, however the percentage of
overweight adults has dropped from 2013 to 2017. NSW rates of adult obesity
have been rising gradually, but rates in the overweight category have
plateaued (Figure 21). For adults in MLHD (and all NSW) being overweight was
more prevalent in males (35%) than females (29%), but levels of obesity were
similar in both sexes.
For school students aged 12-17 years in 2014 the MLHD/Albury/Southern
NSW LHD (combined), 23 per cent were reported to be overweight or obese
compared to 20.6 per cent in NSW. The 2011 rate was the highest rate among
Local Health District Groups (NSW School Students Survey), however in 2014
the rate had dropped. The prevalence of overweight/obesity in NSW
Secondary School students has changed very little since 2005 remaining
around 15 per cent, in MLHD/Albury/Southern LHD the prevalence has
increased slightly but not significantly from 19.8 per cent in 2008 to 27.0 per
cent in 2011 and 19.5 per cent in 2014. For NSW, the rate of overweight and
obesity in children aged 5 to 16 years has been around 20 to 25 per cent from
2007 to 2016, the latest figures sit at 23 per cent for boys, 21 per cent for girls
and 22 per cent overall (NSW Population Health Survey 2016).
High body mass attributable hospitalisations are those where high body mass
(BM) is considered to have contributed to the underlying illness, for example
a proportion of diabetes and cardiovascular disease admissions. The MLHD
had the highest age-adjusted rate of high BM attributable admissions among
all LHDs in NSW for males and females separately and for the population as a
whole. In 2014-15 in MLHD, 1,987 admissions were attributed to high BM at
an age-adjusted rate of 630.0 per 100,000 population. The MLHD rate was
significantly higher than NSW rate of 436.8 per 100,000 population. In NSW,
BM attributable admissions have been gradually declining since 2010-11 as
have the rates in MLHD. High Body Mass attributable death rates have been
decreasing in MLHD from 2001 to 2013. In 2013 there were estimated to be
120 deaths in MLHD which could be attributed to high body mass at a rate of
35.9 per 100,000 which was higher than the NSW rate of 29.5 per 100,000,
but not significantly. In 2013 in MLHD, 120 deaths were considered
attributable to a high body mass, the standardised rate was higher than NSW
but not significantly, the death rate has been in decline since 2001. Relatively
higher BM related mortality rates by LGA were reported with increasing
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 43/49
remoteness, hospitalisation pattern were less distinct with many LGAs in
MLHD having significantly high rates especially in the north of the District.
FOOD INSECURITY Food insecurity in Australia is considered to be an important social
determinant of health and a significant public health issue. Food insecurity is
associated with general poor health and poor nutrition and refers to not
having sufficient food; running out of food and being unable to afford more;
eating a poor quality diet as a result of limited food options; anxiety about
acquiring food; or having to rely on food relief. The NSW Health Survey
measures food insecurity in the adult population by telephone survey asking
if in the last 12 months were there times when they ran out of food and could
not afford to buy more. In MLHD (including Albury LGA) from 2008 to 2014
the prevalence of food insecurity in the adult population has been gradually
increasing from around 4 per cent to a high of 9.8 per cent in 2010 and a
current rate of 6.8 per cent 2014. A similar pattern can be seen for all NSW
where there has been a recent rise in food insecurity to a 2014 figure of 6.9
per cent. In NSW the rate of food insecurity increased with remoteness and
also with socioeconomic disadvantage where food insecurity was twice as
likely in the areas of high disadvantage compared to those of lowest
disadvantage. The trend for children in all NSW (0-15 years as reported by
their parents) is that household food insecurity has dropped from a high of 6.2
per cent in 2007-2008 to 3.9 per cent in 2013-2014, in MLHD (including Albury
LGA) household food security problems have been experienced by
approximately 5 to 7 per cent of children from 2003 to 2014.
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Pregnancy and the newborn
2,411
Babies born to MLHD mothers in NSW hospitals (MLHD 2016)
M O T H E R S
4.7% Mothers were aged 12-19 years (MLHD 2016: NSW 2.2%))
63.9%
Of mothers had first antenatal visit before 14 weeks gestation (MLHD 2016: NSW 67.8%)
2.8% Mothers were aged 40+ years (MLHD 2016: NSW 4.6%)
16.5%
Of mothers had first antenatal visit at 20+ weeks gestation (MLHD 2016: NSW 10.3%)
9.1% Of mothers were of Aboriginal descent (MLHD 2016: NSW 4.2%)
16.7%
Of mothers had smoked during pregnancy (MLHD 2016: NSW 8.3%)
75.5%
Of babies were being fully breastfed at discharge (MLHD 2016: NSW 74.9%)
More babies being fully breast-fed on discharge home
MLHD to
NSW
More mothers who smoke during pregnancy and have later 1st visit for antenatal
care
ANTENATAL CARE Antenatal care (or pre-natal care) should commence as early as possible in
pregnancy to ensure the best outcomes for the mother and the baby. Up to
2010, the question asked at data collection was ‘Duration of pregnancy at first
antenatal visit’. From 2011, the question asked is: ‘Duration of pregnancy at
first comprehensive booking or assessment by clinician’. Because this new
question more specifically defines the type of visit that is reported as pre-natal
care, the proportion of mothers who commenced pre-natal care in 2011 is
lower than in previous years. In 2016 there were 2370 live births in NSW to
MLHD resident mothers (NSW Perinatal Data Collection which includes only
births occurring in NSW-based hospitals or attended by NSW midwives). In
2016, 63.9 per cent of mothers had antenatal care prior to 14 weeks gestation
and 83.2 per cent had antenatal care prior to 20 weeks gestation, these rates
were slightly lower than NSW at 67.8 per cent and 88.8 per cent respectively.
The rates of antenatal care prior to 14 and/or 20 weeks gestation had been
increasing in MLHD and NSW since 2001 but has dropped significantly since
the definition change and has started to increase since 2015. For Aboriginal
mothers in MLHD 2016, 60.5 per cent had antenatal care prior to 14 weeks
gestation and 80.0 per cent had antenatal care prior to 20 weeks gestation
(18.6% not getting antenatal care until 20+ weeks gestation).
LOW BIRTH WEIGHT A baby's birth weight is an important outcome measure of the health of the
mother and her care during pregnancy. Low birth weight is defined as less
than 2,500 grams (5.5 pounds). In MLHD in 2016, 6.7 per cent of babies (161)
were of low birth weight, which was similar to the NSW rate of 6.6 per cent.
The rate in MLHD has fluctuated between 4.5 and 5.5 per cent from 2001 to
2014 and risen to over 6 per cent in 2015 and 2016, and for NSW has remained
around 6 per cent over this period. For babies born to Aboriginal mothers in
MLHD 14.7 per cent were of low birth weight in 2016 (32 babies out of 218).
SMOKING DURING PREGNANCY The prevalence of smoking anytime during pregnancy in MLHD has declined
from 27 per cent in 2001 to 16.7 per cent in 2016, however rates were higher
than for NSW at only 8.3 per cent. All the rural LHDs had higher percentages
of mothers who smoked during pregnancy compared to the NSW total and
the metropolitan LHDs. Aboriginal mothers were more likely to have smoked
during pregnancy than non-Aboriginal mothers (45.6% compared to 13.7% in
MLHD 2016). Aboriginal mothers made up 9 per cent of all mothers in MLHD
but 25 per cent of mothers who smoked. Mothers living in LGAs where babies
may be born in Victoria or the ACT (including the major maternity unit of
Albury Wodonga Health) are not included in the NSW Perinatal Data and
therefore data will be incomplete for border areas.
Summing up People in rural and remote Australia tend to have higher rates of disease and injury and die younger than their counterparts in major cities. This can be explained
in part because they have poorer access to goods and services and educational and employment opportunities, as well as lower levels of income. (National Rural
Health Alliance 2018).
The five disease groups causing the most burden on health in Australia in 2011 were cancer, cardiovascular diseases, mental and substance use disorders,
musculoskeletal conditions and injuries; together, these account for 66 per cent of the total burden. Coronary heart disease, back pain and problems, chronic
obstructive pulmonary disease and lung cancer, as the leading specific diseases, contributed 18 per cent of the total burden (Burden of Disease Study, Australia
2011, AIHW, 2016). At least 31 per cent of the burden of disease in 2011 was considered preventable. The risk factors causing the most burden were tobacco use,
high body mass, alcohol use, physical inactivity and high blood pressure. (AIHW, 2011).
The prevalence of personal and behavioural risk factors tend to increase with increasing remoteness due to a failure to reduce them over the years, for example,
where smoking rates have decreased significantly in major cities since the 1990’s they have not decreased as markedly in rural and remote areas, which suggests
that public health campaigns and other preventive interventions are not working as well in rural and remote areas as in the major cities (National Rural Health
Alliance 2011).
The MLHD population follows many of the traits expressed for rural areas in Australia, with higher levels of major health risk behaviours such as smoking, high
alcohol consumption, high body mass, physical inactivity and low fruit and vegetable consumption. These risks impact significantly on the likelihood of developing
cardiovascular disease, respiratory disease, diabetes and cancer, conditions which place a heavy burden on already stretched rural health services.
For 2018
Ongoing challenges Could do better Improving Ageing population
Aboriginal health
Socioeconomic disadvantage
Lower levels of academic qualifications
Rural isolation/ access
Increasing cost of chronic disease
Cardiovascular disease
Diabetes and dialysis
Chronic Obstructive Pulmonary Disease
Preventable deaths and hospitalisations
Overweight and Obesity
Alcohol hospitalisations
Mental health
Bowel cancer
Injury (falls in particular)
Diet and food security
Exercise
Smoking
Survival rates from cancer
Smoking
Smoking during pregnancy
Risk alcohol consumption
Cervical cancer – new cases
Lung cancer – new cases
Death from flu
COPD hospitalisation
Cardiovascular disease hospitalisation and deaths
Data sources The data quoted in this document are from two main sources, the methods, coding and additional information about the data can be accessed via the following
websites:
1. Social Health Atlas of Australia 2018, Public Health Information Development Unit (PHIDU), http://phidu.torrens.edu.au/ 2. Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health 2018, Sydney. www.healthstats.nsw.gov.au
NSW Admitted Patient Data ABS Deaths NSW Health Survey: adult and children reports NSW School Students Survey NSW Central Cancer Registry NSW Perinatal Data Collection
3. Reporting of Better Cancer Outcomes, Performance Report 2017, Murrumbidgee LHD. Cancer Institute NSW, 2017. 4. Cancer Institute NSW online statistics, www.statistics.cancerinstitute.org.au
Supporting information Population projections for NSW – 2016 series: www.mlhd.health.nsw.gov.au/about/health-statistics/ Social Health Atlas Data – compiled from Social Health Atlas of Australia www.mlhd.health.nsw.gov.au/about/health-statistics/ Murrumbidgee LHD reports from : www.mlhd.health.nsw.gov.au/about/health-statistics/ National Rural Health Alliance Fact Sheets http://ruralhealth.org.au/factsheets/thumbs Australian Institute of Health and Welfare Burden of Disease and Injury 2011, published 2016 www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-
causes-of-illness-death-2011
Infographics Next two pages: (available from http://www.mlhd.health.nsw.gov.au/about/health-statistics/)