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/
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
Potentially Preventable Hospitalisations ...... 19 Contents Health topics ...... 22 Injury and poisoning ...... 22 Contents ...... 2 Cardiovascular disease ...... 24 Figures ...... 3 Blood pressure and cholesterol ...... 27 Tables ...... 3 Diabetes ...... 28 The Murrumbidgee LHD ...... 4 Respiratory disease ...... 29 Facilities ...... 5 COPD ...... 29 The population ...... 6 Asthma ...... 29 The population now ...... 6 Influenza and pneumonia ...... 30 The population in the future ...... 6 Mental health (suicide and self-harm) ...... 31 Summary from the Census ...... 8 Cancer ...... 33 Cultural and linguistic diversity ...... 8 Breast cancer ...... 34 Education ...... 8 Lung cancer ...... 34 The working population ...... 8 Bowel cancer ...... 35 Socioeconomic disadvantage 2016 ...... 8 Skin Cancer ...... 35 Families ...... 11 Prostate cancer ...... 35 Income support ...... 11 Cervical cancer ...... 35 Disability ...... 12 Risk Behaviours ...... 37 Burden of Disease ...... 13 Smoking...... 38 Mortality ...... 13 Alcohol ...... 39 Life expectancy ...... 13 Physical activity ...... 40 Causes of death ...... 14 Fruit and vegetable consumption ...... 41 Potentially avoidable deaths ...... 14 Obesity/ high BMI related illness ...... 42 Hospitalisations ...... 15 Food insecurity ...... 43
Pregnancy and the newborn ...... 44 Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW ...... 23 Antenatal care ...... 44 Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW 25 Low birth weight ...... 44 Figure 13 - Circulatory procedures, Murrumbidgee LHD 2001-02 to 2015-16 (Health Statistics NSW) ...... 27 Smoking during pregnancy ...... 44 Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW ...... 30 Summing up ...... 45 Figure 15 – Mental and behavioural disorders trend in deaths and hospitalisations, For 2018 ...... 46 MLHD and NSW ...... 32 Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW ...... 34 Data sources ...... 47 Figure 17 - Trend in adult smoking prevalence, MLHD and NSW 2002 to 2017 ...... 38 Supporting information ...... 47 Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 to 2017 ...... 39 Infographics ...... 47 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 Figures Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 to Figure 1 – NSW Local Health Districts ...... 4 2017 ...... 42 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 Tables Figure 4 - 2016 Australian Bureau of Statistics Census and PHIDU Social Health Atlas Table 1 - MLHD facilities by type and location ...... 5 data...... 9 Table 2 - Income support recipients by type of benefit and eligible population, MLHD Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local and NSW, June 2016 ...... 11 Government Area ...... 10 Table 3 - Hospitalisations by cause and sex, Murrumbidgee LHD and NSW, 2016-17 Figure 6 - Deaths by category of cause, MLHD, 2015 (HealthStats NSW 2018) ...... 14 (Health Statistics NSW, 2018)...... 17 Figure 7 - Hospitalisation all causes trend 2011-02 to 2016-17, MLHD (HealthStats Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015- NSW, 2018) ...... 15 16 (Health Statistics NSW) ...... 21 Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018) ...... 16 Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Figure 9 - Potentially preventable Hospitalisations all conditions, MLHD and Total Statistics NSW, June 2018) ...... 26 NSW, 2015-16 (HealthStats NSW, 2018) ...... 19
Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018) ...... 20
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 3/49 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. 4/49 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 Cootamundra, Corowa, Leeton, Narrandera, (D1a) Temora, Tumut Community Hospitals without Finley, Hay, Holbrook, Harden, West Wyalong surgery (D1b) Multi Purpose Services (F3) Barham, Batlow, Berrigan, Boorowa, Coolamon, Culcairn, Gundagai, Henty, Hillston, Jerilderie, Junee, Lake Cargelligo, Lockhart, Tocumwal, Tumbarumba, Urana Affiliated Health Organisations Mercy Health Service Albury and Mercy Care Centre Figure 2 - MLHD Facility locations and Local Government Areas (sub-acute F4) 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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 5/49 largest percentage growth were: Junee (5.1% net increase of 315 people), The population 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 Estimated Wagga Wagga people). LGAs with the largest percentage decrease were, Narrandera (-1.9% 242,840 resident + 1,922 LGA population net decrease of 177 people), Hay (-1.8% net decrease of 53 people) and Lake population increase Cargelligo (-1.1% net decrease of 21 people). (June 30, 2016) P (2012 to 2016) O Junee and Annual growth Carrathool LGAs + 1,000 In MLHD P + 5% The population in the future (2012 to 2016) U % increase (2012 to 2016) The population is projected to grow by just over 1 per cent from the ERP 2011 L to 2021 to reach approximately 244,870 people then increase by 0.5% to Narrandera LGA Annual growth 246,220 by 2026 with a projected decline from 2026 to 2031 (2016 A decrease (177 + 1.8% In MLHD - 2% Department of Planning and Environment New South Wales State and Local T people) (2012 to 2016) Government Area Population Projections). This is slow to negative growth I (2012 to 2016) compared to total NSW figures which increased by 6.8 per cent from 2011 to O Projected 2016 and are projected to increase by around 6 per cent for the next two five- Projected increase in N year forecast periods. The Albury LGA had a population of 49,451 in 2011 this + 1 % growth + 10,000 people aged 75+ is projected to increase to 52,100 by 2016 (+5.1% increase from 2011) then to (2011 to 2021) years 56,550 by 2026. (2011 to 2026) While the overall MLHD population number is not projected to change significantly, projections indicate growth in the older population (Figure 3). The population now People aged 75 years and over made up 8 per cent of the total population in The MLHD as of June 2016, had an estimated resident population (ERP) of 2011 (around 18,000 people), this is projected to increase to 12 per cent of 242,840 (Albury LGA of 52,165 is not included). The Murrumbidgee LHD has the total population in 2026 (around 29,000 people) an increase of more than grown by approximately one thousand people per year from 2012 to 2016 a 10,000 older people. The aged population in NSW was 7 per cent in 2011 1.8 per cent increase over the five years. The largest population increase was increasing to 9 per cent in 2026. There were 3,547 people aged 75 years or in Wagga Wagga with an extra 1,922 people since 2012, followed by Griffith over in Albury in 2011 this is expected to increase to 4,000 in 2016 and to with an extra 784 (Albury LGA had an increase of 2,363 people). LGAs with the 5,800 in 2026.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 6/49
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. 7/49 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 Summary from the Census Christian-based (68% in MLHD and 55% in NSW, 2016). Education Non-English Seventy-nine per cent of sixteen year olds in MLHD were full-time participants Aboriginal people 5.3% Speaking COB 4.8% (2.9% NSW) in secondary school compared to eighty –four per cent in NSW (in 2016). Five (21% NSW) per cent of the MLHD population were enrolled in Tertiary education, Speak Language C Difficulty speaking compared to seven per cent in NSW. The age standardised rate of people who other than English 6.1% E < 1.5% English left school at Year 10 or who did not go to school in Murrumbidgee was 42 per at home (4.5% NSW) (25.5% NSW) N 100 adults compared with 33 per 100 adults in NSW. Education to Year 12 (or Post school equivalent) was reported by 34 per cent of the adult population compared to Unemployed S 52 per cent of NSW. University education of Bachelor degree or higher were 41% qualifications 4.8% (5.9% NSW) 15+ years (50.4% NSW) U reported by 11.4 per cent of the MLHD population compared to 23.4 per cent People needing Concession card in NSW. In 2016, 41 per cent of adults had attained some type of post school S assistance with 66,000 holders (27% of the 13,019 qualification in MLHD compared to 50.4 per cent of NSW. population compared to core activities 24% NSW) (5.5% of the population compared to 5.4 % 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 A full report of Census statistics for Murrumbidgee LHD is available at: agriculture was the main industry employer followed by Health Care and www.mlhd.health.nsw.gov.au/about/health- Social Assistance (11.8%), retail trades (9.7%) and manufacturing (9.3%). The statistics/dem/MurrumbidgeeCensus2016profile_release2_Dec2017.pdf 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 Cultural and linguistic diversity 2017 the unemployment rate for the September Quarter for MLHD LGAs The people of MLHD were mostly born in Australia (82.2%, 2016) or were from varied, with highest unemployment in Edward River (7.7%), Hilltops (6.9%) English speaking overseas countries (3.2%, 2016). Only 5.3 per cent of the and Narrandera (6.5%) and the lowest Lockhart (2.6%), information is not MLHD population were born in a predominantly non-English speaking country available for Lake Cargelligo. (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 Socioeconomic disadvantage 2016 respectively. Just over one per cent of the MLHD population had difficulty The Index of Relative Socio-economic Disadvantage (IRSD) is a general socio- speaking English compared to 4.5 per cent in NSW. People of Aboriginal economic index that summarises a range of information about the economic
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 8/49 and social conditions of people and households within an area. Unlike the The SEIFA score of 1000 is the national mean, scores below 1000 show higher other indexes, this index includes only measures of relative disadvantage. A disadvantage than the average and scores above 1000 show less low score indicates relatively greater disadvantage in general. For example, an disadvantage. A score of 500 does not indicate twice as much disadvantage as area could have a low score if there are (among other things): - many a score of 1000, a decile band of 1 indicates the top 10 per cent most households with low income, many people with no qualifications, or many disadvantaged areas. Narrandera and Lachlan are the LGAs with the greatest people in low skill occupations. A high score indicates a relative lack of average disadvantage within MLHD (Figure 5). These LGAs are among the top disadvantage in general. For example, an area may have a high score if there 25 per cent of disadvantaged LGAs in Australia and rank 21st and 25th are (among other things):- few households with low incomes, few people with respectively of the 129 LGAs in NSW. Averaging scores to LGA level may mask no qualifications, and few people in low skilled occupations. 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. 9/49 Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local Government Area
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 10/49 Table 2 - Income support recipients by type of benefit and eligible population, MLHD Families and NSW, June 2016 There were approximately 94,500 occupied private dwellings in the MLHD in MLHD NSW 2016, 60,451 family households (64% of households) and 24,378 lone person Income support benefits Age pensioners households (26%). In MLHD 23,989 households (25.4% of all households) were Age pensioners 32410 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 Persons aged 65 years and over 45755 families (10.7%) to MLHD and more couple families with children (31.5%), % age pensioners 70.8 67.6 Disability support pensioners most likely due to a younger age structure than MLHD. More families, Disability support pensioners 9543 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 Persons aged 16 to 64 years 144530 NSW (2016) was $1780/week the approximate median for MLHD is % disability support pensioners 6.6 5.2 $1500/week with Gundagai, Berrigan and Hilltops LGAs having median family Female sole parent pensioners incomes below $1000/week. Twenty per cent of families reported incomes of Female sole parent pensioners 3271 over $4,000/week in NSW compared to 15% of families in MLHD. In 2011, Females aged 15 to 54 years 56976 there were 6,523 children under 15 years in jobless families (or 14.6% of all % female sole parent pensioners 5.7 3.7 children under 15 years compared to 14.7% in NSW), this varied by LGA with People receiving an unemployment benefit the highest percentage of children in jobless families in Hay (21.7%), Lake People receiving an unemployment benefit 8219 Cargelligo (20.2%) and Narrandera (19.9%) and the lowest in Jerilderie (8.6%) Persons aged 16 to 64 years 144530 and Lockhart (10.1%) (PHIDU Social Health Atlas, Dec 2017). % people receiving an unemployment benefit 5.7 4.8 People receiving an unemployment benefit long-term Income support People receiving an unemployment benefit for longer than 6839 Murrumbidgee LHD had approximately 32,400 aged pensioners in June 2016, 6 months 71 per cent of the eligible population compared to 68 per cent in NSW. In June Persons aged 16 to 64 years 144530 2016 there were 14,000 Health Care Card holders in MLHD and 52,000 % people receiving an unemployment benefit long-term 4.7 4.0 Pensioner Concession Card holders making a total of approximately 66,000 Young people aged 16 to 24 receiving an unemployment benefit concession card holders or 27 per cent of the total population compared to 24 Young people 1132 per cent in NSW. The percentage of concession card holders ranged from over (16 to 24 years) receiving an unemployment benefit Persons aged 16 to 24 years 27793 one third of the population in Federation (34.5%), Berrigan (34.1%) Gundagai % young people receiving an unemployment benefit 4.1 3.0 (33.9%) and Cootamundra (33.7%) to less than a quarter of the population in Low income, welfare-dependent families (with children) Carrathool (21.6%), Griffith (23.5%) Junee (24.2%) and Wagga Wagga (24.4%) Low income, welfare-dependent families (with children) 6420 (PHIDU Social Health Atlas, March 2018). Full income support details for the 60540 MLHD population are in Table 2. Total families % low income, welfare-dependent families (with children) 10.6 9.9
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 11/49 Income support benefits MLHD NSW per cent in all NSW. Cootamundra (11.6%) and Urana (11.5%) had the highest Children in low income, welfare-dependent families percentages of their eligible populations on disability pensions among MLHD
Children in low income, welfare-dependent families 12570 LGAs, and Conargo (2.5%) and Carrathool (4.2%) the lowest.
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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 12/49 Burden of Disease Mortality LIFE EXPECTANCY Life expectancy in NSW and MLHD continues to increase. In 2015 newborn D Hospital males could expect to live for 80.9 years in NSW and 79.5 years in MLHD, while Male Life 79.5 I admissions per newborn females could expect to live for 85.0 years in NSW and 83.9 years in expectancy S 127,143 year years MLHD. At age 65 years males could expect to live until age 85.0 years in NSW at birth (NSW 80.9 yrs) E (significantly high rate compared to NSW) and 84.5 years in MLHD and females until 87.6 in NSW and 87.4 years in MLHD. A S Potentially Although females can still expect to live longer than males, the gap between Preventable the sexes is narrowing. In NSW life expectancy increased by 10 years for Female Life E 83.9 Hospital (PPH) females since 1974, whereas there has been a 10 year increase for males since expectancy 8,367 B admissions per 1980. years at birth (NSW 85.0 yrs) U year (close to 6.5% of all Life expectancy at birth in 2015 by LGA differs by approximately four years R admissions) from the highest in Lockhart of 85.7 to the lowest in Narrandera of 81.2. D Hospital bed days Deaths per year E The median age at death for MLHD was 78 years for male; 84 years for females 2,409 In 2015 27,329 a year for PPH N (2015-16) (2010 to 2014), the same as for NSW (PHIDU 2018). Potentially avoidable deaths Of all hospital Aboriginal people have a much shorter life expectancy than non-Aboriginal per year admissions in people. In 2010-12, life expectancy in NSW was estimated to be 70.5 years in 344 (significantly higher rate 10% MLHD are for Aboriginal males and 74.6 years in Aboriginal females, almost 10 years lower in MLHD 129.0/100,000 compared to NSW dialysis than in males and females in the general population (ABS 3302.0.55.003 105.9/100,000) 2013). MLHD Significantly higher Significantly higher death rate to hospitalisation rate for all for all causes and potentially NSW causes and potentially avoidable causes preventable causes
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 13/49 CAUSES OF DEATH POTENTIALLY AVOIDABLE DEATHS The age-adjusted “all cause” death rate 2015 in MLHD was significantly higher Potentially avoidable deaths are those that occur before age 75 years and are than expected based on NSW rates (603.1 per 100,000 population compared caused by conditions that are potentially preventable through individualised to 546.0 per 100,000 in NSW). There were 2,409 deaths in MLHD 2015 and the care and/or treatable through existing primary or hospital care. Deaths are death rate has been decreasing steadily for both males and females since the defined as avoidable in the context of the present health system. MLHD in early 2000’s. The major causes of death for males and females are circulatory 2014-15 had an annual average of 344.0 avoidable deaths with an age- diseases and cancers (Figure 6). 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. 14/49 Hospitalisations The most significant cause of hospitalisation in MLHD (2016-17) was “other In 2016-17 financial year there were 127,143 episodes of hospital care for factors influencing health care” (ICD10 Z-codes*) (15,383 episodes, 12.1%); residents of the MLHD. The age-adjusted rates of hospitalisation were followed by digestive system diseases (13,327, 10.5%), and then dialysis significantly higher than the NSW averages for both sexes separately and (12,630 episodes, 9.9%). The pattern for most causes was similar for males combined. In the past 20 years hospitalisation rates have steadily increased 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) 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 Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 15/49 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).
Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018)
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 16/49 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 Rate per 100,000 LL 95% CI UL 95% CI Rate per 100,000 LL 95% CI UL 95% CI Different from hospitalisations population population 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. 17/49 Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of Rate per 100,000 LL 95% CI UL 95% CI Rate per 100,000 LL 95% CI UL 95% CI Different from hospitalisations population population 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. Males 986 1.6 830.6 779.4 884.2 729.0 720.5 737.6 HIGH congenital 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 Males 5,996 9.6 4071.4 3964.8 4180.0 2894.0 2877.4 2910.6 HIGH findings 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. 18/49 Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of Rate per 100,000 LL 95% CI UL 95% CI Rate per 100,000 LL 95% CI UL 95% CI Different from hospitalisations population population 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. 19/49 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 Diabetes complications Asthma Ear, nose and throat infections Bronchiectasis Gangrene Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018) Cellulitis Hypertension Congestive cardiac failure Iron deficiency anaemia Convulsions and epilepsy Urinary tract infections, including pyelonephritis COPD
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 20/49 Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015-16 (Health Statistics NSW)
Murrumbidgee LHD NSW PPH Conditions Number Rate per 100,000 Average bed days Total bed Rate Average bed days Rate in MLHD days Compared to NSW 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. 21/49 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 Health topics 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, Injury and poisoning 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). Male suicides per For the MLHD population injury and poisoning hospitalisations had been 128 Deaths per year 25 year (Average 2011-2015) increasing steadily from early 2000’s to around 2009 when they dropped Of all deaths I Female suicides per slightly for males and females and have since increased to 2016-17, NSW rates 5.9% (6.6% for males, 5.1% N 3 year have shown more of a gradual increase (Figure 11). Injury and poisoning was females) (Average 2011-2015) J recorded as the principal diagnosis in a total of 10,391 episodes of care in Admissions to Admissions to 2016-17 for MLHD residents (data for acute hospital transfer and “statistical U 10,391 hospital 2,405 hospital for falls discharge” were excluded). MLHD had the highest rate of hospitalisation for In 2016-17 In 2015-16 R injury among all NSW LHDs at 4,009 per 100,000 population, significantly Of all injury hospital Y higher than the NSW rate of 2,598 per 100,000 as well as all other LHDs in Admissions per day admissions in MLHD 28 across MLHD 7% are for Motor NSW. Approximately 2,405 injury hospitalisations in 2015-16 in MLHD were Vehicle Crashes due to fall-related injury making up 26 per cent of all injury hospitalisations; MLHD 703 motor vehicle transport related (7%); and 437 self-harm related (5%). Not significantly higher death Significantly higher to Females were overrepresented in the self-harm hospitalisations with close to rate hospitalisation rate NSW 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 There were 128 injury and poisoning deaths in 2015 (including suicide) in NSW as of March 2018). 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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 22/49
Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 23/49 Cardiovascular disease 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 Admissions per day 629 Deaths per year 24 steadily since the early 2000’s and still dropped significantly from 2009-10 to across MLHD 2012-13 and again in 2014-15 where the rate is no longer significantly higher Revascularisation Of all deaths than the rest of NSW (Figure 12). The majority of deaths were due to coronary 28.9% (29.6% NSW) C 662 procedures per year heart disease (38%) followed by stroke (16%), heart failure (10%) and (MLHD 2015-16) peripheral vascular disease (4%); (“other circulatory diseases” made up 32% V Of MLHD adults of circulatory disease deaths). Rates of death for all causes have been Admissions to reported High Blood D decreasing since 2000 except for “other circulatory diseases”. 8,722 hospital 33% Pressure In 2016-17 (NSW Health Survey In 2016-17 there were 8,722 hospitalisations in total for circulatory disease, 2013) (27% for coronary heart disease, 11% heart failure, 11% atrial fibrillation and MLHD Not significantly higher death Significantly higher flutter and 7% for stroke). Circulatory disease also comprises hospitalisation to rate hospitalisation rate for varicose veins and haemorrhoids which together make up 16 per cent of NSW 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 Cardiovascular (or circulatory) diseases comprise all diseases of the heart and NSW at 1,765 per 100,000. Overall Murrumbidgee LHD had the highest rates blood vessels. Among these diseases, the four types responsible for the most of most categories of circulatory disease hospitalisation compared to other deaths in NSW are: coronary heart disease (or ischaemic heart disease), stroke LHDs in NSW and in fact was statistically significantly higher for almost all (or cerebrovascular disease), heart failure, and peripheral vascular disease. categories from all LHDs – with the exception of tachycardia, varicose veins Other causes of death are cardiac arrhythmias (most notably atrial and TIA (Table 5 and Figure 12). 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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 24/49
Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 25/49 Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Statistics NSW, June 2018)
Murrumbidgee LHD NSW Circulatory disease type Rate per Rate per Number of 100,000 100,000 UL 95% Comparison separations population LL 95% CI UL 95% CI population LL 95% CI CI 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. 26/49 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).
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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 27/49 Diabetes 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 Deaths with Of hospital episodes responsible for dramatic decreases in the number and rate of hospitalisation diabetes as of care were for 62 underlying cause D 10% dialysis for diabetes as a principal diagnosis in NSW between 2009-10 and 2010-11 (MLHD 2015) I (MLHD 2016-17) (around a 60% drop), then in 2012 the coding changed again, this time to Deaths where include diabetes as a comorbidity if it is mentioned in the patients notes which A Of adults reported underlying or B being diagnosed has resulted in a spike in comorbidity coding. 218 associated cause is 13.5% E with diabetes diabetes (MLHD 2017) In the 2017 NSW Health Survey 13.5 per cent of adults in MLHD said they had (MLHD 2015) T been diagnosed with diabetes or high blood glucose (not during pregnancy) Of all deaths were E Aboriginal adults this was higher than NSW adults at 10.1 per cent (but not significantly so). The attributed to 9% S 14.0% reported diabetes prevalence of adult diabetes has been gradually increasing in MLHD since the diabetes (NSW 2017) (MLHD 2015) early 2000s to 2017 with some annual fluctuations. Diabetes prevalence MLHD increases with age, increasing levels of disadvantage and is more prevalent Not significantly higher death Significantly higher to among Aboriginal people. rate hospitalisation rate NSW
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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 28/49 Respiratory disease 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). Of hospitalisations Deaths from were for COPD 228 respiratory diseases 6.5% respiratory Chronic Obstructive Pulmonary Disease (COPD), which includes chronic (MLHD 2015) disease bronchitis and emphysema accounted for an average of 111 deaths per year (MLHD 2015) R (2013 to 2015) in MLHD at an age adjusted rate of 30.5/100,000 which was COPD Of all deaths were E significantly higher than NSW rate of 24 per 100,000. Death rates from COPD from respiratory hospitalisations 10.5% S 1,500+ declined dramatically for males from the early 2000s to 2008-2010, but have diseases per year (MLHD 2015) P (MLHD 2015) been increasing slightly since then for both men and women. There were I Of children 1,548 hospitalisations for COPD in MLHD in 2016-17 the rate was significantly Deaths per year R reported to higher than NSW (MLHD: 436.8 per 100,000, NSW: 253/100,000). Cigarette 111 from COPD A 21% currently have smoking is the main risk factor for both COPD and lung cancer and the current (MLHD 2013-2015) T asthma incidence rates of these conditions reflect smoking rates 20 years and more in (MLHD 2014-2015) O the past. People die per R Of adults reported 6 year from asthma 19% to have asthma ASTHMA (MLHD 2016) Y (MLHD 2017) Approximately six people have died per year from asthma in MLHD from 2012 Deaths per years Influenza and to 2015. The latest age-standardised death rate of 1.5 per 100,000 for 2014- from influenza pneumonia 35 1,670 2015 was the same as the NSW rate. The death rate has been decreasing since and pneumonia hospitalisations (MLHD 2014-2015) (MLHD 2015-2016) the early 2000s. There were 677 hospitalisations of Murrumbidgee LHD MLHD Significantly higher residents of all ages in 2016-17 for asthma at a rate of 278.2 per 100,000 Not significantly higher death to hospitalisation rate for COPD, population, which was significantly higher than the NSW rate of 177.2 per rate from suicide NSW asthma and influenza & 100,000. The hospitalisation rate for those aged 5-34 years, where asthma is pneumonia 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 Respiratory disease deaths made up 10.5 per cent of deaths in MLHD 2015, 100,000 and has been gradually decreasing since the early 2000s. In the 2017 the main contributor to respiratory disease deaths for 2013-2015 was chronic NSW Health Survey, 19.1 per cent of the adult MLHD population reported obstructive pulmonary disease (COPD) making up 58 per cent of respiratory having current asthma (symptoms or treatment for asthma in the past 12 deaths. There were 8,270 hospitalisations for respiratory disease in MLHD in months) which was significantly higher than NSW at 10.9 per cent. In 2015-16 2016-17 making up 6.5 per cent of all hospitalisations at an age-adjusted rate 21.4 per cent of children aged 2 to 15 years were reported to have current of 2,965 per 100,000 which was significantly higher than the rest of NSW at 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. 29/49 of childhood asthma among NSW LHDs but was only significantly higher than The number of potentially preventable hospitalisations due to influenza and Sydney and SE Sydney LHDs. 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 INFLUENZA AND PNEUMONIA rate was similar to the NSW rate at 63.8 per 100,000 and accounted for a total Death rates from influenza and pneumonia have dropped significantly in of 1,167 bed days and on average 6.2 bed days per admission in MLHD. 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 In 2015-16 the NSW Health Survey reported that 71.3 per cent of the MLHD higher than 8.6 per 100,000 for NSW. In 2015-16 there were 1,670 population aged 65 years or over had been immunised against flu in the hospitalisations of Murrumbidgee LHD residents of all ages the age-adjusted previous 12 months and 52.2 per cent had been vaccinated against rate of 547.2 per 100,000 was significantly higher than the NSW rate of 349.9 pneumococcal pneumonia in the past 5 years, immunisation rates for per 100,000. There were 105 hospitalisations for those aged 0-4 years (age- influenza were slightly lower than NSW and slightly higher for pneumococcal, adjusted rate: 693.8/100,000) in MLHD and 955 for persons aged 65 years and but not significantly so. Influenza immunisation rates for the 65 plus age over (age-adjusted rate: 1971.8/100,000, 57% of total), the rate for the older group, reported by the NSW Health Survey, have mostly remained above 70 population was significantly higher than NSW at 1,236 per 100,000. In older per cent since 2002-2003 in MLHD and in NSW, for pneumococcal people in MLHD, the rate of influenza and pneumonia hospitalisations for immunisation the rates reached a peak of close to 70 per cent in 2011-2012 males was over 1.5 times that of females. Influenza and pneumonia and have since dropped to around 50 per cent. hospitalisations are considered to be partly preventable through immunisation.
Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 30/49 Mental health (suicide and self-harm) 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 Deaths from olds in MLHD in 2016-17, both rates were significantly higher than NSW and mental and Hospitalisations for M the rate for young males was the highest among all LHD and for young females 107 behavioural 2,949 mental disorders the second highest in NSW LHDs. There were 2,949 hospitalisations for mental disorders (non- E per year disorders (not suicide or self-harm related) in 2016-17 at a rate significantly suicide) N (MLHD 2016-17) (MLHD 2015) T lower than NSW. The death rates and hospitalisations rates for mental and Deaths from A Hospitalisations for behavioural disorders have been increasing since the early 2000’s in both NSW 33 suicide L 523 self-harm and MLHD (Figure 15). (MLHD 2015) (MLHD 2016-17)
Of adults reported In the 2015-2017 NSW Health Survey 15.7 per cent of adults in MLHD had high H Female suicide to have high to very high psychological distress (assessed by the K10 10-item questionnaire 3 deaths per years E 15.7% psychological that measures the level of psychological distress in the most recent 4-week (MLHD 2011-2015) A distress period) a rate slightly higher than NSW at 13.4 per cent, there has been an L (MLHD 2017) increase in the rate of “High distress” in MLHD in recent years (but not T Of 12-17 year olds significant). Male suicide H reported to have 25 deaths per years 13.4% high psychological Behavioural problem risk is a recent indicator included in the NSW Child (MLHD 2011-2015) distress Health Survey which is a series of questions from the Strengths and Difficulties (MLHD 2014) Questionnaire (SDQ) (see methodology section of NSW Health Statistics for MLHD Significantly higher Significantly lower death rate more information). In 2013-14 it was determined by this survey that 8.0 per to hospitalisation rate for self- from mental disorders cent of children (aged 2-15 years) in MLHD were at substantial risk of NSW harm 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, There were 107 deaths due to mental and behavioural disorders in 2015 at a 32.8 per cent were nervous, stressed or under pressure and 15.8 per cent had rate of 25.0 per 100,000 population in MLHD this rate was significantly lower been in trouble because of behaviour a further 13.4 per cent were rated as than that of NSW at 32.2 per 100,000. In 2015 there were 33 deaths from having high psychological distress (this is for the combined MLHD and suicide registered in the MLHD population, with an average number per year Southern NSW LHDs). 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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 31/49
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. 32/49 Cancer 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 New cases of Deaths from cancer descending order were: prostate cancer; colorectal cancer; breast cancer; 665 1,686 cancer (MLHD 2015) melanoma and lung cancer accounting for 60.4 per cent of new cases. The rate (MLHD 2013) of diagnosis of new cases of cancer in NSW has increased steadily since 1990, Deaths from lung New cases of lung 106 cancer per year 149 cancer per year whereas the death rate has been decreasing. For MLHD it is projected that in (MLHD 2009-2013) (MLHD 2009-2013) 2026 there will be over 2,000 new cancers diagnosed, the majority of these New cases of will be prostate (25%), bowel (13%), lung (10%) and breast (9%) (NSW Cancer Deaths from bowel colon cancer per Registry data (population data are sourced from NSW Ministry of Health 69 cancer per year 135 (MLHD 2009-2013) year Secure Analytics for Population Health Research and Intelligence (SAPHaRI) (MLHD 2009-2013) C and NSW Department of Planning and Environment). Deaths from New cases of A 43 prostate cancer per 352 prostate cancer year N per year There were 665 deaths reported as due to malignant neoplasms in 2015 for (MLHD 2009-2013) C (MLHD 2009-2013) MLHD residents, 264 females and 401 males. In 2015 cancer deaths made up Deaths from E 31 per cent of all causes of death in MLHD and 28 per cent in NSW. The MLHD 32 pancreatic cancer rate was significantly higher than NSW. Narrandera and Lachlan Shires had per year R higher death rates from cancer than expected based on NSW averages,
(MLHD 2009-2013) Murray, Wakool and Conargo Shires all had lower death rates than expected New cases of Deaths from breast based on NSW averages. Death rates and hospitalisation rates from cancer breast cancer per 31 cancer per year 169 have decreased slightly since the early 2000s in MLHD and NSW (Figure 16). (MLHD 2009-2013) year (MLHD 2009-2013) There were 1,686 new cancers diagnosed in MLHD in 2013 at an New cases of Deaths from skin overall incidence rate significantly higher than NSW. melanoma of skin 18 cancer per year 138 Carrathool, Cootamundra, Gundagai and Lachlan Shires all had higher (MLHD 2009-2013) per year (MLHD 2009-2013) than expected incidence rates of new cancers compared to NSW MLHD Significantly higher incidence averages. to of total cancers and deaths MLHD is reported to have significantly higher incidence of bowel Significantly lower death rate NSW from all cancers, prostate and cancer (includes rectal and colon cancers) than other LHD’s and for liver cancer bowel cancer (rectal in significantly higher incidence of urogenital cancers, but significantly particular) lower incidence of skin and thyroid cancers (Reporting for Better Cancer Outcomes, 2015).
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 33/49
Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW BREAST CANCER Albury, Lachlan, Jerilderie, Carrathool, Corowa, Berrigan, Conargo, Wakool From 2009 to 2013 there were on average 169 new cases of breast cancer and Murray were all below the 55 per cent target. Where residents may access diagnosed in MLHD with an age/sex standardised rate of 59.2 per 100,000 services outside NSW (primarily Victorian border areas) the rates of screening population was slightly lower than the NSW rate of 62.4 per 100,000. There then drop significantly below the NSW rate as only NSW based screening is were on average 31 breast cancer deaths per year in MLHD in 2009-2013 with included in the data set. Wakool and Murray LGAs have rates of less than 10 an age-standardised rate of 10.3 per 100,000 which was lower but not per cent due to cross-border flows. significantly different from the NSW rate of death of 11.4 per 100,000 The screening rate for Aboriginal women in MLHD for 2015-16 was 34.1 per population. cent which has been increasing since 2011-12. The rate for culturally and Mammographic screening is seen as the best population-based method to linguistically diverse women was 29.3 per cent in 2015-16 which is significantly reduce mortality and morbidity attributable to breast cancer. BreastScreen below the rates for this group in all NSW. Australia aims to screen at least 55 per cent of women aged 50 to 74 years LUNG CANCER every two years by 2018. The two-yearly screening rate for breast cancer in In MLHD there were on average 149 new cases of lung cancer diagnosed women aged 50-74 years in MLHD for 2015-16 was 53.8 per cent. Lockhart annually from 2009-2013 at an age-adjusted incidence of 47.5 per 100,000 LGA had the highest screening rate among MLHD LGAs at 64.6 per cent of the population this was slightly higher than the NSW rate of 44.2 per 100,000 target women with Temora, Tumut, Murrumbidgee, Cootamundra, Gundagai population. There were 106 lung cancer deaths on average per year in MLHD and Wagga Wagga all above 60 per cent. However Junee, Greater Hume,
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 34/49 2009-2013 at an age-adjusted rate of 33.3 per 100,000 which was similar to PROSTATE CANCER the NSW rate of 33.2 per 100,000. The incidence of lung cancer for males in In 2009-2013 in MLHD there were an average of 352 new cases of prostate MLHD has been decreasing since the late 1980’s as has the rate of death, cancer diagnosed annually at an age-adjusted incidence of 112.4 per 100,000 however for women the incidence and death rates have been increasing, this population which was significantly higher than the NSW rate of 85.3 per is in-line with the general trend in NSW. The incidence of lung cancer was 100,000 population and significantly higher than all other LHDs in NSW. There significantly higher than NSW rates in Hay and Narrandera LGAs (2009-2013). 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 BOWEL CANCER NSW rate of 11.6 per 100,000. The incidence of prostate cancer for males in In 2009-2013 in MLHD there were 213 new cases of bowel cancer (colon and MLHD and in NSW has increased significantly since the late 1980’s, due in part rectal cancers combined) diagnosed on average annually at an age-adjusted to increased awareness, screening and detection, while the death rate has incidence of 69 per 100,000 population, this rate was significantly higher than decreased. Bland, Cootamundra, Griffith, Gundagai, Hay, Murrumbidgee, the NSW rate of 61.5 per 100,000 population. There were on average 69 Temora, Tumbarumba, Urana, Wagga Wagga and Young LGAs all had deaths annually in MLHD from bowel cancer at an age-adjusted rate of 21.4 incidence rates of prostate cancer significantly higher than expected based on per 100,000 which was similar to the NSW rate of 21.4 per 100,000. The NSW rates. 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 CERVICAL CANCER been showing a downward trend for both sexes. The participation rate in In MLHD 2009-2013 there was an average of nine new cases of cervical cancer bowel cancer screening for 2016 in MLHD (including Albury LGA) was 40.8 per diagnosed at an age-adjusted incidence of 4.0 per 100,000 compared to the cent of the 22,349 people who were eligible, which was significantly higher NSW rate of 3.7 per 100,000 population. There were on average 1.8 deaths than the NSW rate of 37.8 per cent. Bland, Greater Hume, Gundagai and per year in MLHD at a rate of 0.3 per 100,000 population which was less than Tumbarumba LGAs all had significantly high incidence rates of bowel cancer the NSW rate of 1.0 per 100,000 but not significantly so. Both incidence of and compared to NSW. Participation rates in the mortality from cervical cancer have decreased since the early 2000s. SKIN CANCER The biennial cervical screening participation rate for 2015-2016 for MLHD was In 2009-2013 in MLHD an average of 138 new cases of melanoma were 54 per cent which was lower than the NSW rate of 56 percent. The screening diagnosed at an age-adjusted incidence of 46.7 per 100,000 population, this rate for MLHD has decreased slightly since 2013-14 but more so in the 25-34 rate was significantly lower than the NSW rate of 54.6 per 100,000 population. year age group than others up to 69 years, however the screening rates in the Approximately 18 people died annually in the 2009-2013 period in MLHD at younger group are in line with NSW rates and in the age groups 35 to 69 years an age standardised rate of 6.0 per 100,000, the rate was similar to NSW at are significantly lower (RBCO Performance Report 2017: Murrumbidgee). 6.3 per 100,000. In MLHD the incidence of melanoma for males and females The uptake of Human Papilloma Virus (HPV) vaccination for females in has increased since the early 2000s whereas the death rate for males and secondary school was reported to be 86.3 per cent of 15 year olds fully females varies over the years due to small numbers. Coolamon and Lachlan immunised in Murrumbidgee in 2014-2015, which was higher than the state LGAs had a significantly high incidence of skin cancer in the 2009-2013 period. 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. 35/49 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. 36/49 Risk Behaviours
Of children
Of adults reported reported adequate Deaths attributed Of adults smoke adequate vegetable vegetable 22% (MLHD 2017, 15% NSW) 253 to smoking per year 6% 8% (MLHD 2013, significantly consumption consumption H higher rate than NSW) (NSW 2017, 7% ) (2 to 15 yrs, NSW 2016-17, E 7% ) Of 12-17 year olds Hospitalisations Of adults reported Of children 5% smoke A reported adequate 2,614 attributed to 39% adequate fruit 63% (MLHD/SNSW 2014, 6.7% smoking per year consumption fruit consumption NSW) L (2 to 15 yrs, NSW 2016-17, (MLHD 2014-15, significantly (NSW 2017, 46% ) T higher rate than NSW) 67% ) Of adults drink Of adults were Deaths attributed Deaths attributed alcohol at risk levels H overweight or to high body mass 34% 51 to alcohol per year 62% 120 obese per year to health (MLHD 2012-2013) (MLHD 2017, 31% NSW) (NSW 2017, 54% ) (MLHD 2013) R Hospitalisations Hospitalisations Of 12-17 year olds Of adults were had drunk alcohol in I attributed to attributed to high 37% 30% obese 1,987 the last month 1,860 alcohol per year body mass S (MLHD 2014-15, significantly (NSW 2017, 21% ) (MLHD 2014-15, significantly (MLHD/SNSW 2014, 37.6% higher rate than NSW) higher rate than NSW) NSW) K Significantly higher prevalence S Of children Of adults had of overweight and obesity in experienced food MLHD Of adults reported reported sedentary adults and higher rates of insecurity in to 51% insufficient exercise 32% behaviour 7% hospitalisations related to NSW (NSW 2017, 42% ) (5 to 15 yrs, NSW 2016-17, previous year smoking, alcohol and high body 44% ) (NSW 2014, 7% ) mass risk factors.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 37/49 SMOKING 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.
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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 38/49 ALCOHOL 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 Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 causes, such as injury and cardiovascular disease as well as liver disease and to 2017 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 Long term adverse effects of high consumption of alcohol on health include males and 566.4 per 100,000 females, which was significantly higher than the contribution to cardiovascular disease, some cancers, nutrition-related NSW rates for males of 797.8 per 100,000 but not for females (NSW: 544.7 conditions, risks to unborn babies, cirrhosis of the liver, mental health per 100,000). The overall rate was 727.3 per 100,000 population in MLHD conditions, tolerance and dependence, long term cognitive impairment, and which was significantly higher than 671.6 per 100,000 in NSW. The age- self- harm. Excessive alcohol consumption is one of the main preventable adjusted rate of alcohol attributable hospitalisations in MLHD has been public health problems in Australia. increasing since the early 2000s for both males and females as is the same for In the 2017 NSW Health Survey risk consumption of alcohol was defined as: NSW. There were 51 deaths per year in the 2012 to 2013 period which could consuming more than 2 standard drinks on a day when drinking alcohol. have been attributed to alcohol in MLHD at rate of 18 deaths per 100,000 Adults in MLHD had a slightly higher rate of risk consumption than NSW in population this was slightly higher than the NSW rate of 16 per 100,000. 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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 39/49 PHYSICAL ACTIVITY 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.
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
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 40/49 FRUIT AND VEGETABLE CONSUMPTION 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.
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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 41/49 OBESITY/ HIGH BMI RELATED ILLNESS 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 Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 (BM) is considered to have contributed to the underlying illness, for example to 2017 a proportion of diabetes and cardiovascular disease admissions. The MLHD Excess weight, especially obesity, is a risk factor for cardiovascular disease, had the highest age-adjusted rate of high BM attributable admissions among Type 2 diabetes, some musculoskeletal conditions and some cancers. As the all LHDs in NSW for males and females separately and for the population as a level of excess weight increases, so does the risk of developing these whole. In 2014-15 in MLHD, 1,987 admissions were attributed to high BM at conditions. In addition, being overweight can hamper the ability to control or an age-adjusted rate of 630.0 per 100,000 population. The MLHD rate was manage chronic disorders (AIHW Cat. no. AUS 122 2010). The NSW Health significantly higher than NSW rate of 436.8 per 100,000 population. In NSW, Survey 2017 reported that in MLHD more adults were overweight or obese (as BM attributable admissions have been gradually declining since 2010-11 as measured by self-reported height and weight used to calculate Body Mass have the rates in MLHD. High Body Mass attributable death rates have been Index) when compared to NSW (MLHD: 62.1%, NSW 53.5%), but not decreasing in MLHD from 2001 to 2013. In 2013 there were estimated to be significantly so. In MLHD 30.2% of adults were classified as obese (significantly 120 deaths in MLHD which could be attributed to high body mass at a rate of higher than NSW at 21.0%) and 31.9% as overweight (not significantly lower 35.9 per 100,000 which was higher than the NSW rate of 29.5 per 100,000, than NSW at 32.5%). In MLHD the proportion of adults who are obese has but not significantly. In 2013 in MLHD, 120 deaths were considered been gradually increasing from 2002 to 2017, however the percentage of attributable to a high body mass, the standardised rate was higher than NSW overweight adults has dropped from 2013 to 2017. NSW rates of adult obesity but not significantly, the death rate has been in decline since 2001. Relatively have been rising gradually, but rates in the overweight category have higher BM related mortality rates by LGA were reported with increasing
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 42/49 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.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 43/49 Pregnancy and the newborn 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 Babies born to Mothers were aged and 83.2 per cent had antenatal care prior to 20 weeks gestation, these rates MLHD mothers in 2,411 4.7% 12-19 years were slightly lower than NSW at 67.8 per cent and 88.8 per cent respectively. NSW hospitals (MLHD 2016: NSW 2.2%)) (MLHD 2016) 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 Of mothers had M first antenatal visit Mothers were aged the definition change and has started to increase since 2015. For Aboriginal O 63.9% before 14 weeks 2.8% 40+ years mothers in MLHD 2016, 60.5 per cent had antenatal care prior to 14 weeks gestation T (MLHD 2016: NSW 4.6%) gestation and 80.0 per cent had antenatal care prior to 20 weeks gestation (MLHD 2016: NSW 67.8%) H (18.6% not getting antenatal care until 20+ weeks gestation). Of mothers had E first antenatal visit R Of mothers were of LOW BIRTH WEIGHT 16.5% at 20+ weeks S 9.1% Aboriginal descent A baby's birth weight is an important outcome measure of the health of the (MLHD 2016: NSW 4.2%) gestation mother and her care during pregnancy. Low birth weight is defined as less (MLHD 2016: NSW 10.3%) than 2,500 grams (5.5 pounds). In MLHD in 2016, 6.7 per cent of babies (161) Of babies were Of mothers had being fully were of low birth weight, which was similar to the NSW rate of 6.6 per cent. smoked during 16.7% 75.5% breastfed at The rate in MLHD has fluctuated between 4.5 and 5.5 per cent from 2001 to pregnancy 2014 and risen to over 6 per cent in 2015 and 2016, and for NSW has remained (MLHD 2016: NSW 8.3%) discharge (MLHD 2016: NSW 74.9%) around 6 per cent over this period. For babies born to Aboriginal mothers in MLHD More mothers who smoke MLHD 14.7 per cent were of low birth weight in 2016 (32 babies out of 218). More babies being fully breast- to during pregnancy and have fed on discharge home NSW later 1st visit for antenatal SMOKING DURING PREGNANCY care 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 ANTENATAL CARE than for NSW at only 8.3 per cent. All the rural LHDs had higher percentages Antenatal care (or pre-natal care) should commence as early as possible in of mothers who smoked during pregnancy compared to the NSW total and pregnancy to ensure the best outcomes for the mother and the baby. Up to the metropolitan LHDs. Aboriginal mothers were more likely to have smoked 2010, the question asked at data collection was ‘Duration of pregnancy at first during pregnancy than non-Aboriginal mothers (45.6% compared to 13.7% in antenatal visit’. From 2011, the question asked is: ‘Duration of pregnancy at MLHD 2016). Aboriginal mothers made up 9 per cent of all mothers in MLHD first comprehensive booking or assessment by clinician’. Because this new but 25 per cent of mothers who smoked. Mothers living in LGAs where babies question more specifically defines the type of visit that is reported as pre-natal may be born in Victoria or the ACT (including the major maternity unit of care, the proportion of mothers who commenced pre-natal care in 2011 is Albury Wodonga Health) are not included in the NSW Perinatal Data and lower than in previous years. In 2016 there were 2370 live births in NSW to therefore data will be incomplete for border areas.
The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 44/49 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 Overweight and Obesity Survival rates from cancer Aboriginal health Alcohol hospitalisations Smoking Socioeconomic disadvantage Mental health Smoking during pregnancy Lower levels of academic qualifications Bowel cancer Risk alcohol consumption Rural isolation/ access Injury (falls in particular) Cervical cancer – new cases Increasing cost of chronic disease Diet and food security Lung cancer – new cases Cardiovascular disease Exercise Death from flu Diabetes and dialysis Smoking COPD hospitalisation Chronic Obstructive Pulmonary Disease Cardiovascular disease hospitalisation and deaths Preventable deaths and hospitalisations
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/)