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Impact of Alcohol on the Population
of Western Australia
Epidemiology Branch
Department of Health WA
January 2008
Abbreviations ABS Australian Bureau of Statistics AF Aetiological Fraction AIHW Australian Institute of Health and Welfare AR-DRG Australian Refined Diagnosis Related Group ARIA+ Accessibility/Remoteness Index of Australia (+) ASR Age standardised rate CI Confidence interval CPI Consumer Price Index DOHAC Department of Health and Aged Care ED Emergency Department EDIS Emergency Department Information System HMDS Hospital Morbidity Data System ICD-9-CM International Classification of Diseases, 9th Revision, Clinical
Modification ICD-10-AM International Statistical Classification of Diseases and Related Health
Problems, 10th Revision, Australian Modification LCI Lower limit for 95% confidence interval MDB Mortality Data Base PYL Person years of life RR Relative risk SLA Statistical local area SMR Standardised mortality ratio SRR Standardised rate ratio TOPAS The Open Patient Administration System UCI Upper limit for 95% confidence interval WHO World Health Organisation YLD Years lost due to disability YLL Years of life lost
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Suggested citation Xiao J, Rowe T, Somerford P, Draper G, Martin J. (2008). Impact of Alcohol on the Population of Western Australia. Epidemiology Branch, Department of Health WA. Acknowledgements Thanks to the following people who provided assistance: Steve Allsop and Richard Pascal of the National Drug Research Institute, Curtin University of Technology for providing per capita consumption data. Emily Schleihauf, Audrey Garden, Kathy Crouchley and Stella Serafino of Epidemiology Branch, Department of Health WA. Laura Santana, Catherine McGregor, Gary Kirby, Naomi Henrickson and Clare Brans of the Drug and Alcohol Office WA. Michele Russell, Non Admitted Data Collections, Information Management and Reporting, Department of Health WA for reviewing alcohol-related ED attendances section. Marea Gent of Health Network, Health Policy and Clinical Reform Directorate, Department of Health WA for advising on Emergency Department services. Gerard Montague of Health Finance, Department of Health WA for providing unweighted ED attendance prices. Particular thanks to Gary Kirby and Naomi Henrickson of the Drug and Alcohol Office WA for reviewing the draft of the report.
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Table of Contents
Abbreviations ......................................................................................................... iii Suggested citation....................................................................................................iv Acknowledgements .................................................................................................iv List of Tables ..........................................................................................................vii List of Figures....................................................................................................... viii List of Appendices....................................................................................................x Executive Summary.................................................................................................1 1. Introduction...................................................................................................3 2. Methodology ..................................................................................................5 2.1 Determining alcohol consumption at different risk levels..............................5 2.2 Choosing relative risk estimates at different levels of risk .............................6 2.3 Deriving Aetiological Fractions by age, sex, Aboriginality and region .........6 2.4 Applying AFs to mortality and morbidity data.............................................10 2.5 Other alcohol-related areas explored ............................................................12 3. Alcohol Consumption in Western Australia.............................................13 3.1 Trends in alcohol consumption.....................................................................13 3.2 Prevalence of alcohol consumption by health region ...................................14 3.3 Prevalence of alcohol consumption by age and sex......................................15 3.4 Prevalence of alcohol consumption by Aboriginality...................................16 3.5 Trend of prevalence of alcohol consumption over time ...............................16 4. Alcohol-Related Hospitalisations...............................................................18 4.1 Hospital admissions and beddays caused by alcohol-related conditions......18 4.2 Top five alcohol-related conditions responsible for hospital admissions.....19 4.3 Top five alcohol-related conditions responsible for hospital beddays..........20 4.4 Age pattern of hospital admissions due to alcohol-caused chronic and acute
conditions......................................................................................................21 4.5 Proportion of all hospital admissions due to alcohol ....................................23 4.6 Impact of alcohol on hospital admissions and beddays ................................24 4.7 Alcohol-caused hospitalisation costs ............................................................26 4.8 Trends in alcohol-caused admissions and beddays for acute and chronic
conditions......................................................................................................27 4.9 Number of alcohol-caused admissions and beddays wholly attributable to
alcohol use ....................................................................................................29 4.10 Comparison of alcohol-caused admission among health regions and SLAs 30 5. Alcohol-Related Mortality..........................................................................36 5.1 Deaths due to alcohol-related conditions......................................................36 5.2 Top five alcohol-related conditions responsible for deaths ..........................38 5.3 Age pattern of deaths (or lives saved) due to chronic and acute alcohol- caused conditions ..........................................................................................39 5.4 Proportion of all deaths due to alcohol by age groups..................................41 5.5 Impact of alcohol on deaths by sex and Aboriginality .................................42 5.6 Person years of life attributed due to alcohol use .........................................43 5.7 Influence of Aboriginality on person years of life attributed to alcohol use 44 5.8 Trends in alcohol-caused deaths for chronic and acute conditions...............45 5.9 Proportion of deaths wholly attributable to alcohol......................................46 5.10 Comparison of alcohol-caused deaths among health regions .......................47 6. Alcohol-Related Emergency Department Attendances...........................50
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6.1. Alcohol-related ED attendances and costs....................................................50 6.2. Alcohol-related ED attendance rates ............................................................56 6.3 Alcohol-related injury and assault ED attendances………………………...57 7. Discussions and Implications .....................................................................58
7.1 Issues about aetiological fractions ................................................................58 7.2 Alcohol-related mortality and morbidity ......................................................59 7.3 Prevalence of alcohol consumption ..............................................................61 7.4 Alcohol-related ED attendances ...................................................................62 7.5 Strengths and limitations of this study..........................................................63 7.6 Conclusion ....................................................................................................64 References...............................................................................................................65 Appendices..............................................................................................................69
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List of Tables Table 1: Total alcohol consumption and per capita consumption (litres of absolute
alcohol per person 15 years and over) by beverage type, WA, 2004/05 .............13 Table 2: Proportions (%) of population aged 14 years and over drinking alcohol at
risky/high risk of harm by short/long-term harm and health region, WA, 2004/05 ............................................................................................................. 15
Table 3: Prevalence of alcohol consumption, Australia, by age, Aboriginality and sex, 2004–05 ........................................................................................................15
Table 4: Proportion of the population aged 18 years and over consuming alcohol at risky or high risk levels, by Aboriginality, region and sex .............................16
Table 5: Alcohol-caused admissions and beddays by sex and condition, WA, 2005..18 Table 6: Number of alcohol-caused admissions by age group, WA, 2005..................22 Table 7: Number of alcohol-caused admissions and beddays, by Aboriginality and
sex, WA, 2005......................................................................................................24 Table 8: Number of alcohol-caused admissions and the cost of hospitalisation,
WA, 2002-2006....................................................................................................26 Table 9: Number of alcohol-caused deaths, by sex and condition, WA, 1997-2005 ..37 Table 10: Number of alcohol-caused deaths and lives saved by age group and sex,
WA, 2005.............................................................................................................40 Table 11: Estimated number of lives lost and saved from alcohol use, by
Aboriginality and sex, WA, 1997-2005...............................................................42 Table 12: Person years of life attributed to alcohol use, by sex and Aboriginality,
WA, 1997-2005....................................................................................................44 Table 13: Number of alcohol-related ED attendances by presenting reason and
year, metropolitan ED departments, WA 2002-2006 ..........................................51 Table 14: Number of alcohol-related ED attendances by teaching status of ED
departments and triage category, metropolitan ED departments, WA 2002-2006.....................................................................................................51
Table 15: Number of alcohol-related ED attendances by gender, presenting reason and triage category, metropolitan ED departments, WA 2002-2006...................52
Table 16: Number of alcohol-related ED attendances by presenting reason and day of week, metropolitan ED departments, WA 2002-2006..............................53
Table 17: Number of alcohol-related ED attendances by presenting reason, region and gender, metropolitan residents, WA, 2005-2006 ..........................................53
Table 18: Number of alcohol-related ED attendances of top 10 diagnostic categories for males, metropolitan ED departments, WA, 2002-2006 ................55
Table 19: Number of alcohol-related ED attendances of top 10 diagnostic categories for females, metropolitan ED departments, WA, 2002-2006.............55
Table 20: Number of alcohol-related ED attendances and costs by teaching status of ED departments, metropolitan ED departments, WA, 2006 .................55
Table 21: Crude rate and age standardised rate of alcohol-related ED attendances by Aboriginality, region and gender, metropolitan residents, WA, 2005-2006 ..57
Table 22: Emergency Department presentations, metropolitan hospitals, WA 2005 –2006……………………………………………………………………...57
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List of Figures Figure 1: Overall analysis process of the project...........................................................5 Figure 2: Standard procedure for calculating aetiological fractions..............................8 Figure 3: Procedure for calculating hospitalisation aetiological fractions for heart
failure .....................................................................................................................9 Figure 4: Procedure for calculating death aetiological fractions for heart failure .........9 Figure 5: Formula for calculating death and hospitalisation AFs for stroke ...............10 Figure 6: Per capita alcohol consumption by beverage type, WA, 1990/91 to
2004/05 ................................................................................................................14 Figure 7: Proportion of respondents reporting alcohol consumption by risk level,
persons aged 16 years and over, WA, 2002–2006...............................................17 Figure 8: Age-specific admission rates for alcohol-caused acute conditions by sex,
WA, 1997-2006....................................................................................................21 Figure 9: Age-specific admission rates for alcohol-caused chronic conditions by
sex, WA, 1997-2006 ............................................................................................22 Figure 10: Alcohol-caused admissions as a percentage of all admissions, by age
group, WA, 2005..................................................................................................23 Figure 11: Impact of alcohol on hospital admissions, WA, 2005................................24 Figure 12: The impact of alcohol on hospital beddays, WA, 2005 .............................25 Figure 13: Age-standardised rates for alcohol-caused admissions by year of
separation, WA, 1997-2006 .................................................................................27 Figure 14: Age-standardised rates for alcohol-caused beddays by year of
separation, WA, 1997-2006 .................................................................................28 Figure 15: Percentage of alcohol-harm (admissions and beddays) wholly
attributable to alcohol, WA, 2005........................................................................29 Figure 16: SRRs and CIs for alcohol-related hospitalisations, males, 2002-2006 ......31 Figure 17: SRRs and CIs for alcohol-related hospitalisations, females, 2002-2006 ...31 Figure 18: SRRs and CIs for alcohol-related hospitalisations, Aboriginal, 2002-
2006......................................................................................................................32 Figure 19: SRRs and CIs for alcohol-related hospitalisations, non-Aboriginal,
2002-2006 ............................................................................................................32 Figure 20: Alcohol-related hospitalisation SRRs relative to the State males by
SLA, males, 2002-2006,WA................................................................................34 Figure 21: Alcohol-related hospitalisation SRRs relative to the State females by
SLA, females, 2002-2006,WA.............................................................................35 Figure 22: Age-specific death rates for acute alcohol-caused conditions, by sex,
WA, 1997-2005....................................................................................................39 Figure 23: Age-specific death rates for chronic alcohol-caused condition, by sex,
WA, 1997-2005....................................................................................................40 Figure 24: Alcohol-caused deaths as a percentage of all deaths, by age group,
WA, 2005.............................................................................................................41 Figure 25: The impact of alcohol on deaths, WA, 1997-2005.....................................42 Figure 26: Average number of person years attributed to alcohol use by sex, WA,
1997-2005 ............................................................................................................43 Figure 27: Age-standardised rates for alcohol-caused deaths and lives saved, by
type of condition and year of death, WA, 1997-2005..........................................45 Figure 28: Percentage of alcohol deaths that are wholly attributable to alcohol, by
Aboriginality and sex, WA, 1997-2005...............................................................46
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Figure 29: SMRs and CIs for alcohol-related deaths, males, 1997-2005 ....................48 Figure 30: SMRs and CIs for alcohol-related deaths, females, 1997-2005.................48 Figure 31: SMRs and CIs for alcohol-related deaths, Aboriginal, 1997-2005 ............49 Figure 32: SMRs and CIs for alcohol-related deaths, non-Aboriginal, 1997-2005.....49 Figure 33: Time of alcohol-related ED attendances, metropolitan ED departments,
WA, 2002-2006....................................................................................................52 Figure 34: Month of alcohol-related ED attendances by presenting reason,
metropolitan ED departments, WA, 2002-2006 ..................................................54 Figure 35: Age specific rate of alcohol-related ED attendances, metropolitan
residents, 2005-2006............................................................................................56
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List of Appendices Appendix 1: AFs for Male Aboriginal Non-Remote ...................................................69 Appendix 2: AFs for Female Aboriginal Non-Remote................................................70 Appendix 3: AFs for Male Aboriginal Remote ...........................................................71 Appendix 4: AFs for Female Aboriginal Remote........................................................72 Appendix 5: AFs for Male Non-Aboriginal Capital City ............................................73 Appendix 6: AFs for Female Non-Aboriginal Capital City.........................................74 Appendix 7: AFs for Male Non-Aboriginal Non-Capital City....................................75 Appendix 8: AFs for Female Non-Aboriginal Non-Capital City ................................76 Appendix 9: Number of alcohol-related hospitalisations, ASRs, SRRs and CIs by
gender and health region......................................................................................77 Appendix 10: Number of alcohol-related hospitalisations, ASRs, SRRs and CIs by
Aboriginality and health region ...........................................................................77 Appendix 11: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Goldfields Health Region...............................................................78 Appendix 12: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Great Southern Health Region .......................................................79 Appendix 13: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Kimberley Health Region...............................................................80 Appendix 14: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Midwest Health Region..................................................................81 Appendix 15: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – North Metro Health Region............................................................82 Appendix 16: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Pilbara Health Region ....................................................................83 Appendix 17: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – South Metro Health Region............................................................84 Appendix 18: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – South West Health Region .............................................................85 Appendix 19: Number of alcohol-related hospitalisations, SRRs and CIs by SLA
and gender – Wheatbelt Health Region ...............................................................86 Appendix 20: Number of alcohol-related deaths, ASRs, SMRs and CIs by gender
and health region..................................................................................................88 Appendix 21: Number of alcohol-related deaths, ASRs, SMRs and CIs by
Aboriginality and health region ...........................................................................88
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Executive Summary This report assesses the impact of alcohol consumption on the health of the general population of Western Australia for the period 1997 - 2006. Alcohol-related hospitalisations and mortality in WA were determined using WA-specific alcohol-related aetiological fractions for the first time. Alcohol harm in relation to morbidity and mortality, per capita alcohol consumption, prevalence of alcohol consumption and alcohol-related emergency department attendances in WA were also analysed. Key findings in the five areas analysed are as follows. 1. Alcohol-related costs to the health system • In Western Australia, total hospitalisation costs associated with alcohol were more
than $33 million in 2006. This does not include the costs of emergency department presentations.
• The costs of alcohol-related hospitalisations increased significantly over the period 2002-2006, even after being adjusted for inflation.
• In 2005/06, alcohol-related emergency department (ED) attendances for injury and assault alone, was conservatively estimated at $7.15 million. Addi t ional ly , in 2006, the service provision costs of attendances for conditions such as alcohol intoxication and withdrawal in all metropolitan ED departments were over $1.15 million.
2. Alcohol consumption and its prevalence • There was an increasing trend of per capita alcohol consumption among people
aged 15 years and over in WA based on alcohol wholesale sales data. • Among Western Australians aged 14 years and over, around 39% reported that
within the last 12 months they had consumed alcohol at levels that placed them at risk of harm in the short term. Furthermore, 11% reported drinking at levels that placed them at risk of harm in the long-term.
3. Alcohol-related hospitalisations • The number of alcohol-related hospital admissions for chronic diseases increased
significantly over the period 2002-2006. • Five conditions (fall injuries, assault, supraventricular cardiac dysrhythmia,
alcohol abuse, alcohol dependence) were responsible for 60% of alcohol-related hospital admissions over the period 1997-2006.
• For acute alcohol-related conditions, the patterns of age-specific alcohol-related hospitalisation and mortality rates were similar, increasing steeply among those aged 15–19 years and peaking in the 20-24 years age group. Rates declined steadily among those aged 25 years and over before increasing again for those aged 70 years and older.
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• The Kimberley and Pilbara regions had the highest hospitalisation rates due to alcohol consumption.
• The population living in statistical local areas (SLAs) of the northern and eastern regions of WA had significantly higher alcohol-related hospitalisation rates in comparison to the overall State rate. Conversely, the population in SLAs that had significantly lower rates than the State lived in the metropolitan and southern regions of the State.
4. Alcohol-related mortality • The age-standardised rate (ASR) of alcohol-related deaths for chronic conditions
increased significantly over the period 1997-2005 for both genders; while the ASR for acute conditions for males showed a significant decrease over the same period.
• Five conditions (suicide, alcoholic liver cirrhosis, stroke, road injuries-vehicle, oesophageal cancer) were responsible for 59% of all alcohol-related deaths over the period 1997-2005.
• For males, alcohol-related death rates were significantly higher for the Goldfields, Kimberley and Pilbara; and for females, significantly higher for the Kimberley and the Pilbara.
• Among the Aboriginal population, alcohol-related death rates for all regions were similar to the State rate, with the exception of a significantly higher rate for the Pilbara, and a significantly lower rate for the South West.
5. Alcohol-related ED attendances in the metropolitan area • Alcohol-related ED attendances for alcohol intoxication, withdrawal, other
alcohol-related issues such as the toxic effect of alcohol and poisoning due to the mixed use of alcohol and other substances and alcohol-related non-ED reviews represented around 0.8% of all ED attendances in metropolitan hospitals in WA.
• In 2005-2006, it is conservatively estimated that there were 30 202 alcohol-related injury and assault attendances to metropolitan hospital emergency departments, representing a further 7.8% of the total ED presentations.
• Teaching hospitals treated more than 76% of alcohol-related ED attendances in metropolitan hospitals.
• Both Aboriginal males and females experienced significantly higher ED attendance rates than their non-Aboriginal counterparts in almost all the age groups.
The results from this project indicate that the harmful effects of alcohol consumption were evident in both acute and chronic conditions and had a significant impact on the entire population of WA, particularly among young people. Continual monitoring of the impact of alcohol on the population should be carried out and projects of this type should be conducted every two years.
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1. Introduction The misuse of alcohol represents one of the leading causes of preventable death, illness and injury in many societies throughout the world (WHO, 2000). The World Health Organisation (2002) also estimates that alcohol is responsible for 4% of the total global burden of disease, a figure only slightly lower than that associated with either smoking or high blood pressure (Somerford, Katzenellenbogen & Codde, 2004). Alcohol consumption has been found to be associated with a variety of adverse health and social consequences. Adverse effects of alcohol have been demonstrated for many disorders such as liver cirrhosis, mental illness, several types of cancer, pancreatitis, and damage to the fetus among pregnant women. Both physical and mental alcohol-related harm result in a large number of accident and emergency attendances in the Emergency Department (ED), thus imposing a significant burden on the workload and financial resources of the department (Charalambous, 2002). Alcohol use is also significantly associated with social consequences including drink driving injuries and fatalities, aggressive behaviour, family disruptions and reduced industrial productivity. In Australia, alcohol is the most widely used psychoactive, or mood-changing, recreational drug with the majority of adults (62%) consuming alcohol on a weekly basis; and alcohol misuse has also a significant impact on health (AIHW, 2007). However, the effects of alcohol differ from population to population. Thus it is important to quantify the effects on the WA population and monitor the trends in alcohol use and harm. The Impact of Alcohol on the Population of Western Australia examines trends of alcohol consumption and different levels of alcohol consumption prevalence among the population of WA were examined. Newly derived WA specific aetiological fractions were used to assess alcohol-related hospitalisations and mortality. Alcohol-related ED attendances in the metropolitan ED departments in terms of presenting problems and diagnostic categories, triage categories, presenting time and month, and health regions were examined. Alcohol-related ED attendance rates by gender, Aboriginality, health regions, were also analysed and at-risk sub-populations identified. This is the second report produced by the Epidemiology Branch, Department of Health WA to examine the impact of alcohol on the health of Western Australians. The first (Unwin et al., 2004) used national aetiological fractions to estimate alcohol-related deaths and hospitalisations, while this second report has used WA specific fractions. Regional profiles for the nine health regions in WA have also been produced as companion documents to this report. The profiles will be made available online from the Drug and Alcohol Office WA (http://www.dao.health.wa.gov.au/). The profiles present detailed information on alcohol drinking patterns, alcohol-related hospitalisations and hospitalisation costs and alcohol-related deaths. The purpose of this report is to inform the process for developing strategies to reduce the harm associated with alcohol consumption in the WA population. While it is acknowledged that alcohol has a positive effect on some chronic diseases, the focus of this report is on harm associated with risky levels of alcohol consumption.
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High risk drinking contributes to substantial burden of disease, particularly among the ages younger than 45 years, whereas the benefits of alcohol consumption are almost entirely restricted to the older age groups resulting from low risk drinking through the protective effects of alcohol on some chronic diseases (Somerford, Katzenellenbogen & Codde, 2004).
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2. Methodology The overall analytical process used within this report is illustrated below (Figure 1). The key process was the development of WA specific aetiological fractions (AFs). The calculation of these fractions required two fundamental pieces of information – the relative risk (measuring the causal relationship between exposure to risky alcohol consumption and the condition being studied) and prevalence (measuring the proportion of the relevant population engaging in the risky behaviour). Once the AFs were determined, they were applied to alcohol-related morbidity episodes and mortality cases to estimate alcohol attributed hospitalisation and costs, deaths and person years of life.
Figure 1: Overall analysis process of the project
2.1 Determining alcohol consumption at different risk
levels Martin (2007) reviewed a number of surveys in both Australia and Western Australia and identified those that best represented alcohol consumption prevalence using the following three criteria: • Results reflective of known population alcohol consumption patterns and
prevalence. • Large numbers enabling comparison between sex, age groups and regions. • Consistency with other surveys and consistency within the same survey over time.
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Estimates for the non-Aboriginal WA population were determined by aggregating WA data from the 2001 and 2004 National Drug Strategy Household Surveys. The alcohol consumption prevalence at low, hazardous and harmful levels by age, sex and region (Capital City versus Non-capital City) were derived. The Perth metropolitan area was defined as Capital City and all other areas in WA as Non-capital City. Aboriginal estimates were obtained from the National Aboriginal and Torres Strait Islander Health Survey 2004-05. Prevalence figures at low, hazardous and harmful levels by age, sex and region (Remote versus Non-remote) were derived. The remote and non-remote regions were determined based on the Accessibility/Remoteness Index of Australia (+) (ARIA+) (DOHAC, 2001). The two categories – Very Remote Australia and Remote Australia – were combined to form the Remote region, while all other categories (Outer Regional Australia, Inner Regional Australia and Major Cities of Australia) formed the Non-remote region. 2.2 Choosing relative risk estimates at different
levels of risk Relative risk (RR) is the risk of an event (or of developing a disease) relative to exposure. It is a ratio of the probability of the event occurring in the exposed group versus the control (non-exposed) group. For example, if the probability of developing laryngeal cancer among harmful alcohol drinkers was 10% and among non-alcohol drinkers 2%, then the relative risk of cancer associated with harmful alcohol drinking would be 5. Harmful alcohol drinkers would be five times as likely as non-drinkers to develop laryngeal cancer. There are several sets of RR estimates available. The relative risks developed by Ridolfo and Stevenson were used, which built on the RRs developed by English et al. in 1995 (English et al., 1995; Ridolfo & Stevenson 2001). Relative risks by level of alcohol consumption, sex and age were utilised. Details on how RRs are derived can be found in the NHMRC guidelines (2001), NATSIHS 2004-05 and NDSHS 2001 and 2004 (ABS & AIHW, 2005) and Ridolfo and Stevenson (2001). 2.3 Deriving Aetiological Fractions by age, sex,
Aboriginality and region The strength of the causal link between alcohol use and its consequences for a particular health problem is represented by the aetiological fraction. As Ridolfo and Stevenson (2001) defined, an aetiological fraction - also known as an attributable proportion or attributable risk - is a form of indirect quantification of morbidity and mortality due to a specified risk factor. In this case the risk factor is the consumption of alcohol. AFs were derived using the method proposed by Ridolfo and Stevenson (2001) in which two methods for calculating AFs – direct and indirect – have been used. The direct method estimates AFs for conditions associated with acute alcohol intoxication (most forms of injury) that do not require local survey data on the prevalence of alcohol consumption. This method attributes alcohol use on the basis of case series
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studies in which alcohol’s involvement is systematically investigated either by blood alcohol level or self-reported drinking prior to the injury event. In this method, individual risk factor-caused cases are identified. For example, acute alcohol intoxication, or alcoholic psychosis or alcoholic gastritis will have an AF value of 1.0. Another example is that from a representative series of drowning deaths subjected to review, an estimated 19% were caused by alcohol consumption. Thus, an aetiological fraction of 19% can be applied to all drowning deaths in the population to estimate the number attributable to alcohol consumption. The indirect method is the preferred method of estimating an AF, where alcohol is a contributory but not the sole cause of morbidity or mortality. In this method, estimates of the relative risk of disorders for different levels of alcohol use are combined with prevalence data on the number of persons consuming different levels of alcohol. This method is generally applied to disease, partly caused by the effects of long-term alcohol consumption. The distinguishing characteristic of the indirect method is that individual risk factor-caused cases are not identified. For example, if there is a probability of 0.4 that a case of mouth and oropharynx cancer is caused by alcohol, then the product of this probability (the aetiological fraction) and the total number of cases with mouth and oropharynx cancers in a population gives an estimate of the number of mouth and oropharynx cancer cases attributable to alcohol. An aetiological fraction which is positive but less than one indicates that the particular medical condition has more than one cause. For example, alcohol consumption is not the only cause of stroke. An aetiological fraction can be negative as well, indicating that alcohol has a protective effect against the medical condition under study. A detailed discussion on the protective effects of low to moderate alcohol consumption can be found in Sacco et al. (1999), Single et al. (2000), Wannamethee (2005), Elkind et al. (2006), O’Keefe et al. (2007). For the present study, two sets of AFs were derived – one for mortality data and another for morbidity data, as the risk of death and hospitalisation may differ. For example, the AF for hospitalisation due to heart failure for Aboriginal male aged 20-24 years in a Non-remote region is 0.071, while the AF for deaths due to the same condition is 0.000. For conditions such as drowning, homicide or violence etc., the AFs for both mortality and hospitalisation are identical where the effects of alcohol on the condition are considered to be similar. Such AFs are denoted as “Both” in the all AFs listed in Appendix 1 to Appendix 8 and those AFs that are different for death and hospitalisaton are denoted as “Death” and “Hosp” or “Hospital”, respectively. Further details regarding these two methods can be found in English et al. (1995), Single et al. (2000), Ridolfo & Stevenson (2001), and World Health Organisation (2000). 2.3.1 Standard procedure for deriving AFs The majority of indirectly calculated AFs were based on the sum of the partial AFs as below:
1)1()1(+−
−=∑∑
ii
ii
RRPRRP
AF
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where Pi is the prevalence of different risk levels of alcohol consumption; RRi relative risk of diseases associated with different levels of alcohol consumption compared with non alcohol consumption. This is further illustrated below (Figure 2).
Figure 2: Standard procedure for calculating aetiological fractions
(Prev. = Prevalence; RR = Relative Risk; AF=Aetiological Fraction)
2.3.2 Procedure for deriving AFs for heart failure Ridolfo and Stevenson’s (2001) method was used to construct a fraction for heart failure (both AF for heart failure disability and AF for heart failure death), which is a weighted average of fractions for all other forms of heart disease (Figures 3 and 4).
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Figure 3: Procedure for calculating hospitalisation aetiological fractions for heart
failure (Hypert.=Hypertension; IHD=Ischaemic Heart Disease; SVD=Supraventricular Cardiac Dysrhythmia;
ACM=Alcoholic Cardiomyopathy; CVD=Cardiovascular Diseases; HF= Heart Failure)
Figure 4: Procedure for calculating death aetiological fractions for heart failure
(Hosp.=Hospitalisations; Hypert.=Hypertension; IHD=Ischaemic Heart Disease; SVD=Supraventricular Cardiac Dysrhythmia; ACM=Alcoholic Cardiomyopathy;
CVD=Cardiovascular Diseases; HF= Heart Failure)
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Due to the small number of cases in remote Aboriginal populations, the AFs for heart failure for the whole State were used for this population to avoid unstable and unreliable AFs. 2.3.2 Procedure for deriving AFs for stroke AFs for ischaemic and haemorrhagic stroke were calculated separately using the standard procedure as depicted in Figure 2. However, in morbidity and mortality data, the majority of stroke cases were coded as unspecified stroke as ischaemic and haemorrhagic stroke could only be differentiated definitively by sophisticated imaging techniques that were not always available. As presumed by Martin (2007), among unspecified strokes there should be a similar distribution between ischaemic and haemorrhagic events as is seen in diagnosed events. The AF calculation formula for unspecified stroke is illustrated in Figure 5.
AF for unspecified stroke death=
x Ischaemic stroke AF
x Haemorrhagic stroke AF
AF for unspecified stroke hospitalisation=
x Ischaemic stroke AF
x Haemorrhagic stroke AF
No. Ischaemic stroke deaths + No. Haemorrhagic stroke deathsNo. Ischaemic stroke deaths
+
No. Haemorrhagic stroke deaths
No. Haemorrhagic stroke hosp.No. Ischaemic stroke hosp. + No. Haemorrhagic stroke hosp.
No. Ischaemic stroke deaths + No. Haemorrhagic stroke deaths
No. Ischaemic stroke hosp.No. Ischaemic stroke hosp. + No. Haemorrhagic stroke hosp.
+
Figure 5: Formula for calculating death and hospitalisation AFs for stroke
(Hosp. = Hospitalisations)
2.4 Applying AFs to mortality and morbidity data The AFs derived via the above process were applied to Western Australian mortality and morbidity data for relevant sub-groups (i.e. age, sex, Aboriginality, region) in order to determine the alcohol-attributed deaths and hospital separations for various population groups. Data from the WA Hospital Morbidity Data System (HMDS) for 2001-2005 were used to derive the number of hospitalisations with a principal diagnosis associated with alcohol. Mortality data for 2001-2005 provided by the Australian Bureau of Statistics (ABS) were used to determine the number of deaths related to alcohol consumption.
10
Alcohol-attributed deaths and hospitalisations were determined by multiplying the disease, sex, age, Aboriginality and region specific AF by the numbers of deaths and hospital separations respectively in the corresponding categories. Alcohol-related age-specific morbidity and mortality rates by sex, Aboriginality and region were calculated by the direct method using the number of alcohol-related hospital separations and deaths, and the sum of the estimated resident populations for 2001-2005. In the non-Aboriginal population, estimates for Statistical Local Areas (SLAs) supplied by the ABS from the 2001 Census were used to estimate the residential population for metropolitan/non-metropolitan areas. Aboriginal population estimates were derived by using the weighted population counts from the National Aboriginal and Torres Strait Islander Health Survey 2004-05 (ABS, 2006) and classified to the ARIA+. Potential Years of Life Lost (PYLL) provides a measure of the time lost due to premature mortality. It can be calculated in two ways: by choosing an arbitrary limit to life, in which case the PYLL is the difference between this limit and the actual age at death; or by equating the PYLL with a measure of average community life expectancy at the actual age of death. The PYLL presented in this report are calculated using the latter method. The number of years that would have been lived by a person who died due to alcohol if that person survived to age 75 is calculated using the method described by Romeder and McWhinnie (1988). Population estimates for statistical local areas supplied by the ABS from the 2001 Census were used to estimate the resident population for metropolitan/non-metropolitan areas and remote/non-remote areas and years of life lost expressed as PYLL per 1,000 persons.
Throughout this report, mortality is expressed as the number of people who died from a specific cause; and the PYLL for each cause. Morbidity is expressed as the number of hospital separations attributable to a specific principal diagnosis; and the number of patient days attributable to a specific principal diagnosis. Alcohol-related hospitalisation costs were derived by applying AFs to the Australian Refined Diagnostic Related Group (AR-DRG) costs for each episode. These DRG costs were developed by the Commonwealth Department of Health and Ageing (2006). The Consumer Price Index (CPI) sourced from ABS (2006a) was used to derive CPI adjusted costs in order to remove the effects of inflation. The number of alcohol-related hospitalisations, standardised rate ratios (SRRs) and 95% confidence intervals (CIs, that is, lower limit for CI – LCI and upper limit for CI - UCI) were produced for each statistical local area (SLA) by gender. To ensure robust and reliable standardised rate ratios (SRRs), SLAs with less than ten alcohol-related hospitalisations for the period 2002-2006 were merged with adjoining SLAs within the same region. Where possible, merges were made with SLAs that had fewer alcohol-related hospitalisations. The number of alcohol-related hospitalisations, age standardised rates (ASRs), standardised rate ratios (SRRs) and 95% CIs were produced for each health region by gender and Aboriginality. The number of alcohol-related deaths, age standardised rates (ASRs), standardised mortality ratios (SMRs) and 95% CIs were also computed for each health region by gender and Aboriginality. The direct standardisation method
11
was used to calculate ASRs and the 2001 Australian population was used as the standard population. Indirect standardisation method was used to derive standardised mortality ratios (SMRs) by applying the State rates for each age group of a particular population, say, Aboriginal males, to the population of interest, say, Aboriginal males in Kimberley Health Region and obtaining expected counts. The actual counts were then divided by the expected counts to obtain SRRs. A rate ratio of 1 demonstrates that there is no difference between the regional rate and the State rate. A rate ratio of 2 indicates that twice the number of events is taking place in a region compared to the reference population (the State). A rate ratio of 0.5 indicates that the number of cases in a region is half that of the State population. The 95% confidence intervals indicated the possible range of the actual SRR or SMR with 95% confidence. The following three criteria were used to judge whether a regional ASR was statistically significantly different from the State ASR.
If a value of 1 was included within the range of the 95% LCI and UCI, the region and the State had similar alcohol-related rates.
If a value of 1 was NOT included within the range of the 95% LCI and UCI
and the SRR or SMR was smaller than 1, the region had significantly lower alcohol-related rates than the State.
If a value of 1 was NOT included within the range of the 95% LCI and UCI
and the SRR or SMR was greater than 1, the region had significantly higher alcohol-related rates than the State.
Details on the definitions and calculations of ASR, SRR, SMR and their confidence intervals can be found in Rothman and Greenland (1998). 2.5 Other alcohol-related areas explored In addition to the analysis described in Sections 2.1 to 2.4 above, the trend in alcohol consumption over years in WA was also examined using data from the National Alcohol Indicators Project, National Drug Research Institute, Curtin University of Technology, the National Drug Strategy Household Survey by the AIHW (2005) and the WA Health and Wellbeing Surveillance System by the Epidemiology Branch, Department of Health WA. The proportions of the population aged 14 years and over at a risky or high risk of harm due to alcohol consumption in the short and long term were analysed in terms of health regions, age, sex and Aboriginality. The trend in alcohol consumption over years was also examined. Alcohol-related emergency department (ED) attendances were also analysed in terms of presenting problems and diagnostic categories, triage categories, presenting time and month, and health regions. Alcohol-related ED attendance rates by gender, Aboriginality and health regions were calculated and at-risk sub-populations identified. Methods for these two areas are detailed in the corresponding sections.
12
3. Alcohol Consumption in Western Australia 3.1 Trends in alcohol consumption Data from the National Alcohol Indicators Project, National Drug Research Institute, Curtin University of Technology indicated that there was an increasing trend in alcohol consumption in WA. Alcohol volume sales (pure or absolute litres of alcohol) and per capita consumption per person 15 years and over in 2004/05 in WA are presented in Table 1. In 2004/05, the main alcohol beverages consumed by Western Australians were high alcohol beer (35.1%), spirits (31.4%) and high alcohol wine (27.4%). This equated to each person aged 15 years and over consuming an average of 5.2 (beer), 3.5 (wine) and 4.0 (spirits) litres of pure alcohol in a year.
Table 1: Total alcohol consumption and per capita consumption (litres of absolute alcohol per person 15 years and over) by beverage type, WA, 2004/05
High alcohol beer Low alcohol beer High alcohol wine Low alcohol wine Spirits All alcoholTotal litres consumed 7,148,850 1,248,707 5,586,062 271 6,408,902 20,392,792 % 35.1 6.1 27.4 0.0 31.4 100.0 Per capita consumption (litres) 4.44 0.78 3.47 0.00 3.98 12.66% 35.1 6.1 27.4 0.0 31.4 100.0 Total alcohol beverage consumption increased significantly by 34.1% between 1990/91 and 2004/05, owing to the dramatic increases of 222.8% and 62.0% in the consumption of spirits and high alcohol wine during this period, especially after 2001/02. Low alcohol wine and beer showed significant decreases of 99.7% and 49.5%, respectively during the same period (Figure 6).
13
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
90/91 91/92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05
Year
Per c
apita
con
sum
ptio
n (p
ure
litre
s of
alc
ohol
)
High alcohol beer Low alcohol beer High alcohol wine
Low alcohol wine Spirits All beverages
Figure 6: Per capita alcohol consumption by beverage type, WA, 1990/91 to 2004/05
3.2 Prevalence of alcohol consumption by health
region The proportions of those aged 14 years and over consuming alcohol at a risky or high risk of harm in the short or long term were based on data from the 2004 National Drug Strategy Household Survey (AIHW, 2005). Both risky and high-risk levels were combined to derive risky drinking proportions for short and long-term harms. Risky and high-risk drinking for short-term harm was defined as 7-10 and 11 or more standard drinks on any one day for males, respectively and 5-6 and 7 or more standard drinks on any one day for females, respectively (NHMRC, 2001). These short-term harms were usually related to injury and trauma but related also to neurological deficit or disorder and some acute cardiovascular episodes (AIHW, 2004). Risky and high-risk drinking in the long term was defined as 5-6 and 7 or more standard drinks per day for males and 3-4 and 5 or more standard drinks per day for females (NHMRC, 2001). The NHMRC Guidelines for “long-term” drinking were aimed at more chronic consumers and consider harms that may emerge in the drinker more gradually such as liver damage, cancers and brain damage (AIHW, 2004). Proportions for the regions were compared with those of the State. No significant differences were found between the regions and the State for both short- and long-term harms (Table 2).
14
Table 2: Proportions (%) of population aged 14 years and over drinking alcohol at risky/high risk of harm by short/long-term harm and health region, WA,
2004/05 Health Region Short-term Long-termGoldfields 36.9 10.7Great Southern 37.7 12.1Kimberley 41.6 19.1Midwest 34.0 8.7North Metro 37.4 10.5Pilbara 41.3 22.1South Metro 39.1 10.9South West 37.8 11.7Wheatbelt 30.3 9.4State 39.1 11.4
3.3 Prevalence of alcohol consumption by age and sex Prevalence of alcohol consumption by age, sex and Aboriginality in WA was not available due to small sample size in the 2004 National Drug Strategy Household Survey (AIHW 2005). In Australia, Aboriginal and non-Aboriginal males were more likely than their female counterparts to consume alcohol at risky/high risk levels. The highest proportion of risky/high risk alcohol consumption was recorded by Aboriginal males aged 35-44 years (28%). However, younger Aboriginal males (18–24 years) were less likely than non-Aboriginal males in the same age group to consume alcohol at risky or high-risk levels (25% and 30% respectively). For females, risky and high-risk consumption was most prevalent in the 18-24 age group (23% Aboriginal, 15% non-Aboriginal drinking at risky or high risk levels) with a steady decline in risky consumption until a plateau at 35-44 years with around 10% of females reporting that they drank at risky/high risk levels (Table 3).
Table 3: Prevalence of alcohol consumption, Australia, by age, Aboriginality and sex, 2004–05
Alcohol risk level Aboriginal
non-Aboriginal Aboriginal
non-Aboriginal Aboriginal
non-Aboriginal Aboriginal
non-Aboriginal
Alcohol risk Low risk 36.6 44.0 48.2 58.4 32.9 60.6 31.6 56.5Risky / High risk 25.4 30.0 25.1 20.1 28.7 21.5 11.4 18.0Occasional (a) 34.1 21.3 21.3 20.8 32.3 16.2 49.3 22.0Abstainer (b) 3.9 4.7 5.4 0.7 6.1 1.7 7.7 3.5Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Alcohol risk Low risk 31.3 43.5 19.8 51.8 34.6 48.7 16.9 44.5Risky / High risk 23.4 15.2 19.5 11.7 13.8 12.2 9.8 11.1Occasional (a) 35.3 35.4 58.4 25.7 44.1 30.3 50.2 30.5Abstainer (b) 10.0 5.9 2.3 10.8 7.5 8.8 23.1 13.9Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Source: National Aboriginal and Torres Strait Islander Health Survey 2004-05
MALE
FEMALE
(a) Last consumed alcohol 1 week to less than 12 months ago(b) Last consumed alcohol more than 12 months ago or never consumed alcohol
18-24 25-34 35-44 45+
15
3.4 Prevalence of alcohol consumption by Aboriginality Compared to non-Aboriginal people, Aboriginal people had a higher prevalence of abstinence (never consumed a full serve of alcohol) and also a higher prevalence of alcohol consumption at high-risk levels. According to the National Aboriginal and Torres Strait Islander Health Survey 2004-05, 24% of Aboriginal people described themselves as abstainers from alcohol or as not having an alcoholic drink within the previous 12 months. Sixteen percent of respondents described drinking at risky or high risk levels (ABS, 2006b). According to the 2004 National Drug Strategy Household Survey, 16.4% of those aged 14 years and over (both Aboriginal and non- Aboriginal persons) described themselves as either abstainers or not having consumed an alcoholic drink within the past 12 months, while 9.9% reported that they drank at levels considered risky or high-risk (AIHW, 2005). There was a higher prevalence of high-risk alcohol consumption in Aboriginal people in WA remote areas compared with Aboriginal people at the national level while Aboriginal people in WA non remote areas had a slightly lower high-risk alcohol consumption prevalence (Table 4).
Table 4: Proportion of the population aged 18 years and over consuming alcohol at risky or high risk levels, by Aboriginality, region and sex
Area Male FemaleWestern Australian Aboriginal remote (a) 27 20Western Australian Aboriginal non remote (a) 18 12National Aboriginal remote (a) 17 10National Aboriginal non remote (a) 21 14Western Australian non-Aboriginal non-capital city (b) 14 12Western Australian non-Aboriginal capital city (b) 12 10National Australian non-Aboriginal non-capital city (b) 13 12National non-Aboriginal capital city (b) 10 9(a) Source: National Aboriginal and Torres Strait Islander Health Survey 2004-05. Australian Bureau of Statistics.(b) Source: National Drug Strategy Household Survey 2001 and 2004. Australian Institiute of Health and Welfare. 3.5 Trend of prevalence of alcohol consumption over
time WA Health and Wellbeing Survey data were used to assess the trend of prevalence of alcohol consumption over time (Figure 7). The data indicated that in WA as a whole, self-reported consumption of alcohol has not changed significantly in the past five years (Wood and Daly, 2007).
16
0
10
20
30
40
50
60
70
80
2002 2003 2004 2005 2006
Year
Perc
enta
ge
no alcohol low risk risky high risk
Figure 7: Proportion of respondents reporting alcohol consumption by risk level, persons aged 16 years and over, WA, 2002–2006
17
4. Alcohol-Related Hospitalisations 4.1 Hospital admissions and beddays caused by
alcohol-related conditions In 2005, the harmful effects of alcohol, resulting in the development of acute and chronic conditions, were responsible for an estimated 11,878 hospital admissions and 63,607 beddays (Table 5).
Table 5: Alcohol-caused admissions and beddays by sex and condition, WA, 2005
Males Females #Persons Males Females #PersonsAlcohol harm (acute)*Alcoholic poisoning 15 10 25 17 10 27Aspiration 15 10 25 187 100 287Fall injuries 903 1,198 2,101 8,042 12,679 20,721Fire injuries 19 4 23 136 24 160Drowning 3 1 3 7 2 9Occupational & machine injuries 140 35 175 308 95 403Self-inflicted harm 381 617 998 3,226 3,237 6,463Assault 969 522 1,491 2,759 1,326 4,085Child abuse 12 11 23 80 47 127Road injuries - pedestrian 65 8 72 641 39 680Road injuries - vehicle 493 95 588 2,828 500 3,328Total acute harm 3,015 2,510 5,525 18,231 18,059 36,290Alcohol harm (chronic)*Alcoholic psychosis 354 95 449 2,533 900 3,433*Alcohol dependence 684 415 1,099 3,467 2,411 5,878*Alcohol abuse 637 465 1,102 1,160 820 1,980*Alcoholic poly neuropathy 5 0 5 29 0 29*Alcoholic cardiomyopathy 9 1 10 33 7 40*Alcoholic liver cirrhosis 52 135 457 2,271 1,203 3,474*Alcoholic gastritis 154 64 218 311 120 431Chronic pancreatitis 171 61 233 617 199 816Unspecified liver cirrhosis 52 39 91 196 127 323Oropharyngeal cancer 99 28 127 659 224 883Oesophageal cancer 158 42 201 847 262 1,109Liver cancer 65 23 88 428 273 702Laryngeal cancer 50 4 53 371 11 382Female breast cancer 0 246 246 0 801 801Epilepsy 124 70 194 327 273 600Hypertension 17 1 18 78 2 80Supraventricular cardiac dysrhythmias 769 548 1,317 1,622 1,676 3,297Oesophageal varices 26 14 40 40 31 71Gastro-oesophageal haemorrhage 35 15 50 101 45 146Acute pancreatitis 128 91 219 810 536 1,346Ischaemic heart disease 0 0 0 0 0 0Heart failure 1 0 1 6 1 7Cholelithiosis 0 0 0 0 0 0Psoriasis 11 9 20 96 83 179Stroke 114 2 116 1,295 15 1,311Total chronic harm 3,714 2,369 6,353 17,299 10,019 27,317Total harm 6,729 4,879 11,878 35,530 28,077 63,607
Number of admissions Number of beddays
# The use of aetiologic fractions sometimes results in fractions of cases. Thus the number of persons may not equal the sum of males and females because numbers are rounded for presentation.
* these conditions are wholly attributable to alcohol.
Condition / Effect
18
4.2 Top five alcohol-related conditions responsible for hospital admissions
Five conditions were responsible for 60% of alcohol-caused hospital admissions1 in 2005. These were:
1. Fall injuries (17.7%) 2. Assault (12.5%) 3. Supraventricular cardiac dysrhythmia (11.1%) 4. Alcohol abuse (9.3%) 5. Alcohol dependence (9.2%).
The top five conditions differed slightly for males and females. The top five conditions for males, responsible for 57% of alcohol-caused male admissions in 2005, were:
1. Assault (13.8%) 2. Fall injuries (12.9%) 3. Supraventricular cardiac dysrhythmia (11.0%) 4. Alcohol dependence (9.8%) 5. Alcohol abuse (9.1%).
The top five conditions for females, responsible for 69% of alcohol-caused female admissions in 2005, were:
1. Fall injuries (24.5%) 2. Self-inflicted harm (12.6%) 3. Supraventricular cardiac dysrhythmia (11.2%) 4. Assault (10.7%) 5. Alcohol abuse (9.5%).
1 To calculate the percentages of hospital admissions, conditions for which alcohol had a protective effect for certain sex/age groups were excluded.
19
4.3 Top five alcohol-related conditions responsible for hospital beddays
Five conditions were responsible for 64% of alcohol-caused hospital beddays2 in 2005. These were:
1. Fall injuries (32.6%) 2. Self-inflicted harm (10.2%) 3. Alcohol dependence (9.2%) 4. Assault (6.4%) 5. Alcoholic liver cirrhosis (5.5%).
The top five conditions varied slightly for males and females. The top five conditions for males, responsible for 57% of alcohol-caused male beddays in 2005, were:
1. Fall injuries (22.6%) 2. Alcohol dependence (9.8%) 3. Self-inflicted harm (9.1%) 4. Road injuries – vehicle (8.0%) 5. Assault (7.8%).
The top five conditions for females, responsible for 76% of alcohol-caused female beddays in 2005, were:
1. Fall injuries (45.2%) 2. Self-inflicted harm (11.5%) 3. Alcohol dependence (8.6%) 4. Supraventricular cardiac dysrhythmia (6.0%) 5. Assault (4.7%).
2 To calculate the percentages of hospital beddays, conditions for which alcohol had a protective effect for certain sex and age groups were excluded.
20
4.4 Age pattern of hospital admissions due to
alcohol-caused chronic and acute conditions The age patterns of hospital admissions due to acute and chronic conditions were significantly different due to the protective effect of alcohol on some chronic diseases. Consequently they are presented separately below. Acute The male age-specific admission rates due to acute alcohol-related conditions had a sharp increase in the 15 to 19 years age group and peaked in the 20 to 24 years age group (609 admissions per 100,000 population). The rates steadily decreased from the 25 to 29 years age group to 65 to 69 years age group and then steeply increased once more to a peak in the 85+ years age group (1,321 admissions per 100,000 population). The pattern of female age-specific admission rates due to acute alcohol-caused conditions was similar to that of the males, however the peaks in ASRs reached in the 15-19 and 20-24 years age groups for females were not as high as those peaks in ASRs for males. The rates for females steadily decreased from the 25-29 years age group (as with the males) and then increased more steeply than the male rates, reaching a higher peak in the 85+ years age group of 1,899 admissions per 100,000 population (Figure 8).
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age group
Age
spe
cific
rate
s
Male Female Figure 8: Age-specific admission rates for alcohol-caused acute conditions by sex,
WA, 1997-2006
21
Chronic For both males and females the age-specific admission rates for alcohol-caused chronic conditions increased from age 15-19 years to a peak at the 40-44 years age group. The rates for males remained higher than for females for all age groups (Figure 9). For chronic conditions, alcohol was found to have a protective effect only among the elderly. For hospitalisations due to chronic alcohol-related conditions the protective effect did not appear until the 60-64 years age group for females and the 70-74 years age group for males. The protective effect of low risk alcohol consumption was evident in the elderly due to the high prevalence of chronic conditions in this age group.
-1600
-1400
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-200
0
200
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600
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age group
Age
spe
cific
rate
s
Male Female Figure 9: Age-specific admission rates for alcohol-caused chronic conditions by
sex, WA, 1997-2006 The total number of admissions estimated to be due to alcohol was highest for ages 25 to 44 years for both genders, with admissions for all age groups indicating an overall harmful effect from alcohol (Table 6).
Table 6: Number of alcohol-caused admissions by age group, WA, 2005
Sex 0-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65+ yrsMale 50 1,050 2,229 1,512 436Female 20 594 1,165 724 265Persons 70 1,644 3,393 2,236 701
22
4.5 Proportion of all hospital admissions due to alcohol
An estimated 1.6% of all male admissions and 0.75% of all female admissions were due to alcohol. The highest proportion of alcohol-caused admissions (males 4.9%; females 1.8%) was among young people aged 15 to 24 years (Figure 10).
0.00
1.00
2.00
3.00
4.00
5.00
6.00
0-14 15-24 25-44 45-64 65+ Total
% o
f all-
caus
e ad
mis
sion
s du
e to
alc
ohol
Male Female Figure 10: Alcohol-caused admissions as a percentage of all admissions, by age
group, WA, 2005
23
4.6 Impact of alcohol on hospital admissions and beddays
Table 7 shows the numbers of alcohol-caused hospital admissions and beddays in 2005 in Western Australia. There were differences in the impact of alcohol-caused hospitalisations by sex and Aboriginality, with the harm for males higher than for females (Table 7). Aboriginal people derived little benefit from alcohol use, reflecting the relatively high levels of risky drinking and lower levels of low risk drinking (Table 3). These effects are further illustrated in Figure 11 and Figure 12.
Table 7: Number of alcohol-caused admissions and beddays, by Aboriginality and sex, WA, 2005
Male Female Male Female Male Female TotalAdmissionsAlcohol harm 5,922 4,084 1,077 795 6,999 4,879 11,878Alcohol benefit -1,689 -2,071 -35 -40 -1,723 -2,111 -3,834Net effect 4,234 2,014 1,042 755 5,276 2,768 8,044BeddaysAlcohol harm 31,357 24,979 4,173 3,099 35,530 28,077 63,607Alcohol benefit -5,935 -11,907 -126 -169 -6,060 -12,076 -18,136Net effect 25,423 13,072 4,047 2,929 29,470 16,001 45,471
Non-Aboriginal Aboriginal *Persons
* This includes cases where Aboriginality was missing, so the sum of the non-Aboriginal and Aboriginal cases does not add up to the total number of persons.
Effect
Num
ber o
f adm
issi
ons
-3000
-2000
-1000
0
1000
2000
3000
4000
5000
6000
7000
Alcohol harm Alcohol benefit Net effect
Num
ber o
f adm
issi
ons
aver
ted
Non-Aboriginal males Non-Aboriginal females Aboriginal males Aboriginal females Figure 11: Impact of alcohol on hospital admissions, WA, 2005
24
Num
ber o
f bed
days
-15000
-10000
-5000
0
5000
10000
15000
20000
25000
30000
35000
Alcohol harm Alcohol benefit Net effect
Num
ber o
f bed
days
ave
rted
Non-Aboriginal males Non-Aboriginal females Aboriginal males Aboriginal females
Figure 12: The impact of alcohol on hospital beddays, WA, 2005
25
4.7 Alcohol-caused hospitalisation costs Both the number of alcohol-related hospital admissions and the cost of hospitalisations increased significantly over the period 2002-2006. The average yearly increase in the number of alcohol-related admissions was 4.45%, from 6,876 admissions in 2002 to 8,539 admissions in 2006. The total cost of alcohol-related hospitalisations increased by an average of 11.1% each year, from $21.4 million in 2002 to $33.5 million in 2006. CPI-adjusted costs increased significantly from 2002 to 2006 by an average of 8.22% each year (Table 8).
Table 8: Number of alcohol-caused admissions and the cost of hospitalisation, WA, 2002-2006
Year Total admissions Total cost Cost per
admissionCPI adjusted
total cost
CPI adjusted cost per
admission2002 6,876 $21,441,399 $3,118 $20,504,147 $2,9822003 6,857 $22,541,191 $3,287 $20,991,705 $3,0612004 7,180 $24,899,814 $3,468 $22,653,123 $3,1552005 8,044 $30,896,930 $3,841 $27,325,287 $3,3972006 8,539 $33,503,208 $3,924 $28,852,783 $3,379
Note: CPI adjusted to the financial year 2000-2001.
26
4.8 Trends in alcohol-caused admissions and beddays for acute and chronic conditions
Age standardised rates (ASRs) for chronic alcohol-caused conditions among males increased significantly (t-score = 5.47; p = 0.012) over the ten-year period. The ASRs for chronic alcohol-caused conditions among females also increased significantly (t-score = 15.62; p = 0.001). The combined effect of the trend for acute and chronic diseases has seen the overall rate of alcohol-caused deaths increase over the last decade. ASRs for acute conditions amongst both males and females showed no significant changes during the ten-year period (Figure 13).
-100
-50
0
50
100
150
200
250
300
350
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year of separation
Age
sta
ndar
dise
d ad
mis
sion
rate
s
Males - chronic Males - acute Females - chronic Females - acute Figure 13: Age-standardised rates for alcohol-caused admissions by year of
separation, WA, 1997-2006
Age-standardised rates for beddays relating to alcohol-caused chronic conditions amongst females increased significantly over the ten-year period (t-score = 14.04; p = 0.001). For females, the combination of declining admissions for alcohol-related chronic conditions and the constant rate of admissions from the harmful effects of alcohol due to chronic conditions explains the increase in beddays. The ASRs for chronic conditions for males, and for acute conditions for both males and females showed no significant changes over the ten years (Figure 14).
27
-1500
-1000
-500
0
500
1000
1500
2000
2500
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year of separation
Age
sta
ndar
dise
d be
dday
rate
s
Males - chronic Males - acute Females - chronic Females - acute Figure 14: Age-standardised rates for alcohol-caused beddays by year of
separation, WA, 1997-2006
28
4.9 Number of alcohol-caused admissions and beddays wholly attributable to alcohol use
During 2005, 28% of hospital admissions and 24% of beddays from the harmful effects of alcohol were wholly attributable to alcohol3. There were differences in the proportions of alcohol harm that were wholly attributable to alcohol between Aboriginals and non-Aboriginals and males and females (Figure 15). For non-Aboriginal males 30% of alcohol-caused admissions and 26% of alcohol-caused beddays were due to wholly attributable conditions, whereas the proportions were 37% of alcohol-caused admissions and 38% of alcohol-caused beddays for Aboriginal males. A similar difference in Aboriginality was seen amongst females. For non-Aboriginal females 23% of alcohol-caused admissions and 18% of alcohol-caused beddays were due to wholly attributable conditions whereas the proportions for Aboriginal females were 31% and 27% respectively.
0
5
10
15
20
25
30
35
40
45
Males Females
Perc
enta
ge o
f alc
ohol
har
m (a
dmis
sion
s or
bed
days
)
Non-Aboriginal admissions Aboriginal admissions Non-Aboriginal beddays Aboriginal beddays Figure 15: Percentage of alcohol-harm (admissions and beddays) wholly
attributable to alcohol, WA, 2005
3 Conditions wholly attributable to alcohol are indicated in Table 5.
29
4.10 Comparison of alcohol-caused admission among health regions and SLAs
Figure 16 to Figure 19 illustrate the standard rate ratios and confidence intervals for each health region by gender and Aboriginality. To quantify the harm due to alcohol in regional areas only conditions for which alcohol had a harmful effect for certain sex/age groups were included in the analysis. State rates for the corresponding gender and Aboriginality were taken as a reference, that is, the State standardised rate ratio (SRR) = 1.0. If the confidence intervals (CIs) of an SRR do not overlap with the State SRR (i.e. 1.0), the region’s rate will be statistically higher (if above 1.0) or lower (if below 1.0) than the State rate. The comparison of hospitalisation rates due to alcohol consumption among the nine health regions in Western Australia revealed significant differences between the regions and the State. Alcohol-related hospitalisation rates for males were significantly lower than the State for North Metropolitan and South Metropolitan regions, while they were significantly higher for the Goldfields, Great Southern, Kimberley, Midwest, Pilbara and Wheatbelt regions. The Pilbara rate was around double that of the State, and the highest hospitalisation rate was for the Kimberley, almost four times greater than the State rate. Similarly, for females, the North Metropolitan and South Metropolitan had rates significantly lower than the State, with significantly higher rates seen for the Goldfields, Great Southern, Kimberley (over five times greater than the State), Midwest, Pilbara and Wheatbelt. The rates for both males and females in the South West were similar to those for the State. A comparison of hospitalisation rates per region for the Aboriginal population showed significantly lower (than the Aboriginal State) rates for North Metropolitan, South Metropolitan, South West and Wheatbelt regions. The alcohol-related hospitalisation rates for the Goldfields, Great Southern, Kimberley, Midwest and Pilbara regions were significantly higher than the State rate. Amongst the non-Aboriginal population all regions, except North Metropolitan and South Metropolitan (which had significantly lower rates than the non-Aboriginal State) had alcohol-related hospitalisation rates that were greater than the State rate. Overall, the Kimberley and Pilbara regions had the highest hospitalisation rates due to alcohol consumption. Detailed information on the number of alcohol-related hospitalisations, ASRs, SRRs and 95% CIs, per 100,000 population, by gender and regions are presented in Appendix 9. The numbers of alcohol-related hospitalisations, ASRs, SRRs and 95% CIs, per 100,000 population, by Aboriginality and regions are presented in Appendix 10.
30
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5
State rate Figure 16: SRRs and CIs for alcohol-related hospitalisations, males, 2002-2006
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0
State rate Figure 17: SRRs and CIs for alcohol-related hospitalisations, females, 2002-2006
31
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
State rate Figure 18: SRRs and CIs for alcohol-related hospitalisations, Aboriginal, 2002-
2006 North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
State rate Figure 19: SRRs and CIs for alcohol-related hospitalisations, non-Aboriginal,
2002-2006
32
Figure 20 and Figure 21 show the distribution of significantly higher, significantly lower and similar alcohol-related hospitalisation SRRs for each SLA in comparison to the State, for males and females respectively. The figures clearly demonstrate that the SLAs located in the northern and eastern regions of WA have significantly higher alcohol-related hospitalisation rates in comparison with the overall State rate. Conversely, for both males and females, the SLAs that have rates that are significantly lower than the State are located around the metro and southern regions of the State, with the exception of Manjimup SLA, which has a significantly higher rate for both genders. Detailed information on the number of alcohol-related hospitalisations, SRRs and 95% CIs, per 100,000 population, by gender and SLAs are presented in Appendix 11 to Appendix 19.
33
Figure 20: Alcohol-related hospitalisation SRRs relative to the State males by
SLA, males, 2002-2006,WA
34
Figure 21: Alcohol-related hospitalisation SRRs relative to the State females by
SLA, females, 2002-2006,WA
35
5. Alcohol-Related Mortality 5.1 Deaths due to alcohol-related conditions Alcohol can have harmful effects, resulting in the development of acute and chronic conditions. In WA between 1997 and 2005, alcohol was estimated to cause a total of 3,975 deaths (Table 9).
36
Table 9: Number of alcohol-caused deaths, by sex and condition, WA, 1997-2005 Condition / Effect Males Females #PersonsAlcohol harm (acute)Alcoholic poisoning 10 6 16Aspiration 3 3 6Fall injuries 38 32 70Fire injuries 18 7 25Drowning 20 6 26Occupational & machine injuries 2 0 3Suicide 533 130 663Assault 55 34 89Child abuse 2 1 3Road injuries - pedestrian 52 8 60Road injuries - vehicle 298 38 336Total acute harm 1,031 265 1,297Alcohol harm (chronic)*Alcoholic psychosis 43 15 58*Alcohol dependence 66 12 78*Alcohol abuse 52 11 63*Alcoholic poly neuropathy 1 0 1*Alcoholic cardiomyopathy 51 8 59*Alcoholic liver cirrhosis 432 153 585Chronic pancreatitis 13 3 16Unspecified liver cirrhosis 75 45 119Oropharyngeal cancer 121 36 157Oesophageal cancer 236 87 322Liver cancer 133 50 183Laryngeal cancer 76 11 87Female breast cancer 0 229 229Epilepsy 18 14 32Hypertension 23 0 24Supraventricular cardiac dysrhythmias 85 113 198Oesophageal varices 4 1 5Gastro-oesophageal haemorrhage 0 2 2Acute pancreatitis 12 13 25Ischaemic heart disease 0 0 0Heart failure 0 0 0Cholelithiasis 0 0 0Psoriasis 0 0 1Stroke 431 3 434Total chronic harm 1,872 806 2,678Total harm 2,903 1,071 3,975
# the use of aetiologic fractions sometimes results in fractions of cases. Thus the number of persons may not equal the sum of males and females because numbers are rounded for presentation.
* these conditions are wholly attributable to alcohol.
37
5.2 Top five alcohol-related conditions responsible for deaths
Five conditions were responsible for 59% of alcohol-caused deaths4 over the period 1997-2005. These were:
1. Suicide (16.7%) 2. Alcoholic liver cirrhosis (14.7%) 3. Stroke (10.9%) 4. Road injuries – vehicle (8.4%) 5. Oesophageal cancer (8.1%).
The top five conditions varied slightly for males and females. The top five conditions for males, responsible for 66% of alcohol-caused male deaths over the period 1997 to 2005, were:
1. Suicide (18.4%) 2. Alcoholic liver cirrhosis (14.9%) 3. Stroke (14.8%) 4. Road injuries – vehicle (10.2%) 5. Oesophageal cancer (8.1%).
The top five conditions for females, responsible for 66% of alcohol-caused female deaths over the period 1997 to 2005, were:
1. Female breast cancer (21.4%) 2. Alcoholic liver cirrhosis (14.3%) 3. Suicide (12.1%) 4. Supraventricular cardiac dysrhythmias (10.6%) 5. Oesophageal cancer (8.1%).
4 To calculate the percentages of deaths, conditions for which alcohol had a protective effect for certain sex/age groups were excluded.
38
5.3 Age pattern of deaths (or lives saved) due to chronic and acute alcohol-caused conditions
Like alcohol-related hospitalisations, the age patterns of deaths due to acute and chronic alcohol-caused conditions were also different due to the protective effect of alcohol on some chronic diseases. Therefore they are presented here separately. Acute For acute alcohol-caused conditions, male age-specific death rates were higher than those for females in all age groups, especially between the ages of 15 and 49 years (Figure 22). Male death rates increased dramatically in the 15-19 years age group and peaked in the 20-24 years age group at 23.1 deaths per 100,000 population. After the peak the male rates declined substantially to a plateau at around eight deaths per 100,000 population between the ages of 50 and 70 years. The rate then increased again for ages over 70 years. Female death rates due to acute alcohol-caused conditions showed a slight increase in the 15-19 years age group and continued to slightly increase to around five deaths per 100,000 population in the 25-29 years age group. It then remained fairly stable amongst the 30-74 years age groups, with a slight drop in the 55-59 years age group (2.2 deaths per 100,000 population), before the age of 75 years when it began to increase again.
0
5
10
15
20
25
30
35
40
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Age group
Age
spe
cific
rate
s
Male Female Figure 22: Age-specific death rates for acute alcohol-caused conditions, by sex,
WA, 1997-2005
39
Chronic For deaths due to chronic alcohol-caused conditions, male and female age-specific rates remained low until the age of 25 years, when there were slight increases in the rates (more so for males). At 60 years of age the male rate peaked at 21.3 deaths per 100,000 people. The female rate peaked at the age of 50-54 years (8.6 deaths per 100,000 people). The male rate remained higher than the female rate for all age groups. For chronic conditions, alcohol was found to have a protective effect only among the elderly. At 65-69 years of age the protective effect of alcohol became evident for females, whilst the protective effect for males began at 75-79 years of age (Figure 23). The protective effect of low risk alcohol consumption was evident in the elderly due to the high prevalence of chronic conditions in this age group.
-1400
-1200
-1000
-800
-600
-400
-200
0
200
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age group
Age
spe
cific
rate
s
Male Female
Figure 23: Age-specific death rates for chronic alcohol-caused condition, by sex, WA, 1997-2005
The total number of estimated deaths due to alcohol in 2005 was highest in the 45 to 64 year age group, with an overall protective effect among those older than 65 years (Table 10).
Table 10: Number of alcohol-caused deaths and lives saved by age group and sex, WA, 2005
Sex 0-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65+ yrs*Male 1 22 50 59Female 0 3 16 17 -239All persons 1 25 66 76 -* Negative numbers denote number of alcohol-related lives saved
-10
249
40
5.4 Proportion of all deaths due to alcohol by age groups
In 2005, an estimated 21% of all deaths among males aged 15-24 years, and 15% of deaths among males aged 25-44 years were due to alcohol, while only about 8% of all female deaths between 15-44 years were alcohol-caused. In older people (65 years and over), 0.2% of male deaths and 5.6% of female deaths were saved through alcohol use (Figure 24).
-10
-5
0
5
10
15
20
25
0-14 yrs 15-24 yrs 25-44 yrs 45-64 yrs 65+ yrs
% o
f all-
caus
e de
aths
due
to a
lcoh
ol
Male Female Figure 24: Alcohol-caused deaths as a percentage of all deaths, by age group,
WA, 2005
41
5.5 Impact of alcohol on deaths by sex and Aboriginality The impact of the effects of alcohol on mortality varied with sex and Aboriginality, with the number of deaths attributed to the harmful effects of alcohol use greatest among non-Aboriginal males. Aboriginal people derived little benefit from alcohol use, as relatively few deaths were attributed to those chronic conditions for which alcohol has a protective effect. The greater longevity of non-Aboriginal females compared to non-Aboriginal males contributes to a relatively large benefit. More females than males die of ischaemic stroke as the majority of ischaemic strokes occur among ages greater than 75 years (Figure 25 and Table 11).
Num
ber o
f dea
ths
-4000
-3000
-2000
-1000
0
1000
2000
3000
Alcohol harm Alcohol benefit Net effect
Num
ber o
f liv
es s
aved
Non-Aboriginal males Non-Aboriginal females Aboriginal males Aboriginal females Figure 25: The impact of alcohol on deaths, WA, 1997-2005
Table 11: Estimated number of lives lost and saved from alcohol use, by Aboriginality and sex, WA, 1997-2005
Male Female Male Female Male Female TotalLives lost 2,537 940 231 95 2,904 1,073 3,977Lives saved -1,653 -3,125 -27 -13 -1,741 -3,240 -4,980Net effect 884 -2,185 204 81 1,163 -2,167 -1,003
*PersonsAboriginalNon-Aboriginal
* This includes cases where Aboriginality was missing, so the sum of the non-Aboriginal and Aboriginal cases does not add up to the total number of persons
Effect
42
5.6 Person years of life attributed due to alcohol use Person years of life (PYL) measures the level of premature death resulting from alcohol use by taking the age of death into account. The formulas used here calculate the number of years of life attributed to alcohol use up to the age of 74 years. Overall, males lost over five times as many years of life than they gained through alcohol use, and females lost over three times as many years of life than they gained. Both males and females lost an average of twice as many years per death than gained (Figure 26). Considering the age at death highlights the impact of alcohol use. The harmful effects of high risk drinking were experienced across all age groups, with the greatest impact among young people (see Figure 24). Deaths among the young will greatly increase the PYL lost. Whereas the benefits from alcohol use gained from the protective effect on chronic condition, mainly affected the elderly and contributed little to PYL attributed to alcohol use.
Average PYLS/life saved
29.6
-15.3
28.8
-13.9
-20 -15 -10 -5 0 5 10 15 20 25 30 3
Average PYLL/death
5
Males Females Figure 26: Average number of person years attributed to alcohol use by sex, WA,
1997-2005
43
5.7 Influence of Aboriginality on person years of life attributed to alcohol use
The average PYL per death due to the harmful effects of alcohol was 1.6 years higher for Aboriginal males compared with non-Aboriginal males and 4.6 years higher for Aboriginal females compared with non-Aboriginal females. However, when the average PYL per 1,000 population due to the harmful effects of alcohol was examined, a different picture emerged because of the smaller Aboriginal population. The average of PYL per 1,000 population for Aboriginal people was almost four times higher for males, and five times higher for females compared with non-Aboriginal males and females (Table 12). Table 12: Person years of life attributed to alcohol use, by sex and Aboriginality,
WA, 1997-2005
HARM Number of deaths (0-74 years) Number of PYLL Average PYLL /
deathAverage PYLL /
1,000 popnNon-AboriginalsMales 1,863 54,010 29.0 6.8Females 573 15,838 27.6 2.0AboriginalsMales 223 6,828 30.6 23.3Females 92 2,956 32.2 10.1
BENEFITNumber of deaths
averted (0-74 years)
Number of PYLS Average PYLS / life saved
Average PYLS / 1,000 popn
Non-AboriginalsMales 665 9,996 15.0 1.3Females 405 5,549 13.7 0.7AboriginalsMales 23 476 21.0 1.6Females 9 173 19.2 0.6
NET EFFECT Net number of lives lost
Net number of PYLL
Net ave PYLL / death
Net ave PYLL / 1,000 popn
Non-AboriginalsMales 1,198 44,014 14.0 5.5Females 168 10,288 13.9 1.3AboriginalsMales 200 6,352 9.6 21.7Females 83 2,783 13.0 9.5
44
5.8 Trends in alcohol-caused deaths for chronic and acute conditions
There were significant changes in age-standardised death rates (ASRs) for chronic conditions for both genders and acute conditions for males over the nine-year period. The ASRs for chronic conditions increased significantly (Figure 27), for both males (t-score = 3.35; p = 0.04) and females (t-score = 14.95; p = 0.001). The ASR for acute conditions for males showed a significant decrease over the nine-year period, i.e. there were fewer deaths (t-score = -7.91; p = 0.004). The ASRs for female acute conditions showed a slight decrease over the nine-year period, however, this trend was not statistically significant (t-score = -2.25; p = 0.11), see Figure 27. The combined effect of the trend for acute and chronic diseases has seen the overall rate of alcohol-caused deaths increase over the last decade.
-40
-30
-20
-10
0
10
20
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year of death
Age
sta
ndar
dise
d de
ath
rate
s
Males - chronic Males - acute Females - chronic Females - acute Figure 27: Age-standardised rates for alcohol-caused deaths and lives saved, by
type of condition and year of death, WA, 1997-2005
45
5.9 Proportion of deaths wholly attributable to alcohol
Over the period 1997 to 2005, around 22% of deaths from the harmful effects of alcohol were wholly attributable to alcohol5. There were noticeable differences in the proportion of alcohol-caused deaths that were wholly attributable by sex and Aboriginality. For non-Aboriginal males 20% of alcohol deaths were due to wholly attributable conditions, whereas for Aboriginal males the proportion was more than double that of non-Aboriginal males (43%). Such a difference was more evident amongst females. Almost 16% of alcohol deaths among non-Aboriginal females were due to wholly attributable conditions, whereas over half (55%) of the alcohol deaths for Aboriginal females were wholly attributable to alcohol (Figure 28).
0.0
10.0
20.0
30.0
40.0
50.0
60.0
Male Female
Perc
enta
ge o
f alc
ohol
har
m (d
eath
s)
Aboriginal Non-Aboriginal Figure 28: Percentage of alcohol deaths that are wholly attributable to alcohol,
by Aboriginality and sex, WA, 1997-2005
5 Conditions wholly attributable to alcohol are identified in Table 9.
46
5.10 Comparison of alcohol-caused deaths among health regions
To quantify the harm due to alcohol in regional areas alcohol-caused deaths by gender and Aboriginality by health regions were determined by including only conditions in which the deaths were attributed to alcohol consumption and excluding conditions in which the deaths might have been saved by alcohol consumption. Standardised mortality ratios (SMRs) and their 95% confidence intervals (CIs) for each health region were computed and contrasted using the State as a reference, that is, a rate of 1.0. A comparison of alcohol-related death rates due to alcohol consumption among the nine health regions showed that for males, rates were significantly higher for the Goldfields, Kimberley and Pilbara, and for females significantly higher for the Kimberley and the Pilbara. The rates for all other regions were similar to the State rate (Figures 29 and 30). Among the Aboriginal population, alcohol-related death rates for all regions were similar to the State Aboriginal rate, with the exception of a significantly higher rate for the Pilbara, and a significantly lower rate for the South West. For the non-Aboriginal population, the alcohol-related death rate was significantly higher for the Goldfields compared with the non-Aboriginal State rate, while the rate for North Metropolitan region was significantly lower compared with the State. The other regions all had rates similar to the State (Figures 31 and 32). Detailed information on the number of alcohol-related deaths, ASRs, SMRs and 95% CIs, per 100,000 population, by gender and regions is presented in Appendix 20. The numbers of alcohol-related deaths, ASRs, SMRs and 95% CIs, per 100,000 population, by Aboriginality and regions are presented in Appendix 21.
47
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5
State rate Figure 29: SMRs and CIs for alcohol-related deaths, males, 1997-2005
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0
State rate Figure 30: SMRs and CIs for alcohol-related deaths, females, 1997-2005
48
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
State rate Figure 31: SMRs and CIs for alcohol-related deaths, Aboriginal, 1997-2005
North Metro
South Metro
Goldfields
Great Southern
Kimberley
Midwest
Pilbara
South West
Wheatbelt
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
State rate Figure 32: SMRs and CIs for alcohol-related deaths, non-Aboriginal, 1997-2005
49
6. Alcohol-Related Emergency Department
Attendances Emergency department data for 2002-2006 were sourced from the Emergency Department Data Collection at the Department of Health WA. In metropolitan areas, the data were mainly collected via the Emergency Department Information System (EDIS) where the principal problems for the attendances were recorded and coded using a presenting symptom hierarchy where alcohol-related attendances could be identified and classified. However, the data collection systems from emergency departments in rural areas of WA do not have the capacity to record such a coded hierarchy to enable a reliable analysis. Therefore, it was decided that only data from metropolitan areas would be included in the analysis. The data analysed covered all attendances to all the emergency departments in the metropolitan area, including the Royal Perth Hospital, Sir Charles Gairdiner Hospital, Fremantle Hospital, Princess Margaret Hospital, King Edward Memorial Hospital, Swan District Hospital, Armadale-Kelmscott Hospital, Rockingham-Kwinana Hospital and Joondalup Health Campus. It is worth noting that the data from these hospitals came on-line gradually and used different systems such as EDIS or The Open Patient Administration System (TOPAS). In addition, alcohol-related injuries presented at ED departments were not identified because the current data collection systems did not include external cause information. Such information was required to apply the aetiological fraction derived by this study. Thus, the data presented in Sections 6.1 and 6.2 should be seen as underestimates.
There are other alcohol-related attendances, such as injury and assaults, not identified due to limitations of the existing data collection systems. Section 6.3 has been included to demonstrate the extent of alcohol-related injury and assault as a contribution to total Emergency Department presentation in 2005/2006. In this project, an emergency department attendance occurs when a patient is registered in any manner in one of the electronic data collection systems. Alcohol intoxication, also known as drunkenness, is the state of being intoxicated by consumption of alcohol to a degree that mental and physical facilities are noticeably impaired. Alcohol withdrawal, also known as alcohol withdrawal syndrome, refers to the characteristic signs and symptoms that appear when alcohol causing physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. ED costs for 2006 were estimated using WA 2005/06 unweighted ED attendance service costs produced by the Health Finance Division WA with teaching and non teaching rates of $385 and $237 per attendance, respectively. 6.1. Alcohol-related ED attendances and costs Table 13 lists the number of alcohol-related ED attendances by presenting problems in all metropolitan ED departments during 2002-2006. These alcohol-related ED attendances represented around 0.8% of all ED attendances. Nearly half of those
50
attendances were due to alcohol intoxication, with around 4% due to alcohol withdrawal. More than a quarter of these attendances were due to other alcohol-related issues such as the toxic effect of alcohol and poisoning due to the mixed use of alcohol and other substances. Almost 24% were alcohol-related non-ED reviews where patients’ conditions were not urgent, and their alcohol-related problems were reviewed by clinicians especially during after-hour periods. Examples of these alcohol-related non-ED reviews include blood alcohol tests requested by either patients or police, and alcohol-related DNA or forensic tests.
Table 13: Number of alcohol-related ED attendances by presenting reason and year, metropolitan ED departments, WA 2002-2006
Year Alcohol intoxication
Alcohol withdrawal
Other alcohol related
Alcohol related non ED review
Total alcohol related ED
attendances
Alcohol related attendances of
all ED attendances%
2002 1,009 118 703 343 2,173 0.872003 986 73 518 403 1,980 0.752004 1,065 81 543 411 2,100 0.702005 1,278 90 666 797 2,831 0.802006 1,488 101 757 996 3,342 0.89Total 5,826 463 3,187 2,950 12,426 0.80% alcohol related ED attendances 46.89 3.73 25.65 23.74 100.00
Table 14 presents the number of these alcohol-related ED attendances by teaching status of ED departments and triage category in all metropolitan ED departments during 2002-2006. ED departments in teaching hospitals treated more than 76% of all these alcohol-related ED attendances in metropolitan ED departments in WA with a similar percentage treated in teaching hospitals among different triage categories.
Table 14: Number of alcohol-related ED attendances by teaching status of ED departments and triage category, metropolitan ED departments, WA 2002-2006
Teaching status of ED departments1 2 3 4 5
Non-teaching hospitals 30 202 843 1,166 660 2,901 23.35Teaching hospitals 101 850 2,490 3,980 2,104 9,525 76.65Total 131 1,052 3,333 5,146 2,764 12,426 100.00% teaching ED in each triage category 77.10 80.80 74.71 77.34 76.12 76.65Triage Category: 1=Resuscitation: Immediate (within seconds); 2 = Emergency: Within 10 minutes; 3 = Urgent: Within 30 minutes; 4 = Semi-urgent: Within 60 minutes; 5 = Non-urgent: Within 120 minutes.
Triage category Total %
Triage Category is a standardised national scale that indicates the urgency of patient treatment in an ED. Table 15 lists the number of ED attendances by gender, presenting reason and triage category in metropolitan ED departments during 2002-2006. Significantly more females than males presented at ED with alcohol-related conditions in triage categories 1 to 3 (39.1% versus 33.8%, chi square = 33.378 and p = 0.0001). Relatively, females had a greater proportion of alcohol intoxication and other alcohol-related attendances than males.
51
Table 15: Number of alcohol-related ED attendances by gender, presenting reason and triage category, metropolitan ED departments, WA 2002-2006
Gender Presenting reason1 2 3 4 5
Male Alcohol intoxication 26 202 875 1,905 342 3,350Alcohol withdrawal 0 10 142 181 21 354Alcohol-related non-ED review 0 11 64 396 884 1,355Other alcohol-related 49 247 579 481 100 1,456Subtotal 75 470 1,660 2,963 1,347 6,515Male % of all triage categories 1.15 7.21 25.48 45.48 20.68 100.00
Female Alcohol intoxication 13 202 830 1,343 88 2,476Alcohol withdrawal 0 4 38 61 6 109Alcohol-related non-ED review 0 14 33 274 1,274 1,595Other alcohol-related 43 362 772 505 49 1,731Subtotal 56 582 1,673 2,183 1,417 5,911Female % of all triage categories 0.95 9.85 28.30 36.93 23.97 100.00
Total Alcohol intoxication 39 404 1,705 3,248 430 5,826Alcohol withdrawal 0 14 180 242 27 463Alcohol-related non-ED review 0 25 97 670 2,158 2,950Other alcohol-related 92 609 1,351 986 149 3,187Grand total 131 1,052 3,333 5,146 2,764 12,426
% of all triage categories 1.05 8.47 26.82 41.41 22.24 100.00
Triage category Total
Triage Category: 1=Resuscitation: Immediate (within seconds); 2 = Emergency: Within 10 minutes; 3 = Urgent: Within 30 minutes; 4 = Semi-urgent: Within 60 minutes; 5 = Non-urgent: Within 120 minutes. Figure 33 illustrates the presenting time of ED attendances in all metropolitan ED departments during 2002-2006. Males and females had similar presenting patterns with a high peak in the evening and night. Females had also a small peak of visits for these alcohol-related issues around 10 am.
0
20
40
60
80
100
120
0:00
0:05
1:04
2:03
3:02
4:01
5:00
5:05
6:04
7:03
8:02
9:01
10:0
0
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5
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20:0
5
21:0
4
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3
23:0
2
Time of day
Num
ber o
f ED
atte
ndan
ces
Male Female Figure 33: Time of alcohol-related ED attendances, metropolitan ED
departments, WA, 2002-2006 The number of ED attendances by presenting reason and day of a week among metropolitan residents are presented in Table 16. The greatest proportions of these
52
types of ED attendances were on Sunday and Monday due to both alcohol intoxication and withdrawal.
Table 16: Number of alcohol-related ED attendances by presenting reason and day of week, metropolitan ED departments, WA 2002-2006
Presenting problem Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total
Alcohol intoxication 1,371 533 501 542 628 881 1,370 5,826 Alcohol withdrawal 83 68 58 72 42 67 73 463 Other alcohol-related 667 379 337 357 423 415 609 3,187 Alcohol-related non-ED review 488 419 345 375 391 448 484 2,950
Total 2,609 1,399 1,241 1,346 1,484 1,811 2,536 12,426 % of all days 21.00 11.26 9.99 10.83 11.94 14.57 20.41 100.00
The number of ED attendances by presenting reason, region and gender among metropolitan residents are presented in Table 17. In both health regions, more attendances among males than females were related to alcohol intoxication and withdrawal, however, more attendances among females than males were associated with other alcohol-related conditions and non-ED reviews.
Table 17: Number of alcohol-related ED attendances by presenting reason, region and gender, metropolitan residents, WA, 2005-2006
Region Gender Total no. attendances
No. attendances
% within region &
presenting problem
No. attendances % within region
& presenting problem
No. attendances
% within region &
presenting problem
No. attendances
% within region &
presenting problem
North Metro Male 625 53.33 71 71.72 250 45.05 239 32.69 1,185Female 547 46.67 28 28.28 305 54.95 492 67.31 1,372Subtotal 1,172 100.00 99 100.00 555 100.00 731 100.00 2,557
South Metro Male 606 56.22 56 86.15 249 46.63 245 34.65 1,156Female 472 43.78 9 13.85 285 53.37 462 65.35 1,228Subtotal 1,078 100.00 65 100.00 534 100.00 707 100.00 2,384
Total 2,250 100.00 164 100.00 1,089 100.00 1,438 100.00 4,941
Alcohol intoxication Alcohol withdrawal Other alcohol related Alcohol related non ED review
Figure 34 shows the presenting months of ED attendances by these presenting problems in all metropolitan ED departments during 2002-2006. Alcohol intoxications occurred most during October to January. The other three presenting problems did not have apparent patterns.
53
0
100
200
300
400
500
600
700
Jan. Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Month
No. E
D a
ttend
ance
s
Other alcohol related Alcohol intoxicationAlcohol withdrawal Alcohol related non ED review
Figure 34: Month of alcohol-related ED attendances by presenting reason,
metropolitan ED departments, WA, 2002-2006
Diagnostic categories of all alcohol-related attendances were determined based on ICD-10AM codes by using Australian Burden of Disease Study minor categories (Mathers et al., 1999). Top 10 diagnostic categories for males and females in metropolitan ED departments during 2002-2006 are presented respectively in Tables 18 and 19. Both males and females had the same top diagnostic category, i.e., neurotic, personality and other non-psychotic mental disorders, accounting for 36% and 34% of all ED attendances, respectively. The top 5 categories were identical for both genders, accounting for around 90% of all alcohol-related ED attendances represented here.
54
Table 18: Number of alcohol-related ED attendances of top 10 diagnostic categories for males, metropolitan ED departments, WA, 2002-2006
Top 10 diagnostic categories No. ED attendances %
Neurotic, personality & other non-psychotic mental disorders 2339 35.90 Other factors influencing health and contact with health services 1557 23.90 Other accidental injuries 1191 18.28 Ill-defined & unknown causes of morbidity & mortality 485 7.44 Organic psychotic conditions 450 6.91 Conditions influencing health status 85 1.30 Other conditions originating in perinatal period 72 1.11 Diseases of oesophagus, stomach & duodenum 53 0.81 External causes 27 0.41 Other metabolic disorders & immunity disorders 22 0.34
Total 6515 100.00
Table 19: Number of alcohol-related ED attendances of top 10 diagnostic categories for females, metropolitan ED departments, WA, 2002-2006
Top 10 diagnostic categories No. ED attendances %
Neurotic, personality & other non-psychotic mental disorders 2036 34.44 Other accidental injuries 1340 22.67 Other factors influencing health and contact with health services 1168 19.76 Ill-defined & unknown causes of morbidity & mortality 369 6.24 Organic psychotic conditions 164 2.77 Chemotheraphy 156 2.64 Other pregnancy with abortive outcome 92 1.56 Conditions influencing health status 91 1.54 Other conditions originating in perinatal period 65 1.10 Ectopic and molar pregnancy 60 1.02
Total 5911 100.00 Table 20 presents the numbers of alcohol-related ED attendances for the four reported categories and costs by teaching status of all metropolitan ED departments in 2006 in WA. The total costs were over $1.15 million with ED departments in teaching hospitals covering more than 80% of the total costs.
Table 20: Number of alcohol-related ED attendances and costs by teaching status of ED departments, metropolitan ED departments, WA, 2006
Teaching status of ED No. attendances Cost per attendance ($) Total costs % of all ED costs
Non-teaching 898 237 $212,826 18.45Teaching 2444 385 $940,940 81.55
Total 3342 $1,153,766 100.00
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6.2. Alcohol-related ED attendance rates While alcohol-related ED attendances in the previous section included attendances in ED departments in metropolitan areas regardless of residential location of patients, the alcohol-related ED attendance rates in this section deal with ED attendances in all ED departments in metropolitan areas only for metropolitan residents. For the years examined, not all metropolitan ED departments submitted their data via the EDIS system, and not all hospitals collected the information required for analysis. The Joondalup Health Campus was excluded, as postcode data were not available. Consequently, the alcohol-related ED attendances presented here should be seen as an underestimate. Data for 2005 and 2006 were considered complete for all metropolitan ED departments and as such, the data for this two-year period were used to illustrate the age-specific rates of ED attendances among different populations in the metropolitan area. In 2005–06 both Aboriginal males and females experienced significantly higher rates for the four reported categories than non-Aboriginal people in almost all the age groups (Figure 35). Aboriginal males had higher rates than Aboriginal females in the age groups 0-4, 5-9 and 20-24 and over. Both Aboriginal males and females had two apparent peaks. For Aboriginal males, the peaks were at the age groups 40-45 and 60-64 (5 and 2.8 episodes per 100 Aboriginal male population, respectively); while for Aboriginal females the two peaks were at 15-19 and 40-44 (1.4 and 1.7 episodes per 100 Aboriginal female population, respectively). Non-Aboriginal females had higher rates than non-Aboriginal males across the majority of age groups.
0
500
1000
1500
2000
2500
3000
3500
4000
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age groups
Age
spe
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rate
s (p
er 1
00,0
00 p
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atio
n)
Aboriginal Male Non-Aboriginal Male Aboriginal Female Non-Aboriginal Female Figure 35: Age-specific rate of alcohol-related ED attendances, metropolitan
residents, 2005-2006
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Both overall crude rates and ASRs (per 100,000 population) for Aboriginal males and females were significantly higher than the non-Aboriginal population. Rates for Aboriginal males were also significantly higher than Aboriginal females. Non-Aboriginal females had a significantly higher ASR than non-Aboriginal males (Table 21). Rates for males living in South Metropolitan region were significantly higher than their counterpart residents in North Metropolitan region, while there was no significant difference recorded for females6. Overall, females experienced higher ED attendance rates than males regardless of region.
Table 21: Crude rate and age standardised rate of alcohol-related ED attendances by Aboriginality, region and gender, metropolitan residents, WA,
2005-2006 Aboriginality/Region/Gender No. occasions Crude Rate ASR LCI UCI Aboriginal Male 237 968.9 1216.1 1046.7 1385.5Non-Aboriginal Male 2104 139.7 136.4 130.6 142.3Aboriginal Female 189 744.4 709.5 600.2 818.8Non-Aboriginal Female 2411 157.5 157.6 151.3 163.9
North Metro Male 1185 141.8 137.8 129.9 145.6South Metro Male 1156 157.6 155.3 146.3 164.2North Metro Female 1372 163.0 162.4 153.8 171.0South Metro Female 1228 166.2 167.4 158.0 176.8 ASR = Age standardized rate; LCI = Lower limit of 95% confidence interval; UCI = Upper limit of 95% confidence interval.
6.3 Alcohol-related injury and assault ED attendances There are a range of emergency department presentations in which alcohol use is a factor. Two of the common alcohol-related reasons for ED presentation are injury and assault. It is estimated that in 2005/2006 these two reasons for presentation at emergency departments in the metropolitan hospitals totalled 30 202, cost $7.16 million and represented 7.8% of the total emergency department presentations. Poynton et al (2005) found that 45% of all assault presentations and 32.7% of all injury presentations were alcohol-related. In addition, almost 1% of all presentations were as a result of alcohol intoxication. Table 22 provides the number and cost of alcohol-related presentations to Western Australian metropolitan emergency departments when the Poynton findings are applied to data from the 2005/2006 EDIS data. Costings are based on ED presentations using the lower non-teaching rate of $237 per presentation.
Table 22: Emergency Department presentations, metropolitan hospitals, 2005 – 2006
Presentations Injury Assault TotalTotal presentations (n=365449) 85,995 4,054 90,049Alcohol-related presentations 28,378 1,824 30,202Proportion of total presentations that are alcohol-related (%) 33 45Total cost (alcohol-related presentations) $6,725,586 $432,288 $7,157,874
6 Note that metropolitan (mainly north-metropolitan) residents attending Joondalup Health Campus were excluded from the analysis due to unavailability of postcode information. This could change the ED attendance rates among north metropolitan residents greatly.
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7. Discussions and Implications 7.1 Issues about aetiological fractions This report described the health impact of alcohol consumption on Western Australians using newly derived WA-specific aetiological fractions. The previous WA Department of Health report (Unwin et al., 2004) described the impact of alcohol using the AIHW (nationally derived) aetiological fractions. The main difference seen between these two reports is the greater burden of harm due to alcohol consumption when using the WA AFs. This effect is especially evident in Aboriginal groups with both Aboriginal males and females experiencing twice the harm to benefit ratio as a consequence of the newly derived AFs compared with the previous report, in which the AIHW AFs were employed. As a result of the greater harm seen in this report, there is also a substantial increase in hospitalisation costs, both total and cost per admission. As this report determines hospitalisations as net costs (the difference between the harm and the benefit of alcohol consumption), costs also increase due to the smaller benefit that the new AFs produce. A greater burden on health is seen in this report as the AFs were developed according to Aboriginality and region (remote/non-remote and metropolitan/non-metropolitan). These fractions considered the higher prevalence of risky and high-risk alcohol consumption seen in Aboriginal people, especially in remote areas. Therefore, alcohol-related outcomes for Western Australians seen in this report are more reliable than the previous report, due to the use of WA-specific fractions. A further explanation for the greater burden on health due to alcohol seen in this report, compared with the previous report, is the declining trend in conditions that benefit from the positive effects of low-level alcohol use, namely cardiovascular disease and stroke. Between 1983 and 2003 in Western Australia, mortality rates for coronary heart disease experienced an average annual decline of 4.8% for males and 4.7% for females. Similarly for stroke, between 1983 and 2003 there was a steady decrease in the mortality rate of 3.5% and 3.2% annually for males and females respectively (Draper et al., 2005). This decrease over time in the number of cases of stroke and cardiovascular disease, for which alcohol has a positive effect, has also contributed to the smaller beneficiary effect, and overall greater burden on health due to alcohol that is seen in this report compared with the previous report. Another contributing factor in the apparent greater alcohol-related health burden is the difference in aetiological fractions used for supraventricular cardiac dysrhythmia (SVD) in this report compared to the previous AIHW report. The AFs for SVD in the AIHW report were based on the study by English et al. (1995) whereby the ischaemic heart disease AFs were used for SVD and thereby a protective effect on health due to alcohol consumption was attributed. This report, however, calculated AFs for SVD based on research used by English et al. (1995) where relative risks and AFs were created specifically for SVD and portray a harmful effect due to the consumption of alcohol.
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In 2001 the AIHW published a report quantifying the morbidity and mortality due to alcohol consumption, using their own aetiological fractions. A common theme evident in the AIHW report (Ridolfo & Stevenson, 2001), the previous Western Australian Department of Health report (Unwin et al., 2004), and this report, is the net reduction in deaths associated with alcohol consumption, along with a net increase in potential years of life lost. This occurs because the decrease in deaths applies to illnesses that occur at older ages (heart disease and stroke) while the harmful effects apply across all ages. Deaths at younger ages contribute more potential years of life lost than deaths at older ages (Ridolfo & Stevenson, 2001). A further similarity between the AIHW AFs and the WA-derived AFs is the difference in risk between ischaemic stroke and haemorrhagic stroke. The AFs derived by English et al. (1995) presented stroke as one category in identifying the risk from alcohol consumption. However, Ridolfo & Stevenson (2001) examined the relative risk of stroke associated with alcohol consumption because recent research had suggested that the risk differed between ischaemic and haemorrhagic stroke. As a result, different fractions were estimated for the two different types of stroke in the AIHW AFs. The same methodology was applied to WA data for calculation of AFs, with alcohol producing a protective effect against ischaemic stroke for all female categories (Aboriginal and non-Aboriginal) and non-Aboriginal males residing in the capital city, while a harmful effect was seen for haemorrhagic stroke. However, a protective effect for haemorrhagic stroke was seen for non-Aboriginal females. A comparison of the new WA fractions with the AIHW nationally derived fractions revealed that the small number of hospitalisations and deaths due to cardiovascular disease for Aboriginal people living in remote areas, jeopardised the reliability of the AFs for heart failure (which were derived differently from most of the AFs, see Figure 3 & Figure 4). To overcome the issue of reliability due to small numbers for Aboriginal-remote heart failure AFs, WA state figures were used instead of Aboriginal-remote figures. WA state prevalence data and relative risk figures were used to calculate AFs for each of ischaemic heart disease, supraventricular dysrhythmia, alcoholic cardiomyopathy and hypertensive heart disease. Deaths and hospitalisations for the State for these four conditions and all cardiovascular disease were extracted and used in the Aboriginal remote heart failure AF calculations. AFs derived by the direct method are identical to those in the Australian Burden of Disease Study (Mathers et al., 1999) as these were not dependent on the prevalence of alcohol consumption, but rather a series of uncontrolled observations and investigations of case series. The AFs derived by the indirect method in this study were higher than those in the Australian Burden of Disease Study, both in terms of disease caused and disease prevented by alcohol. Therefore, we believe that WA-specific AFs are needed to reflect the true picture of the local situation, especially the difference in alcohol consumption prevalence and relative risk for population sub-groups. 7.2 Alcohol-related mortality and morbidity A national report on Australian alcohol data (AIHW, 2004) reported that the leading causes of death due to alcohol consumption were alcohol liver disease, followed by road crash injury, cancer and suicide. A similar trend was seen in this (WA) report,
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with suicide, alcoholic liver cirrhosis and road injuries (vehicle) all appearing in the top five conditions responsible for alcohol-caused deaths. In this report, stroke was also a leading cause of death, and specifically oesophageal cancer accounted for the majority of cancer deaths attributable to alcohol consumption. Trends in alcohol-caused deaths were similar for WA as described nationally. Nationally, more people died in 1990-2001 from acute rather than chronic affects of alcohol (Chikritzhs et al., 2002). A similar pattern occurred in WA from 1997 to 2005, especially when looking at the net effect of alcohol consumption on deaths. In addition, as with the Australian results (Chikritzhs et al., 2003), the protective effects of low-risk alcohol consumption were only evident in persons aged 65 years and over. In WA, the protective effects of alcohol become evident among females aged 65-69 years, while the protective effect begins at around 75–79 years for males. As indicated by Single et al (2000), there is an increasing body of evidence that alcohol consumption has a protective effect against ischaemic heart disease and ischemic stroke (Maclure, 1993; English et al., 1995; Poikolainen, 1995; Sacco et al., 1999; Single et al., 2000; Wannamethee, 2005; Elkind et al., 2006 and O’Keefe et al. 2007). The level of consumption required to obtain a beneficial effect remains unclear with studies identifying a beneficial impact at different levels of consumption, but it is clear that relatively low levels of consumption are associated with lower rates of cardiovascular disease. Results of this project indicate a greater protective effect of alcohol consumption among women than men, largely from the protective effects of alcohol on stroke among women. This finding is due to the much higher risk faced by men who consume harmful quantities of alcohol of having a stroke compared with abstainers. The relative risk in women is significantly lower. In this report, a considerable burden was attributed to alcohol consumption due to the morbidity and mortality from acute diseases and chronic diseases among the young, males and the Aboriginal population. Hospital admission rates for chronic and acute diseases were high among the young, with the highest number of admissions among people aged 15 to 44 years. Death rates were also high among the young, with a high proportion of all-cause deaths attributed to alcohol in this age group. The ongoing disability and health care costs from hospitalisation at an early age and the potential years of life lost from premature death impact heavily on the population of WA. There is the potential for substantial misinterpretation of health outcomes attributed to alcohol as a result of the existence of both harmful and protective effects of alcohol consumption. Alcohol should not be universally prescribed for health enhancement to non-drinking individuals owing to the lack of randomised outcome data and the potential for problem drinking (O’Keefe et al., 2007). As Wannamethee (2005) pointed out, the degree of protection of alcohol claimed may still be exaggerated by comparisons with a heterogeneous group and by the limited adjustment procedures
used to take into account the differing characteristics of the various alcohol intake groups. For all-cause mortality there is no general agreement regarding benefit, and the benefit of alcohol on all-cause mortality in older men is small and this lower risk may well be attributed to residual confounding. Therefore, the development of
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policies designed to minimise alcohol-related harm needs to consider the age distribution of benefit and harm. 7.3 Prevalence of alcohol consumption A useful indicator of consumption is total litres of pure alcohol per capita (or per capita aged 15 years and over), which has been shown to correlate with other measures of alcohol-related harm (AIHW, 2007). Despite the constant level of self-reported prevalence in recent years, this report found an increasing trend of per capita alcohol consumption (aged 15 years and over) in terms of total litres of pure alcohol from 1990/91 to 2004/05 in WA although the recent data showed a stable trend in prevalence (Figure 6). Therefore, it is imperative to examine the potential effects of such an increase on the health of population and also assess the association between per capita consumption and prevalence in the coming years. Alcohol consumption prevalence has remained fairly consistent over the last 10 years as shown by both self-reported surveys (Draper et al., 2005) and customs and excise data (AIHW, 2005). In WA, 13.1% of persons aged 14 years and over reported themselves as abstainers or as not having consumed alcohol within the last 12 months; while11.4% drank at risky/high risk levels. In Australia, 16.4% of persons aged 14 years and over described themselves as abstainers or not having an alcoholic drink within the last 12 months, while 9.9% drank at levels considered risky or high-risk (Draper et al., 2005; AIHW, 2004). In a comparison of alcohol consumption prevalence among States and Territories conducted by AIHW (2005), alcohol was found to be the most used drug in WA, with around 87% of those aged 14 years and over having consumed at least one standard drink in the previous year. On average, WA males and females have their first full glass of alcohol at 16.3 years of age. The proportion of daily drinkers is also higher in WA than any other State or Territory (10.1%) with the Northern Territory reporting the second highest figure at 9.7%. Almost 57% of Western Australians reported that they drink alcohol at least weekly. This was higher than the Australian figure (50.1%) and while not statistically significant, was higher than any other State or Territory (AIHW, 2005). It will be worthwhile continuing to monitor this trend and evaluate the implications of such a trend. This report found that the Pilbara and Kimberley health regions were identified as having highest proportions of population aged 14 years and over drinking alcohol at risky/high risk of harm for both short-term and long-term harms (both regions about 40% short-term and 20% long-term). Although in this report no significant differences were found between the regions and the State for both short- and long-term harms due to alcohol consumption, it was potentially due to the relatively small sample size, especially in these two regions. In any future survey of similar nature, it is recommended that sample size should be increased, particularly in the remote regions of WA, to ensure robust and reliable estimates of short- and long-term harm due to alcohol.
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More than 11% of all Western Australians aged 14 years and over consume alcohol at levels that put them at risk of harm in the long term, while at least 40% consume at levels putting them at risk of harm in the short term. Between 2001 and 2004, the proportion of WA males who consumed alcohol on a daily basis increased significantly from 11% to 15%; however, there was no significant change among WA females (Draper et al., 2005; AIHW, 2005). Therefore, programs that deal with alcohol problems should be developed to accommodate the difference in alcohol consumption prevalence in different population. 7.4 Alcohol-related ED attendances It is worth noting that although the current ED data collection systems have recorded several diagnosis fields, the principal presenting problem was the only field available for analysis. Being unable to examine all diagnostic codes has limited the identification of alcohol-related problems. This would result in an under-representation of alcohol-related attendances in the data. This issue was addressed by using a coded presenting symptom hierarchy. By using the hierarchy more alcohol-related ED attendances were identified than using the ICD-10-AM codes for the primary condition. In addition, there were no external cause codes available enabling us to identify alcohol-related injuries in the ED data. The data for alcohol-related injury and assault ED attendances presented in Section 6.3 indicate the additional ED attendances attributable to alcohol due to the external causes of injury and assault. Compared with the results in the previous report by Unwin et al. (2004), alcohol-related ED attendances to metropolitan EDs for the four categories remained around 0.80% of all ED attendances, although the total numbers of ED attendances increased from about 2,000 per year in 1997/1998 to 3,000 per year in 2005/2006 due to population increase. Consistent with a New Zealand study (Humphrey et al., 2003), young people were more likely to present an alcohol-relation problem at the ED than older people. This is also true for non-Aboriginal population in metropolitan areas of WA. However, this study identifies significantly different patterns between Aboriginal and non-Aboriginal populations where the rates for non-Aboriginal population peaked in the 15-19 age group, while the age-specific rates for the Aboriginal population remained high from 15-19 to 65-69 age groups. In contrast to the above referred studies, it is found in this study that non-Aboriginal women were more likely to present with alcohol-related problems at ED departments than non-Aboriginal men. The age-specific rates for non-Aboriginal women were higher than those for non-Aboriginal men from 15-19 to 55-59 age groups. Considering that nearly one-third of Western Australian women report regular alcohol consumption outside the NHMRC guldelines (Unwin et al., 2004), it is clear that alcohol consumption is a critical health issue for women in WA. ED attendances due to drinking problems can occur at any part of the day, but they usually occur more often at nights and during weekends (Pirmohamed et al., 2000). This study shows that the patients presented most in the evening and at night, and at the weekend. Unique in WA metropolitan ED data was a greater proportion of attendances on Monday due to alcohol intoxication and withdrawal.
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The results from this study show that the great majority of alcohol-related ED patients were 18–60 years old, with mental health conditions common among both genders. These patients are very likely to attend the ED department on more than one attendance over a short period of time, and, in some or all of these attendances, be admitted into hospital for a substantial period, thus imposing a significant burden on the workload and financial resources of both the ED department and the hospital (Rainer et al., 1996; Pirmohamed et al., 2000). 7.5 Strengths and limitations of this study 7.5.1 Strengths The use of WA-specific prevalence figures and WA-specific morbidity and mortality data to develop WA specific AFs was a major strength of the present study. This enabled the study to reflect the local reality in a far more accurate way than would have been possible with the use of national fractions that may not be applicable to WA. Martin (2007) showed that the health impact of alcohol on the WA population is higher when calculated with WA-specific AFs, rather than when using nationally derived fractions. This is due in part to the higher prevalence of risky/high risk alcohol consumption in WA. This project confirms the importance of using local prevalence data to calculate AFs. The AFs developed in this project result in alcohol-caused age-standardised hospitalisation and mortality rates approximately 30% higher than would be the case if the AFs from the Australian Burden of Disease were used. WA-specific AFs also allowed for the examination of alcohol consumption trends and the different level of alcohol consumption among various population groups in WA. Thus at-risk sub-populations could be identified. Through the analysis of the project, the Aboriginal population as a whole and young people have been identified as a major high risk population. Geographically, health regions such as Kimberley and Pilbara and some SLAs were also identified as high risk areas. A further strength of the present study was the detailed analysis of alcohol-related emergency department attendances in all metropolitan ED departments and also among metropolitan residents. These attendances have been examined in terms of presenting problems and diagnostic categories, triage categories, presenting time of day, day of week and month of year, and health regions. 7.5.2 Limitations The AF method was used in the evaluation of the impact of alcohol on the population of WA. The reliability of the method is dependent on the reliability and the generalisability of the relative risks and the prevalence of alcohol consumption used. The use of WA-specific prevalence, morbidity and mortality data to derive AFs in some cases produced unstable AFs due to small sample sizes, especially for remote Aboriginal data. In order to address this issue, more stable State AFs were used instead of these unstable AFs. In the future, survey sample sizes for Aboriginal populations could be increased in order to achieve reliable prevalence estimates. Relative risks were sourced from established large-scale meta-analysis studies. However, these RRs might not reflect the risks associated with sub-populations such
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as Aboriginal populations. Therefore, caution should be exercised when interpreting the results of the present report, especially when examining such populations. 7.6 Conclusion Aboriginal people, males, young people aged 15-24 and residents of remote regions of the State were identified as at-risk sub-populations from the harmful effects of alcohol consumption. Differences in the impact of alcohol for sub-populations demonstrate the need for continual monitoring of the impact of alcohol. Public health campaigns must give a clear statement of the harm caused by alcohol and not being confused by potential benefits. Comparing the costs and benefits of alcohol use to population health is not a zero-sum game where the object is to achieve parity between the two sets of figures. There is little purpose in ‘balancing’ the number of deaths caused by alcohol with the number of deaths prevented by alcohol. The objective of alcohol-related health education programs is to reduce deaths, hospitalisations and other adverse consequences of alcohol misuse, regardless of the number of lives and hospitalisations prevented by moderate use. The cardiovascular benefits of low-level drinking must be weighed against risks. Single et al. (2000) showed that even low-level drinking might carry increased risk of trauma from alcohol-related accidents and certain forms of cancer.
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Poikolainen, K. (1995) Alcohol and mortality: A review [published erratum appears in J Clin epidemiol 1995 Sep;48(9):i]. Journal of Clinical Epidemiology 48:455-465. Poynton S, Donnelly N, Weatherburn D, Fulde G & Scott L. (2005). The role of alcohol in injuries presenting to St Vincent’s Hospital Emergency Department and the associated short-term costs. Alcohol Studies Bulletin No. 6, NSW Bureau of Crime Statistics and Research, Sydney. Rainer TH, Swann IJ and Crawford R. (1996). Critical analysis of an accident and emergency ward. Journal of Accident and Emergency Medicine 13:325–329. Ridolfo B, Stevenson C. (2001). The quantification of drug-caused mortality and morbidity in Austrlalia, 1998. AIHW Cat. No. PHE 29. Canberra: AIHW (Drug Statistics Series no. 7). Romeder JM & McWhinnie JR. (1998). Potential years of life lost between ages 1 and 70: an indicator of premature mortality for health planning. In: Buck C, Llopis A, Najera E, et al., eds. The challenge of epidemiology: issues and selected readings. Washington: Pan American Health Organisation, 699-718. Rothman KJ & Greenland S. (1998). Modern Epidemiology. Lippincott Willians & Wilkins. 2nd edition. Sacco RL, Elkind M, Boden-Albala B, Lin IF, Kargman DE, Hauser WA, Shea S, Paik MC. (1999). The protective effect of moderate alcohol consumption on ischemic stroke. Journal of American Medical Association 281:53-60. Single E, Ashley MJ, Bondy S, Rankin J and Jürgen Rehm J. (2000). Evidence regarding the level of alcohol consumption considered to be low-risk for men and women. http://www.nhmrc.gov.au/publications/synopses/_files/alc-comp.pdf. Accessed on 24 September 2007. Somerford P, Katzenellenbogen J and Codde J (2004). Disease burden: A detailed analysis by modifiable risk factor. WA Burden of Disease Study: Bulletin No. 6. Department of Health, Western Australia. Perth. Unwin E, Codde JP, Bartu A (2004). The impact of alcohol on the health of Western Australians. Epidemiology Occasional Paper 19, ISSN:1329-7252. Drug and Alcohol Office and the Epidemiology Branch, Health Information Centre, Department of Health, Perth, Western Australia. Wannamethee SG. (2005). Commentary: Alcohol and mortality: diminishing returns for benefits of alcohol. International Journal of Epidemiology 34:205-206. Wood N and Daly A. (2007). Health and wellbeing of adults in Western Australia 2006. Trends over time for chronic conditions and risk factors. Department of Health Western Australia.
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World Health Organization. (2000). International Guide for Monitoring Alcohol Consumption and Related Harm. http://whqlibdoc.who.int/hq/2000/WHO_MSD_MSB_00.4.pdf. Accessed on 11 October 2007. World Health Organization. (2002). The World Health Report 2002 – Reducing Risks, Promoting Healthy Life. Geneva: WHO.
Appendices
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Appendix 1: AFs for Male Aboriginal Non-Remote Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.422 0.422 0.422 0.422 0.461 0.461 0.461 0.461 0.461 0.461 0.461 0.461 0.461 0.461 0.461Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.454 0.454 0.454 0.454 0.466 0.466 0.466 0.466 0.466 0.466 0.466 0.466 0.466 0.466 0.466Liver cancer Both 0.000 0.000 0.000 0.000 0.401 0.401 0.401 0.401 0.407 0.407 0.407 0.407 0.407 0.407 0.407 0.407 0.407 0.407 0.407Larynx cancer Both 0.000 0.000 0.000 0.000 0.516 0.516 0.516 0.516 0.520 0.520 0.520 0.520 0.520 0.520 0.520 0.520 0.520 0.520 0.520Breast cancer Both 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.136 0.136 0.136 0.136 0.156 0.156 0.156 0.156 0.156 0.156 0.156 0.156 0.156 0.156 0.156Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.125 -0.125 -0.125 -0.125 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111 -0.111Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.325 0.325 0.325 0.325 0.316 0.316 0.316 0.316 0.316 0.316 0.316 0.316 0.316 0.316 0.316Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 0.066 0.066 0.066 0.066 0.083 0.083 0.083 0.083 0.083 0.083 0.083 0.083 0.083 0.083 0.083Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.276 0.276 0.276 0.276 0.278 0.278 0.278 0.278 0.278 0.278 0.278 0.278 0.278 0.278 0.278Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 0.000 0.276 0.171 0.108 0.148 0.191 0.164 0.083 0.102 0.131 0.161 0.156 0.083 0.083 0.083Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.276 0.000 0.000 0.000 0.278 0.000 0.000 0.278 0.000 0.000 0.180 0.083 0.083 0.083Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.646 0.646 0.646 0.646 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.646 0.646 0.646 0.646 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655Psoriasis Hospital 0.000 0.000 0.000 0.000 0.309 0.309 0.309 0.309 0.307 0.307 0.307 0.307 0.307 0.307 0.307 0.307 0.307 0.307 0.307Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.154 -0.164 -0.159 -0.159 -0.160 -0.151 -0.147 -0.150 -0.147 -0.144 -0.142 -0.141 -0.143 -0.131 -0.131Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.319 0.319 0.319 0.319 0.317 0.317 0.317 0.317 0.317 0.317 0.317 0.317 0.317 0.317 0.317Road traffic accidents vehicle Death 0.328 0.328 0.328 0.328 0.299 0.394 0.394 0.397 0.397 0.397 0.397 0.097 0.097 0.097 0.097 0.097 0.097 0.097 0.097Road traffic accidents vehicle Hospital 0.246 0.246 0.246 0.246 0.205 0.327 0.327 0.240 0.240 0.240 0.240 0.095 0.095 0.095 0.095 0.095 0.095 0.095 0.095Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.690 0.580 0.580 0.510 0.510 0.510 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.350 0.450 0.450 0.460 0.460 0.460 0.460 0.230 0.230 0.230 0.230 0.230 0.230 0.230 0.230Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.037 0.046 0.070 0.095 0.094 0.098 0.098 0.089 0.094 0.095 0.084 0.092 0.083 0.078 0.086 0.086 0.068 0.063 0.063Fires/burns/scalds Death 0.000 0.407 0.407 0.407 0.407 0.000 0.407 0.407 0.407 0.364 0.407 0.358 0.407 0.407 0.364 0.407 0.407 0.277 0.277Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.646 0.646 0.646 0.646 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655 0.655Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.000 0.000 0.000 0.000 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.096 0.071 -0.015 -0.043 -0.029 -0.042 -0.070 -0.058 -0.024 -0.058 -0.030 -0.031 -0.093 -0.079 -0.079Heart failure Death 0.000 0.000 0.000 0.000 0.000 0.000 -0.083 -0.038 -0.044 -0.053 -0.037 -0.025 -0.042 -0.049 -0.027 -0.024 -0.044 -0.067 -0.067
Appendix 2: AFs for Female Aboriginal Non-Remote Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.324 0.324 0.324 0.324 0.279 0.279 0.279 0.279 0.279 0.279 0.279 0.279 0.279 0.279 0.279Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.363 0.363 0.363 0.363 0.329 0.329 0.329 0.329 0.329 0.329 0.329 0.329 0.329 0.329 0.329Liver cancer Both 0.000 0.000 0.000 0.000 0.318 0.318 0.318 0.318 0.302 0.302 0.302 0.302 0.302 0.302 0.302 0.302 0.302 0.302 0.302Larynx cancer Both 0.000 0.000 0.000 0.000 0.426 0.426 0.426 0.426 0.405 0.405 0.405 0.405 0.405 0.405 0.405 0.405 0.405 0.405 0.405Breast cancer Both 0.000 0.000 0.000 0.000 0.103 0.103 0.103 0.103 0.094 0.094 0.094 0.094 0.094 0.094 0.094 0.094 0.094 0.094 0.094Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.019 0.019 0.019 0.019 0.016 0.016 0.016 0.016 0.016 0.016 0.016 0.016 0.016 0.016 0.016Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.086 -0.086 -0.086 -0.086 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077 -0.077Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.254 0.254 0.254 0.254 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 -0.225 -0.225 -0.225 -0.225 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202 -0.202Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.204 0.204 0.204 0.204 0.115 0.115 0.115 0.115 0.115 0.115 0.115 0.115 0.115 0.115 0.115Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 -0.225 0.000 -0.225 -0.011 -0.111 -0.116 -0.134 -0.134 -0.149 -0.111 -0.075 -0.202 -0.096 -0.139 -0.139Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.115 0.115 0.115 0.115 0.115 0.000 0.000 0.115 0.000 0.000Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.562 0.562 0.562 0.562 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.562 0.562 0.562 0.562 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559Psoriasis Hospital 0.000 0.000 0.000 0.000 0.237 0.237 0.237 0.237 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.111 -0.113 -0.113 -0.112 -0.096 -0.096 -0.095 -0.096 -0.095 -0.096 -0.093 -0.093 -0.088 -0.084 -0.084Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.247 0.247 0.247 0.247 0.234 0.234 0.234 0.234 0.234 0.234 0.234 0.234 0.234 0.234 0.234Road traffic accidents vehicle Death 0.107 0.107 0.107 0.107 0.078 0.155 0.155 0.184 0.184 0.184 0.184 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Road traffic accidents vehicle Hospital 0.106 0.106 0.106 0.106 0.095 0.150 0.150 0.125 0.125 0.125 0.125 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.500 0.110 0.110 0.420 0.420 0.420 0.420 0.060 0.060 0.060 0.060 0.060 0.060 0.060 0.060Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.160 0.190 0.210 0.210 0.210 0.210 0.210 0.030 0.030 0.030 0.030 0.030 0.030 0.030 0.030Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.040 0.045 0.059 0.061 0.068 0.070 0.067 0.074 0.062 0.066 0.077 0.071 0.066 0.069 0.062 0.064 0.062 0.057 0.057Fires/burns/scalds Death 0.000 0.407 0.407 0.000 0.000 0.000 0.407 0.407 0.407 0.333 0.000 0.407 0.407 0.407 0.407 0.407 0.222 0.284 0.284Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.562 0.562 0.562 0.562 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559 0.559Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.000 0.033 -0.024 -0.021 -0.003 -0.034 -0.029 -0.037 -0.035 -0.028 -0.026 -0.024 -0.034 -0.036 -0.036Heart failure Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.086 0.000 -0.019 -0.005 -0.006 -0.014 -0.036 -0.018 -0.005 -0.019 -0.024 -0.024
70
71
Appendix 3: AFs for Male Aboriginal Remote Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.336 0.336 0.336 0.336 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.363 0.363 0.363 0.363 0.385 0.385 0.385 0.385 0.385 0.385 0.385 0.385 0.385 0.385 0.385Liver cancer Both 0.000 0.000 0.000 0.000 0.322 0.322 0.322 0.322 0.338 0.338 0.338 0.338 0.338 0.338 0.338 0.338 0.338 0.338 0.338Larynx cancer Both 0.000 0.000 0.000 0.000 0.428 0.428 0.428 0.428 0.444 0.444 0.444 0.444 0.444 0.444 0.444 0.444 0.444 0.444 0.444Breast cancer Both 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.102 0.102 0.102 0.102 0.127 0.127 0.127 0.127 0.127 0.127 0.127 0.127 0.127 0.127 0.127Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.079 -0.079 -0.079 -0.079 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069 -0.069Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.249 0.249 0.249 0.249 0.246 0.246 0.246 0.246 0.246 0.246 0.246 0.246 0.246 0.246 0.246Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 0.052 0.052 0.052 0.052 0.072 0.072 0.072 0.072 0.072 0.072 0.072 0.072 0.072 0.072 0.072Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.213 0.213 0.213 0.213 0.222 0.222 0.222 0.222 0.222 0.222 0.222 0.222 0.222 0.222 0.222Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 0.213 0.052 0.075 0.092 0.109 0.113 0.151 0.147 0.112 0.116 0.125 0.072 0.147 0.097 0.097Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.222 0.222 0.072 0.147 0.147 0.222 0.000 0.000 0.000Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.576 0.576 0.576 0.576 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.576 0.576 0.576 0.576 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602Psoriasis Hospital 0.000 0.000 0.000 0.000 0.231 0.231 0.231 0.231 0.232 0.232 0.232 0.232 0.232 0.232 0.232 0.232 0.232 0.232 0.232Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.099 -0.105 -0.102 -0.102 -0.106 -0.100 -0.098 -0.099 -0.098 -0.096 -0.094 -0.093 -0.095 -0.087 -0.087Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.247 0.247 0.247 0.247 0.253 0.253 0.253 0.253 0.253 0.253 0.253 0.253 0.253 0.253 0.253Road traffic accidents vehicle Death 0.328 0.328 0.328 0.328 0.299 0.394 0.394 0.397 0.397 0.397 0.397 0.097 0.097 0.097 0.097 0.097 0.097 0.097 0.097Road traffic accidents vehicle Hospital 0.246 0.246 0.246 0.246 0.205 0.327 0.327 0.240 0.240 0.240 0.240 0.095 0.095 0.095 0.095 0.095 0.095 0.095 0.095Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.690 0.580 0.580 0.510 0.510 0.510 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.350 0.450 0.450 0.460 0.460 0.460 0.460 0.230 0.230 0.230 0.230 0.230 0.230 0.230 0.230Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.037 0.046 0.070 0.095 0.094 0.098 0.098 0.089 0.094 0.095 0.084 0.092 0.083 0.078 0.086 0.086 0.068 0.063 0.063Fires/burns/scalds Death 0.000 0.407 0.407 0.407 0.407 0.000 0.407 0.407 0.407 0.364 0.407 0.358 0.407 0.407 0.364 0.407 0.407 0.277 0.277Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.576 0.576 0.576 0.576 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602 0.602Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.000 0.000 0.000 0.000 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.018 0.020 0.015 0.007 -0.004 -0.012 -0.021 -0.022 -0.023 -0.020 -0.018 -0.017 -0.016 -0.014 -0.014Heart failure Death 0.000 0.000 0.000 0.000 -0.012 -0.035 -0.048 -0.069 -0.112 -0.106 -0.138 -0.116 -0.111 -0.123 -0.119 -0.107 -0.097 -0.093 -0.093
Appendix 4: AFs for Female Aboriginal Remote Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.347 0.347 0.347 0.347 0.238 0.238 0.238 0.238 0.238 0.238 0.238 0.238 0.238 0.238 0.238Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.343 0.343 0.343 0.343 0.267 0.267 0.267 0.267 0.267 0.267 0.267 0.267 0.267 0.267 0.267Liver cancer Both 0.000 0.000 0.000 0.000 0.317 0.317 0.317 0.317 0.237 0.237 0.237 0.237 0.237 0.237 0.237 0.237 0.237 0.237 0.237Larynx cancer Both 0.000 0.000 0.000 0.000 0.415 0.415 0.415 0.415 0.328 0.328 0.328 0.328 0.328 0.328 0.328 0.328 0.328 0.328 0.328Breast cancer Both 0.000 0.000 0.000 0.000 0.097 0.097 0.097 0.097 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.066 0.066 0.066 0.066 0.019 0.019 0.019 0.019 0.019 0.019 0.019 0.019 0.019 0.019 0.019Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.053 -0.053 -0.053 -0.053 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051 -0.051Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.222 0.222 0.222 0.222 0.180 0.180 0.180 0.180 0.180 0.180 0.180 0.180 0.180 0.180 0.180Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 -0.105 -0.105 -0.105 -0.105 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124 -0.124Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.350 0.350 0.350 0.350 0.153 0.153 0.153 0.153 0.153 0.153 0.153 0.153 0.153 0.153 0.153Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 0.000 0.008 0.122 0.285 -0.078 0.030 -0.065 -0.069 -0.032 -0.074 -0.069 -0.045 -0.085 -0.124 -0.124Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.153 0.000 0.000 0.153 0.014 0.000 0.000 0.000 0.000 -0.124 -0.124Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.599 0.599 0.599 0.599 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.599 0.599 0.599 0.599 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475Psoriasis Hospital 0.000 0.000 0.000 0.000 0.195 0.195 0.195 0.195 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.093 -0.094 -0.094 -0.094 -0.067 -0.067 -0.066 -0.067 -0.066 -0.067 -0.065 -0.064 -0.061 -0.058 -0.058Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.232 0.232 0.232 0.232 0.178 0.178 0.178 0.178 0.178 0.178 0.178 0.178 0.178 0.178 0.178Road traffic accidents vehicle Death 0.107 0.107 0.107 0.107 0.078 0.155 0.155 0.184 0.184 0.184 0.184 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Road traffic accidents vehicle Hospital 0.106 0.106 0.106 0.106 0.095 0.150 0.150 0.125 0.125 0.125 0.125 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.500 0.110 0.110 0.420 0.420 0.420 0.420 0.060 0.060 0.060 0.060 0.060 0.060 0.060 0.060Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.160 0.190 0.210 0.210 0.210 0.210 0.210 0.030 0.030 0.030 0.030 0.030 0.030 0.030 0.030Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.040 0.045 0.059 0.061 0.068 0.070 0.067 0.074 0.062 0.066 0.077 0.071 0.066 0.069 0.062 0.064 0.062 0.057 0.057Fires/burns/scalds Death 0.000 0.407 0.407 0.000 0.000 0.000 0.407 0.407 0.407 0.333 0.000 0.407 0.407 0.407 0.407 0.407 0.222 0.284 0.284Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.599 0.599 0.599 0.599 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475 0.475Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.020 0.012 0.006 0.004 0.000 -0.002 -0.006 -0.010 -0.010 -0.005 -0.006 -0.006 -0.004 -0.005 -0.005Heart failure Death 0.000 0.000 0.000 0.000 -0.041 -0.041 -0.065 -0.034 -0.025 -0.071 -0.080 -0.060 -0.090 -0.080 -0.082 -0.081 -0.076 -0.073 -0.073
72
Appendix 5: AFs for Male Non-Aboriginal Capital City 73
Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.383 0.383 0.383 0.383 0.348 0.348 0.388 0.388 0.338 0.338 0.338 0.338 0.338 0.338 0.338Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.463 0.463 0.463 0.463 0.458 0.458 0.471 0.471 0.434 0.434 0.434 0.434 0.434 0.434 0.434Liver cancer Both 0.000 0.000 0.000 0.000 0.389 0.389 0.389 0.389 0.376 0.376 0.386 0.386 0.341 0.341 0.341 0.341 0.341 0.341 0.341Larynx cancer Both 0.000 0.000 0.000 0.000 0.513 0.513 0.513 0.513 0.505 0.505 0.513 0.513 0.470 0.470 0.470 0.470 0.470 0.470 0.470Breast cancer Both 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.096 0.096 0.096 0.096 0.071 0.071 0.090 0.090 0.064 0.064 0.064 0.064 0.064 0.064 0.064Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.176 -0.176 -0.176 -0.176 -0.197 -0.197 -0.190 -0.190 -0.172 -0.172 -0.172 -0.172 -0.172 -0.172 -0.172Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.350 0.350 0.350 0.350 0.356 0.356 0.355 0.355 0.325 0.325 0.325 0.325 0.325 0.325 0.325Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 0.019 0.019 0.019 0.019 -0.007 -0.007 0.008 0.008 -0.009 -0.009 -0.009 -0.009 -0.009 -0.009 -0.009Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.270 0.270 0.270 0.270 0.263 0.263 0.268 0.268 0.233 0.233 0.233 0.233 0.233 0.233 0.233Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 0.210 0.174 0.164 0.117 0.098 0.099 0.069 0.063 0.032 0.026 0.030 0.035 0.029 0.027 0.027Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.270 0.270 0.000 0.270 0.263 0.224 0.231 0.235 0.172 0.189 0.172 0.146 0.129 0.104 0.104Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.580 0.580 0.580 0.580 0.535 0.535 0.552 0.552 0.468 0.468 0.468 0.468 0.468 0.468 0.468Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.580 0.580 0.580 0.580 0.535 0.535 0.552 0.552 0.468 0.468 0.468 0.468 0.468 0.468 0.468Psoriasis Hospital 0.000 0.000 0.000 0.000 0.347 0.347 0.347 0.347 0.356 0.356 0.359 0.359 0.334 0.334 0.334 0.334 0.334 0.334 0.334Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.175 -0.186 -0.181 -0.181 -0.186 -0.176 -0.175 -0.178 -0.149 -0.146 -0.143 -0.142 -0.144 -0.132 -0.132Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.326 0.326 0.326 0.326 0.323 0.323 0.326 0.326 0.292 0.292 0.292 0.292 0.292 0.292 0.292Road traffic accidents vehicle Death 0.328 0.328 0.328 0.328 0.299 0.394 0.394 0.397 0.397 0.397 0.397 0.097 0.097 0.097 0.097 0.097 0.097 0.097 0.097Road traffic accidents vehicle Hospital 0.246 0.246 0.246 0.246 0.205 0.327 0.327 0.240 0.240 0.240 0.240 0.095 0.095 0.095 0.095 0.095 0.095 0.095 0.095Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.690 0.580 0.580 0.510 0.510 0.510 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.350 0.450 0.450 0.460 0.460 0.460 0.460 0.230 0.230 0.230 0.230 0.230 0.230 0.230 0.230Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.037 0.046 0.070 0.095 0.094 0.098 0.098 0.089 0.094 0.095 0.084 0.092 0.083 0.078 0.086 0.086 0.068 0.063 0.063Fires/burns/scalds Death 0.000 0.407 0.407 0.407 0.407 0.000 0.407 0.407 0.407 0.364 0.407 0.358 0.407 0.407 0.364 0.407 0.407 0.277 0.277Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.580 0.580 0.580 0.580 0.535 0.535 0.552 0.552 0.468 0.468 0.468 0.468 0.468 0.468 0.468Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.000 0.000 0.000 0.000 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.040 0.035 0.033 0.014 -0.006 -0.022 -0.047 -0.055 -0.053 -0.046 -0.047 -0.044 -0.040 -0.036 -0.036Heart failure Death 0.000 0.000 0.000 0.000 0.000 -0.035 -0.015 -0.053 -0.044 -0.068 -0.078 -0.074 -0.057 -0.059 -0.051 -0.047 -0.046 -0.047 -0.047
Appendix 6: AFs for Female Non-Aboriginal Capital City Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.362 0.362 0.362 0.362 0.337 0.337 0.312 0.312 0.282 0.282 0.282 0.282 0.282 0.282 0.282Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.461 0.461 0.461 0.461 0.445 0.445 0.429 0.429 0.392 0.392 0.392 0.392 0.392 0.392 0.392Liver cancer Both 0.000 0.000 0.000 0.000 0.396 0.396 0.396 0.396 0.357 0.357 0.342 0.342 0.302 0.302 0.302 0.302 0.302 0.302 0.302Larynx cancer Both 0.000 0.000 0.000 0.000 0.519 0.519 0.519 0.519 0.486 0.486 0.471 0.471 0.428 0.428 0.428 0.428 0.428 0.428 0.428Breast cancer Both 0.000 0.000 0.000 0.000 0.146 0.146 0.146 0.146 0.132 0.132 0.126 0.126 0.108 0.108 0.108 0.108 0.108 0.108 0.108Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 -0.058 -0.058 -0.058 -0.058 -0.093 -0.093 -0.099 -0.099 -0.088 -0.088 -0.088 -0.088 -0.088 -0.088 -0.088Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.185 -0.185 -0.185 -0.185 -0.187 -0.187 -0.180 -0.180 -0.152 -0.152 -0.152 -0.152 -0.152 -0.152 -0.152supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.360 0.360 0.360 0.360 0.342 0.342 0.332 0.332 0.296 0.296 0.296 0.296 0.296 0.296 0.296Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 -0.657 -0.657 -0.657 -0.657 -0.689 -0.689 -0.664 -0.664 -0.524 -0.524 -0.524 -0.524 -0.524 -0.524 -0.524Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 -0.157 -0.157 -0.157 -0.157 -0.270 -0.270 -0.378 -0.378 -0.293 -0.293 -0.293 -0.293 -0.293 -0.293 -0.293Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 -0.282 -0.443 -0.470 -0.511 -0.548 -0.567 -0.554 -0.574 -0.473 -0.456 -0.478 -0.484 -0.481 -0.485 -0.485Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.000 -0.157 -0.157 -0.410 -0.438 -0.400 -0.400 -0.322 -0.314 -0.330 -0.365 -0.367 -0.397 -0.397unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.596 0.596 0.596 0.596 0.494 0.494 0.470 0.470 0.408 0.408 0.408 0.408 0.408 0.408 0.408unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.596 0.596 0.596 0.596 0.494 0.494 0.470 0.470 0.408 0.408 0.408 0.408 0.408 0.408 0.408psoriasis Hospital 0.000 0.000 0.000 0.000 0.349 0.349 0.349 0.349 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.196 -0.199 -0.200 -0.199 -0.180 -0.180 -0.168 -0.170 -0.140 -0.141 -0.136 -0.136 -0.129 -0.123 -0.123Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.333 0.333 0.333 0.333 0.307 0.307 0.296 0.296 0.261 0.261 0.261 0.261 0.261 0.261 0.261Road traffic accidents vehicle Death 0.107 0.107 0.107 0.107 0.078 0.155 0.155 0.184 0.184 0.184 0.184 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Road traffic accidents vehicle Hospital 0.106 0.106 0.106 0.106 0.095 0.150 0.150 0.125 0.125 0.125 0.125 0.025 0.025 0.025 0.025 0.025 0.025 0.025 0.025Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.500 0.110 0.110 0.420 0.420 0.420 0.420 0.060 0.060 0.060 0.060 0.060 0.060 0.060 0.060Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.160 0.190 0.210 0.210 0.210 0.210 0.210 0.030 0.030 0.030 0.030 0.030 0.030 0.030 0.030Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.040 0.045 0.059 0.061 0.068 0.070 0.067 0.074 0.062 0.066 0.077 0.071 0.066 0.069 0.062 0.064 0.062 0.057 0.057Fires/burns/scalds Death 0.000 0.407 0.407 0.000 0.000 0.000 0.407 0.407 0.407 0.333 0.000 0.407 0.407 0.407 0.407 0.407 0.222 0.284 0.284Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.596 0.596 0.596 0.596 0.494 0.494 0.470 0.470 0.408 0.408 0.408 0.408 0.408 0.408 0.408gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116heart failure Hospital 0.000 0.000 0.000 0.000 0.047 0.025 0.012 0.015 0.001 -0.001 -0.010 -0.017 -0.015 -0.018 -0.014 -0.017 -0.011 -0.014 -0.014heart failure Death 0.000 0.000 0.000 0.000 -0.092 0.000 -0.034 -0.037 -0.021 -0.055 -0.050 -0.033 -0.039 -0.038 -0.038 -0.037 -0.038 -0.038 -0.038
74
75 Appendix 7: AFs for Male Non-Aboriginal Non-Capital City Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.391 0.391 0.391 0.391 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389 0.389Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.473 0.473 0.473 0.473 0.472 0.472 0.472 0.472 0.460 0.460 0.460 0.460 0.460 0.460 0.460Liver cancer Both 0.000 0.000 0.000 0.000 0.405 0.405 0.405 0.405 0.396 0.396 0.396 0.396 0.380 0.380 0.380 0.380 0.380 0.380 0.380Larynx cancer Both 0.000 0.000 0.000 0.000 0.529 0.529 0.529 0.529 0.521 0.521 0.521 0.521 0.505 0.505 0.505 0.505 0.505 0.505 0.505Breast cancer Both 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 0.103 0.103 0.103 0.103 0.096 0.096 0.096 0.096 0.097 0.097 0.097 0.097 0.097 0.097 0.097Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.183 -0.183 -0.183 -0.183 -0.187 -0.187 -0.187 -0.187 -0.169 -0.169 -0.169 -0.169 -0.169 -0.169 -0.169Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.363 0.363 0.363 0.363 0.359 0.359 0.359 0.359 0.341 0.341 0.341 0.341 0.341 0.341 0.341Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 0.024 0.024 0.024 0.024 0.016 0.016 0.016 0.016 0.020 0.020 0.020 0.020 0.020 0.020 0.020Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 0.284 0.284 0.284 0.284 0.276 0.276 0.276 0.276 0.262 0.262 0.262 0.262 0.262 0.262 0.262Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 0.154 0.198 0.128 0.190 0.123 0.139 0.102 0.077 0.056 0.046 0.058 0.059 0.049 0.049 0.049Stroke - Unspecified Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.276 0.276 0.229 0.239 0.227 0.227 0.208 0.147 0.128 0.102 0.102Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.609 0.609 0.609 0.609 0.582 0.582 0.582 0.582 0.564 0.564 0.564 0.564 0.564 0.564 0.564Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.609 0.609 0.609 0.609 0.582 0.582 0.582 0.582 0.564 0.564 0.564 0.564 0.564 0.564 0.564Psoriasis Hospital 0.000 0.000 0.000 0.000 0.355 0.355 0.355 0.355 0.357 0.357 0.357 0.357 0.342 0.342 0.342 0.342 0.342 0.342 0.342Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.185 -0.196 -0.191 -0.191 -0.191 -0.181 -0.176 -0.179 -0.163 -0.159 -0.156 -0.155 -0.158 -0.144 -0.144Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.339 0.339 0.339 0.339 0.333 0.333 0.333 0.333 0.317 0.317 0.317 0.317 0.317 0.317 0.317Road traffic accidents vehicle Death 0.328 0.328 0.328 0.328 0.299 0.394 0.394 0.397 0.397 0.397 0.397 0.097 0.097 0.097 0.097 0.097 0.097 0.097 0.097Road traffic accidents vehicle Hospital 0.246 0.246 0.246 0.246 0.205 0.327 0.327 0.240 0.240 0.240 0.240 0.095 0.095 0.095 0.095 0.095 0.095 0.095 0.095Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.690 0.580 0.580 0.510 0.510 0.510 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160 0.160Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.350 0.450 0.450 0.460 0.460 0.460 0.460 0.230 0.230 0.230 0.230 0.230 0.230 0.230 0.230Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.037 0.046 0.070 0.095 0.094 0.098 0.098 0.089 0.094 0.095 0.084 0.092 0.083 0.078 0.086 0.086 0.068 0.063 0.063Fires/burns/scalds Death 0.000 0.407 0.407 0.407 0.407 0.000 0.407 0.407 0.407 0.364 0.407 0.358 0.407 0.407 0.364 0.407 0.407 0.277 0.277Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070Pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840Pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.609 0.609 0.609 0.609 0.582 0.582 0.582 0.582 0.564 0.564 0.564 0.564 0.564 0.564 0.564Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.000 0.000 0.000 0.000 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.012 0.017 0.014 0.011 -0.002 -0.003 -0.009 -0.011 -0.012 -0.009 -0.009 -0.007 -0.006 -0.003 -0.003Heart failure Death 0.000 0.000 0.000 0.000 0.000 0.000 -0.037 -0.042 -0.042 -0.063 -0.059 -0.063 -0.056 -0.059 -0.045 -0.048 -0.050 -0.041 -0.041
Condition Hosp/Dth 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84Mouth and oropharynx cancers Both 0.000 0.000 0.000 0.000 0.382 0.382 0.382 0.382 0.379 0.379 0.348 0.348 0.272 0.272 0.272 0.272 0.272 0.272Oesophagus cancer Both 0.000 0.000 0.000 0.000 0.474 0.474 0.474 0.474 0.469 0.469 0.431 0.431 0.380 0.380 0.380 0.380 0.380 0.380Liver cancer Both 0.000 0.000 0.000 0.000 0.412 0.412 0.412 0.412 0.409 0.409 0.347 0.347 0.294 0.294 0.294 0.294 0.294 0.294Larynx cancer Both 0.000 0.000 0.000 0.000 0.535 0.535 0.535 0.535 0.531 0.531 0.472 0.472 0.417 0.417 0.417 0.417 0.417 0.417Breast cancer Both 0.000 0.000 0.000 0.000 0.153 0.153 0.153 0.153 0.151 0.151 0.125 0.125 0.104 0.104 0.104 0.104 0.104 0.104Hypertensive heart disease (hypertension) Both 0.000 0.000 0.000 0.000 -0.046 -0.046 -0.046 -0.046 -0.043 -0.043 -0.057 -0.057 -0.081 -0.081 -0.081 -0.081 -0.081 -0.081Ischaemic heart disease Both 0.000 0.000 0.000 0.000 -0.189 -0.189 -0.189 -0.189 -0.184 -0.184 -0.158 -0.158 -0.142 -0.142 -0.142 -0.142 -0.142 -0.142Supra ventricular dysrythmia Both 0.000 0.000 0.000 0.000 0.370 0.370 0.370 0.370 0.366 0.366 0.320 0.320 0.286 0.286 0.286 0.286 0.286 0.286Stroke - Ischaemic Both 0.000 0.000 0.000 0.000 -0.666 -0.666 -0.666 -0.666 -0.639 -0.639 -0.528 -0.528 -0.481 -0.481 -0.481 -0.481 -0.481 -0.481Stroke - Haemorrhagic Both 0.000 0.000 0.000 0.000 -0.075 -0.075 -0.075 -0.075 -0.066 -0.066 -0.021 -0.021 -0.266 -0.266 -0.266 -0.266 -0.266 -0.266Stroke - Unspecified Hospital 0.000 0.000 0.000 0.000 -0.666 -0.504 -0.393 -0.370 -0.248 -0.366 -0.309 -0.392 -0.413 -0.432 -0.431 -0.438 -0.453 -0.466Stroke - Unspecified Death 0.000 0.000 0.000 0.000 -0.075 0.000 0.000 -0.370 -0.066 -0.066 -0.190 -0.122 -0.293 -0.358 -0.266 -0.316 -0.384 -0.424Unspecified liver cirrhosis Hospital 0.000 0.000 0.000 0.000 0.622 0.622 0.622 0.622 0.621 0.621 0.508 0.508 0.404 0.404 0.404 0.404 0.404 0.404Unspecified liver cirrhosis Death 0.000 0.000 0.000 0.000 0.622 0.622 0.622 0.622 0.621 0.621 0.508 0.508 0.404 0.404 0.404 0.404 0.404 0.404Psoriasis Hospital 0.000 0.000 0.000 0.000 0.357 0.357 0.357 0.357 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Gallbladder and bile duct disease (Cholelithiasis) Both 0.000 0.000 0.000 0.000 -0.207 -0.210 -0.211 -0.209 -0.199 -0.199 -0.161 -0.162 -0.132 -0.133 -0.129 -0.128 -0.121 -0.116Suicide and self-inflicted injuries Both 0.000 0.000 0.000 0.000 0.346 0.346 0.346 0.346 0.342 0.342 0.292 0.292 0.252 0.252 0.252 0.252 0.252 0.252Road traffic accidents vehicle Death 0.107 0.107 0.107 0.107 0.078 0.155 0.155 0.184 0.184 0.184 0.184 0.000 0.000 0.000 0.000 0.000 0.000 0.000Road traffic accidents vehicle Hospital 0.106 0.106 0.106 0.106 0.095 0.150 0.150 0.125 0.125 0.125 0.125 0.025 0.025 0.025 0.025 0.025 0.025 0.025Road traffic accidents pedestrian Death 0.000 0.000 0.000 0.000 0.500 0.110 0.110 0.420 0.420 0.420 0.420 0.060 0.060 0.060 0.060 0.060 0.060 0.060Road traffic accidents pedestrian Hospital 0.000 0.000 0.000 0.000 0.160 0.190 0.210 0.210 0.210 0.210 0.210 0.030 0.030 0.030 0.030 0.030 0.030 0.030Falls Both 0.000 0.000 0.000 0.000 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.220 0.120 0.120 0.120 0.120Fires/burns/scalds Hospital 0.040 0.045 0.059 0.061 0.068 0.070 0.067 0.074 0.062 0.066 0.077 0.071 0.066 0.069 0.062 0.064 0.062 0.057Fires/burns/scalds Death 0.000 0.407 0.407 0.000 0.000 0.000 0.407 0.407 0.407 0.333 0.000 0.407 0.407 0.407 0.407 0.407 0.222 0.284Drowning Both 0.000 0.000 0.000 0.000 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190 0.190Homicide and violence (Assault) Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Machinery accidents (Machine injuries) Both 0.000 0.000 0.000 0.000 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070 0.070pancreatitis (chronic) Both 0.000 0.000 0.000 0.000 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840 0.840pancreatitis (acute) Both 0.000 0.000 0.000 0.000 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240 0.240Alcoholic cardiomyopathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic poisoning Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic psychosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic dependence Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol abuse Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcohol polyneuropathy Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic gastritis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Alcoholic liver cirrhosis Both 0.000 0.000 0.000 0.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000Oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.622 0.622 0.622 0.622 0.621 0.621 0.508 0.508 0.404 0.404 0.404 0.404 0.404 0.404Gastro-oesophageal haemorrhage Both 0.000 0.000 0.000 0.000 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470 0.470Epilepsy Both 0.000 0.000 0.000 0.000 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150 0.150Child abuse Both 0.160 0.160 0.160 0.160 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000Suffocation and foreign bodies Both 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116 0.116Heart failure Hospital 0.000 0.000 0.000 0.000 0.013 0.011 0.015 0.004 0.007 0.003 -0.002 -0.003 -0.002 0.001 -0.002 -0.003 -0.002 -0.001Heart failure Death 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 -0.018 -0.048 -0.038 -0.046 -0.046 -0.036 -0.030 -0.037 -0.027 -0.035
Appendix 8: AFs for Female Non-Aboriginal Non-Capital City
85+0.2720.3800.2940.4170.104
-0.081-0.1420.286
-0.481-0.266-0.466-0.4240.4040.4040.470
-0.1160.2520.0000.0250.0600.0300.1200.0570.2840.1900.4700.0700.8400.2401.0001.0001.0001.0001.0001.0001.0001.0000.4040.4700.1500.0000.116
-0.001-0.035
76
Appendix 9: Number of alcohol-related hospitalisations, ASRs, SRRs and CIs by gender and health region
Region Gender No. hospitalisations
Crude rate*
ASR* SRR LCI UCI
Goldfields Male 1,440 986.60 1,030.30 1.59 1.51 1.68Female 862 679.30 728.00 1.63 1.52 1.74Total 2,302 843.60 894.80 1.63 1.57 1.70
Great Southern Male 1,036 762.00 797.20 1.13 1.07 1.21Female 731 550.60 538.00 1.12 1.04 1.20Total 1,766 657.60 669.80 1.13 1.08 1.18
Kimberley Male 2,128 2,329.20 2,354.50 3.93 3.76 4.10Female 1,692 2,113.40 2,059.70 5.53 5.27 5.80Total 3,821 2,228.40 2,224.50 4.58 4.43 4.73
Midwest Male 1,577 1,008.10 1,051.60 1.55 1.48 1.63Female 943 651.00 688.90 1.46 1.37 1.56Total 2,520 836.40 881.50 1.53 1.47 1.59
North Metro Male 11,572 582.60 599.30 0.87 0.85 0.88Female 8,825 435.80 415.60 0.88 0.87 0.90Total 20,396 508.50 508.50 0.87 0.86 0.88
Pilbara Male 1,210 1,117.00 1,204.50 1.90 1.79 2.01Female 840 947.40 1,043.60 2.55 2.38 2.73Total 2,050 1,040.60 1,136.80 2.17 2.08 2.27
South Metro Male 9,967 572.70 585.90 0.85 0.83 0.86Female 7,380 416.10 394.00 0.84 0.82 0.86Total 17,347 493.70 489.70 0.84 0.83 0.85
South West Male 2,285 674.10 706.90 1.02 0.98 1.07Female 1,477 443.00 443.40 0.94 0.89 0.99Total 3,761 559.50 578.00 0.99 0.96 1.02
Wheatbelt Male 1,383 730.20 760.00 1.10 1.04 1.16Female 905 517.00 523.10 1.09 1.02 1.17Total 2,288 627.80 649.00 1.10 1.06 1.15
*per 100,000 population Appendix 10: Number of alcohol-related hospitalisations, ASRs, SRRs and CIs by Aboriginality
and health region
Region Aboriginality No. hospitalisations
Crude rate* ASR* SRR LCI UCI
Goldfields Aboriginal 1,765 3,123.80 3,584.60 1.06 1.01 1.11Non-Aboriginal 2,683 537.60 611.40 1.29 1.24 1.34
Great Southern Aboriginal 645 3,360.50 4,491.80 1.17 1.09 1.27Non-Aboriginal 2,960 583.30 597.70 1.20 1.16 1.25
Kimberley Aboriginal 5,905 3,854.30 4,584.50 1.38 1.34 1.41Non-Aboriginal 1,180 737.70 767.60 1.74 1.64 1.84
Midwest Aboriginal 2,013 2,935.10 3,709.90 1.05 1.01 1.10Non-Aboriginal 3,100 583.70 620.20 1.28 1.23 1.33
North Metro Aboriginal 1,968 1,838.90 2,578.50 0.67 0.64 0.70Non-Aboriginal 35,256 460.80 467.40 0.96 0.95 0.97
Pilbara Aboriginal 2,751 4,217.90 4,649.20 1.40 1.35 1.46Non-Aboriginal 1,577 469.50 573.60 1.26 1.20 1.33
South Metro Aboriginal 1,916 1,571.10 2,245.50 0.58 0.55 0.60Non-Aboriginal 29,915 452.00 453.70 0.93 0.92 0.94
South West Aboriginal 529 1,926.20 2,902.00 0.72 0.66 0.78Non-Aboriginal 6,387 514.30 538.10 1.10 1.08 1.13
Wheatbelt Aboriginal 794 2,406.80 3,411.60 0.88 0.82 0.94Non-Aboriginal 3,590 513.90 537.70 1.09 1.06 1.13
*per 100,000 population
77
Appendix 11: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Goldfields Health Region
SLA GenderNo.
hospitalisationsCrude rate* ASR* SRR LCI UCI
Coolgardie Male 75 6.80 7.90 1.20 0.95 1.51Female 49 5.40 7.00 1.51 1.09 1.95Total 124 6.20 7.50 1.33 1.11 1.60
Dundas Male 73 22.00 20.70 3.29 2.60 4.17Female 27 11.00 11.89 2.46 1.56 3.50Total 99 17.30 16.90 3.10 2.53 3.78
Esperance Male 352 10.30 10.70 1.65 1.48 1.83Female 165 5.04 5.26 1.13 0.97 1.32Total 517 7.70 8.10 1.44 1.32 1.57
Kalgoorlie Pt A Male 724 9.20 9.60 1.55 1.44 1.67Female 408 5.95 6.37 1.47 1.34 1.63Total 1,132 7.70 8.10 1.55 1.46 1.64
Laverton Male 53 14.90 14.90 2.20 1.66 2.90Female 58 27.50 27.86 6.94 5.32 9.04Total 111 19.60 19.10 3.64 3.01 4.40
Leonora Male 51 8.70 8.70 1.31 0.99 1.74Female 42 12.15 13.43 3.19 2.25 4.26Total 92 10.00 10.00 1.90 1.54 2.34
Menzies & Kalgoorlie Pt B Male 22 12.67 11.62 1.96 1.16 2.85Female 14 11.20 10.60 2.98 1.47 4.73Total 35 12.00 11.20 2.29 1.54 3.11
Ngaanyatjarraku Male 58 14.10 15.40 2.48 1.90 3.23Female 80 19.21 16.97 4.84 3.86 6.05Total 137 16.70 16.30 3.44 2.90 4.08
Ravensthorpe Male 34 7.90 9.20 1.17 0.79 1.61Female 20 5.90 5.59 1.35 0.78 2.02Total 53 7.00 7.40 1.26 0.96 1.66
* per 1,000 population
78
Appendix 12: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Great Southern Health Region
SLA GenderNo.
hospitalisationsCrude rate* ASR* SRR LCI UCI
Albany - Central Male 434 11.00 11.00 1.57 1.43 1.73Female 347 8.11 7.07 1.42 1.27 1.58Total 781 9.50 9.00 1.49 1.39 1.60
Albany - Bal Male 151 3.80 4.00 0.59 0.50 0.69Female 96 2.57 2.89 0.60 0.49 0.74Total 247 3.20 3.50 0.60 0.52 0.68
Broomehill & Kojonup Male 69 9.70 10.80 1.51 1.18 1.92Female 32 4.90 5.50 1.03 0.67 1.41Total 101 7.40 8.20 1.32 1.08 1.61
Cranbrook Male 11 3.80 4.10 0.55 0.24 0.93Female 13 5.48 5.58 1.22 0.57 1.92Total 24 4.60 4.90 0.81 0.48 1.14
Denmark Male 79 6.20 6.30 0.92 0.73 1.16Female 47 3.76 3.47 0.77 0.56 1.01Total 126 5.00 4.90 0.86 0.72 1.03
Gnowangerup Male 42 10.50 11.70 1.74 1.23 2.32Female 23 6.74 7.95 1.54 0.94 2.28Total 64 8.80 10.10 1.69 1.31 2.17
Katanning & Woodanilling Male 115 9.50 10.20 1.53 1.27 1.84Female 88 7.60 8.00 1.68 1.35 2.08Total 202 8.50 9.10 1.59 1.38 1.83
Kent & Jerramungup Male 24 4.90 5.50 0.80 0.48 1.15Female 8 1.90 2.10 0.49 0.17 0.88Total 32 3.60 4.00 0.70 0.46 0.97
Plantagenet Male 93 7.70 8.50 1.15 0.93 1.41Female 62 5.52 5.67 1.18 0.91 1.52Total 155 6.70 7.10 1.17 1.00 1.37
Tambellup Male 19 10.20 12.60 1.70 0.95 2.53Female 15 9.58 10.86 2.25 1.11 3.42Total 35 9.90 10.70 1.95 1.32 2.67
*per 1,000 population
79
Appendix 13: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Kimberley Health Region
SLA Gender No. hospitalisations
Crude rate* ASR* SRR LCI UCI
Broome Male 688 18.50 18.60 3.13 2.91 3.38Female 492 14.58 13.70 3.81 3.48 4.16Total 1,180 16.70 16.40 3.42 3.23 3.62
Derby-West Kimberley Male 593 25.90 26.60 4.45 4.10 4.82Female 477 24.29 24.70 6.40 5.84 7.00Total 1,071 25.10 25.80 5.24 4.93 5.56
Halls Creek Male 352 32.50 34.90 6.03 5.43 6.71Female 361 36.84 36.90 9.81 8.84 10.89Total 713 34.60 35.80 7.54 7.00 8.12
Wyndham-East Kimberley Male 495 24.30 23.80 4.08 3.73 4.46Female 362 20.75 20.40 5.58 5.03 6.19Total 857 22.70 22.40 4.69 4.39 5.02
*per 1,000 population
80
Appendix 14: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Midwest Health Region
SLA Gender No. hospitalisations
Crude rate* ASR* SRR LCI UCI
Carnarvon Male 301 17.90 18.60 2.82 2.52 3.17Female 162 10.61 11.30 2.51 2.15 2.94Total 463 14.40 15.30 2.73 2.49 3.00
Coorow Male 17 4.50 5.30 0.73 0.40 1.13Female 10 3.23 3.90 0.76 0.33 1.35Total 26 4.00 4.80 0.75 0.46 1.
Exmouth Male 41 6.60 8.10 1.04 0.73 1.Female 20 3.90 4.80 0.93 0.53 1.37Total 61 5.40 6.70 1.02 0.79 1.
Geraldton & Chapman Valley Male 628 12.40 12.80 1.89 1.74 2.04Female 353 6.80 6.70 1.42 1.27 1.Total 980 9.60 9.80 1.68 1.58 1.79
Greenough - Pt A Male 169 4.90 5.70 0.81 0.70 0.95Female 109 3.43 4.40 0.84 0.70 1.Total 279 4.20 5.10 0.83 0.74 0.94
Greenough Pt B Male 169 5.00 4.70 0.81 0.70 0.95Female 109 2.17 4.20 0.84 0.70 1.Total 279 3.80 4.00 0.83 0.74 0.94
Irwin Male 42 5.20 5.20 0.77 0.54 1.Female 45 6.04 5.90 1.29 0.92 1.71Total 87 5.60 5.50 0.98 0.79 1.
Meekatharra Male 112 27.30 30.40 4.47 3.70 5.40Female 102 31.83 31.00 8.15 6.68 9.94Total 214 29.30 29.60 5.87 5.12 6.72
Mingenew & Morawa Male 30 7.60 8.30 1.21 0.79 1.69Female 14 4.20 4.30 0.94 0.47 1.50Total 44 6.00 6.20 1.13 0.80 1.
Mount Magnet Male 15 7.30 8.00 1.15 0.60 1.84Female 11 6.85 7.30 1.73 0.75 2.86Total 26 7.10 7.50 1.38 0.86 1.
Mullewa Male 34 11.60 14.20 2.05 1.37 2.79Female 14 5.64 7.10 1.46 0.74 2.39Total 48 8.90 10.70 1.87 1.35 2.45
Northampton & Shark Bay Male 80 7.20 7.20 1.07 0.85 1.34Female 44 4.30 4.10 0.93 0.66 1.22Total 124 5.80 5.60 1.02 0.85 1.22
Sandstone & Cue Male 15 10.00 12.10 1.48 0.75 2.30Female 6 5.60 5.90 1.29 0.35 2.Total 21 8.20 9.50 1.48 0.86 2.
Three Springs & Caramah Male 20 4.90 5.80 0.77 0.45 1.16Female 13 3.90 4.00 0.88 0.42 1.41Total 32 4.40 5.10 0.81 0.53 1.
Upper Gascoyne & Murchison Male 16 11.00 12.40 1.81 0.98 2.89Female 4 3.80 4.20 0.96 0.15 2.Total 20 7.70 8.50 1.61 0.92 2.
Wiluna Male 37 11.80 12.60 1.73 1.17 2.31Female 27 19.13 25.90 4.56 2.86 6.42Total 64 14.10 16.70 2.53 1.97 3.25
Yalgoo & Perenjori Male 22 8.40 9.30 1.25 0.73 1.80Female 9 5.20 6.20 1.21 0.44 2.Total 32 7.10 7.70 1.29 0.86 1.
*per 1,000 population
0540
32
57
02
02
02
21
49
97
5118
11
1139
0279
81
Appendix 15: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – North Metro Health Region
SLA GenderNo.
hospitalisationsCrude rate* ASR* SRR LCI UCI
Bassendean M ale 203 5.90 5.80 0.87 0.75 0.99Female 140 3.90 3.40 0.76 0.64 0.90Total 343 4.90 4.60 0.81 0.73 0.91
Bayswater M ale 921 6.40 6.10 0.91 0.86 0.98Female 654 4.62 4.00 0.88 0.81 0.95Total 1,575 5.50 5.10 0.90 0.86 0.95
Cam bridge M ale 306 5.10 5.00 0.74 0.66 0.83Female 319 5.03 4.20 0.92 0.83 1.03Total 625 5.10 4.60 0.82 0.76 0.89
Clarem ont M ale 169 7.70 6.80 1.08 0.92 1.26Female 123 5.07 3.50 0.82 0.68 0.98Total 291 6.30 5.10 0.94 0.84 1.06
Cottesloe M ale 137 7.30 6.60 1.03 0.87 1.23Female 89 4.62 3.50 0.85 0.68 1.05Total 226 5.90 5.10 0.95 0.83 1.08
Joondalup - North M ale 492 3.90 4.50 0.65 0.59 0.71Female 432 3.37 4.00 0.80 0.73 0.88Total 924 3.60 4.30 0.71 0.66 0.76
Joondalup - South M ale 1,089 4.10 4.40 0.63 0.60 0.67Female 950 3.55 3.60 0.77 0.72 0.82Total 2,038 3.80 4.00 0.69 0.66 0.72
Kalamunda M ale 599 4.80 5.00 0.73 0.67 0.79Female 429 3.38 3.30 0.72 0.65 0.79Total 1,028 4.10 4.20 0.72 0.68 0.77
Mosman Park M ale 160 8.00 7.40 1.13 0.97 1.32Female 110 4.79 4.10 0.87 0.72 1.06Total 270 6.30 5.70 1.00 0.89 1.13
Mundaring M ale 332 3.70 4.00 0.57 0.51 0.64Female 273 3.07 3.10 0.67 0.59 0.75Total 604 3.40 3.60 0.61 0.56 0.66
Nedlands M ale 265 5.00 5.00 0.74 0.66 0.84Female 327 5.77 4.30 1.01 0.90 1.12Total 592 5.40 4.70 0.87 0.80 0.94
Peppermint Grove M ale 14 3.90 3.80 0.57 0.28 0.90Female 20 4.22 3.80 0.88 0.50 1.30Total 34 4.10 3.80 0.70 0.47 0.95
Perth - Inner M ale 48 13.40 12.90 1.80 1.29 2.33Female 10 4.93 5.00 0.99 0.42 1.73Total 58 10.40 10.30 1.68 1.28 2.18
Perth - Rem ainder M ale 310 11.60 10.90 1.51 1.35 1.69Female 98 4.79 4.70 0.91 0.74 1.11Total 408 8.60 8.40 1.33 1.21 1.47
Stirling - Centra l M ale 1,819 7.40 7.10 1.06 1.01 1.11Female 1,448 5.59 5.20 1.08 1.03 1.14Total 3,267 6.50 6.10 1.06 1.02 1.10
Stirling - Coastal M ale 958 6.10 5.90 0.87 0.82 0.93Female 867 5.32 4.60 1.00 0.94 1.07Total 1,825 5.70 5.30 0.93 0.89 0.97
Stirling - South-Eastern M ale 242 6.20 6.00 0.89 0.78 1.01Female 243 5.79 4.30 0.98 0.86 1.11Total 486 6.00 5.10 0.93 0.85 1.02
Subiaco M ale 322 8.10 8.00 1.15 1.03 1.28Female 269 6.37 5.80 1.20 1.06 1.35Total 591 7.20 6.90 1.16 1.07 1.26
Swan M ale 1,066 4.60 5.30 0.77 0.72 0.82Female 751 3.27 3.70 0.76 0.71 0.82Total 1,818 4.00 4.50 0.76 0.73 0.80
Vincent M ale 874 12.80 12.70 1.78 1.67 1.90Female 410 6.18 5.40 1.13 1.02 1.25Total 1,285 9.50 9.20 1.51 1.43 1.60
Wanneroo - North-East M ale 310 4.60 5.00 0.74 0.66 0.83Female 215 3.27 3.60 0.74 0.65 0.85Total 525 3.90 4.40 0.74 0.68 0.81
Wanneroo - North-West M ale 393 4.70 5.40 0.79 0.72 0.88Female 215 3.63 4.20 0.89 0.80 1.00Total 703 4.10 4.80 0.83 0.77 0.89
Wanneroo - South M ale 540 5.30 6.10 0.89 0.82 0.97Female 339 3.35 3.80 0.80 0.71 0.89Total 879 4.30 5.00 0.85 0.79 0.91
*per 1,000 population
82
Appendix 16: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Pilbara Health Region
SLA GenderNo.
hospitalisationsCrude rate* ASR* SRR LCI UCI
Ashburton Male 151 9.00 9.20 1.58 1.34 1.86Female 140 10.45 10.30 2.91 2.46 3.44Total 290 9.60 9.60 2.08 1.85 2.34
East Pilbara Male 241 14.00 14.00 2.33 2.05 2.65Female 194 15.17 15.40 4.16 3.60 4.79Total 435 14.50 14.40 3.00 2.73 3.30
Port Hedland Male 418 12.10 13.10 2.06 1.87 2.27Female 276 9.68 10.80 2.59 2.29 2.91Total 694 11.00 12.10 2.29 2.13 2.47
Roebourne Male 400 9.30 10.40 1.62 1.47 1.79Female 230 6.44 7.90 1.74 1.52 1.Total 630 8.00 9.20 1.70 1.57 1.84
*per 1,000 population
98
83
Appendix 17: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – South Metro Health Region
SLA Gender No. hospitalisations
Crude rate* ASR* SRR LCI UCI
Armadale Male 877 6.70 7.20 1.06 1.00 1.Female 576 4.38 4.60 0.98 0.90 1.Total 1,453 5.50 5.90 1.03 0.97 1.08
Belmont Male 562 7.30 7.20 1.05 0.97 1.14Female 396 5.09 4.50 0.97 0.88 1.Total 958 6.20 5.90 1.01 0.95 1.08
Canning Male 1,035 5.30 5.50 0.80 0.75 0.85Female 826 4.10 4.00 0.85 0.80 0.Total 1,862 4.70 4.70 0.82 0.78 0.86
Cockburn Male 914 4.90 5.20 0.77 0.72 0.82Female 619 3.34 3.60 0.75 0.69 0.Total 1,533 4.10 4.40 0.76 0.72 0.80
East Fremantle Male 119 7.00 7.10 1.02 0.85 1.22Female 51 2.94 2.60 0.57 0.43 0.75Total 170 4.90 4.80 0.82 0.70 0.96
Fremantle Inner & Remainder Male 673 10.30 9.40 1.43 1.32 1.54Female 346 5.20 4.60 0.96 0.00 1.Total 1,018 7.80 7.00 1.23 1.15 1.30
Gosnells Male 1,160 5.10 5.60 0.82 0.77 0.Female 760 3.39 3.60 0.77 0.71 0.Total 1,920 4.30 4.60 0.80 0.76 0.83
Kwinana Male 310 5.20 5.70 0.83 0.74 0.93Female 181 3.26 3.50 0.75 0.65 0.Total 491 4.30 4.60 0.81 0.74 0.88
Mandurah Male 869 6.20 5.90 0.89 0.83 0.95Female 641 4.46 3.90 0.88 0.81 0.Total 1,510 5.30 4.90 0.88 0.84 0.93
Melville Male 1,032 4.40 4.20 0.64 0.60 0.Female 1,094 4.31 3.60 0.81 0.77 0.Total 2,126 4.40 3.90 0.71 0.68 0.74
Murray Male 201 6.70 6.30 0.94 0.82 1.Female 96 3.31 3.20 0.70 0.57 0.86Total 297 5.00 4.80 0.85 0.76 0.96
Rockingham Male 973 4.80 5.10 0.75 0.71 0.80Female 664 3.24 3.30 0.71 0.66 0.Total 1,638 4.00 4.20 0.73 0.70 0.77
Serpentine-Jarrahdale Male 136 4.20 4.80 0.67 0.57 0.80Female 70 2.28 2.80 0.54 0.42 0.68Total 205 3.30 3.90 0.62 0.54 0.71
South Perth Male 523 5.50 5.40 0.77 0.71 0.84Female 555 5.63 4.80 0.99 0.91 1.Total 1,078 5.60 5.10 0.87 0.82 0.92
Victoria Park Male 550 7.90 7.80 1.07 0.99 1.Female 480 6.56 5.20 1.06 0.97 1.Total 1,031 7.20 6.50 1.07 1.00 1.14
Waroona Male 32 3.50 4.00 0.53 0.35 0.Female 25 2.87 2.90 0.63 0.39 0.91Total 56 3.20 3.50 0.57 0.44 0.
*per 1,000 population
1406
07
91
81
07
8782
87
95
6886
08
77
08
1716
74
75
84
Appendix 18: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – South West Health Region
SLA Gender No. hospitalisations
Crude rate* ASR* SRR LCI UCI
Augusta-Margaret River Male 206 7.20 7.50 1.10 0.96 1.27Female 130 4.86 5.00 1.04 0.87 1.Total 336 6.00 6.40 1.08 0.97 1.21
Busselton Male 411 6.40 6.50 0.97 0.88 1.07Female 269 4.12 3.90 0.84 0.75 0.Total 680 5.30 5.20 0.92 0.85 0.99
Bridgetown-Greenbushes Male 79 7.70 8.20 1.16 0.93 1.46Female 78 7.73 8.80 1.66 1.32 2.08Total 157 7.70 8.50 1.37 1.17 1.60
Boyup Brook Male 26 6.40 6.90 0.94 0.59 1.Female 15 4.02 3.90 0.78 0.39 1.20Total 41 5.30 5.30 0.88 0.61 1.
Bunbury Male 529 6.80 6.80 1.01 0.93 1.10Female 346 4.44 4.10 0.88 0.79 0.Total 876 5.60 5.50 0.96 0.89 1.02
Capel Pt A Male 46 4.00 4.70 0.70 0.50 0.Female 22 1.94 2.40 0.50 0.30 0.73Total 67 3.00 3.50 0.62 0.48 0.
Capel Pt B Male 54 4.90 5.30 0.76 0.58 1.Female 31 2.76 3.10 0.66 0.44 0.92Total 85 3.80 4.20 0.72 0.58 0.
Collie Male 255 11.10 11.60 1.71 1.51 1.94Female 172 7.82 7.80 1.67 1.43 1.Total 427 9.50 9.80 1.70 1.54 1.87
Dardanup Pt A Male 74 4.00 5.00 0.68 0.54 0.Female 44 2.41 2.90 0.58 0.41 0.76Total 117 3.20 3.90 0.63 0.53 0.76
Dardanup Pt B Male 29 4.10 4.50 0.66 0.42 0.Female 18 2.90 3.40 0.71 0.39 1.06Total 47 3.50 3.90 0.68 0.49 0.
Donnybrook-Balingup Male 73 6.00 6.90 0.92 0.73 1.Female 45 3.83 4.00 0.84 0.59 1.09Total 118 4.90 5.40 0.89 0.74 1.07
Harvey Pt A Male 112 4.00 4.60 0.66 0.54 0.79Female 68 2.52 2.80 0.59 0.47 0.76Total 180 3.30 3.70 0.63 0.54 0.73
Harvey Pt B Male 159 7.50 7.90 1.17 0.99 1.36Female 83 4.16 4.10 0.91 0.73 1.13Total 243 5.90 6.10 1.07 0.94 1.21
Manjimup Male 209 8.20 8.60 1.28 1.12 1.Female 141 5.83 6.00 1.28 1.08 1.Total 350 7.10 7.40 1.29 1.16 1.44
Nannup Male 23 7.20 7.80 1.06 0.64 1.54Female 14 4.78 5.00 1.00 0.49 1.58Total 37 6.00 6.40 1.04 0.71 1.
*per 1,000 population
24
95
35
17
98
92
7900
90
94
86
92
8917
4752
40
85
Appendix 19: Number of alcohol-related hospitalisations, SRRs and CIs by SLA and gender – Wheatbelt Health Region
SLA GenderNo.
hospitalisationsCrude rate* ASR* SRR LCI UCI
Beverley Male 27 6.40 6.80 0.91 0.58 1.30Female 12 3.14 2.60 0.61 0.28 1.01Total 39 4.80 4.80 0.80 0.56 1.08
Boddington Male 24 6.50 7.70 1.03 0.61 1.45Female 15 4.44 4.80 1.07 0.56 1.72Total 39 5.50 6.40 1.05 0.72 1.41
Brookton Male 23 8.40 9.10 1.20 0.73 1.76Female 10 3.98 4.20 0.80 0.33 1.36Total 33 6.30 6.90 1.05 0.70 1.45
Bruce Rock Male 36 12.90 11.50 1.91 1.30 2.60Female 27 10.91 9.40 2.14 1.35 3.02Total 63 12.00 10.50 2.02 1.57 2.61
Chittering Male 39 4.60 5.10 0.71 0.49 0.94Female 15 1.90 2.30 0.45 0.23 0.70Total 55 3.30 3.60 0.62 0.47 0.81
Corrigin Male 12 3.90 4.00 0.57 0.26 0.92Female 10 3.31 2.60 0.61 0.26 1.07Total 22 3.60 3.30 0.59 0.35 0.87
Cunderdin Male 21 5.80 5.90 0.89 0.51 1.30Female 12 3.78 3.70 0.79 0.37 1.31Total 33 4.90 4.70 0.86 0.57 1.18
Dalwallinu Male 28 6.30 6.90 1.02 0.66 1.45Female 16 4.42 4.50 0.94 0.49 1.43Total 44 5.40 5.90 1.01 0.72 1.33
Dandaragan Male 51 6.40 7.00 0.97 0.73 1.29Female 21 3.03 3.30 0.68 0.40 1.01Total 71 4.80 5.20 0.88 0.69 1.11
Dowerin & Goomalling Male 28 6.00 6.40 0.92 0.60 1.31Female 29 6.80 6.20 1.43 0.93 2.03Total 56 6.40 6.30 1.14 0.87 1.48
Dumbleyung & Kulin Male 26 6.20 6.30 0.92 0.56 1.29Female 13 3.50 3.80 0.77 0.37 1.25Total 39 4.90 5.20 0.87 0.60 1.17
Gingin Male 56 4.70 5.40 0.70 0.53 0.92Female 36 3.31 3.10 0.73 0.50 1.00Total 91 4.00 4.20 0.72 0.58 0.89
Kellerberrin Male 52 17.80 18.90 2.54 1.92 3.35Female 28 9.46 9.10 1.77 1.12 2.46Total 81 13.60 14.00 2.21 1.76 2.76
Kondinin Male 25 9.10 9.30 1.41 0.87 2.02Female 10 4.48 4.80 1.06 0.42 1.75Total 35 7.00 7.20 1.31 0.87 1.77
Lake Grace Male 22 5.40 5.90 0.83 0.49 1.20Female 11 3.11 4.00 0.73 0.31 1.20Total 33 4.30 5.10 0.81 0.53 1.09
Merredin Male 97 10.40 10.80 1.63 1.32 1.99Female 51 6.07 6.10 1.33 1.00 1.76Total 148 8.30 8.70 1.53 1.29 1.80
Moora & Victoria Plains Male 85 9.10 9.90 1.43 1.15 1.77Female 57 6.80 7.10 1.53 1.17 1.99Total 143 8.00 8.70 1.49 1.26 1.76
Mount Marshall & Koorda Male 19 6.40 6.40 0.99 0.54 1.45Female 9 3.50 4.40 0.84 0.32 1.46Total 28 5.10 5.60 0.94 0.60 1.32
Narembeen Male 15 6.00 6.50 0.93 0.49 1.49Female 11 4.78 4.60 0.95 0.43 1.64Total 25 5.40 5.90 0.95 0.58 1.34
*per 1,000 population (continued over page)
86
Narrogin & Wickepin Male 17 4.20 4.40 0.63 0.35 0.98Female 8 2.20 2.50 0.55 0.19 0.Total 24 3.30 3.40 0.59 0.36 0.
Narrogin (T) Male 120 11.00 11.50 1.68 1.40 2.02Female 97 8.23 8.00 1.66 1.36 2.04Total 217 2.10 9.70 1.67 1.46 1.91
Northam (S) Male 45 4.60 4.80 0.71 0.51 0.Female 23 2.61 3.00 0.60 0.35 0.86Total 68 3.70 4.00 0.68 0.53 0.
Northam (T) Male 166 10.50 11.00 1.64 1.40 1.92Female 148 9.17 9.00 1.80 1.53 2.Total 314 9.80 10.10 1.71 1.52 1.91
Pingelly Male 26 8.40 8.10 1.24 0.77 1.76Female 16 5.72 6.10 1.09 0.56 1.66Total 42 7.10 7.20 1.19 0.83 1.
Quairading Male 31 11.10 13.60 1.68 1.11 2.36Female 15 5.86 6.40 1.14 0.57 1.74Total 46 8.60 9.90 1.46 1.05 1.
Toodyay Male 52 4.70 4.70 0.70 0.53 0.Female 39 3.87 4.10 0.86 0.60 1.16Total 91 4.30 4.50 0.77 0.62 0.
Trayning & Nungarin Male 11 6.30 7.00 0.98 0.45 1.71Female 12 8.00 8.40 1.71 0.78 2.80Total 23 7.60 9.10 1.29 0.78 1.
Wagin Male 39 8.50 8.30 1.26 0.86 1.Female 31 6.71 5.70 1.30 0.85 1.79Total 70 7.60 7.10 1.28 1.00 1.
Wandering & Cuballing Male 22 7.50 7.50 1.13 0.68 1.68Female 4 1.40 1.30 0.35 0.05 0.Total 25 4.60 4.50 0.83 0.51 1.
West Arthur & Williams Male 29 5.90 6.10 0.87 0.57 1.24Female 14 3.40 3.80 0.71 0.35 1.12Total 43 4.80 4.90 0.83 0.59 1.
Westonia & Mukinbudin Male 16 6.90 9.70 1.06 0.55 1.62Female 8 3.80 4.70 0.88 0.31 1.Total 24 5.40 6.90 1.00 0.61 1.
Wongan-Ballidu Male 37 9.00 9.20 1.48 1.01 2.01Female 21 6.06 6.40 1.34 0.79 1.99Total 58 7.60 8.20 1.45 1.11 1.
Wyalkatchem & Tammin Male 12 7.20 7.70 0.64 0.30 1.07Female 15 9.30 10.40 1.25 0.64 1.95Total 27 8.20 8.70 0.89 0.56 1.
Yilgarn Male 37 8.00 9.10 1.25 0.86 1.Female 19 5.15 5.70 1.21 0.69 1.84Total 56 6.70 7.90 1.28 0.97 1.
York Male 41 4.80 5.10 0.72 0.50 0.96Female 42 5.18 4.60 1.02 0.72 1.37Total 82 5.00 4.80 0.85 0.68 1.
*per 1,000 population
9985
94
86
12
57
9292
95
8768
62
7718
10
5944
89
2669
67
06
87
Appendix 20: Number of alcohol-related deaths, ASRs, SMRs and CIs by gender and health region
Region Gender No. deaths Crude rate* ASR* SM R LCI UCI
G old fie lds Male 108 40.30 53.40 1.49 1.23 1.80Fem ale 30 13.10 17.20 1.42 0.91 1.94Tota l 138 27.70 35.90 1.53 1.29 1.82
G reat Southern Male 93 38.40 41.00 1.05 0.85 1.29Fem ale 27 11.50 10.40 0.86 0.54 1.21Tota l 120 25.10 25.00 1.01 0.84 1.22
Kimberley Male 107 70.30 87.80 2.85 2.35 3.45Fem ale 28 20.90 29.60 2.76 1.75 3.85Tota l 136 47.20 61.00 2.98 2.51 3.54
Midwest Male 107 37.90 47.10 1.18 0.97 1.43Fem ale 30 11.50 13.20 1.04 0.68 1.46Tota l 137 25.30 29.80 1.19 1.00 1.41
North Metro Male 1 ,048 30.10 35.00 0.89 0.83 0.94Fem ale 417 11.80 11.40 0.92 0.84 1.02Tota l 1 ,466 20.80 21.90 0.89 0.84 0.94
Pilbara Male 65 32.80 52.60 1.45 1.13 1.86Fem ale 29 17.70 25.60 2.59 1.68 3.65Tota l 94 26.00 41.00 1.79 1.45 2.20
South Metro Male 1 ,033 34.10 38.10 0.98 0.92 1.04Fem ale 405 13.10 12.40 1.01 0.91 1.11Tota l 1 ,438 23.50 24.00 0.98 0.93 1.03
South W est Male 190 32.50 37.10 0.95 0.82 1.09Fem ale 62 10.80 10.80 0.88 0.68 1.14Tota l 252 21.80 23.30 0.94 0.83 1.07
W heatbelt Male 137 39.80 43.80 1.14 0.96 1.35Fem ale 35 11.20 11.50 0.89 0.59 1.20Tota l 172 26.10 27.80 1.11 0.95 1.29
*per 100,000 popu lation Appendix 21: Number of alcohol-related deaths, ASRs, SMRs and CIs by Aboriginality and
health region
Region Aborig inality No. deaths Crude rate* ASR* SM R LCI UCI
Goldfie lds Aboriginal 30 57.30 78.70 0.98 0.62 1.35Non-Aboriginal 103 22.90 30.60 1.42 1.16 1.72
Great Southern Aboriginal 6 32.60 65.60 0.61 0.17 1.25Non-Aboriginal 112 24.40 24.00 1.08 0.89 1.30
Kimberley Aboriginal 92 66.30 100.00 1.20 0.97 1.47Non-Aboriginal 33 22.00 30.80 1.44 0.96 1.99
Midwest Aboriginal 34 53.90 98.40 0.96 0.65 1.32Non-Aboriginal 106 22.20 24.90 1.12 0.92 1.36
North Metro Aboriginal 43 43.90 102.70 0.87 0.61 1.15Non-Aboriginal 1,344 19.40 20.30 0.92 0.87 0.97
Pilbara Aboriginal 53 89.80 126.70 1.50 1.14 1.98Non-Aboriginal 35 11.70 23.00 0.95 0.63 1.28
South Metro Aboriginal 46 41.00 83.90 0.82 0.59 1.09Non-Aboriginal 1,336 22.20 22.50 1.02 0.97 1.08
South West Aboriginal 5 21.40 96.60 0.43 0.09 0.83Non-Aboriginal 243 21.50 22.80 1.03 0.91 1.17
Wheatbelt Aboriginal 13 42.10 86.80 0.76 0.37 1.27Non-Aboriginal 155 24.70 25.90 1.15 0.98 1.35
*per 100,000 population
88
89
NOTES:
90
NOTES:
91
NOTES:
