the murrumbidgee local health district 2018

Murrumbidgee Local Health District

ABN 71 172 428 618

Locked Bag 10, Wagga Wagga NSW 2650

Tel 02 6933 9100 Fax 02 6933 9188

Website www.mlhd.health.nsw.gov.au

The Murrumbidgee Local Health District 2018

Summary Population and Health Profile

Population, Hospitalisation and Potentially Preventable Hospitalisations update, June 2018

Date: June 2018 revision

Author: Kim Gilchrist, Epidemiologist, Public Health Unit, MLHD [email protected]

Copies available: www.mlhd.health.nsw.gov.au/about/health-statistics/

mailto:[email protected]

http://www.mlhd.health.nsw.gov.au/about/health-statistics/

Contents Contents ............................................................................................................. 2

Figures ............................................................................................................ 3

Tables .............................................................................................................. 3

The Murrumbidgee LHD ..................................................................................... 4

Facilities .............................................................................................................. 5

The population ................................................................................................... 6

The population now ....................................................................................... 6

The population in the future .......................................................................... 6

Summary from the Census ................................................................................. 8

Cultural and linguistic diversity ...................................................................... 8

Education ........................................................................................................ 8

The working population ................................................................................. 8

Socioeconomic disadvantage 2016 ................................................................ 8

Families ......................................................................................................... 11

Income support ............................................................................................ 11

Disability ....................................................................................................... 12

Burden of Disease ............................................................................................. 13

Mortality ....................................................................................................... 13

Life expectancy ......................................................................................... 13

Causes of death ........................................................................................ 14

Potentially avoidable deaths .................................................................... 14

Hospitalisations ............................................................................................ 15

Potentially Preventable Hospitalisations ................................................. 19

Health topics .................................................................................................... 22

Injury and poisoning .................................................................................... 22

Cardiovascular disease ................................................................................. 24

Blood pressure and cholesterol ............................................................... 27

Diabetes ....................................................................................................... 28

Respiratory disease ...................................................................................... 29

COPD ........................................................................................................ 29

Asthma ..................................................................................................... 29

Influenza and pneumonia ........................................................................ 30

Mental health (suicide and self-harm) ........................................................ 31

Cancer .......................................................................................................... 33

Breast cancer ........................................................................................... 34

Lung cancer .............................................................................................. 34

Bowel cancer ............................................................................................ 35

Skin Cancer ............................................................................................... 35

Prostate cancer ........................................................................................ 35

Cervical cancer ......................................................................................... 35

Risk Behaviours ............................................................................................ 37

Smoking.................................................................................................... 38

Alcohol ..................................................................................................... 39

Physical activity ........................................................................................ 40

Fruit and vegetable consumption ............................................................ 41

Obesity/ high BMI related illness ............................................................. 42

Food insecurity ......................................................................................... 43

The Murrumbidgee LHD 2018, Public Health, Murrumbidgee LHD, June 2018 revision. 3/49

Pregnancy and the newborn ........................................................................ 44

Antenatal care .......................................................................................... 44

Low birth weight ....................................................................................... 44

Smoking during pregnancy ....................................................................... 44

Summing up ...................................................................................................... 45

For 2018 ............................................................................................................ 46

Data sources ..................................................................................................... 47

Supporting information .................................................................................... 47

Infographics ...................................................................................................... 47

Figures Figure 1 – NSW Local Health Districts ............................................................................. 4 Figure 2 - MLHD Facility locations and Local Government Areas ................................... 5 Figure 3 – MLHD population projections (no Albury), NSW Department of Planning and Environment Projections 2016 ................................................................................ 7 Figure 4 - 2016 Australian Bureau of Statistics Census and PHIDU Social Health Atlas data. ................................................................................................................................ 9 Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local Government Area ......................................................................................................... 10 Figure 6 - Deaths by category of cause, MLHD, 2015 (HealthStats NSW 2018) ........... 14 Figure 7 - Hospitalisation all causes trend 2011-02 to 2016-17, MLHD (HealthStats NSW, 2018) ................................................................................................................... 15 Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018) ............ 16 Figure 9 - Potentially preventable Hospitalisations all conditions, MLHD and Total NSW, 2015-16 (HealthStats NSW, 2018) ...................................................................... 19 Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018) ....................... 20

Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW ...................................................................................................................................... 23 Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW 25 Figure 13 - Circulatory procedures, Murrumbidgee LHD 2001-02 to 2015-16 (Health Statistics NSW) .............................................................................................................. 27 Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW ...................................................................................................................................... 30 Figure 15 – Mental and behavioural disorders trend in deaths and hospitalisations, MLHD and NSW ............................................................................................................ 32 Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW .................. 34 Figure 17 - Trend in adult smoking prevalence, MLHD and NSW 2002 to 2017 ........... 38 Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 to 2017 .......................................................................................................................... 39 Figure 19- Trend in adult insufficient physical activity prevalence, MLHD and NSW 2002 to 2017 ................................................................................................................. 40 Figure 20 - Trend in adult adequate fruit and vegetable consumption prevalence, MLHD and NSW 2002 to 2017 ...................................................................................... 41 Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 to 2017 .............................................................................................................................. 42

Tables Table 1 - MLHD facilities by type and location ............................................................... 5 Table 2 - Income support recipients by type of benefit and eligible population, MLHD and NSW, June 2016 ..................................................................................................... 11 Table 3 - Hospitalisations by cause and sex, Murrumbidgee LHD and NSW, 2016-17 (Health Statistics NSW, 2018). ...................................................................................... 17 Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015-16 (Health Statistics NSW) ............................................................................................ 21 Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Statistics NSW, June 2018) ............................................................................................ 26


The Murrumbidgee LHD Murrumbidgee LHD is 123,233 sq/km in area and encompasses

21 Local Government Areas in the central south of NSW (Figure

1Figure 1 and Table 1) Berrigan, Bland, Carrathool, Coolamon,

Cootamundra, Deniliquin, Edward River, Federation, Greater

Hume, Griffith, Gundagai, Junee, Lake Cargelligo part of

Lachlan Shire, Leeton, Murray River, Murrumbidgee,

Narrandera, Snowy Valleys, Temora and Wagga Wagga and

also includes providing services to the Albury City population.

Most of the LHD is considered inner regional or outer regional

with only the north western LGA of Hay classified as remote.

Figure 1 – NSW Local Health Districts


Facilities The MLHD includes one Referral Base Hospital at Wagga Wagga and one Rural

Base Hospital at Griffith. There are currently fifteen District and Community

Hospitals and a further fourteen Multi Purpose Services (Table 1 and Figure

1).

Table 1 - MLHD facilities by type and location

Facility type Location

Major hospital (B) Wagga Wagga

District Hospital – group 1 (C1) Griffith

District Hospital – group 2 (C2) Deniliquin, Young

Community Hospitals with surgery (D1a)

Cootamundra, Corowa, Leeton, Narrandera, Temora, Tumut

Community Hospitals without surgery (D1b)

Finley, Hay, Holbrook, Harden, West Wyalong

Multi Purpose Services (F3) Barham, Batlow, Berrigan, Boorowa, Coolamon, Culcairn, Gundagai, Henty, Hillston, Jerilderie, Junee, Lake Cargelligo, Lockhart, Tocumwal, Tumbarumba, Urana

Affiliated Health Organisations (sub-acute F4)

Mercy Health Service Albury and Mercy Care Centre Young

Other Services

South West Brain Injury Rehabilitation Service, BreastScreen NSW and Public Health, Mental Health Accessline

Community Health Posts

Adelong, Ardlethan, Barellan, Barmedman, Coleambally, Darlington Point, Mathoura, Moama, Moulamein, Tarcutta, Tooleybuc, Ungarie, Weethalle

Figure 2 - MLHD Facility locations and Local Government Areas


The population

242,840

Estimated resident population (June 30, 2016) P

O P U L A T I O N

+ 1,922

Wagga Wagga LGA population increase (2012 to 2016)

+ 1,000 Annual growth In MLHD (2012 to 2016)

+ 5%

Junee and Carrathool LGAs % increase (2012 to 2016)

+ 1.8% Annual growth In MLHD (2012 to 2016)

- 2%

Narrandera LGA decrease (177 people) (2012 to 2016)

+ 1 % Projected growth (2011 to 2021)

+ 10,000

Projected increase in people aged 75+ years (2011 to 2026)

The population now The MLHD as of June 2016, had an estimated resident population (ERP) of

242,840 (Albury LGA of 52,165 is not included). The Murrumbidgee LHD has

grown by approximately one thousand people per year from 2012 to 2016 a

1.8 per cent increase over the five years. The largest population increase was

in Wagga Wagga with an extra 1,922 people since 2012, followed by Griffith

with an extra 784 (Albury LGA had an increase of 2,363 people). LGAs with the

largest percentage growth were: Junee (5.1% net increase of 315 people),

Carrathool (4.9% net increase of 132 people) and Murray River (4.4% net

increase of 496 people). The largest drop in population was experienced by

Narrandera (177 people), Snowy Valleys (109 people) and Federation (97

people). LGAs with the largest percentage decrease were, Narrandera (-1.9%

net decrease of 177 people), Hay (-1.8% net decrease of 53 people) and Lake

Cargelligo (-1.1% net decrease of 21 people).

The population in the future The population is projected to grow by just over 1 per cent from the ERP 2011

to 2021 to reach approximately 244,870 people then increase by 0.5% to

246,220 by 2026 with a projected decline from 2026 to 2031 (2016

Department of Planning and Environment New South Wales State and Local

Government Area Population Projections). This is slow to negative growth

compared to total NSW figures which increased by 6.8 per cent from 2011 to

2016 and are projected to increase by around 6 per cent for the next two five-

year forecast periods. The Albury LGA had a population of 49,451 in 2011 this

is projected to increase to 52,100 by 2016 (+5.1% increase from 2011) then to

56,550 by 2026.

While the overall MLHD population number is not projected to change

significantly, projections indicate growth in the older population (Figure 3).

People aged 75 years and over made up 8 per cent of the total population in

2011 (around 18,000 people), this is projected to increase to 12 per cent of

the total population in 2026 (around 29,000 people) an increase of more than

10,000 older people. The aged population in NSW was 7 per cent in 2011

increasing to 9 per cent in 2026. There were 3,547 people aged 75 years or

over in Albury in 2011 this is expected to increase to 4,000 in 2016 and to

5,800 in 2026.


Figure 3 – MLHD population projections (no Albury), NSW Department of Planning and Environment Projections 2016


Summary from the Census

5.3% Non-English Speaking COB (21% NSW)

C E N S U S

4.8% Aboriginal people (2.9% NSW)

6.1%

Speak Language other than English at home (25.5% NSW)

< 1.5% Difficulty speaking English (4.5% NSW)

41% Post school qualifications 15+ years (50.4% NSW)

4.8% Unemployed (5.9% NSW)

66,000

Concession card holders (27% of the

population compared to 24% NSW)

13,019

People needing assistance with core activities (5.5% of the population compared to 5.4 % NSW)

A full report of Census statistics for Murrumbidgee LHD is available at:

www.mlhd.health.nsw.gov.au/about/health-

statistics/dem/MurrumbidgeeCensus2016profile_release2_Dec2017.pdf

Cultural and linguistic diversity The people of MLHD were mostly born in Australia (82.2%, 2016) or were from

English speaking overseas countries (3.2%, 2016). Only 5.3 per cent of the

MLHD population were born in a predominantly non-English speaking country

(NESB COB 2016) and 6.1 per cent stated speaking a language other than

English (LOTE) at home, compared to 21.0 per cent and 25.5 per cent in NSW

respectively. Just over one per cent of the MLHD population had difficulty

speaking English compared to 4.5 per cent in NSW. People of Aboriginal

background made up 4.8 per cent of the MLHD population compared to 2.9

per cent of all NSW. The majority of religious affiliations reported were

Christian-based (68% in MLHD and 55% in NSW, 2016).

Education Seventy-nine per cent of sixteen year olds in MLHD were full-time participants

in secondary school compared to eighty –four per cent in NSW (in 2016). Five

per cent of the MLHD population were enrolled in Tertiary education,

compared to seven per cent in NSW. The age standardised rate of people who

left school at Year 10 or who did not go to school in Murrumbidgee was 42 per

100 adults compared with 33 per 100 adults in NSW. Education to Year 12 (or

equivalent) was reported by 34 per cent of the adult population compared to

52 per cent of NSW. University education of Bachelor degree or higher were

reported by 11.4 per cent of the MLHD population compared to 23.4 per cent

in NSW. In 2016, 41 per cent of adults had attained some type of post school

qualification in MLHD compared to 50.4 per cent of NSW.

The working population In 2016 Census 4.8 per cent of the labour force of MLHD reported to be

unemployed compared to 5.9 per cent of the NSW labour force. In 2016

agriculture was the main industry employer followed by Health Care and

Social Assistance (11.8%), retail trades (9.7%) and manufacturing (9.3%). The

main occupations of employment in MLHD were Managers (17.8%) and

Professionals (14.6%). The NSW workforce had proportionally more people

classified as Professionals (23.6%) and Clerical workers (13.8%) than MLHD. In

2017 the unemployment rate for the September Quarter for MLHD LGAs

varied, with highest unemployment in Edward River (7.7%), Hilltops (6.9%)

and Narrandera (6.5%) and the lowest Lockhart (2.6%), information is not

available for Lake Cargelligo.

Socioeconomic disadvantage 2016 The Index of Relative Socio-economic Disadvantage (IRSD) is a general socio-

economic index that summarises a range of information about the economic

http://www.mlhd.health.nsw.gov.au/about/health-statistics/dem/MurrumbidgeeCensus2016profile_release2_Dec2017.pdf

http://www.mlhd.health.nsw.gov.au/about/health-statistics/dem/MurrumbidgeeCensus2016profile_release2_Dec2017.pdf


and social conditions of people and households within an area. Unlike the

other indexes, this index includes only measures of relative disadvantage. A

low score indicates relatively greater disadvantage in general. For example, an

area could have a low score if there are (among other things): - many

households with low income, many people with no qualifications, or many

people in low skill occupations. A high score indicates a relative lack of

disadvantage in general. For example, an area may have a high score if there

are (among other things):- few households with low incomes, few people with

no qualifications, and few people in low skilled occupations.

The SEIFA score of 1000 is the national mean, scores below 1000 show higher

disadvantage than the average and scores above 1000 show less

disadvantage. A score of 500 does not indicate twice as much disadvantage as

a score of 1000, a decile band of 1 indicates the top 10 per cent most

disadvantaged areas. Narrandera and Lachlan are the LGAs with the greatest

average disadvantage within MLHD (Figure 5). These LGAs are among the top

25 per cent of disadvantaged LGAs in Australia and rank 21st and 25th

respectively of the 129 LGAs in NSW. Averaging scores to LGA level may mask

pockets of disadvantage at the smaller SA1 level. Griffith and Wagga Wagga

have the widest range of scores indicating a broad social gradient of high levels

of disadvantage to relatively low levels

.

Figure 4 - 2016 Australian Bureau of Statistics Census and PHIDU Social Health Atlas data.


Figure 5 – 2016 ABS Socioeconomic Index of Relative Disadvantage by Local Government Area


Families There were approximately 94,500 occupied private dwellings in the MLHD in

2016, 60,451 family households (64% of households) and 24,378 lone person

households (26%). In MLHD 23,989 households (25.4% of all households) were

couple families with children, 26,206 (27.7%) couples with no children, and

9,427 (10.0%) one parent families. NSW had a similar proportion of one parent

families (10.7%) to MLHD and more couple families with children (31.5%),

most likely due to a younger age structure than MLHD. More families,

proportionally, reported incomes of less than $800 a week in MLHD compared

to NSW (20.0% and 16.8% respectively). The median household income in

NSW (2016) was $1780/week the approximate median for MLHD is

$1500/week with Gundagai, Berrigan and Hilltops LGAs having median family

incomes below $1000/week. Twenty per cent of families reported incomes of

over $4,000/week in NSW compared to 15% of families in MLHD. In 2011,

there were 6,523 children under 15 years in jobless families (or 14.6% of all

children under 15 years compared to 14.7% in NSW), this varied by LGA with

the highest percentage of children in jobless families in Hay (21.7%), Lake

Cargelligo (20.2%) and Narrandera (19.9%) and the lowest in Jerilderie (8.6%)

and Lockhart (10.1%) (PHIDU Social Health Atlas, Dec 2017).

Income support Murrumbidgee LHD had approximately 32,400 aged pensioners in June 2016,

71 per cent of the eligible population compared to 68 per cent in NSW. In June

2016 there were 14,000 Health Care Card holders in MLHD and 52,000

Pensioner Concession Card holders making a total of approximately 66,000

concession card holders or 27 per cent of the total population compared to 24

per cent in NSW. The percentage of concession card holders ranged from over

one third of the population in Federation (34.5%), Berrigan (34.1%) Gundagai

(33.9%) and Cootamundra (33.7%) to less than a quarter of the population in

Carrathool (21.6%), Griffith (23.5%) Junee (24.2%) and Wagga Wagga (24.4%)

(PHIDU Social Health Atlas, March 2018). Full income support details for the

MLHD population are in Table 2.

Table 2 - Income support recipients by type of benefit and eligible population, MLHD and NSW, June 2016

Income support benefits MLHD NSW

Age pensioners

Age pensioners 32410

Persons aged 65 years and over 45755

% age pensioners 70.8 67.6

Disability support pensioners

Disability support pensioners 9543

Persons aged 16 to 64 years 144530

% disability support pensioners 6.6 5.2

Female sole parent pensioners

Female sole parent pensioners 3271

Females aged 15 to 54 years 56976

% female sole parent pensioners 5.7 3.7

People receiving an unemployment benefit

People receiving an unemployment benefit 8219


% people receiving an unemployment benefit 5.7 4.8

People receiving an unemployment benefit long-term

People receiving an unemployment benefit for longer than 6 months

6839


% people receiving an unemployment benefit long-term 4.7 4.0

Young people aged 16 to 24 receiving an unemployment benefit

Young people (16 to 24 years) receiving an unemployment benefit

1132


% young people receiving an unemployment benefit 4.1 3.0

Low income, welfare-dependent families (with children)

Low income, welfare-dependent families (with children) 6420

Total families 60540

% low income, welfare-dependent families (with children) 10.6 9.9


Income support benefits MLHD NSW

Children in low income, welfare-dependent families

Children in low income, welfare-dependent families 12570

Children under 16 years 51391

% children in low income, welfare-dependent families 24.5 22.3

Health Care Card holders

Health Care Card holders 14081

Persons 0 to 64 years 195921

% Health Care Card holders 7.2 6.4

Pensioner Concession Card holders

Pensioner Concession Card holders 52147


% Pensioner Concession Card holders 26.9 21.9

Seniors Health Card holders

Seniors Health Card holders 3788


% Seniors Health Card holders 8.3 8.3

Source: Compiled by PHIDU based on data from the Department of Human Services and Centrelink June

2016; and the ABS Estimated Resident Population, 30 June 2015 (accessed March 2018).

Disability On Census night August 2016, 13,019 people in MLHD reported needing

assistance with core activities, which made up 5.5 per cent of the population

compared to 5.4 per cent of NSW. For people aged 0 to 64 years

approximately 3.1 per cent reported needing help with core activities (5,874

people), this proportion increased for those aged 65 years and over to 15

percent (7154 people). In the 65 years and over group there were 4,470

people with a profound or severe disability living in the community and 5,176

people aged 0 to 64 years (MLHD 2011). There were 10,160 people aged 16

years or over in MLHD (June 2014) who were receiving a disability support

pension, making up 7.1 per cent of the eligible population, compared to 5.6

per cent in all NSW. Cootamundra (11.6%) and Urana (11.5%) had the highest

percentages of their eligible populations on disability pensions among MLHD

LGAs, and Conargo (2.5%) and Carrathool (4.2%) the lowest.

http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-primary-health-networks


Burden of Disease

79.5 years

Male Life expectancy at birth (NSW 80.9 yrs)

D I S E A S E

B U R D E N

127,143

Hospital admissions per year (significantly high rate compared to NSW)

83.9 years

Female Life expectancy at birth (NSW 85.0 yrs)

8,367

Potentially Preventable Hospital (PPH) admissions per year (close to 6.5% of all admissions)

2,409 Deaths per year In 2015 27,329

Hospital bed days a year for PPH (2015-16)

344

Potentially avoidable deaths per year (significantly higher rate in MLHD 129.0/100,000 compared to NSW 105.9/100,000)

10%

Of all hospital admissions in MLHD are for dialysis

Significantly higher death rate for all causes and potentially

avoidable causes

MLHD to

NSW

Significantly higher hospitalisation rate for all

causes and potentially preventable causes

Mortality

LIFE EXPECTANCY Life expectancy in NSW and MLHD continues to increase. In 2015 newborn

males could expect to live for 80.9 years in NSW and 79.5 years in MLHD, while

newborn females could expect to live for 85.0 years in NSW and 83.9 years in

MLHD. At age 65 years males could expect to live until age 85.0 years in NSW

and 84.5 years in MLHD and females until 87.6 in NSW and 87.4 years in MLHD.

Although females can still expect to live longer than males, the gap between

the sexes is narrowing. In NSW life expectancy increased by 10 years for

females since 1974, whereas there has been a 10 year increase for males since

1980.

Life expectancy at birth in 2015 by LGA differs by approximately four years

from the highest in Lockhart of 85.7 to the lowest in Narrandera of 81.2.

The median age at death for MLHD was 78 years for male; 84 years for females

(2010 to 2014), the same as for NSW (PHIDU 2018).

Aboriginal people have a much shorter life expectancy than non-Aboriginal

people. In 2010-12, life expectancy in NSW was estimated to be 70.5 years in

Aboriginal males and 74.6 years in Aboriginal females, almost 10 years lower

than in males and females in the general population (ABS 3302.0.55.003

2013).


CAUSES OF DEATH The age-adjusted “all cause” death rate 2015 in MLHD was significantly higher

than expected based on NSW rates (603.1 per 100,000 population compared

to 546.0 per 100,000 in NSW). There were 2,409 deaths in MLHD 2015 and the

death rate has been decreasing steadily for both males and females since the

early 2000’s. The major causes of death for males and females are circulatory

diseases and cancers (Figure 6).

POTENTIALLY AVOIDABLE DEATHS Potentially avoidable deaths are those that occur before age 75 years and are

caused by conditions that are potentially preventable through individualised

care and/or treatable through existing primary or hospital care. Deaths are

defined as avoidable in the context of the present health system. MLHD in

2014-15 had an annual average of 344.0 avoidable deaths with an age-

adjusted rate significantly higher than NSW (MLHD: 129.0/100,000; NSW:

105.9/100,000). The avoidable death rate for males was significantly higher

than females in MLHD and significantly higher than the NSW rate for males.

Similar to NSW and other LHDs the avoidable death rates for males were

significantly higher than that of females. Given that in NSW approximately 35

per cent of all deaths occur before the age of 75 years from MLHD figures

approximately 840 deaths per year are for people aged less than 75 years

around 40 per cent of these are considered potentially avoidable. From a

significant drop in rates from 2001-2002 to 2004-05 the overall MLHD rate has

remained around 130 to 135 per 100,000. The male rate of avoidable deaths

is around double that of the female rate in MLHD and the gap between males

and females has only changed in recent years as the male rate has dropped

and female rate increased slightly, for NSW on the other hand there has been

a gradual decline in both male and female rates since the early 2000’s and a

slight decrease in the gap between male and female rates. In NSW death rates

for avoidable causes were seen to increase with geographic remoteness,

particularly in males, however in females the potentially avoidable death rate

for those in Very Remote areas is significantly higher than any other category

for females and is at a rate comparable with males in Very Remote NSW.

Figure 6 - Deaths by category of cause, MLHD, 2015 (HealthStats NSW 2018)


Hospitalisations In 2016-17 financial year there were 127,143 episodes of hospital care for

residents of the MLHD. The age-adjusted rates of hospitalisation were

significantly higher than the NSW averages for both sexes separately and

combined. In the past 20 years hospitalisation rates have steadily increased

with a slight drop in 2010-11 when a change of coding for diabetes made

significant changes to rates, since then the rates have continued to rise (Figure

7). The increase in rates over time is due to increases in hospitalisation rates

for the people aged over 65 years, the highest rates of hospitalisation are for

those aged 80 to 94 years (in NSW).

The most significant cause of hospitalisation in MLHD (2016-17) was “other

factors influencing health care” (ICD10 Z-codes*) (15,383 episodes, 12.1%);

followed by digestive system diseases (13,327, 10.5%), and then dialysis

(12,630 episodes, 9.9%). The pattern for most causes was similar for males

and females however the highest rate of hospitalisation for females was

maternal and neonatal related diagnoses.

Since the early 2000’s rate of separations for most major categories of cause

have been increasing slightly, however the major contributor to increased

separation rates overall for the MLHD is the increasing rate of dialysis

admissions which have doubled in 15 years. Dialysis has increased from

around 3% of admissions in 2001-02 to around 10% in 2016-17. For MLHD

residents the age-adjusted rates of hospitalisation by cause were significantly

higher than the NSW rates for a large number of causes (Table 3 and Figure

8).

Figure 7 - Hospitalisation all causes trend 2011-02 to 2016-17, MLHD (HealthStats NSW, 2018)


Figure 8 - Hospitalisations by cause MLHD 2016-17 (HealthStats NSW, 2018)

International Classification of Disease (ICD) “Z” codes – “other factors

influencing health”

Categories Z00-Z99 are for occasions where situations other than a disease,

external or internal injury, or other external cause of which is classifiable to

categories A00-Y89 are recorded as one of the diagnoses or presenting

problems. Such situation can arise from one of two ways:

1. To receive limited care or service for an ongoing condition, to

donate an organ and/or tissue, to receive prophylactic

immunization, or to discuss a problem other than a disease or

injury.

2. for a situation or problem that influences the person's health

status, however, is not currently an illness or injury.

In 2016 in MLHD there were around 13,500 episodes with this coding

although specific reasons for hospital contact are varied, some of the major

reasons for these encounters were for chemotherapy (~4,000), newborns

(~2,000), surgical care follow up (~1000) and endoscopic examinations

(~500).


Table 3 - Hospitalisations by cause and sex, Murrumbidgee LHD and NSW, 2016-17 (Health Statistics NSW, 2018). ^ Statistically significant difference from NSW age-standardised rates, based on 95% confidence limits.

Murrumbidgee LHD NSW Cause of hospitalisation Sex Number Per cent of

hospitalisations Rate per 100,000

population LL 95% CI UL 95% CI Rate per 100,000

population LL 95% CI UL 95% CI Different from

state^

Infectious diseases Males 1,199 1.9 882.8 831.6 936.2 652.7 644.8 660.7 HIGH

Females 1,326 2.1 1006.7 950.4 1065.4 675.4 667.5 683.5 HIGH

Persons 2,525 2.0 943.0 904.9 982.2 661.6 656.0 667.2 HIGH

Malignant neoplasms Males 3,209 5.1 1928.3 1860.5 1997.8 1507.6 1496.0 1519.3 HIGH

Females 1,967 3.0 1180.9 1126.8 1236.9 1045.4 1035.9 1054.9 HIGH

Persons 5,176 4.1 1540.1 1496.9 1584.1 1258.8 1251.5 1266.3 HIGH

Other neoplasms Males 1,164 1.9 728.6 686.0 773.1 692.4 684.5 700.4

Females 1,158 1.8 832.5 782.8 884.5 814.6 806.0 823.4

Persons 2,323 1.8 775.1 742.4 808.8 749.9 744.1 755.8

Blood immune diseases Males 814 1.3 503.8 468.6 540.8 412.7 406.5 418.9 HIGH

Females 1,061 1.6 724.3 678.7 772.1 536.5 529.5 543.5 HIGH

Persons 1,875 1.5 608.4 579.7 638.0 473.3 468.6 477.9 HIGH

Endocrine diseases Males 880 1.4 616.0 574.1 660.1 455.1 448.5 461.7 HIGH

Females 1,210 1.9 913.5 859.9 969.4 636.3 628.5 644.2 HIGH

Persons 2,090 1.6 762.6 728.5 797.7 545.2 540.1 550.3 HIGH

Mental disorders Males 1,563 2.5 1397.8 1327.4 1470.9 1781.2 1767.7 1794.7 LOW

Females 1,386 2.1 1172.5 1109.0 1238.5 2039.5 2025.3 2053.8 LOW

Persons 2,949 2.3 1285.8 1238.3 1334.7 1909.4 1899.6 1919.2 LOW

Nervous sense disorders Males 3,910 6.2 2611.8 2527.4 2698.1 2516.2 2500.9 2531.6

Females 4,088 6.3 2695.4 2609.0 2783.7 2521.6 2506.8 2536.5 HIGH

Persons 7,998 6.3 2646.2 2585.9 2707.5 2514.9 2504.3 2525.6 HIGH

Circulatory diseases Males 5,132 8.2 3144.8 3056.7 3234.7 2217.6 2203.5 2231.8 HIGH

Females 3,590 5.6 2007.3 1938.7 2077.6 1352.1 1341.7 1362.7 HIGH

Persons 8,722 6.9 2568.9 2513.3 2625.5 1765.7 1757.0 1774.4 HIGH

Respiratory diseases Males 4,204 6.7 3006.8 2913.7 3102.1 1909.6 1896.1 1923.3 HIGH

Females 4,066 6.3 2943.1 2848.5 3039.8 1685.6 1673.0 1698.2 HIGH






state^

Persons 8,270 6.5 2965.2 2898.9 3032.5 1787.2 1778.0 1796.5 HIGH

Digestive system diseases Males 6,617 10.6 4802.0 4682.0 4924.2 3792.6 3773.4 3811.8 HIGH

Females 6,710 10.4 5030.5 4904.7 5158.5 3555.8 3537.4 3574.3 HIGH

Persons 13,327 10.5 4904.7 4817.8 4992.6 3665.2 3651.9 3678.5 HIGH

Skin diseases Males 1,129 1.8 837.3 787.2 889.8 687.0 678.8 695.3 HIGH

Females 921 1.4 656.0 611.7 702.5 532.3 525.2 539.4 HIGH

Persons 2,050 1.6 745.5 712.0 780.2 607.7 602.3 613.2 HIGH

Musculoskeletal diseases Males 3,197 5.1 2279.2 2197.2 2363.3 1839.7 1826.4 1853.0 HIGH

Females 3,137 4.9 2128.9 2051.0 2208.8 1724.7 1712.3 1737.1 HIGH

Persons 6,334 5.0 2205.5 2148.8 2263.2 1784.8 1775.7 1793.9 HIGH

Genitourinary diseases Males 2,790 4.5 1877.6 1805.8 1951.5 1447.5 1435.8 1459.2 HIGH

Females 3,610 5.6 2839.0 2742.2 2938.2 2156.8 2142.3 2171.4 HIGH

Persons 6,400 5.0 2351.2 2291.0 2412.5 1797.7 1788.4 1807.0 HIGH

Maternal, neon. congenital

Males 986 1.6 830.6 779.4 884.2 729.0 720.5 737.6 HIGH

Females 5,968 9.3 6144.6 5989.3 6302.9 4637.6 4615.6 4659.7 HIGH

Persons 6,954 5.5 3467.0 3385.6 3549.8 2686.8 2674.9 2698.6 HIGH

Symptoms abnormal findings

Males 5,996 9.6 4071.4 3964.8 4180.0 2894.0 2877.4 2910.6 HIGH

Females 5,730 8.9 4063.9 3953.0 4176.9 3059.5 3042.6 3076.4 HIGH

Persons 11,726 9.2 4051.0 3974.3 4128.7 2965.4 2953.6 2977.2 HIGH

Injury poisoning Males 5,897 9.4 4736.5 4612.3 4863.0 3002.5 2985.3 3019.9 HIGH

Females 4,494 7.0 3256.0 3155.4 3358.8 2184.8 2170.7 2199.1 HIGH

Persons 10,391 8.2 4008.7 3928.6 4090.1 2597.9 2586.8 2609.1 HIGH

Dialysis Males 6,249 10.0 4116.9 4011.7 4224.1 5616.2 5593.5 5639.0 LOW

Females 6,381 9.9 4048.3 3944.9 4153.8 3243.8 3227.1 3260.5 HIGH

Persons 12,630 9.9 4046.4 3973.1 4120.8 4363.9 4350.0 4377.8 LOW

Other factors infl. health Males 7,699 12.3 5290.1 5168.2 5414.1 3340.4 3322.7 3358.3 HIGH

Females 7,684 11.9 5551.0 5420.9 5683.2 4244.7 4224.4 4265.0 HIGH






state^

Persons 15,383 12.1 5414.4 5325.3 5504.6 3783.1 3769.7 3796.6 HIGH

Other Males 10 0.0 8.7 4.1 16.1 73.1 70.3 75.9 LOW

Females 10 0.0 9.6 4.5 17.9 27.5 25.9 29.2 LOW

Persons 20 0.0 9.1 5.5 14.1 50.3 48.7 51.9 LOW

Total Males 62,645 100.0 43670.9 43315.7 44028.1 35567.2 35509.0 35625.4 HIGH

Females 64,497 100.0 47204.0 46819.6 47590.6 36674.5 36615.7 36733.3 HIGH

Persons 127,143 100.0 45298.7 45037.7 45560.7 35968.8 35927.6 36009.9 HIGH

POTENTIALLY PREVENTABLE HOSPITALISATIONS Potentially preventable hospitalisations (PPH) are those which are considered

avoidable through prevention or appropriate primary care (also known as

Ambulatory Care Sensitive Conditions). In 2016, NSW Health applied two new

exclusion rules to the calculation of potentially preventable hospitalisations.

Hospital episodes with source of referral being a transfer from another

hospital or a type change admission are excluded in order to reduce multiple

counting of hospitalisation episodes relating to the same event. Hospital

episodes with bed/unit type being hospital in the home are also excluded.

These rules are applied to the whole period from 2001/02 onwards to allow

for comparisons over time. Rates of PPH in MLHD have remained significantly

higher than NSW in the last decade but have decreased slightly since 2001-02

(Figure 9).

Figure 9 - Potentially preventable Hospitalisations all conditions, MLHD and Total NSW, 2015-16 (HealthStats NSW, 2018)


In relation to PPH rates by condition type (2015-16) the most common in terms

of total bed days (Table 4) per year in MLHD were:

Chronic obstructive pulmonary disease (5,579 total bed days);

Congestive cardiac failure (4,228 total bed days);

Cellulitis (3,253 total bed days);

Urinary Tract Infections (2,847 total bed days);

Diabetes complications (2,216 total bed days);

The most frequent in terms of number of admissions (Figure 10, Table 4) in

2015-16 were:

COPD (1,250);

Urinary tract infections (1,022)

Cellulitis (838);

Congestive cardiac failure (807);

Iron deficiency anaemia (589)

Ear nose and throat infections (536)

Diabetes complications (527)

The causes with significant increasing trend in admission rates since 2001-02

were:

Urinary tract infections

Cellulitis and

Iron deficiency anaemia.

The age-adjusted rates of PPH by condition in MLHD were significantly higher

than the rates for NSW (Table 4) for the following: Angina

Asthma

Bronchiectasis

Cellulitis

Congestive cardiac failure

Convulsions and epilepsy

COPD

Diabetes complications

Ear, nose and throat infections

Gangrene

Hypertension

Iron deficiency anaemia

Urinary tract infections, including pyelonephritis

Figure 10 - PPH by condition MLHD, 2015-16 (HealthStats NSW 2018)


Table 4 - Potentially Preventable Hospitalisations, Murrumbidgee LHD and NSW 2015-16 (Health Statistics NSW)

Murrumbidgee LHD NSW

Rate in MLHD Compared to NSW

PPH Conditions Number Rate per 100,000 Average bed days Total bed days

Rate Average bed days

COPD 1250 359.9 4.5 5579 217.6 5.2 HIGH

Urinary tract infections, including pyelonephritis 1022 337.7 2.8 2847 230.1 3.7 HIGH

Cellulitis 838 309.3 3.9 3253 259.6 4.3 HIGH

Congestive cardiac failure 807 213.5 5.2 4228 154.9 6.2 HIGH

Iron deficiency anaemia 589 203.5 1.2 724 140.6 1.5 HIGH

Ear, nose and throat infections 563 243.3 1.5 825 158.7 1.6 HIGH

Dental conditions 536 227.2 1.2 635 219.2 1.2

Diabetes complications 527 191.2 4.2 2216 127.9 5.2 HIGH

Convulsions and epilepsy 482 205.3 1.9 909 141 2.7 HIGH

Angina 436 129.1 1.6 694 97.5 1.9 HIGH

Asthma 418 171.6 2.1 875 123.9 2.1 HIGH

Hypertension 205 62.1 2.3 477 29.9 2.4 HIGH

Pneumonia and influenza (vaccine-preventable) 187 66.7 6.2 1167 63.8 6.9

Bronchiectasis 183 52.8 4.5 815 20.3 6 HIGH

Gangrene 134 47.5 9.4 1255 21.3 11.8 HIGH

Other vaccine-preventable conditions 80 31.9 4.1 329 85.5 5

Perforated/bleeding ulcer 70 23.7 5.9 411 17.6 6.5

Rheumatic heart diseases 34 10.9 6.1 209 8.1 7.8

Pelvic inflammatory disease 31 15.2 1.9 60 13.5 2.7

Pneumonia (not vaccine-preventable) 21 8.8 4 85 12.8 6

Nutritional deficiencies 1 0.2 2 2 1.8 15.3 LOW

Eclampsia 0 0 0 0 0.2 4.6 LOW

Total 8367 2893.8 3.3 27329 2126.3 3.8 HIGH


Health topics

Injury and poisoning

128 Deaths per year

I N J U R Y

25 Male suicides per year (Average 2011-2015)

5.9% Of all deaths (6.6% for males, 5.1% females)

3 Female suicides per year (Average 2011-2015)

10,391 Admissions to hospital In 2016-17

2,405 Admissions to hospital for falls In 2015-16

28 Admissions per day across MLHD

7%

Of all injury hospital admissions in MLHD are for Motor Vehicle Crashes

Not significantly higher death rate

MLHD to

NSW

Significantly higher hospitalisation rate

There were 128 injury and poisoning deaths in 2015 (including suicide) in

MLHD making up 5.9 per cent of all deaths. The age-adjusted rate of 38.7 per

100,000 in MLHD was slightly higher than the NSW rate of 32.5 per 100,000,

but not significantly so. In previous years the overall rate in MLHD especially

for males was significantly higher than NSW rates. The leading causes of injury

death (2011-2015) varied for males and females with suicide making up 25 per

cent of male injury deaths followed by motor vehicle transport deaths (23%)

and falls (9.7%); for women falls accounted for 27 per cent of injury deaths,

motor vehicle transport 21.5 per cent and “exposure to unspecified factor” 19

per cent (studies have shown these are predominantly in the older age groups

and are due to death certificates lacking sufficient information to code from).

For the MLHD population injury and poisoning hospitalisations had been

increasing steadily from early 2000’s to around 2009 when they dropped

slightly for males and females and have since increased to 2016-17, NSW rates

have shown more of a gradual increase (Figure 11). Injury and poisoning was

recorded as the principal diagnosis in a total of 10,391 episodes of care in

2016-17 for MLHD residents (data for acute hospital transfer and “statistical

discharge” were excluded). MLHD had the highest rate of hospitalisation for

injury among all NSW LHDs at 4,009 per 100,000 population, significantly

higher than the NSW rate of 2,598 per 100,000 as well as all other LHDs in

NSW. Approximately 2,405 injury hospitalisations in 2015-16 in MLHD were

due to fall-related injury making up 26 per cent of all injury hospitalisations;

703 motor vehicle transport related (7%); and 437 self-harm related (5%).

Females were overrepresented in the self-harm hospitalisations with close to

two thirds the admissions being females, conversely males were

overrepresented in the motor vehicle injury hospitalisations with 75 per cent

of admissions in this category were for males. (Latest figures from HealthStats

NSW as of March 2018).

http://www.healthstats.nsw.gov.au/



Figure 11 – Injury and Poisoning trend in deaths and hospitalisations, MLHD and NSW


Cardiovascular disease

629 Deaths per year

C V D

24 Admissions per day across MLHD

28.9% Of all deaths (29.6% NSW) 662

Revascularisation procedures per year (MLHD 2015-16)

8,722 Admissions to hospital In 2016-17

33%

Of MLHD adults reported High Blood Pressure (NSW Health Survey 2013)


MLHD to

NSW


Cardiovascular (or circulatory) diseases comprise all diseases of the heart and

blood vessels. Among these diseases, the four types responsible for the most

deaths in NSW are: coronary heart disease (or ischaemic heart disease), stroke

(or cerebrovascular disease), heart failure, and peripheral vascular disease.

Other causes of death are cardiac arrhythmias (most notably atrial

fibrillation), heart valve disorders, non-ischaemic cardiomyopathies,

pulmonary embolism, and hypertensive renal and heart disease. Significant

causes of morbidity include hypertension, deep vein thrombosis,

haemorrhoids and varicose veins.

There were 629 deaths in MLHD from circulatory disease in 2015. The age-

adjusted death rate of 159.9 per 100,000 in MLHD was similar to the NSW rate

of 153.5/100,000. The rate of circulatory disease deaths has been decreasing

steadily since the early 2000’s and still dropped significantly from 2009-10 to

2012-13 and again in 2014-15 where the rate is no longer significantly higher

than the rest of NSW (Figure 12). The majority of deaths were due to coronary

heart disease (38%) followed by stroke (16%), heart failure (10%) and

peripheral vascular disease (4%); (“other circulatory diseases” made up 32%

of circulatory disease deaths). Rates of death for all causes have been

decreasing since 2000 except for “other circulatory diseases”.

In 2016-17 there were 8,722 hospitalisations in total for circulatory disease,

(27% for coronary heart disease, 11% heart failure, 11% atrial fibrillation and

flutter and 7% for stroke). Circulatory disease also comprises hospitalisation

for varicose veins and haemorrhoids which together make up 16 per cent of

these hospitalisations. The age-adjusted rate of hospitalisation for circulatory

disease in MLHD in 2016-17 of 2,568 per 100,000 was significantly higher than

NSW at 1,765 per 100,000. Overall Murrumbidgee LHD had the highest rates

of most categories of circulatory disease hospitalisation compared to other

LHDs in NSW and in fact was statistically significantly higher for almost all

categories from all LHDs – with the exception of tachycardia, varicose veins

and TIA (Table 5 and Figure 12).


Figure 12 - Circulatory disease trend in deaths and hospitalisations, MLHD and NSW


Table 5 - Circulatory disease hospitalisations by type MLHD and NSW 2016-17 (Health Statistics NSW, June 2018)

Murrumbidgee LHD NSW Circulatory disease type

Number of separations

Rate per 100,000

population LL 95% CI UL 95% CI

Rate per 100,000

population LL 95% CI UL 95%

CI Comparison with NSW #

Coronary Heart Disease 2536 741.3 711.9 771.5 536.0 531.2 540.8 HIGHER

Remaining circulatory diseases 2277 715.0 684.6 746.4 453.5 449.0 458.0 HIGHER

Atrial fibrillation and flutter 1083 311.9 293.1 331.6 215.1 212.1 218.1 HIGHER

Heart failure 1016 259.6 243.6 276.3 186.0 183.3 188.8 HIGHER

Haemorrhoids 834 315.2 293.2 338.3 148.2 145.6 150.9 HIGHER

Stroke 694 196.0 181.1 211.7 144.4 141.9 146.9 HIGHER

Peripheral Vascular Disease 680 188.4 174.2 203.5 112.7 110.6 114.9 HIGHER

Varicose veins of lower extremities 206 78.8 67.9 90.9 65.6 63.8 67.4 HIGHER

Transient ischaemic attacks 192 55.4 47.5 64.2 57.5 56.0 59.1

Paroxysmal tachycardia 230 78.0 67.8 89.3 52.5 51.0 54.1 HIGHER

All Circulatory Disease* 8722 2568.9 2513.3 2625.5 1765.7 1757.0 1774.4 HIGHER

All circulatory (or cardiovascular) disease* does not include Transient ischaemic attacks (TIA) or Haemorrhoids. # 95% Confidence interval on age-adjusted rates


Figure 13 - Circulatory procedures, Murrumbidgee LHD 2001-02 to 2015-16 (Health Statistics NSW)

Hospitalisations for cardiovascular procedures (used to restore adequate

blood flow to blocked arteries) were highest for residents of the South Eastern

Sydney LHD and lowest in the Northern NSW LHD. Murrumbidgee LHD

residents had a CVD procedure rate of 203.8 per 100,000 (2015-16) which was

not significantly higher than NSW at 185.9 per 100,000. The combined

procedure rate had been increasing steadily since the early 1990’s due to

increases in angioplasty and stent surgery, but have remained fairly constant

since the early 2000’s in NSW, MLHD saw a peak around 2009-11 which has

dropped off in more recent years (Figure 13). Males have significantly higher

rates of these procedures than females.

BLOOD PRESSURE AND CHOLESTEROL The NSW Health Survey from 2002 to 2013 has shown an increase in the

prevalence of self-reported high blood pressure (Question: Have you ever

been told by a doctor or hospital you have high blood pressure?) in adults in

the MLHD* from 24 per cent to 33 per cent, a similar increase was seen in

NSW overall with 20 per cent in 2002 and 28 per cent 2013 of adults reporting

high blood pressure (MLHD* rates were not significantly higher than NSW).

High cholesterol in adults of MLHD* saw a rise from 23 per cent in 2002 to a

peak of 31 per cent in 2008 and has dropped to 22 per cent in 2013, a similar

trend was observed for all NSW (MLHD* rates were not significantly higher

than NSW). (MLHD* including Albury LGA population).


Diabetes

62

Deaths with diabetes as underlying cause (MLHD 2015)

D I A B E T E S

10%

Of hospital episodes of care were for dialysis (MLHD 2016-17)

218

Deaths where underlying or associated cause is diabetes (MLHD 2015)

13.5%

Of adults reported being diagnosed with diabetes (MLHD 2017)

9%

Of all deaths were attributed to diabetes (MLHD 2015)

14.0% Aboriginal adults reported diabetes (NSW 2017)


MLHD to

NSW


There were 62 deaths in MLHD in 2015 where diabetes was the principal

cause, but a total of 218 where diabetes was an underlying or associated cause

making up 9 per cent of all deaths in 2015. The MLHD death rate in 2015 from

diabetes as a principal cause was 16.4 per 100,000 which was not significantly

higher than the NSW rate of 15.8 per 100,000.

In 2016-17 there were 710 hospitalisations where diabetes was the principal

diagnosis in MLHD at an age-adjusted rate of 255.7 per 100,000, the MLHD

rate was significantly higher than NSW at 151.8 per 100,000 and all other LHDs

except Far West. The female rate of hospitalisation in MLHD was higher than

the male rate, which was not the case in most LHDs except for Far West. A

serious complication of diabetes is chronic kidney disease leading to the need

for dialysis. Dialysis accounted for 12,630 hospital episodes of care in 2016-

17, 10 per cent of all hospitalisations.

In July 2010 the Australian Coding Standard for diabetes was revised resulting

in a major change affecting the coding of diabetes as a principal diagnosis or

an additional diagnosis (or comorbidity) in the hospital data. This change is

responsible for dramatic decreases in the number and rate of hospitalisation

for diabetes as a principal diagnosis in NSW between 2009-10 and 2010-11

(around a 60% drop), then in 2012 the coding changed again, this time to

include diabetes as a comorbidity if it is mentioned in the patients notes which

has resulted in a spike in comorbidity coding.

In the 2017 NSW Health Survey 13.5 per cent of adults in MLHD said they had

been diagnosed with diabetes or high blood glucose (not during pregnancy)

this was higher than NSW adults at 10.1 per cent (but not significantly so). The

prevalence of adult diabetes has been gradually increasing in MLHD since the

early 2000s to 2017 with some annual fluctuations. Diabetes prevalence

increases with age, increasing levels of disadvantage and is more prevalent

among Aboriginal people.


Respiratory disease

228 Deaths from respiratory diseases (MLHD 2015)

R E S P I R A T O R Y

6.5%

Of hospitalisations were for respiratory disease (MLHD 2015)

10.5% Of all deaths were from respiratory diseases (MLHD 2015)

1,500+

COPD hospitalisations per year (MLHD 2015)

111 Deaths per year from COPD (MLHD 2013-2015)

21%

Of children reported to currently have asthma (MLHD 2014-2015)

6 People die per year from asthma (MLHD 2016)

19% Of adults reported to have asthma (MLHD 2017)

35

Deaths per years from influenza and pneumonia (MLHD 2014-2015)

1,670

Influenza and pneumonia hospitalisations (MLHD 2015-2016)

Not significantly higher death rate from suicide

MLHD to

NSW

Significantly higher hospitalisation rate for COPD,

asthma and influenza & pneumonia

Respiratory disease deaths made up 10.5 per cent of deaths in MLHD 2015,

the main contributor to respiratory disease deaths for 2013-2015 was chronic

obstructive pulmonary disease (COPD) making up 58 per cent of respiratory

deaths. There were 8,270 hospitalisations for respiratory disease in MLHD in

2016-17 making up 6.5 per cent of all hospitalisations at an age-adjusted rate

of 2,965 per 100,000 which was significantly higher than the rest of NSW at

1,787 per 100,000. The rates for death from respiratory disease fluctuate in

MLHD but have been decreasing in NSW since 2001, the hospitalisation rates

have been increasing slowly since 2001-02 (Figure 14).

COPD Chronic Obstructive Pulmonary Disease (COPD), which includes chronic

bronchitis and emphysema accounted for an average of 111 deaths per year

(2013 to 2015) in MLHD at an age adjusted rate of 30.5/100,000 which was

significantly higher than NSW rate of 24 per 100,000. Death rates from COPD

declined dramatically for males from the early 2000s to 2008-2010, but have

been increasing slightly since then for both men and women. There were

1,548 hospitalisations for COPD in MLHD in 2016-17 the rate was significantly

higher than NSW (MLHD: 436.8 per 100,000, NSW: 253/100,000). Cigarette

smoking is the main risk factor for both COPD and lung cancer and the current

incidence rates of these conditions reflect smoking rates 20 years and more in

the past.

ASTHMA Approximately six people have died per year from asthma in MLHD from 2012

to 2015. The latest age-standardised death rate of 1.5 per 100,000 for 2014-

2015 was the same as the NSW rate. The death rate has been decreasing since

the early 2000s. There were 677 hospitalisations of Murrumbidgee LHD

residents of all ages in 2016-17 for asthma at a rate of 278.2 per 100,000

population, which was significantly higher than the NSW rate of 177.2 per

100,000. The hospitalisation rate for those aged 5-34 years, where asthma is

more clearly diagnosed and likely to be acute, was 261.1 per 100,000 which

was also significantly higher than the NSW rate for the same ages at 180.5 per

100,000 and has been gradually decreasing since the early 2000s. In the 2017

NSW Health Survey, 19.1 per cent of the adult MLHD population reported

having current asthma (symptoms or treatment for asthma in the past 12

months) which was significantly higher than NSW at 10.9 per cent. In 2015-16

21.4 per cent of children aged 2 to 15 years were reported to have current

asthma and 32 per cent had “ever had asthma”. MLHD had the highest rates


of childhood asthma among NSW LHDs but was only significantly higher than

Sydney and SE Sydney LHDs.

INFLUENZA AND PNEUMONIA Death rates from influenza and pneumonia have dropped significantly in

MLHD from 2003-2004 to 2014-15. There were approximately 35 deaths per

year in the 2014-2015 period at a rate of 9.6 per 100,000 which was slightly

higher than 8.6 per 100,000 for NSW. In 2015-16 there were 1,670

hospitalisations of Murrumbidgee LHD residents of all ages the age-adjusted

rate of 547.2 per 100,000 was significantly higher than the NSW rate of 349.9

per 100,000. There were 105 hospitalisations for those aged 0-4 years (age-

adjusted rate: 693.8/100,000) in MLHD and 955 for persons aged 65 years and

over (age-adjusted rate: 1971.8/100,000, 57% of total), the rate for the older

population was significantly higher than NSW at 1,236 per 100,000. In older

people in MLHD, the rate of influenza and pneumonia hospitalisations for

males was over 1.5 times that of females. Influenza and pneumonia

hospitalisations are considered to be partly preventable through

immunisation.

The number of potentially preventable hospitalisations due to influenza and

pneumonia (considered vaccine preventable) in Murrumbidgee LHD in 2015-

2016 was 187 at an age-standardised rate of 66.7 per 100,000 population, this

rate was similar to the NSW rate at 63.8 per 100,000 and accounted for a total

of 1,167 bed days and on average 6.2 bed days per admission in MLHD.

In 2015-16 the NSW Health Survey reported that 71.3 per cent of the MLHD

population aged 65 years or over had been immunised against flu in the

previous 12 months and 52.2 per cent had been vaccinated against

pneumococcal pneumonia in the past 5 years, immunisation rates for

influenza were slightly lower than NSW and slightly higher for pneumococcal,

but not significantly so. Influenza immunisation rates for the 65 plus age

group, reported by the NSW Health Survey, have mostly remained above 70

per cent since 2002-2003 in MLHD and in NSW, for pneumococcal

immunisation the rates reached a peak of close to 70 per cent in 2011-2012

and have since dropped to around 50 per cent.

Figure 14 - Respiratory disease trend in deaths and hospitalisations, MLHD and NSW


Mental health (suicide and self-harm)

107

Deaths from mental and behavioural disorders (non- suicide) (MLHD 2015)

M E N T A L

H E A L T H

2,949

Hospitalisations for mental disorders per year (MLHD 2016-17)

33 Deaths from suicide (MLHD 2015)

523 Hospitalisations for self-harm (MLHD 2016-17)

3 Female suicide deaths per years (MLHD 2011-2015)

15.7%

Of adults reported to have high psychological distress (MLHD 2017)

25 Male suicide deaths per years (MLHD 2011-2015)

13.4%

Of 12-17 year olds reported to have high psychological distress (MLHD 2014)

Significantly lower death rate from mental disorders

MLHD to

NSW

Significantly higher hospitalisation rate for self-

harm

There were 107 deaths due to mental and behavioural disorders in 2015 at a

rate of 25.0 per 100,000 population in MLHD this rate was significantly lower

than that of NSW at 32.2 per 100,000. In 2015 there were 33 deaths from

suicide registered in the MLHD population, with an average number per year

of 27.8 from 2011 to 2015. The age-adjusted rate of suicide for MLHD was 14.7

per 100,000 compared to 10.6 per 100,000 in NSW in 2015, it was not

significantly higher.

There were 523 (184 males, 339 females) hospital admissions where “self-

harm” was recorded as the external cause of injury or poisoning at a rate of

248.9 per 100,000 population for all ages and 722.2 per 100,000 for 15-24 year

olds in MLHD in 2016-17, both rates were significantly higher than NSW and

the rate for young males was the highest among all LHD and for young females

the second highest in NSW LHDs. There were 2,949 hospitalisations for mental

disorders (not suicide or self-harm related) in 2016-17 at a rate significantly

lower than NSW. The death rates and hospitalisations rates for mental and

behavioural disorders have been increasing since the early 2000’s in both NSW

and MLHD (Figure 15).

In the 2015-2017 NSW Health Survey 15.7 per cent of adults in MLHD had high

to very high psychological distress (assessed by the K10 10-item questionnaire

that measures the level of psychological distress in the most recent 4-week

period) a rate slightly higher than NSW at 13.4 per cent, there has been an

increase in the rate of “High distress” in MLHD in recent years (but not

significant).

Behavioural problem risk is a recent indicator included in the NSW Child

Health Survey which is a series of questions from the Strengths and Difficulties

Questionnaire (SDQ) (see methodology section of NSW Health Statistics for

more information). In 2013-14 it was determined by this survey that 8.0 per

cent of children (aged 2-15 years) in MLHD were at substantial risk of

developing a clinically significant behavioural problem, compared to 8.3 per

cent in NSW as a whole. Lower socioeconomic groups were more likely to be

at significant risk. In the NSW School Students Health Behaviours Survey 2014,

30.5 per cent of 12-17 year olds reported being unhappy, sad or depressed,

32.8 per cent were nervous, stressed or under pressure and 15.8 per cent had

been in trouble because of behaviour a further 13.4 per cent were rated as

having high psychological distress (this is for the combined MLHD and

Southern NSW LHDs).


Figure 15 – Mental and behavioural disorders trend in deaths and hospitalisations, MLHD and NSW


Cancer

665 Deaths from cancer (MLHD 2015)

C A N C E R

1,686 New cases of cancer (MLHD 2013)

106 Deaths from lung cancer per year (MLHD 2009-2013)

149 New cases of lung cancer per year (MLHD 2009-2013)

69 Deaths from bowel cancer per year (MLHD 2009-2013)

135

New cases of colon cancer per year (MLHD 2009-2013)

43

Deaths from prostate cancer per year (MLHD 2009-2013)

352

New cases of prostate cancer per year (MLHD 2009-2013)

32

Deaths from pancreatic cancer per year (MLHD 2009-2013)

31 Deaths from breast cancer per year (MLHD 2009-2013)

169

New cases of breast cancer per year (MLHD 2009-2013)

18 Deaths from skin cancer per year (MLHD 2009-2013)

138

New cases of melanoma of skin per year (MLHD 2009-2013)

Significantly lower death rate for liver cancer

MLHD to

NSW

Significantly higher incidence of total cancers and deaths

from all cancers, prostate and bowel cancer (rectal in

particular)

Cancer is Australia's leading cause of disease burden. It accounts for almost

one-fifth of years of healthy life lost due to premature death, disease, and

injury. In 2013 in NSW the five leading types of new cases of cancer in

descending order were: prostate cancer; colorectal cancer; breast cancer;

melanoma and lung cancer accounting for 60.4 per cent of new cases. The rate

of diagnosis of new cases of cancer in NSW has increased steadily since 1990,

whereas the death rate has been decreasing. For MLHD it is projected that in

2026 there will be over 2,000 new cancers diagnosed, the majority of these

will be prostate (25%), bowel (13%), lung (10%) and breast (9%) (NSW Cancer

Registry data (population data are sourced from NSW Ministry of Health

Secure Analytics for Population Health Research and Intelligence (SAPHaRI)

and NSW Department of Planning and Environment).

There were 665 deaths reported as due to malignant neoplasms in 2015 for

MLHD residents, 264 females and 401 males. In 2015 cancer deaths made up

31 per cent of all causes of death in MLHD and 28 per cent in NSW. The MLHD

rate was significantly higher than NSW. Narrandera and Lachlan Shires had

higher death rates from cancer than expected based on NSW averages,

Murray, Wakool and Conargo Shires all had lower death rates than expected

based on NSW averages. Death rates and hospitalisation rates from cancer

have decreased slightly since the early 2000s in MLHD and NSW (Figure 16).

There were 1,686 new cancers diagnosed in MLHD in 2013 at an

overall incidence rate significantly higher than NSW.

Carrathool, Cootamundra, Gundagai and Lachlan Shires all had higher

than expected incidence rates of new cancers compared to NSW

averages.

MLHD is reported to have significantly higher incidence of bowel

cancer (includes rectal and colon cancers) than other LHD’s and

significantly higher incidence of urogenital cancers, but significantly

lower incidence of skin and thyroid cancers (Reporting for Better

Cancer Outcomes, 2015).

https://www.cancerinstitute.org.au/data-research/access-our-data/cancer-statistics-nsw#/


Figure 16 – Cancer trend in deaths and hospitalisations, MLHD and NSW

BREAST CANCER From 2009 to 2013 there were on average 169 new cases of breast cancer

diagnosed in MLHD with an age/sex standardised rate of 59.2 per 100,000

population was slightly lower than the NSW rate of 62.4 per 100,000. There

were on average 31 breast cancer deaths per year in MLHD in 2009-2013 with

an age-standardised rate of 10.3 per 100,000 which was lower but not

significantly different from the NSW rate of death of 11.4 per 100,000

population.

Mammographic screening is seen as the best population-based method to

reduce mortality and morbidity attributable to breast cancer. BreastScreen

Australia aims to screen at least 55 per cent of women aged 50 to 74 years

every two years by 2018. The two-yearly screening rate for breast cancer in

women aged 50-74 years in MLHD for 2015-16 was 53.8 per cent. Lockhart

LGA had the highest screening rate among MLHD LGAs at 64.6 per cent of the

target women with Temora, Tumut, Murrumbidgee, Cootamundra, Gundagai

and Wagga Wagga all above 60 per cent. However Junee, Greater Hume,

Albury, Lachlan, Jerilderie, Carrathool, Corowa, Berrigan, Conargo, Wakool

and Murray were all below the 55 per cent target. Where residents may access

services outside NSW (primarily Victorian border areas) the rates of screening

then drop significantly below the NSW rate as only NSW based screening is

included in the data set. Wakool and Murray LGAs have rates of less than 10

per cent due to cross-border flows.

The screening rate for Aboriginal women in MLHD for 2015-16 was 34.1 per

cent which has been increasing since 2011-12. The rate for culturally and

linguistically diverse women was 29.3 per cent in 2015-16 which is significantly

below the rates for this group in all NSW.

LUNG CANCER In MLHD there were on average 149 new cases of lung cancer diagnosed

annually from 2009-2013 at an age-adjusted incidence of 47.5 per 100,000

population this was slightly higher than the NSW rate of 44.2 per 100,000

population. There were 106 lung cancer deaths on average per year in MLHD


2009-2013 at an age-adjusted rate of 33.3 per 100,000 which was similar to

the NSW rate of 33.2 per 100,000. The incidence of lung cancer for males in

MLHD has been decreasing since the late 1980’s as has the rate of death,

however for women the incidence and death rates have been increasing, this

is in-line with the general trend in NSW. The incidence of lung cancer was

significantly higher than NSW rates in Hay and Narrandera LGAs (2009-2013).

BOWEL CANCER In 2009-2013 in MLHD there were 213 new cases of bowel cancer (colon and

rectal cancers combined) diagnosed on average annually at an age-adjusted

incidence of 69 per 100,000 population, this rate was significantly higher than

the NSW rate of 61.5 per 100,000 population. There were on average 69

deaths annually in MLHD from bowel cancer at an age-adjusted rate of 21.4

per 100,000 which was similar to the NSW rate of 21.4 per 100,000. The

incidence of bowel cancer for males and females in MLHD had been increasing

since the early 2000s but has decreased since 2009. Death rates however have

been showing a downward trend for both sexes. The participation rate in

bowel cancer screening for 2016 in MLHD (including Albury LGA) was 40.8 per

cent of the 22,349 people who were eligible, which was significantly higher

than the NSW rate of 37.8 per cent. Bland, Greater Hume, Gundagai and

Tumbarumba LGAs all had significantly high incidence rates of bowel cancer

compared to NSW. Participation rates in the

SKIN CANCER In 2009-2013 in MLHD an average of 138 new cases of melanoma were

diagnosed at an age-adjusted incidence of 46.7 per 100,000 population, this

rate was significantly lower than the NSW rate of 54.6 per 100,000 population.

Approximately 18 people died annually in the 2009-2013 period in MLHD at

an age standardised rate of 6.0 per 100,000, the rate was similar to NSW at

6.3 per 100,000. In MLHD the incidence of melanoma for males and females

has increased since the early 2000s whereas the death rate for males and

females varies over the years due to small numbers. Coolamon and Lachlan

LGAs had a significantly high incidence of skin cancer in the 2009-2013 period.

PROSTATE CANCER In 2009-2013 in MLHD there were an average of 352 new cases of prostate

cancer diagnosed annually at an age-adjusted incidence of 112.4 per 100,000

population which was significantly higher than the NSW rate of 85.3 per

100,000 population and significantly higher than all other LHDs in NSW. There

were an average of 43 deaths per year in MLHD from prostate cancer in 2009-

2013 at a rate of 12.7 per 100,000 which was not significantly higher than the

NSW rate of 11.6 per 100,000. The incidence of prostate cancer for males in

MLHD and in NSW has increased significantly since the late 1980’s, due in part

to increased awareness, screening and detection, while the death rate has

decreased. Bland, Cootamundra, Griffith, Gundagai, Hay, Murrumbidgee,

Temora, Tumbarumba, Urana, Wagga Wagga and Young LGAs all had

incidence rates of prostate cancer significantly higher than expected based on

NSW rates.

CERVICAL CANCER In MLHD 2009-2013 there was an average of nine new cases of cervical cancer

diagnosed at an age-adjusted incidence of 4.0 per 100,000 compared to the

NSW rate of 3.7 per 100,000 population. There were on average 1.8 deaths

per year in MLHD at a rate of 0.3 per 100,000 population which was less than

the NSW rate of 1.0 per 100,000 but not significantly so. Both incidence of and

mortality from cervical cancer have decreased since the early 2000s.

The biennial cervical screening participation rate for 2015-2016 for MLHD was

54 per cent which was lower than the NSW rate of 56 percent. The screening

rate for MLHD has decreased slightly since 2013-14 but more so in the 25-34

year age group than others up to 69 years, however the screening rates in the

younger group are in line with NSW rates and in the age groups 35 to 69 years

are significantly lower (RBCO Performance Report 2017: Murrumbidgee).

The uptake of Human Papilloma Virus (HPV) vaccination for females in

secondary school was reported to be 86.3 per cent of 15 year olds fully

immunised in Murrumbidgee in 2014-2015, which was higher than the state

average of 81.5 per cent. For 15 year old males the uptake was 68.7 per cent


which was also higher than the NSW rate of 64.7 per cent. HPV has been

reported to account for more than 99 per cent of all cervical cancer.


Risk Behaviours

22% Of adults smoke (MLHD 2017, 15% NSW)

H E A L T H

R I S K S

253

Deaths attributed to smoking per year (MLHD 2013, significantly higher rate than NSW)

5% Of 12-17 year olds smoke (MLHD/SNSW 2014, 6.7% NSW)

2,614

Hospitalisations attributed to smoking per year (MLHD 2014-15, significantly higher rate than NSW)

34%

Of adults drink alcohol at risk levels to health (MLHD 2017, 31% NSW)

51 Deaths attributed to alcohol per year (MLHD 2012-2013)

37%

Of 12-17 year olds had drunk alcohol in the last month (MLHD/SNSW 2014, 37.6% NSW)

1,860

Hospitalisations attributed to alcohol per year (MLHD 2014-15, significantly higher rate than NSW)

51% Of adults reported insufficient exercise (NSW 2017, 42% )

32%

Of children reported sedentary behaviour (5 to 15 yrs, NSW 2016-17, 44% )

6%

Of adults reported adequate vegetable consumption (NSW 2017, 7% )

8%

Of children reported adequate vegetable consumption (2 to 15 yrs, NSW 2016-17, 7% )

39%

Of adults reported adequate fruit consumption (NSW 2017, 46% )

63%

Of children reported adequate fruit consumption (2 to 15 yrs, NSW 2016-17, 67% )

62%

Of adults were overweight or obese (NSW 2017, 54% )

120

Deaths attributed to high body mass per year (MLHD 2013)

30% Of adults were obese (NSW 2017, 21% )

1,987

Hospitalisations attributed to high body mass (MLHD 2014-15, significantly higher rate than NSW)

7%

Of adults had experienced food insecurity in previous year (NSW 2014, 7% )

MLHD to

NSW

Significantly higher prevalence of overweight and obesity in

adults and higher rates of hospitalisations related to

smoking, alcohol and high body mass risk factors.


SMOKING

Figure 17 - Trend in adult smoking prevalence, MLHD and NSW 2002 to 2017

Tobacco smoking is the single most preventable cause of ill health and death

in Australia, contributing to more drug-related hospitalisations and deaths

than alcohol and illicit drug use combined. It is a major risk factor for coronary

heart disease, stroke, peripheral vascular disease, cancer and a variety of

other diseases and conditions.

The per cent of the MLHD adult population reporting to be current smokers

has been declining since 2002 and has remained below 20 per cent since 2013,

however in 2017 the adult smoking prevalence was 21.9 per cent, which was

higher (not significantly) than the NSW rate of 15.2 per cent (Figure 17). For

school students in MLHD/Albury/Southern NSW LHD (combined) aged 12-17

years in 2014 the per cent of students who reported to be heavy, light or

occasional smokers was 4.9 per cent which was a significant decrease from

2005 where 13.9 per cent reported to be smokers. The equivalent rate for

NSW was 6.7 per cent of students.

Smoking was believed to have contributed to 2,614 hospitalisations in the

MLHD in 2014-15 at an age-adjusted rate of 830.1 per 100,000 population this

rate was significantly higher than NSW at 542.1 per 100,000. MLHD had the

highest rate of smoking attributable hospitalisations among NSW LHDs for

males and females. MLHD has seen a decrease in smoking attributable

hospitalisations since the early 2000s but only in males, for females the rate

has increased slightly. The number of deaths which could be attributed to

smoking in 2013 in MLHD was 253 at a rate of 75.3 per 100,000 population

which was significantly higher than the NSW rate of 60.8 per 100,000.

Smoking during pregnancy is reported in the Pregnancy and New born section

below.


ALCOHOL

Figure 18 - Trend in adult risk alcohol consumption prevalence, MLHD and NSW 2002 to 2017

Long term adverse effects of high consumption of alcohol on health include

contribution to cardiovascular disease, some cancers, nutrition-related

conditions, risks to unborn babies, cirrhosis of the liver, mental health

conditions, tolerance and dependence, long term cognitive impairment, and

self- harm. Excessive alcohol consumption is one of the main preventable

public health problems in Australia.

In the 2017 NSW Health Survey risk consumption of alcohol was defined as:

consuming more than 2 standard drinks on a day when drinking alcohol.

Adults in MLHD had a slightly higher rate of risk consumption than NSW in

2017 at 33.5 per cent compared to 31.1 per cent. The prevalence in MLHD had

remained fairly steady from 2002 to 2013 when the rate was significantly

higher than NSW, the rate is no longer significantly higher as the rate in NSW

and MLHD have both increased from a low in 2014 (Figure 18). Another

category of risk consumption is the “immediate risk to health” defined as

consuming more than 4 standard drinks on a single occasion in the last 4

weeks. In the 2017 survey 30.7 per cent of adults in MLHD drank at this level

compared to 26.1 per cent in NSW. The frequency of consuming alcohol is

another measure of risk with 13.8 per cent of adult males in MLHD (2016-

2017) reporting drinking alcohol on a daily basis compared to 5.6 per cent of

females; weekly consumption was reported by 36.7 per cent of the adult

population; less than weekly consumption by 23.0 per cent of adults and 30.6

per cent reported never drinking alcohol (22.8% of males compared to 38.5%

of females). For school students aged 12 to 17 years 13.4 per cent reported to

have consumed alcohol in the 7 days, and 23.6 per cent in the month, prior to

survey in the MLHD/Albury/Southern NSW LHDs (combined) compared to

14.0 per cent and 23.6 per cent in NSW (2014 School Students Survey), the

rates for MLHD/Albury/Southern NSW LHD have dropped since 2008 as have

the rates for all NSW.

Alcohol attributable hospitalisations are those where the consumption of

alcohol is believed to make up a percentage of hospitalisations for certain

causes, such as injury and cardiovascular disease as well as liver disease and

mental health conditions. Alcohol consumption in MLHD contributed to 1,860

hospital admissions in 2014-15 at an age-adjusted rate of 882.8 per 100,000

males and 566.4 per 100,000 females, which was significantly higher than the

NSW rates for males of 797.8 per 100,000 but not for females (NSW: 544.7

per 100,000). The overall rate was 727.3 per 100,000 population in MLHD

which was significantly higher than 671.6 per 100,000 in NSW. The age-

adjusted rate of alcohol attributable hospitalisations in MLHD has been

increasing since the early 2000s for both males and females as is the same for

NSW. There were 51 deaths per year in the 2012 to 2013 period which could

have been attributed to alcohol in MLHD at rate of 18 deaths per 100,000

population this was slightly higher than the NSW rate of 16 per 100,000.


PHYSICAL ACTIVITY

Figure 19- Trend in adult insufficient physical activity prevalence, MLHD and NSW 2002 to 2017

Physical activity is an important factor in maintaining good health at any age.

People with adequate physical activity have lower rates of preventable

morbidity and mortality than those who are physically inactive. To maintain

good health, the National physical activity guidelines for adults recommend at

least 30 minutes of moderate activity on most, and preferably all, days of the

week. Moderate intensity activity includes brisk walking, dancing, swimming,

or cycling, which can be undertaken in shorter bursts such as 3 lots of 10

minutes (AGDHA, 1999 and 2005).

In the 2017 NSW Health survey 50.5 per cent of adults reported insufficient

physical activity in MLHD, the prevalence has been between 45 to 52 per cent

since 2010. The rate of insufficient physical activity was 41.6 per cent for

adults in NSW in 2017 and the prevalence has been decreasing (i.e. more

adults are getting adequate exercise) (Figure 19). The NSW Population Health

Survey of 2016-17 reported that 34.8 per cent of children (5 to 15 years) in

MLHD were undertaking adequate physical activity and 32.4 per cent had

“sedentary behaviours” (spending 2+ hours per day in sedentary leisure

activities) compared to 24.2 per cent “active” and 44.0 per cent “sedentary”

in NSW. Sedentary behaviour levels had dropped in MLHD since 2006-2007,

however so had the rate of adequate physical activity, until 2016-2017. The

NSW School Student Survey of 2014 reported that 29.6 per cent of boys ages

12 to 17 years and 24.8 per cent of girls undertook adequate physical activity

in MLHD/Albury/Southern NSW LHDs (combined), this was a significant

increase on the 2011 rates and was reported across the state and in particular

among 12-15 year olds.


FRUIT AND VEGETABLE CONSUMPTION

Figure 20 - Trend in adult adequate fruit and vegetable consumption prevalence, MLHD and NSW 2002 to 2017

Fruit and vegetable consumption is strongly linked to the prevention of

chronic diseases and to better health. Vegetables and fruits are sources of

antioxidants, fibre, folate and complex carbohydrates. The MLHD population

reported rate of adequate vegetable consumption (five or more serves per

day, a serve = ½ cup cooked or 1 cup salad vegetables) at 5.7 per cent of the

adult population was not significantly lower than the NSW rate in 2017 of 6.6

per cent of adults. Adequate fruit consumption in MLHD was lower than NSW

rates at 39.0 per cent compared to 46.4 per cent for NSW. In MLHD fruit and

vegetable consumption since 2002 had been increasing to a peak at around

2009-2010 and has since levelled off and dropped slightly. A similar trend has

been experienced by NSW as a whole (Figure 20). For adults in NSW the

consumption of fruit has dropped off from a high of 56.4 per cent in 2009 to

a low of 46.4 per cent in 2017 and for vegetables there was a high of 9.2 per

cent in 2007 decreasing to 6.6 per cent in 2017.

Recommended vegetable consumption for children aged 2 to 15 years was

reported to be 8.2 per cent of the MLHD population in 2016-2017 and

recommended levels of fruit was eaten by 62.6 per cent of children, neither

of these rates has changed significantly over time in MLHD. Since 2004-2005

in NSW the reported vegetable consumption for children had increased

slightly reaching a high of 7.7 per cent in 2014-2015 and fruit consumption

had risen to 69.2 per cent in 2012-2013 but dropped to 66.8 per cent in 2016-

2017.

The School Students Survey (2014) reported that MLHD/Albury/Southern

NSW LHDs (combined) students aged 12 to 17 years had an adequate fruit

consumption rate of 78.7 per cent and adequate vegetable consumption rate

of 10.7 per cent which were similar to the rates in NSW (77.7% fruit and 9.9%

vegetable). The trend for NSW students as a whole has been a plateau at

around 10 per cent for adequate vegetable consumption and 77 per cent for

fruit consumption between 2008 and 2014.


OBESITY/ HIGH BMI RELATED ILLNESS

Figure 21 - Trend in adult overweight and obesity prevalence, MLHD and NSW 2002 to 2017

Excess weight, especially obesity, is a risk factor for cardiovascular disease,

Type 2 diabetes, some musculoskeletal conditions and some cancers. As the

level of excess weight increases, so does the risk of developing these

conditions. In addition, being overweight can hamper the ability to control or

manage chronic disorders (AIHW Cat. no. AUS 122 2010). The NSW Health

Survey 2017 reported that in MLHD more adults were overweight or obese (as

measured by self-reported height and weight used to calculate Body Mass

Index) when compared to NSW (MLHD: 62.1%, NSW 53.5%), but not

significantly so. In MLHD 30.2% of adults were classified as obese (significantly

higher than NSW at 21.0%) and 31.9% as overweight (not significantly lower

than NSW at 32.5%). In MLHD the proportion of adults who are obese has

been gradually increasing from 2002 to 2017, however the percentage of

overweight adults has dropped from 2013 to 2017. NSW rates of adult obesity

have been rising gradually, but rates in the overweight category have

plateaued (Figure 21). For adults in MLHD (and all NSW) being overweight was

more prevalent in males (35%) than females (29%), but levels of obesity were

similar in both sexes.

For school students aged 12-17 years in 2014 the MLHD/Albury/Southern

NSW LHD (combined), 23 per cent were reported to be overweight or obese

compared to 20.6 per cent in NSW. The 2011 rate was the highest rate among

Local Health District Groups (NSW School Students Survey), however in 2014

the rate had dropped. The prevalence of overweight/obesity in NSW

Secondary School students has changed very little since 2005 remaining

around 15 per cent, in MLHD/Albury/Southern LHD the prevalence has

increased slightly but not significantly from 19.8 per cent in 2008 to 27.0 per

cent in 2011 and 19.5 per cent in 2014. For NSW, the rate of overweight and

obesity in children aged 5 to 16 years has been around 20 to 25 per cent from

2007 to 2016, the latest figures sit at 23 per cent for boys, 21 per cent for girls

and 22 per cent overall (NSW Population Health Survey 2016).

High body mass attributable hospitalisations are those where high body mass

(BM) is considered to have contributed to the underlying illness, for example

a proportion of diabetes and cardiovascular disease admissions. The MLHD

had the highest age-adjusted rate of high BM attributable admissions among

all LHDs in NSW for males and females separately and for the population as a

whole. In 2014-15 in MLHD, 1,987 admissions were attributed to high BM at

an age-adjusted rate of 630.0 per 100,000 population. The MLHD rate was

significantly higher than NSW rate of 436.8 per 100,000 population. In NSW,

BM attributable admissions have been gradually declining since 2010-11 as

have the rates in MLHD. High Body Mass attributable death rates have been

decreasing in MLHD from 2001 to 2013. In 2013 there were estimated to be

120 deaths in MLHD which could be attributed to high body mass at a rate of

35.9 per 100,000 which was higher than the NSW rate of 29.5 per 100,000,

but not significantly. In 2013 in MLHD, 120 deaths were considered

attributable to a high body mass, the standardised rate was higher than NSW

but not significantly, the death rate has been in decline since 2001. Relatively

higher BM related mortality rates by LGA were reported with increasing


remoteness, hospitalisation pattern were less distinct with many LGAs in

MLHD having significantly high rates especially in the north of the District.

FOOD INSECURITY Food insecurity in Australia is considered to be an important social

determinant of health and a significant public health issue. Food insecurity is

associated with general poor health and poor nutrition and refers to not

having sufficient food; running out of food and being unable to afford more;

eating a poor quality diet as a result of limited food options; anxiety about

acquiring food; or having to rely on food relief. The NSW Health Survey

measures food insecurity in the adult population by telephone survey asking

if in the last 12 months were there times when they ran out of food and could

not afford to buy more. In MLHD (including Albury LGA) from 2008 to 2014

the prevalence of food insecurity in the adult population has been gradually

increasing from around 4 per cent to a high of 9.8 per cent in 2010 and a

current rate of 6.8 per cent 2014. A similar pattern can be seen for all NSW

where there has been a recent rise in food insecurity to a 2014 figure of 6.9

per cent. In NSW the rate of food insecurity increased with remoteness and

also with socioeconomic disadvantage where food insecurity was twice as

likely in the areas of high disadvantage compared to those of lowest

disadvantage. The trend for children in all NSW (0-15 years as reported by

their parents) is that household food insecurity has dropped from a high of 6.2

per cent in 2007-2008 to 3.9 per cent in 2013-2014, in MLHD (including Albury

LGA) household food security problems have been experienced by

approximately 5 to 7 per cent of children from 2003 to 2014.


Pregnancy and the newborn

2,411

Babies born to MLHD mothers in NSW hospitals (MLHD 2016)

M O T H E R S

4.7% Mothers were aged 12-19 years (MLHD 2016: NSW 2.2%))

63.9%

Of mothers had first antenatal visit before 14 weeks gestation (MLHD 2016: NSW 67.8%)

2.8% Mothers were aged 40+ years (MLHD 2016: NSW 4.6%)

16.5%

Of mothers had first antenatal visit at 20+ weeks gestation (MLHD 2016: NSW 10.3%)

9.1% Of mothers were of Aboriginal descent (MLHD 2016: NSW 4.2%)

16.7%

Of mothers had smoked during pregnancy (MLHD 2016: NSW 8.3%)

75.5%

Of babies were being fully breastfed at discharge (MLHD 2016: NSW 74.9%)

More babies being fully breast-fed on discharge home

MLHD to

NSW

More mothers who smoke during pregnancy and have later 1st visit for antenatal

care

ANTENATAL CARE Antenatal care (or pre-natal care) should commence as early as possible in

pregnancy to ensure the best outcomes for the mother and the baby. Up to

2010, the question asked at data collection was ‘Duration of pregnancy at first

antenatal visit’. From 2011, the question asked is: ‘Duration of pregnancy at

first comprehensive booking or assessment by clinician’. Because this new

question more specifically defines the type of visit that is reported as pre-natal

care, the proportion of mothers who commenced pre-natal care in 2011 is

lower than in previous years. In 2016 there were 2370 live births in NSW to

MLHD resident mothers (NSW Perinatal Data Collection which includes only

births occurring in NSW-based hospitals or attended by NSW midwives). In

2016, 63.9 per cent of mothers had antenatal care prior to 14 weeks gestation

and 83.2 per cent had antenatal care prior to 20 weeks gestation, these rates

were slightly lower than NSW at 67.8 per cent and 88.8 per cent respectively.

The rates of antenatal care prior to 14 and/or 20 weeks gestation had been

increasing in MLHD and NSW since 2001 but has dropped significantly since

the definition change and has started to increase since 2015. For Aboriginal

mothers in MLHD 2016, 60.5 per cent had antenatal care prior to 14 weeks

gestation and 80.0 per cent had antenatal care prior to 20 weeks gestation

(18.6% not getting antenatal care until 20+ weeks gestation).

LOW BIRTH WEIGHT A baby's birth weight is an important outcome measure of the health of the

mother and her care during pregnancy. Low birth weight is defined as less

than 2,500 grams (5.5 pounds). In MLHD in 2016, 6.7 per cent of babies (161)

were of low birth weight, which was similar to the NSW rate of 6.6 per cent.

The rate in MLHD has fluctuated between 4.5 and 5.5 per cent from 2001 to

2014 and risen to over 6 per cent in 2015 and 2016, and for NSW has remained

around 6 per cent over this period. For babies born to Aboriginal mothers in

MLHD 14.7 per cent were of low birth weight in 2016 (32 babies out of 218).

SMOKING DURING PREGNANCY The prevalence of smoking anytime during pregnancy in MLHD has declined

from 27 per cent in 2001 to 16.7 per cent in 2016, however rates were higher

than for NSW at only 8.3 per cent. All the rural LHDs had higher percentages

of mothers who smoked during pregnancy compared to the NSW total and

the metropolitan LHDs. Aboriginal mothers were more likely to have smoked

during pregnancy than non-Aboriginal mothers (45.6% compared to 13.7% in

MLHD 2016). Aboriginal mothers made up 9 per cent of all mothers in MLHD

but 25 per cent of mothers who smoked. Mothers living in LGAs where babies

may be born in Victoria or the ACT (including the major maternity unit of

Albury Wodonga Health) are not included in the NSW Perinatal Data and

therefore data will be incomplete for border areas.

Summing up People in rural and remote Australia tend to have higher rates of disease and injury and die younger than their counterparts in major cities. This can be explained

in part because they have poorer access to goods and services and educational and employment opportunities, as well as lower levels of income. (National Rural

Health Alliance 2018).

The five disease groups causing the most burden on health in Australia in 2011 were cancer, cardiovascular diseases, mental and substance use disorders,

musculoskeletal conditions and injuries; together, these account for 66 per cent of the total burden. Coronary heart disease, back pain and problems, chronic

obstructive pulmonary disease and lung cancer, as the leading specific diseases, contributed 18 per cent of the total burden (Burden of Disease Study, Australia

2011, AIHW, 2016). At least 31 per cent of the burden of disease in 2011 was considered preventable. The risk factors causing the most burden were tobacco use,

high body mass, alcohol use, physical inactivity and high blood pressure. (AIHW, 2011).

The prevalence of personal and behavioural risk factors tend to increase with increasing remoteness due to a failure to reduce them over the years, for example,

where smoking rates have decreased significantly in major cities since the 1990’s they have not decreased as markedly in rural and remote areas, which suggests

that public health campaigns and other preventive interventions are not working as well in rural and remote areas as in the major cities (National Rural Health

Alliance 2011).

The MLHD population follows many of the traits expressed for rural areas in Australia, with higher levels of major health risk behaviours such as smoking, high

alcohol consumption, high body mass, physical inactivity and low fruit and vegetable consumption. These risks impact significantly on the likelihood of developing

cardiovascular disease, respiratory disease, diabetes and cancer, conditions which place a heavy burden on already stretched rural health services.

For 2018

Ongoing challenges Could do better Improving Ageing population

Aboriginal health

Socioeconomic disadvantage

Lower levels of academic qualifications

Rural isolation/ access

Increasing cost of chronic disease

Cardiovascular disease

Diabetes and dialysis

Chronic Obstructive Pulmonary Disease

Preventable deaths and hospitalisations

Overweight and Obesity

Alcohol hospitalisations

Mental health

Bowel cancer

Injury (falls in particular)

Diet and food security

Exercise

Smoking

Survival rates from cancer

Smoking

Smoking during pregnancy

Risk alcohol consumption

Cervical cancer – new cases

Lung cancer – new cases

Death from flu

COPD hospitalisation

Cardiovascular disease hospitalisation and deaths

Data sources The data quoted in this document are from two main sources, the methods, coding and additional information about the data can be accessed via the following

websites:

1. Social Health Atlas of Australia 2018, Public Health Information Development Unit (PHIDU), http://phidu.torrens.edu.au/ 2. Health Statistics NSW, Centre for Epidemiology and Evidence, NSW Ministry of Health 2018, Sydney. www.healthstats.nsw.gov.au

NSW Admitted Patient Data ABS Deaths NSW Health Survey: adult and children reports NSW School Students Survey NSW Central Cancer Registry NSW Perinatal Data Collection

3. Reporting of Better Cancer Outcomes, Performance Report 2017, Murrumbidgee LHD. Cancer Institute NSW, 2017. 4. Cancer Institute NSW online statistics, www.statistics.cancerinstitute.org.au

Supporting information Population projections for NSW – 2016 series: www.mlhd.health.nsw.gov.au/about/health-statistics/ Social Health Atlas Data – compiled from Social Health Atlas of Australia www.mlhd.health.nsw.gov.au/about/health-statistics/ Murrumbidgee LHD reports from : www.mlhd.health.nsw.gov.au/about/health-statistics/ National Rural Health Alliance Fact Sheets http://ruralhealth.org.au/factsheets/thumbs Australian Institute of Health and Welfare Burden of Disease and Injury 2011, published 2016 www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-

causes-of-illness-death-2011

Infographics Next two pages: (available from http://www.mlhd.health.nsw.gov.au/about/health-statistics/)

http://phidu.torrens.edu.au/


http://www.statistics.cancerinstitute.org.au/




http://ruralhealth.org.au/factsheets/thumbs

http://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-death-2011

http://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-death-2011


the murrumbidgee local health district 2018

Documents