Southern NSW Local Health District: Our Population s Health

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1 Page 1 of 5 This Factsheet summarises a selection of health indicators (health behaviours & risk factors, hospitalisations and deaths) for the of the Southern NSW Local Health District (LHD). Health services The Southern NSW LHD occupies the southeastern corner of NSW and is made up of ten Local Government Areas (LGAs), with an estimated resident of 196,128 in June Map 1 shows the location of key health facilities throughout the LHD, including: Goulburn Base Hospital, Bourke St Health Service District Hospitals in Bega, Crookwell, Yass,, Batemans Bay, Moruya, Cooma, Pambula Multi Purpose Services (MPS) in Braidwood, Bombala and Delegate Community Health Services Determinants of health Whether people are healthy or not is determined by their circumstances and environment. The determinants of health include: income and social status education levels employment and working conditions the physical environment gender and age personal behaviour and coping skills genetics social support networks and culture access to and use of health services Yass YASS VALLEY SNOWY RIVER Jindabyne Map 1: Key health facilities in the Southern NSW LHD, by LGA. A.C.T. Gunning Cooma BOMBALA Bombala Delegate UPPER LACHLAN COOMA- MONARO Crookwell Braidwood PALERANG Batemans Bay Moruya EUROBODALLA Bega Pambula Goulburn GOULBURN MULWAREE Narooma BEGA VALLEY Eden The Index of Relative Socio-economic Disadvantage (IRSD) is a SEIFA index score derived from 2006 Census data related to income, educational attainment and employment (Map 2). It allows comparison of socio-economic disadvantage across areas at a given point in time, and provides some context to the data on risk factors, hospitalisations and deaths in this factsheet. The average IRSD score for NSW is 1000, a lower score indicates relatively greater disadvantage, eg, Bombala LGA (956), Eurobodalla LGA (961), Goulburn Mulwaree LGA (962), and Bega Valley LGA (977). However, it must be kept in mind that the score for an LGA is an average within each LGA there will be regions of more advantaged and less advantaged households. Map 2: Index of Relative Socio-economic Disadvantage, by SLA, Southern NSW LHD, 2006 Sources: World Health Organisation; PHIDU, Social Health Atlas of Australia, Accessed online 26 April 2012

2 Page 2 of 5 The decision to smoke tobacco, drink alcohol, the choice of foods we eat and the amount we exercise all have major implications for our health. The NSW Population Health Survey annually monitors certain health behaviours. Results for some of the major indicators in 2010 are summarised in Figure 1. Recently released 2011 data show that the LHD has higher overall rates of smoking (19% vs 15%) and overweight & obesity (60% vs 53%) than the NSW average. Health behaviours & risk factors Figure 1: Selected health behaviours by percent of, Southern NSW LHD and NSW, 2010 Current smokers (age 16+), males Current smokers (age 16+), females Risk drinking, males Risk drinking, females Overweight or obese (age 16+), males Overweight or obese (age 16+), females Adequate physical activity (age 16+), males Adequate physical activity (age 16+), females Recommended vegetable consumption Recommended fruit consumption 19% 18% 17% 14% 14% 10% 18% 20% 31% 40% 53% 48% 45% 51% Southern NSW LHD NSW 66% 61% 64% 60% 61% 56% 0% 20% 40% 60% 80% Source: NSW Population Health Survey (HOIST). Centre for Epidemiology and Evidence, NSW Ministry of Health. Risk drinking defined as consuming more than 2 standard drinks on a day when drinking alcohol. Overweight defined as BMI 25.0 to 29.9, obese BMI 30.0 and over. Adequate physical activity defined as at least 150 minutes per week over 5 separate occasions. Recommended vegetable consumption 5 serves per day. Recommended fruit consumption 2 serves per day. Table 1: Selected hospitalisations, Southern NSW LHD, Hospitalisation Rate / 100,000 to NSW rate Smoking-attributable Males Same Females Persons 1, Alcohol-attributable Males Same Females Same Persons 1, Same High BMI-attributable Males Same Fall related injury (overnight stay, age 65+) Females Same Persons 1, Same Males 337 2,313 Females 662 3,475 Same Persons 999 2,993 Same Source: NSW Admitted Patient Data Collection and ABS estimates (HOIST). Centre for Epidemiology and Evidence, NSW Ministry of Health. LHD rates not significantly different (Same), significantly higher ( ) or lower ( ) than NSW age-standardised rates, based on 95% confidence limits. Smoking: Unlike the stable trend in NSW, Southern NSW LHD has seen an increase in smoking-attributable hospitalisations of females (Table 1). Of further concern, rates of smoking during pregnancy in the LHD (19% in non-aboriginal women, 47% in Aboriginal women in ) were well above the NSW average (10% and 48%). Alcohol: Survey data suggest risk drinking in females has remained stable since 2002, and appears to be decreasing in males. Ageadjusted rates of alcohol-attributable hospitalisations were increasing steadily across the District until , but recently appear to have begun to decline. High BMI attributable admissions have remained relatively stable in the LHD and NSW. Fall related injury hospitalisations in people age 65 years and over continue to increase across NSW, but may be stabilising in male residents of this LHD. Online data sources for this factsheet, and further information can be found at: Health Statistics NSW Population Health Cancer Institute NSW Statistics Reporting Public Health Information Development Unit (PHIDU, SA) Social Health Atlas of Australia and interactive Australian Institute of Health and

3 Page 3 of 5 Cancer Cancer is Australia's leading cause of disease burden. It accounts for almost one-fifth of years of healthy life lost due to premature death, disease and injury. The number of people being diagnosed with cancer directly correlates with the growing in NSW. In Southern NSW LHD, the age-standardised incidence rate of cancer has been rising in older age groups, particularly those 65+ and 80+ years. However, mortality rates due to cancer have remained stable in all age groups, except 80+ years with a rate increasing since the mid-1990 s. Table 2: Cancer incidence and mortality, by LGA, Southern NSW LHD and NSW residents, LGA New cases Cancer incidence Rate / 100,000 Deaths Cancer deaths Rate / 100,000 Bega Valley 1, Same Same Bombala Same Same Cooma-Monaro Same Same Eurobodalla 1, Same Same Goulburn Mulwaree Same Same Palerang Same Same Same Snowy River Upper Lachlan Same Same Yass Valley Same Southern NSW LHD 5, Same 2, Same NSW 177, na 66, na Source: NSW Central Cancer Registry and ABS estimates (HOIST) Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed May Available at LGA/LHD rates not significantly different (Same) or significantly lower ( ) than NSW age-standardised rates, based on 95% confidence limits. The 5 most common cancers diagnosed in the LHD in 2008 were: prostate (229 cases, 19% of total) breast (135, 11%) colon (118, 10%) melanoma (111, 9%) lung (109, 9%) The 5 most common cancers causing death in the LHD in 2008 were: lung (97 deaths, 23% of total) colon (48, 11%) prostate (34, 8%) pancreas (26, 6%) breast (24, 6%) The age-adjusted incidence and mortality rates for these cancers were all within expected ranges based on NSW figures. The Cancer Institute NSW reports that the incidence of cancer in NSW is projected to increase by 44% between 2006 and The greatest increase (70%) is expected in the Southern NSW LHD. The number of cancer deaths in NSW is expected to increase by 13% between 2006 and 2021, with the greatest increase (33%) again expected in the Southern NSW LHD. The variations between LHDs are mainly due to differences in the proportion of the that is aged 65 years and older, and expected increases in this older over time. Mental health Mental health problems affect the perceptions, emotions, behaviour and resulting well-being of individuals, and accounted for 13% of the disease burden in Australia in The 2011 NSW Population Health Survey found that in both NSW and Southern NSW LHD, 10% of people aged 16 years and over experienced high or very high levels of psychological distress in the month prior to being surveyed. In SNSW LHD in there were 317 hospitalisations (121 males, 196 females) where self-harm was identified. The LHD hospitalisation rate was 175 / 100,000 for all ages (128 / 100,000 in NSW) and 488 / 100,000 (352 / 100,000 in NSW) for females aged years, a group that has seen increasing rates of hospitalisation since the mid 1990 s. Suicide rates have been dropping in NSW since 1997; 541 people died by suicide in 2007, of whom 76% were males. Source: NSW Admitted Patient Data Collection and ABS estimates (HOIST). Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed May Available at healthstats.nsw.gov.au

4 Hospitalisations All Causes In the financial year there were 67,688 episodes of hospital care for residents of the Southern NSW LHD. The age-adjusted rates of hospitalisation (30,321 / 100,000) were the lowest in NSW, and significantly lower than the NSW average (35,425 / 100,000), indicating lower than expected rates for the age-profile of the. However, the 2,716 hospitalisations of Aboriginal residents in SNSW LHD represents a significantly higher rate (69,499 / 100,000) than for non-aboriginal LHD residents (28,516 / 100,000) and Aboriginal people across NSW (58,789 / 100,000). The most significant cause (26.7%, Table 3) of hospitalisation in the District was dialysis (18,058 episodes, 63% females), with a rate of 8715 / 100,000 more than double that of NSW (4,232 / 100,000). This is partly due to multiple admissions of one person during a course of dialysis, as well as a higher proportion of LHD residents using hospital dialysis units rather than home dialysis. Cause of hospitalisation % Page 4 of 5 Table 3: Hospitalisations by cause, Southern NSW LHD residents, Rate / 100,000 * Dialysis ,715 Injury & poisoning ,303 Same Digestive system diseases 9.3 2,770 Other factors infl. health 8.8 2,711 Cardiovascular diseases 6.6 1,779 Same Symptoms & abnormal findings 6.5 1,912 Maternal, neonatal & congenital 5.5 2,379 Nervous & sense disorders 5.3 1,524 Respiratory diseases 5.2 1,615 Same Musculoskeletal diseases 4.5 1,278 Malignant neoplasms 4.0 1,053 Genitourinary diseases 3.7 1,155 Mental disorders 3.4 1,156 Infectious diseases Other neoplasms Blood & immune diseases Endocrine diseases (incl diabetes) Same Skin diseases *Significantly higher ( ) or lower ( ) than NSW age-standardised rates, based on 95% confidence limits. Table 4: Potentially preventable hospitalisations by condition type, Southern NSW LHD residents, Condition type Average bed days Total bed days Dehydration and gastroenteritis* ,619 COPD* ,506 UTIs & pyelonephritis ,154 Congestive heart failure* ,195 Ear, nose & throat infections* Diabetes complications* ,052 Asthma Convulsions & epilepsy Angina* Cellulitis ,336 *LHD rate is significantly higher than the NSW rate, based on 95% confidence limits (except Cellulitis: LHD rate is significantly lower). Potentially preventable hospitalisations (PPH), or hospitalisations for Ambulatory Care Sensitive Conditions (ACSC), are those which are considered potentially avoidable through preventive care and early disease management, usually delivered in an ambulatory setting, such as primary health care (eg, GPs, community health centres). Source: NSW Admitted Patient Data Collection and ABS estimates (HOIST). Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed May 2012, healthstats.nsw.gov.au In , there were 5,609 PPH in the LHD, 8.3% of all hospitalisations, at a significantly higher rate (2,497 / 100,000) than for NSW (2,346 / 100,000). The 10 most common PPH condition types for SNSW LHD residents are shown in Table 4 and LGA-specific PPH rates are shown in Table 5. The 281 PPH of Aboriginal residents in SNSW LHD represents a significantly higher rate (7,512 / 100,000) than for non-aboriginal LHD residents (2,355 / 100,000) and Aboriginal people across NSW (5,771 / 100,000). Table 5: Potentially preventable hospitalisations by LGA, Southern NSW LHD residents, to LGA Smoothed separations / year Smoothed rate / 100,000 Upper Lachlan 329 3,931 Goulburn Mulwaree ,723 Bega Valley ,123 Cooma-Monaro 345 3,059 Bombala 83 2,778 Same Eurobodalla ,591 Same Palerang 234 1,837 Yass Valley 261 1, ,784 Snowy River 113 1,524 Bayesian smoothing used to determine statistically significant differences from NSW average: (Same) no significant difference, ( ) significantly higher at 1% level, ( ) significantly lower at 1% level.

5 Page 5 of 5 Deaths All Causes The life expectancy for a person born between 2003 and 2007 in Southern NSW LHD is 80.7 years (78.4 for males, 82.9 for females), which is significantly lower than NSW at 81.6 years. In , there was an annual average of 1,400 deaths in SNSW LHD. The total death rate for the District was 623 deaths per 100,000, compared to 597 / 100,000 in NSW. In NSW in , the leading cause of death was cardiovascular disease, including coronary heart disease and stroke (35% of all deaths, 33% of male and 38% of female), followed by cancers (29%, 32% of male and 26% of female), respiratory diseases (8%) and injury & poisoning (5%). Map 3: Amenable (treatable) mortality, 0-74 years, in Southern NSW LHD, by SLA, Standardised Mortality Ratio (SMR) Australia = 100 >100 = avg deaths <100 = avg deaths NSW = 101 Country NSW = 111 Potentially avoidable deaths are those premature deaths (before the age of 75 years) that theoretically could have been avoided, given our current understanding of disease causes, prevention and health care. Similar to all NSW, the leading causes of avoidable deaths in the LHD are cancers (41%) and cardiovascular disease (25%). There has been a significant and continuing decline in potentially avoidable deaths since the 1980 s. The age-adjusted rate of avoidable deaths in SNSW LHD was 163 per 100,000 (154 / 100,000 in NSW) in , accounting for an annual average of 347 deaths, ie, approximately one quarter of all deaths and two-thirds of premature deaths in the LHD. Potentially avoidable deaths encompass those deemed preventable and those that are amenable to health care (treatable). Amenable mortality can be used as an indicator of access to and use of health services. Map 3 compares the relative risk for potentially amenable deaths within the LHD in Figure 2: and average annual rate of premature deaths in SNSW LHD residents, by LGA, Rate* / 100,000 NSW: 253 / 100, Bombala Goulburn Mulwaree Upper Lachlan In the LHD in , there were 2,705 premature deaths: 38% deemed preventable (1,040), 28% treatable (744) and 34% unavoidable (921) (Figure 2, PHIDU). Some LGAs within the District experience significantly higher rates of potentially avoidable deaths from certain causes, compared to NSW (Table 6). Table 6: Average annual rate of avoidable deaths per 100,000 residents by selected LGAs and NSW, Goulburn Mulwaree Palerang Upper Lachlan NSW rate Cardiovascular disease Cooma-Monaro Eurobodalla Bega Valley Yass Valley Palerang Snowy River *Rate is significantly higher or lower than NSW Colorectal cancer 18* Respiratory disease Road traffic injuries 18 All LHD rates are significantly higher than the NSW average at the 1% or *5% level. Sources: ABS mortality data and estimates (HOIST). Centre for Epidemiology and Evidence, NSW Ministry of Health, PHIDU, Social Health Atlas of Australian Local Government Areas, Accessed online May Unavoidable Treatable Preventable