Report of the New South Wales Chief Health Officer	Table of contents On this page: Print version
	Executive summary

This report presents information for more than 250 health indicators, arranged in thematic chapters covering determinants of health, burden of disease, health inequalities and health priority areas. This summary presents some of the key findings overall, and for people at different stages of their lives.

How healthy are we?

Around 85,600 babies were born in NSW in 2004. Male babies could expect to live 78.9 years (78.8 years is the national average), while female babies could expect to live 83.7 years (83.8 years is the national average). Only males and females born in Japan and Switzerland, and males born in Iceland, could expect to live longer.

However, not all NSW residents can expect such a long life. The life expectancy of Aboriginal people is about 17 years less than for the general population. An Aboriginal male born now in NSW can expect to live to around 60 years of age, while an Aboriginal female born now in NSW can expect to live to around 65 years of age.

Longer lives are the result of reductions in the death rate. The age-adjusted death rate in NSW decreased by more than half (51%) over the 33-year period 1972 to 2004. The death rate in babies aged less than one year (infant mortality rate) also declined quickly (49% since 1986), and was 4.6 per 1,000 live births in 2004 (lower than the national average at 4.7). However, the infant mortality rate among Aboriginal babies in NSW was almost double the rate for the general population.

Although females born in NSW in 2004 could still expect to live longer than males, this difference decreased from 6.8 years in 1972 to 4.8 years in 2004. In 2004, the overall male death rate was 50% higher than the female death rate, down from a difference of 61% in 1972.

Around 46,400 NSW residents died in 2004. Cardiovascular diseases, including ischaemic heart disease and stroke, were the leading cause of death and were responsible for 39% of all deaths. The next most common causes of death were cancers (28%), respiratory diseases (9%), injuries and poisoning (5%), nervous system diseases and digestive system diseases (both at over 3%). The main causes of death among Aboriginal residents in NSW were cardiovascular diseases (33%), cancers (19%), injury and poisoning (13%) and diabetes (5%).

Rates of premature death (before age 75 years) declined among all socioeconomic groups in NSW in the 20 years to 2004. By far the steepest decline was in the highest socioeconomic group, resulting in an increase in the relative 'gap' between this group and the rest of the population. The relative 'gap' between the lowest socioeconomic group and the middle three-fifths of the population appears to be narrowing.

In 2004, 67% of all premature deaths were due to causes that could potentially be reduced or avoided through promotion of healthy lifestyles, prevention or early detection of disease or improved treatment and management of disease. The comparable figure for Aboriginal residents in NSW was 76%. Ischaemic heart disease and stroke together contributed more than one-third of these 'avoidable' deaths, with lung cancer and colorectal cancer the next largest causes. Compared with people who lived in metropolitan areas of NSW, people who lived in remote or very remote areas were 1.5 to 2 times more likely to die from causes classified as 'avoidable'.

Just under 2.2 million hospitalisations were recorded in NSW in the financial year 2004-05. By 2014-15, there is expected to be a 25% increase in the number of hospitalisations in NSW to around 2.8 million if the trend over the last 16 years continues into the future. Most of this increase is caused by the ageing of the population in NSW. Between 1989-90 and 2004-05, the age-adjusted rate of hospitalisation increased by more than one-third (36%). In 2004-05, the most common causes of hospitalisation were 'factors influencing health' (including symptoms without a specific cause, admissions of newborn infants, and admissions for rehabilitation, nursing home and respite care), injuries (including injuries sustained in motor vehicle crashes and falls), conditions relating to pregnancy and childbirth and digestive system diseases.

Around 7% of hospitalisations in NSW in the financial year 2004-05 were considered to be potentially avoidable through preventive care and early disease management (usually delivered by general practitioners or other primary health care). People who lived in remote or very remote areas of NSW were more than twice as likely than those living in metropolitan areas to be hospitalised for these conditions. The most important causes of these avoidable hospitalisations over the period 2002-03 to 2004-05 were chronic obstructive pulmonary disease, diabetes with complications, angina, asthma, dehydration and gastroenteritis, dental conditions and congestive heart failure.

What are some of the important issues for babies and young children?

In 2004, deaths soon after birth, congenital abnormalities and injury and poisoning claimed the most lives of young children aged less than five years. Just over 7% of all babies were born prematurely (with higher rates for teenage and older mothers), and almost 6.5% were of low birthweight (with a higher rate for teenage mothers), while under 2% were reported to have a congenital abnormality. Around 15% of all babies were admitted to a neonatal special care nursery and just under 3% were admitted to a neonatal intensive care unit. Rates of prematurity (12%) and low birthweight (13%) were much higher in Aboriginal babies than in the general population.

In 2004, 13 children aged 0-4 years drowned in NSW, and in the financial year 2004-05 there were 78 hospitalisations following near-drowning among children in this age group. There were a further 2,378 hospitalisations for injuries caused by falls, 340 hospitalisations for burn and scald injuries, and 548 hospitalisations for unintentional poisoning in 2004-05 in this age group.

In 2003 and 2004 combined, 88% of children aged 2-8 years consumed the recommended daily minimum quantity of fruit. Only around 20% of children in this age group (one in five) consumed the recommended daily minimum quantity of vegetables.

At the end of December, 2005, 91% of non-Aboriginal infants and 88% of Aboriginal infants aged 12 to 15 months were fully immunised. These high immunisation rates have been accompanied by declines in notifications for vaccine-preventable diseases, including rubella, pertussis and measles.

What are some of the important issues for school-aged children and young people?

Injury and poisoning were the leading causes of death in children and young people aged 5-24 years in 2004. In recent years, motor vehicle transport injuries killed 30 young people aged 0-14 years, and were responsible for 1,477 hospitalisations of people in this age group annually. There were 8,295 hospitalisations for injuries caused by falls in children aged 0-14 years and 298 hospitalisations for injuries caused by interpersonal violence among children aged 0-14 years annually.

In 2004, almost one quarter of school students aged 5-16 years in NSW were overweight or obese, with rates around 33% in boys and 30% in girls aged 9-12 years. These rates have increased markedly over the last 20 years. Despite this, three-quaters of boys and girls aged 11-16 years met the national recommendation of at least one hour of moderate to vigorous physical activity each day.

In 2003 and 2004 combined, 17% of children aged 5-8 years, 14% of children aged 9-15 years and 13% of youth aged 16-24 years had asthma. In the financial year 2004-05, there were 4,503 hospitalisations for asthma among NSW residents aged 5 to 34 years. Hospitalisation rates for asthma in this age group almost halved between 1989-90 and 2004-05. Exposure to fumes from unflued heating is associated with an increased risk of asthma symptoms. In 2004, just under one-third of NSW households used unflued heating, including unflued gas and slow combustion heaters, and open fireplaces.

Almost one in six (17%) NSW secondary school students reported high levels of psychological distress in 2005. In NSW in 2004, the death rate from suicide was 12.4 per 100,000 in males aged 15-24 years, which was the lowest suicide rate in the last 20 years. Nonetheless, in 2004, 58 males and 17 females aged 15-24 years died through suicide. Females in this age group, however, were around two-and-a-half times more likely to be hospitalised for suicide attempts, with 2,159 hospitalisations of females and 925 hospitalisations of males recorded in the financial year 2004-05.

In 2005, one-third of secondary school students in NSW reported ever smoking tobacco, while 9% of boys and 8% of girls reported smoking in the previous week. Use of tobacco was lower than in 2002.

Use of sun protection measures (covering the body, wearing a hat or staying in the shade) by secondary school students declined between 2002 and 2005, however the use of maximum protection sunscreen increased. Just over two-thirds of secondary school students in 2005 reported doing moderate or vigorous physical activity on one to four occasions in the previous week.

Between 1990 and 2004, the teenage pregnancy rate in NSW declined from just over 2% of all teenage girls to 1.5% of all teenage girls. The teenage pregnancy rate was consistently higher among girls living in the lowest socioeconomic group than in the highest socioeconomic group over this period (with a ratio of 8:1 in 2004).

What are some of the important issues for adults?

Injuries, both intentional and unintentional, were by far the leading cause of death in young males aged 25 to 44 years anually, in recent years, but cancers were the leading cause of death in females in this age group. Cancers, followed by cardiovascular diseases, were the major causes of death in people of both sexes aged 45 to 64 years.

In 2004, there were 34,092 new cases of cancer and 13,100 deaths from cancer in NSW. The most common types of cancers causing death among males were lung, prostate and colorectal and among females were breast, lung and colorectal. The most common types of cancers diagnosed in males were prostate, colorectal, melanoma of skin, and lung and in females were breast, colorectal, melanoma of skin, and lung. The death rate from lung cancer decreased by 22% in males. There were declines in the death rates from colorectal cancer (by 25%) and from prostate cancer (by 20%) over the same period. The death rate from breast cancer fell by more than 14%, and the death rate from cervical cancer almost halved. In NSW in 2003 and 2004, just over half of women aged 50-69 years participated in breast cancer screening and just over 57% of women aged 20-69 years had a Pap test.

Coronary heart disease caused 8,722 deaths in 2004 and more than 54,000 hospitalisations in the financial year 2004-05. The rate of hospitalisations decreased by almost 20% between 1995-96 and 2004-05. About 4,100 (5,100 in 2002-03) coronary artery bypass graft procedures and 10,000 (7,700 in 2002-03) coronary angioplasty procedures were performed in 2004-05. About three-quarters of those undergoing surgery were males. In 2004, stroke caused more than 4,500 deaths in NSW, and was the principal reason for almost 18,000 hospitalisations in 2004-05. Death rates from both coronary heart disease and stroke have more than halved since 1985, as a result of both decreased incidence - associated with reductions in risk factors - and increased survival in those affected. Aboriginal residents of NSW were 50% more likely as non-Aboriginal people to be hospitalised for cardiovascular diseases, while residents born in Lebanon, Fiji and India had higher rates of hospitalisation for coronary heart disease than the Australian-born.

In 2005, over 8% of males and almost 7% of females in NSW aged 16 years and over reported having diabetes or high blood sugar. This was a significant increase since 1997 (when it was just over 5% and 4% respectively). In the financial year 2003-04, there were 11,645 hospitalisations for diabetes. People who were hospitalised at least once with diabetes (either as a principal diagnosis or co-morbidity) in that year had on average 1.7 hospitalisations. Aboriginal residents of NSW were almost three times more likely than non-Aboriginal people to be hospitalised for diabetes. NSW residents born in some overseas countries, particularly Lebanon, Vietnam, Italy, India and Philippines, had higher rates of hospitalisation for diabetes than the Australian-born.

Among NSW residents aged 16 years and over in 2005, 14% of females and more than 9% of males reported high or very high levels of psychological distress. However the rates of suicide continue to decrease - they fell by over 29% in persons of all ages between 1995 and 2004.

Among NSW residents aged 16 years and over in 2005, almost 23% of males and 18% of females were current smokers, representing a further 2% decline since 2003. However, smoking contributed to more than 6,500 deaths in NSW in 2004 and more than 55,500 hospitalisations in the financial year 2004-05 - more than any other health behaviour. Smoking rates were higher in Aboriginal people than in non-Aboriginal people.

Among NSW residents aged 16 years and over in 2005, 37% of males and 27% of females reported risky drinking behaviours, which was an improvement on the figures reported in 2003 (41% and 30% respectively). Males were more likely than females to report risk drinking behaviour across all age groups. Alcohol use caused more than 1,400 deaths in NSW in 2004 (100 fewer than in 2002) and over 40,000 hospitalisations in the financial year 2004-05.

Opiate (mainly heroin) overdose killed 146 NSW residents in 2004. The death rate from heroin overdose declined steeply between 1999 and 2002. In 2001, prisoners in NSW reported higher levels of illicit drug use than the general population, and Aboriginal prisoners reported particularly high levels of illicit drug use (almost 90% of Aboriginal prisoners reported ever using illicit drugs).

In 2005, well over half of male (57.5%) and approaching half of female (42.3%) residents of NSW aged 16 years and over were overweight or obese (56% and 41% respectively in 2003). Only 56.6% of men and 47.3% of women were adequately physically active, but it was an improvement on reported figures in 2003 (50% and 41% respectively). Vegetable consumption deteriorated substantially in men, as only 4.7% of men reported eating recommended quantities of vegetables in 2005 (down from 8.0% in 1997). There was some improvement in women since 1997 when 9.7% reported eating recommended quantities of vegetables and 10.1% reported that in 2005. fruit consumption increased in 2005 and more than 50% of persons aged 16 years and over reported eating recommended quantitty of fruit in 2005.

HIV diagnoses in NSW declined steadily through the 1990s and to 2001, increased in 2002 and 2003, and declined again in 2004 and 2005. Among the 390 cases notified in 2005 (414 in 2003), 91% were males and 68% reported male homosexual sex as a primary risk factor.

What are some of the important issues for older adults?

In 2004, cardiovascular diseases, followed by cancers, were the major causes of death in people of both sexes aged 65 years and over in NSW.

Almost 880 people died of heart failure in NSW in 2004, of whom most were over 75 years of age. In the financial year 2004-05, there were more than 12,700 hospitalisations for heart failure in NSW. Presentations to emergency departments for heart failure peaked in the winter months.

Chronic obstructive pulmonary diseases (COPD), including chronic bronchitis and emphysema, were responsible for more than 1,600 deaths in NSW in 2004 and more than 18,000 hospitalisations in the financial year 2004-05. Around 90% of deaths and more than three-quarters of hospitalisations were in people aged 65 years and over. Similarly, 73% of persons who die from lung cancer are aged over 65 years.

In 2004, 336 people died in NSW with falls as a principal or contributing cause of death. People aged 65 years and over accounted for more than 86% of all fall-related deaths. The rate of fall-related deaths in NSW increased from 1997 to 2001, but decreased in men afterwards. The rate continued to grow in women. In the financial year 2004-05, there were more than 52,000 hospitalisations of NSW residents following a fall. More than half of those hospitalised following a fall (54%) were aged 65 years or more.

Around half of all hospitalisations for pneumococcal disease in 2004-05, and of hospitalisations for influenza and pneumonia in the same financial year, were in people aged 65 years and older. However, 93% of death from influenza and pneumonia were in people 65 years and older. Vaccination for pneumococcal disease and influenza is recommended for all people aged 65 years and over (as well as Aboriginal people aged 50 years and over, and others who are at high risk of infection). In 2005, over 60% of NSW residents aged 65 years and older had been vaccinated against influenza in the past year and around 54% had been vaccinated for pneumococcal pneumonia in the past five years.

Levels of particle pollution in the air are associated with hospital admissions for cardiac disease in the elderly and respiratory symptoms. Improvements in particle levels were seen in NSW the 1980s, due to the elimination of backyard burning and emission control on vehicles, but recently, levels in urban areas have fluctuated, with peaks seen in years of major bushfires. Rural areas may experience high particle levels in winter in association with wood heater use.

In 2005, rates of edentulism (all natural teeth missing) among people aged 55 years and over in NSW ranged from 8% (in 55 to 64 years olds) to 20% (in 75 years old and older) in males and 12% to 36%, respectively, in females.

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