A REPORT ON WOMEN’S HEALTH
MURRUMBIDGEE LOCAL HEALTH DISTRICT
Date:
June 2014
Author:
Kim Gilchrist, Epidemiologist, Public Health Unit, MLHD
Kim.Gilchrist@gsahs.health.nsw.gov.au
Copies available:
www.mlhd.health.nsw.gov.au/about/health-statistics/reports
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
CONTENTS
Executive Summary ...................................................................................................................................................... 2
The Population ............................................................................................................................................................. 3
Priority Subgroups........................................................................................................................................................ 4
Deaths ........................................................................................................................................................................ 10
Hospitalisations .......................................................................................................................................................... 11
Health Conditions and Risks ....................................................................................................................................... 16
Screening .................................................................................................................................................................... 19
More Information ...................................................................................................................................................... 21
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Public Health Unit – MLHD (Document1)
EXECUTIVE SUMMARY
This report was compiled to provide locally relevant data on women’s health for the Murrumbidgee Local Health
District. The health indicators and health determinants included in this report are based on the priorities for
women’s health as outlined in the NSW Health Framework for Women’s Health 2013 (Integrated Care Branch,
NSW Ministry of Health 2013 www.health.nsw.gov.au).
Issues of significance which impact on women’s health in MLHD are:

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MLHD has areas of significant socioeconomic disadvantage. Certain LGAs have high proportions of their
population living in highly disadvantaged areas namely Narrandera, Harden and the Lake Cargelligo area of
Lachlan;
Wagga Wagga, Albury, Griffith and Murray have pockets of highly disadvantaged areas in their LGAs;
MLHD has some areas with high numbers of Aboriginal people;
New settlers (especially refugees) to Albury, Wagga Wagga and Griffith may have complex healthcare
needs;
Significant numbers of women in the region are unpaid carers of others;
MLHD has a higher proportion of teenage mothers compared with NSW;
Significant numbers of domestic assaults and/or alcohol-related assaults annually;
MLHD has a higher rate of death for women compared to NSW overall, and specifically for cardiovascular
disease and digestive system disorders;
MLHD has higher rates of hospitalisation for many causes, most notably those considered potentially
avoidable;
High risk alcohol consumption;
High level of overweight and obesity;
Smoking in general and during pregnancy;
Lower than target screening rates for both breast and cervical cancer increases the probability of
diagnosing later stage cancers – and decreasing survival.
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THE POPULATION
There were an estimated 287,869 people living in MLHD (including Albury LGA and Lake Cargelligo area) in 2012
with 143,824 females making up 50 per cent of the population (ABS 2013 ERPs, Table 1).
Table 1 – Female population by age and Local Government Area, 2012 Estimated resident population, MLHD
Source: Australian Bureau of Statistics, Estimated Resident Population as of June 30, 2012.
Local Government Area
Albury
0 to 9 yrs
10 to 24
yrs#
25 to 49
years
50 to 65
years
65 + yrs
Total 10+
yrs
Total
Females
Total
Males and
Females
3020
5418
8006
4699
4340
22463
25483
49655
Berrigan
452
601
1088
910
1107
3706
4158
8337
Bland
471
503
843
568
622
2536
3007
6055
Boorowa
134
234
317
277
267
1095
1229
2525
Carrathool
163
234
422
237
214
1107
1270
2700
Conargo
121
156
239
157
96
648
769
1577
Coolamon
290
419
540
436
503
1898
2188
4289
Cootamundra
470
624
1003
843
972
3442
3912
7620
Corowa Shire
697
896
1488
1187
1412
4983
5680
11383
Deniliquin
444
657
1043
757
834
3291
3735
7327
Greater Hume Shire
636
935
1430
1110
908
4383
5019
10137
Griffith
1798
2549
4109
2104
1932
10694
12492
25489
Gundagai
253
328
524
366
397
1615
1868
3763
Harden
246
312
471
398
423
1604
1850
3712
Hay
193
262
430
291
305
1288
1481
3002
85
139
161
175
140
615
700
1526
Junee
359
481
750
572
453
2256
2615
6127
Lake Cargelligo*
127
182
256
161
177
776
903
1830
Leeton
774
1432
1629
1030
926
5017
5791
11498
Lockhart
230
253
398
309
290
1250
1480
3082
Murray
399
573
948
775
892
3188
3587
7312
Murrumbidgee
173
201
363
207
189
960
1133
2415
Narrandera
441
493
880
581
638
2592
3033
6071
Temora
390
499
784
577
732
2592
2982
5969
Tumbarumba
207
274
435
367
350
1426
1633
3517
Tumut Shire
746
927
1658
1117
1097
4799
5545
11290
83
100
121
125
128
474
557
1180
61746
Jerilderie
Urana
Wagga Wagga
4261
7127
10012
5364
4529
27032
31293
Wakool
188
336
539
471
433
1779
1967
4033
Young
902
1212
1849
1200
1301
5562
6464
12702
18753
28357
42736
27371
26607
125071
143824
287869
MLHD total
# In the 2011 Census 10-11 yr olds made up 13.8% of this age group
Life expectancy for women in MLHD born between 2003 and 2007 was estimated to be 83 years, one year less than
the NSW average of 84 years. The MLHD female population age structure is different to NSW in that there are
proportionally fewer women aged 25 to 49 years with around 30 per cent of MLHD women in this age range
compared to 35 per cent in NSW. Conversely there are slightly more females proportionally in the age groups up
to 24 years and over 50 years (Figure 1).
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Percentage of females by age group, MLHD and NSW 2012
40%
Per cent of total females
35%
30%
25%
20%
15%
10%
5%
0%
0 to 9 yrs
10 to 24 yrs
25 to 49 years
50 to 65 years
65 + yrs
MLHD
13.0%
19.7%
29.7%
19.0%
18.5%
NSW
12.3%
18.7%
34.7%
18.3%
16.0%
Figure 1 - Female population age structure
Source: Australian Bureau of Statistics, Estimated Resident Population as of June 30, 2012.
PRIORITY SUBGROUPS
Major concerns for MLHD:







MLHD has areas of significant socioeconomic disadvantage. Certain LGAs have high
proportions of their population living in highly disadvantaged areas namely Narrandera,
Harden and the Lake Cargelligo area of Lachlan.
Wagga Wagga, Albury, Griffith and Murray have pockets of highly disadvantaged areas in
their LGAs.
MLHD has some areas with high numbers of Aboriginal people.
New settlers (esp. refugees) to Albury, Wagga Wagga and Griffith may have complex
healthcare needs.
Significant numbers of women are unpaid carers of others.
Higher proportion of teenage mothers.
Significant numbers of domestic assaults and/or alcohol-related assaults annually.
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Women who are socio-economically disadvantaged
The Index of Relative Socio-economic Disadvantage (IRSD) is a general socio-economic index that summarises a
range of information about the economic and social conditions of people and households within an area. 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.
Figure 2 shows the scores for disadvantage for the MLHD LGAs – the blue dot is the average score for the SA1s (ABS
geographic areas) in the LGA, and the vertical blue line shows the range of scores within the LGA. Griffith, Wagga
Wagga, Albury and Murray Shires have the widest range of scores indicating a broad social gradient of high levels
of disadvantage to relatively low levels. The line at 1,000 shows the average for Australia and the average for NSW
at 994 and rural NSW at 958. Thirteen LGAs are below the rural NSW average and only four LGAs are above the
NSW average, indicating general disadvantage of the MLHD population. The proportion of the population living in
disadvantaged areas for each LGA gives an indication of the extent of disadvantage in that area. Areas such as Lake
Cargelligo, Narrandera and Harden had 30 per cent or more of their population living in disadvantaged areas,
followed by Jerilderie and Urana with 25 to 30 per cent (Figure 3).
Figure 2 - Relative socioeconomic disadvantage score MLHD LGAs
Source - Australian Bureau of Statistics SEIFA scores 2011
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Figure 3 – Proportion of LGA population living in highly disadvantaged areas, MLHD, map 2011.
Source: ABS SEIFA indices, mapping by Epidemiology, Public Health MLHD
Unemployment rates ranged from the highest in Albury (6.5%), Junee (6.0%) and Leeton (6.0%) to lowest in
Carrathool (3.0%) and Boorowa (3.1%) with an average across LGAs of 4.4% (Department of Employment: Small
Area Labour Market data for September quarter 2013). The unemployment rate for NSW for the same period was
5.9 per cent.
Aboriginal women
There were an estimated 10,546 Aboriginal people living in MLHD (including Albury LGA and Lake Cargelligo area)
in August 2011 (ABS 2011 Census). In NSW, Aboriginal people made up 2.5 per cent of the total population and in
MLHD the percentage of Aboriginal people was 3.8 per cent. Aboriginal women made up 50.3 per cent of the MLHD
Aboriginal population, with 5,316 women identified in the 2011 ABS Census. The areas with the highest proportions
of Aboriginal people in MLHD are Lake Cargelligo – part of Lachlan Shire – (14%, 247 people), Murrumbidgee Shire
(10%, 229 people) and Narrandera Shire (10%, 592), with the largest numbers of Aboriginal people in Wagga Wagga
(2,732, 4.6%), Albury (1,108, 2.3%) and Griffith (1,003, 4.1%) LGAs.
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Women from Culturally and Linguistically Diverse communities
The people of MLHD were mostly born in Australia or were from English speaking countries. Only 4.7 per cent of
the MLHD population were born in a non-English speaking country (NESB COB) and 5.0 per cent stated speaking a
language other than English (LOTE) at home, compared to 18.6 per cent and 22.5 per cent in NSW respectively. Less
than one per cent of the MLHD population had difficulty speaking English compared to 3.7 per cent in NSW. The
majority of religious affiliations reported were Christian-based (75.7 % in MLHD and 64.5% in NSW).
Refugees
From 2009 to 2013 areas within MLHD have received approximately 4,155 new settlers, 777 of these were
“humanitarian arrivals” or refugees, 284 of which were women (Department of Immigration Settlement Statistics
Reports). The major areas settled were Albury (369), Wagga Wagga (292) and Griffith (75), with smaller numbers
in Leeton (31), Narrandera, Murrumbidgee and Wakool Shires.
The major ethnic backgrounds of settlers arriving in MLHD were Bhutanese in the Albury (and Wodonga) area;
Burmese in Wagga Wagga; Afghanis in Griffith, Leeton, Narrandera and Wagga; as well as the African nations of
Sierra Leone, Rwanda, Democratic Republic of Congo and Sudan in both Albury and Wagga Wagga.
Teenage mothers
There were close to 200 mothers aged less than 20 years in 2013 who live in MLHD (Families NSW database), 54 of
which were Aboriginal. Teenage mothers made up 5.8 per cent of all mothers for that year – and 21 per cent of all
Aboriginal mothers were teens. In NSW in 2010, 3.3 per cent of mothers were aged less than 20 years and 18.6 per
cent of Aboriginal mothers were teens.
Women with a disability or are carers for other people
On Census night August 2011, 14,076 people (7,463 women) in MLHD reported needing assistance with core
activities, which made up 5.0 per cent of the population compared to 4.9 per cent of NSW. For people aged 15
years to 44 years, approximately 2 per cent reported needing help with core activities, this proportion increased
with age from 4 per cent of 45-64 year olds, 12 per cent of 65-84 year olds, 46 per cent of people aged 85 years or
older.
There were 11,400 people aged 16 years or over in MLHD in June 2009 who were receiving a disability support
pension, making up 6.3 per cent of the eligible population, compared to 5.0 per cent in all NSW. Boorowa (10.1%),
Cootamundra (9.8%), Harden (9.3%) and Young (8.2%), had the highest percentages of their eligible populations on
disability pensions among MLHD LGAs, and Carrathool (4.8%) and Wagga Wagga (5.0%) the lowest.
There were 15,985 women (aged 15 years or older) in MLHD who reported giving unpaid assistance to a person
with a disability, and 12,815 reported unpaid child care for children who were not their own (ABS 2011).
Women who lack qualifications
A target in the NSW Health Women’s Health Framework is a 50 per cent increase in the proportion of people aged
20 to 64 years in NSW with qualifications at Certificate iii level or above. MLHD has lower proportions of qualified
20-64 year olds than NSW, which could be due to the labour market, travelling away for education and also an
artefact of having less young people proportionally than NSW.
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Table 2 – Qualification to Certificate iii level or higher, MLHD 2011
Source: ABS Census of Population and Housing 2011 – Table Builder
MLHD
NSW
Cert iii or above (number)
Total 20-64 yrs
20-64 yrs with Cert. iii or above
20-64 yrs with Cert. iii or above
Male
35212
76500
46.0%
54.0%
Females
31510
76990
40.9%
48.2%
Total
66722
153490
43.5%
51.0%
Women who experience violence
There were on average 1,600 females who were victims of assaults reported to police in MLHD per year from 2008
to 2013. Of all assaults 1,250 per year were domestic violence related and alcohol related assaults averaged around
1,500 per year for the same period (assaults could be both domestic violence related and involve alcohol). Rates of
sexual offences (Figure 4) and domestic assaults (Figure 4) where a female was the victim were considerably higher
in some MLHD LGAs than the NSW rates.
Figure 4 - Sexual offences by LGA
Figure 5 - Domestic violence related assaults by LGA
Maps showing rates for all NSW LGAs of alcohol related assaults and domestic violence related assaults show some
areas of MLHD experience higher levels of these crimes than others. This is based on reporting of the issue and
police involvement in the incident. Alcohol related and domestic violence related assaults appear to increase with
remoteness and domestic violence assaults also occur more frequently in larger population centres.
(NSW Bureau of Crime Statistics and Research - http://crimetool.bocsar.nsw.gov.au/bocsar/).
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Figure 6 - Alcohol related assault 2012-2013, rates per 100,000 population by LGA in NSW.
Source: NSW Bureau of Crime Statistics and Research
Figure 7 – Domestic assaults 2012-2013, rates per 100,000 population by LGA in NSW.
Source: NSW Bureau of Crime Statistics and Research
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Women living in rural or remote areas
The majority of the MLHD population live in areas categorised as “accessible” or “moderately accessible” under the
ARIA+ 2011 classifications. The north-west of MLHD is however considered “remote” – which is Hay Shire (excluding
Hay township area) and most of Carrathool Shire, as well as Lake Cargelligo part of Lachlan Shire. The map shows
the outline of LGAs in MLHD overlaying the ARIA+ Remoteness Areas. (Figure 8).
Figure 8 - Remoteness map, MLHD
Source: Australian Bureau of Statistics, Remoteness Areas 201. Produced by Epidemiology, MLHD (2014)
DEATHS
Major concern for MLHD:
MLHD has a higher rate of death for women compared to NSW overall, and specifically for
cardiovascular disease and digestive system disorders.
The death rate for women in MLHD for the 2010-11 of 510.0 per 100,000 was significantly higher than the NSW
rate 472.2 per 100,000. In MLHD approximately 420 women die per year from cardiovascular disease (36.5% of
deaths) and 290 from cancers (25.1% of deaths), the two major causes of death in both MLHD and NSW. The age
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standardised death rates by category of cause show that MLHD has significantly more women than expected dying
from both cardiovascular disease and digestive system disorders compared to NSW (Figure 9).
Figure 9 - Female deaths by category of cause.
Source: ABS Deaths, Health Statistics NSW accessed, February 2014.
HOSPITALISATIONS
Major concerns for MLHD:

MLHD has higher rates of hospitalisation for many causes, most notably those considered
potentially avoidable.
In NSW, hospitalisation for the female population occurred at an annual rate (2011-12) of around 37,044.2 episodes
of care per 100,000 people, for MLHD females this rate is around 38,832 episodes per 100,000, a rate significantly
higher than NSW. In MLHD for the 2011-12 year there were 61,561 episodes of care for MLHD resident women.
Cause of hospitalisation
The major category of cause of hospitalisation for females in Murrumbidgee LHD for 2011-12 was injury and
poisoning which made up 12 per cent of all admissions; digestive system disorders 11 per cent; and maternal
neonatal – eight per cent (Table 3). The “other factors influencing health” category made up 10.5 per cent of
admissions and includes admissions of live-born infants, symptoms and signs without a specific cause, and
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admissions for rehabilitation, nursing home and respite care. Follow up care after surgery, artificial openings
(stoma) care, fitting of prosthetic devices, supervision of high risk pregnancies, in vitro fertilisation and admissions
after contact with and exposure to communicable diseases (quarantine) also belong to this group.
Maternal and neonatal conditions had the highest age-standardised rate in MLHD, however injury and poisoning;
digestive system diseases; symptoms and abnormal findings; genitourinary diseases; cardiovascular diseases;
musculoskeletal diseases; infectious diseases; endocrine diseases; skin diseases and blood and immune diseases all
had significantly higher rates of admission than NSW (Figure 10).
Some categories of hospitalisation had lower rates of admission compared to NSW including “other factors
influencing health”; dialysis; mental disorders and other neoplasms.
Table 3 – Hospitalisations by category of cause, females, MLHD 2011-12.
Source: Health Statistics NSW.
Cause of hospitalisation
by ICD10 category
Number per year
Per cent of
hospitalisations
Rate per
100,000
population
LL 95% CI
UL 95%
CI
Infectious diseases
1,052
1.7
672.1
630.6
715.6
Malignant neoplasms
1,913
3.1
1029.5
982.4
1078.2
Other neoplasms
1,026
1.7
*637.2
597.4
678.8
Blood & immune diseases
741
1.2
444.7
412.1
479.2
Endocrine diseases
847
1.4
549.3
511.6
588.9
Mental disorders
1,841
3
*1314.6
1253.6
1377.7
Nervous & sense disorders
3,814
6.2
2233.0
2160.4
2307.4
Cardiovascular diseases
3,989
6.5
2076.7
2010.2
2144.7
Respiratory diseases
3,618
5.9
2272.7
2197.0
2350.3
Digestive system diseases
6,613
10.7
4238.0
4133.2
4344.8
810
1.3
498.5
463.4
535.5
Musculoskeletal diseases
3,176
5.2
1867.8
1801.2
1936.1
Genitourinary diseases
3,534
5.7
2400.2
2319.1
2483.3
Maternal, neon. & congenital
5,092
8.3
4322.9
4204.2
4444.0
Symptoms & abnormal findings
5,306
8.6
3208.8
3119.6
3299.7
Injury & poisoning
7,327
11.9
4246.3
4145.0
4349.4
Dialysis
4,355
7.1
*2683.6
2602.5
2766.6
Other factors infl. health
6,494
10.5
*4138.4
4034.9
4243.7
13
0
10.0
5.2
17.2
61,561
100
38832.3
38514.3
39152.1
Skin diseases
Other
Total
* Significantly lower than NSW, Significantly higher than NSW
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Figure 10 - Hospitalisations by category of cause, females, MLHD and NSW 2011-12
Source: Health Statistics NSW.
Potentially Preventable Hospitalisation (PPH)
The Women’s Health Framework is looking for a 1 per cent decrease in potentially preventable hospitalisation
overall, and 2.5 per cent for Aboriginal people by 2014/15. Also known as hospitalisations for Ambulatory Care
Sensitive Conditions, these give an indication of the access to and effectiveness of primary care and prevention
services in an area. In MLHD, PPH have fluctuated over time but are generally declining. Acute conditions however
have increased slightly in recent years (Figure 11).
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Figure 11 - Trend in potentially preventable hospitalisations by category, MLHD 1992 to 2012 .
Sources: NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.
Notes :Potentially Preventable Hospitalisations (PPH) are also known as hospitalisations for Ambulatory Care Sensitive (ACS) Conditions. The definitions used
in HSNSW for ACS conditions were modified from the Victorian Department of Human Services, 2004. Conditions are mutually exclusive. Only NSW residents
are included. Figures are based on where a person resides, not where they are treated. Hospital separations were classified using ICD-9-CM up to 1997-98 and
ICD-10-AM from 1998-99 onwards. Rates were age-adjusted using the Australian population as at 30 June 2001. Numbers for the two latest years include an
estimate of the small number of hospitalisations of NSW residents in interstate public hospitals, data for which were unavailable at the time of production
The MLHD rates of hospitalisation for specific categories of PPH are in general significantly higher than NSW rates
and with longer average lengths of stay. There were nearly 42,000 bed days for MLHD residents which are classified
potentially preventable, the majority of them were for Chronic Obstructive Pulmonary Disease and congestive heart
failure.
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Table 4 - Potentially preventable hospitalisations by condition, Murrumbidgee LHD, 2011-12
Source: NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health
Condition and
Category*
MLHD
Number
Rate per
100,000
population
LL 95%
CI
NSW
UL 95%
CI
Average
bed days
Total
bed
days
Rate per
100,000
populatio
n
Average
bed days
MLHD
vs
NSW#
Chronic obstructive
pulmonary disease
C
1,570
417.9
397.3
439.4
11.3
8,601
266.8
6.4
high
Urinary tract
infections and
pyelonephritis
A
1,212
350.8
330.7
371.7
8.4
4,598
249.5
4.5
high
Dehydration and
gastroenteritis
A
1,183
379.0
357.1
401.9
4.4
2,607
255.7
2.4
high
Congestive heart
failure
C
1,068
268.0
252
284.8
14.0
6,796
175.7
7.2
high
Asthma
C
753
257.1
238.8
276.4
4.5
1,569
181.4
2.1
high
Diabetes
complications
C
734
225.0
208.6
242.3
9.3
3,726
116.7
6.6
high
Angina
C
726
196.7
182.5
211.8
4.3
1,584
116.2
2.2
high
Ear nose and throat
infections
A
724
252.8
234.5
272.1
3.5
1,311
154.9
1.7
high
Dental conditions
A
678
240.3
222.3
259.4
2.4
881
225.4
1.2
Cellulitis
A
644
197.1
181.7
213.4
9.8
3,421
192
5.2
Convulsions and
epilepsy
A
557
191.6
175.8
208.5
3.9
1,161
154
3
Iron deficiency
anaemia
C
359
104.2
93.4
115.8
3.7
735
111.2
1.8
Influenza and
pneumonia
V
289
87.5
77.5
98.5
11.3
1,962
62.9
7.5
high
Hypertension
C
260
72.5
63.7
82.1
8.0
740
30.6
3
high
Ruptured appendix
A
102
35.7
29
43.5
10.9
671
37.6
4.7
Perforated/bleeding
ulcer
A
87
24.8
19.7
30.7
16.2
728
20.9
6.7
Gangrene
A
69
21.5
16.6
27.4
27.3
1,098
15.9
13.8
Pelvic inflammatory
disease
A
52
19.3
14.4
25.5
3.6
124
18.1
2.4
Other vaccine
preventable
V
28
9.6
6.3
13.9
7.4
158
13.7
6.6
Nutritional
deficiencies
C
2
0.6
0.1
2.1
5.5
11
1.5
16.6
11,047
3334.9
3271.3
3399.3
7.6
41,947
2392.7
4.1
Total
high
high
* Category:
A- Acute C- Chronic
V - Vaccine preventable
# Statistically significantly higher rates per 100,000 of hospitalisation compared to NSW.
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HEALTH CONDITIONS AND RISKS
Major concerns for MLHD:



Risk alcohol consumption
Overweight and obesity
Smoking in general and during pregnancy
Tobacco
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 percentage of women (16+ years) who are current smokers in MLHD was 18.1 per cent compared to NSW at
14.1 per cent (NSW Health Survey 2012). Smoking attributable hospitalisation for females of MLHD occurred at a
significantly higher rate than NSW, and a higher percentage of women reported smoking during pregnancy (Table
5). Smoking at all during pregnancy was reported by approximately 50 per cent of Aboriginal mothers in MLHD (50.5
per cent of Aboriginal mothers in NSW) who had babies in 2009 (NSW Perinatal Data Collection).
Table 5 – Risk behaviour health indicators, MLHD and NSW.
Source: Health Statistics NSW, and personal correspondence with Manager of NSW Health Survey Program.
Indicator
Risk alcohol – more than 2 standard drinks on
a day when consuming alcohol
Alcohol attributable hospitalisation
Overweight and obesity – Body Mass Index
calculated from self- reported height and
weight
High Body Mass attributable hospitalisation
Current smoking
Smoking attributable hospitalisation
Smoking during pregnancy*
Adequate physical activity
Psychological distress
Year
MLHD
NSW
Significantly
higher than
NSW
18.3
No
2012
%
20.6
2011-12
2012
ASR
%
491.4
48.5
534.0
44.9
No
No
2011-12
2012
2011-12
2011
2012
2011
ASR
%
ASR
%
%
%
488.0
18.1
584.5
17.4
49.3
10.5
357.5
14.1
424.7
11.1
51.4
11.7
Yes
No
Yes
n.a.
n.a.
n.a.
ASR – Age-standardised rate per 100,000
* Only NSW mothers having babies in NSW
Alcohol
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 (National Health and Medical Research
Council 2009). In the 2012 NSW Health survey risk consumption of alcohol was defined as: consuming more than 2
standard drinks on a day when drinking alcohol. 20.6 per cent of adult females in MLHD reported risk alcohol
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consumption compared to 18.3 per cent of NSW. Alcohol attributable hospitalisations occurred at a slightly lower
rate in MLHD than NSW for females in 2011-12 (Table 5).
Physical activity
In the 2012 NSW Health survey 49.3 per cent of adult females reported undertaking adequate physical activity in
MLHD, slightly lower than the rate in NSW of 51.4 per cent. In the New South Wales Population Health Survey,
adequate physical activity is calculated from questions asked in the Active Australia Survey, and is defined as
undertaking physical activity for a total of at least 150 minutes per week over 5 separate occasions. The total
minutes are calculated by adding minutes in the last week spent walking continuously for at least 10 minutes,
minutes doing moderate physical activity, and minutes doing vigorous physical activity multiplied by 2.
Obesity/ high BMI related illness
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 reported that in MLHD 48.5 per cent of adult females were overweight
or obese (as measured by self-reported height and weight used to calculate Body Mass Index) compared to 44.9
per cent in NSW (Table 5).
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.
Females in MLHD had a significantly higher rate of high BM attributable admissions compared to NSW (Table 5).
The Australian Longitudinal Study on Women’s Health (ALSWH) found one of the most significant differences in
health risks between women of rural, remote and urban areas was the increasing prevalence of overweight and
obesity with increasing distance from major cities. The prevalence of diabetes and hypertension, conditions which
are associated with obesity were also consistently higher (Rural Remote and Regional Differences in Women’s
Health, ALWSH).
Diabetes
The National Diabetes Service Scheme1 data is considered a very good indicator of the number of people currently
living with diabetes in Australia. Just over one million people in Australia with diabetes are registered with the
NDSS, 86 per cent of registrants are Type 2; 11 per cent Type 1; and 2 per cent had gestational diabetes. Data are
not age-standardised and therefore will be influenced by the proportion of older people in a given area. As of June
2013, 7,643 women in MLHD were registered with NDSS, approximately 5.3 per cent of the total female population,
compared to 5.4 per cent in Australia. Of the MLHD women registered, 276 had gestational diabetes. Some areas
of MLHD had higher percentages of female diabetes registration than others with Urana, Junee, Cootamundra and
1
The NDSS started in 1987 and is funded by the Australian Government. Diabetes Australia administers the Scheme on the
Government’s behalf. To register with the NDSS, applicants must be diagnosed with diabetes and hold or be eligible to hold a
Medicare card and live in Australia. Sometimes visitors to Australia may be eligible through a Reciprocal Health Care
Agreement with their home country. People who are registered with the NDSS can access a range of subsidised Government
approved products including:
•
subsidised testing strips for checking blood glucose levels
•
free insulin syringes and pen-needles (if you require insulin)
•
subsidised insulin pump consumables (IPCs)
•
information services on managing life with diabetes.
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Jerilderie all having seven per cent or more of the female population with diabetes. (NDSS www.ndss.com.au/en/AustralianDiabetes-Map/).
Sexual Health
Chlamydia is a sexually transmissible infection caused by the bacterium Chlamydia trachomatis. Many people who
are infected do not have symptoms of infection but can still transmit the bacterium. A chlamydia infection if not
properly treated can lead to serious complications. The notification data are heavily influenced by health screening
behaviour and testing practices. The higher rate of infection in women is most likely due to a testing bias, where
women are more likely to be tested than men (Health Statistics NSW). The number of notifications of chlamydia in
MLHD has been increasing in past years and is more often notified in females than in males (Figure 12). Notification
rates can be an indicator of local safe-sex practices, age-standardised rates of notification were significantly higher
in females of MLHD compared to NSW (Health Statistics NSW 2011-12).
Figure 12 - Chlamydia notifications by gender, MLHD 2009 to 2013
Source: NSW Notifiable Conditions Information Management System (NCIMS), Public Health MLHD.
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SCREENING
Major concern for MLHD:



Although breast screening rates have been increasing in recent years the current rates are
significantly below the target of 70 per cent.
Increasing equity of access to screening services both geographically and to cultural
groups.
Low screening rates for both breast and cervical cancer increase the probability of
diagnosing later stage cancers – and decreasing survival.
Breast screening
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 70 per cent of women aged 50 to 74
years every two years and in June 2013 the Commonwealth Government announced funding to increase the
previous target age group from 50-69 years to 50-74 year olds.
The two-yearly screening rate for breast cancer in women aged 50-69 years in MLHD as of December 2012 was
56.4 per cent (RBCO Performance Report 2013: Murrumbidgee), this rate has been increasing since the 2009-10
period (these data do not include Albury LGA). More recent unpublished data from the BreastScreen Information
System indicates the screening rates in Murrumbidgee and Southern NSW LHDs are continuing to increase with the
combined LHDs having the second highest participation rate among NSW LHDs.
The screening rate for Aboriginal women in MLHD for 2011-12 was 35.4 per cent which has been showing an
increasing trend since 2009-10. The rate for culturally and linguistically diverse women was 31 per cent in 2012 and
has not changed significantly. The screening rates vary significantly by LGA with Lockhart, Temora and Tumut LGAs
having rates of approximately 68 per cent whereas Victorian border areas of Wakool and Murray LGAs have rates
of 10 per cent or below due to cross-border flows.
MLHD had incidence and deaths rates for breast cancer within the normal range for NSW, however Griffith and
Gundagai LGAs had significantly higher incidence rates (new cases) than expected for their populations (2004-2008
NSW Cancer Registry Statistical Reporting www.statistics.cancerinstitute.org.au) .
Cervical Screening
A population screening program using the Pap test results in lower incidence and mortality from cervical cancer in
the population. This is because the Pap test is very effective at detecting precancerous lesions in the cervix and
regular two-yearly testing with appropriate follow-up treatment can prevent cervical cancer from developing in
most cases. Mobility of the population and differences in risk factors prevent clear reflection of the relationship
between the incidence and screening rates at the district level. At the NSW level the rate of incidence of cervical
cancer decreased by 60 per cent and the rate of death by 48 per cent in the last 20 years (Health Statistics NSW).
The biennial cervical screening participation rate for 2010-2012 for MLHD was 54.8 per cent which was 2
percentage points below the NSW average 56.8 per cent. The screening rate for MLHD has not changed significantly
in past years (RBCO Performance Report 2013: Murrumbidgee).
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There was significant variation in the screening rates across the LGAs of MLHD with Urana LGA having rates well
above 70 per cent since 2008-2009 while other LGAs fell within the range of 50-60 per cent. Wakool, Tumbarumba,
Narrandera, Murrumbidgee, Leeton, Jerilderie and Hay however, were all between 40-50 per cent and Conargo
only 24.8 per cent. Variation may be influenced by the limited numbers of General Practitioners (GPs); GPs who
bulk bill Pap tests; access to Women’s Health Nurses and free Pap test services.
MLHD had incidence and deaths rates for cervical cancer within the normal range for NSW as a whole and for
individual LGAs (2004-2008 NSW Cancer Registry Statistical Reporting www.statistics.cancerinstitute.org.au) .
Human Papillomavirus (HPV) vaccination
Human Papillomavirus (HPV) is a common virus that affects both males and females. Anyone who has ever had
sexual contact could have HPV. Different kinds of HPV can affect different parts of the body, and some types are
more harmful than others. The more harmful types of HPV can cause abnormal cells that lead to a range of cancers
and disease. HPV infection can be prevented by vaccination. The vaccination is most effective when given before a
person becomes sexually active. The HPV School Vaccination Program began in 2007 and provides free HPV vaccine
to 12 to 13 year old girls and 14 to 15 year old boys, in three doses over 6 months (Australian Government HPV
School Vaccination Program 2013 web-site, http://hpv.health.gov.au/the-program/ ). In MLHD in 2013, 85 per cent
of eligible girls were vaccinated through the school program for their first dose and 70 per cent for their second
dose (NSW: 1st dose 85% and 2nd dose 69%), for boys 80 per cent had the first dose and 66 per cent the second dose
(NSW: 1st dose 79% and 2nd dose 60%). Note that these figures are only for those who have vaccination at school
and do not provide information on vaccination given in other settings for example by a medical practitioner
privately (Immunisation Unit, Health Protection NSW, NSW Ministry of Health 2014).
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MORE INFORMATION
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NSW Health Framework for Women’s Health (2013) www.health.nsw.gov.au/women
Health Statistics NSW, online www.healthstats.nsw.gov.au
Rural Remote and Regional Differences in Women’s Health: Findings from then Australian Longitudinal
Study on Women’s Health (ALSWH)
www.alswh.org.au/images/content/pdf/major_reports/2011_rural_remote_and_regional_differences_r1
63.pdf
Reporting of Better Cancer Outcomes Performance Report 2013, Murrumbidgee LHD. Cancer Institute
NSW, October 2013.
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