A REPORT ON THE ABORIGINAL POPULATION OF
MURRUMBIDGEE LOCAL HEALTH DISTRICT
Date:
August 2012
Author:
Kim Gilchrist, Epidemiologist, Public Health Unit, MLHD
Kim.Gilchrist@gsahs.health.nsw.gov.au
Input from:
Diann Tremain, Manager Aboriginal Health
Sabrina Brown, Coordinator Aboriginal Maternal and Infant Health Service
Copies available:
www.gsahs.nsw.gov.au/gsho/refreplink.html
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.health.nsw.gov.au/mlhn/
CONTENTS
About this Report ........................................................................................................................................................................... 2
The Population ............................................................................................................................................................................... 2
Socioeconomic status ................................................................................................................................................................. 5
Deaths............................................................................................................................................................................................. 5
Hospitalisations .............................................................................................................................................................................. 6
Potentially Preventable Hospitalisations (PPH) .......................................................................................................................... 9
Health Conditions and Risks ......................................................................................................................................................... 10
Maternal and Child health ............................................................................................................................................................ 12
Current Staffing in MLHD ............................................................................................................................................................. 14
In Summary .................................................................................................................................................................................. 15
More Information ......................................................................................................................................................................... 16
1|P a g e
Public Health Unit – MLHD (Document1)
ABOUT THIS REPORT
Data relating to Aboriginal health at LHD level is limited but improving. Small numbers make it difficult to report data for
specific conditions and deaths; in addition to this the identification of Aboriginality in some databases is unreliable. This
report summarises information available from the NSW Ministry of Health web-site Health Statistics NSW. Where possible,
figures for MLHD have been included; however for some health indicators only State level data is available.
Files containing the full data tables and charts are available electronically from www.gsahs.nsw.gov.au/gsho/refreplink.html.
THE POPULATION
Figure 1 - Aboriginal population percentage of total population by LGA and population density by Statistical Area 1*, MLHD, 2011
Census.
Note: *Statistical Area 1 (SA1) is a new geographic boundary for the 2011 ABS Census, there may be several SA1’s per LGA.
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 (Table 1). The shaded areas of the map above () show the distribution of
Aboriginal people in MLHD as a percentage of the total population by LGA. The LGAs 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). The actual numbers of Aboriginal people are demonstrated by “dot density” on
Figure 1 , where one dot represents 20 Aboriginal people 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%).
2|P a g e
Public Health Unit – MLHD (Document1)
Table 1 – Aboriginal people by Local Government Area, 2011 Census, MLHD
Local Government Area
Albury (C)
Berrigan (A)
Bland (A)
Boorowa (A)
Carrathool (A)
Conargo (A)
Coolamon (A)
Cootamundra (A)
Corowa Shire (A)
Deniliquin (A)
Greater Hume Shire (A)
Griffith (C)
Gundagai (A)
Harden (A)
Hay (A)
Jerilderie (A)
Junee (A)
Leeton (A)
Lockhart (A)
Murray (A)
Murrumbidgee (A)
Narrandera (A)
Temora (A)
Tumbarumba (A)
Tumut Shire (A)
Urana (A)
Wagga Wagga (C)
Wakool (A)
Young (A)
Lake Cargelligo part of Lachlan
ALL MLHD
All NSW
Aboriginal
Males
545
82
120
20
75
16
47
132
71
143
91
498
44
81
93
23
279
297
51
109
123
290
56
56
208
22
1333
47
175
119
5246
85083
Aboriginal
Females
563
84
118
25
102
15
59
149
72
115
110
505
46
80
75
23
112
356
27
121
106
302
47
28
284
16
1399
47
202
128
5316
87542
Aboriginal
Persons
1108
166
238
45
177
31
106
281
143
258
201
1003
90
161
168
46
391
653
78
230
229
592
103
84
492
38
2732
94
377
247
10562
172625
Total LGA
population
47810
8066
5865
2399
2587
1540
4099
7334
11000
7120
9815
24364
3662
3584
2956
1496
5878
11037
2998
6957
2261
5902
5776
3358
10934
1159
59458
3962
12236
1764
277377
6917656
Per cent of LGA
population
Aboriginal
2.3%
2.1%
4.1%
1.9%
6.8%
2.0%
2.6%
3.8%
1.3%
3.6%
2.0%
4.1%
2.5%
4.5%
5.7%
3.1%
6.7%
5.9%
2.6%
3.3%
10.1%
10.0%
1.8%
2.5%
4.5%
3.3%
4.6%
2.4%
3.1%
14.0%
3.8%
2.5%
Life expectancy for Aboriginal people in NSW born between 2005-2007 was estimated to be 67.2 years for Aboriginal males
and 75.0 years for Aboriginal females, this is from 7 to 9 years fewer than the general population. The Aboriginal population
is younger, with around 34.7% of the population under 15 years of age, compared with around 19.6% of the non-Aboriginal
population in MLHD (Figure 2). The proportion of the Aboriginal population in each 5-year age group decreases with
increasing age, whereas in the non-Aboriginal population, there is no decrease until after the age of 49 years. The proportion
of the Aboriginal population over the age of 65 years is just 4.5% compared with 17.5% in the non-Aboriginal population.
There is also a substantial drop in the size of the Aboriginal population between 10-14 years and 15-19 years, reflecting a
relatively high mortality rate among older teenagers as well as migration out of the area for 20-29 year olds. From 1991 to
2011 the proportion of Aboriginal people aged 75 years or over has increased slightly from 1.1 per cent to 1.3 per cent. The
proportion of the Aboriginal population aged 0-4 years has decreased from 17.1 per cent to 10 per cent.
3|P a g e
Public Health Unit – MLHD (Document1)
Figure 2
SIGNIFICANCE:



Proportion of population identifying as Aboriginal in MLHD is higher than the State therefore Aboriginal health issues
are even more critical in MLHD.
The Aboriginal population is not evenly spread across all LGAs so areas such as Narrandera and Murrumbidgee Shire
need pay particular attention to cultural issues as well as LGAs such as Wagga Wagga, Albury and Griffith where
there are higher numbers of Aboriginal people residing.
Life expectancy is much shorter for Aboriginal people as far fewer Aboriginal MLHD residents are living beyond the
age of 49 years.
4|P a g e
Public Health Unit – MLHD (Document1)
SOCIOECONOMIC STATUS
Figure 3
The relative socioeconomic disadvantage experienced by Aboriginal people in NSW continues to place them at a greater risk
of exposure to behavioural and environmental health risk factors. A range of socioeconomic indicators from the 2006 Census
demonstrate the relative disadvantage of the Aboriginal population in NSW (Figure 3). In NSW, larger proportions of
Aboriginal people are: unemployed; have no post-school qualifications; no household internet connection; a weekly
household income less than $500; rent, live in multi-family households; and reside in dwellings with 7 or more people than
non-Aboriginal people (Health Statistics NSW).
DEATHS
In NSW the leading causes of death were the same for Aboriginal and non-Aboriginal people in 2003-2007. Cardiovascular
diseases were the main cause of death for all people in NSW; accounting for 30.8 per cent of all deaths among Aboriginal
people compared to 36.5 per cent of deaths in non-Aboriginal people. Malignant neoplasms (cancers) were the cause of 21.1
per cent of all deaths among Aboriginal people and 28.8 per cent of deaths among non-Aboriginal people. The third most
common cause of death for Aboriginal people was injury and poisoning (11.7%) followed by respiratory diseases (8.4%)
compared to non-Aboriginal people where respiratory disease made up 8.7 per cent of causes of death and injury and
poisoning 5.2 per cent. Among Aboriginal people in NSW, 63.6 per cent of potentially avoidable deaths (death occurring
before 75 years of age thought to be able to avoided through prevention or treatment) were classed as preventable
compared to 58.8 per cent in the non-Aboriginal population. Data for the MLHD is not reported separately as it varies widely
from year to year due to the small number of actual events, making data by Aboriginality unreliable.
5|P a g e
Public Health Unit – MLHD (Document1)
SIGNIFICANCE:


Aboriginal people are dying from similar causes as non-Aboriginal people; however they die at a much younger age.
Aboriginal people are more likely to die from causes considered to be preventable, than non-Aboriginal people.
HOSPITALISATIONS
In NSW, hospitalisation for the general population occurred at an annual rate (2010-11) of around 35,400 episodes of care
per 100,000 people, for Aboriginal people this rate is around 59,000 episodes per 100,000 around 1.7 times the rate of
34,400 per 100,000 for non-Aboriginal people. Hospitalisations for all causes in MLHD occurred at a rate of 39,202 episodes
per 100,000 residents; 38,744 per 100,000 non-Aboriginal people with significantly more episodes of hospital care for
Aboriginal people at 48,678 per 100,000 Aboriginal residents. When comparing hospitalisation by Aboriginality across Local
Health Districts in NSW, MLHD appears to have significantly fewer hospitalisations for the Aboriginal population than NSW
and other rural LHDs, however the MLHD non-Aboriginal population has a significantly higher rate of hospitalisation than
NSW and other LHDs. This could in part be due to non-identification of Aboriginality for an admission, as 0.4 per cent of
hospitalisations in MLHD did not have Aboriginality recorded (if these were for Aboriginal people it would increase the
number of admissions by 10%). The rate of hospitalisation for Aboriginal people has increased significantly since the early
1990’s and at a much higher rate than the non-Aboriginal population; this could in part be due to increases in identification
and recording of aboriginality at admission and better access to services since the late 1990’s.
CAUSE OF HOSPITALISATION
The major category of cause of hospitalisation for Aboriginal people in Murrumbidgee LHD for 2008-09 to 2010-11 was Injury
and Poisoning making up around 16 per cent of all hospitalisations or approximately 600 hospitalisations per year at an agestandardised rate of 6,894 per 100,000 Aboriginal people in 2010-11 significantly higher than the rate of 5,033 per 100,000
non-Aboriginal people. When looking at annual data for MLHD, the number in each category fluctuates due to small
numbers, making annual comparisons difficult. Data also has been influenced by the changes in hospital coding, in particular
coding for diabetes (Table 2).
In NSW for the 10 years from 2001-02 to 2010-11 the major category for hospitalisation for Aboriginal people was Dialysis
followed by Injury and Poisoning. Compared with rates in non-Aboriginal people, hospitalisation rates in Aboriginal people in
NSW are (around):






150% higher for conditions for which hospitalisation can be avoided through prevention and early management
170% higher for diabetes
60% higher for cardiovascular diseases
250% higher for chronic respiratory diseases
50% higher for injury and poisoning
200% higher for alcohol-related conditions.
(Health Statistics NSW)
In the MLHD the rates of hospitalisation which were significantly higher in the Aboriginal population compared to the nonAboriginal population are indicated in the table as bold figures for the 95 per cent confidence interval (Table 2), these
include: cardiovascular disease; certain infectious and parasitic diseases; endocrine diseases (includes diabetes); dialysis;
injury and poisoning; maternal, neonatal and congenital causes; mental and behavioural disorders; respiratory disease; skin
and subcutaneous tissue diseases and ill-defined conditions.
6|P a g e
Public Health Unit – MLHD (Document1)
Table 2- Hospitalisation by Aboriginality, cause and year, MLHD and NSW
N = Number of hospitalisations per year
LCL= Lower limit of 95% confidence interval of standardised rate
Unk = Not stated for Aboriginality in dataset
Rate =Age Standardised rate per 100,000
UCL=Upper limit of 95% confidence interval of standardised rate
Aboriginal
Category of Cause / Year
Blood & immune system diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Cardiovascular diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Certain infectious and parasitic
diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Digestive system diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Endocrine diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Factors influencing health: dialysis
2006-07
2007-08
2008-09
2009-10
2010-11
Factors influencing health: other
2006-07
2007-08
2008-09
2009-10
2010-11
Genitourinary diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Non-Aboriginal
N
Rate
LCL
UCL
N
Rate
LCL
23
584.9
320.3
946.7
1007
324.1
22
367.6
194.4
606.2
998
315.9
20
518.3
284.9
844.7
1024
19
271.5
126.2
476.3
17
155.6
84.3
258.2
157
3146.1
2619.9
3738.5
151
3234
2665.2
3876
188
3501.3
2939.9
4126.9
170
3023.6
2536.7
178
3350
74
76
Unk
All residents
UCL
N
N
Rate
LCL
UCL
304.1
345
11
1041
327.5
307.7
348.3
296.3
336.4
0
1020
316
296.6
336.2
318.7
299.1
339.1
2
1046
317.7
298.5
337.9
1067
325.3
305.7
345.8
3
1090
326.1
306.6
346.4
1395
413
391.1
435.7
0
1412
409.3
387.8
431.6
8657 2648.9 2592.8 2705.9
66
8880
2683
2627 2739.9
8638 2599.9 2544.7
2656
51
8840 2618.3 2563.3 2674.1
9271
2791
43
9502 2758.5 2702.5 2815.3
3569.2
8623 2491.7 2438.6 2545.7
24
8817 2506.2 2453.3 2559.9
2811.1
3952.2
8802 2501.1 2448.2 2554.8
17
8997 2517.7
2465 2571.2
483.2
366.1
622.3
1608
568.8
541.1
597.6
12
1694
572.9
545.8
601.1
615.5
461.6
798.1
1416
496.6
470.8
523.5
10
1502
505.3
479.8
531.8
77
857.4
627
1130.5
1969
680
649.8
711.3
8
2054
682.4
652.7
713.1
78
858.5
621
1139.5
2058
693.8
663.5
725.1
4
2140
697.9
668.1
728.7
94
1010
786.8
1270.4
2024
678.1
648.2
709
5
2123
687.3
657.8
717.8
272
4188.3
3610.7
4820.3 12626 4262.5 4187.3 4338.6
60
12958 4273.4 4199.1 4348.6
276
3757.4
3255.4
4306.3 12729 4240.5 4165.9 4316.1
28
13033 4241.3 4167.7 4315.8
277
3962.3
3397.6
4579.7 12909 4241.7 4167.5 4316.9
45
13231 4246.4 4173.2 4320.6
324
4324.4
3783.2
4912.1 13285 4338.3 4263.3 4414.4
22
13630 4346.6 4272.5 4421.7
284
3817.3
3297.4
4385 12779 4134.6 4061.5 4208.8
21
13084 4129.3 4057.3 4202.3
2734 2677.8
61
1219
869
1642.6
2136
682.5
653.5
712.5
18
2215
695.9
666.9
725.9
89
1999.1
1532.8
2545.1
2335
738.7
708.5
769.8
6
2430
754.2
724.1
785.2
76
1400.8
1057.5
1808
2131
664
635.6
693.4
17
2224
680.2
651.8
709.5
65
1153.5
851.7
1516.5
1930
605
577.7
633.2
3
1998
610.8
583.8
638.8
58
883.1
628.7
1192.6
1467
468.8
444.5
494
9
1534
477.7
453.5
502.8
519 12498.1 11412.5 13656.6
7088
2190 2138.7 2242.2
7
7614 2321.3
387
8536.1
7682.1
9457
6788 2024.4 1976.1 2073.7
3
7178 2134.9 2085.4 2185.3
223
3786.7
3303.6
4320.3
8397 2462.3 2409.3 2516.1
42
8662 2531.2 2477.6 2585.6
432
7038.6
6389.3
7735.9
7860 2277.5 2226.7
2329
16
267
4193.5
3704.6
4728.8 12463
4479
3
591
9612.2
8656.8 10627.6 11354 3865.6 3793.9 3938.2
315
3301.9
2816.4
3829.7 12310 4114.9 4041.5 4189.3
42
12667 4104.1
344
4003.4
3488
4561.7 13048 4309.1 4234.2 4384.9
52
13444
318
3466.6
2981.7
3993.5 13083 4264.9 4190.8
4340
31
13432 4247.4 4174.6
362
3657.8
3211.3
4140.5 12793 4136.2 4063.3
4210
34
13188 4137.5 4065.8 4210.1
113
1587.3
1259
1964.9
5365
1870 1819.4 1921.6
140
2128.6
1722
2589.6
5816 1986.3 1934.6
160
2234.7
1854.9
2661.8
6107
148
2007.2
1634
160
2199.2
1810.4
4398 4318.1
2269 2374.5
8308 2391.2 2339.5 2443.8
12734 4406.7
4328 4486.6
226 12171 3996.3 3924.9 4068.7
4032 4177.1
4299 4225.6 4373.4
19
5497 1870.2 1820.4 1921.1
2039
16
5972 1992.3 1941.2 2044.4
2053 2000.7 2106.2
23
6290
2428.8
6107 2040.5 1988.3 2093.6
16
6271 2042.2 1990.8 2094.6
2636.4
6294 2071.1 2018.8 2124.3
23
6477 2079.1 2027.5 2131.7
2067 2015.2 2119.7
7|P a g e
Public Health Unit – MLHD (Document1)
4321
Aboriginal
Category of Cause / Year
Injury & poisoning
2006-07
2007-08
2008-09
2009-10
2010-11
Malignant neoplasms= cancers
2006-07
2007-08
2008-09
2009-10
2010-11
Maternal, neonatal & congenital
causes
2006-07
2007-08
2008-09
2009-10
2010-11
Mental and behavioural disorders
2006-07
2007-08
2008-09
2009-10
2010-11
Musculoskeletal & connective tissue
diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Nervous system & sense organ
disorders
2006-07
2007-08
2008-09
2009-10
2010-11
Other (incomplete records)
2008-09
2010-11
Other neoplasms
2006-07
2007-08
2008-09
2009-10
2010-11
Respiratory diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Non-Aboriginal
UCL
N
Rate
LCL
Unk
UCL
N
All residents
N
Rate
LCL
N
Rate
LCL
519
6355.9
5701.3
7054.5 15101
5105 5022.7 5188.4
161 15781 5208.3 5126.2 5291.3
497
5632.1
5059.8
6243.7 15807 5275.4 5192.1 5359.7
105 16409 5333.9 5251.3 5417.5
617
6944.9
6285.9
7644.5 16384 5356.8 5273.5
573
6263.5
612
5441
82
17083 5438.7
5690
6873.6 16560 5369.4 5286.1 5453.6
63
17197 5430.8 5348.3 5514.3
5356 5522.4
6894
6257
7570.2 15729 5033.3 4952.9 5114.6
66
16407 5108.6 5028.8 5189.3
53
1306.2
936.9
1759.5
4930 1496.4 1454.5 1539.1
36
5019 1503.2 1461.6 1545.7
46
1079.2
759
1478.2
5003 1492.8 1451.3 1535.2
25
5074 1491.5 1450.4 1533.6
58
1109.4
793
1494.3
5114 1486.3 1445.4 1528.1
22
5194 1489.6 1448.9 1531.1
43
824
568
1145.9
5339 1527.5 1486.2 1569.6
12
5393 1521.5 1480.7 1563.3
75
1601
1216.5
2057.5
5164 1451.1 1411.2 1491.8
12
5251 1455.6 1415.9 1496.1
419
3648.8
3291.1
4033.3
7355 3097.2 3026.4 3169.2
73
7847 3154.6 3084.7 3225.6
418
3653.1
3296
4037
6942 2908.4
2840
2978
50
7410 2962.9 2895.4 3031.5
460
3973.1
3602.7
4370
7179 2986.6 2917.5
3057
81
7720 3063.1 2994.7 3132.7
415
3386.6
3056.1
3742
7195 3022.5 2952.6 3093.6
48
7658 3063.7 2994.9 3133.6
462
3682
3338.7
4049.8
7083 3004.6 2934.6 3075.9
60
7605 3067.2 2998.1 3137.4
232
2902.8
2504
3342.5
2979 1092.1 1052.7 1132.7
41
3252 1165.3
202
2313.9
1984
2680.3
2804 1025.9
987.7 1065.2
29
3035 1085.2 1046.4 1125.1
191
2324.5
1993.6
2692.9
2824 1024.2
986.1 1063.4
27
3042 1072.7 1034.2 1112.1
317
3899.7
3453.4
4384.8
3282 1193.2 1151.9 1235.6
5
3603 1273.9 1231.8 1316.9
261
2984.5
2613.2
3391.5
3122 1149.3 1108.4 1191.2
32
3415 1223.3 1181.8 1265.9
95
1626.3
1263.4
2049
5721 1892.7 1843.3 1943.1
21
5837
86
1355.7
1034.4
1732.9
5772 1881.3 1832.3 1931.3
22
5880 1877.5 1829.1 1926.8
1125 1206.5
1893 1844.1 1942.8
90
1666.2
1283.6
2113.8
6051 1943.2 1893.6 1993.7
15
6156 1934.4 1885.5 1984.2
104
1547.2
1235.4
1908.1
6333 2013.7 1963.3
2065
10
6447
90
1199.6
944.4
1498.3
6311 1969.8 1920.3 2020.2
23
6424 1960.4 1911.7 2010.1
110
1425.3
1097.2
1803.4
6446 2067.9
2017 2119.7
23
6579
127
1781.5
1393.8
2223.9
6703 2109.6 2058.6 2161.4
29
6859 2114.5 2064.1 2165.9
105
1466.6
1132.4
1852.9
6449 2005.2 1955.8 2055.6
91
6645 2022.7 1973.6 2072.6
142
1659.3
1331
2031.4
6824 2101.8 2051.2 2153.3
24
6989 2112.3 2062.2 2163.4
153
1738.2
1418.1
2099
7612 2303.7 2251.1 2357.2
45
7810 2322.6 2270.3 2375.7
6
66.3
22.4
147.8
7
2.2
0.9
4.5
0
13
4.1
2.2
7.1
9
101.6
44.1
196.8
80
28.1
22.2
35.2
1
90
31.1
24.9
38.4
27
491.5
303.5
742.3
2023
662
633
691.9
3
2053
658.6
630
688.1
26
450.3
274.4
686.4
2079
667.9
639
697.7
6
2111
664
635.6
693.4
37
508.2
323.3
744.6
2256
712.6
682.9
743.1
9
2302
712.4
683.1
742.6
23
325.5
200.3
496.3
2145
673.5
644.7
703.2
9
2176
668
639.7
697.2
32
372.3
234.5
552
2394
739.4
709.4
770.3
7
2433
737.4
707.8
767.9
299
3824.5
3226.5
4476.1
6065 2030.8 1979.4 2083.2
36
6400 2077.5 2026.4 2129.5
318
4547.6
3869.5
5284.6
6884 2284.6 2230.2
2340
14
7216 2316.8
362
4855.1
4182.7
5581.9
6946 2289.4
2235 2344.8
23
7331 2333.1 2279.3 2387.9
331
3752.7
3249.4
4298.7
7004 2303.6
2249 2359.2
15
7350 2334.9 2280.9 2389.8
360
4247.9
3711.6
4827.8
7237 2366.6 2311.3 2422.9
30
7627
2006 1956.3 2056.5
2071 2020.7 2122.2
2263 2371.5
2408 2353.3 2463.7
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UCL
Aboriginal
Category of Cause / Year
Skin & subcutaneous tissue diseases
2006-07
2007-08
2008-09
2009-10
2010-11
Symptoms, signs & abnormal findings
2006-07
2007-08
2008-09
2009-10
2010-11
N
Non-Aboriginal
Unk
All residents
Rate
LCL
UCL
N
Rate
LCL
UCL
N
N
Rate
LCL
UCL
68
866
605.4
1178.3
1535
522.6
496.4
549.8
11
1614
536
509.9
563.2
62
604.3
445.4
796.3
1508
504.6
479
531.2
6
1576
515
489.4
541.4
60
603.7
444.4
796.9
1569
513.2
487.7
539.8
5
1634
521.9
496.4
548.3
83
861.8
639.3
1123.7
1635
534.6
508.4
561.8
5
1723
549.8
523.6
577
59
608.3
426.1
829.6
1590
511.4
485.9
537.8
9
1658
519.2
493.9
545.5
302
4510.5
3926.1
5147
8217 2691.9 2633.2 2751.6
44
8563 2754.7 2695.9 2814.4
313
4444.4
3876.4
5062.1
8796 2841.9 2781.9
2903
35
9144 2894.8 2834.9 2955.7
288
4199.1
3627.3
4823.1
9454 2999.2 2937.9 3061.4
24
9766 3029.5 2968.7 3091.3
355
5249.2
4625.9
5923.5 10149 3175.2 3112.4 3238.9
15
10520
325
4808.5
4204.9
5463.8
17
10223 3092.6 3031.6 3154.6
9881 3057.2 2995.8 3119.6
3217 3154.6 3280.4
POTENTIALLY PREVENTABLE HOSPITALISATIONS (PPH)
Potentially Preventable Hospitalisations (also known as Ambulatory Care Sensitive Conditions) are those which are
considered potentially avoidable through preventive care and early disease management. In NSW over the period 1993-94 to
2010-11, PPH rates in Aboriginal people were consistently more than double those in non-Aboriginal people, both overall and
in each of the vaccine-preventable, acute and chronic categories. In 2010-11, in MLHD, the rate of PPH for Aboriginal people
was 6,914 per 100,000, more than double the rate for non-Aboriginal people of 3,149 per 100,000. The PPH rate for
Aboriginal people in MLHD was also significantly higher than the NSW rate for Aboriginal people of 5,770 per 100,000, but
lower than for other rural LHDs. Where the trend in PPH rates for non-Aboriginal people has been gradually decreasing since
the early 1990s the rate of PPH for Aboriginal people has been increasing (this is again influenced by increased identification
of Aboriginality as well as coding changes for diabetes). After July 2010, numbers and rates were affected by a significant
change in coding standards for diabetes, a substantial contributor to total preventable hospitalisations.
Figure 4 - Potentially Avoidable Hospitalisations 1993-94 to 2010-11, by Aboriginality, MLHD
Sources: NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of
Health.
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SIGNIFICANT ISSUES:



Significant improvements in health outcomes (and reductions in hospitalisations) for Aboriginal people could be
made through preventive care and early disease management as well as management of certain conditions outside
the hospital system.
Even though the identification and recording of Aboriginality in the hospital data sets is reported to be low,
Aboriginal people are over-represented in hospital statistics for some causes.
Reporting/recording of Aboriginality in the hospital data in MLHD could be improved.
HEALTH CONDITIONS AND RISKS
Figure 5
From Health Statistics NSW:
Chronic conditions such as cardiovascular disease and kidney disease share common risk factors, such as tobacco smoking,
physical inactivity, poor diet and heavy alcohol consumption. Kidney damage is often caused by diabetes, and risk factors for
kidney failure include high blood pressure, infections, low birth weight and obesity.
In the National Aboriginal and Torres Strait Islander Health Survey 2004-05, 29% of Aboriginal people reported their health as
poor or fair, compared with 16% of non-Aboriginal people. Almost half the Aboriginal respondents (47%) reported having
three or more long term conditions (such as kidney disease, asthma, bronchitis, migraine, diabetes, high cholesterol, cancers
and infectious diseases), compared with 36.5% of non-Aboriginal people.(Figure 5)
Using body mass index calculated from self-reported height and weight, the rate of overweight and obesity among Aboriginal
people was 25% higher than among non-Aboriginal people. Diabetes and high blood sugar were 170% higher among
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Aboriginal people than among non-Aboriginal people, and the asthma rate among Aboriginal people was double the rate (i.e.
100% higher) among non-Aboriginal people.
Table 3 - Hospitalisation for select causes by Aboriginality, MLHD and NSW 2010-11.
Hospitalisation cause
Diabetes
Number
MLHD
NSW
Alcohol attributable
MLHD
NSW
Smoking attributable
MLHD
NSW
Aboriginal
Non-Aboriginal
Aboriginal
Non-Aboriginal
Aboriginal
Non-Aboriginal
Aboriginal
Non-Aboriginal
Aboriginal
Non-Aboriginal
Aboriginal
Non-Aboriginal
41
666
573
10,326
142
1,964
2,185
46,126
119
2,668
1,423
42,651
Rate
605.1
210.4
513.9
137.8
1,641.9
662.8
1,681.0
624.6
2,052.3
757.7
1,587.8
538.8
LCL
401.8
194.3
464.6
135.1
1,363.3
633.0
1,605.1
618.9
1,643.4
728.8
1,491.1
533.6
UCL
862.1
227.5
566.3
140.5
1,957.5
693.6
1,759.5
630.4
2,873.3
787.5
1,688.3
543.9
DIABETES
Rates of hospitalisation in 2010-11 for diabetes related causes in Aboriginal people of MLHD were significantly higher than
for the non-Aboriginal population (Table 3); however the rates were not significantly higher than the rates for all Aboriginal
people in NSW. Diabetes hospitalisation for Aboriginal people in MLHD occurred at an age-standardised rate three times that
of non-Aboriginal people and in NSW close to four times higher.
ALCOHOL
Alcohol consumption is the preventable risk factor responsible for the largest burden of premature death and disability in
males under the age of 45 years. Drinking alcohol at risk levels to health was reported by approximately four in ten Aboriginal
adults in the NSW Health Survey results from 2006-2009 (Figure 6).
Figure 6
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Hospitalisations regarded as being attributable to alcohol consumption occurred at a rate of 1,642 hospitalisation per
100,000 Aboriginal people in MLHD (2010-11) which is 2.5 times the rate for non-Aboriginal people in MLHD and slightly
higher than the rate for Aboriginal people in all NSW (Table 3 - Hospitalisation for select causes by Aboriginality, MLHD and
NSW 2010-11.Table 3). Alcohol attributable hospitalisations for Aboriginal people have risen steadily since the early 1990’s in
MLHD but have remained relatively steady for non-Aboriginal people in MLHD for the same period.
SMOKING
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 drugs combined. It is a major risk factor for cardiovascular disease and
cancer. In NSW over the period 2006-2009 approximately one in three Aboriginal males and females aged 16 years or over
were current smokers, which was double the reported rate for non-Aboriginal people (
Figure 6). The reported rate of smoking for Aboriginal adults has significantly decreased since 2002-2005. For the former
Greater Southern Area (approximately MLHD plus Southern NSW LHD) for 2006-2009, the adult Aboriginal smoking rate was
50 per cent, compared to around 34 per cent of Aboriginal adults (NSW Health Survey results).
Hospitalisations regarded as being attributable to tobacco smoking occurred at a rate of 2,052 hospitalisation per 100,000
Aboriginal people in MLHD (2010-11) which is 2.7 times the rate for non-Aboriginal people in MLHD and slightly higher than
the rate for Aboriginal people in all NSW, but not significantly so (Table 3 - Hospitalisation for select causes by Aboriginality,
MLHD and NSW 2010-11.). Smoking attributable hospitalisations for Aboriginal people have increased since the early 1990’s
to 2010-11 for Aboriginal males and females in NSW, but decreased for non-Aboriginal people, similarly in MLHD the rates of
smoking attributable hospitalisations have increased for Aboriginal people and decreased slightly for non-Aboriginal people
for the same period.
Smoking during pregnancy can increase the risk of pregnancy complications as well as premature births, low birth weight
babies and the risk of stillbirths; as smoking reduces the oxygen supply to the baby in the womb. 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) compared to 10.1 per cent of all mothers in NSW and of 17.3
per cent of all mothers in MLHD.
INJURY
Injury and poisoning hospitalisation for Aboriginal people of MLHD was significantly higher than non-Aboriginal people at
around 1.4 times the rate (Table 2). Deaths from injury and poisoning for Aboriginal people in NSW made up 12 per cent of
deaths compared to 5 per cent for non-Aboriginal people. Aboriginal people are more likely than non-Aboriginal people to
be victims of inter-personal violence. In NSW in the past 20 years the rate of hospitalisation for interpersonal violence was
consistently five times higher in Aboriginal people compared to non-Aboriginal people.
SIGNIFICANT ISSUES:



Smoking rates, including smoking during pregnancy
Alcohol consumption
Injury prevention
MATERNAL AND CHILD HEALTH
INFANT MORTALITY
Aboriginal infant mortality was 6.8 per 100,000 live births in NSW in 2007-2009. The rates of Aboriginal infant mortality are
closer to rates of Indigenous communities in other countries than they are to rates in the general population of Australia (4.3
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deaths per 1,000 live births in 2007-2009). Infant mortality in the Aboriginal population of NSW has approximately halved
since 1998-2000. Infant mortality is the number of deaths in children aged up to one year per 1,000 live births.
PERINATAL DEATH
Perinatal deaths include stillbirths or deaths within 28 days of birth and only include those reported to the Perinatal Data
Collection (PDC), deaths occurring after discharge or transfer of the baby may not be included, and Aboriginality is not well
reported, such that there is likely to be an under-reporting of true number by around 30%. In NSW, the perinatal death rate
in babies born to Aboriginal mothers was higher than to non-Aboriginal mothers from 1991 to 2010, although the rate has
decreased from around 20-25 deaths per 1,000 live births to around 15 deaths per 1,000 live births compared to around 9-10
per 1,000 live births to non-Aboriginal mothers. In general, perinatal mortality rates are higher among teenage mothers and
Aboriginal teenage mothers make up 5 times the proportion of Aboriginal mothers compared to non-Aboriginal mothers.
LOW BIRTH WEIGHT
Low birth weight babies (birth weight less than 2,500 grams) have a greater risk of poor health and dying, require longer
hospitalisation after birth, and are more likely to develop disabilities. Low birth weight is also an indication of the health and
care of the mother during pregnancy. In NSW in 2010, the proportion of low birth weight babies among Aboriginal mothers
was around double the proportion in non-Aboriginal mothers, this proportion has not changed over the past twenty years
(Health Statistics NSW). It is difficult to analyse data for births in the MLHD as only births occurring in NSW facilities or
attended by NSW midwives are recorded in the NSW Midwives Data Collection. MLHD has significant patient flows across
State borders to Victoria (including all births to mothers of Albury LGA and surrounding areas) and the Australian Capital
Territory. Where a birth occurred in NSW for MLHD residents in 2007, around seven per cent of babies of Aboriginal mothers
were of low birth weight compared to around five per cent of babies with non-Aboriginal mothers. Another data source is
the locally collected data for the Universal Home Visit and Safe Start programs. In this data-base for the period July 2011 to
May 2012, there were 3,083 births to MLHD mothers with 228 families identifying as Aboriginal (approximately 7% of births).
Six per cent of all babies born in MLHD were low birth weight babies during this period, five per cent of non-Aboriginal babies
were low birth weight and nine per cent of Aboriginal babies. Aboriginal babies made up seven per cent of all births in MLHD
but twelve per cent of all low birth weight babies.
ANTENATAL CARE
Antenatal care should commence as early as possible in pregnancy to ensure the best outcomes for the mother and baby. In
NSW for the period 1996 to 2010, the proportion of Aboriginal mothers who attended their first antenatal visit before 14
weeks gestation increased from 44 per cent to 71 per cent. However the proportion is still below that recorded for nonAboriginal mothers. For MLHD-based mothers giving birth in NSW, 75 per cent of Aboriginal mothers attended their first
antenatal visit before 14 weeks gestation compared to 88 per cent of non-Aboriginal mothers. Antenatal visits prior to 20
weeks gestation were reported by 87 per cent of Aboriginal mothers and 95 per cent of non-Aboriginal mothers in MLHD in
2010 compared to 84 per cent of Aboriginal mothers and 92 per cent of non-Aboriginal mothers in NSW. The proportion of
Aboriginal women in MLHD attending antenatal care has been gradually increasing from 1996 to 2010
PREMATURITY
Births for a gestational age less than 37 weeks are classified as premature. In NSW in period 2009-2010, 7.3 per cent of all
babies were premature; 11 per cent of Aboriginal babies and 7.2 per cent of non-Aboriginal babies. For the MLHD from the
NSW-based births; 7.3 per cent of Aboriginal babies were premature compared to 6.3 per cent of non-Aboriginal babies. The
proportion of Aboriginal babies born prematurely has decreased slightly since 2000-01 to 2009-10.
ACUTE RESPIRATORY INFECTIONS
In 2010-11, hospitalisation rates for acute respiratory infections in Aboriginal children (younger than 5 years) were 7393.1
per 100,000 population for males and 5317.8 per 100,000 for females. The rates have generally been 70-80% higher among
Aboriginal children than among non-Aboriginal children. Rates for male Aboriginal children have been 30-40% higher than for
females. Across all ages, rates in the Aboriginal population have been twice the rates in the non-Aboriginal population.
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Housing has been identified as a major factor affecting the health of Aboriginal people. Inadequate or poorly maintained
housing and the absence of functioning infrastructure can pose serious health risks. Overcrowded dwellings and poor quality
housing can lead to the spread of infectious diseases. (Health Statistics NSW)
Note: acute respiratory infections include various acute upper and lower respiratory infections, influenza and pneumonia.
IMMUNISATION
At the end of December 2010, 91.8 per cent of Aboriginal children in MLHD (excluding Albury LGA) and 100 per cent of
Aboriginal children in Albury LGA aged 12-15 months were fully immunised compared to 93.4 per cent of all children in
MLHD and 94.4 per cent in Albury LGA. In NSW for the same period, 88.3 per cent of Aboriginal children aged 12-15 months
were fully immunised compared to 91.5 per cent of all children of that age.
SIGNIFICANT ISSUES:



Increasing antenatal care at very early stages of pregnancy to assess risks and improve health outcomes.
Educate pregnant women and families about the risk factors associated with perinatal morbidity and mortality i.e.
reducing alcohol and tobacco use in pregnancy and promote breastfeeding.
Transport services, whether provided by public system, Aboriginal Community Controlled Organisations or the AMIHS
team, are essential for access to care.
CURRENT STAFFING IN MLHD
Figure 7 - Location of Aboriginal Health Staff and Aboriginal populations in MLHD, 2011
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Aboriginal Health Staff in MLHD consists of a Manager in Albury and Aboriginal Health Education and Hospital Liaison Officers
(AHEO_LO) in other centres across the District, as well as the Aboriginal Maternal Infant Health Strategy (AMIHS) staff;
Chronic Care; and Home Visiting (Table 4). Murrumbidgee LHD employs many Aboriginal people throughout the District who
bring their expertise to areas such as Mental Health and Drug and Alcohol as well as Aboriginal traineeships in mental health,
Environmental Health and administration. Most staff are centred where the large populations of Aboriginal people reside,
Albury, Wagga Wagga and Griffith and provide outreach to other areas. Some Aboriginal people in MLHD live 100 to 200km
from specialist staff requiring long distance travel by either MLHD staff or Aboriginal clients, this is of particular note in West
Wyalong, Young, Boorowa and Hay regions (Figure 7).
Other organisations with an Aboriginal health focus within the MLHD - but not funded by MLHD - are the Aboriginal Medical
and Dental Health Services in Albury and Wagga Wagga and the Griffith Aboriginal Medical Service as well a as programs run
through the Medicare Locals.
Table 4 – MLHD Staff either employed by Aboriginal Health or with an Aboriginal health focus, August 2011
Location
Service
FTE
Position
Albury Area Office
Aboriginal Health
1.0
Manager Aboriginal Health
Albury Area Office
Aboriginal Health
1.0
Team Leader Aboriginal Health
Albury Area Office
Aboriginal Health
1.0
Coordinator Aboriginal Maternal Infant Health Strategy
Albury Area Office
Public Health
1.0
Aboriginal Environmental Health Officer
Albury CHC
Aboriginal Health
1.0
Aboriginal Health Education/Hospital Liaison Officers
Albury CHC
Aboriginal Health
Vacant
Aboriginal Health Education/Hospital Liaison Officers
Deniliquin CHC
Aboriginal Health
1.0
Aboriginal Health Education/Hospital Liaison Officers
Griffith Hospital
Aboriginal Health
Vacant
Team Leader Aboriginal Health
Griffith CHC
Aboriginal Health
Vacant
Aboriginal Health Education/Hospital Liaison Officers
Griffith Hospital
Aboriginal Health
2 x 0.6
Aboriginal Maternal Infant Health Strategy
Lake Cargelligo
Aboriginal Health
2 x 0.2
Aboriginal Maternal Infant Health Strategy
Lake Cargelligo
Aboriginal Health
0.8
Aboriginal Health Education/Hospital Liaison Officers
Leeton CHC
Aboriginal Health
0.8
Aboriginal Health Education/Hospital Liaison Officers
Narrandera CHC
Aboriginal Health
1.0
Aboriginal Health Education/Hospital Liaison Officers
Narrandera CHC
Aboriginal Health
2 x 0.6
Aboriginal Maternal Infant Health Strategy
Tumut CHC
Aboriginal Health
2 x 1.0
Aboriginal Health Education/Hospital Liaison Officers
Wagga Aboriginal Health Unit
Aboriginal Health
1.0
Coordinator Chronic Care
Wagga Aboriginal Health Unit
Aboriginal Health
1.0
Administrative assistant
Wagga CHC
Aboriginal Health
1.0
Aboriginal Health Chronic Care
Wagga CHC
Aboriginal Health
1.0
Aboriginal Health Education/Hospital Liaison Officers
Wagga CHC
Aboriginal Health
2 x 1.0
Wagga CHC
Aboriginal Health
1.1
Aboriginal Home Visiting
Aboriginal Maternal Infant Health Strategy
*Vacant positions are currently being recruited
IN SUMMARY
Socioeconomic disadvantage is a key determinant of health and Aboriginal people in NSW experience significant
disadvantage compared to non-Aboriginal people. Aboriginal people have lower household incomes than the general
population which is contributed to by lower labour force participation, school retention rates, and lack of post school
qualifications.
The higher burden of disease in the Aboriginal population is due largely to preventable disease such as cardiovascular
disease; type 2 diabetes; mental disorders; chronic respiratory disease; and cancer, the major risk factors for which are
tobacco, overweight, physical inactivity and alcohol (Aboriginal Health Report Card).
The MLHD should continue to work in partnership with the Aboriginal population to improve lifestyles with focus on diet,
exercise, tobacco use, and alcohol consumption. In addition the health service should work towards providing culturally
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appropriate health care services which enable early detection and treatment of conditions to avoid disease progression and
hospitalisation and sustain the Aboriginal Maternal Infant Health Service (AMIHS) where partnership between the
AHEO/Midwife is a crucial factor in the provision of culturally appropriate care. The health service needs to ensure that
Aboriginal people are correctly identified in data collection systems to improve the quality of our health data and accuracy of
health indicator reporting.
MORE INFORMATION





Health Statistics NSW, online www.healthstats.nsw.gov.au
Reports complied from Health Statistics NSW for Aboriginal populations available from:
www.gsahs.nsw.gov.au/gsho/refreplink.html
o Health Statistics reports Burden of disease (deaths and hospitalisations)
o Health Statistics reports Maternal and child health
o Health Statistics reports Health Conditions and risk behaviours
2006-2009 Report on Adult Aboriginal Health from the NSW Health Survey (former Area Health Service data)
www.health.nsw.gov.au/publichealth/surveys/hsa/0609ab/index.asp
Aboriginal Health in NSW www.health.nsw.gov.au/publichealth/aboriginal/index.asp
Aboriginal Health Report Card www.healthstats.nsw.gov.au/ContentText/Display/ReportCards
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