SLHD Picture of Health · Sydney Local Health District Picture of Health List of Figures Figure 1:...

A Picture of Health

Sydney Local Health DistrictHealth Profile

2015

Copies of this document can be downloaded from the SLHD website at: http://www.slhd.nsw.gov.au/planning/profiles.html

Enquires in relation to this profile should be directed to: Dr Pamela Garrett

Director, Planning

SLHD Planning Unit

Telephone: 02 9515 9517

Email: [email protected]

Date of Publication: December 2015

Population Projection Data updated April 2017

http://www.slhd.nsw.gov.au/planning/profiles.html

mailto:[email protected]

Sydney Local Health District Picture of Health

Table Of Contents Introduction ............................................................................................................................................... 4 Geography and Transport ........................................................................................................................ 4 The Population of SLHD ........................................................................................................................... 6 Characteristics of our local population ................................................................................................ 11

Education and Occupation .................................................................................................................... 11 Economic Resources ............................................................................................................................ 12 Family Characteristics ........................................................................................................................... 13 Dwelling Characteristics ........................................................................................................................ 14 Homelessness ....................................................................................................................................... 14 Socioeconomic Status ........................................................................................................................... 15 Food Security ........................................................................................................................................ 18

Priority Population Groups .................................................................................................................... 18 Aboriginal People .................................................................................................................................. 18 People from Culturally and Linguistically Diverse Backgrounds ........................................................... 19 Humanitarian Arrivals ............................................................................................................................ 22 People with Disability ............................................................................................................................ 23 Carers .................................................................................................................................................... 23 Older People ......................................................................................................................................... 24

Health Status and Lifestyle Behaviours ............................................................................................... 25 Smoking ................................................................................................................................................ 25 Alcohol ................................................................................................................................................... 27 Overweight and Obesity ........................................................................................................................ 28 Illicit Drug Use ....................................................................................................................................... 29

Priority Health Areas ............................................................................................................................... 36 Cancer ................................................................................................................................................... 36 Cancer Screening ................................................................................................................................. 38 Maternal Health ..................................................................................................................................... 39 Injury and Poisoning .............................................................................................................................. 40

Infectious Diseases ................................................................................................................................ 40 TB…………. .......................................................................................................................................... 40 HIV……….. ............................................................................................................................................ 40 Chlamydia ............................................................................................................................................. 42 Gonorrhoea ........................................................................................................................................... 43 Infectious Syphilis ................................................................................................................................. 44 Hepatitis B ............................................................................................................................................. 45 Hepatitis C ............................................................................................................................................. 46

Chronic Diseases .................................................................................................................................... 47 Diabetes ................................................................................................................................................ 47 Respiratory Disease .............................................................................................................................. 49 Cardiovascular Disease ........................................................................................................................ 49 Musculoskeletal Conditions ................................................................................................................... 50 Oral Health ............................................................................................................................................ 50 Dementia ............................................................................................................................................... 51 Mental Health ........................................................................................................................................ 52

Mortality ................................................................................................................................................... 54 Appendices ................... ……………………………………………………………………………….. ……55

Appendix 1: SLHD population profile (2011 Census Estimated Resident Population) ............................. 55 Appendix 2: Health of the SLHD population, selected indicators ............................................................. 58

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List of Figures Figure 1: SLHD estimated resident population, by age and gender, 2014 ............................................. 6

Figure 2: Estimated resident population, by age and gender, SLHD and NSW, 2014 ........................... 7

Figure 3: Babies born to SLHD residents, 2006-2013 ............................................................................ 9

Figure 4: Projected population of SLHD, by LGA, 2011-2031 .............................................................. 10

Figure 5: Projected population SLHD, by age groups, 2011-2031 ....................................................... 11

Figure 6: Index of education and occupation, by SA1, SLHD LGAs, 2011 ......................................... 12

Figure 7: Index of economic resources, by SA1, SLHD LGAs, 2011 ................................................... 13

Figure 8: Index of relative socioeconomic disadvantage, by SA1, SLHD LGAs, 2011 ........................ 17

Figure 9: Food insecurity experienced among adults, SLHD, 2002- 2014 ........................................... 18

Figure 10: Smoking during pregnancy, SLHD, 2000- 2013 .................................................................. 26

Figure 11: Alcohol attributable hospitalisations, comparison by Aboriginality, NSW ............................ 27

Figure 12: Acute hospital separations at RPA Hospital, by LHD of residence, 2013-14 ...................... 32

Figure 13: Acute hospital separations at Concord Hospital, by LHD of residence, 2013-14 ................ 33

Figure 14: Separations at Canterbury Hospita,l by LHD of residence, 2013 -14 .................................. 34

Figure 15: Separations at Balmain Hospital, by LHD of residence, 2013 -14 ...................................... 35

Figure 16: Cancer projections by site, SLHD residents, 2011, 2016 and 2021 .................................... 38

Figure 17: Number and rate of HIV infection notication, 2005 - 2014 .................................................. 41

Figure 18: HIV notification rate, by LGA, 2005 - 2014 ......................................................................... 41

Figure 19: Chlamydia notification rate, by SLHD and NSW, 2010 - 2014 ............................................ 42

Figure 20: Gonorrhoea notification rate, by SLHD and NSW, 2010 - 2014 .......................................... 43

Figure 21: Gonorrhoea notification rate, by LGA, 2005 - 2014 ............................................................. 43

Figure 22: Infectious syphilis notification rate, by SLHD and NSW, 2010 - 2014 ................................ 44

Figure 23: Infectious Syphilis notification rate, by LGA, 2005 – 2014 .................................................. 44

Figure 24: Hepatitis B notification rate, by SLHD and NSW, 2005 - 2014 ............................................ 45

Figure 25: Hepatitis B notification rate (per 100,000), by LGA, 2005 – 2014 ....................................... 45

Figure 26: Hepatitis C notification rate, by SLHD and NSW, 2005 - 2014 ........................................... 46

Figure 27: Hepatitis C notification rate by LGA, 2005 – 2014 ............................................................... 46

Figure 28: SLHD National Diabetes Services Scheme (NDSS) registrants, June 2015 ...................... 48

Figure 29: Suicide rates per 100,000, SLHD residents, 2001-2012 ..................................................... 53

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List of Tables Table 1: Estimated resident population of SLHD, by age and gender, 2014 .......................................... 6

Table 2: Births in SLHD, by Statistical Local Area, 2008 - 2013............................................................. 9

Table 3: Projected population, by SLHD, 2011-2031 ........................................................................... 10

Table 4: Projected population, by SLHD, by selected age groups, 2011-2031 .................................... 10

Table 5: Proportion low and high household incomes, by LGA, SLHD and NSW 2011 ....................... 13

Table 6: Housing tenure, by LGA, SLHD and NSW, 2011 ................................................................... 14

Table 7: Ranking of SLAs, by Index of relative socioeconomic disadvantage, 2011 ........................... 16

Table 8: Ten most disadvantaged suburbs in SLHD, 2011 .................................................................. 16

Table 9: SLHD resident birthplace and english proficiency, 2011 ........................................................ 20

Table 10: Health differences, by key countries of birth ......................................................................... 21

Table 11: Top 10 languages spoken at home, inpatient separations, by hospital, 2013 -14 ............... 22

Table 12: Inpatient separations in SLHD facilities, by hospital and country of birth, 2013 -14 ............. 22

Table 13: LGA of initial settlement for humanitarian entrants, SLHD, 2010 to 2015 ............................ 23

Table 14: Health behaviours of the residents, by SLHD and NSW ...................................................... 25

Table 15: Smoking-related hospitalisations, SLHD residents and NSW .............................................. 26

Table 16: Smoking in pregnancy, SLHD and NSW, 2013 .................................................................... 27

Table 17: Alcohol-attributable hospitalisations, SLHD residents and NSW .......................................... 28

Table 18: High body mass index-attributable hospitalisations and deaths for SLHD residents ........... 29

Table 19: Ten most common service related groups (SRGs) for hospitalisations, 2013 -14 ............... 31

Table 20: Ten most common SRGs for hospitalisations at RPA Hospital, 2013 -14 ............................ 32

Table 21: Ten most common SRGs for hospitalisations at Concord Hospital, 2013 -14...................... 33

Table 22: Ten most common SRGs for hospitalisations at Canterbury Hospital, 2013-14 .................. 34

Table 23: Ten most common SRGs for hospitalisations at Balmain Hospital, 2013-14 ....................... 35

Table 24: Cancer Incidence, SLHD and NSW, 2004 -2008 .................................................................. 36

Table 25: Cancer mortality, SLHD and NSW, 2004 -2008 ................................................................... 37

Table 26: Cancer screening rate, by SLHD residents, 2009 -10 .......................................................... 38

Table 27: Maternal Health Indicators, by SLHD and NSW, 2012 - 2013 .............................................. 39

Table 28: HIV notification rate, by LGA, 2005-2014 ............................................................................. 41

Table 29: Chlamydia notification rate, by LGA, 2005 to 2014 .............................................................. 42

Table 30: Gonorrhoea notification rate, by LGA, 2005-2014 ................................................................ 43

Table 31: Infectious syphilis notification rate, by LGA, 2005 – 2014 ................................................... 44

Table 32: Hepatitis B age-standardised notification rate, by LGA, 2005 – 2014 ................................. 45

Table 33: Hepatitis C age-standardised notification rate, by LGA, 2005 – 2014 .................................. 46

Table 34: Respiratory disease related hospitalisations, SLHD and NSW, 2013 -14 ............................ 49

Table 35: Oral health status of NSW and Australian adults, 2004-06 .................................................. 51

Table 36: Fall-related injury overnight stay hospitalisations, by sex, SLHD, 2013-14 .......................... 51

Table 37: Deaths by category of cause and gender, SLHD, 2011-2012 .............................................. 54

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Introduction This health profile is one of a series describing key demographic and health characteristics of the Sydney Local Health District (SLHD, or the District) population, while also providing, where possible, comparisons with the population of NSW. The health profile provides: • a brief description of the District and its location within NSW; • the current and projected population; • key demographic characteristics including Aboriginality, countries of birth, languages

spoken, income, labour force and socioeconomic status; • selected indicators of health including health behaviours, births and maternal health,

chronic disease, mental health, cancer, mortality and morbidity; • patient flow patterns; and • selected projections of health service need.

Geography and Transport SLHD is centrally located in the Sydney metropolitan area, positioned directly west of the Sydney central business district (CBD). In 2015 the District covered the eight Local Government Areas (LGAs) of Ashfield, Burwood, Canada Bay, Canterbury, City of Sydney (Sydney South and West Statistical Local Areas only), Leichhardt, Marrickville and Strathfield. The SLHD encompasses a total land area of 126 square kilometres with a population density of 4,890 residents per square kilometre. In 2016, the NSW Government implemented a program to amalgamate local government administrations. By the end of 2016 twenty new local councils had been created, and eleven “merger proposals” were pending. SLHD previously engaged with eight local governments and the current amalgamations have reduced this to six. The previous Ashfield, Marrickville and Leichhardt Councils have been amalgamated into the Inner West Council and Canterbury and Bankstown Councils have been amalgamated to make the Canterbury – Bankstown Council. SLHD is the only local health district that does not sit wholly within these new local government boundaries. SLHD will cross the newly created Canterbury-Bankstown Council. Canterbury-Bankstown is shared with South Western Sydney Local Health District (SWSLHD). SLHD remains bounded by Western Sydney LHD and South Western Sydney LHD to the west, South Eastern Sydney LHD to the south and east and Northern Sydney LHD across the Parramatta River. The District incorporates a large part of Sydney’s global economic corridor, including high density commercial precincts, a strong employment base, and extensive health, education and sporting facilities. Key industries located in the District supporting the state’s economy include finance, services, education, retail, creative arts and information and communication technologies. The two world-renowned education and research precincts in Broadway/Ultimo and Camperdown are within the District’s borders.

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The District is strongly connected within the Sydney metropolitan area by well-utilised road networks and various public transport options. However, the rising population density of the area coupled with greater freight movements in and out of Port Botany has led to increasing pressure on local roads and on public transport, with congestion and overcrowding common in peak commuter periods. Initiatives planned by the State Government to address transport issues include delivering: • the CBD and South East light rail from Circular Quay to Central Station then to

Randwick, and extending the network to Dulwich Hill; • a networked cycleway and additional bus routes; • the Sydney Metro train system, linking the Metro Northwest and Southwest to the Metro

City through a harbour crossing to Sydenham; and • the WestConnex, which includes:

o Stage 1: Widening of the M4 and Extension of the M4 via a tunnel to Parramatta Road and City West Link, Haberfield,

o Stage 2: Extension of the M5 which will run from the existing M5 East Corridor at Beverly Hills via a tunnel to St Peters, and

o Stage 3: A motorway tunnel between the first two stages, linking the M4 and M5 corridors. Stage 3 is due to open to traffic in 20231.

1 Roads and Maritime Services, 2015, WestConnex: http://www.westconnex.com.au/explore_the_route/index.html

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The Population of SLHD Population Size and Structure The District provides healthcare to approximately 640,000 SLHD residents, as well as to a large population of non-SLHD people who require the tertiary and quaternary healthcare services of the District, such as trauma care, intensive care and transplantation surgery. Figure 1 and Table 1 below demonstrate the 2016 estimated local population breakdown by five year age groups. The age cohorts with the largest representation in the District are 25-29 years, followed by 30-34 years and 35-39 years. Figure 1: SLHD estimated resident population, by age and gender, 2016

Source: NSW Department of Planning & Environment Population and Household Projections, 2016 *Sydney South and Sydney West SLAs only Table 1: Estimated resident population of SLHD, by age and gender, 2016

Age group Males % of age Females % of age Total % of total 0-4 years 21,200 7% 20,250 6% 41,450 6.4% 5-9 years 16,790 5% 15,860 5% 32,650 4.9%

10-14 years 13,760 4% 13,000 4% 26,760 4.0% 15-19 years 13,910 4% 13,940 4% 27,850 4.5% 20-24 years 22,930 7% 24,130 8% 47,060 8.2% 25-29 years 33,860 11% 33,760 11% 67,620 10.9% 30-34 years 34,870 11% 33,800 11% 68,670 10.6% 35-39 years 28,930 9% 27,410 9% 56,340 8.4% 40-44 years 24,650 8% 23,750 7% 48,400 7.6% 45-49 years 21,350 7% 21,110 7% 42,460 6.5% 50-54 years 19,060 6% 19,060 6% 38,120 6.1% 55-59 years 16,850 5% 17,090 5% 33,940 5.2% 60-64 years 13,800 4% 14,750 5% 28,550 4.5% 65-69 years 12,140 4% 12,520 4% 24,660 3.8% 70-74 years 9,110 3% 9,560 3% 18,670 2.8% 75-79 years 6,860 2% 7,660 2% 14,520 2.3% 80-84 years 5,000 2% 5,850 2% 10,850 1.7% 85+ years 4,290 1% 6,670 2% 10,960 1.6%

Total 319,360

49.9% 320,170 50.1% 639,530 100% Source: NSW Department of Planning & Environment Population and Household Projections, 2016 *Sydney South and Sydney West SLAs only

6.6% 5.3%

4.3% 4.4%

7.2% 10.6% 10.9%

9.1% 7.7%

6.7% 6.0%

5.3% 4.3%

3.8% 2.9%

2.1% 1.6%

1.3%

6.3% 5.0%

4.1% 4.4%

7.5% 10.5% 10.6%

8.6% 7.4%

6.6% 6.0%

5.3% 4.6%

3.9% 3.0%

2.4% 1.8%

2.1%

14% 12% 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% 14%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+SLHD Females 2016 SLHD Males 2016

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Figure 2 is a comparison of the 2016 SLHD and NSW population structure. This figure shows that SLHD had a greater proportion of adults between 20 to 44 years of age than the state. Most other groups were proportionately underrepresented in the District. The burgeoning of younger adults in their 20’s, 30’s and early 40’s in the District is thought to be due to a preference for proximity to jobs, education and services. Figure 2: Estimated resident population, by age and gender, proportion of total, SLHD and NSW, 2016

Source: NSW Department of Planning & Environment Population and Household Projections, 2016 *Sydney South and Sydney West SLAs only

In 2015-16, some of the largest population increases in New South Wales occurred in the SLHD SA2 of Waterloo - Beaconsfield (2,400) 2, large amonuts of growth were also seen in the outer south-west and in the north-west of greater Sydney. Greater Sydney also contained nine of the ten fastest-growing SA2s in New South Wales. Cobbitty - Leppington was the fastest growing SA2 (28%). This was followed by Riverstone - Marsden Park (24%), Homebush Bay - Silverwater (12%), Waterloo - Beaconsfield and Mascot - Eastlakes (both 7.9%).

2 Australian Bureau of Statistics, Regional Population Growth, Australia, 2015-16 Cat.no. 3218.0, Canberra: ABS, viewed April 2017 from http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/3218.0Main%20Features202015-16?opendocument&tabname=Summary&prodno=3218.0&issue=2015-16&num=&view

14% 12% 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% 14%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

SLHD Females 2016 NSW Females 2016 SLHD Males 2016 NSW Males 2016

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http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/3218.0Main%20Features202015-16?opendocument&tabname=Summary&prodno=3218.0&issue=2015-16&num=&view

http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/3218.0Main%20Features202015-16?opendocument&tabname=Summary&prodno=3218.0&issue=2015-16&num=&view


New Dwelling Constructions In 2015, Sydney LGA had the highest net dwelling completions (948) across the state3. Local Environmental Plans (LEPs) for local governments within SLHD indicate continued planned growth over the next decade: • City of Sydney LEP plans for an additional 50,000 new homes (including Glebe

Affordable Housing Project) and 52,000 jobs; • Canada Bay Council over 10,000 dwellings; • Burwood Council over 5,000 additional dwellings; • Strathfield Council 4,110 new homes; • Marrickville Council over 4,000 new homes and 1,100 new jobs; and • Ashfield Council over 2,000 dwellings and 1,400 jobs.

Significant planned urban developments in the SLHD may further impact on the expected population numbers. Key urban renewal projects include:

• continued development in Green Square, with work to progress the Green Square Town Centre having commenced in July 2014 to accommodate a further 1,800 dwellings and introduce 6,000 new jobs to the area;

• urban renewal along the Parramatta Road corridor, which will aim to deliver 50,000 new dwellings and 50,000 jobs;

• the Bays Precinct urban transformation, to regenerate waterfront areas in and around Blackwattle Bay including the Sydney Fish Market, Rozelle Bay, Rozelle Rail Yards and the heritage-listed White Bay Power Station;

• the Central to Eveleigh urban transformation and transport program, which will gradually transform 80 hectares of government-owned land in and around the rail corridor from Central to Macdonaldtown and Erskineville stations; and

• continued developments in Breakfast Point, Burwood, Strathfield/Homebush and Redfern/Waterloo.

Nearby developments in Western Sydney LHD that will impact on the SLHD include the development of the Sydney Olympic Park site, Wentworth Point, Carter Street-Lidcombe, Rhodes, and a range of private developments.

3 NSW Department of Planning & Infrastructure (2015), Metropolitan Development Program Quarterly Monitor December 2015, Sydney: NSW Department of Planning and Infrastructure, accessed April 2017 from http://www.planning.nsw.gov.au/housing-data-for-sydney-quarterly-reports

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Births and Fertility Rate As shown in Table 2, shows that in 2015 there were 9,787 births to women living in SLHD, this is a slight decrease (2%) from 2010. The Total Fertility Rate (TFR) across the District LGA’s have also shown a slight decrease across the majority of LGA’s. Table 2: Births in SLHD 2010-2015, by Local Government Area (LGA)

2010 2015 Estimated

resident population

Births

Total fertility rate

Estimated resident population

Births

Total fertility rate

% change in births from 2010 to 2015

Ashfield 43,038 593 1.63 44,540 578 1.47 -2.5% Burwood 33,835 401 1.55 36,139 448 1.45 11.7% Canada Bay 77,709 1,261 1.82 88,819 1,334 1.74 5.8% Canterbury 143,933 2,568 2.30 151,746 2,497 2.09 -2.8% Leichhardt 54,969 1,121 1.86 58,756 923 1.61 -17.7% Marrickville 80,388 1,434 1.70 84,270 1,150 1.35 -19.8% Strathfield 37,002 481 1.50 40,125 548 1.52 13.9% Sydney 180,748 2,126 1.08 205,339 2,309 1.01 8.6% SLHD Total

9,985

9,787

-2.0%

Source: ABS 2015, Births, Australia, 2015, Cat.no. 3301.0. *As the geographical classification SLA is no longer used by the ABS to report statistics, proportions of births according to 2011 figures have been applied to 2012 and 2013 LGA births to estimate City of Sydney SLHD residents. City of Sydney TFR represented overall LGA rate and should be interpreted as an estimate only Figure 3: Babies born to SLHD residents, 2010-2015

Source: Births Australia 2015, Australian Bureau of Statistics, (Cat.no. 3301.0) *As the geographical classification SLA is no longer used by the ABS to report statistics, proportions of births according to 2011 figures have been applied to 2012 and 2013 LGA births to estimate City of Sydney SLHD residents. City of Sydney TFR represented overall LGA rate and should be interpreted as an estimate only.

Projected Growth By 2021, the SLHD population is expected to reach 706,850, and growing further to 832,790 by 2031. Table 3, Figure 4 and Figure 5 illustrate these projected changes in population numbers. All SLHD LGAs are projected to increase in population size. The growth in the aged and the “old old” population of SLHD is especially important for healthcare delivery over the forthcoming two decades, with an increase of 84% predicted in the 65+ year age groups, respectively (Table 3).

6% 6% 4% 5% 13% 14%

26% 26%

11% 9%

14% 12%

5% 6%

21% 24%

0

2,000

4,000

6,000

8,000

10,000

12,000

2010 2015

Sydney (C)

Strathfield (A)

Marrickville (A)

Leichhardt (A)

Canterbury (C)

Canada Bay (A)

Burwood (A)

Ashfield (A)

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Table 3: SLHD Projected population, by 2015and 2016 LGAs 2011-2031

2011 2016 2021 2026 2031

% change

from 2011 to

2031 2015 LGAs 2016 LGAs Ashfield Inner West

Sydney

43,538 45,150 47,840 48,640 49,580 14% Leichhardt 55,642 58,250 60,990 62,990 65,520 18% Marrickville 81,121 87,090 93,130 99,070 106,630 31% 180,301 190,490 201,960 210,700 221,730 23% Burwood Burwood 34,176 38,850 44,900 49,130 53,490 57% Canada Bay Canada Bay 80,065 90,840 95,190 103,880 113,630 42%

Canterbury

Canterbury-Bankstown

(part)

145,089 156,650 174,780 194,710 217,750 50%

Strathfield Strathfield 37,239 41,230 50,410 55,930 60,190 62% Sydney City (part)

Sydney City (part)

105,066 121,470 139,610 152,180 166,000 58%

Total 581,936 639,530 706,850 766,530 832,790 43% Source: NSW Department of Planning & Environment Population and Household Projections, 2016

With the exception of the City of Sydney and Canterbury Bankstown Councils, the remaining councils are wholly within SLHD boundaries. SLHD covers approximately 45-50% of the City of Sydney, with the remainder being part of Sydney South Eastern Local Health District and 30% of Canterbury Bankstown, with the remainder being part of South Western Sydney Local Health District. The newly amalgamated Inner West Sydney Council now includes the Ashfield, Marrickville and Leichhardt LGAs. Please refer to page 4 for further information regarding the Council amalgamations undertaken in 2016.

Figure 4: Projected population of SLHD, by LGA, 2011-2031

Source: NSW Department of Planning & Environment Population and Household Projections, 2016 *Sydney South and Sydney West SLAs only Table 4: Projected population SLHD by selected age groups 2011-2031

Age-Related Projections 0-14 15-64 65+ years TOTAL 2011 87,849 426,169 67,918 581,936 2026 126,400 531,890 108,240 766,530 2031 135,580 572,180 125,030 832,790 % Change 2011-2031 54% 34% 84% 32.%

Source: NSW Department of Planning & Environment Population and Household Projections, 2016

0

50000

100000

150000

200000

250000

2011 2016 2021 2026 2031

Ashfield (A)

Burwood (A)

Canada Bay (A)

Canterbury (C)

Leichhardt (A)

Marrickville (A)

Strathfield (A)

Sydney (C) (South& West SLAs)

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Figure 5: Projected population SLHD by age groups 2011-2031

Source: NSW Department of Planning & Environment Population and Household Projections, 2016

Characteristics of our local population Education and Occupation Overall SLHD residents are generally well-educated. The majority of residents (64.8%) have been educated to year 12 or equivalent (compared to 49.2% for the state), however the pattern is uneven across the District with pockets of lower education and literacy levels evident. Residents of Canterbury LGA (54.9%) and Canada Bay (64.2%) LGA reported lower year 12 or equivalent attainment than the rest of the District, whilst residents of Sydney LGA have the highest levels. Appendix 1 provides more detailed data at LGA level. In 2011, almost two thirds of the SLHD labour force were employed full time (63.5%). The proportion of the labour force employed full time ranged between 68.1% in Leichhardt LGA and 57.2% in Burwood LGA. The proportion of the population describing themselves as unemployed in SLHD was the same as the state (5.9%) and ranged from 8.2% in Canterbury LGA to 4% in Leichhardt LGA. Figure 6 is a choropleth map representing the spatial distribution of SEIFA 2011 Index of Education and Occupation (IEO) decile ranks down to Statistical Area Level 1 zones within the SLHD LGAs. The IEO index score summarises the general level of education and occupation-related skills of people within an area using information derived from the 2011 Census. A relatively low rank on this index (demonstrated by red gradients on map) indicates the area has more people with relatively lower levels of educational attainment, lower skilled occupations and relatively fewer people with higher education and higher skilled occupations.

0 to 14, 87,849

0 to 14, 126,400

0 to 14, 135,580

15 to 64, 426,169

15 to 64, 531,890

15 to 64, 572,180

65+, 67,918

65+, 108,240

65+, 125,030

0 200,000 400,000 600,000 800,000 1,000,000

2011

2026

2031

0 to 14

15 to 64

65+

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Figure 6: Index of education and occupation, by SA1, for SLHD LGAs, 2011

Source: Australian Bureau of Statistics SEIFA 2011 The map shows that the District’s lower ranked areas are concentrated in the western region of Canterbury LGA and the southern region of Strathfield LGA, with pockets of lower scores evident in Camperdown, Surry Hills, Redfern and Waterloo areas. Economic Resources The median individual weekly income of SLHD residents in 2011 ranged from $430 in Canterbury LGA to $1,086 in Leichhardt LGA, compared to $561 for NSW. A similar pattern is reflected in median weekly household incomes which ranged from $1,029 in Canterbury LGA to $2,234 in Leichhardt LGA, compared with $1,237 for NSW. Figure 7 is a choropleth map representing the spatial distribution of SEIFA 2011 Index of Economic Resources (IER) decile ranks down to Statistical Area Level 1 zones within the SLHD LGAs. The IER index score reflects the economic resources of households within an area using information derived from the 2011 Census. A relatively low rank on this index indicates the area has more households with relatively fewer economic resources, and fewer households with relatively high economic resources. Regions in the District with greatest concentrations of 1st decile areas include Riverwood, Punchbowl, Campsie, Burwood and Ashfield. It is also evident that a greater concentration of disadvantage is present along the inner west and Bankstown train lines, and the southern major arterial roads.

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Figure 7: Index of economic resources, by SA1, for SLHD LGAs, 2011

Source: Australian Bureau of Statistics SEIFA 2011 The map above demonstrates that within SLHD suburbs, there are areas of extreme advantage and extreme disadvantage that may be masked when averages are taken of larger areas. Table 5 outlines the proportions of low family household incomes (less than $600 per week) and high family household incomes (more than $2500 per week) in the SLHD LGAs. Table 5: Proportion low and high household incomes, by LGA, SLHD and NSW 2011

Ash

field

Bur

woo

d

Can

ada

Bay

Can

terb

ury

Leic

hhar

dt

Mar

rickv

ille

Stra

thfie

ld

Sydn

ey*

SLH

D

NSW

Family households with incomes under $600 per week 10.2% 13.3% 8.7% 17.2% 5.3% 9.3% 11.6% 9.6% 11.3% 12.3%

Family households with incomes $2500 or more per week 29.2% 25.3% 39.6% 15.2% 53.0% 35.4% 27.8% 41.7% 32.0% 23.3%

Source: Australian Bureau of Statistics (2011), Basic Community Profiles for NSW Local Government Areas, Canberra: ABS. *Sydney South and Sydney West SLAs only

Family Characteristics Couple families with children comprised 43.3% of all SLHD households in 2011.4 There was a considerable degree of variance between the LGAs within SLHD, with the proportion of couple family households ranging from 51.6% in Strathfield LGA to 25.3% in the City of Sydney (South and West SLAs).

4Australian Bureau of Statistics 2012, Census of Population and Housing, Expanded Community Profile, 2011, Cat.no. 2005.0, Canberra: ABS, accessed July 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument

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http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument


SLHD had a slightly lower proportion of single parent households than NSW (14.8% and 16.3% respectively). Again there was considerable variation between the LGAs with Canterbury LGA having the highest proportion of single parent households (17.6%) and Canada Bay LGA the lowest (12.4%). Detailed data on family characteristics at LGA level is provided in Appendix 1.

Household Composition According to the 2011 Census5 there were approximately 205,000 households in SLHD. The majority of these (65.2%) are family households (less than for the state at 71.9%). Around a quarter (26.8%) of households in SLHD are lone person households (slightly higher than for NSW at 24.2%). The proportion of lone person households varies from 18.9% in Strathfield to 26.8% in the City of Sydney (South and West SLAs). Detailed data on household composition is provided in Appendix 1.

Dwelling Characteristics Table 6 shows the proportion of occupied private dwellings in each LGA which are owned and rented (privately or publicly). The use of Housing NSW accommodation is greater in SLHD than the state (5.4% and 4.4% respectively). The highest proportion of dwellings which are rented from Housing NSW is located in Canterbury LGA (5.8%). The proportion of homes which are owned by their occupiers is lower in SLHD than in the state (54.6% and 66.5% respectively). Canada Bay LGA shows the highest proportion of home ownership in the District (64.1%); slightly lower than the proportion for the state. Overall 42.2% of dwellings in SLHD are rented, a much higher rate than for the state (30.1%). Table 6: Housing tenure, by LGA, SLHD and NSW, 2011

Ash

field

Bur

woo

d

Can

ada

Bay

Can

terb

ury

Leic

hhar

dt

Mar

rickv

ille

Stra

thfie

ld

Sydn

ey*

SLH

D

NSW

Dwellings that are owned 56.5% 59.7% 64.1% 59.3% 57.3% 54.2% 59.9% 38.5% 54.6% 66.5% Dwellings that are rented 40.1% 36.6% 33.1% 36.5% 40.6% 43.0% 36.5% 58.7% 42.2% 30.1% Dwellings that are rented from Housing NSW

1.5% 2.9% 2.6% 5.8% 4.3% 2.9% 4.0% 11.6% 5.4% 4.4%

Source: Australian Bureau of Statistics (2011), Basic Community Profiles for NSW Local Government Areas, Canberra: ABS.*Sydney South and Sydney West SLAs only

In 2011, the median monthly loan repayment ranged from $2,000 in Canterbury LGA to $3,000 in Leichhardt LGA, which is much higher than the state median loan repayment of $1,993. This reflects the high cost of housing in SLHD when compared with NSW as a whole. At the same time, the median weekly rent across the District ranged from $300 in Canterbury LGA to $480 in Canada Bay LGA and Leichhardt LGA, compared to $300 in NSW. Homelessness Homelessness is described by NSW Housing as ranging from primary (sleeping rough) to tertiary (living in insecure housing such as boarding houses and caravan parks). Due to the transient nature and vulnerability of this population, accurately quantifying homelessness is

5 ibid. accessed July 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument

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very difficult. Official estimates of the prevalence of homelessness from the 2011 Census6 indicate that the area with the highest number of homeless persons is the City of Sydney LGA, with approximately 3,307 persons recorded in the region shared between SLHD and South Eastern Sydney LHD. A further 1,356 homeless people were recorded in Strathfield-Burwood-Ashfield, 910 in Marrickville-Sydenham-Petersham, 663 in Canterbury, 288 in Leichhardt and 171 in Canada Bay. The Australian Bureau of Statistics figures take into account persons living in improvised dwellings, supported accommodation for the homeless, temporary arrangements within other households, boarding houses, and ‘severely’ crowded dwellings. It is acknowledged that individuals who are ‘couch surfing’, a particularly common situation amongst homeless youth and those fleeing domestic or family violence, are masked within Census data as they cannot be distinguished from other people who were visiting on Census night. For this reason Census-based estimates must be recognised as being an underestimate for these groups. Aboriginal people are also more likely to live in improvised dwellings or in Specialist Homelessness Support program accommodation than non-Aboriginal people. The rate of Aboriginal homelessness is a particular issue. Estimates indicate a rate of 566 per 10,000 Aboriginal people in Sydney, Leichhardt and Marrickville LGAs compared to 125 per 10,000 non-Aboriginal people in the same area. Homelessness is a significant factor in the SLHD which severely impacts on people with a mental illness. A recent 2015 survey of homelessness conducted by the City of Sydney7 identified 827 people in the Sydney CBD who were either ‘rough-sleepers’ or who were accommodated in hostels for the homeless. A more in-depth survey in 2010 of the prevalence of homelessness found 82% of rough sleepers reported substance abuse issues, 54% a mental illness, 48% dual diagnosis, 55% tri-morbidity and 63% serious medical issues. The Redfern Waterloo Public Housing Tenant Survey undertaken in 2011, commissioned by Housing NSW, identified that drug and alcohol related problems were the most significant issue experienced within the estate.

Socioeconomic Status SLHD is characterised by socioeconomic diversity with pockets of advantage and disadvantage. Relative disadvantage across Australia is measured by the Socioeconomic Indices for Areas (SEIFA) produced by the Australian Bureau of Statistics. The Index of Relative Socioeconomic Disadvantage (IRSD) contains indicators of disadvantage such as low income, high unemployment and low levels of education. Relative disadvantage is associated with a low number. The average across Australia is 1,000, with a number below 1,000 indicating lower socioeconomic status. As shown in Table 7, the two Statistical Local Areas in SLHD with an overall score under 1,000 in 2011 were Canterbury and Burwood.

6Australian Bureau of Statistics (2012), Census of Population and Housing, Expanded Community Profile, 2011, Cat.no. 2005.0, second release, Canberra: ABS, accessed July 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument 7City of Sydney Council (2013), City of Sydney Homelessness Street Count August 2013, data obtained from the City of Sydney Homelessness Unit, accessed July 2015 from http://www.cityofsydney.nsw.gov.au/community/community-support/homelessness/street-count.

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http://www.cityofsydney.nsw.gov.au/community/community-support/homelessness/street-count

http://www.cityofsydney.nsw.gov.au/community/community-support/homelessness/street-count


Table 7: Ranking of SLAs in SLHD, by index of relative socioeconomic disadvantage, 2011

Statistical Local Area Index score

Minimum score for SA1s in

area

Maximum score for SA1s in

area Rank (SLAs within LHD)

Usual resident population

(Census 2011) Ashfield (A) 1015 856 1112 8 41,216 Burwood (A) 996 870 1073 9 32,428 Canada Bay (A) - Concord 1066 948 1140 3 39,196 Canada Bay (A) - Drummoyne 1068 819 1138 2 36,554 Canterbury (C) 922 413 1081 10 137,406 Leichhardt (A) 1079 733 1150 1 52,196 Marrickville (A) 1022 498 1135 6 76,448 Strathfield (A) 1022 749 1134 5 35,222 Sydney (C) - South 1017 435 1138 7 56,626 Sydney (C) - West 1022 615 1138 4 41,275 Sydney LHD 1006 413 1150

548,568

Source: Australian Bureau of Statistics SEIFA 2011

The 10 most disadvantaged suburbs within SLHD are listed in Table 8. Consistent with its overall ranking as the most disadvantaged LGA within SLHD, Canterbury LGA has the most suburbs experiencing disadvantage in the District. Other pockets of particular disadvantage include Waterloo, Redfern, Haymarket, Ultimo (Sydney LGA), Marrickville and Sydenham (Marrickville LGA), Homebush West, Belfield (Strathfield LGA) and Burwood (Burwood LGA). Table 8: Ten Most Disadvantaged Suburbs in SLHD, Index of Socioeconomic Disadvantage 2011

Suburb Rank in SLHD Rank in NSW State Decile State Percentile LGA Punchbowl 1 136 1 6 Canterbury Riverwood 2 137 1 6 Canterbury Wiley Park 3 138 1 6 Canterbury Lakemba 4 139 1 6 Canterbury Waterloo 5 231 1 10 Sydney Campsie 6 237 2 11 Canterbury Greenacre 7 293 2 12 Canterbury,

Strathfield Belmore 8 310 2 13 Canterbury Haymarket 9 314 2 13 Sydney Narwee 10 624 3 25 Canterbury


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Figure 8 is a choropleth map representing the spatial distribution of SEIFA 2011 Index of Relative Socioeconomic Disadvantage (IRSD) decile ranks down to Statistical Area Level 1 zones within the SLHD LGAs. The IRSD index score ranks regions on a continuum from areas with relatively low incidence of disadvantage to most disadvantaged. Four out of the five most disadvantaged suburbs in the District are within Canterbury LGA (Punchbowl, Riverwood, Wiley Park and Lakemba). It is also evident that a greater concentration of disadvantage is present along the inner west and Bankstown train lines, and the southern major arterial roads. Figure 8: Index of relative socioeconomic disadvantage, by SA1, for SLHD LGAs, 2011


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Food Security A significant health issue for people of low socioeconomic status is food insecurity, or lack of access to food. In 2014, approximately 7.2% of District residents who responded to the NSW Population Health Survey experienced food insecurity, a similar proportion to NSW as a whole (7.2%). From 2002 food insecurity within SLHD remained below 10%, peaking in 2004 at 8.4%. Figure 9: Food insecurity experienced in the last 12 months among adults aged 16 years and over, SLHD 2002 to 2014

Source: Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW Ministry of Health.

Priority Population Groups Aboriginal People The original owners of the land on which SLHD stands are the people of the Eora nation. At the time of the 2011 Census8, there were 4,875 people who identified as either Aboriginal or Torres Strait Islander (herein referred to as Aboriginal people) living in SLHD. The proportion of Aboriginal people in the District is lower than the state at 0.9%, compared with 2.5% for NSW. The Sydney (South and West Statistical Local Areas) and Marrickville LGA have the highest number of Aboriginal residents (1,714 and 1,111 respectively), with the lowest number of Aboriginal people residing in Strathfield LGA (102). Consistent with state and national figures, the age profile for Aboriginal people in SLHD is younger than the non-Aboriginal population. In particular, 24% of the Aboriginal population is aged under 15 years, and less than 1% is aged over 65 years, compared with 15% and 12% respectively for the non-Aboriginal SLHD population. Aboriginal people are widely recognised as having poorer health and poorer access to appropriate health services as well as a reduced life expectancy, when compared to the non-Aboriginal population. According to the NSW Chief Health Officer’s Report 20129, for SLHD:

8 Australian Bureau of Statistics (2012), Census of Population and Housing, Expanded Community Profile, 2011, Cat.no. 2005.0, second release, Canberra: ABS, accessed July 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument 9 NSW Health Centre for Epidemiology and Research (2012), The Health of Aboriginal People of NSW: Report of the Chief Health Officer 2012, North Sydney: NSW Ministry of Health, accessed July 2015 from http://www.healthstats.nsw.gov.au/ContentText/Display/ahchor_toc.

8.0%

6.4%

8.4%

6.2% 6.7%

5.6%

4.3%

6.1%

3.2%

6.5%

7.2%

6.4% 6.8%

6.4% 6.1%

6.4%

5.0%

6.0%

5.1% 5.4%

7.2% 6.9%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2014

SLHD

NSW

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http://www.healthstats.nsw.gov.au/ContentText/Display/ahchor_toc


• In 2010/11 Aboriginal people were far more likely to be hospitalised for any cause than their non-Aboriginal counterparts (58,220 per 100,000 compared to 31,861 per 100,000). This divide was larger for Aboriginal women, who in SLHD were hospitalised at a rate of 74,109 per 100,000 compared to non-Aboriginal women at 32,968 per 100,000). The overall hospitalisation rate for Aboriginal people increased rapidly between 2003/04 and 2008/09, but has exhibited a downward trend since.

• In 2010/11 the most common causes of hospitalisation in Aboriginal people were dialysis, maternal/neonatal and congenital issues, and injury and poisoning.

• In 2010/11 the rate of smoking attributable hospitalisations was higher for Aboriginal people than non-Aboriginal people (824 per 100,000 compared to 323 per 100,000). Both rates compared favourably to the NSW average in each category.

• In 2010/11 the rate of alcohol attributable hospitalisations for local residents was considerably higher for Aboriginal people than non-Aboriginal people (1,727 per 100,000 compared with 604 per 100,000).

• In 2010 only 48% of Aboriginal women in SLHD attended an antenatal visit before 14 weeks gestation, compared to 70% of non-Aboriginal women. A similar pattern is reflected at the 20 week gestation mark (72% and 90% respectively). In 2009/10, Aboriginal women were also more likely to have a pre-term birth (8.2% compared with 6.7%).

• 54% of Aboriginal women in SLHD smoked during pregnancy in 2010, compared to 7.5% of non-Aboriginal women.

• Diabetes prevalence is particularly significant in Aboriginal people. Hospitalisation rates for diabetes as a principal diagnosis in Aboriginal people are significantly worse than for non-Aboriginal people (626 per 100,000 compared with 96 per 100,000). This rate is also higher than that for NSW (514 per 100,000).

People from Culturally and Linguistically Diverse Backgrounds According to the 2011 Census10, across SLHD 43% of residents speak a language other than English at home, almost twice the level of NSW as a whole (22%). The proportion and numbers of people speaking another language ranged from 64% (87,793 people; third highest proportion in the state) in Canterbury LGA, to 15% (7,892 people) in Leichhardt LGA. In SLHD, 7.7% of the population born overseas in predominantly non-English speaking countries describe themselves as not speaking English well, or not at all. The main languages spoken were Mandarin (28,712 people), Arabic (26,665 people), Greek (24,654 people) and Cantonese (22,881 people). According to data provided in Table 9, 34.1% of the SLHD population were born in predominately non-English speaking countries, with 20.8% of this grouping residing in Australia for less than five years. Certain LGAs recorded higher proportions of particular cultural groups than the District average; for example most Italian speakers live in Canada Bay LGA and Ashfield LGA, whilst most Arabic speakers live in Canterbury LGA. Across NSW, people from culturally and linguistically diverse (CALD) communities generally have a better health profile than the Australian born population, when considering measures such as mortality, hospitalisation rates and the prevalence of lifestyle-related health risk factors. This is described as the ‘healthy migrant effect’, whereby people in good health are

10 Australian Bureau of Statistics (2012), Census of Population and Housing, Expanded Community Profile, 2011, Cat.no. 2005.0, second release, Canberra: ABS, accessed July 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument

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more likely to meet recipient country migration eligibility criteria, and to be willing and in an economic position to migrate.11 However, the relative health advantage of migrants has been shown to reduce with increasing length of residency.12 In addition, there are certain diseases and behavioural risk factors more prevalent among some country of birth groups. Table 10 shows health differences by country of birth for the largest country of birth cohorts residing in SLHD. Table 9: SLHD resident birthplace and English proficiency, 2011

L

eich

hard

t (A

)

Mar

rickv

ille

(A)

Syd

ney

(C) –

S

outh

Syd

ney

(C) –

W

est

Can

terb

ury

(C)

Ash

field

(A)

Bur

woo

d (A

)

Str

athf

ield

(A)

SLH

D

Total population 52,198 76,500 56,614 41,279 137,454 41,214 32,423 35,188 548,632 People born in Australia 34,100 44,629 28,589 18,416 61,424 20,325 13,528 14,016 278,969 % Australian born 65.3 58.3 50.5 44.6 44.7 49.3 41.7 39.8 50.8 Rank (SLAs within LHD, or LHD compared to all NSW LHDs) 1 3 5 8 7 6 9 10 15

People born (overseas) in English speaking countries 7,808 6,937 6,720 4,847 4,206 2,524 1,239 1,060 40,520

% born overseas in English-speaking countries 15 9.1 11.9 11.7 3.1 6.1 3.8 3 7.4

Rank (SLAs within LHD, or LHD compared to all NSW LHDs) 1 4 2 3 9 6 8 10 7

People born in non-English speaking countries 7,130 19,155 15,119 12,930 61,926 15,720 15,827 17,469 187,009

% born in non-English speaking countries 13.7 25 26.7 31.3 45.1 38.1 48.8 49.6 34.1


People born in a NES country, resident in Australia for five years or more

5,735 15,292 10,701 7,536 48,812 11,251 10,969 12,925 140,357

% born in a NES country, resident in Australia for five years or more

11 20 18.9 18.3 35.5 27.3 33.8 36.7 25.6


People born in a NES country resident in Australia for less than five years

1,088 3,007 3,901 4,786 10,577 3,803 4,101 3,836 38,819

% born in a NES country, resident in Australia for less than five years

2.1 3.9 6.9 11.6 7.7 9.2 12.6 10.9 7.1

Rank (SLAs within LHD, or LHD compared to all geographically-defined NSW LHDs)

9 8 7 2 6 4 1 3 1

People born overseas who speak English not well or not at all

825 4,729 2,522 1,578 16,596 3,143 3,406 3,235 39,534

People aged 5 years and over 47,899 71,496 54,015 39,701 127,015 38,812 30,771 33,263 513,536

11 Singh M & de Looper M (2002), Australian health inequalities: birthplace, AIHW Bulletin no. 2, Cat. no. AUS 27, Canberra: AIHW. Accessed July 2015 from http://www.aihw.gov.au/publication-detail/?id=6442467357. 12 Young C (1992), ‘Mortality, the ultimate indicator of survival: the differential experience between birthplace groups’, In: Donovan J, d’Espaignet ET, Merton C & van Ommeren M (eds), Immigrants in Australia: a health profile, Canberra: AGPS.

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Lei

chha

rdt (

A)

Mar

rickv

ille

(A)

Syd

ney

(C) –

S

outh

Syd

ney

(C) –

W

est

Can

terb

ury

(C)

Ash

field

(A)

Bur

woo

d (A

)

Str

athf

ield

(A)

SLH

D

% born overseas who speak English not well or not at all, aged 5 years+

1.7 6.6 4.7 4 13.1 8.1 11.1 9.7 7.7

Rank (SLAs within LHD, or LHD compared to all geographically-defined NSW LHDs)

10 5 7 8 1 4 2 3 2

Source: Census of Population and Housing, Expanded Community Profile, 2011, Australian Bureau of Statistics (2011)

Table 10: Health differences compared to Australian born population, by key countries of birth, 2010

Country of Birth Health Difference to Australian Born Population Lebanon More likely to smoke

More likely to self-report as overweight or obese More likely to self-report as having diabetes More likely to be hospitalised for coronary heart disease and cardiac revascularisation procedures More likely to have self-reported psychological distress Less likely to receive antenatal care before 20 weeks

Iraq More likely to be hospitalised for coronary heart disease and cardiac revascularisation procedures Less likely to receive antenatal care before 20 weeks

China and Hong Kong More likely to have tuberculosis Less likely to be overweight or obese

Vietnam More likely to have tuberculosis Less likely to receive antenatal care before 20 weeks Less likely to be overweight or obese

Greece Women are more likely to self-report as overweight or obese More likely to self-report as having diabetes More likely to be hospitalised for cardiac revascularization procedures More likely to self-report psychological distress

Italy Women are more likely to self-report as overweight or obese More likely to self-report as having diabetes More likely to be hospitalised for cardiac revascularisation procedures

Source: NSW Health Centre for Epidemiology and Research (2010), The Health of the People of New South Wales: Report of the Chief Health Officer, North Sydney: NSW Department of Health.

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Over 125 languages were recorded as spoken at home by inpatients in SLHD facilities in 2013-14. The most common language other than English spoken amongst Balmain and RPA inpatients was Greek, Arabic at Canterbury Hospital, and Italian at Concord Hospital. Around 49% of all inpatient separations in SLHD facilities during 2013-14 had Australia recorded as the country of birth in the medical record. This varied greatly between District facilities, ranging from 41% at Concord Hospital to 66% at Balmain Hospital. Table 11: Top 10 languages spoken at home recorded in SLHD inpatient separations, 2013-14

Balmain Canterbury Concord RPA Language # Seps Language # Seps Language # Seps Language # Seps

English 1,052 English 10,001 English 31,295 English 60,588 Greek 37 Arabic 1,801 Italian 2,981 Greek 3,406 Italian 22 Greek 869 Arabic 1,990 Arabic 1,972 Arabic 10 Mandarin 603 Greek 1,724 Vietnamese 1,487 Portuguese 9 Korean 472 Korean 1,724 Italian 1,480 Cantonese 8 Bengali 366 Cantonese 1,435 Mandarin 1,444 Mandarin 5 Cantonese 296 Mandarin 1,051 Tongan 1,228 Polish 4 Italian 292 Vietnamese 540 Cantonese 1,079 Russian 4 Vietnamese 291 Spanish 530 Fijian 670 Spanish 4 Chinese nfd 202 Turkish 339 Portuguese 631

Source: FlowInfo v14 includes all Inpatient activity (ED, Chemotherapy and Dialysis) Note: RPA includes Institute of Rheumatology and Orthopaedics Table 12: Inpatient separations in SLHD facilities, by hospital and country of birth, 2013-14

Balmain Canterbury Concord RPA

Country of birth Se

para

tions

% S

epar

atio

ns

Country of birth Se

para

tions

% S

epar

atio

ns

Country of birth Se

para

tions

% S

epar

atio

ns

Country of birth Se

para

tions

% S

epar

atio

ns

Australia 778 66% Australia 7,921 46% Australia 19,247 42% Australia 43,872 54% England 77 7% Lebanon 1,336 8% Italy 4,474 10% Greece 3,921 5% Greece 44 4% China 974 6% Lebanon 2,945 6% China 2,682 3%

Italy 29 2% Greece 890 5% China 2,332 5% Italy 2,448 3% Ireland 26 2% Korea,

Republic of 455 3% Greece 1,789 4% Lebanon 2,394 3%

New Zealand

22 2% Bangladesh 438 3% Korea 1,744 4% England 2,234 3%

China 17 1% Italy 426 2% England 1,176 3% Vietnam 1,857 2% Netherland 12 1% Vietnam 291 2% Vietnam 871 2% Tonga 1,459 2%

Scotland 11 1% Iraq 288 2% Sri Lanka 854 2% New Zealand

1,413 2%

Source: FlowInfo v14 includes all Inpatient activity (ED, Chemotherapy and Dialysis) Note: RPA includes Institute of Rheumatology and Orthopaedics Humanitarian Arrivals As shown in Table 13, the Australian Department of Immigration & Citizenship Settlement Database recorded 1,910 humanitarian arrivals who initially settled in SLHD between April 2010 and March 2015 (8% of the humanitarian arrivals in NSW). The majority (1,169 or 61%) settled in Canterbury LGA, and the lowest number (28) settled in Leichhardt LGA. People who entered Australia as humanitarian arrivals came from a wide range of countries. The ten countries of birth with the highest number of humanitarian arrivals residing in SLHD between 2010 and 2015 were Afghanistan (895), Iran (300), Iraq (279), Burma (268), China (237), Pakistan (218), Syria (195), Sri Lanka (117), Egypt (99), and Turkey (39). Humanitarian arrivals often have complex health problems related to either their prior limited access to health care and/or their individual experiences of persecution or trauma. General health issues for humanitarian arrivals include psychological problems, injuries and other physical effects of torture, poor oral health, infectious and vaccine preventable diseases, health problems related to poor nutrition, and child development issues.

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Table 13: LGA of initial settlement for humanitarian entrants, SLHD, April 2010 to March 2015

LGA No. of Humanitarian Entrants 2010-15 Ashfield 65 Burwood 90 Canada Bay 55 Canterbury 1,169 Leichhardt 28 Marrickville 89 Strathfield 167 City of Sydney 247 Total 1,604

Source: Australian Government Department of Immigration & Citizenship Settlement Reporting Database, accessed July 2015. Note: City of Sydney includes all SLAs.

People with Disability At the time of the 2011 Census13, 23,264 people with disability in SLHD required assistance with core activities of daily living. This equates to 4.2% of the population, compared with 4.9% for NSW. The highest numbers of people with a disability reside in Canterbury LGA, consistent with the lower socioeconomic status of that area. In applying the findings of the ABS Survey of Disability and Carers 201214 to NSW Health’s 2014 population projections, an estimated 111,000 people with a disability live in SLHD. The number of people with a disability living in SLHD is predicted to rise, consistent with population growth and ageing. Carers At the 2011 Census, 44,960 people identified themselves as providing unpaid care or assistance to people with a disability, chronic long term health problem, or old age. These include carers of people with dementia and mental health conditions. This equates to 8.2% of the population, which is less than the NSW average of 9.2%. The proportion of people identifying as carers ranged from 6.3% in the SLHD part of Sydney LGA to 9.2% in Burwood LGA (see Appendix 1). In both SLHD and the state, there are approximately double the number of people reporting themselves as carers as there are reporting themselves as having a disability requiring assistance. Both the number of people and the proportion of the population identifying as carers are likely to increase as a result of population ageing. Carers experience challenges in managing the health of the person they care for as well as problems with their own personal health (physical and mental). In NSW, only 27% of carers are satisfied with their caring role , half report sleep interruption as a result of their caring role, a small proportion of carers identify themselves as having a stress related illness as a result of their caring role, whilst a similar proportion consider themselves angry or resentful about their role. 15

13 Australian Bureau of Statistics (2012), Census of Population and Housing, Expanded Community Profile, 2011, Cat.no. 2005.0, second release, Canberra: ABS, accessed August 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/2005.0Main+Features12011%20Second%20Release?OpenDocument 14 Australian Bureau of Statistics (2012), Disability, Ageing and Carers, Australia: Summary of Findings, Cat.no. 4430.0, Canberra: ABS, accessed August 2015 from http://www.abs.gov.au/ausstats/[email protected]/Lookup/3A5561E876CDAC73CA257C210011AB9B?opendocument 15 Australian Bureau of Statistics (2012), Caring in the Community, Australia, 2012, Cat.no. 4436.0, Canberra: ABS, accessed August 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/4436.0Main%20Features22012?opendocument&tabname=Summary&prodno=4436.0&issue=2012&num=&view=

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Older People Health status generally declines with age, with older people more likely to report health problems and/or disability and hospitalisation, than those in younger age groups. In 2012, males at age 65 could expect to live an average 8.7 years without disability and another 10.4 years with some form of disability, including 3.7 years with severe or profound core activity limitation. Females at age 65 could expect to live 9.5 years without disability and another 12.5 years with some form of disability, including 5.8 years with severe or profound core activity limitation.16 According to the Australian Institute of Health and Welfare’s Older Australians at a Glance 200717, the key health issues in relation to older people are: - Low levels of physical activity and inadequate nutritional intake; - High rates of osteoporosis and arthritis, knee and hip replacements and hip fractures -

with associated risks of and from falls; - High blood pressure and high cholesterol - present in over half of people; - High rates of respiratory illness (see section on Chronic Diseases); - High rates of chronic health conditions, including multiple conditions - associated links

with polypharmacy; - Problems with vision, hearing, oral health and continence; - End of life care - palliative care and advanced care planning; - Mental illness, particularly depression linked to social isolation and high rates of suicide; - High rates of dementia; and - Inability to perform activities of daily living e.g. bathing, dressing, meal preparation.

16 Australian Institute of Health and Welfare (2014), Healthy life expectancy in Australia: patterns and trends 1997 to 2012, Cat no. AUS 187. Accessed August 2015 from http://www.aihw.gov.au/publication-detail/?id=60129549634&tab=2 17 Australian Institute of Health and Welfare (2007), Older Australia at a Glance, Cat.no. AGE52, fourth edition, AIHW, Canberra, accessed August 2013 from http://www.aihw.gov.au/publication-detail/?id=6442468045.

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Health Status and Lifestyle Behaviours Table 14 provides detail reflecting lifestyle behaviours of residents within SLHD and NSW with a demonstrated impact on health, either through increasing risk of developing a disease or condition, or through exacerbating a current illness. Data has been extracted from the NSW Population Health Survey Report on Adult Health 2014.18 Table 14: Health behaviours, SLHD and NSW residents, 2013 and 2014

Indicator SLHD SLHD trend NSW NSW trend Excellent, very good, or good self-rated health, persons aged 16 years and over, 2014

81.8% Steady since 2002. 80.6% Steady since 2002.

Consumes more than 2 standard drinks per day when drinking alcohol, persons aged 16 years and over, 2014

26.7% Steady since 2002. 27.4% Since 2002 steady with slight reduction.

Current smoking, persons aged 16 years and over, 2014 16.2% Decreasing since 2002. 15.6% Decreasing since 2002.

Recommended fruit consumption, persons aged 16 years and over, 2014 55% Steady. 53.9% Steady.

Recommended vegetable consumption, persons aged 16 years and over, 2014 8.1% Steady. 8.9% Steady.

Adequate physical activity, persons aged 16 years and over, 2014 67.5% Overall increase from

2002. 55.2% Overall increase from 2002.

Vaccinated against influenza in the last 12 months, persons aged 65 years and over, 2013

64.5% Steady. 71.0% Steady.

Vaccinated against pneumococcal disease, persons aged 65 years and over, 2013 44.6%

Slight increase between 2002 to 2009, with a decrease from 2010 to 2013.

59.9% Slight increase from 2002.

Source: NSW Adult Population Health Survey 2014 (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health. Vaccination rates for adults within the SLHD are lower than that for NSW, with other indicators reflecting a similar health behaviour pattern to the rest of the state. People living in SLHD generally consider themselves to have good health. In 2014, 81.8% of SLHD residents over 16 considered themselves to have excellent, very good or good health, compared to 80.6% for NSW. Smoking Estimates from the NSW Adult Population Health Survey indicates that in 2014 16.2% of SLHD residents aged over 16 smoke, compared to 15.6% for NSW19. This proportion has been steadily decreasing since 2002.20 Table 15 outlines details of smoking-related hospitalisations and deaths of residents of SLHD. In 2013/14 there were 2,522 smoking-attributable hospitalisations for SLHD residents, a rate of 420.6 per 100,000 people (significantly less than the state rate of 543.9). Rates for all smoking related hospitalisations have decreased since 1998.21 Compared with NSW, SLHD resident smoking attributable hospitalisations were significantly lower than the state in each of the eight LGAs (See Appendix 2). The NSW State Plan target is to reduce smoking rates by 3% by 2015 for non-Aboriginal people and by 4% for Aboriginal people.

18NSW Health Centre for Epidemiology and Research (2014), New South Wales Population Health Survey: NSW Ministry of Health, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicatorgroup/TopicIndicatorGroups 19NSW Adult Population Health Survey 2014 (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn. 20ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn_trend. 21ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn.

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http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn

http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn_trend



In 2011 there were 343 smoking-attributable deaths for SLHD residents (a rate of 61.1 per 100,000). The smoking attributable death rate in SLHD is similar to that for NSW (64.2 per 100,000). Detailed data is provided in Appendix 2. Smoking attributable death rates have decreased for SLHD since 2000, while the smoking attributable death rate remains two times higher in SLHD males (131 per 100,000) then SLHD females (45.5 per 100,000), which is consistent with the State .22 Table 15: Smoking-related hospitalisations, SLHD and NSW residents

Indicator

SLHD NSW No. Rate

per 100,000

LL 95% CI

UL 95% CI No. Rate per 100,000

LL 95% CI

UL 95% CI

Smoking-attributable hospitalisations, 2013-14 2,522 420.6 404.3 437.5 46,335 543.9 538.9 548.9

Smoking-attributable deaths, 2011 343 61.1 54.7 67.9 5,491 64.2 62.5 66.0

Source: Australian Coordinating Registry. Centre for Epidemiology and Evidence, NSW Ministry of Health

Table 16 and Figure 10 show the rates of smoking in pregnancy are over fifteen times higher for Aboriginal SLHD residents than non-Aboriginal residents. The NSW State Plan target is to reduce smoking by non-Aboriginal pregnant women by 0.5% per year and 2% per year for pregnant Aboriginal women. Figure 10: Smoking during pregnancy among Aboriginal and non-Aboriginal mothers, SLHD, 2000- 2013

Source: NSW Admitted Patient Epidemiology Data and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health

22 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_smo_age/beh_smo_lhn.

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Table 16: Smoking in pregnancy, SLHD and NSW, 2013

SLHD NSW

No. % No % Smoking in pregnancy, Aboriginal women, 2013 42 46.7 1,629 46.6 Smoking in pregnancy, non-Aboriginal women, 2013 211 2.6 7,656 8.3 Smoking in pregnancy, all residents, 2013 253 3.0 9,285 9.7

Source: NSW Perinatal Data Collection (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health

Alcohol Excessive alcohol consumption is understood to have adverse health consequences in both the short and long term. The NSW State Plan target is to reduce total risk drinking to below 25 per cent of the adult population by 2015. Estimates produced by NSW Health from the 2011 NSW Adult Population Health Survey indicate that in 2011, 23.9% of SLHD residents aged over 16 years consumed more than two standard drinks a day, compared to 29.9% for NSW23. In 2013/14 there were 4,533 alcohol attributable hospitalisations in SLHD, a rate of 725.6 per 100,000 people (higher than the state rate of 687.9). At an LGA level, over 2012/13 to 2013/14 there were significantly more alcohol attributable hospitalisations for residents of Leichhardt, Marrickville and City of Sydney LGAs than the state. In 2013/14 Aboriginal residents in NSW were hospitalised at a rate almost 2.3 times that of non-Aboriginal people for alcohol attributable reasons. Figure 11: Alcohol attributable hospitalisations, comparison by Aboriginality, NSW

Source: NSW Combined Admitted Patient Epidemiology Data and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

23 ibid. Accessed July 2013 from http://www.healthstats.nsw.gov.au/Indicator/beh_alc_age/beh_alc_lhn.

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http://www.healthstats.nsw.gov.au/Indicator/beh_alc_age/beh_alc_lhn


Table 17: Alcohol-attributable hospitalisations, SLHD and NSW residents

Indicator

SLHD NSW No. Rate per

100,000 LL 85%

CI UL 95%

CI No. Rate per

100,000 LL 85% CI UL 95% CI

Alcohol-attributable hospitalisations, 2013/14

4,533 725.6 704.4 747.4 54,374 687.9 682.1 693.8

Alcohol-attributable hospitalisations, Aboriginal, 2013/14

- - - - 2,491 1502.3 1437.6 1568.9

Alcohol-attributable hospitalisations, non-Aboriginal, 2013/14

- - - - 50,628 650.9 645.2 656.7

Alcohol-attributable injury hospitalisations, 2013/14

1,775 279.0 265.9 292.6 26,639 329.0 325.0 333.1

Alcohol-attributable deaths, 2011

93 16.2 13.0 19.8 1,261 15.6 14.8 16.5

Source: NSW Admitted Patient Data Collection, ABS mortality data and population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

There were 93 alcohol attributable deaths in SLHD in 2011, a rate similar to the state rate (16.2 compared to 15.6 deaths per 100,000 people). The alcohol attributable death rate in SLHD has decreased in the period 2000 to 2011.24 The alcohol attributable death rate was significantly higher than the state in the City of Sydney LGA. Detailed data is provided in Appendix 2. Overweight and Obesity Overweight and obesity are measured by body mass index (BMI). Overweight and obesity occurs when a person’s BMI is over 25kg/height in metres squared. Excessive weight gain is largely caused by an imbalance in the number of kilojoules consumed and energy expended daily, with a small contribution from genetics evident in some individuals. Being overweight or obese significantly increases the risk of developing type 2 diabetes, cardiovascular disease, endocrine and gastrointestinal problems, and some cancers in adults. Children who are overweight or obese are at greater risk of developing chronic conditions such as asthma and Type 2 diabetes; and may experience negative social and mental wellbeing.25 The NSW State Plan priority is to reduce overweight and obesity rates of children by 5% over the next ten years26 The NSW Adult Population Health Survey reports that in 2014 an estimated 45.1% of adults in SLHD are overweight or obese, compared to 52.5% of the NSW population. Despite the rate being lower than the state, this is still a proportion of significant concern for the health system. District level data on childhood obesity is not available, however in NSW, in 2014 27.7% of children aged 5-16 years were overweight or obese. According to the 2014 NSW Adult Population Health Survey : - 67.5% of SLHD adults undertake adequate physical activity - 19.3% of SLHD children aged 5-15 undertake adequate physical activity

24 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_alcafdth/beh_alcafdth_lhn_trend 25 Australian Institute of Health and Welfare (2013), Australia’s Health 2012, Australia’s health series no.13. Cat.no. AUS 156, Canberra: AIHW, p. 209. 26 NSW Making it Happen (2015), State Priorities. NSW Government.

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- 8.1% of SLHD adults consume five serves of vegetables per day - 55% of SLHD adults consume two serves of fruit per day In 2013-14 there were 2,063 hospitalisations of SLHD residents attributable to high Body Mass Index, a rate of 350.7 per 100,000 people. Of note is that the rate of hospitalisation for males (429.5 per 100,000 people) is considerably higher than that for females (275.9 per 100,000)27. For all groups, the rate in SLHD is much lower than for the state and is decreasing over time. Across NSW, Aboriginal people are more likely to be hospitalised for high BMI attributable reasons than non-Aboriginal people. Table 18: High body mass index-attributable hospitalisations and deaths, for SLHD residents

Indicator

SLHD NSW No. Rate per

100,000 LL 95%

CI UL 95%

C No. Rate per

100,000 LL 95% CI UL 95% C

High BMI-attributable hospitalisations, 2013/14

2,063 350.7 335.7 366.3 39,289 456.8 452.3 461.4

High BMI-attributable hospitalisations, Aboriginal, 2013/14

- - - - 1,248 1019.5 957.9 1083.8

High BMI-attributable hospitalisations, non-Aboriginal, 2013/14

- - - - 37,636 442.6 438.1 447.1

High BMI -attributable deaths, 2011

188 33.2 28.6 38.3 2,811 32.7 31.5 33.9

Source: NSW Admitted Patient Data Collection, ABS mortality data and population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

There were 188 high BMI attributable deaths of SLHD residents in 2011 (a rate of 33.2 per 100,000 compared to 32.7 per 100,000 for NSW). Detailed data in relation to high BMI attributable hospitalisations and deaths is provided in Appendix 2. Illicit Drug Use Limited information is available to quantify the number of people in SLHD who use illicit drugs. According to the 2013 National Drug Strategy Household Survey28 some illicit drug use across Australia has declined, including ecstasy, heroin and GHB; while there was a rise in the misuse of pharmaceuticals. In Australia, the two most commonly used drugs were marijuana/cannabis and ecstasy. Health Service Utilisation

The Royal Prince Alfred Hospital (RPA) is a principle referral hospital, providing tertiary and quaternary referral acute services to its IWS catchment, rural and other metropolitan residents, interstate and overseas patients. Examples of RPA’s tertiary and quaternary medical, surgical and diagnostic services include Liver and Kidney Transplantation, Open Heart Surgery, Cardiology, Neurology, Respiratory, Immunology, Maternity, Gynaecology,

27 NSW Adult Population Health Survey 2014 (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/beh_bmiafhos/beh_bmiafhos_lhn_snap?&topic=Overweight or obesity&topic1=topic_bmi&code=beh_bmi 28 Australian Institute of Health and Welfare (2014), 2013 National Drug Strategy Household Survey detailed report. Drug Statistics Series number 28, Cat.no. PHE 183, Canberra: AIHW, accessed August 2015 from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848

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Neo-natal Intensive Care, Colorectal and Upper GI Surgery, Emergency and Critical Care and Trauma Services. The Institute of Orthopaedics and Rheumatology and the Professor Marie Bashir Mental Health Centre are located at RPA. Cancer care, including Haematology and Neurosurgery is provided at the highest level at RPA with other selected cancer services provided in collaboration with the Chris O’Brien Lifehouse, a not-for-profit hospital located on the RPA campus. RPA provides a wide range of non-inpatient services across all medical and surgical specialties, including Hospital-in-the Home. A defining attribute of RPA is its world class research and teaching. The SLHD in collaboration with the University of Sydney, and thirteen affiliated Medical Research Institutes forms Sydney Research. The SLHD is also part of Sydney Health Partners which is an Advanced Health Research and Translation Centre of the NHMRC. Concord Repatriation General Hospital (CRGH or Concord Hospital) is a principle referral hospital, providing tertiary and quaternary referral acute services to its IWS catchment, rural and other metropolitan residents, interstate and overseas patients. Examples of the tertiary and quaternary medical and surgical services at Concord include the state-wide Burns service, Andrology, Bariatric Surgery, Neurology and Stroke, Cardiology, Aged Care, Medical Rehabilitation, Ophthalmology, Urology, Immunology, Upper GI, Colorectal, Orthopaedics, Plastic Surgery, Cancer Care, Emergency Medicine and Critical Care. Inpatient Maternity and Paediatric Services are not available at Concord Hospital. Concord provides a wide range of non-inpatient services across all medical and surgical specialties, including Hospital-in-the Home. The Concord Centre for Mental Health is located at Concord Hospital. The Concord Hospital provides world class research and teaching in collaboration with the University of Sydney and its affiliated Medical Research Institutes. The Canterbury Hospital is a major metropolitan hospital that provides district level hospital care to its local community. Canterbury provides Emergency Services, Maternity, Paediatrics, Aged Care, Medical and Surgical Services and a range of non-inpatient services including Hospital-in-the Home. The Balmain Hospital is a specialist Aged Care and Rehabilitation Hospital. It provides General Practice Casualty service through a consortium of local General Practitioners. The hospital provides a range of outpatient services including Hospital-in-the Home. The Sydney Local Health District provides a comprehensive range of community health and community based health services providing prevention, early intervention, assessment, treatment, health maintenance and continuing care services. Community based services include:

• Community Health Services • Health Promotion • Aboriginal Health Services • Community Mental Health Services • Community Aged, Chronic Care and Rehabilitation Services • Community Oral Health Services • Community Drug Health Services

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Community based health services are located in numerous facilities including community health centres, community clinics, schools and outreach centres. Large multidisciplinary Community Health Centres are located at Croydon, Marrickvillle, Canterbury and Redfern. In 2013-14 there were 199,371 hospitalisations recorded for residents of SLHD, a rate of 32,661 per 100,000 people. This was lower than the overall rate for the state (36,725 per 100,000 people).29 The main reason for hospitalisation in the District was for dialysis (accounting for 30,617 hospitalisations or 15.4%), this was followed by digestive system diseases (18,851 hospitalisations or 9.5%) and mental disorders (14,358 hospitalisations or 7.2%). Overall, females were more likely to be hospitalised than males, though this relates to use of hospital maternity services30. Table 19 shows the ten most common service related groups (SRG) to which a patient separation in SLHD was coded during hospitalisation in 2013/14. The most common hospitalisation grouping to which patients were coded was Renal Dialysis, followed by Obstetrics and then Orthopaedics. The large number of Psychiatry separations reflects both the significance of mental health in SLHD and the presence of tertiary referral mental health services. It should be noted that the high number of Renal Dialysis separations reflects the requirement for patients with chronic kidney disease to receive treatment an average of 3-4 times per week. Table 19: Ten most common service related groups for hospitalisations in SLHD facilities, 2013/14

Service Related Group Separations % of Total

Separations Beddays % of Total Beddays

23 Renal Dialysis 35,017 23.0% 35,030 6.6% 72 Obstetrics 11,481 7.6% 30,684 5.8% 49 Orthopaedics 9,410 6.2% 43,749 8.2% 27 Non Subspecialty Medicine 8,458 5.6% 35,802 6.7% 82 Psychiatry - Acute 7,230 4.8% 61,999 11.6% 15 Gastroenterology 7,041 4.6% 23,806 4.5% 54 Non Subspecialty Surgery 6,789 4.5% 21,493 4.0% 24 Respiratory Medicine 6,483 4.3% 34,970 6.6% 74 Unqualified Neonate (well babies) 6,090 4.0% 17,457 3.3% 11 Cardiology 5,788 3.8% 20,665 3.9%

Source: NSW Health FlowInfo v14.0 The hospitals of SLHD provide healthcare to the local residents and to a large population of people who reside outside of SLHD, including people living overseas, interstate and from rural districts. The data provided in the figures and tables below are based on the acute separations. For specific tertiary and quaternary referral services there are very significant populations of patients from outside of SLHD. For example the transplant services at RPA or the burns service at Concord do not predominately provide care to SLHD residents.

29 NSW Adult Population Health Survey 2014 (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/bod_projhos/bod_hos_lhn?&topic=Overview of hospitalisations&topic1=topic_hos&code=bod_hos 30 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/bod_hos_cat/bod_hos_cat

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Figure 12: Acute hospital separations at RPA Hospital, by LHD of residence, 2013/14

Source: NSW Health FlowInfo v14.0 excludes sub and non-acute activity only

Table 20 shows the ten most common service related groups (SRG) to which a patient separation was coded during hospitalisation at RPA Hospital in 2013/14. The most common hospitalisation grouping to which patients were coded was Obstetrics, followed by Renal Dialysis and then Orthopaedics. In 2013/14, 5,060 deliveries occurred at RPA Hospital. Table 20: Ten most common service related groups for hospitalisations at RPA Hospital, 2013/14



72 Obstetrics 9284 11.6% 24535 8.8% 23 Renal Dialysis 19531 24.5% 19531 7.0% 49 Orthopaedics 3818 4.8% 19475 7.0% 24 Respiratory Medicine 3110 3.9% 18277 6.6% 27 Non Subspecialty Medicine 4339 5.4% 15941 5.7% 82 Psychiatry - Acute 1296 1.6% 14629 5.3% 74 Unqualified Neonate 4400 5.5% 12745 4.6% 15 Gastroenterology 3111 3.9% 12580 4.5% 54 Non Subspecialty Surgery 3586 4.5% 12453 4.5% 17 Haematology 1171 1.5% 11134 4.0%

Source: NSW Health FlowInfo v14.0

Sydney, 54976, 70%

South Western Sydney, 5666, 7% South Eastern Sydney,

5076, 6%

Interstate and Other, 3625, 5%

North Sydney, 2734, 3%

West Sydney, 2253, 3%

West NSW, 1500, 2%

Illawarra Shoalhaven, 1010, 1%

Hunter New England, 770, 1%

Nepean Blue Mountains, 620, 1%

Central Coast, 501, 1%

Other, 4401, 6%

Page 32 of 61


Concord Hospital’s proximity to Ryde, Parramatta and Auburn LGAs means that there are some “natural flows” from outside of SLHD to this tertiary hospital. Figure 13: Acute hospital separations at Concord Hospital, by LHD of residence, 2013/14


Table 21 shows the ten most common service related groups (SRG) to which a patient separation was coded during hospitalisation at Concord Hospital in 2013/14. The most common hospitalisation grouping to which patients were coded was Renal Dialysis, followed by Psychiatry - Acute and then Neurology. The high numbers of psychiatry – acute separations is supported by the Concord Centre for Mental Health, located on the Concord Hospital campus which provides specialist care for people with recognised and chronic mental health conditions. Table 21: Ten most common service related groups for hospitalisations at Concord Hospital, 2013/14



23 Renal Dialysis 15486 29.7% 15499 8.3% 82 Psychiatry - Acute 5889 11.3% 47221 25.2% 21 Neurology 2900 5.6% 7834 4.2% 49 Orthopaedics 2488 4.8% 11813 6.3% 52 Urology 2388 4.6% 4364 2.3% 27 Non Subspecialty Medicine 2343 4.5% 12299 6.6% 15 Gastroenterology 2211 4.2% 7505 4.0% 54 Non Subspecialty Surgery 2062 4.0% 6013 3.2% 24 Respiratory Medicine 1890 3.6% 10105 5.4% 11 Cardiology 1760 3.4% 7196 3.8%


Sydney, 26771, 52%

North Sydney, 7677, 15%

West Sydney, 7474, 14%

South West Sydney, 5196,

10%

South Eastern Sydney, 1362, 3%


Nepean Blue Mountains, 886, 2%

Illawarra Shoalhaven, 369, 1%


Western, 251

Hunter New England, 248

Other, 1236, 2%

Page 33 of 61


The Canterbury Hospital predominately services Canterbury LGA, with some inflows from the nearby Bankstown LGA and the southern suburbs of Rockdale and Hurstville. Figure 14: Separations at Canterbury Hospital, by LHD of residence, 2013/14


Table 22 shows the ten most common service related groups (SRG) to which a patient separation was coded during hospitalisation at Canterbury Hospital in 2013/14. The most common hospitalisation grouping to which patients were coded was Obstetrics, followed by Gastroenterology and then Non Specialty Surgery. In 2013/14, 1,750 deliveries occurred at Canterbury Hospital. Table 22: Ten most common service related groups for hospitalisations at Canterbury Hospital, 2013/14



72 Obstetrics 2166 12.7% 6107 11.4% 15 Gastroenterology 1627 9.5% 3445 6.4% 27 Non Subspecialty Medicine 1407 8.3% 5986 11.2% 24 Respiratory Medicine 1377 8.1% 6179 11.5% 49 Orthopaedics 1362 8.0% 6199 11.6% 54 Non Subspecialty Surgery 1092 6.4% 2863 5.3% 11 Cardiology 929 5.4% 3365 6.3% 52 Urology 770 4.5% 1580 3.0% 71 Gynaecology 709 4.2% 1113 2.1%


Sydney, 12353, 73%

South West Sydney, 2446, 14% South East Sydney, 932,

6% Interstate and Other, 496,

3%

West Sydney, 493, 3% North Sydney, 127, 1%

Illawarra Shoalhaven , 67

Nepean Blue Mountains, 56

Hunter New England, 23

Page 34 of 61


The Balmain Hospital’s role in geriatric medicine and rehabilitation has been developed to provide for local need, with 95% of its services being provided to SLHD residents.

Figure 15: Separations at Balmain Hospital, by LHD of residence, 2013/14


Table 23 shows the ten most common service related groups (SRG) to which a patient separation was coded during hospitalisation at Balmain Hospital in 2013/14. The most common hospitalisation grouping to which patients were coded was Non Specialty Medicine, followed by Cardiology and then Orthopaedics. Table 23: Ten most common service related groups for hospitalisations at Balmain Hospital, 2013/14



27 Non Subspecialty Medicine 368 31.2% 1575 32.0% 11 Cardiology 182 15.4% 426 8.7% 49 Orthopaedics 142 12.1% 999 20.3% 24 Respiratory Medicine 106 9.0% 409 8.3% 15 Gastroenterology 92 7.8% 276 5.6% 21 Neurology 86 7.3% 353 7.2% 54 Non Subspecialty Surgery 41 3.5% 132 2.7% 82 Psychiatry - Acute 22 1.9% 45 0.9% 13 Dermatology 18 1.5% 101 2.1% 46 Neurosurgery 17 1.4% 154 3.1%


Sydney, 1006, 86%


Northern Sydney, 40, 3%

South Eastern Sydney, 24, 2%

Western Sydney, 19, 2%

South Western Sydney, 15, 1%


Hunter New England, 8, 1% Nepean Blue Mountains, 8,

1%

Page 35 of 61


Priority Health Areas Cancer Cancer is the leading cause of death in Australia and a significant health priority area for SLHD. Detailed information on cancer incidence by cancer type in SLHD and NSW between 2004 and 2008 is provided in Table 24. Over this period 11,397 residents of SLHD were diagnosed with cancer, representing a directly standardised rate of 449.1 per 100,000. This was lower than the directly standardised rate for NSW (483.2) and represented 6.4% of all new cancer cases in NSW over the same period. According to the NSW Central Cancer Registry, between 2004 and 2008 the majority (53%) of all new cancer cases in SLHD were attributable to five cancer sites. In descending order these were prostate (1,647 new cases, 14.5%), breast (1,447 new cases, 12.7%), lung (1,157 new cases, 10.2%), colon (988 new cases, 8.7%) and melanoma (726 new cases, 6.4%).

Of particular note is that incidence rates for head and neck, liver, lung, ovarian, stomach and thyroid cancers as well as non-Hodgkins lymphoma are higher than the state. At the same time, incidence rates for prostate cancer and melanoma are well below the state rates. Table 24: Cancer incidence, SLHD and NSW residents, 2004-2008

Cancer Site

SLHD NSW

Count

Rate per 100,000

population Lower 95%

CI Upper 95%

CI Count

Rate per 100,000


CI Upper 95% CI All Cancers 11,397 449.1 440.8 457.4 117,519 483.2 481.0 485.5 Bladder 243 9.7 8.5 11 3,631 9.7 9.3 10.0 Brain 166 6.3 5.4 7.3 2,356 6.6 6.3 6.8 Breast 1,447 56.2 53.3 59.1 21,102 58.2 57.5 59 Cancer at indef and unspecified site 364 14.4 13 16 6,014 16.0 15.6 16.4 Cervix 92 3.3 2.7 4.1 1,228 3.5 3.3 3.7 Colon 988 39.5 37.1 42.0 15,072 40.6 39.9 41.2 Head and Neck 370 14.6 13.1 16.1 4,686 12.8 12.5 13.2 Kidney 321 12.8 11.4 14.3 4,857 13.2 12.9 13.6 Leukaemia 314 12.5 11.1 13.9 4,605 12.6 12.3 13.0 Lip 44 1.8 1.3 2.4 1,203 3.3 3.1 3.5 Liver 224 8.9 7.8 10.1 2,088 5.7 5.4 5.9 Lung 1,157 46.5 43.9 49.3 15,905 43 42.3 43.7 Melanoma 726 27.8 25.8 29.9 17,716 48.8 48.1 49.5 Mesothelioma 56 2.2 1.7 2.9 1,047 2.8 2.6 3.0 Non-Hodgkins Lymphoma 485 18.9 17.2 20.7 6,828 18.6 18.2 19.1 Oesophagus 108 4.3 3.5 5.1 2,024 5.4 5.2 5.7 Other cancers 803 31.5 29.3 33.7 10,542 28.8 28.2 29.3 Ovaries 195 7.6 6.6 8.8 2,191 6.0 5.8 6.3 Pancreas 275 11.0 9.7 12.3 4,062 10.9 10.5 11.2 Prostate 1,647 66.3 63.1 69.6 31,321 84.4 83.4 85.3 Rectal 501 19.9 18.2 21.8 8,338 22.6 22.1 23.1 Stomach 285 11.4 10.1 12.8 3,275 8.8 8.5 9.1 Testicular 80 2.6 2.1 3.2 1,084 3.2 3.0 3.4 Thyroid 316 11.7 10.4 13.1 3,301 9.4 9.1 9.8 Uterus 190 7.5 6.5 8.6 3,043 8.3 8.0 8.6

Source: NSW Central Cancer Registry, Cancer Institute NSW Notably, despite having a lower cancer incidence rate overall in SLHD compared with NSW, the cancer mortality rate over the period 2004-2008 was higher (181 per 100,000 compared to 176.9). Mortality data over the same period reflects a different profile when compared to incidence within SLHD. Of note, the most likely cause of cancer death between 2004 and 2008 was lung cancer (937 deaths, 20%). This was followed by colon (365 deaths, 8%), breast (296 deaths, 7%) and prostate cancer (287, 6%). Melanoma was the 15th most common cause of cancer death (though the 5th most common cancer site) with 125 deaths (3%) over the same period.

Page 36 of 61


Table 25 shows mortality by cancer type for SLHD and NSW. Over these 5 years, there were 4,547 deaths of SLHD residents due to cancer. Mortality rates were higher in SLHD than in NSW for cancers of the brain, head and neck, liver, lung, ovaries, stomach, thyroid and uterus, as well as non-Hodgkins lymphoma. Table 25: Cancer mortality, SLHD and NSW residents, 2004-2008

Cancer Site

SLHD NSW

Count

Mortality Rate per 100,000


CI Upper 95%

CI Count

Mortality Rate per 100,000


CI Upper 95% CI All Cancers 4,547 181 175.7 186.3 66,228 176.9 175.5 178.2 Bladder 106 4.2 3.4 5.1 1,644 4.3 4.1 4.5 Brain 126 4.9 4.1 5.8 1,716 4.7 4.5 5.0 Breast 296 11.7 10.4 13.1 4,693 12.6 12.3 13.0 Cancer at indef and unspecified site 287 11.4 10.1 12.8 4,473 11.8 11.5 12.2 Cervix 28 1.1 0.7 1.5 415 1.1 1.0 1.2 Colon 365 14.5 13.0 16.0 5,511 14.6 14.3 15.0 Head and Neck 154 6.1 5.2 7.2 1,762 4.7 4.5 5.0 Kidney 87 3.4 2.8 4.3 1,605 4.3 4.1 4.5 Leukaemia 148 5.9 5.0 6.9 2,248 6.0 5.8 6.3 Lip N/A N/A N/A N/A 50 0.1 0.1 0.2 Liver 162 6.5 5.5 7.6 1,527 4.1 3.9 4.3 Lung 937 37.7 35.3 40.2 12,781 34.4 33.8 35.0 Melanoma of skin 125 5.0 4.1 5.9 2,314 6.2 6.0 6.5 Mesothelioma 56 2.3 1.5 2.5 947 2.5 2.4 2.7 Non-Hodgkins Lymphoma 176 6.9 5.9 8.0 2,569 6.8 6.6 7.1 Oesophagus 92 3.6 2.9 4.4 1,590 4.2 4.0 4.4 Other Cancers 337 13.4 12.0 15.0 4,411 11.8 11.4 12.1 Ovarian 104 4.2 3.4 5.1 1,394 3.7 3.5 3.9 Pancreatic 240 9.6 8.4 10.9 3,611 9.6 9.3 9.9 Prostate 287 11.4 10.1 12.8 4,904 12.8 12.4 13.1 Rectal 194 7.7 6.7 8.9 3,018 8.1 7.8 8.4 Stomach 182 7.3 6.2 8.4 2,232 6 5.7 6.2 Testicular N/A N/A N/A N/A 31 0.1 0.1 0.1 Thyroid 12 0.5 0.3 0.9 168 0.4 0.4 0.5 Uterus 43 1.7 1.2 2.3 614 1.6 1.5 1.8

Source: NSW Central Cancer Registry, Cancer Institute NSW In 2011, the SLHD population accounted for 6% of the state’s cancer cases, with 2,351 cases of cancer projected to have been diagnosed in 2011. Into the future, this is projected to rise to 2,912 cases in 2016 and 3,244 cases in 2021, increasing at a rate of between 2-3 % per year. It is important to understand that these cases reflect the local population need, rather than the cases being seen in the SLHD hospitals. The SLHD has considerable inflows for cancer care. Figure 16 shows the SLHD new cancer cases by site, the projections for cancer to 2021, and the projections by clinical group for new cancer cases.

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Figure 16: Cancer projections by site, SLHD residents, 2011, 2016 and 2021

Source: NSW Cancer Institute (2011), Cancer incidence and mortality: projections 2011 to 2021: Cancer Institute NSW. Cancer Screening Screening for cancers in a target population where no symptoms are present may lead to early detection of cancer and early treatment intervention, which has shown to improve survival rates. Currently available national screening programs include:

• Mammographic screening for breast cancer every two years for women aged 40 years and over.

• Pap test for cancer of the cervix every two years in women aged 18 to 69 years. • Bowel cancer screening for men and women between 50 and 74 years of age every

two years.

At an LHD level, cancer screening data is available for both breast and cervical cancer. This is shown in Table 26.

Table 26: Cancer Screening rates amongst target population for SLHD residents, 2009/10

Screening Number Screened % of Target Population Breast, Women Aged 50-69 25,450 47.0% Cervical, Women Aged 20-69 100,231 54.9% Cervical, Women Aged 20-49 75,813 53.0% Cervical, Women Aged 50-69 24,418 62.1%

Sources: BreastScreen NSW and ABS population estimates. Centre for Epidemiology and Evidence, NSW Ministry of Health and NSW Cervical Screening Program, the NSW Pap Test Register and ABS population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health

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Maternal Health Table 27 provides a summary of data in relation to maternal health. More detailed information at an LGA level is provided in Appendix 2. Patterns of attendance for antenatal care reflect the level of preventative care provided to mother and child. In 2013, 92.6% of women within SLHD attended for antenatal care prior to 20 weeks gestation, compared with 84.0% for NSW. While, 72.1% attended prior to 14 weeks gestation, compared with 60.0% for NSW.31 It should be noted that the situation was considerably poorer for Aboriginal mothers, of whom less than half (48.3%) received antenatal care prior to 14 weeks gestation. According to data reported in the NSW Chief Health Officer’s Report 2014, SLHD mothers were less likely to smoke during pregnancy than the NSW average (3.0% compared to 9.7%). However, as shown in Table 16 rates of smoking in pregnancy are over fifteen times higher for Aboriginal SLHD residents than non-Aboriginal residents. The trend is similar, though not as severe, across NSW.

Table 27: Maternal health indicators, SLHD and NSW residents, 2012 and 2013

Maternal Health Indicator SLHD NSW No. % No. %

Antenatal care before 14 weeks gestation, 2013 6,010 72.1 57,336 60.0 Antenatal care before 14 weeks gestation, Aboriginal women, 2013 42 46.7 1,740 49.8 Antenatal care before 14 weeks gestation, non-Aboriginal women, 2013

5,968 72.4 55,543 60.4

Antenatal care before 20 weeks gestation, 2013 7,717 92.6 80,252 84.0 Antenatal care before 20 weeks gestation, Aboriginal women, 2013 69 76.7 2,538 72.7 Antenatal care before 20 weeks gestation, non-Aboriginal women, 2013

7,648 92.8 77,657 84.4

Preterm births , Aboriginal women, 2012 - - 450 13.2 Preterm births, non-Aboriginal women, 2012 - - 7,091 7.4 Preterm births, all babies, 2012 633 7.1 7,549 7.6 Low birth weight, all babies, 2013 523 6.2 6,154 6.3 Low birth weight, Aboriginal mothers, 2013 - - 403 11.4 Source: NSW Perinatal Data Collection (SAPHaRI); Centre for Epidemiology and Evidence, NSW Ministry of Health In 2013 the proportion of women smoking during pregnancy varied across Local Government Areas and was likely to be associated with factors such as socioeconomic status and maternal age. In SLHD the proportion of women smoking during pregnancy ranged from 8.0% in Marrickville to 4.0% in Canada Bay. By 2013, these rates had reduced across the LHD and state. Factors such as smoking during pregnancy can contribute to low birth weight (under 2.5kg). Babies with low birth weights are more likely than other babies to require medical treatment at birth and beyond. Consistent with the lower than average reported smoking rates in SLHD, the proportion of babies born with low birth weights in 2013 was also the slightly lower than the state average (6.2% and 6.3% respectively). This still accounted for 523 births to SLHD mothers. Rates of preterm births were also lower in District residents than across the state. Preterm birth rates for Aboriginal women have increased between 1993 and 2013, whilst also slightly increasing for the non-Aboriginal population. 32 However, perinatal mortality rates were slightly higher than the state in SLHD in 2013 ( 8.0 per 1,000 and 7.9 per 1,000 respectively). This equated to 67 babies across the District in that year.

31 NSW Ministry of Health Centre for Epidemiology and Research, Health Statistics NSW, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicatorgroup/IndicatorviewList?IndicatorGroupCode=mum_antegage&code=ante&topic=topic_mab&name=Antenatal careTopic 32 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/mab_pretbth/mab_pretbth_atsi_trend

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Injury and Poisoning In the period 2011/12, 163 SLHD residents died due to injury or poisoning, two thirds of whom were males. The injury and poisoning death rate in SLHD is less than that for the state (26.6 and 32.8 per 100,000 respectively) 33 and has been decreasing steadily since 1999. The top 3 causes of injury and poisoning death in SLHD were suicide (27.8%), unintentional poisoning (19.0%) and falls (16.2%).34 More recent data shows that in the period 2013/14 there were 13,133 hospitalisations of SLHD residents due to injury or poisoning, just over half of whom (55%) were male. The rate of hospitalisations was considerably less in SLHD than NSW (2,142.1 and 2,470.8 per 100,000 respectively)35. The majority of injury and poisoning hospitalisations related to falls (44.2%) and motor vehicle accidents (7.8%). Infectious Diseases Infectious diseases are those that can be transferred via microorganisms from one host (human or non-human) to another. Communicable diseases include those that are sexually transmissible, blood, air and vector borne. The most serious diseases are notifiable and are monitored by public health units at a district, state and national level. The key infectious diseases of interest in SLHD are TB, HIV, chlamydia, gonorrhoea, infectious syphilis, hepatitis B, hepatitis C, pertussis, varicella and measles.

• TB From 2005 to 2014, the average annual age-standardised rate of TB in SLHD was 1.5 times higher for females and 2 times higher for males compared to NSW. However, the age- standardised rate of TB for both males and females in SLHD decreased in 2014 to approximately 8-9 notifications per 100 0000 population. Notifications of TB in SLHD were most common in the 20-34 year old age group, with males being the predominant gender affected. For the period 2005 to 2014, Burwood, Strathfield and Canterbury Local Government Areas (LGAs) had the highest notification rates. In 2014, Burwood LGA had a notification rate of 17 per 100 000 population.

• HIV The rate of newly diagnosed HIV infections in NSW in 2014 was 5 cases per 100,000 population. In 2014, there were 82 new HIV infections diagnosed in SLHD. SLHD had the highest rates of newly diagnosed HIV infections in the state at 13.4 cases per 100,000 population (Figure 17). Sydney City (South and West) and Marrickville LGA had the highest notification rates, at 45 and 19 cases per 100,000 population, respectively (Figure 18).

33 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/inj_projpcodth/inj_dth_lhn_snap 34 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/inj_dth_cat/inj_dth_cat_lhn 35 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/inj_projpcohos/inj_hos_lhn

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Figure 17: Number and rate of notifications of newly diagnosed HIV infection in SLHD, 2005-2014

Source: NSW HIV/AIDS database. (Accessed 21/04/2015)

Figure 18: HIV notification rate (per 100,000 of population), by LGA, SLHD 2005-2014

Source: NSW HIV/AIDS database. (Accessed 21/04/2015) Table 28: HIV notification rate (per 100,000 of population), by LGA, 2005-2014

LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 15 5 8 3 7 7 5 5 2 1 Burwood 10 5 6 5 4 5 2 11 0 5 Canada Bay 9 9 3 6 4 5 1 6 2 4 Canterbury 2 5 11 2 4 5 4 3 7 5 Leichhardt 14 6 4 15 7 7 13 11 5 0 Marrickville 32 28 26 24 28 16 27 28 27 19 Strathfield 5 7 10 3 0 3 3 10 0 2 Sydney City* 54 38 46 42 51 41 43 59 47 45

* Sydney City (South and West SLAs). Source: NSW HIV/AIDS database. (Accessed 18/05/2015)

In 2014, the average age of newly diagnosed HIV cases in SLHD was 37 years, and 94% of the cases were male. This has remained constant since 2004. In 2014, 48% of all HIV notifications were in Australian born residents. Of the total notifications (50%) in Australian residents born overseas, 39% were born in a high prevalence country and 11% were born in a low prevalence country. In 2014, 59% of newly diagnosed HIV infections were defined as ‘at an early stage of infection’ and there was a 13% increase in notifications classified as early between 2013 and 2014. For the period 2005 to 2014, on average, greater than 88% of all notifications were homosexually acquired, 6% heterosexually acquired and 2% acquired through injecting drug use (IDU).

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• Chlamydia Between 2010 and 2014, notification rates for chlamydia remained higher in SLHD compared to NSW. In 2014, SLHD had 1.5 times the rate of chlamydia notifications compared to NSW i.e. 36.8 vs 26.4 cases/100,000 population (Figure 19). Around half of all cases from 2010 to 2014 occurred in the 20-29 year age group. In 2014, 54% of cases were male, with males continuing to have slightly higher rates of chlamydia in SLHD compared to females. Figure 19: Chlamydia notification rate (per 100,000 population) for SLHD and NSW, 2010 to 2014

Source: NSW NCIMS database. (Accessed 26/02/2015)

Table 29 shows that Sydney and Marrickville LGAs had the highest chlamydia notification rates of all LGAs in SLHD. During the period from 2009 to 2014 there was almost a doubling of the notification rate for Sydney from 529 to 1009 cases/100,000 population. Table 29: Chlamydia notification rate (per 100,000 population), by LGA, 2005 to 2014

LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 173.9 143.0 188.5 180.1 177.7 213.8 218.2 244.6 244.5 259.9 Burwood 183.0 127.3 182.4 251.9 225.5 195.1 266.3 270.8 221.0 310.5 Canada Bay 124.0 143.5 128.2 178.4 161.9 212.3 219.8 254.0 242.6 268.7 Canterbury 126.3 148.4 114.0 134.5 152.8 164.7 202.6 187.3 209.6 208.2 Leichhardt 261.2 253.7 243.8 235.3 216.2 238.3 316.3 271.6 284.8 318.5 Marrickville 302.4 338.3 338.7 346.0 323.1 362.0 457.3 496.8 561.1 629.1 Strathfield 152.4 136.2 175.3 189.6 136.6 181.1 244.4 244.3 273.7 257.4 Sydney* 542.8 490.9 556.4 573.0 529.0 636.3 703.7 762.3 732.8 1009.2

* Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

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• Gonorrhoea The notification rates of gonorrhoea are 2-3 times greater in SLHD than NSW. In 2014, the average annual notification rate per 100,000 was 14.4 for SLHD versus 5.3 for all of NSW (Figure 20). In 2014, the notification rate for males was almost 10 times higher than for females. Greater than 50% of all cases occur in the 20-39 age group for both sexes. Marrickville and Sydney City (South and West) continue to have the highest notification rates in SLHD (Figure 21 and Table 30). Figure 20: Gonorrhoea notification rate (per 100,000 population), by SLHD and NSW, 2010 to 2014

Source: NSW NCIMS database. (Accessed 26/02/2015) Figure 21: Gonorrhoea notification rate (per 100,000 population), by LGA, 2005-2014

Source: NSW NCIMS database. (Accessed 26/02/2015) Table 30: Gonorrhoea notification rate (per 100,000 population), by LGA, 2005-2014



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• Infectious Syphilis Figure 22 shows the infectious syphilis notification rate remained relatively stable between 2010 and 2012 for the SLHD, but increased between 2013 and 2014 to almost three times the average annual notification rate in NSW (Figure 22). Males comprised the vast majority (98%) of cases of infectious syphilis in 2014. The highest proportion of cases occurred in the 40-49 year age group. Marrickville and Sydney City (South and West) continue to have the highest notification rates (Figure 23 and Table 31). Figure 22: Infectious syphilis notification rate (per 100,000 population), by SLHD and NSW, 2010-2014


Figure 23: Infectious Syphilis notification rate (per 100,000) by LGA, 2005 – 2014


Table 31: Infectious syphilis notification rate (per 100,000) by LGA, 2005 – 2014

LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 0.0 9.7 7.2 2.4 4.7 18.6 4.6 6.9 13.6 13.4 Burwood 0.0 6.2 3.0 12.0 5.9 8.9 11.7 5.8 8.5 27.7 Canada Bay 4.5 1.5 2.8 2.8 1.3 1.3 5.0 3.6 8.2 14.9 Canterbury 3.7 2.2 4.4 6.4 2.1 3.5 1.4 5.4 9.4 8.6 Leichhardt 11.8 9.8 21.1 11.3 18.5 9.1 14.4 10.6 10.5 32.9 Marrickville 14.7 13.3 26.2 32.0 56.8 29.9 29.6 34.3 58.2 69.5 Strathfield 6.2 6.1 0.0 5.7 5.5 2.7 0.0 0.0 7.8 0.0 Sydney* 30.8 44.5 79.5 68.6 83.7 74.3 54.3 65.1 116.4 150.9 * Sydney City (South and West SLAs). Source: NSW NCIMS database. (Accessed 26/02/2015)

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• Hepatitis B For SLHD, the hepatitis B notification rate has remained relatively stable between 2010 and 2014. However, notification rates were consistently higher in the SLHD relative to NSW, and in 2014, was almost twice the rate of NSW (Figure 24). Figure 24: Hepatitis B notification rate (per 100,000 population), by SLHD and NSW 2005-2014


Males continue to have higher rates of hepatitis B infection (69.7 notifications/ 100,000 population) compared to females (56.8 notifications/100,000 population). In 2014 the 20-39 year age group had the highest number of notifications for both males and females. The LGAs with the highest notification rates for 2014 were (in decreasing order): Strathfield, Burwood, Canterbury and Ashfield LGA (Figure 25). Figure 25: Hepatitis B notification rate (per 100,000) by LGA, 2005 – 2014


Table 32: Hepatitis B age-standardised notification rate (per 100,000) by LGA, 2005 – 2014 LGA 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Ashfield 92.2 78.0 99.4 91.5 101.8 66.2 74.1 106.3 73.7 73.8 Burwood 126.3 117.1 99.0 76.5 95.5 84.7 68.6 83.5 99.2 88.5 Canada Bay 46.5 37.1 36.9 30.4 43.7 50.4 38.8 35.4 49.8 45.8 Canterbury 109.3 102.6 90.0 87.2 85.4 75.2 80.0 71.4 80.9 82.9 Leichhardt 14.1 9.4 25.3 16.0 17.2 10.8 14.0 9.6 17.6 15.3 Marrickville 73.0 75.2 60.5 55.6 54.2 44.1 51.0 41.0 41.4 37.1 Strathfield 130.3 92.6 67.6 88.4 75.4 81.1 70.6 89.2 68.1 89.3 Sydney* 84.0 56.6 62.3 51.5 48.5 50.6 48.8 54.3 47.3 45.6


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• Hepatitis C The hepatitis C notification rate has decreased over time in SLHD, and in 2014 was the same as the NSW notification rate (Figure 26). In 2014, notifications in males occurred at more than twice the rate (68.7 notifications/100 000 population) as those in females (33.3 notifications/100,000 population). The highest numbers of notifications were in the 20-39 year age group for females and in the 30-49 year age group for males. The LGAs with the highest notification rates for 2014 were (in decreasing order): Sydney City (South and West), Ashfield, Leichhardt and Marrickville (Figure 26). Figure 26: Hepatitis C notification rate (per 100,000 population), by SLHD and NSW, 2005-2014


Figure 27: Hepatitis C notification rate (per 100,000) by LGA, 2005 – 2014

Source: NSW NCIMS database. (Accessed 03/02/2015) Table 33: Hepatitis C age-standardised notification rate (per 100,000) by LGA, 2005 – 2014



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CHRONIC DISEASES Chronic diseases are medical conditions that tend to be long lasting and persistent in their symptoms or development. Examples include diabetes, respiratory disease, coronary heart disease and oral disease. Many of these diseases are preventable as they are related to lifestyle factors such as excess weight, poor diet and nutrition, physical inactivity, high blood pressure, high cholesterol, alcohol use and smoking. Increases in life expectancy are often accompanied by increasing disability from chronic illness. Actions taken earlier in life can prevent or mitigate chronic disease, yet preventable chronic illnesses, such as diabetes pose a significant and growing burden of mortality, morbidity and health care costs. Chronic diseases associated with ageing pose both medical and managerial challenges. Chronic diseases also dominate the long list of health problems experienced by Indigenous communities. Although there is an increasing focus on self-management and outreach support to manage chronic disease, a high number of hospitalisations are still required to manage acute episodes and comorbidities. A brief description of chronic disease in SLHD is provided under disease categories below.

• Diabetes Diabetes is a chronic condition where the body does not produce effective or sufficient amounts of insulin to convert glucose (sugar) from food into energy. A build-up of glucose in the bloodstream can lead to various damaging consequences over the long term if left undiagnosed or uncontrolled. The most common form of diabetes, type 2, has strong associations with inadequate levels of physical activity, overweight or obesity, with high blood pressure, high cholesterol and an ‘apple’ body shape, where excess weight is carried around the waist. According to the Atlas of Diabetes Prevalence by LGA36 in June 2015, over 28,000 District residents were registered under the National Diabetes Services Scheme (NDSS). The NDSS delivers diabetes-related products at subsidised prices and provides information and support services to people with all types of diabetes.

36 Diabetes NSW (2008), Atlas of Diabetes Prevalence by LGA, accessed July 2013 from http://dias.diabetesnsw.com.au/DAW2008/atlas.asp.

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http://dias.diabetesnsw.com.au/DAW2008/atlas.asp


Figure 28: SLHD National Diabetes Services Scheme (NDSS) registrants, by LGA of residence, number and proportion of LGA population, June 2015

Source: Diabetes Australia (2015), National Diabetes Services Scheme Australian Diabetes Map, accessed Aug 2015 from http://www.ndss.com.au/en/Australian-Diabetes-Map/. N.B.: City of Sydney LGA data covers both SLHD and SESLHD Statistical Local Areas.

Additionally, the results of the biomedical collection component of the Australian Health Survey 2011-12 revealed that in Australia, around one in five adults with diabetes do not know they have the condition.37 Locally, this could mean a further 6,500 residents may not know they have diabetes. This is of concern as the earlier a person is diagnosed and management of diabetes begins, the better the chances of preventing harmful and costly complications. In 2013/14, 691 SLHD residents were hospitalised for diabetes, a rate of 116.2 per 100,000, which was lower than the state rate of 151.1 per 100,00038. Significantly more Canterbury LGA residents were hospitalised for diabetes in 2012/13 to 2013/14, when compared with NSW. In 2013/14, NSW hospitalisation rates for diabetes were significantly higher for Aboriginal people (622.0 per 100,000) than for non-Aboriginal people (142.3 per 100,000)39. Further, in 2012 there were 162 diabetes related deaths in SLHD, a rate of 27.2 per 100,000 people, similar to the state rate of 28.9 per 100,00040.

37 Australian Bureau of Statistics (2013), Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12, Cat.no. 4634.0.55.005, Canberra: ABS, accessed August 2015: http://www.abs.gov.au/ausstats/[email protected]/mf/4364.0.55.005. 38 Health Statistics New South Wales, NSW Ministry of Health, North Sydney, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/dia_typehos/dia_typehos_lhn_snap 39 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/dia_pcohos/dia_pcohos_atsi 40 ibid. Accessed August 2013 from http://www.healthstats.nsw.gov.au/Indicator/dia_dth/dia_dth_lhn_snap.

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http://www.ndss.com.au/en/Australian-Diabetes-Map/

http://www.abs.gov.au/ausstats/[email protected]/mf/4364.0.55.005

http://www.healthstats.nsw.gov.au/Indicator/dia_dth/dia_dth_lhn_snap


• Respiratory Disease Respiratory diseases include influenza and pneumonia, asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. According to data reported in the NSW Population Health Survey 2014, SLHD residents, aged 16 years and over were less likely to report having asthma than the NSW average (7.7% compared to 9.9%)41. Table 34: Respiratory disease related hospitalisations, SLHD and NSW residents, 2013/14

SLHD NSW

Number per year

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CI UL 95%

CI Number per year

Rate per 100,000

population LL 95%

CI UL 95%

CI Asthma hospitalisations, all ages 821 151.3 140.9 162.2 12,993 177.1 174.0 180.2 COPD hospitalisations, all ages 1,241 210.0 198.4 222.1 21,904 246.5 243.2 249.8 Influenza and pneumonia hospitalisations, all ages 1,442 239.0 226.6 251.8 24,919 292.1 288.4 295.8

Source: NSW Ministry of Health Centre for Epidemiology and Evidence (2013), NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI), North Sydney: NSW Health.

In 2013/14 rates of hospitalisation for asthma, COPD and influenza and pneumonia were all lower in SLHD than the state. Across SLHD, from 2011 to 2012 there were 108.8 deaths from COPD per year. Consistent with overall rates of respiratory illness, this was a lower rate than that for the state (18.6 and 22.2 per 100,000 respectively). The COPD death rate in SLHD has decreased steadily between 2001/02 to 2011/12.42 Respiratory disease can be caused by smoking, including passive smoking. According to the NSW Adult Population Health Survey 2014, 91.2% of people in SLHD lived in a smoke free household43. LGA level data on respiratory disease hospitalisations is provided in Appendix 2.

• Cardiovascular Disease Coronary heart disease and stroke are the leading causes of cardiovascular disease and account for the majority of cardiovascular disease hospitalisations and deaths in NSW. Coronary heart disease accounted for 2,134 hospitalisations of SLHD residents in 2013/14, a rate significantly lower than the state. This was consistent in each of the 8 SLHD LGAs. Coronary heart disease hospitalisation rates in SLHD have decreased in the period 2001/02 to 2013/1444. A similarly lower rate of hospitalisations for coronary revascularisation procedures was recorded in SLHD (160.8 per 100,000) when compared to the state (194.8 per 100,000) in 2013/14. On the whole, the rate of coronary revascularisation procedures has decreased in both male and female District residents since 2004/05.45

41ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/res_astprev_age/res_astprev_lhn 42 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/res_copddth/res_copddth_lhn_trend 43 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/env_smohous_age/env_smohous_lhn 44 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/cvd_chdhos/cvd_chdhos_lhn_trend 45ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/cvd_chdprochos/cvd_chdprochos_lhn_trend

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In 2013/14 there were 722 hospitalisations as a result of stroke, a rate of 119.2 per 100,000 which was lower than that for the state at 144.3 per 100,000. Approximately 54% of SLHD resident hospitalisations were for people aged over 7546. LGA level data is provided in Appendix 2.

• Musculoskeletal Conditions In 2013/14 there were 1,545 total replacement procedures of hip and knee conducted on SLHD residents. SLHD residents had a much lower rate of hospitalisation for these procedures than the state (263.8 per 100,000 and 331.6 per 100,000 respectively). More women than men required this procedure to be undertaken.47

• Oral Health Oral health is integral to good general health. Oral diseases and disorders may create short and long term physical discomfort, compromised nutrition, and bacterial infections which may contribute to other physical health conditions such as heart disease and diabetes.48 In addition, the pain and disability often accompanying oral disease may impact one’s psychosocial wellbeing and general quality of life. A key indicator of the oral health status of the population is the incidence of dental caries, which is a largely preventable, chronic and multifactorial lifestyle related disease of microbial origin. In 2007, 65.2% of SLHD children (5-6 years) and 75.2 % of SLHD children (11-12 years) were free of dental caries which was higher than the NSW average (61.2% and 65.4% respectively). This data is from the most recent survey of child dental health in NSW which was undertaken in 2007, data collection for the next Child Oral Health Survey commenced in 2012/13. The oral health status of adult SLHD residents is difficult to quantify due to a lack of available data. The most recent data for adults is provided by the National Survey of Adult Oral Health 2004-06. As identified in Table 35 the oral health status indicators for NSW adults did not differ significantly from the national average.

46 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/cvd_strhos/cvd_strhos_lhn_trend 47 ibid. Accessed Aug 2015 from http://www.healthstats.nsw.gov.au/Indicator/mus_procrepkhhos_lhn/mus_procrepkhhos_lhn 48 National Advisory Council on Dental Health (2012), Report of the National Advisory Council on Dental Health, Canberra: National Advisory Council on Dental Health, accessed August 2013 from http://www.health.gov.au/internet/main/publishing.nsf/Content/final-report-of-national-advisory-council-on-dental-health.htm.

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http://www.health.gov.au/internet/main/publishing.nsf/Content/final-report-of-national-advisory-council-on-dental-health.htm

http://www.health.gov.au/internet/main/publishing.nsf/Content/final-report-of-national-advisory-council-on-dental-health.htm


Table 35: Oral health status, by NSW and Australian Adults, 2004/06

Source: The National Survey of Adult Oral Health 2004–06, Australian Institute of health and Welfare

• Falls

Falls are a significant health issue for people aged over 65. In 2013/14 there were 2,364 hospitalisations resulting from falls recorded for people in this age group in SLHD, an age-standardised rate of 3,044.1 per 100,000 (compared to 2,995.0 per 100,000 for NSW).49 Falls rates were significantly higher than the state in the LGAs of Leichhardt and City of Sydney50. Detailed data is provided in Table 36 and in Appendices 1 and 2. Table 36: Fall-related injury overnight stay hospitalisations, by sex, persons aged 65 years and over, SLHD and NSW, 2013/14

SLHD NSW

Number per year Rate per 100,000

population Number per year Rate per 100,000

population Males 826 2476.4 12,119 2388.2 Females 1,537 3484.1 24,170 3454.6 Persons 2,364 3044.1 36,289 2995.0

Source: NSW Ministry of Health Centre for Epidemiology and Evidence (2013), NSW Admitted Patient Data Collection and ABS population estimates (SAPHaRI), North Sydney: NSW Health.

• Dementia Dementia is a symptom of many illnesses including Alzheimer’s, Parkinson’s disease, Huntington’s disease and AIDS. Effects include loss of memory, intellect, rationality, social skills and normal emotional reactions. Dementia is a significant and increasingly important health issue for older people. According to a 2009 report by Deloitte Access Economics,51 there were an estimated 91,000 people living with dementia in NSW in 2011. This number is projected to increase to over 128,200 by 2020. Local prevalence data estimates that there were 4,892 people living with dementia in the Sydney Inner West in 2010.52 Dementia places a significant burden on carers, the community based care system and the hospital system, primarily where dementia is a comorbidity linked to increased length of stay.

49 Centre for Epidemiology and Evidence, Health Statistics New South Wales, : NSW Ministry of Health, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/inj_falloldhos/inj_falloldhos_totalstay_lhn_snap 50 Ibid. Accessed August 2015. http://www.healthstats.nsw.gov.au/Indicator/inj_falloldhos/inj_falloldhos 51 Deloitte Access Economics on behalf of Alzheimer’s Australia (2009), Keeping dementia front of mind: incidence and prevalence 2009-2050, Barton: Deloitte. 52 Alt Betty Consulting on behalf of Alzheimer's Australia NSW (2010), Count Me In: Needs Analysis of people with dementia and their carers in the HACC target population and an analysis of the current service system in responding to their needs, NSW Department of Family and Community Services Metro South Region.

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• Mental Health According to the 2013 NSW Adult Population Health Survey, 10.2% of people in SLHD considered themselves to have high or very high psychological distress, higher than the state average of 9.8%. The SLHD rate has decreased from 14.8% in 199753. According to the National Survey of Mental Health and Wellbeing in Australia:54

- Prevalence of mental illness is highest in the 16-24 age group (26%); and - At any one time, 2-3% of the population will be affected by a severe mental illness, 4-

5% by a moderate to severe mental illness and 9-10% by a moderate mental illness.

The Physical Care of Mental Health Consumers55 guidelines observe that people with a mental illness often undertake high health risk behaviours such as smoking, high alcohol and/or other drug consumption, poor nutrition, low levels of physical activity, high use of psychotropic medication and associated high risk social behaviours (e.g. unsafe sex, injurious activity). These behaviours combine with an overall reduced level of access to the health system and poor health literacy to result in high rates of coronary heart disease, diabetes, cancers, infections, obesity, respiratory disease, dental disease and poor outcomes following acute episodes. Further, a number of health and other conditions also co-occur with mental illness. These include intellectual disability, organic brain disorders (such as dementia) and alcohol and drug related problems. Whilst there is no single cause of suicidal behaviour, suicide is a major cause of death among people with a mental illness. Other individual circumstances and attributes which may compound to an attempt on one’s own life may include gender, stressful life events, issues concerning identity formation and identity challenge, victims of childhood abuses, inadequate protective factors, and social disconnection. Social determinants increasing the risk of suicide include socioeconomic disadvantage, unemployment, school disengagement, contact with criminal justice or correctional systems and cultural differences.56

53Centre for Epidemiology and Evidence, Health Statistics New South Wales, : NSW Ministry of Health, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/men_distr_age/men_distr_lhn 54 ABS 2007, National Survey of Mental Health and Wellbeing: Summary of results, Cat.no. 4326.0, accessed August 2015 from http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/4326.02007?OpenDocument. 55 NSW Ministry of Health (2009), Physical Care of Mental Health Consumers, Doc.no. GL2009_007, North Sydney: NSW Ministry of Health, accessed August 2015 from http://www.cadre.com.au/nsw_health/pdf/phmh_guidelines.pdf. 56 NSW Mental Health Drug and Alcohol Office (2010), NSW Suicide Prevention Strategy 2010-2015, North Sydney: NSW Ministry of Health, pp.11-17, accessed August 2015 from http://www0.health.nsw.gov.au/pubs/2010/pdf/suicide_ps.pdf.

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http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/4326.02007?OpenDocument

http://www.cadre.com.au/nsw_health/pdf/phmh_guidelines.pdf

http://www0.health.nsw.gov.au/pubs/2010/pdf/suicide_ps.pdf


Figure 29: Suicide rates per 100,000, SLHD residents, 2001-2012

Source: ABS mortality data and population estimates (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health.

Figure 29 shows that suicide rates have reduced by half since 2001, however there were still 39 suicides recorded for SLHD residents in 2012. The suicide rate was lower in SLHD than NSW in 2012 (6.4 and 9.8 per 100,000 respectively)57. Additionally, in 2013/14 there were 751 intentional self-harm hospitalisations, representing a considerably lower rate than for the state (120.2 and 142.7 per 100,000 respectively). The rate of intentional self-harm over the same period was higher for female SLHD residents (152.8 per 100,000) than for male residents (88.2 per 100,000) 58. Of note is that the rate of intentional self-harm for female SLHD residents increased sharply between 2010-11 and 2012-1359.

57Centre for Epidemiology and Evidence, Health Statistics New South Wales, : NSW Ministry of Health, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/men_suidth/men_suidth_lhn_trend 58ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/men_suihos/men_suihos_lhn 59ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/men_suihos/men_suihos_lhn_trend

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Mortality Based on data from 2012, life expectancy at birth for SLHD residents is 81.7 years for males and 86.4 years for females, compared to 80.8 and 85.2 for NSW60. Detailed data on median age of death by LGA is provided in Appendix 2. In 2012/13, the death rate from all causes in SLHD was 496.0 per 100,000 people, similar to NSW with 556.6. This rate has decreased dramatically for both male and female SLHD residents in the period 2001-02 to 2011-12.61 One of the key indicator groups when examining the health of a population is potentially avoidable mortality. Potentially avoidable mortality refers to premature deaths (persons aged under 75 years) that, theoretically, could have been avoided given current understanding of causation, and available disease prevention and healthcare. There were 539 potentially avoidable deaths of SLHD residents in 2011/12, a rate slightly lower than for the state (101.0 and 108.3 per 100,000 respectively)62. The rate of potentially avoidable death was significantly above the state average in the City of Sydney LGA (detailed data is provided in Appendix 2). As shown in Table 37, circulatory disease and malignant neoplasms (cancer) accounted for the majority of deaths per year in SLHD in the period 2011 to 2012. Table 37: Deaths by category of cause and gender, SLHD, 2011-2012

Category of cause of death

Males Females Number of deaths per

year

Rate per

100,000

LL 95% CI

UL 95% CI

Number of deaths per

year

Rate per

100,000

LL 95% CI

UL 95% CI

Circulatory diseases 463.5 185.0 173.3 197.4 444.8 123.1 115.0 131.6 Neoplasms - malignant 503.8 196.2 184.2 208.7 357.7 115.1 106.7 124.0 Respiratory diseases 179.9 73.6 66.2 81.7 144.6 40.9 36.2 46.0 Injury and poisoning 112.0 39.0 34.0 44.5 55.7 16.6 13.6 20.1 Endocrine diseases 58.6 23.3 19.2 27.9 58.6 17.1 14.1 20.5 Digestive system diseases 55.8 21.5 17.7 25.9 55.4 16.2 13.3 19.6 Mental disorders 64.7 26.7 22.3 31.7 119.4 30.8 26.9 35.0 Nervous and sense disorders 51.8 20.4 16.6 24.8 55.8 16.7 13.6 20.2

Genitourinary diseases 38.1 15.6 12.3 19.5 39.3 10.8 8.5 13.5 Infectious diseases 47.3 18.2 14.7 22.3 33.5 9.9 7.6 12.6 Maternal, neonatal and congenital causes 17.2 5.8 4.0 8.1 13.9 5.0 3.3 7.2

Ill-defined and unknown causes 24.9 9.6 7.1 12.7 23.1 7.1 5.2 9.5

Musculoskeletal diseases 7.7 3.1 1.7 5.0 10.0 3.3 2.0 5.1 Neoplasms - other than malignant 10.0 4.1 2.5 6.3 6.7 1.9 1.0 3.3

Blood and immune diseases 6.1 2.3 1.2 4.1 5.0 1.7 0.8 3.2 Skin diseases 5.1 2.0 1.0 3.7 5.5 1.5 0.7 2.7 SLHD Total 1646.5 646.4 624.3 669.0 1429.0 417.5 402.0 433.5

Source: ABS Mortality data 2003-2007, HOIST, NSW Health. Note: Deaths are classified using ICD-10 classification and distributed according to ICD-10 chapters. Chapters on diseases of the nervous system, eye and ear and chapters on conditions relating to pregnancy, perinatal period and congenital diseases are combined into one category in the analysis.

60 NSW Health Centre for Epidemiology and Evidence, Health Statistics NSW, North Sydney: NSW Ministry of Health, accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/bod_lexbth/bod_lexbth 61 ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/bod_projdth/bod_dth_lhn_trend 62ibid. Accessed August 2015 from http://www.healthstats.nsw.gov.au/Indicator/bod_avodth/bod_avodth_lhn

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Appendices

Appendix 1: SLHD population profile based on the 2011 Census Estimated Resident Population

Population Characteristics Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield Sydney# SLHD NSW

Total persons (2014 ERP) 44,498 36,053 87,480 150,626 58,136 83,356 39,481 116,193 615,823 7,410,399

7.2% 5.9% 14.2% 24.5% 9.4% 13.5% 6.4% 18.9% 8.3%

Aboriginal people and Torres Strait Islanders

233 120 286 794 514 1,111 103 1,714 4,875 172,621

0.6% 0.4% 0.4% 0.6% 1.0% 1.5% 0.3% 1.8% 0.9% 2.5%

Persons born overseas 18,247 17,065 26,914 66,130 14,940 26,094 18,531 39,609 227,530 1,778,548

44.3% 52.6% 35.5% 48.1% 28.6% 34.1% 52.7% 40.5% 41.5% 25.7%

Language spoken at home – English only

20,348 11,606 44,186 40,804 41,457 47,700 11,309 58,329 275,739 5,013,343

49.4% 35.8% 58.3% 29.7% 79.4% 62.4% 32.1% 59.6% 50.3% 72.5%

1st most common language other than English spoken at home

Mandarin Mandarin Italian Arabic Italian Greek Korean Mandarin N.A. Arabic

3,740 (9.1%) 4,126 (12.7%) 6,674 (8.8%) 18,175

(13.2%) 1,587 (3%) 4,235 (5.5%) 3,133 (8.9%) 5,210 (5.3%) 184,252 (2.7%)

2nd most common language other than English spoken at home

Italian Cantonese Mandarin Greek Greek Vietnamese Cantonese Cantonese N.A. Mandarin

2,805 (6.8%) 2,857 (8.8%) 3,833 (5.1%) 13,411 (9.8%) 730 (1.4%) 2,827 (3.7%) 2,830 (8.0%) 3,316 (3.4%) 139,825

(2.0%)

3rd most common language other than English spoken at home

Cantonese Italian Cantonese Mandarin Spanish Arabic Mandarin Greek N.A. Cantonese

1,864 (4.5%) 1,837 (5.7%) 2,802 (3.7%) 7,696 (5.6%) 530 (1.0%) 1,791 (2.3%) 2,822 (8.0%) 1,637 (1.7%) 136,374 (2.0%)

Disability: need for assistance with core activities

2,452 1,684 2,921 7,238 1,655 3,282 1,412 2,620 23,264 338,362

5.9% 5.2% 3.9% 5.3% 3.2% 4.3% 4.0% 2.7% 4.2% 4.9%

Carers: Unpaid assistance to a person with a disability

3,514 2,974 6,698 12,347 4,115 6,190 2,976 6,146 44,960 638,614

8.5% 9.2% 8.8% 9.0% 7.9% 8.1% 8.5% 6.3% 8.2% 9.2%

Education

Total persons 15 years and over who are no longer attending primary or secondary school

33,876 26,532 60,899 105,546 42,515 63,825 28,056 88,319 449,568 5,344,114

Education: Completed Year 12 or equivalent

22,108 17,594 36,105 57,994 30,639 41,742 19,542 62,655 288,379 2,631,287

65.3% 66.3% 64.2% 54.9% 72.1% 65.4% 69.7% 70.9% 64.8% 49.2%

Education: Completed Year 3,783 2,836 8,937 15,727 4,431 6,966 2,736 6,924 52,340 1,278,047

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Population Characteristics Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield Sydney# SLHD NSW 10 or equivalent 11.2% 10.7% 14.7% 14.9% 10.4% 10.9% 9.8% 7.8% 11.6% 23.9%

Education: Completed Year 10 or below

7,385 5,713 14,658 32,875 6,944 13,595 4,912 11,425 97,507 1,983,205

21.8% 21.5% 24.1% 31.1% 16.3% 21.3% 17.5% 12.9% 21.7% 37.1%

Employment

Total labour force 21,969 16,191 40,422 59,517 31,259 44,205 17,622 59,048 290,233 3,334,857

Employed full time 13,353 9,259 26,407 34,275 21,275 28,704 10,662 40,261 184,196 2,007,925

60.8% 57.2% 65.3% 57.6% 68.1% 64.9% 60.5% 68.2% 63.5% 60.2%

Unemployed 1,349 1,095 1,741 4,855 1,256 2,325 1,130 3,459 17,210 196,526

6.1% 6.8% 4.3% 8.2% 4.0% 5.3% 6.4% 5.9% 5.9% 5.9%

Income: Median individual ($/weekly) 628 490 782 430 1,086 772 558 888* N.A. 561

Income: Median household ($/weekly) 1,413 1,310 1,817 1,029 2,234 1,605 1,421 1639* N.A. 1,237

Family characteristics

Families 10,422 8,054 20,558 36,216 13,532 18,622 8,982 20,965 137,351 1,829,553

Couple families with children 4,613 3,874 9,545 18,544 5,679 7,286 4,633 5,298 59,472 831,850

44.3% 48.1% 46.4% 51.2% 42.0% 39.1% 51.6% 25.3% 43.3% 45.5%

Couple families without children

3,945 2,651 8,025 10,497 5,830 7,798 2,812 12,045 53,603 669,019

37.9% 32.9% 39.0% 29.0% 43.1% 41.9% 31.3% 57.5% 39.0% 36.6%

One parent families 1,530 1,251 2,546 6,362 1,689 2,946 1,290 2,665 20,279 297,904

14.7% 15.5% 12.4% 17.6% 12.5% 15.8% 14.4% 12.7% 14.8% 16.3%

Other families 334 278 442 813 334 592 247 957 3,997 30,780

3.2% 3.5% 2.2% 2.2% 2.5% 3.2% 2.7% 4.6% 2.9% 1.7%

Household composition: private dwellings

Households 15,296 10,728 28,016 45,928 21,316 29,977 11,378 41,895 204,534 2,471,296

Family household 10,096 7,652 20,076 34,634 13,391 18,110 8,617 20,691 133,267 1,777,398

66.0% 71.3% 71.7% 75.4% 62.8% 60.4% 75.7% 49.4% 65.2% 71.9%

Lone person household 4,181 2,209 6,459 9,746 6,290 8,773 2,151 15,075 54,884 599,148

27.3% 20.6% 23.1% 21.2% 29.5% 29.3% 18.9% 36.0% 26.8% 24.2%

Other households 1,019 867 1,481 1,548 1,635 3,094 610 6,129 16,383 94,750

6.7% 8.1% 5.3% 3.4% 7.7% 10.3% 5.4% 14.6% 8.0% 3.8%

Dwelling characteristics

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Population Characteristics Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield Sydney# SLHD NSW Total private dwellings 16,332 11,373 30,386 48,657 23,352 32,364 11,916 45,656 220,036 2,736,637

Median rent ($/weekly) (occupied private) 365 400 480 300 480 370 400 465* N.A. 300

Median housing loan repayment ($/monthly) (occupied private)

2,167 2,179 2,600 2,000 3,000 2,485 2,195 2539* N.A. 1,993

Occupied private dwellings - fully owned

4,407 3,641 9,268 14,112 5,206 7,012 3,257 5,504 52,407 820,006

27.0% 32.0% 30.5% 29.0% 22.3% 21.7% 27.3% 12.1% 23.8% 30.0%

Occupied private dwellings - rented including rent-free

6,141 3,925 9,273 16,750 8,648 12,891 4,151 24,594 86,373 743,050

37.6% 34.5% 30.5% 34.4% 37.0% 39.8% 34.8% 53.9% 39.3% 27.2% Source: Australian Bureau of Statistics (2011), Census of Population and Housing: Expanded Community Profile, 2011, Cat.no. 2005.0, second release, Canberra: ABS, accessed August 2013 from http://www.abs.gov.au/AUSSTATS/[email protected]/productsbyCatalogue/974A1A5E73830E9ACA2570D90018BFB0?OpenDocument. # Includes Sydney South and Sydney West SLAs only * Median for the Sydney LGA

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http://www.abs.gov.au/AUSSTATS/[email protected]/productsbyCatalogue/974A1A5E73830E9ACA2570D90018BFB0?OpenDocument


Appendix 2: Health of the SLHD population, selected indicators Indicator Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield

City of Sydney

NSW (Ratio only)

Smoking attributable hospitalisations, 2012-13 to 2013-14, smoothed number of separations per year (smoothed estimate of Standardised Separation Ratio-seSSR) 1

176 (66.6) 135 (66) 351 (69.5) 704 (79.7) 251 (82.8) 317 (74.2) 136 (67.3) 794 (99.1) 100

Smoking attributable deaths 2012, smoothed number of deaths per year (smoothed estimate of Standardised Mortality Ratio - seSMR) 2

31 (94.7) 21 (83.4) 49 (85.8) 84 (85.1) 129 (99.7) 43 (97.9) 18 (82) 77 (101.3) 100

Alcohol attributable hospitalisations 2012-13 to 2013-14 smoothed number of hospitalisations per year (smoothed estimate of Standardised Separation Ratio-seSSR) 1

393 (119.6) 215 (83.8) 512 (83.8) 634 (61.4) 492 (123.8) 675 (116.2) 154 (58.1) 1,616 (118.5) 100

Alcohol attributable deaths 2011 to 2012, smoothed number of deaths per year (smoothed estimate of Standardised Mortality Ratio - seSMR) 2

7.1 (92) 5.1 (85.9) 11.2 (81.9) 20.4 (86.1) 8.7 (104.1) 12.2 (98.9) 5 (85.3) 25.9 (99) 100

High body mass index attributable hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

144 (67.7) 110 (66.5) 311 (75.2) 619 (86.5) 181 (71.1) 257 (72.7) 116 (70.6) 551 (82.1) 100

High body mass attributable deaths 2006 to 2007, Smoothed Number of Deaths per Year (smoothed estimate of Standardised Mortality Ratio - seSMR) 2

17 (93.6) 15 (102.7) 28 (93.2) 23 (41.1) 16 (89.2) 20 (74.9) 14 (104.1) 69 (141.4) 100

Asthma hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

44 (61.2) 50 (92.3) 97 (67.2) 305 (111.3) 78 (77.1) 111 (84.3) 39 (63.9) 142 (62.8) 100

COPD hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

75 (74.2) 60 (76.3) 126 (68.9) 293 (92.9) 93 (108) 139 (102) 42 (60.9) 195 (86.9) 100

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Indicator Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield City of Sydney

NSW (Ratio only)

Influenza and pneumonia hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

125 (81.7) 97 (84.3) 180 (65.1) 414 (86.9) 133 (85.4) 234 (103.4) 75 (67.5) 329 (79.7) 100

Stroke hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

70 (87.6) 47 (76.5) 103 (73.3) 212 (89) 58 (80.1) 89 (81.7) 48 (86.1) 209 (106.5) 100

Falls related hospitalisations, smoothed number of separations per year 2012-13 to 2013-14 (smoothed estimate of Standardised Separation Ratio - seSSR) 1

382 (97.6) 265 (88.7) 632 (92) 954 (81.1) 452 (121.1) 587 (106.4) 221 (77.1) 1133 (108.8) 100

Data derived from NSW Health Centre for Epidemiology and Evidence, Health Statistics New South Wales, North Sydney: NSW Ministry of Health. Available at: www.healthstats.nsw.gov.au.

Above the state average at 1% level of significance

Above the state average at 5% level of significance

Below the state average at 1% level of significance

Below the state average at 5% level of significance

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Cancer Indicator Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield

City of Sydney (part) SLHD NSW

All cancers, count and (age standardised incidence rate per 100,000), 2004 to 2008

988 (440.7) 720 (404.7) 464.0) 2,984 (435.6)

1,159 (503.7)

1,540 (461.5) 642 (389.7) 1,617

(479.9) 11,397 (449.1)

177,519 (483.2)

All cancers, count and (age standardised mortality rate per 100,000), 2004 to 2008

404 (168.6) 291 (155.0) 655 (168.2) 1,282 (187.7) 426 (198.1) 673 (213.5) 251 (147.4) 565 (183.5) 4,547

(181.0) 66,228 (176.9)

Source: Cancer Institute NSW Registry 2011, accessed August 2015 from http://www.cancerinstitute.org.au/data-and-statistics/cancer-statistics/online-statistics-module.

Maternal Indicator Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield City of Sydney NSW

Smoking at all during pregnancy, 2011 to 2013 combined, number of mothers who smoked per year (smoothed estimate of standardised prevalence ratio)

19 (52.1) 8 (43) 20 (32.4) 121 (61.2) 22 (44.3) 54 (68.3) 14 (49.6) 79 (52.9) 100

First antenatal visit before 14 weeks of gestation, 2011 to 2013 combined, Number of mothers per year , (95% confidence interval for smoothed ratio)

391 (72-78.3) 268 (77-84.4) 926 (89-93.5) 1,705 (90.9-93.6) 725 (87-91.5) 735 (72-76.7) 341(83.8-90.2) 1,388 (88.3-

91.3) (100)

Source: NSW Health Centre for Epidemiology and Evidence, NSW Perinatal Data Collection (SAPHaRI), North Sydney: NSW Ministry of Health.

Mortality Indicator Ashfield Burwood Canada Bay Canterbury Leichhardt Marrickville Strathfield City of Sydney NSW

Potentially avoidable deaths, persons aged under 75 years, 2011 to 2012, smoothed number of deaths per year (smoothed estimate of Standardised Mortality Ratio - seSMR) 2

37.9 (90.2) 26 (78.5) 61.7 (74.8) 128.5 (87.8) 49.2 (89.6) 75.9 (99.5) 27.7 (80.5) 188.6 (118.4) 100

Median age of death, Males, 2003 to 2007 79 77 77 76 76 74 79 70 77

Median age of death, Females, 2003 to 2007 85 84 82 82 81 82 84 80.5 83

Source: NSW Health Centre for Epidemiology and Evidence, NSW Perinatal Data Collection (SAPHaRI), North Sydney: NSW Ministry of Health. Source: Public Health Information Development Unit, Social Health Atlas of Australia: Statistical Local Areas and Local Government Areas 2012, Adelaide: The University of Adelaide, accessed August 2013 from http://www.publichealth.gov.au/data/

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