RESPI-Cardio Disease - Ministry Of Health

Presentation of data includingdata type, source and presentationData describing the health of the population of HNEAHShospital was diagnosed as respiratory disease, includingare presented in seven sections. The health conditionsasthma, and cardiovascular disease. This was obtained fromreviewed in these sections include those that have beenthe NSW Admitted Patients Data Collection. Separationdocumented in the research literature as being associatedrates are presented by local government area for all ofwith exposure to ambient air pollution. There is also aHNEAHS and for NSW overall.section describing how drinking water is monitored inHNEAHS and Australian and state standards for watercompliance. There has been some community concernSection 4 – Self-reported data onoverall health, asthma and smokingabout local drinking water quality being affected by airThroughout the year the NSW Department of Healthpollution.collects information on how people in NSW report theirA description of the methods used is presented at theown health status (for children this is reported by a parentbeginning of each section. A complete set of data Tablesor guardian), their quality of life and a range of healthand three Figures are found in Appendix D. A description ofissues including asthma and tobacco smoking. This sectionthe limitations of the data is found in Appendix B.presents data from the NSW Population Health Survey. DataSection 1 – The populationof Hunter New Englandare presented by HNEAHS cluster.Section 5 – MortalityThis section describes the population of HNEAHS and theThe latest available mortality data from people who wereareas where they live. The location of coal mines and powerresident in HNEAHS at the time of their deaths arestations have been mapped by location and type of minepresented, including the causes of death that are(open-cut and underground).considered most likely to be associated with air pollution.Section 2 – Emergency departmentpresentations for respiratory illnessand asthmaData were provided by the Australian Bureau of Statistics.Rates are presented by HNEAHS cluster.Section 6 – CancerThe total number of people resident in HNEAHS whoThe latest available cancer data on both the incidence ofpresented to emergency departments and who werecancer (the number of new cases of a cancer diagnosedassigned a diagnosis of any respiratory condition (includingand reported in a given year) and the mortality from cancerasthma) were obtained from the NSW Emergency(the number of people who died as a result of a cancerDepartment Data Collection for the period 2007 to 2009in a given year) are presented for the most common cancersinclusive. Emergency department presentations are analysedexperienced by residents of HNEAHS, as well as cancersby postcode area.with the strongest links to particulate matter pollution.Section 3 – Hospital separationsfrom respiratory diseases (includingasthma) and cardiovascular diseasesRates are presented by HNEAHS cluster. Cancer data wereextracted from the NSW Central Cancer Registry,maintained by the NSW Cancer Institute.This section details the number of people discharged fromhospital, where the primary reason for their admission toRespiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health Service NSW Health PAGE 5XXXXXX HNE Respi Cardio Disease Inner v06.indd 505/05/2010 2:55:08 PM

Section 7 – Drinking water qualityin the Hunter New England areaThe NSW Health Drinking Water Monitoring Programspecifies the minimum number of samples that should betaken based on the size and complexity of water supplysystems, and in accordance with the National Health andMedical Research Council (NHMRC) Australian DrinkingWater Guidelines (available at: syn.htm). In the Hunter Valley,the larger towns are tested for chemical quality each monthand the smaller towns are tested every 6 months. Thedrinking water supplies are tested for a range of chemicalsincluding aluminium, arsenic, barium, boron, cadmium,calcium, chloride, chromium, copper, cyanide, iodide, iron,lead, magnesium, manganese, mercury, molybdenum,nickel, nitrate, nitrite, selenium, silver, sodium, sulphate andzinc. NSW Health does not routinely monitor the quality ofdomestic rainwater tanks.Description of findings in the reportRates derived from the data are described as being eitherhigher than or lower than a specified reference rate (such asthe rate for the whole of NSW or the rate for all of NEAHS)when their 95% confidence intervals do not include thereference rate’s value. This condition is approximately thesame as there being less than a 5% probability that thedifference between an observed rate and the reference ratecould be a chance finding.When the rates between one area and a comparison areaare very different in magnitude but do not meet the abovecondition, they are discussed in this report as beingdifferent, but noted as not being “statistically significantlydifferent” from the reference rate.PAGE 6 NSW Health Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health ServiceXXXXXX HNE Respi Cardio Disease Inner v06.indd 605/05/2010 2:55:08 PM

SECTION 1The population of Hunter New EnglandKey pointsnHunter New England HealthArea Health Service unter New England Area Health Service (HNEAHS)His one of eight area health services in NSWHunter New England is one of eight area health servicesn bout 12% of the NSW population live in the HNEAHSAin NSW (Figure 1). It is one of four rural area health servicesn ver one in five of the state’s Aboriginal people liveOand, of these, is the only one that includes a large cityin the HNEAHS(Newcastle) within its boundaries. Newcastle has the second NEAHS’s population is ageing, with 16% 65 yearsHbusiest harbour on the east coast and is the largest coalor older, compared to 14% for NSWexporting port in the world. HNEAHS covers more thanT he Muswellbrook and Singleton local government130 000 square kilometres.nnareas contain the greatest concentration of open-cutcoal mines and coal-fired power stations in the UpperHunter and Lower Hunter.This section provides information about the populationof HNEAHS and where the people live in the region.The source of information is from the Australian Bureauof Statistics.Throughout this report, three geographical categorieswithin HNEAHS are considered:n lusters: administrative regions established by theCHNEAHS for the purposes of delivering health services;each cluster consists of a number of local governmentFigure 1. Area Health Services in NSWareasnnL ocal government areas (LGAs): administrative divisionsof NSW for which a local government (council) isIn HNEAHS, there are 25 local government areas and theseresponsible; each local government area consists of oneare grouped into eight administrative clusters. Table 2or more postcodesshows the cluster populations by local government area.P ostcodes.Local government areas are the smallest geographicalarea for which population health information is routinelycollected.Additional information supporting the findings presentedin this section is contained in Appendix D, Tables 1-8.Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health Service NSW Health PAGE 7XXXXXX HNE Respi Cardio Disease Inner v06.indd 705/05/2010 2:55:08 PM

Table 2. Hunter New England Area Health Service, NSW,estimated total residential population by cluster and localgovernment area, 2009HNEAHS clusterGreater NewcastleLocalgovernment areaPopulationLake Macquarie195 479representing approximately 12% of the population of NSW.153 171The population lives in communities across the region, pper Hunter49 751853969 878Singleton23 747Gloucester151 9134995the densely populated coastal zone to small rural townships(Table 2). Tables 3 to 8 in Appendix D provide more detailabout the population at the local government area levelby age, gender and Indigenous status.HNEAHS has a diverse population. There are 32 889Aboriginal people living in the Area, representingapproximately 22% of the state’s Aboriginal population,Greater Lakes35 986and 4% of the HNEAHS population (Table 6, Appendix D).Greater Taree47 866The local government areas with the highest proportionTOTAL88 847of Aboriginal residents are Moree Plains (20.7%), GunnedahInverell16 169(10.3%), Guyra (10.4%) and Narrabri (9.3%). There is alsoa higher proportion of older people (aged over 65 years) inGwydir5421TOTAL21 591HNEAHS, approximately 16% compared with 14% for theMoree Plain14 427state (Table 8, Appendix D).Narrabri13 454TOTAL27 881Socioeconomic disadvantage is found across HNEAHS,Gunnedah11 840particularly where there is a higher Aboriginal population,Tamworth57 066public housing and lower employment. The mostdisadvantaged local government areas are: Inverell,Walcha3291TOTAL72 197Tenterfield, Glen Innes Severn, Guyra, Liverpool Plains,Armidale Dumaresq24 538Gunnedah, Moree Plains, Cessnock and Greater Taree.Guyra4404Tenterfield6812Uralla6008Glen Innes Severn9065Mining in Hunter New England areaOver the past 30 years, there has been a six-fold increaseTOTAL50 827in coal production through open-cut mining in the HunterMuswellbrook16 167Valley. There are currently six coal-fired electrical powerUpper Hunter Shire13 524stations of which four lie within the HNEAHS and twoLiverpool PlainsHNEAHS combined67 144415 794MaitlandTOTALLower MidNorth CoastThe population of HNEAHS in 2009 was 866 566,NewcastlePort StephensLower HunterWho are the people who live withinthe boundaries of the Hunter NewEngland Health Area Service?7825TOTAL37 516TOTAL866 566fall outside the southern boundary (Figure 2). Operationalcoal mines are located in the Local Government Areas asdescribed in Table 9 (also Appendix C).Source: Australian Bureau of Statistics, ABS Estimated Resident PopulationCoal mining activities and coal-fired electrical powergeneration in the Hunter Valley are a source of airpollutants, including particulate matter. The level ofexposure to air pollutants for the population living in theareas affected by these activities is not yet known. TheDepartment of Environment, Climate Change and Wateris currently planning to install an air quality monitoringarray in the Hunter Valley.PAGE 8 NSW Health Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health ServiceXXXXXX HNE Respi Cardio Disease Inner v06.indd 805/05/2010 2:55:08 PM

Table 9. Number of operating coal mines in the Hunter New England Area Health Service, April 2010Coal minesLocal government areaCombined (open-cutand lbrook5-1*Cessnock111Lake Macquarie15-Wyong**-2-Gloucester1--Great Lakes1--Gunnedah3--Liverpool Plains1--Narrabri21-Total26116*The combined open-cut and underground coal mine in Muswellbrook local government areas also falls across into boundary of Singleton local government areas.Not included in data set for Singleton local government areas.**Wyong local government areas mine sites are located outside HNEAHS.Source: Department of Environment, Climate Change and Water, Environment Protection and Regulation Division, Newcastle Office (April 2010)The areas with the most intensive coal mining and powergeneration activities include the Upper and Lower Hunterclusters, and primarily the Muswellbrook and Singleton localgovernment areas. There are a small number of open-cut coalmines in the Mehi cluster (Narrabri local government area),and the Peel cluster (Gunnedah local government area).Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health Service NSW Health PAGE 9XXXXXX HNE Respi Cardio Disease Inner v06.indd 905/05/2010 2:55:08 PM

Figure 2. Location of coal mines and power stations in the Hunter New England Area Health Service by clusterand local government area, 2010PAGE 10 NSW Health Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health ServiceXXXXXX HNE Respi Cardio Disease Inner v06.indd 1005/05/2010 2:55:08 PM

SECTION 2Emergency department presentationsfor respiratory illness and asthmaKey points2006 Australian Standard Geographic Classification (ASGC):Central Northern Sydney, Northern Beaches, Blacktown,nT he rates of presentation for all respiratory illnessesFairfield-Liverpool, St George-Sutherland, Lower Northin Muswellbrook and Singleton postcodes rankedSydney, Central Western Sydney, Canterbury-Bankstown,below those of Tamworth, Gunnedah and CessnockInner Western Sydney, Eastern Suburbs and Inner Sydney.in all age groupsnnn uswellbrook area has high rates for emergencyMAttendance rates at emergency departments per 100 000department presentation for asthma, but not theresident population were calculated (ABS Estimated Residenthighest (Tamworth and Gunnedah) in Hunter NewPopulation). Two levels of analysis were undertaken: firstly,England Area Health Service (HNEAHS)rates for each of the Singleton and MuswellbrookS ingleton also ranks highly for rates of emergencypostcodes were compared with all remaining postcodesdepartment presentations for asthma in those agedfor HNEAHS combined and with the Sydney area; secondly,15-64 yearsrates for postcodes in HNEAHS with populations of at least uswellbrook and Singleton are equally highly rankedM10 000 were ranked according to rates of emergencyfor rates of emergency department presentations fordepartment visits for respiratory problems and asthma.conditions unrelated to air pollution.Additional information supporting the findings presentedin this section are contained in Appendix D, Table 10-14.MethodsFindingsIn this section, the rate of presentations to emergencyIn the period 2007 to 2009, 0-35 year-old people residentdepartments (EDs) for respiratory illness including asthma inin the Muswellbrook postcode had higher rates ofthe Singleton and Muswellbrook postcode areas areemergency department presentations for both asthma andcompared with the remainder of HNEAHS and Sydney.overall respiratory illness than the remainder of HNEAHSand Sydney.For the period 2007 to 2009 inclusive, data on the totalnumber of emergency department presentations assigned aResidents in the Singleton postcode had rates ofdiagnosis of any respiratory condition, including asthma,presentation to emergency departments for asthma similarwere obtained from the NSW Emergency Department Datato residents in the rest of HNEAHS and Sydney. However,Collection. The analysis considered the postcode of thethe overall emergency department presentation rate forpatient’s place of residence and the patient’s age group.respiratory illness was similar to that of Muswellbrook.The age groups reviewed were 0-14-years, 15-34-years,Rates of asthma presentations for Singleton postcode in the35-64-years and 65-years and over.15-35-year-old age group were lower than Muswellbrookbut still higher than Sydney and the rest of HNEAHS.Because the NSW Emergency Department Data CollectionSingleton postcode had the highest overall rate ofdoes not have complete coverage of the population ofrespiratory illness in this age group (Table 10).NSW, areas with good coverage of hospital attendanceswere selected as comparators. HNEAHS and the mostThe 35-64-year-old residents in the Singleton andpopulated part of the Sydney area both had good coverageMuswellbrook postcodes had higher rates of presentationsover the analysis period. For Sydney, we included allfor both asthma and respiratory illness than Sydney or thepostcodes in the following statistical subdivisions from therest of HNEAHS. Among those aged 65 years or more,Respiratory and cardiovascular diseases and cancer among residents in the Hunter New England Area Health Service NSW Health PAGE 11XXXXXX HNE Respi Cardio Disease Inner v06.indd 1105/05/2010 2:55:08 PM

Muswellbrook postcode had higher rates of presentationspeople aged 35 years and over. Gunnedah ranked higherfor both asthma and respiratory illness than Sydney or thethan both Singleton and Muswellbrook in those aged 65rest of HNEAHS. In this age group, Singleton postcode hadyears and over (Table 12).lower rates than the other postcodes for asthma and similarrates to the rest of HNEAHS for respiratory illness.Respiratory presentations to emergencydepartmentsRespiratory illness presentationsFor overall respiratory presentations, Singleton postcodeFor rates of overall respiratory illness presentations,ranked 7th highest with a standardised incidence ratio (SIR)Muswellbrook and Singleton postcodes ranked below thoseof 145, indicating that the rate in Singleton was 45% higherof Tamworth, Gunnedah and Cessnock in all age groups.than HNEAHS. Muswellbrook postcode ranked 10th highestMuswellbrook and Singleton postcodes ranked 6th andwith an SIR of 137 (37% higher than HNEAHS overall), but7th highest in the 0-14-year age group, 7th and 4th highestthe SIR was broadly similar to that of the Singletonin the 15-34-year age group, 6th and 5th highest in thepostcode. Taking into account the statistical precision of35-64-year age group, and 8th and 15th highest in thosethese estimates, postal areas with higher rates thanaged 65 years and over, respectively (Table 11).Singleton postcode included Tamworth, Cessnock,Abermain, Gunnedah and Kurri Kurri (Table 13). Those withAsthma presentationsbroadly similar rates included Quirindi, Dundee, Inverell andFor rates of asthma presentations, residents in theMoree, as well as Muswellbrook postcodes.Muswellbrook postcode ranked highest among people agedless than 35 years of age, 7th highest in 35-64 year-olds,Asthma presentationsand 4th highest in those aged 65 years or more. SingletonFor asthma presentations, Muswellbrook postcode rankedpostcode ranked 11th in 0-14 year-olds, 6th in 15-34 year-5th highest with an SIR of 185 (85% higher than HNEAHSolds, 3rd in 35-64 year-olds and 25th in those aged 65overall) and Singleton ranked 14th highest with an SIR ofyears and over. Moree and Tamworth postcodes ranked120 (20% higher than HNEAHS overall). Taking into accounthigher than both Singleton and Muswellbrook postcodes inthe statistical precision of these estimates, Muswellbrook’sTable 10. Rates of emergency department presentations for all respiratory illness and asthma in residents of Singletonand Muswellbrook postcodes, the Hunter New England Area Health Service (HNEAHS) postcodes combined and Sydneypostcodes,

XXXXXX HNE Respi Cardio Disease Outer v04.indd 5 05/05/2010 2:51:29 PM. NSW DEPARTMENT OF HEALTH 73 Miller Street NORTH SYDNEY NSW 2060 Tel. (02) 9391 9000 Fax. (02) 9391 9101 TTY. (02) 9391 9900 www.health.nsw.gov.au Produced by: Population Health Division NSW Department for Health