Health of the SEH Population

Contents

Demographic characteristics of the Population

South East Health (SEH) covers a geographic area of 543 square kilometres, extending from Sydney Harbour in the north, through the eastern and southern beaches, Botany Bay, George’s River, Port Hacking and south to the Royal National Park at Waterfall. Ten local government areas are covered by SEH: Botany, Hurstville, Kogarah, Randwick, Rockdale, South Sydney (part), Sutherland, Sydney (part), Waverley and Woollahra. Health services in Lord Howe Island are also under the administration of SEH.

There are about 772,910 people living in SEH, representing approximately 12% of the NSW total population. Children under 15 years constitute 16% of the SEH population and older people aged 70 and over make up about 10%. Less than 1% (0.7%) of the SEH population are Aboriginal and Torres Strait Islander people. About 33% of the population are overseas born. People who speak a language other than English at home account for about 26% of the SEH population aged 5 and over.

  Compared to the whole of NSW, more people in SEH are aged 70 and over, are overseas born and are non-English speakers.

The SEH population has increased over the past 3 censuses. Sydney, Sutherland and South Sydney LGAs recorded the greatest population growth in the Area. People aged 70 years and over as a percentage of the total population increased, from 8.7% in 1986 to 9.8% in 1996. Non-English speaking background and Aboriginal and Torres Strait Islander populations have also increased.

SEH had the second best Socio-economic Index for Areas score in NSW for all four Indexes, after Northern Sydney Area Health Service. Compared to the NSW average, the SEH population had higher levels of education, income, private health insurance cover, employment in skilled occupations, and a lower unemployment rate. However SEH had a greater percentage of aged persons and a higher percentage of poor English speakers.

The environment

The SEH Public Health Unit closely monitors the quality of the air, drinking water, recreational waters/ pools and food within the Area. Special surveillance programs are carried out for Legionnaires’ disease, lead poisoning and tobacco control. Infection control is one of the public health priorities, such as infection control surveillance in premises where professional skin penetration is carried out (e.g. acupuncturists, tattooists, hairdressers, barbers and beauticians).

Prevalence of health related risk behaviours

Of residents aged 16 years and over, 27% of the males and 22% of the females in SEH are current smokers; 17% of the males and 18% of the females are hazardous alcohol drinkers; 31% of the males and 49% of the females do not exercise adequately; 57% of the males and 37% of the females do not use sunscreen in the sun; 88% of the males and 80% of the females do not eat enough vegetables; 59% of the males and 46% of the females do not eat enough fruit.

About 31% of adult females aged 50-69 years (recommended breast cancer screening age group) in SEH have not had a breast cancer screening mammogram in the past 2 years. About 19% of children under 18 in SEH were overdue for scheduled immunisation in September 2000.

Availability of health services

SEH residents have access to a range of health services in the Area, such as health promotion, disease prevention, primary health care, community health services, home care, hospital services and nursing home care. On average, there are 1.4 GPs, 3.1 public hospital beds and 1.6 private hospital beds for every 1000 residents. In addition, there are 72 nursing home/hostel beds for every 1000 residents aged 70 and over. 

General health

SEH residents live longer now than they did 10 or 20 years ago. Based on the 1994-1998 mortality rate, life expectancy at birth was 77 years for males and 83 years for females in SEH. For people aged 70 years, on average, males were expected to live for 14 more years and females for 17 more years.

South Eastern Sydney residents were generally healthier than the NSW average, in terms of self-rated health status, hospital admission and mortality.

About 62% of residents aged 16 and over in SEH rated their health as very good or excellent.

Each year, on average, there are 12.3 newborn babies, 7.4 deaths, 130 disabled people, 290 hospital inpatient episodes and 13,085 Medicare claims (including GP attendances and other services), for every 1,000 SEH residents.

Health trends

The age standardised death rate from all causes in SEH declined continually for both males and females over the period 1973-1998. The decline in death rate was most noticeable among children under 15 and adults aged 45 years and over.

The rate of hospitalisation did not significantly change over time over the period from 1993/94 to 1998/99 for both SEH males and females after adjustment for age. However for males and females aged 70 years and over alone, the hospitalisation rate increased significantly over the past 6 financial years.

Causes

Diseases of the circulatory system and cancer were the leading causes of death in SEH in 1994-1998, accounting for 67% of all male deaths and 71% of all female deaths, respectively. Respiratory disease and injury/poisoning were also the important causes of death for both males and females. HIV/AIDS and drug related disorders were the 5^th and 6^th most common causes of death in SEH males. Nervous system/sense organ diseases and digestive system diseases were among the top 6 killers in SEH females.

Circulatory diseases and cancer also accounted for the largest number of years of life lost in SEH whilst drug related deaths, HIV/AIDS and suicide had the highest number of years of life lost per death as deaths from these diseases involved mainly young people.

Physical conditions, including musculoskeletal disorders, were the most common causes of disability (85%). Mental or behavioural disorders were identified as the main conditions among 15% of people with disability.

Digestive system diseases were the most common cause of hospitalisation among SEH males whilst the most common reason for females being admitted to hospital was pregnancy/childbirth. While circulatory system diseases and cancer were the important causes of hospitalisation for both males and females, injury and poisoning was a relatively more common diagnosis among males and genitourinary disease a more common diagnosis among females.

Major diseases

Ten diseases were responsible for over half of the deaths in SEH during 1994-1998. They were ischaemic heart disease (22% of all deaths), stroke (10%), lung cancer (5%), chronic obstructive pulmonary disease (4%), colorectal cancer (4%), heart failure (2%), breast cancer (2%), dementia (2%), prostate cancer (2%) and suicide (2%).

Arthritis and related conditions was the most important cause of disability, existing in 14% of all people with disability. Other main causes included asthma (5%), ischaemic heart disease (4%), hypertension (2%), nervous tension/stress (2%), diabetes (2%), dementia and Alzheimer’s (2%) and mood affective disorders (2%).

The top ten diseases that accounted for the largest number of hospital separations were dialysis (7%), chemotherapy (3%), ischaemic heart disease (3%), cataracts (3%), benign neoplasms (2%), falls (2%), care involving use of rehabilitation procedures (2%), other labour and delivery complications (2%) and abortion (2%).

Compared to the whole of NSW, SEH males experienced a higher death rate from illicit drug use, HIV/AIDS and colorectal cancer and a lower death rate from ischaemic heart disease, stroke, lung cancer, smoking related conditions, chronic obstructive pulmonary disease and road traffic accidents.

Females in SEH had a lower than the NSW average death rate from ischaemic heart disease, stroke, smoking related conditions and dementia. The death rates in SEH females were not higher than the NSW average for any of the diseases under study.

A higher than the NSW average incidence/notification rate was found in males for cancer (all types), colorectal cancer, hepatitis C, HIV infection, AIDS, Gonorrhoea, Syphilis and sexually transmitted Chlamydia and in females for cancer (all types), breast cancer, hepatitis C, Syphilis and sexually transmitted Chlamydia.

A lower than the NSW average incidence/notification rate was found in males for lung cancer and females for gestitational diabetes.

Compared to the whole NSW, males in SEH were more likely to be hospitalised for ischaemic heart disease, hepatitis C and HIV/AIDS. SEH females were more likely to be hospitalised for mental disorders, alcohol caused conditions and HIV/AIDS.

Fewer males in SEH than in NSW were admitted to hospital for stroke, illicit drug use disorders, type I diabetes, type II diabetes, asthma, suicide, road traffic accidents, falls and homicide/violence. Fewer females in SEH than in NSW were admitted to hospital for ischaemic heart disease, stroke, illicit drug use disorders, type I and type II diabetes, asthma, suicide, road traffic accidents, falls and homicide/violence.

A declining trend in death rate was found in males for ischaemic heart disease, stroke, lung cancer, alcohol caused conditions, smoking related conditions, chronic obstructive pulmonary disease, road traffic accidents, falls and HIV/AIDS, and in females for ischaemic heart disease, stroke, colorectal cancer, cervical cancer, smoking related conditions and road traffic accidents.

An increasing trend in death rate was found in males for dementia, lymphoma and illicit drug use, and in females for lung cancer, dementia and lymphoma.

A declining trend in incidence/notification rate was found in males for lung cancer, measles, hepatitis C, HIV infection, AIDS and syphilis, and in females for cervical cancer, measles and hepatitis C.

An increasing trend in incidence/notification rates were found in males for cancer (all types), colorectal cancer, melanoma, prostate cancer, lymphoma and gonorrhoea, and in females for cancer (all types), lung cancer, breast cancer, melanoma, lymphoma, leukaemia and gestational diabetes.

The hospital separation rates for homicide/violence in males and suicide in females have declined.

The hospital separation rate has increased for stroke and mental disorders in males, and for mental disorders and falls in females.

Population subgroups

Infants

Infants under the age of 1 year had the second highest death rate and hospital separation rate in SEH, after those aged 65 and over. For every 1,000 infants, on average, 4.7 died and 535 were hospitalised each year. The infant death rate continued to decline over the past 25 years in SEH. Infants mainly died from birth trauma/asphyxia, low birth weight and sudden infant death syndrome. Birth trauma and low birth weight were also the most common reasons for hospitalisation among infants. Other common causes of hospitalisation included acute respiratory infection, sleeping disturbance, and intestinal infectious diseases.

Young people

Young people aged 15-44 years constitute about 49% of the SEH population. For every 1,000 young people, 1 died and 65 were admitted to hospital each year on average. The death rate was higher among young males than among young females. Residents of this age group died mainly from HIV/AIDS (20%), suicide (18%), opiates use (14%), road traffic accidents (6%) and homicide/violence (3%). Breast cancer was also one of the leading causes of deaths in young females, accounting for 9% of all deaths in females of this age group.

Older people

People aged 70 years and over make up approximately 10% of the SEH population. About 60% of them are females. According to the 1996 Census, of all people aged 70 and over in SEH, 77% spoke English only, 17% spoke a language other than English at home, and 6% did not state their main language.

Both death rate and the use of health services were the highest in this group. About 72% of deaths, 31% of people with disabilities and 28% of hospital separations involved people aged 70 and over. For every 1,000 older people, there were 494 disabled people, 831 hospital separations and 55 deaths. The death rate among older people decreased over the past 25 years. The hospital separation rate however increased significantly in this group over the past 6 financial years. Older people died mainly from ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, colorectal cancer and heart failure. Dialysis, cataract, ischaemic heart disease, rehabilitation, falls, chemotherapy, stroke and heart failure were the most common reasons for hospitalisation among older people.

Males and females

Compared to female residents of SEH, males lived 3-5 years shorter. The risk of males dying was about 1.6 times that of females. Males were more likely than females to be admitted to hospital except for those at fertility ages. Males were less likely than females to see a GP.

The age standardised death rate was higher in males than in females in all years between 1973 and 1998. The gap in death rate between the sexes was the greatest among those aged between 15-44 years. Males of this age group were at a much higher risk of dying from AIDS and road traffic accidents than females. However the decline in overall death rate over the past 25 years was greater in males than in females. The gap between the sexes has been narrowing, especially for infants for whom there was almost no sex difference in recent years.

Males were more likely than females to die from ischaemic heart disease, lung cancer, colorectal cancer, lymphoma, leukaemia, drug related disorders, alcohol caused conditions, cigarette smoking related conditions, diabetes, chronic obstructive pulmonary disease, suicide, road traffic accidents and HIV/AIDS.

More males than females were admitted to hospital for ischaemic heart disease, stroke, drug related disorders, alcohol caused conditions, cigarette smoking related conditions, Type II diabetes, chronic obstructive pulmonary disease, road traffic accidents, homicide/violence and hepatitis C. Males were less likely than females to be admitted for suicide and mental disorders.

The incidence/notification rate was higher in males than in females for lung cancer, colorectal cancer, melanoma, lymphoma, rubella, hepatitis C, HIV, AIDS, gonorrhoea, syphilis and sexually transmitted Chlamydia disease.

Aboriginal and Torres Strait Islander people

There were 4672 Aboriginal and Torres Strait Islander people in SEH on the 1996 Census night. They constituted about 0.7% of the SEH population. The Aboriginal/Torres Strait Islander population has increased significantly, from 3001 at the 1986 Census to 4672 at the 1996 Census. A greater willingness to identify one’s indigenous status may partly contribute to the increase. Approximately 28% of this group were under the age of 15 years and less than 2% of Aboriginal people lived up to the age of 70. Compared to other SEH residents, Aboriginal/Torres Strait Islander people were less likely to have post-school qualifications, and more likely to be unemployed and to have lower income. Health and community services were the industries that employed the largest number of Aboriginal/Torres Strait Islander people in the Area.

Local mortality data were not available for Aboriginal and Torres Strait Islander people. National data showed that the life expectancy at birth for Aboriginal / Torres Strait Islander was 20 years shorter than other Australians, based on mortality data in 1996-1998. The hospital data indicated that Aboriginal/Torres Strait Islander people were less likely than other SEH residents to be admitted to hospital.

In Australia the major causes of deaths among indigenous people were cardiovascular diseases, injury, respiratory diseases, cancer, and endocrine diseases (e.g. diabetes). These causes accounted for about three-quarters of deaths among indigenous people.

In SEH fewer Aboriginal/Torres Strait Islander people were hospitalised than other residents. The reasons for being admitted to hospital varied greatly between the two groups. Mental disorders and drug related disorders were more common diagnoses among Aboriginal and Torres Strait Islander patients than in other SEH residents. A smaller proportion of Aboriginal and Torres Strait Islander residents were admitted for diseases of circulatory system and cancer, compared to other residents.

Aboriginal/Torres Strait Islander babies were more likely to have low birth weight and to be admitted to SCN/NICU. Almost 5% of Aboriginal/Torres Strait Islander mothers were aged under 18. This proportion was much higher than that for other SEH mothers (0.5%). The smoking rate during pregnancy in Aboriginal/Torres Strait Islander mothers was 4 times higher than other SEH mothers.

Overseas born population

The size of the Australian born population and the main English speaking country born population did not change greatly over the past three Censuses, while a positive growth was recorded for the non-English speaking country born population. According to the 1996 Census, non-English speaking country born people made up about 22% and main English speaking country born people made up 10% of the total SEH population.

Residents born in English speaking countries other than Australia tended to be older, with 11% of them being aged 70 years and over, compared to 10% for the Australian born population and 9% for the non-English speaking population. People of a non-English speaking background were more disadvantaged when compared with the other two groups, in terms of education, employment, occupation and income.

Residents born in non-English speaking countries had a lower death rate than those born in Australia. The death rates were similar between residents born in Australian and in other main English speaking countries. Australian born residents were more likely to be hospitalised than residents born overseas.

Circulatory system diseases (mainly ischaemic heart disease and stroke) were the common leading causes of death for residents of all origins. Respiratory system diseases, especially chronic obstructive pulmonary disease, were relatively more significant among residents born in Australia or in other main English speaking countries than for residents of non-English speaking origins. Diabetes was a relatively more important cause of death among non-English speaking country born residents, while HIV/AIDS was one of the top ten causes of death among residents born in main English speaking countries (other than Australia).

Diseases of the digestive system was the most common diagnosis for all SEH residents of English and non-English speaking backgrounds. Compared to those born in Australia and main English speaking countries, residents of non-English speaking origins were more likely to be admitted for diseases of the circulatory system and less likely for injury/poisoning, mental disorder and HIV/AIDS.

Birth and fertility rates were higher among residents from a non-English speaking background than in residents born in Australia and other main English speaking countries. Overseas born mothers were generally older than those born in Australia. Mothers of non-English speaking background were more likely to have pregnancy induced conditions. The smoking rate during pregnancy was the highest among mothers born in other main English speaking countries and the lowest among mothers born in non-English speaking countries. No significant difference in baby health indicators was found between babies born to mothers of different country origins, in terms of premature birth, low birth weight, low Apgar score, neonatal morbidity and perinatal mortality.

Residents of inner city

The inner city area (SEH parts of South Sydney and Sydney LGAs) was distinguished from other parts of the Area, by demography, socio-economic characteristics and health status. Approximately 65,200 people live in the inner city area. The inner city area recorded the greatest population growth in SEH. The majority of people living in the inner city area are young adults and the middle aged. Fewer people in the inner city area are aged under 15 and over 70 years, compared to those in other parts of SEH. The inner city area is diverse and the very poor and the more affluent residents are living alongside each other. The inner city area accommodates a large overseas born population as well a large homeless population.

Males living in South Sydney was the only group in SEH that had a higher than the NSW average death rate from all causes in 1994-1998. Both males and females in South Sydney and Sydney were more likely than those in NSW to be hospitalised or to consult a GP.

Unlike most other areas in SEH, HIV/AIDS was the second leading cause of death in both South Sydney and Sydney. Opiates use, alcohol abuse and suicide were three of the top ten causes of death in the inner city area. HIV/AIDS was also the second most common diagnosis among South Sydney residents admitted to hospital during 1996/97 and 1998/99 and the fifth among Sydney residents. Mental disorders and alcohol abuse were among the most common causes of hospitalisation for inner city residents.

Birth and general fertility rates were much lower in South Sydney and Sydney than in other SEH LGAs.

Homeless people

According to the 1996 Census, 3625 homeless persons were in SEH on Census night. Over two thirds of them were males. About 40% of homeless persons were aged between 25 and 44 years. Children under 15 accounted for about 2% of all homeless persons and older people aged 65 and over made up about 15%. Homeless people in SEH concentrated mainly in the northern part of the Area, especially in the inner city area.

Homeless people were at a higher risk of death than others. Most of them died from cardiovascular disease, suicide, cancer and other injuries.

Drug dependence and harmful use was the major reason for homeless people being admitted to hospital. Alcohol dependence alone was responsible for over 17% of hospital admissions for this group while opiates use accounted for another 9%. Schizophrenia was the second most common diagnosis for homeless people. Rehabilitation, skin infection, epilepsy, homicide and suicide were also more common among homeless inpatients.