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Acknowledgments The Eastern Sydney Medicare Local would like to acknowledge the Australian Government Department of Health for funding the preparation of this report. We extend sincere thanks to those representatives that contributed to the preparation of this report specifically, the South Eastern Sydney Local Hospital District Planning and Population Health Unit
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Contents 1. 2.
Introduction...........................................................................................................................................6 Population and community characteristics .......................................................................................7
2.1. Population characteristics ..............................................................................................................7 2.2. Birth rate .........................................................................................................................................8 2.3. Cultural characteristics ...................................................................................................................8 2.4. Aboriginal and Torres Strait islander community ...........................................................................9 2.5. Family structure ..............................................................................................................................9 2.6. Private health insurance coverage................................................................................................10 2.7. Broadband internet access ...........................................................................................................10 3. Social determinants of health ...........................................................................................................11 3.1. Socio-economic characteristics ....................................................................................................11 3.2. Income ..........................................................................................................................................11 3.3. Employment ..................................................................................................................................12 3.4. Education levels ...........................................................................................................................13 3.5. Homelessness ..............................................................................................................................14 3.6. Social cohesion / community strength ..........................................................................................15 3.7. Barriers to accessing services......................................................................................................15 4. Health characteristics and risk factors ............................................................................................16 4.1. Self-reported health status ...........................................................................................................16 4.2. Health risk factors .........................................................................................................................16 4.3. Immunisation, infant mortality and wellbeing ...............................................................................17 4.4. Prevalence of chronic disease .....................................................................................................18 4.5. Cancer screening rates ................................................................................................................19 4.6. Prevalence of cancer ....................................................................................................................20 4.7. Disability .......................................................................................................................................21 4.8. Mortality ........................................................................................................................................22 4.9. Alcohol-related domestic violence ................................................................................................23 4.10. STI Rates......................................................................................................................................23 4.11. Infectious diseases .......................................................................................................................26 5. Health service availability ..................................................................................................................27 5.1. Hospitals .......................................................................................................................................27 5.2. General practitioners ....................................................................................................................27 5.3. Allied health ..................................................................................................................................28 5.4. Mental health services ..................................................................................................................29 5.5. Community health services ..........................................................................................................30 5.6. Aged care .....................................................................................................................................30 6. Health service utilisation ...................................................................................................................31 6.1. 6.2. 6.3. 6.4. 6.5. 6.6. 6.7. 6.8.
Primary care utilisation .................................................................................................................31 Hospital admission .......................................................................................................................32 Top 10 causes of hospital admission ...........................................................................................32 Ambulatory care sensitive admissions .........................................................................................33 Number of hospitalisations for conditions of interest....................................................................33 Hospitalisations resulting from risk factors ...................................................................................35 Mental health services ..................................................................................................................37 Home and Community Care (HACC) ...........................................................................................37
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List of figures Figure 1: Population profile ............................................................................................................................................ 7 Figure 2: Forecast population growth ............................................................................................................................ 7 Figure 3: Birth rates ........................................................................................................................................................ 8 Figure 4: Primary languages spoken at home ................................................................................................................ 8 Figure 5: Indigenous persons population profile ............................................................................................................ 9 Figure 6: Family structure ............................................................................................................................................... 9 Figure 7: Private health insurance coverage ............................................................................................................... 10 Figure 8: Broadband internet access at home, ............................................................................................................. 10 Figure 9: Comparison of SEIFA* Advantage and Disadvantage .................................................................................. 11 Figure 10: Annual personal income .............................................................................................................................. 11 Figure 11: Income support ............................................................................................................................................ 12 Figure 12: Top five Industry sectors of employment ..................................................................................................... 12 Figure 13: Unemployment ............................................................................................................................................ 13 Figure 14: Highest year of school completed ................................................................................................................ 13 Figure 15: Secondary school participation .................................................................................................................... 14 Figure 16: Homelessness ............................................................................................................................................. 14 Figure 17: Indicators of community strength ................................................................................................................. 15 Figure 18: Barriers to accessing services ..................................................................................................................... 15 Figure 19: Self assessed health ................................................................................................................................... 16 Figure 20 Health risk factors ......................................................................................................................................... 16 Figure 21: Percentage of children fully immunised ...................................................................................................... 17 Figure 22: Pertussis notifications .................................................................................................................................. 17 Figure 23: Pneumococcal notifications ......................................................................................................................... 18 Figure 24: Percentage of low birth weight babies and mothers who smoke whilst pregnant ...................................... 18 Figure 25: Prevalence of selected chronic conditions, .................................................................................................. 19 Figure 26: Cancer screening rates................................................................................................................................ 19 Figure 27: Comparison of cancer screening outcomes................................................................................................. 20 Figure 28: Prevalence of selected cancers ................................................................................................................... 20 Figure 29: Proportion of people with profound or severe disabilities,............................................................................ 21 Figure 30: Proportion of people who have need for assistance with core activities ...................................................... 21 Figure 31: Premature mortality from chronic disease ................................................................................................... 22 Figure 32: Potentially avoidable deaths per 1000 persons ........................................................................................ 22 Figure 33: Comparison of alcohol related domestic violence incidence ....................................................................... 23 Figure 34: HIV notifications ........................................................................................................................................... 23 Figure 35:Chlamydia notifications ................................................................................................................................. 24 Figure 36: Rectal chlamydia notifications ..................................................................................................................... 24 Figure 37: Gonorrhea notifications................................................................................................................................ 25 Figure 38: Syphilis notifications .................................................................................................................................... 25 Figure 39: Hepatitis B notifications ............................................................................................................................... 26 Figure 40: Hepatitis C notifications ............................................................................................................................... 26 Figure 41: GPs ............................................................................................................................................................. 27 Figure 42: After hours GP clinics .................................................................................................................................. 28 Figure 43: Allied health Practitioners ........................................................................................................................... 28 Figure 44: Number of ATAPS providers ....................................................................................................................... 29 Figure 45: Aged care availability ................................................................................................................................... 30 Figure 46: Selected primary care services ................................................................................................................... 31 Figure 47: MBS GP services per person .................................................................................................................... 31 Figure 49: Hospitalisation rate ..................................................................................................................................... 32 Figure 50 Top 10 causes of hospitalisation ................................................................................................................. 32 Figure 51: Preventable hospitalisations for ambulatory-care sensitive conditions ....................................................... 33 Figure 52: Stroke hospitalisations per 1000 population ............................................................................................... 33 Figure 53: Coronary heart disease hospitalisations 1 ................................................................................................... 34 Figure 54: Diabetes related hospitalisations ................................................................................................................ 34 Figure 55: Alcohol related hospitalisations .................................................................................................................. 35 Figure 56: Smoking related hospitalisation ................................................................................................................... 35 Figure 57: High body mass related hospitalisations ..................................................................................................... 36 Figure 58: Number of falls per 1000 population 65 and over ........................................................................................ 36 Figure 59: Percentage of ATAPS referral’s by sub region ............................................................................................ 37 Figure 60: Characteristics of HACC clients .................................................................................................................. 37 Figure 61: Utilisation of HACC services ....................................................................................................................... 38
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Glossary of Terms
Term Eastern Sydney Medicare Local
Eastern Sydney ESML SLA LGA ML ABS PHIDU
Explanation Refers to an independent organization that coordinates primary health care delivery for residents living within the sub-regions of Sydney-Inner SLA, Sydney-East SLA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA and Lord Howe Island Refers to data associated with Sydney LGA, Waverley LGA, Woollahra LGA, Randwick LGA, Botany Bay LGA, but excludes Sydney-North LGA, Sydney West LGA and Lord Howe Island LGA Eastern Sydney Medicare Local Statistical local area Local government area Medicare local Australian Bureau of Statistics Population Health Information Development Unit
Data Data was gathered from a number of different data sets and sources including the Australian Bureau of Statistics (ABS), Public Health Information Development Unit (PHIDU), South East Sydney LHD, NSW Health Stats and ESML. We have relied on the data wherever possible and have avoided carrying out an extrapolations or making assumptions around the data and how it can be interpreted. Data Limitations 1. Comparable data sets were not always available when comparing sub regional information to the Medicare Local level. As such two points of comparison have been primarily used and presented against a NSW figure (where possible); ESML catchment and Eastern Sydney. 2. Large portions of respondents to certain data sets (e.g. in ABS census data) had either not respondent or marked the question non applicable. In all cases where this has occurred these responses have been excluded from the graphical representations of the analysis undertaken. The result of this is that figures presented in certain graphs in this profile do not always total 100%. 3. The HWA data used to present the levels of Allied Health practitioners does not take into consideration those disciplines that are self-regulated. 4. Due to a small population size of approximately 350 residents, data relating to residents on Lord Howe Island have not been included where data is presented at sub-regional level due to privacy reasons.
Disclaimer th This report is prepared solely for the purpose set out in our job arrangement letter dated 10 December 2013 and is not to be used for any other purpose. The information provided in this report is based on information supplied by Eastern Sydney Medicare Local and other publicly available data sources. Paxton Partners has not verified the detailed assumptions and has relied on the information and data as sourced. The scope of work for this project did not include procedures considered necessary under generally accepted auditing standards for the purposes of expressing an opinion on the data provided. Accordingly, Paxton Partners does not express such an opinion
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1. Introduction Sydney is Australia’s largest city and the capital of New South Wales. Sydney-East is one of four Statistical Local Areas (SLA) that form the City of Sydney. Its’ 2011 census count equaling 53,386 people 1 represents roughly 31% of the total City of Sydney population. Sydney-East is bordered by Sydney Harbour to the north, the Woollahra Local Government Area in the east, the Randwick Local Government Area to the south and Sydney-Inner and Sydney-West SLAs in the west. Neighbourhoods within this catchment include Surry Hills, Darlinghurst, Elizabeth Bay, Woolloomolloo, Kings Cross, Potts Point and Rushcutters Bay. The Cadigal band of the Eora Aboriginal tribe are the traditional owners of these lands. Table 1 provides general characteristics of the Sydney East sub-region at a glance. Table 1: Characteristics of the Sydney East sub-region at a glance
Indicator Population Population growth forecast (2011 – 2025) % indigenous persons Average household income* (Sydney city) Unemployment^ % Speak English in the home^ Private health insurance coverage
Value 53,386
Sub-region Rank within ML 4
Medicare local
NSW
383,014
7,211,486
12.2%
3
12.9%
15.3%
0.8%
3
0.9%
2.5%
$85,227
3
N/A
$64,324
4.1% 77% 56.9%
6 3 3
2.7% 69.8% 56.6%
5.3% 76.5% 48.2%
Source: ^Australian Bureau of Statistics; *City profile (profile.id); (unmarked) Public Health Information Development Unit and Australian Bureau of Statistics.
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Our Boundary Fact Sheet. South Eastern Sydney Local Health District, Strategy and Planning Unit. May 2013/http://profile.id.com.au/sydney/about; accessed 29 January 2014. www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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2. Population and community characteristics Headlines
High levels of the population aged between 20-39 years old compared to ESML and NSW.
Lower than average birth rate.
Low levels of couples with one child and one parent families.
2.1. Population characteristics The data used in Figure 1 shows that the population profile of Sydney East sub-region is higher than the Medicare Local (ML) for age ranges 2 0 - 4 9 . These age ranges account for 68% of the total population within the Sydney East, compared to 54% across the Eastern Sydney Medicare Local (ESML) catchment. In contrast, a smaller proportion of Sydney Easts population is aged between 0 and 19 years (7.6%) compared to the ESML (17.6%). Figure 1: Population profile (by age)
Source: PHIDU and Australian Bureau of Statistics (2013)
Population growth forecasts for Sydney East between 2011 and 2025 are provided in Figure 2. According to the Australian Bureau of Statistics (ABS) population growth is due to be 12.2% in Sydney East compared to 12.9% in the ESML catchment and 13.6% across NSW. It is anticipated that new development will be limited in this region over the coming years. Figure 2: Forecast population growth
Source: PHIDU and Australian Bureau of Statistics (2013)
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2.2. Birth rate The birth rate in Sydney East is currently the second-lowest among all sub-regions in the ML (0.87 children per female), which is marginally higher than Sydney Inner (0.81 children per female). This represents only 67% of the average birth rate across the ESML catchment, and less than half (49%) of the average for NSW overall (1.80 children per female). Figure 3: Birth rates
Source: PHIDU and Australian Bureau of Statistics (2013)
2.3. Cultural characteristics The data used in Figure 4 shows a breakdown of the major non English primary languages spoken at home in Sydney East. The majority of the population identifies English as their primary language (77%) after this the most spoken languages are Chinese (3.6%), Iberian dialects (2.2%), Thai (1.7%) and French (1.7%). Of the 913 speakers of Iberian dialects 698 (77%) speak Spanish as their primary language, 211 Portuguese (23%) with the remaining 4 people speaking Catalan. Figure 4: Primary languages spoken at home
Source: Australian Bureau of Statistics (2012)
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2.4. Aboriginal and Torres Strait islander community Indigenous Australians comprise 0.8% of the total population of the Sydney East sub-region, which is lower than for the ESML catchment (0.9%) and the NSW averages (2.4%). Figure 5: Indigenous persons population profile
Source: PHIDU and Australian Bureau of Statistics (2013)
2.5. Family structure Figure 6 shows a breakdown of the predominant family structures living within the catchment. The most common family type in Sydney East is a ‘couple family with no children’ (23%), which is broadly consistent with the ESML catchment (22%) and the NSW average (24%). Sydney East has lower proportions of one parent families and ‘couple family with children’ than both the ESML catchment area and NSW averages. Figure 6: Family structure
Source: Australian Bureau of Statistics (2012)
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2.6. Private health insurance coverage Figure 7 shows that 57% of Sydney East residents have private health insurance. This is the same as the average for residents within the ESML catchment and higher than the NSW average 48%. Figure 7: Private health insurance coverage
Source: PHIDU and Australian Bureau of Statistics (2013)
2.7. Broadband internet access Figure 8 shows that broadband internet penetration within households in Sydney East (73.4%) is lower than the ESML catchment area (74.7%) but higher than the NSW average (69.9%). Figure 8: Broadband internet access at home,
Source: PHIDU and Australian Bureau of Statistics (2013 )
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3. Social determinants of health Headlines
High proportion of the population earning $78,000 or more per annum.
Higher proportion of the population on income support compared to the ESML average.
High levels of homelessness compared to ESML and NSW averages.
3.1. Socio-economic characteristics The Socio-Economic Indexes for Areas (SEIFA) index score for socio-economic advantage and rd disadvantage in Sydney East is 1068, which ranks 3 out of the sub regions. The graph below highlights the respective percentile rank for both socio economic advantage and disadvantage. Figure 9: Comparison of SEIFA* Advantage and Disadvantage
Source: Australian Bureau of Statistics (2013)
3.2. Income Figure 10 shows that a smaller proportion of the Sydney East population earns less than $52,000 or more than $65,000 when compared to the ESML catchment area and the NSW average. The graph also shows relatively high average income level for residents of Sydney East, with approximately 35% of all residents earning more than $65,000 (including over 17% of the population which earns more than $104,000 per annum. Figure 10: Average household income
Source: Australian Bureau of Statistics (2012)
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Figure 11 shows that a higher proportion of people within Sydney East receive all types of income support, than the ESML catchment as a whole. Surprisingly, in spite of this finding, the proportion of ‘welfare dependent’ families is notably lower than both the ESML catchment and NSW. Figure 11: Income support
Source: PHIDU and Centrelink (2013)
3.3. Employment Industry An analysis of the occupations held by residents of Sydney East reveals that the top five industry sectors of employment are professional, scientific and technical services (12%), financial and insurance services (7%), accommodation and food services (6%), health care and social assistance (5%) and retail trade (4%). Together, these five industries employ 33% of the population, which is higher when compared to ESML (26%) and NSW (19%). Figure 12: Top five Industry sectors of employment
Source: Australian Bureau of Statistics (2012)
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Employment status The percentage of people who are unemployed within the Sydney East is 4.06%, which is higher than ESML (2.72%) but lower than the NSW average (5.25%). Figure 13: Unemployment
Source: PHIDU and Australian Bureau of Statistics (2013)
3.4. Education levels Within Sydney East 66% of people aged over 15 years have completed Year 12 schooling/ or equivalent. This is higher than the ESML catchment area (58%) and the overall figure for (NSW 38%). Figure 14: Highest year of school completed
Source: Australian Bureau of Statistics (2012)
Data available from PHIDU shows that secondary school participation at age 16 in Sydney East (78%) is lower than the ESML (83%) and NSW averages (80%). The proportion of school leavers from Sydney East that go on to pursue higher education qualifications (32%) is lower than ESML (41%) but greater than the NSW average (30%).
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Figure 15: Secondary school participation
Source: PHIDU and Australian Bureau of Statistics (2012)
3.5. Homelessness Figure 16 shows that the per-capita rate of homelessness in Sydney East (2.9%) is higher than the level across both the ESML catchment (1.14%) and NSW (0.76%). Figure 16: Homelessness
Source: Australian Bureau of Statistics (2012)
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3.6. Social cohesion / community strength Figure 17 shows that Sydney East is broadly in line with the ESML and NSW when it comes to indicators of community strength. All 3 demographics feel strongly that they can get support in a time of crisis (all over 80%) with only approx. 5% of the population disagreeing with the acceptance of foreign cultures. Figure 17: Indicators of community strength
Source: PHIDU and Australian Bureau of Statistics (2013)
3.7. Barriers to accessing services Figure 18 shows the major barriers to accessing services across Sydney East. The highest proportionate barrier to accessing services within the sub region was not accessing the internet (22%) compared to 21% within ESML catchment area and 28% of people in NSW. Figure 18: Barriers to accessing services,
Source: PHIDU and Australian Bureau of Statistics (2013)
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4. Health characteristics and risk factors Headlines
Higher proportions of overweight and psychologically distressed people then the ESML and NSW averages.
Higher levels of premature mortality from chronic disease for all conditions covered than the ESML and NSW averages.
Higher levels of potentially avoidable deaths than ESML and NSW averages.
Significant amounts of data were not available at the Sydney East SLA level so Sydney LGA figures were used, these include areas of east, south, inner and west Sydney.
4.1. Self-reported health status Figure 19 shows that the levels for fair or poor self-assessed health in Sydney East (11.4%) are lower than the ESML (12.5%) and NSW (16.6%) averages. It also illustrates that the levels of those with restricted core activities are lower in Sydney East (8.8%) than the ESML (9.3%) and NSW (11.5%). Figure 19: Self assessed health
Source: PHIDU and Australian Bureau of Statistics (2013)
4.2. Health risk factors Figure 20 shows that the health risk profile of Sydney East is higher than the ESML catchment in relation to smoking (16% higher), risky alcohol consumption (22% higher), overweight / obesity (12% / 17% higher) and psychological distress (11% higher). The exception is the percentage of physically inactive persons, where a lower proportion of the Sydney East population is inactive (29.6%) compared to the ESML catchment (30.6%) and NSW (34.9%). Figure 20 Health risk factors
Source: PHIDU and Australian Bureau of Statistics (2013) www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.3. Immunisation, infant mortality and wellbeing Childhood immunisation Figure 21 shows the percentage of children that are fully immunised at one, two and five years of age. For ages one and two, immunisation rates in Sydney East are broadly in line with both ESML and NSW overall. Rates of children fully immunized at age five in Sydney East are approximately 9% lower than across the ESML catchment and 15% lower than the average across NSW. Figure 21: Percentage of children fully immunised
Source: PHIDU and Australian Childhood Immunisation Register / Medicare Australia (2013)
Pertussis The graph below shows the number of pertussis notifications in Sydney LGA each year from 2008-12, along with an overall figure for Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The graph shows that the volume of notifications decreased across Sydney LGA from 68 notifications in 2008 to31 in 2012, a decrease of 54%. Figure 22: Pertussis notifications
Source: South Eastern Sydney Local Health District
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Pneumococcal The number of pneumococcal notifications in Sydney LGA has increased from 4 in 2008 to 11 in 2012. For the Eastern Sydney region the number of notifications has increased from 23 per annum to 31, representing an increase of 34%. This is shown in the graph below. Figure 23: Pneumococcal notifications
Source: South Eastern Sydney Local Health District
Low birth weight babies Figure 24 shows the percentage of low birth weight babies and the percentage of mothers who smoke whilst pregnant within Sydney East, ESML and NSW. Sydney East has a higher rate of low birth weight babies (7.2%) than ESML (5.5%) and NSW (6.1%). The level of women who smoke whilst pregnant in Sydney East is 5.5% compared with 2.5% in the ESML and 12.0% in NSW as a whole. Figure 24: Percentage of low birth weight babies and mothers who smoke whilst pregnant
Source: PHIDU and NSW Ministry of Health (2013)
4.4. Prevalence of chronic disease Figure 25 shows that the prevalence rates of mood disorders, are 27% higher than the ESML average and that the levels of Type 2 Diabetes are 6% higher than the ESML average. Circulatory system disease is 12% lower than the ESML average with levels of high cholesterol, respiratory system disease and musculoskeletal diseases broadly in line with ESML and NSW averages.
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Figure 25: Prevalence of selected chronic conditions,
Source: PHIDU and Australian Bureau of Statistics (2013)
4.5. Cancer screening rates Figure 26 shows the percentage of people who were eligible for, and participated in bowel and cervical cancer screening programs in 2010. 27% of those eligible in Sydney East participated in the bowel cancer screening program which was lower than the ESML (30%) and NSW (35%) averages. 59% of those eligible for the cervical cancer screening program in Sydney East took part compared with 60% in the ESML catchment and 56% across NSW. No data was available regarding breast cancer screening. Figure 26: Cancer screening rates
Sources: PHIDU and Department of Health and Ageing (2010). Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data; PHIDU and NSW Central Cancer Registry (2009 and 2010).
Figure 27 shows the proportion of test results in relation to cancer screening programs that indicated some form of abnormality. The percentage of bowel cancer screening participants that showed some form of abnormality was 8.2 % in Sydney East which was higher than the ESML catchment (7.3%) and lower than NSW (8.4%). The rate of low-grade abnormalities from the cervical cancer screening was 5.5 % in Sydney East compared with 4.6% in the ESML catchment and 3.2% in NSW. The rate of high-grade cervical screening abnormalities in Sydney East was 0.9% compared with 0.8% in the ESML and 0.6% in NSW.
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Figure 27: Comparison of cancer screening outcomes
Sources: PHIDU and Department of Health and Ageing (2010). Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data; PHIDU and NSW Central Cancer Registry (2009 and 2010).
4.6. Prevalence of cancer Figure 28 shows the prevalence of certain cancer types across the sub regions and NSW as a whole. No data at the Medicare Local level was available. The data suggests that the Sydney LGA (comprising Sydney Inner, South, East and West) has the highest prevalence of lung cancer (0.55 per 1000 population) of any sub-region across the ESML catchment. Sydney LGA also reported the second-highest rate of prostate (0.91 per 1000 population) and cervical cancers (0.057 per 1000 population) across the ESML catchment. Figure 28: Prevalence of selected cancers
Source: Cancer Institute NSW (2010)
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4.7. Disability Profound or severe disabilities 'People with Profound/severe disability are those who need some ongoing help or supervision with 2 communication, self-care and/or mobility for six months or more . Figure 29 shows the proportion of persons with profound or severe disability within the Sydney East sub region, ESML and NSW. The graph shows that levels of profound or severe disability are generally lower in Sydney East, particularly for persons aged 65 or more. Figure 29: Proportion of people with profound or severe disabilities,
Source: PHIDU and Australian Bureau of Statistics (2013)
Need for assistance with core activities The proportion of people who require assistance with core activities in Sydney East (4.96%) is 67% higher than the average across the ESML catchment (2.96%), but only 6% higher than the average across NSW, as shown in Figure 30. Figure 30: Proportion of people who have need for assistance with core activities
Source: PHIDU and Australian Bureau of Statistics (2011)
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Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Products/4367.0~20072008~Main+Features~Introduction?OpenDocument; on 5 Feb 2014 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.8. Mortality Premature mortality refers to deaths among people aged less than 75 years. Figure 31 presents mortality rates from chronic conditions in Sydney East for persons aged between 0 and 74. The data shows that premature mortality is higher in Sydney East than the ESML average for all conditions listed, particularly suicide (98% higher), external causes (74% higher), circulatory system disease (46% higher), and respiratory disease (46% higher). The prevalence of cancer is the most significant cause of mortality and is 11% higher than the ESML average. Figure 31: Premature mortality from chronic disease
Source: PHIDU and Australian Bureau of Statistics (2013)
A potentially avoidable death is one that, theoretically, could have been avoided given an understanding of causation, the adoption of available disease prevention initiatives and the use of 3 available health care. The graph below illustrates that the per-capita rate of avoidable mortality i n S y d n e y E a s t (1.39 deaths per 1,000 persons) is 7 1 % higher than the ESML catchment (0.82 deaths per 1,000 persons) and 53% higher than the NSW rate (0.91 deaths per 1,000 persons). Figure 32: Potentially avoidable deaths per 1000 persons
Source: Health Statistics NSW and NSW Ministry of Health Note: Sydney LGA includes other areas of the city besides Sydney East SLA
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Australian Bureau of Statistics, accessed from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Chapter~Potentially%20avoidable%20deaths%20 on 5 February 2014 www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.9. Alcohol-related domestic violence The graph below illustrates that the alcohol-related domestic violence rates are higher in the Sydney LGA (2.4 incidences per 1000 population) than in both Eastern Sydney (1.5) and NSW (1.4). Notably, the rate of alcohol-related domestic violence is the highest in Sydney LGA when set against the sub regions comprising ESML. Figure 33: Comparison of alcohol related domestic violence incidence
Source: NSW Bureau of Crime Statistics and Research (2012) Note: Sydney LGA includes other areas of the city besides Sydney East SLA
4.10. Sexually Transmissible Infections HIV The graph below illustrates the volume of HIV notifications since 2011. The data is split between those notifications that occurred in Sydney LGA and those in the rest of the ESML catchment. The reason the data has been presented in this format is due to the sensitivities around providing it at an LGA level due to the low levels of notifications in certain LGA’s. The data shows that from 2011 to 2012 notifications increased in Sydney LGA by 31%, but decreased by 20% in the rest of the region and that this resulted in a 15% increase overall. The data provided for 2013 only covered the period from January – September so has not been used for comparative purposes. Figure 34: HIV notifications
Source: South Eastern Sydney Local Health District
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Chlamydia The graph below shows the annual number of notifications of chlamydia in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 918 to 1258 per annum in Sydney LGA over the period representing an increase of 37%. The overall number of notifications for Eastern Sydney has increased from 1887 to 2556 per annum, representing an increase of 35%. Figure 35:Chlamydia notifications
Source: South Eastern Sydney Local Health District
Rectal Chlamydia in males The graph below shows the annual number of notifications of rectal chlamydia in males in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has increased from 173 to 329 per annum in Sydney LGA over the period representing an increase of 90%. In 2012 the notifications in Sydney LGA represented 77% of the total from the Eastern Sydney region. The overall number of notifications for Eastern Sydney has increased from 249 to 429 per annum, representing an increase of 72%. Figure 36: Rectal chlamydia notifications
Source: South Eastern Sydney Local Health District
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Gonorrhea The graph below shows the annual number of notifications of gonorrhea in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 262 to 751 per annum in Sydney LGA over the period representing an increase of 187%. In 2012 the notifications in Sydney LGA represented 67% of the total from the Eastern Sydney region. The overall number of notifications for Eastern Sydney has increased from 384 to 1114 per annum, representing an increase of 190%. Figure 37: Gonorrhea notifications
Source: South Eastern Sydney Local Health District
Syphilis The graph below shows the annual number of notifications of syphilis in Sydney LGA over the period from 2008-12. Alongside this the graph tracks the overall number of notifications across Eastern Sydney (comprising Botany Bay, Randwick, Sydney, Waverley and Woollahra LGA’s). The number of notifications has risen from 131 to 136 per annum in Sydney LGA over the period, representing an increase of 3.8%. The overall number of notifications for Eastern Sydney has increased from 179 to 191 per annum, representing an increase of 6%. Figure 38: Syphilis notifications
Source: South Eastern Sydney Local Health District www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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4.11. Infectious diseases Hepatitis B From 2008 – 2012 there has been a downward trend in the number of notifications in both Sydney LGA and in the Eastern Sydney region. In Sydney LGA the number of notifications has gone from 101 in 2008 to 67 in 2012, a decrease of 34%. In Eastern Sydney they have decreased from 210 in 2008 to 137 in 2012, a decrease of 35%. This is illustrated on the graph below. Figure 39: Hepatitis B notifications
Source: South Eastern Sydney Local Health District
Hepatitis C The graph below illustrates the number of Hepatitis C notifications in Sydney LGA and the Eastern Sydney region annually from 2008 to 2012. The number of notifications in Sydney LGA has decreased from 165 notifications in 2008 to 100 in 2012, a decrease of 39%. The overall figure for the Eastern Sydney region has declined from256 notifications in 2008 to 179 in 2012, a decrease of 30%. This is shown on the graph below. Figure 40: Hepatitis C notifications
Source: South Eastern Sydney Local Health District
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5. Health service availability Headlines
Highest level of GP’s per 1000 population (Sydney LGA).
Higher levels of all types of aged care beds compared to ESML and NSW averages.
Highest levels of allied health practitioners per 1000 population (Sydney LGA).
5.1. Hospitals There are 5 hospitals located within the Sydney East SLA of which two are public (Sydney Dental Hospital and St Vincent’s Hospital) and three private (St Luke’s Hospital, Sacred Heart Hospice and St Vincents Private Hospital). Hospital name St Vincent’s Hospital Sydney Dental Hospital Sacred Heart Hospice St Luke’s Hospital St Vincent’s Private Hospital
Hospital type Tertiary teaching hospital Dental Services Palliative care and rehabilitation General, surgical and rehab hospital Broad spectrum of services excluding obstetrics and pediatrics
No of beds 358 50 71 250
5.2. General practitioners The graph below shows that the number of GP’s per 1000 population in Sydney (2.26 per 1000 population) is higher than all the sub regions that comprise ESML, as well as being above the Eastern Sydney average (1.77).The availability of GPs within Randwick meets the benchmark of 1 GP for every 4 1133 residents (or the equivalent of 0.88 per 1,000 capita). Figure 41: GPs
Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
4
Benchmark figure is 1 GP per every 1133 people (0.88 per 1000) based on: May J, Jones et all, ‘GP perceptions of workforce shortage in a rural setting’ (2007); Wilkinson D. Inequitable distribution of general practitioners in Australia, Australian Journal of Rural Health (2000); May J, Morrissey et al ‘Supporting the rural GP workforce: impact of a managed care practice. In, Proceedings, General Practice & Primary Health Care Conference; 5-7July 2006; Perth, WA; (2006). www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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After hours GP services ‘After hours’ services are defined as any primary service that is open:
Before 8:00am and after 6pm weekdays;
Before 8:00am and after 12:00pm on Saturday’s; and
All day Sundays and public holidays.
The data illustrated on the graph below details the number of general practices in the region registered with the ESML after hour’s program. The graph shows that there are 24 such practices in Sydney East. Figure 42: After hours GP clinics
Source: Eastern Sydney Medicare Local
5.3. Allied health As shown in Figure 43, Sydney LGA has below average levels of allied health providers across all areas covered in comparison to the other sub regions in ESML. This is partly due to the fact that there are significantly higher levels of allied health practitioners in the Randwick sub region, which has increased the average across the overall ESML catchment as a whole.
Figure 43: Allied health Practitioners
Source: Health Workforce Australia (2013) Note: Sydney LGA includes other areas of the city besides Sydney East and Inner
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5.4. Mental health services Figure 44 shows the total number of ATAPS providers by sub region, as well as providing a calculation to show the number per 100,000 population. The graph shows that there are 22 ATAPS providers in Sydney and 31 per 100,000 population. Figure 44: Number of ATAPS providers
Source: Eastern Sydney Medicare Local
The table below illustrates the volume of available mental health facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services listed in the first column of the table below. However, in order to identify the number of facilities in the region we have only included each facility in the table below once. This means that they have been grouped under the classification that bests first their primary service offering. The table shows that Sydney East has 13 facilities delivering mental health services out of the ESML total of 91. Table 2: Mental health providers Adolescent mental Health General mental health services General Mental Health Services Mental Health Advocacy Mental health assessment/triage/ crisis response Mental health case management/continuing care Mental health information/referral Mental health inpatient services (hospital psychiatric unit) Mental Health non-residential rehabilitation Mental health residential rehabilitation/community care unit Psychiatry (requires referral) Psychology
ESML Total
Botany Bay 0 0 0 0 0 0 0 0 0 0 0 0
0
Sydney (C) - Sydney (C) Inner East Randwick (c) Waverley (A) Woollahra (A) ESML Total 0 1 0 0 0 1 2 1 3 0 0 6 2 1 3 0 0 6 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 2 4 0 0 0 6 0 0 0 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 20 5 2 6 2 35 15 1 6 7 4 33
43
13
15
14
6
91
Source: Eastern Sydney Medicare Local / National Health Service Directory (2013)
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5.5. Community health services The table below illustrates the volume of available unique community health service facilities within the ESML catchment area. Many of the facilities within the region will offer more than one of the types of services listed in the first column of the table below. However, in order to identify the number of facilities in the region we have only included each facility in the table below once. This means that they have been grouped under the classification that bests first their primary service offering. The table shows that Sydney East has 14 facilities delivering community care services out of an ESML wide total of 59. Table 3: Community health care facilities Botany Bay Aboriginal health Community cancer services Community health care Health advocacy/liaison services Health information /referral Immunisation Maternal and child health Nursing lead clinics Sexual health Social support Veterans services Women's health clinic Youth drop in/assistance/support
0 0 0 0 0 0 0 0 0 0 0 0 0
Total
0
Sydney (C) - Sydney (C) Inner East Randwick (c) Waverley (A) Woollahra (A) 1 1 0 0 0 2 1 1 0 1 4 2 2 2 2 1 1 0 0 0 8 4 2 0 0 1 0 1 0 1 1 0 1 0 0 0 0 1 0 0 5 4 0 0 0 0 0 0 0 0 1 1 0 0 0 2 0 2 0 0 2 0 0 1 0
28
14
10
3
4
Total
2 5 12 2 14 3 2 1 9 0 2 4 3
59
Source: South East Sydney Local Health District (2013) and National Health Services Directory (2013)
5.6. Aged care Figure 45 illustrates the availability of aged care services across the Sydney East sub region, ESML and NSW broken down into high, low and community-based aged care. This shows that there are higher levels of availability for all types of care within the sub region compared to the ESML and NSW averages. In terms of comparison to ESML there are 67% more high care places per 1000 persons, 160% more low care places and 306% more community aged care places in Sydney East per 1000 population aged 70+ than the ESML average. Figure 45: Aged care availability, 2011
Source: PHIDU and Department of Health and Ageing (2013)
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6. Health service utilisation Headlines
Highest levels of stroke and alcohol related hospitalisations within the region (Sydney LGA).
Lowest levels of coronary heart disease and high body mass related hospitalisations within the region (Sydney LGA).
Significant amounts of data were not available at the Sydney East SLA level so Sydney LGA figures were used, these include areas of east, south, inner and west Sydney.
6.1. Primary care utilisation Figure 46 shows the number of primary care services per-capita billed for Sydney East residents to the MBS were lower than the Eastern Sydney catchment and NSW for 45 year old health checks, GP health assessments for persons aged 75+ and GP enhanced primary care services. With regards to GP mental health plans the Sydney East number per 1000 population is higher than both the ESML and NSW. Figure 46: Selected primary care services
Source: PHIDU and Department of Health and Ageing (2013)
Figure 47 shows that the level of General Practitioner (GP) MBS services delivered per person per year is lower in Sydney East (4.75) than Eastern Sydney (5.1) or NSW (5.8). Figure 47: MBS GP services per person
Source: PHIDU and Department of Health and Ageing (2013) www.esml.org.au Level 1, 5 Rosebery Avenue, Rosebery NSW 2018 t 02 9663 5958 f 02 9663 5817
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6.2. Hospital admission Figure 48 illustrates that the hospitalisation rates for Sydney (321 per 1000 population) are 21% lower than the Eastern Sydney catchment (404) and 11% lower than NSW (360). Figure 48: Hospitalisation rate
Source: Health Statistics NSW and NSW Ministry of Health (2011) Note: Sydney includes other areas of the city besides Sydney East SLA
6.3. Top 10 causes of hospital admission The graph below outlines the top 10 causes of hospitalisation within Sydney by DRG along with the number of separations. It shows that rehabilitation, same day (Z60C) is the largest cause of hospitalisation in the sub region. The graph below is based on data provided by the LHD using a postcode analysis. For the purposes of this exercise it was assumed that the following postcodes constitute the nearest available match to Sydney LGA: 2000, 2010, 2011, 2021 and 2026. Figure 49 Top 10 causes of hospitalisation
Source: South Eastern Sydney Local Health District
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6.4. Ambulatory care sensitive admissions Ambulatory care sensitive conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in the ambulatory setting. The graph below shows the levels of preventable hospitalisation for ambulatory care sensitive conditions in Sydney (21.9 per 1000 population) are 6% higher than Eastern Sydney (20.7) catchment and 8% higher than NSW (23.8). Figure 50: Preventable hospitalisations for ambulatory-care sensitive conditions
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SLA
6.5. Number of hospitalisations for conditions of interest This section presents data describing the number of hospitalisations per 1000 persons for stroke, coronary heart disease and diabetes. Stroke Figure 50 shows that Sydney LGA’s number of stroke related hospitalisations (1.56 per 1000 of the population) is the highest of the sub regions within ESML and the NSW average. No data is available for the overall ESML catchment. Figure 51: Stroke hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: * The data available for the Sydney LGA includes the east, inner, south and west but excludes Northern Sydney. This differs from the area covered by the ESML catchment which includes only Sydney (Inner) and Sydney (East).
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Coronary heart disease Figure 51 shows that hospitalisations for coronary heart disease are lower in Sydney LGA (4.3 per 1000 population) than any sub-region across the ESML catchment. CHD hospitalisations for Sydney residents are also 29% lower than the NSW average (6.1 per 1000 population). Figure 52: Coronary heart disease hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SLA
Diabetes Figure 53 shows that the levels of diabetes-related hospitalisations within Sydney LGA fall within the midrange of the ESML sub regions. Diabetes-related hospitalisations for Sydney LGA are level with the NSW average. Figure 53: Diabetes related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SLA
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6.6. Hospitalisations resulting from risk factors This section presents data on hospitalisations arising from modifiable risk factors, including alcohol, smoking, high body mass and falls. Alcohol Figure 54 shows that Sydney LGA (9.8 per 1000 population) has higher levels of alcohol-related hospitalisations compared to all other LGA’s in the ESML catchment and the NSW average. Figure 54: Alcohol related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: * The data available for the Sydney LGA includes the east, inner, south and west but excludes Northern Sydney. This differs from the area covered by the ESML catchment which includes only Sydney (Inner) and Sydney (East).
Smoking Figure 55 shows that the levels of smoking-related hospitalisations within Sydney LGA fall within the midrange of the sub regions (6.2 per 1000 population) but are above the NSW average (5.7). Figure 55: Smoking related hospitalisation
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SLA
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High body mass Figure 56 illustrates that the levels of hospitalisation related to high body mass are 42% lower in Sydney LGA (3.99 per 1000 population) than in NSW (4.41). The number of hospitalisations attributable to high body mass in Botany Bay is also below the NSW average. Figure 56: High body mass related hospitalisations
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SL
Falls Sydney LGA has the third highest level of fall related hospitalisations for those aged 65 years and over in ESML catchment (37.74 per 1000 population), behind Randwick (39.89) and Botany Bay (38.13). All of the sub regions have higher rates than the NSW average of 31.29. Figure 57: Number of falls
Source: NSW Ministry of Health and Health Statistics NSW (2012) Note: Sydney includes other areas of the city besides Sydney East SLA
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6.7. Mental health services The graph below illustrates the correlation between the percentages of total ESML residents in each sub region compared to the percentage of total ATAPS referrals. The graph shows that Sydney LGA has 20% of the residents in ESML and provides 19% of the ATAPS referrals. Figure 58: Percentage of ATAPS referral’s by sub region
Source: Eastern Sydney Medicare Local
6.8. Home and Community Care (HACC) Figure 59 shows characteristics of HACC consumers in Sydney East, compared to the ESML catchment overall and NSW. Major differences in the profile of HACC consumers in Sydney East relate to the proportion of clients living alone which is 60% in Sydney East compared to 46% in the ESML and Clients with carer (6% in Sydney East compared to 11% in the ESML). Figure 59: Characteristics of HACC clients, 2010-11
Source: PHIDU and Department of Health and Ageing (2013)
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Figure 60 presents the number of instances of care for selected HACC services across Sydney East, which shows that Sydney East residents are more frequent consumers of most HACC services than both the overall ML and NSW. Notably, the greatest variances in HACC service utilisation relate to:
Allied health care at home (2.19 instances per 1000 compared to 4.22 across ESML and 2.63 in NSW);
Domestic assistance (5.56 instances per 1000 compared to 6.56 across ESML and7.72 in NSW); and
Case management (1.29 instances per 1000 compared to 1.55 across ESML and 1.81 in NSW). Figure 60: Utilisation of HACC services, 2010-11
Source: PHIDU and Department of Health and Ageing (2013)
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