Summary health conditions

Reduction in overweight and obesity

Increase smoking cessation during pregnancy Higher proportion of overweight and obesity (rank 28/31, variance to Aust -11%), in particular for young people (overweight people, rank 30/30, variance to Aust -9%; males, rank 29/30, variance to Aust -8%; females, rank 30/30, variance to Aust -8%) (obese people, rank 28/30, variance to Aust -33%; males, rank 28/30, variance to Aust -31%; females, rank 28/30, variance to Aust -36%) Higher proportion smoking during pregnancy (rank 26/31, variance to Aust -73%) Aboriginal and Torres Strait Islander mothers (rank 26/31, variance to Aust -10%) Higher proportion smoking in first 20 weeks of pregnancy (rank 28/31, variance to Aust -80%) Higher proportions of smoking after 20 weeks of pregnancy (rank 29/31, variance to Aust -16%) AIHW 2017; Table 96 overweight and obesity PHIDU 2017; Table 99 Overweight young people PHIDU 2017; Table 100 Obese young people

PHIDU 2018, PHIDU 2016, AIHW 2018; Table 103 Smoking in pregnancy

The leading causes of death in the Murrumbidgee region for the top three are the same as Australia, these include coronary heart disease, Alzheimer’s disease or dementia and cerebrovascular disease.

Long term health conditions, particularly more than three and those that report being limited a lot by condition are higher in MPHN this suggests that in general the health of MPHN residents is likely to be poorer and not easily resolved as acute conditions may be. This will have an impost on need to use services in the Murrumbidgee region.

Infant deaths 0 – 48 months are higher in the MPHN, details on causes of death are not known, however, this may have an impact for support related to grief and bereavement that need to be considered. Infant mortality in the first 0-12 months is similar in MPHN compared with NSW and Australia.

The median age at death for Murrumbidgee residents is similar to NSW and Australia with males having a median age at death of 78 years and females having a median age of 84 years. For Aboriginal and Torres Strait Islander people in MPHN the median age at death for males is 58 years and for females a decade older at 68 years. This is significantly lower than non-Aboriginal people.

MPHN has higher mortality from all causes for females and males compared with Australia. Premature mortality, potentially avoidable deaths and avoidable deaths in males are higher in MPHN compared with NSW and Australia. For premature mortality, rates are higher in females in MPHN compared with Australia, avoidable deaths and potentially avoidable deaths are not however significantly higher. For Aboriginal and Torres Strait Islander people premature mortality and avoidable deaths are similar in MPHN compares to NSW.

Morbidity measured by potential years of life lost is higher in MPHN compared with Australia, in particular for males but also for females. For Aboriginal and Torres Strait Islander people rates of years of life lost are similar to NSW and Australia. Potential years of life lost by age groupings demonstrate that those aged 25-44 years do not have significantly higher years of life lost in MPHN compared with Australia. This is the case though for those 0-14 years, 15-24 years, 45-64 years and 65-74 years. In particular for males these age groupings have much higher potential years of life lost compared with Australia in MPHN region however for females, those 15-24 years, 45-64 years and 65-74 years have higher potential years of life lost compared with Australia but not for those 0-14 years or 25-44 years.

Mortality related to alcohol attributable deaths is higher in MPHN compared with NSW for both males and females. Deaths attributed to smoking are slightly higher in MPHN compared with NSW.

MPHN has higher proportions of people with long term health conditions for both heart disease and effects of stroke. Heart, stroke and vascular disease rates are higher in MPHN compared with both NSW and Australia. Mortality associated with cardiovascular disease is higher for males for circulatory disease deaths, this is not the case of females or in general. Deaths due to atrial fibrillation are also only marginally higher in MPHN compared with Australia. Premature mortality and avoidable deaths are higher in MPHN for circulatory disease in non-Aboriginal people, is only slightly higher in Aboriginal and Torres Strait Islander people and marginally higher for ischaemic heart disease. Premature deaths due to cerebrovascular disease and avoidable deaths are lower in MPHN compared with NSW and marginally higher than Australia. Potential years of life lost due to circulatory system disease in Aboriginal and Torres Strait Islander people and non-Aboriginal people are similar in MPHN compared with NSW and Australia. Potential years of life lost due to ischaemic heart disease and cerebrovascular disease are also not significantly higher in MPHN compared with NSW and Australia.

The prevalence of diabetes is slightly higher in MPHN compared with NSW and as a long term health condition compared with Australia. The incidence of diabetes in MPHN is lower compared with both NSW and Australia. Mortality due to endocrine and nutritional and metabolic disease is higher in MPHN compared with Australia. Premature mortality due to diabetes was similar in MPHN compared with NSW and Australia. Potential years of life lost attributed to diabetes was similar in MPHN compared with NSW and Australia.

Prevalence of arthritis as a long term health condition is higher in proportion compared with Australia and as a rate compared with both NSW and Australia. Osteoporosis is similar in MPHN compared with NSW and Australia. There is a higher rate of mortality due to musculoskeletal system and connective tissues disease in females in MPHN compared with Australia.

Mortality due to external causes is higher in MPHN compared with Australia for males and females. Premature mortality and avoidable deaths are also higher in MPHN compared with NSW and Australia for non-Aboriginal people. Premature deaths and avoidable deaths for Aboriginal and Torres Strait Islander people are similar in MPHN compared with NSW. Potential years of life lost due to mortality from external causes is much higher in MPHN compared with NSW and Australia.

Mortality due to chronic kidney disease is higher in MPHN compared with NSW. Kidney failure is also the 18th leading cause of death in the Murrumbidgee region.

Mortality due to pregnancy, childbirth and the puerperium are slightly higher compared with Australia as is mortality due to certain conditions originating in the perinatal period. Mortality due to disease of the genitourinary system are similar in MPHN compared with Australia for females but are higher in males.

Infectious disease prevalence for chlamydia and Hepatitis C are higher in MPHN compared with NSW. Gonorrhoea infections are lower in MPHN compared with NSW. The current COVID-19 prevalence and vaccine administration rates are variable given it is an active pandemic. Mortality due to certain infectious and parasitic disease is higher in MPHN compared with Australia particularly in males. Influenza and pneumonia is the 15th leading cause of death in MPHN.

Long term mental health conditions in MPHN are slightly higher but do not rank lower than 25th across the nation. There is no difference in the rate of mental and behavioural problems for males and females compared with NSW and Australia. This is not consistent for age though where people aged 5-11 years and 65 plus years proportions of total mental health conditions are significantly higher in MPHN compared with Australia. These age cohorts have significantly higher mental health conditions for early intervention, mild, moderate or severe mental health conditions in the MPHN compared with Australia. Mortality due to mental and behavioural disorders was similar in MPHN compared with Australia. Specifically mortality due to suicide in males are much higher in MPHN compared with Australia. Both premature mortality, avoidable deaths and potential years of life lost due to suicide and self-inflicted injuries are higher in MPHN compared with Australia.

Cancer as a long term health condition is higher proportionately compared with Australia. The cancer incidence rate is higher in MPHN compared with NSW and Australia, specifically for males. For cancers detected through screening for breast, cervical and bowel cancer rates were similar in MPHN compared with NSW.

Mortality due to neoplasms is higher in MPHN compared with Australia for both males and females. Premature deaths due to cancer and specifically breast cancer is higher in MPHN compared with NSW and Australia and ranks lower than 25th across the nation. Premature deaths due to lung cancer are slightly higher compared with NSW and Australia in MPHN, however, do not rank lower than 25th across the nation. Premature deaths from colorectal cancer and in Aboriginal and Torres Strait Islander people are lower in MPHN compared with NSW and Australia. Avoidable deaths due to cancer, specifically breast and colorectal cancer are higher in MPHN compared with NSW and Australia. Whilst avoidable deaths due to cancer in Aboriginal and Torres Strait Islander people are higher in MPHN compared with Australia, they do not rank lower than 25th across the nation. Morbidity measured by potential years of life lost is higher in MPHN compared with NSW and Australia for all cancers and for breast cancer. Colorectal cancer and Aboriginal and Torres Strait Islander peoples potential for year’s life lost is lower in MPHN compared with NSW and Australia.

As a long term health condition, chronic lung disease is similar in MPHN compared with Australia. Asthma is higher in proportion in MPHN as a long term health condition compared with Australia. Rates of asthma in MPHN are also higher compared with NSW and Australia. Chronic obstructive pulmonary disease is higher as a condition compared with NSW but similar to Australia in MPHN. Mortality due to respiratory disease is higher in MPHN compared with Australia, specifically in males, mortality is higher in females but does not rank lower than 25th across the nation. Premature mortality due to respiratory disease and chronic obstructive pulmonary disease is higher in MPHN compared with NSW and Australia. Premature mortality in Aboriginal and Torres Strait Islander people is also higher in MPHN compared with NSW but does not rank lower than 25th in the nation. Avoidable deaths are higher in MPHN compared with NSW and Australia for respiratory disease and for chronic obstructive pulmonary disease. Avoidable deaths are similar to NSW in the MPHN for Aboriginal and Torres Strait Islander people. Potential for years of life lost is higher in MPHN for respiratory system disease compared with NSW and Australia. Morbidity is slightly higher for chronic obstructive pulmonary disease in MPHN compared with NSW and Australia but does not rank lower than 15th across the nation. Morbidity is lower for Aboriginal and Torres Strait Islander people for respiratory system disease in MPHN compared with NSW.

MPHN has higher rates of both premature mortality and potential years of life lost due to road traffic injuries and avoidable deaths from transport accidents compared with NSW and Australia. Prevalence of Alzheimer’s disease or dementia as a long term health condition is similar in MPHN compared with Australia, chronic pain is slightly higher in MPHN compared with Australia.

Mortality due to skin disease is lower in MPHN compared with Australia for males and females. Other conditions where mortality is higher in MPHN compared with Australia include symptoms‚ signs and abnormal clinical and laboratory findings‚ not elsewhere classified, congenital malformations, deformations and chromosomal abnormalities, nervous system disease and digestive disease. Liver disease is ranked 19th in MPHN as a leading cause of death. Deaths due to hypertensive disease rank 11th in the MPHN.

There are 25 health conditions in MPHN which rank in the lowest third of the nation and require some level of intervention to reduce the burden on incidence/prevalence, mortality and morbidity that they place on the region. Table 7 describes the priority areas and the population groups affected relating to specific health conditions. Table 8 provides a description of evidence for health conditions where MPHN ranks 25th or more indicating that the MPHN is in the lowest third of the nation.

Table 7: Priority areas for action for population groups from health conditions

Reduce coronary heart disease and CHD mortality Reduce mortality related to Alzheimer’s disease or dementia Reduce cerebrovascular mortality

Reduce number of long term health conditions Reduce limitations of long term health conditions Reduce Infant deaths 0-48 months

Reduce all-cause mortality; premature mortality; avoidable deaths; potentially avoidable deaths Reduce morbidity through reduction in potential years of life lost Reduce mortality attributable to alcohol and smoking Reduce mortality due to diabetes

Reduce prevalence of arthritis

Reduce mortality and morbidity due to external causes; premature mortality; avoidable deaths, external causes, other external causes Reduce mortality due to chronic kidney disease or kidney failure Reduce mortality due to genitourinary system disease Reduce mortality due to infectious and parasitic disease Reduce mental health conditions for specific age groups Reduce mortality and morbidity, premature mortality, avoidable deaths due to suicide Reduce incidence of cancer (specific types)

Reduce mortality, premature deaths, avoidable deaths and morbidity due to cancer Reduce prevalence of asthma

Reduce premature mortality due to respiratory system disease Reduce premature mortality due to chronic obstructive pulmonary disease Reduce premature mortality, avoidable deaths and morbidity due to road traffic injuries or transport accidents Reduce mortality due to digestive disease, specifically liver disease Reduce deaths due to hypertensive disease Aboriginal and Torres Strait Islander people Maternal, Child and Youth Older persons Population

Table 8: Summary of evidence for priority areas health conditions

Outcomes of the health needs analysis

Identified Need Key Issue Reduce coronary heart disease and CHD mortality Leading cause of death 8th cause of death for heart failure and complications and ill-defined heart disease 17th cause of death for cardiac arrhythmias Higher proportion (rank 31/31, variance to Aust -32%) and rate of (rank 28/30, variance to Aust -10%) long term health condition – heart disease

Reduce mortality related to Alzheimer’s disease or dementia Second leading cause of death

Reduce cerebrovascular mortality

Reduce number of long term health conditions

Reduce limitations of long term health conditions

Reduce Infant deaths 048 months

Reduce all-cause mortality; premature mortality; avoidable deaths; potentially avoidable deaths

Reduce morbidity through reduction in potential years of life lost

Reduce mortality attributable to alcohol and smoking

Reduce mortality due to diabetes Third leading cause of death

Higher proportion of people with more than three long term health conditions (rank 25/31, variance to Aust 14%) Higher proportion of people with a long term health condition which is limited a lot by condition (rank 27/31, variance to Aust -20%)

Higher rate of infant deaths 0-48 months (rank 28/31, variance to Aust -26%)

Higher rate of all-cause mortality (rank 25/31, variance to Aust -13%), males (rank 25/31, variance to Aust 14%) Higher rate of premature mortality (rank 28/31, variance to Aust -22%), males (rank 28/31, variance to Aust -24%) Higher rate of avoidable deaths (rank 26/31, variance to Aust -24%), males (rank 26/31, variance to Aust 26%) Higher rate of potentially avoidable deaths males (rank 26/31, variance to Aust -34%) Higher rate of potential years of life lost (rank 26/31, variance to Aust -27%), males (rank 26/31, variance to Aust -30%) Persons and males 0-14 (rank 26/31, variance to Aust 19%) males (rank 27/31, variance to Aust -35%), 15-24 (rank 28/31, variance to Aust -77%) males (rank 28/31, variance to Aust -84%), 45-64 (rank 25/31, variance to Aust -21%) males (rank 25/31, variance to Aust -22%), 65-74 (rank 28/31, variance to Aust -21%) males (rank 28/31, variance to Aust -24%) Females 15-24 (rank 27/31, variance to Aust -60%), 4564 (rank 25/31, variance to Aust -19%), 65-74 (rank 25/31, variance to Aust -15%) Higher rate of deaths attributable to alcohol, males and females Higher rate of deaths attributed to smoking

7th leading cause of death Description of Evidence AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

AIHW 2016, PHIDU 2017; Table 120 Cardiovascular and cerebrovascular disease

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

AIHW 2016; Table 105 long term health conditions

AIHW 2016; Table 105 long term health conditions

PHIDU 2014; Table 106 Infant mortality

AIHW 2018; Table 109 mortality all causes

PHIDU 2014; Table 110 Premature mortality

PHIDU 2014; Table 112 Avoidable deaths

PHIDU 2014; Table 114 Potentially avoidable deaths PHIDU 2014; Table 115 Potential years of life lost

HealthStatsNSW, 2018-19, 2019

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Reduce prevalence of arthritis

Reduce mortality and morbidity due to external causes; premature mortality; avoidable deaths, external causes, other external causes

Reduce mortality due to chronic kidney disease or kidney failure

Reduce mortality due to genitourinary system disease

Reduce mortality due to infectious and parasitic disease

Reduce mental health conditions for specific age groups

Reduce morbidity, premature mortality, avoidable deaths due to suicide

Reduce incidence of cancer (specific types) Higher proportion as a long term health condition –arthritis (rank 29/31, variance to Aust -17%) Higher rate of arthritis (rank 30/30, variance to Aust 27%) Higher rate of mortality due to external causes (rank 27/31, variance to Aust -28%), females (rank 29/31, variance to Aust -28%) AIHW 2016; Table 133 Arthritis

PHIDU 2017; Table 133 Arthritis

AIHW 2018; Table 135 Mortality due to external causes

Higher rate of premature deaths due to external causes (rank 27/31, variance to Aust -39%) Higher rate of avoidable deaths due to external causes (rank 26/31, variance to Aust -30%) and other external causes (rank 27/31, variance to Aust -47%) PHIDU 2014; Table 136 Premature mortality due to external causes PHIDU 2014; Table 136 Premature mortality due to external causes

Higher rate of potential years of life lost external causes (rank 28/31, variance to Aust -59%) 12th leading cause of death other ill define causes 20th leading cause of death accidental falls

PHIDU 2014; Table 138 Potential years of life lost, external causes AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN Higher rate of mortality due to chronic kidney disease HelathStatsNSW, 2016-18 18th leading cause of death – kidney failure AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Higher rate of mortality due to genitourinary system disease (rank 25/31, variance to Aust -13%) AIHW 2018; Table 140 Mortality due to disease of the genitourinary system

Higher rate of mortality due to infectious and parasitic disease males (rank 25/31, variance to Aust -17%)

AIHW 2018; Table 141 Mortality due to certain infectious and parasitic disease 15th leading cause of death Influenza and pneumonia AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN

Higher total mental health conditions 5-11 years (rank 25/31, variance to Aust -8%), 65 plus years (rank 31/31, variance to Aust -33%); early intervention 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 26/31, variance to Aust -6%); mild 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 31/31, variance to Aust -44%); moderate 5-11 years (rank 25/31, variance to Aust -8%) 65 plus years (rank 31/31, variance to Aust -47%); severe mental health conditions 5-11 years (rank 25/31, variance to Aust 6%) 65 plus years (rank 31/31, variance to Aust -44%) Higher premature mortality from suicide and selfinflicted injuries (rank 26/31, variance to Aust -37%) Higher avoidable deaths from suicide and self-inflicted injuries (rank 26/31, variance to Aust -37%) Higher rate of potential years of life lost due to suicide and self-inflicted injuries (rank 26/31, variance to Aust -50%) 16th leading cause of death suicide

Higher proportion as a long term condition (rank 29/31, variance to Aust -19%) Higher rate of cancer incidence specifically males (rank 29/31, variance to Aust -9%) Higher incidence colorectal cancer (rank 26/31, variance to Aust -9%); males (rank 29/31, variance to Aust -12%) Higher incidence pancreatic cancer (rank 27/31, variance to Aust -9%), females (rank 27/31, variance to Aust -10%) Higher incidence prostate cancer (rank 31/31, variance to Aust -27%) NMHSPF, PHIDU 2019; Table 143: Mental health conditions - Total mental health conditions

PHIDU 2014; Table 150 Suicide premature deaths PHIDU 2014; Table 151 Avoidable deaths due to suicide and self-inflicted injuries PHIDU 2014; Table 152 Suicide potential years of life lost

AIHW 2015-19; Table 104 20 top leading causes of death in Australia and MPHN AIHW 2016; Table 153 Long term health condition - cancer PHIDU 2010-14; Table 154 Cancer incidence by gender PHIDU 2010-14; Table 155 Colorectal cancer incidence

PHIDU 2010-14; Table 156 Pancreatic cancer incidence

PHIDU 2010-14; Table 157 Prostate cancer incidence