Termination of pregnancy in New South Wales, 1990

Abstract: This article reports on terminations of pregnancy done in New South Wales (NSW) for NSW residents, using routinely collected data from the Health Insurance Commission (HIC) and the NSW Inpatient Statistics Collection (ISC). The HIC and ISC recorded 29 348 terminations for NSW residents in 1990, representing a termination rate of 21.6 per 1000 women aged 15 to 44. Terminations were frequent at all ages, but the highest termination rate was in the 20 to 24 age range (36.8 per 1000). About one-quarter of all known pregnancies were terminated (excluding spontaneous abortions). The majority of terminations were done in private clinics; only 10 per cent of women having terminations were public patients in public hospitals. Outside the Sydney metropolitan area, termination rates were lower than in Sydney, and the procedures were more likely to be done in public hospitals. Large numbers of terminations are done in NSW, but the rate appears to have been constant since the early 1980s.     

Differential and spatial aspects of suicide mortality in New South Wales and Sydney, 1980 to 1990

Abstract: Occupational and marital status dimensions of suicide mortality in New South Wales were examined for the periods 1980 to 1985 and 1986 to 1989-90 respectively, and marital status and birthplace group mortality profiles were examined in relation to grouped occupations, with a view to identifying the relative influence of these differentiating factors on suicide mortality. Spatial analysis was undertaken for different ages, in major regions of New South Wales and statistical local areas in Sydney for the period 1985 to 1991, and associations with socioeconomic characteristics of geographic areas were investigated. Despite residential revitalisation in inner city areas, higher mortality in several inner city localities has persisted over time while levels have risen in some outer areas. Never-married and divorced men in manual work were most at risk of committing suicide and never-married and divorced women had elevated suicide levels. Male suicide levels were elevated among farmers and related workers, and youth and adult male suicide levels were elevated in inland regions of the state. Possible explanations for the variations are discussed.     

Socio-demographic and spatial aspects of male mortality from HIV-AIDS related diseases in New South Wales, Australia, 1990-1994.

During 1990-1994, a very high proportion of males aged under 40 who died from HIV-AIDs related diseases in New South Wales were never married. However, a significant minority of men aged 40-64 who died had been married at some stage in their lives and in the cities of Newcastle, Wollongong and in higher income areas of Sydney this proportion approached 40%. AIDS related mortality was over-represented in professional, managerial, paraprofessional and service occupations even though educational levels were higher in these groups and, thus, presumably knowledge about risk behaviour and preventative behaviour. AIDS related mortality was also elevated among men with no stated occupation. Thus, with males, AIDS was in part a disease of affluence, even though the highest proportions of those dying resided in lower income areas, where marginalised persons may also be at risk. The proportion of deaths to men over age 40 was markedly higher than that in Australia in the 1980s. Elevated mortality with the New Zealand and the Americas birthplace groups may reflect overseas travel and exposure to risk in overseas countries, of persons domiciled in Australia. There was a very strong spatial pattern of AIDS-related mortality in the inner and eastern suburbs in Sydney and there is limited evidence of persons having migrated back to places of origin to be cared for by families. The impact on total mortality under age 65 in these localised areas was considerable. Prevention strategies should include the sensitive targeting of bisexual men, men generally having sex with men and those who are both gay and members of the drug sub-culture.     

Current trends in perinatal mortality statistics at the New Jersey Obstetric Center

The study presents an overview of the changes in perinatal mortality rates at the Statewide Perinatal Center of New Jersey during the past decades. According to the data, the increase in the rate of cesarean sections from 4.5 percent to 17 percent, and the comparable reduction of the rates of manipulative intrapartum and extraction procedures, contributed significantly to the decrease of the perinatal mortality rates from 51/1000 to 17/1000 between 1971 and 1983. Of the new technical tools, those utilized for the evaluation of fetal well-being antepartum appeared to be more useful then those used intrapartum. On account of the high prevalence of genital infections in the population, the recent acceptance in the service of the use of invasive intrapartum technology, appears to have impacted unfavorably upon the perinatal mortality trends. The increased rate of births of premature babies, the widespread abuse of habit forming drugs in the community, and the routine use of procedures requiring artificial rupture of the membranes, probably all contributed to the rapid increase of the perinatal mortality rate in the Center from 15/1000 in 1986 to 28/1000 in 1988. It is concluded that perinatal care is a complex medical and social task. The overall result of the relevant efforts depends to a great extent upon the social environment, and the moral standing, educational level and motivation of the recipients.     

Increased mortality among Indigenous persons during and after release from prison in New South Wales

Objective: To estimate the overall and cause specific mortality of Aboriginal offenders in New South Wales (NSW), Australia. Methods: The study cohort consisted of all Aboriginal men and women aged 18 years and older who had experienced full‐time imprisonment in NSW between 1 January 1988 and 31 December 2002. Their data were linked probabilistically to the Australian National Death Index to obtain information on death. Standardised mortality ratios were calculated for all causes of death and adjusted for age, sex, and calendar year. Results: The cohort comprised 7,980 men and 1,373 women with 75,801 person years of observation. During a median follow‐up period of 8.3 years, 485 men and 73 women died, giving an overall mortality rate of 733 and 755 deaths per 100,000 person‐years. The risk of death in men was 4.8 (95% CI: 4.4–5.3) times and among women 12.6 (95% CI: 10.0–15.8) times that of the NSW residents, with a markedly elevated risk for almost all conditions. The leading cause of death was cardiovascular disease in men (112 deaths, 23%) and mental and behavioural disorders (17 deaths, 23%) in women. The risk of death was greatest following release from prison. Conclusions and Implications: High mortality rates for cardiovascular disease, a preventable and treatable condition, were seen among Aboriginal offenders. Prison has an important role to play in screening marginalised populations for a range of health conditions. This is particularly true for Indigenous offenders.     

Liver cancer and hepatitis B and C in New South Wales, 1990-2002: a linkage study

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) incidence has increased in Australia in the past 20-30 years. We conducted a community-based linkage study to examine the characteristics of hepatocellular carcinoma with particular reference to hepatitis B and C infections. METHODS: Hepatocellular carcinoma cases (n=2,072) notified to the New South Wales (NSW) Central Cancer Registry from 1990 to 2002 were probabilistically linked to HBV and HCV diagnoses notified to NSW Health. Sex, age, year of diagnosis, region of birth, method of diagnosis and spread at diagnosis and survival were compared by linkage group. RESULTS: Hepatocellular carcinoma incidence increased from 1.4/100,000 in 1990 to 2.8/100,000 in 2002. Incidence varied by region of birth (p<0.001), with people born in Vietnam having the highest relative rate compared with those born in Australia (RR=11.7, 95% CI 9.8-13.8). Of the hepatocellular carcinoma records, 15.6%, 12.9% and 0.8% were linked to hepatitis B, hepatitis C and hepatitis B/C co-infection respectively and 70.7% were unlinked. Median age at diagnosis of HCV-related hepatocellular carcinoma varied markedly at 51, 68 and 71 years for Australian, European, and Asian-born groups, respectively (p<0.0001). CONCLUSION: Contrasting age distribution of HCV-related HCC by country/region of birth is consistent with divergent patterns of HCV transmission. IMPLICATIONS: These data highlight the increase in HCC in NSW and the divergent populations whose needs in terms of treatment, care and prevention will need to be met.     

Inequalities in the transition of cerebrovascular disease mortality in New South Wales, Australia 1969-1996

With reference to epidemiological transition theory, this paper examines change in cerebrovascular disease mortality in Australia's most populous state in the 28 year period, 1969-1996. The hypotheses were that in the context of overall stroke mortality decline over the period, marital status, occupational status and spatial differences decreased. However, while overall mortality declined, differentials increased. The reasons for this are considered, with particular implications for epidemiological transition theory and for the targeting of populations at risk in policy terms.     

Stomach cancer mortality in New South Wales and Sydney, 1980 to 1985

Unit list mortality data for the period 1980-1985 are used to examine differential mortality from stomach cancer in New South Wales, with reference to age, marital status, occupational status and birthplace, and geographical variations in mortality in metropolitan Sydney. Ecological correlation and analysis of characteristics of persons dying in areas of high mortality in Sydney are undertaken to determine where populations at risk reside and whether different populations at risk inhabit particular areas, resulting in significantly higher mortality. This was found to be the case in certain areas and it appears that the immigrant population contributed considerably to mortality variation. The implications for health service provision and preventive measures are discussed.     

Chernobyl fallout and perinatal mortality in England and Wales

Previous studies have concluded that radioactive fallout from Chernobyl may have caused an increase in perinatal mortality in West Germany and the U.S.A. The existence of marked geographical variations in contamination from Chernobyl in England and Wales provides an opportunity to investigate this question further by means of a geographical study. The highest doses from Chernobyl in England and Wales were in the counties of Cumbria, Clwyd and Gwynedd where there was heavy rainfall during the passage of the radioactive cloud. However, perinatal mortality in these areas did not rise relative to the national average in the year following Chernobyl. This negative finding was confirmed by a wider study of 14 counties grouped in accordance with levels of radioactive contamination of local milk. It is concluded that this study provides no evidence that radiation from Chernobyl caused a rise in perinatal mortality in England and Wales.     

Fertility and perinatal health among Finnish immigrants in Sweden

Several studies have reported poorer infant outcome among immigrants, but contrary evidence also exists. Between 1940 and 1999 more than a half million Finns emigrated to Sweden, which made Finns the largest minority group in Sweden. Our aim was to investigate fertility trends, parturients' background and pregnancy outcomes among Finns in Sweden, and to compare the findings with those obtained among Swedes in Sweden and Finns in Finland. The data came from the Finnish and Swedish Medical Birth Registers for the years 1987-1998. All deliveries by women born in Finland and having given birth in Sweden (N=33874) were compared with a 10% sample of all deliveries by Swedish parturients in Sweden (N=108549) and of all Finnish deliveries (n=75133). Among Finns in Sweden, the number of live births per 1000 women aged 15-49 years declined significantly in the late 1990s. The change in the total fertility rate was less dramatic: the rate for Finns in Sweden followed the total Swedish rate although it remained from 5% to 10% higher up to the mid-1990s. Finns who had given birth in Sweden were older, had a higher parity and a higher prevalence of previous miscarriages, and smoked more often than did Swedes in Sweden or Finns in Finland. The crude infant outcomes of Finns having given birth in Sweden were equal to those among Swedes in Sweden (except for the incidence of small for gestational age), but poorer than in Finland. Biological factors explained the differences between Finns in Sweden and Finland in being small for gestational age, and biological factors and smoking explained the difference in prematurity. The difference in low birth weight remained statistically significant (3.9% versus 3.6% among singletons). In conclusion, fertility trends followed the pattern prevailing in the resident country. The relatively good outcome of children whose mothers were born in Finland but who had given birth in Sweden can partly be explained by the healthy migrant effect.     

Health-related behaviour in Wales, 1985-1990

This study looked at recent changes in Wales in four health-related behaviours: smoking, alcohol consumption, diet and physical activity. Data are drawn from three large-scale surveys conducted across Wales in 1985, 1988 and 1990. The results show a reduction in smoking prevalence between 1985 and 1990 among men and women, and a growing trend towards healthier eating, with reduced frequent consumption of salt and foods high in saturated fats. Encouraging progress towards healthier living has been made, but the results also indicate the extent of the remaining challenge: greater progress is particularly needed to encourage participation in exercise, and to reduce the numbers of people who drink alcohol in excess of recommended sensible limits.