Air quality and respiratory disease in Newcastle, New South Wales.

OBJECTIVE: To investigate respiratory illnesses in the Newcastle region, their change over time, and their geographic relationship to industrialised areas. DESIGN: We analysed admissions to public hospitals by postcode area in the Newcastle region, for all causes and for all the various respiratory causes, for the years 1979-1988. Comparisons were made between the State of New South Wales and the Newcastle area, and between geographic areas within Newcastle. Changes over the 10-year period were noted. RESULTS: For both all causes and respiratory causes, admission rates to Newcastle hospitals, 1979-1988, were significantly lower than those for the rest of New South Wales in 1986. There was a correlation between living in the industrial part of the city and hospital admission for all causes and respiratory causes. There was also a correlation between mean disposable family income and hospital admissions, with those areas with the higher incomes having lower admission rates. Over the 10 years studied there was a statistically significant decline in admissions for respiratory causes, both in absolute terms and after controlling for changes in admissions for all causes. In children aged 0-14 years a significant increase in admissions for asthma occurred between 1979 and 1988, which could not be explained by diagnostic shift. CONCLUSIONS: On the basis of hospital statistics, the members of the Newcastle population seem little different from those in the remainder of New South Wales. From 1979-1988, the efforts by industry, with the support of the community, to reduce industrial pollution have been accompanied by a reduction in hospital admission rates for respiratory diseases in general and for chronic obstructive lung disease in older people. Other contributing factors include reduced smoking rates and improved medical management. Correlations between geographic location and respiratory admission rates may be a manifestation of social class rather than poor air quality, although a contribution from the latter cannot be discounted. A concomitant rise in asthma admission rates in children aged 0-14 is likely to be unrelated to any change in air quality.     

Prevalence of Huntington disease in New South Wales in 1996

OBJECTIVE: To estimate the prevalence of Huntington disease (HD) in New South Wales on Australian Census Day (6 August) 1996. DESIGN: Survey of records of the Huntington Disease Service and major hospitals, and of neurologists, psychiatrists, clinical geneticists and genetic counsellors. SUBJECTS AND SETTING: All patients in NSW who, on Census Day 1996, either had a definite diagnosis of HD (motor signs of chorea or ataxia and family history of HD or positive DNA test result) or would have had signs and later received a definite diagnosis (assessed 1 April 1997 to 1 July 1999). MAIN OUTCOME MEASURES: Prevalence (HD patients per 100,000 population); patient characteristics; year and basis of diagnosis. RESULTS: 380 patients with definite HD were identified, giving a prevalence of HD in NSW in 1996 of 6.29 per 100,000 population (95% CI, 5.68-6.96). A third of HD patients were aged 60 years or older. Diagnosis was confirmed by DNA testing for 171 patients (45%), including 30 (8%) with no recorded family history. Average numbers of new diagnoses per year were 11.8 (1984-1988), 21.8 (1989-1993) and 28.6 (1994-1998). Estimated number of people with a 50% risk of inheriting the HD mutation was 25.2 per 100,000 population. Estimated incidence of HD in 1996 was 0.65 per 100,000 population. CONCLUSIONS: Prevalence of HD in NSW is similar to estimated prevalence in other Australian and Western populations. Increasing numbers of cases are being diagnosed, and the 18 chronic care beds currently designated for HD patients in NSW are unlikely to be sufficient.     

Tuberculosis in New South Wales

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.     

Youth suicide in New South Wales: urban-rural trends.

OBJECTIVE: The study tested the hypotheses that (i) the rate of suicide by firearms among youth (aged 10-19 years) is increasing at a greater rate than rates of suicide by other methods; (ii) the rate of youth suicide in rural New South Wales is significantly higher than those in urban areas; and (iii) the increase in youth suicide by means of firearms is occurring at a greater rate in rural males aged 15-19 years than in other groups. DESIGN: Data were obtained from the NSW Office of the Australian Bureau of Statistics concerning 735 youth suicides in NSW between 1964 and 1988. These were reviewed for information concerning residential area and method of death. Five five-year periods were used, and rates were calculated with population figures obtained in the census years for the same age and sex group. RESULTS: From 1964 to 1988, suicide by firearms has risen most substantially, from 3.4 to 5.6 per 100,000 per year in 15-19-year-old males. There has also been a substantial increase in 15-19-year-old male suicides by hanging (0.7 to 3.4 per 100,000 per year). Poisoning suicides have declined among females and males in the past 15 years. Suicide rates in Sydney, Newcastle and Wollongong have remained stable. In rural cities, they have increased from 1.5 to 4.7 per 100,000 per year (F = 4.9, P less than 0.02) while in rural municipalities and shires they have increased from 1.3 to 6.4 (F = 14.6, P less than 0.0001). The suicide rate of 15-19-year-old males has shown a modest increase in Sydney and no change in Newcastle or Wollongong, but the rate for 15-19-year-old males in rural cities has more than doubled, from 5.1 to 12.5 (F = 7.7, P less than 0.003), while in rural municipalities and shires, the rate has increased more than fivefold, from 3.9 to 20.7 (F = 9.3, P less than 0.001). There has been no significant change in the suicide rates of 15-19-year-old females, or in 10-14-year-olds. The rate of suicide by firearms among 15-19-year-old males has not risen significantly in rural cities, but in rural municipalities and shires the rates have risen fivefold from 2.8 to 14.8 (F = 5.6, P less than 0.01). CONCLUSIONS: Each hypothesis was confirmed. An increase of this magnitude is not an artefact of coroners' verdicts. The findings are believed to be due to ready access to firearms, the use of alcohol and drugs (particularly in firearms suicides) and increasing socioeconomic, health, and identity problems for rural youth, especially males.