Australian Heart Maps

Data Sources

The Australian Heart Maps draw on the following data sources:

• Hospital Separations (2012-16): AIHW National Hospital Morbidity Database (Customised data request)

• CHD mortality (2012-16): AIHW Mortality Over Regions and Time (MORT) books

• Obesity (2014-15) Public Health Information Development Unit (2017) Social Health Atlas (risk factor modelled estimates)

• Smoking (2014-15) Public Health Information Development Unit (2017) Social Health Atlas (risk factor modelled estimates)

• High Blood Pressure (2014-15) Public Health Information Development Unit (2017) Social Health Atlas (risk factor modelled estimates)

• High cholesterol (2011-12)  Public Health Information Development Unit (2017) Social Health Atlas (risk factor modelled estimates)

• Physical Inactivity (2014-15) Public Health Information Development Unit (2017) Social Health Atlas (risk factor modelled estimates)

• Indigenous risk factor rates (2012-13) Australian Bureau of Statistics (ABS) 4727.0 ABS Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13

• Estimated Population, Proportion of Aboriginal & Torres Strait Islander Peoples, Proportion of total population born overseas, Proportion of people who don’t speak English well or at all
  ABS POPULATION AND PEOPLE, Australia, State and Territory, Statistical Area Levels 2-4, Greater Capital City Statistical Area, 2011-2016

• Proportion of persons 15 and over who did not complete Year 10
  ABS INCOME (INCLUDING GOVERNMENT ALLOWANCES), EDUCATION AND EMPLOYMENT, HEALTH AND DISABILITY, Australia, State and Territory, Statistical Area Levels 2-4, Greater Capital City Statistical Area, 2011-2016

• Proportion of dwellings with no household internet access
  ABS FAMILY AND COMMUNITY, LAND AND ENVIRONMENT, Australia, State and Territory, Statistical Area Levels 2-4, Greater Capital City Statistical Area, 2011-2016.
  No household internet access refers to not accessing the internet through a desktop/laptop computer, mobile or smart phone, tablet, music or video player, gaming console, smart TV or any other devices. It also includes accessing through any type of connection for example ADSL, fibre, cable, wireless, satellite and mobile broadband (3G/4G).

Definitions

‘ALL HEART-RELATED’ HOSPITALISATION

In the Australian Heart Maps ‘All heart-related’ hospitalisations represents the total number of hospitalisations for all the heart-related diagnostic groups: STEMI, NSTEMI, Unstable Angina and Heart Failure. It includes the following ICD codes: I214 I219 I210 I211 I212 I213 I220 I221 I228 I229 I200 I500 I501 I509 I420 I421 I422 I423 I424 I425 I426 I427 I428 I429 I430 I431 I432 I438 I110 I130 I132.

HEART ATTACK

In the Australian Heart Maps ‘Heart Attack’ represents the total number of hospitalisations for STEMI AND NSTEMI (see below) and includes the following ICD codes: I214 I219 I210 I211 I212 I213 I220 I221 I228 I229.

STEMI

STEMI (ST segment elevation myocardial infarction) is a severe form of heart attack caused by a significant or complete blockage of a coronary artery that supplies blood to the heart and results in full-thickness damage to the heart muscle.  STEMI in the Australian Heart Maps includes the following ICD codes: I210 I211 I212 I213 I220 I221 I228 I229.

NSTEMI

NSTEMI (Non-ST segment elevation myocardial infarction) is a less severe form of heart attack caused by a partial blockage of a coronary artery supplying the heart and results in less damage to the heart muscle.  NSTEMI in the Australian Heart Maps includes the following ICD codes: I214 and I219.

UNSTABLE ANGINA

Angina is temporary chest pain or discomfort that happens when your heart muscle can’t get enough oxygen due to poor blood supply. In most cases, the lack of blood flow is due to a narrowing of the coronary arteries. Angina is a symptom of an underlying heart disease. Unstable Angina in the Australian Heart Maps includes the following ICD code: I200.

HEART FAILURE

Heart failure happens when your heart muscle gets damaged, then becomes weak and doesn’t pump properly. Once the heart is damaged, it can’t heal. The damage can be caused by a heart attack, or long-term health problems like high blood pressure, diabetes or heart disease.  It can also be caused by cardiomyopathy, a disease of the heart muscle. Heart Failure in the Australian Heart Maps includes the following ICD codes: I500 I501 I509 I420 I421 I422 I423 I424 I425 I426 I427 I428 I429 I430 I431 I432 I438 I110 I130 I132.

CORONARY HEART DISEASE

Coronary heart disease (CHD), previously called ischemic heart disease, is when coronary arteries get narrower and reduce the blood flow to the heart. It is the usual underlying cause of a heart attack. Cardiovascular disease (CVD) is the broader term that refers to all diseases and conditions involving the heart and blood vessels: coronary heart disease, stroke, cardiomyopathy/heart failure. The CHD mortality data presented in the Australian Heart Maps include deaths coded as I20-I25 (according to the International Classification of Diseases and Related Health Problems (ICD-10).

ASR

The Age-Standardised Rate (per 10,000 for hospital admissions; 100,000 for mortality and 100 for risk factors). Unless otherwise stated, ASR is used when describing the data. ASR for admissions is age adjusted at the national level using the direct method with the Australian Estimated Resident Population on 30 June 2012 (ERP2012) as the standard.

No

The estimated number of people (aged 18 years and over) for the relevant heart health indicator.

Region

A ‘regions’ is defined here based on the Australian Statistical Geography Standard (ASGS) according to Statistical Area Level 3 (for the ACT) and Statistical Area Level 4 (for all other states and Territories). In the Australian Heart Maps there are 86 Statistical Areas Level 4 (SA4) and 10 Statistical Areas Level 3 (SA3) regions in the ACT (a total of 96 ‘regions’). The lowest national ranking for Regions is 96 (hospitalisations), 47 (Indigenous hospitalisations), 94 (CHD Mortality), 92 (Risk factors). The lowest naional ranking across all LGAs nationally is 521 (heart related admissions); 423 (risk factors); and 495 (CHD mortality).

HYPERTENSION

Data for hypertension is modelled from those in the 2014-15 National Health Survey whose blood pressure measured systolic Blood Pressure (BP) of 140 mmHg or more, or diastolic BP of 90 mmHg or more, irrespective of the use of BP medication. It is an estimate of un-managed hypertension, not prevalence per se.

INSUFFICIENT EXERCISE

Data for Insufficient Exercise is modelled from the estimated number of people aged 18 years and over who undertook no or low exercise in the week previous to the National Nealth Survey (2014-15). Exercise level was calculated as ‘Duration of exercise (minutes) x Intensity factor (walking for fitness = 3.5, moderate = 5, vigorous = 7.5): low exercise refers to scores of less than 800.

SMOKING

Smoking rates are estimated from the 2014-15 National Health Survey respondents who who reported that they smoked manufactured (packet) cigarettes, roll-your-own cigarettes, cigars, and/or pipes at least once per week. It excludes chewing tobacco and smoking of non-tobacco products.

OBESITY

Obesity is defined as BMI>30 and the rates here are modelled from the adults in the 2014-15 NHS sample who had their height and weight measured in the National Health Survey.

HIGH CHOLESTEROL

Data for high cholesterol is modelled from the non-fasting blood cholesterol measured level ≥ 5.5 mmol/L (as collected from blood samples in the 2011-12 National Health Survey).

BLANK CELLS OR #

Where cells are blank or #, no data is available.

The Heart Foundation would like to acknowledge the following organisations:

• The Australian Institute of Health and Welfare (AIHW): in seeking clearance from the State/Territory Data custodians and for undertaking the preliminary data analysis.

• The Australian Institute of Health and Welfare (AIHW); for making the mortality data so accessible and for their collaborative approach to using the MORT data.

• State/Territory Health departments: for ongoing feedback relating to the project.

• Professor John Glover and his team at the Public Health Information Development Unit (Torrens University, SA) for their collaborative support and for making their risk factor data freely accessible.

• Statistical Consultant and Epidemiologist, Steve Vander Hoorn: for undertaking comprehensive statistical analysis and for developing the online mapping tool.

• The individuals and organisations who kindly participated in user-testing and provided valuable feedback on design and functionality. 

Victorian Heart Maps

The Victorian Heart Maps have a state-based focus whereas the Australian Heart Maps have a broader national focus, comparing rates to a national average.

The Victorian Heart Maps present 8 years of hospital separations for selected cardiac conditions by Local Government Area (LGA) and State Electoral Division (SED), and also out-of-hospital cardiac arrest by LGA.  The maps also show risk factors and selected socio-demographic data by LGA. 

The data can also be viewed by the LGAs within a Primary Health Network (PHN), or by the SEDs within an Electoral Region. Rates in the Victorian Maps cannot be compared to rates in the Australian Heart Maps because they use data from different years. The Victorian maps have counted patients who have been transferred from another hospital as an episode, whereas they have been excluded in the Australian Heart Maps. 

Data Sources

The Victorian Heart Maps include the following sources of data:

• Hospital separation data was provided by the Victorian Department of Health and Human Services for heart attack, heart failure and unstable angina for all ages from 2007-08 to 2014-15. Data is linked to the local government area where the patient lived, not the local government area where hospital treatment was provided.

• Ambulance Victoria’s out-of-hospital cardiac arrest data, which comes from the Victorian Ambulance Cardiac Arrest Register. Data is for all ages from 2007-08 to 2014-15 and was restricted to cases where it is presumed that a cardiac or respiratory condition precipitated the cardiac arrest. Data is linked to the local government area where the patient lived.

• Victorian Department of Health and Human Services’ 2014 Victorian Population Health Survey, which measured lifestyle risk factors by local government area.

• Australian Bureau of Statistics’ Census data, including population size and persons over 60 years of age, and a measure of socioeconomic disadvantage, the Socioeconomic Index for Areas (SEIFA).

The Heart Foundation would like to thank the following organisations and people who worked with us to develop the maps:

• The Victorian Department of Health and Human Services’ Cardiac Clinical Network for funding part of the project, and providing hospital separation and risk factor data.

• Ambulance Victoria who provided out-of-hospital cardiac arrest data, which comes from the Victorian Ambulance Cardiac Arrest Registry.

• Stephen Vander Hoorn for undertaking the statistical analysis of the data and for developing the online mapping tool

We encourage the use of the Australian Heart Maps, but you must acknowledge the National Heart Foundation as the copyright holder. Please use the follow permission statement:

Reproduced with permission from the National Heart Foundation of Australia website, Australian Heart Maps. ©2016 National Heart Foundation of Australia.  

No permission is required to share links to the Australian Heart Maps on websites or social media. If you want to adapt the Australian Heart Maps in any way, please contact copyright@heartfoundation.org.au to seek permission before publishing your adaptation.

Hospital Admission Data

Please note that the National Heart Foundation has undertaken secondary analysis of Hospital Admission data obtained from the Australian Institute of Health and Welfare. The analysed data represented in the Australian Heart Maps is the property of the National Heart Foundation.  If you are citing the Australian Heart Maps or the hospital admission rates and rankings that appears in them, please reference the National Heart Foundation using the following citation:

National Heart Foundation of Australia. Australian Heart Maps [Internet]. 2016 [Cited date]. Available at [insert URL].

Mortality Data

Australian Institute of Health and Welfare (AIHW) Mortality Over Regions and Time (MORT) books 2012-2016

Risk factor Data

The population risk factor data have been sourced from the Public Health Information Development Unit (PHIDU) at Torrens university and should be cited as follows:

Obesity, smoking, hypertension and insufficient exercise rates should be cited as:

Public Health Information Development Unit (PHIDU). Social Health Atlas Australian atlas: Local Government Areas. Health risk factors - adults (modelled estimates). Adelaide: PHIDU, Torrens University; 2014-5. At:  http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlases-of-australia-local-government-areas  (accessed July 2018).

High cholesterol should be cited as:

Public Health Information Development Unit (PHIDU). Social Health Atlas Australian atlas: Local Government Areas. Health risk factors - adults (modelled estimates). Adelaide: PHIDU, Torrens University; 2011-2. At:  http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlases-of-australia-local-government-areas  (accessed July 2018).

Risk factors for Aboriginal and Torres Strait Islander Peoples should be cited as:

Australian Bureau of Statistics (ABS) 4727.0 ABS Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13

Demographic Data

Population data and Socioeconomic Index for Areas (SEIFA) data was sourced from the Australian Bureau of Statistics (ABS) and should be cited as:

Australian Bureau of Statistics (ABS) 1410.0 - Data by Region, 2011-16 Population and People ASGC 2011-2016

Australian Bureau of Statistics (ABS) 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016

The Victorian Heart Maps have a state-based focus whereas the Australian Heart Maps have a broader national focus, comparing rates to a national average.

The Victorian Heart Maps present 8 years of hospital separations for selected cardiac conditions by Local Government Area (LGA) and State Electoral Division (SED), and also out-of-hospital cardiac arrest by LGA.  The maps also show risk factors and selected socio-demographic data by LGA. 

The data can also be viewed by the LGAs within a Primary Health Network (PHN), or by the SEDs within an Electoral Region. Rates in the Victorian Maps cannot be compared to rates in the Australian Heart Maps because they use data from different years. The Victorian maps have counted patients who have been transferred from another hospital as an episode, whereas they have been excluded in the Australian Heart Maps. 

Data Sources

The Victorian Heart Maps include the following sources of data:

• Hospital separation data was provided by the Victorian Department of Health and Human Services for heart attack, heart failure and unstable angina for all ages from 2007-08 to 2014-15. Data is linked to the local government area where the patient lived, not the local government area where hospital treatment was provided.
• Ambulance Victoria’s out-of-hospital cardiac arrest data, which comes from the Victorian Ambulance Cardiac Arrest Register. Data is for all ages from 2007-08 to 2014-15 and was restricted to cases where it is presumed that a cardiac or respiratory condition precipitated the cardiac arrest. Data is linked to the local government area where the patient lived.
• Victorian Department of Health and Human Services’ 2014 Victorian Population Health Survey, which measured lifestyle risk factors by local government area.
• Australian Bureau of Statistics’ Census data, including population size and persons over 60 years of age, and a measure of socioeconomic disadvantage, the Socioeconomic Index for Areas (SEIFA).

Acknowledgments 

The Heart Foundation would like to thank the following organisations and people who worked with us to develop the maps:

• The Victorian Department of Health and Human Services’ Cardiac Clinical Network for funding part of the project, and providing hospital separation and risk factor data.
• Ambulance Victoria who provided out-of-hospital cardiac arrest data, which comes from the Victorian Ambulance Cardiac Arrest Registry.
• Stephen Vander Hoorn for undertaking the statistical analysis of the data and for developing the online mapping tool