Technical notes

Comparison of national data sources on smoking and alcohol consumption

A number of nationally representative data sources are available to analyse recent trends in tobacco smoking and alcohol consumption. This includes the AIHW National Drug Strategy Household Survey (NDSHS) and the ABS National Health Survey (NHS) for the general population. In addition, the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) collected by the ABS are designed to obtain a representative sample of Indigenous Australians.

Differences in scope, collection methodology and design may account for variation in estimates reported and comparisons between collections should be made with caution.

For a summary of the methodological differences see XLS DownloadTable T1: Methodological differences between surveys.

National Hospital Morbidity Database

The hospital separation data included in this report were extracted from the AIHW National Hospital Morbidity Database using a selection of codes from the International statistical classification of diseases and related health problems, 10th revision, Australian modification 10th edition (ICD-10-AM) as outlined in the table below.

Relationship between the drug of concern and the ICD-10-AM codes

Drug of concern identified in principal diagnosis 

ICD-10-AM codes 

Analgesics

 
Opioids (includes heroin, opium, morphine and methadone) F11.0–11.9, T40.0–40.4, T40.6
Non-opioid analgesics (includes paracetamol)  F55.2, N14.0, T39.0–39.4, T39.8, T39.9
Sedatives & hypnotics  
Alcohol (includes ethanol) E52, F10.0–10.9, G31.2, I42.6, K29.2, K70.0–70.9, K85.2, K86.0, T51.0–51.9, Z71.4
Benzodiazepines T42.4
Other sedatives and hypnotics (includes barbiturates; excludes ethanol) F13.0–13.9, T41.2, T42.0–42.3, T42.5–42.8
Stimulants and hallucinogens   
Cannabinoids (includes cannabis) F12.0–12.9, T40.7
Hallucinogens (includes LSD) F16.0–16.9, T40.8, T40.9 
Cocaine F14.0–14.9, T40.5
Tobacco and nicotine F17.0–17.9, T65.2, Z58.7, Z71.6
Methamphetamines F15.01–15.02, F15.11–15.12, F15.21–15.22,  F15.31–15.32, F15.41–15.42, F15.51–15.52, F15.61–15.62, F15.71–15.72, F15.81–15.82, F15.91–15.92, T43.61–43.62
Other stimulants (includes other amphetamines and caffeine) F15.00, F15.09, F15.10, F15.19, F15.20, F15.29, F15.30, F15.39, F15.40, F15.49, F15.50, F15.59, F15.60, F15.69, F15.70, F15.79, F15.80, F15.89, F15.90, F15.99.  
Antidepressants and antipsychotics  
Antidepressants and antipsychotics F55.0, T43.0–43.5
Volatile solvents   
Volatile solvents F18.0–18.9, T52.0–52.9, T53.0–9, T59.0, T59.8
Other and unspecified drugs of concern   
Multiple drug use F19.0–19.9
Unspecified drug use and other drugs not elsewhere classified (includes psychotropic drugs not elsewhere classified; diuretics; laxatives; anabolic and androgenic steroids and opiate antagonists) F55.1, F55.3–6, F55.8, F55.9, K85.3, N14.1–3, T38.7, T43.8–9, T47.2–47.4, T50.1–3, T50.7, Z71.5
Fetal and perinatal related conditions  
Fetal and perinatal related conditions (includes conditions caused by the mother’s alcohol, tobacco or other drug addiction) P04.2–4, Q86.0

Note: Data for 2018–19 were reported to the NHMD using the ICD-10-AM (10th edition). Revision of ICD-10-AM (10th edition) mapping to drugs of concern were applied in 2017–18. The mapping has been applied to the time series.

References

  1. ACCD (Australian Consortium for Classification Development) 2016a. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM)—10th edn.—tabular list of diseases, and Alphabetic index of diseases. Adelaide: Independent Hospital Pricing Authority.
  2. ACCD 2016b. The Australian Classification of Health Interventions (ACHI)—10th edn.—Tabular list of interventions, and Alphabetic index of interventions. Adelaide: Independent Hospital Pricing Authority.

National Mortality Database

The Medical Certificate of Cause of Death includes all diseases, morbid conditions or injuries that either resulted in or contributed to death and the circumstances of the accident or violence that produced any such injuries.

The underlying cause of death is the disease or injury that initiated the train of morbid events (deaths are referred to as being directly attributable to the disease or injury). Associated causes of death are other causes listed on a death certificate, other than the underlying cause.

Causes of death are coded by the ABS to the International Statistical Classification of Diseases and Related Health Problems (ICD). Deaths in this report are counted according to year of registration of death, which is not necessarily the year in which the death occurred. Further, mortality data by geographical regions were derived using the place of a person’s usual residence at the time of death.

Deaths registered in 2016 and earlier are based on the final version of cause of death data; deaths registered in 2017 are based on revised data; deaths registered in 2018 and 2019 are based on preliminary data. Revised and preliminary data are subject to further revision by the ABS.

This report includes data on drug-induced deaths, alcohol-induced deaths and alcohol-related deaths.

Drug-induced deaths

Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports. The underlying causes of deaths align with the definition of drug-induced deaths used by the ABS reporting on drug-induced deaths as defined in 3303.0 - Causes of Death, Australia. Deaths solely attributable to alcohol and tobacco are excluded. Drug-induced deaths are classified according to their intent—accidental, intentional (including assault and suicide) or undetermined intent. They include deaths from illicit drugs (for example, heroin, amphetamines and cocaine) and licit drugs (for example, benzodiazepines and anti-depressants).

Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Also excluded are newborn deaths associated with mother’s drug use.

The drug-induced deaths data included in this report were extracted from the AIHW NMD using the codes outlined in the table below.

List of ICD-10 codes used for each drug type

Drug type

ICD-10 codes

 

Heroin

T40.1

 

Natural and semi-synthetic opioids

T40.2

e.g. Oxycodone, Codeine, Morphine

Methadone

T40.3

 

Synthetic opioids

T40.4

eg. Fentanyl, Tramadol, Pethidine

All opioids

T40.0, T40.1, T40.2, T40.3, T40.4, T40.6

 

All opioids excluding heroin

T40.0, T40.2, T40.3, T40.4, T40.6

 

Cocaine

T40.5

 

Cannabinoids

T40.7

 

Benzodiazepines

T42.4

 

All depressants

T42.0–T42.8

 

All psychostimulants

T43.6

 

All antidepressants

T43.0, T43.1, T43.2

 

All antipsychotics

T43.3, T43.4, T43.5

 

Paracetamol

T39.1

 

Ibuprofen and aspirin

T39.3

 

All non-opioid analgesics

T39.0–T39.9

 

Alcohol

T51.0, T51.1, T51.2, T51.3, T51.8, T51.9

 

Note: The underlying causes of deaths align with the definition of drug-induced deaths used by the ABS reporting on drug-induced deaths as defined in 3303.0 - Causes of Death, Australia. This classification excludes deaths solely attributable to alcohol and tobacco.

Deaths from external causes are assessed to determine intent. This may also determine how a death is investigated and influence the type of information that can be included on the death record (ABS 2020).

List of ICD-10 codes used for intent
Intent ICD-10 codes
Accidents X40–X44
Intentional (suicide and assault) X60–X64
Undetermined intent

Y10–Y14

List of ICD-10 codes for the top 10 psychosocial risk factors identified
Psychosocial risk factor ICD-10 codes
Personal history of self-harm Z915
Disruption of family by separation and divorce Z635
Disappearance and death of family member Z634
Problems in relationship with spouse or partner Z630
Problems related to other legal circumstances Z653
Release from prison Z652
Limitation of activities due to disability Z736
Other problems related to housing and economic circumstances Z598
Unemployment, unspecified Z560
Family history of other mental and behavioural disorders Z818
List of ICD-10 codes for the top 10 associated causes identified
Associated cause of death ICD-10 codes
Injuries to multiple body regions, crushing, asphyxiation, poisoning by drugs, other T00–T98
Mental and behavioural disorders due to psychoactive substance use F10–F19
Mood (affective) disorders F30–F39
Factors influencing health status and contact with health services Z00–Z99
Other ill-defined causes R00–R94, R96–R99, I46.9, I95.9, I99, J96.0, J96.9, P28.5
Neurotic, stress-related and somatoform disorders F40–F48
Coronary heart disease I20–I25
Accidental poisoning X40–X49
Diseases of the musculoskeletal system and connective tissue M00–M99
Viral hepatitis excl. vaccine-preventable diseases B15–B19 excl. B15, B16, B17.0, B18.0, B18.1, B18.9, B19

Alcohol-induced deaths

Alcohol-induced deaths are defined as deaths that can be directly attributable to alcohol use, as determined by toxicology and pathology reports. The underlying causes of deaths align with the definition of alcohol-induced deaths used by the ABS as defined in 3303.0 - Causes of Death, Australia.

Alcohol-induced causes exclude accidents, homicides, and other causes indirectly related to alcohol use. This category also excludes newborn deaths associated with maternal alcohol use.

Alcohol-induced deaths may be due to a chronic condition which is directly related to alcohol use (e.g. alcoholic liver cirrhosis) or from an acute condition directly related to harmful consumption (e.g. alcohol poisoning which led to respiratory depression).

Alcohol-related deaths

Alcohol-related deaths include deaths directly attributable to alcohol use and deaths where alcohol was listed as an associated cause of death (e.g. a death due to a motor vehicle accident where a person recorded a high blood alcohol concentration).

Pharmaceutical Benefits Scheme (PBS) data collection

The medications reported from PBS data are classified based on the ATC (Anatomical Therapeutic Chemical) classification system, defined by the World Health Organisation Collaborating Centre for Drug Statistics Methodology.

Data contained in this report include prescriptions for the following patient entitlements:

  • General
  • Extemporaneous
  • Dental
  • Palliative care
  • Repatriation

Medicines dispensed under prescriber bag orders were removed from the dataset prior to analysis.

Drugs selected for this report were chosen using the following ATC codes:

Drug ATC codes
Opioids

ATC3 = N02A (Opioids)

ATC5 = R05DA04 (Codeine as a cough suppressant, excluding combinations with expectorants)
Benzodiazepines

ATC4 = N05BA (Benzodiazepine derivatives as anxiolytics)

ATC4 = N05CD (Benzodiazepine derivatives as hypnotics and sedatives)

ATC4 = N03AE (Benzodiazepine derivatives as antiepileptics)

Primary Health Networks

This release includes the following indicator by Primary Health Network (PHN):

Lifetime risky alcohol consumption

New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. Data for alcohol risk in this report are measured against the 2009 guidelines. NDSHS data relating to the updated guidelines are available here.

  • Percentage of adults who consume more than 2 standard drinks per day on average.

Lifetime risky alcohol consumption was determined if alcohol consumption exceeded the 2009 guidelines for reducing health risks associated with alcohol consumption (NHMRC 2009).

The guidelines recommend that healthy men and women drink no more than 2 standard drinks of alcohol per day on average, to reduce their lifetime risk of harm from alcohol-related disease or injury.

Daily smokers

  • Percentage of adults who are daily smokers.

Participants in the ABS NHS 2017–18 were asked whether they currently smoked at least once per day. A current daily smoker was defined as a person who smokes one or more cigarettes, roll-your-own cigarettes, cigars or pipes at least once a day. Chewing tobacco, electronic cigarettes (and similar) and the smoking of non-tobacco products were excluded.

About the data

Primary Health Networks (PHNs) are local organisations that connect health services across a specific geographic area, with the boundaries defined by the Australian Government Department of Health.

The quality of estimates from the NHS can vary across PHN areas, as the survey was not specifically designed to produce estimates at this level of geography.

As an indication of the accuracy of proportions, 95% confidence intervals were produced. These were calculated by the ABS using relative standard error (RSE) estimates of the proportion.

To ensure robust reporting of these data by PHN areas, suppression or interpret with caution rules were developed and applied by the Australian Institute of Health and Welfare.

Estimates of a percentage or its complement that had a relative standard error greater than 50% were suppressed. These estimates were considered unreliable for most practical purposes.

Data for PHN areas were suppressed if there was the likelihood of a non-representative sample, that is, where the survey sample count in the PHN area was less than 20% of the expected number of adults.

The ‘interpret with caution’ flag was applied to the data if the relative standard error associated with the percentage or its complement was greater than 25%. This indicates the proportion derived is subject to high sampling error and should be used with caution.

Data for Northern Territory should be interpreted with caution as the NHS excluded discrete Aboriginal and Torres Strait Islander communities and Very remote areas, which comprise around 28% of the estimated resident population of the Northern Territory.