Non-melanoma skin cancer
General practice consultations, hospitalisation 
and mortality

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Non-melanoma skin cancer
General practice consultations, hospitalisation 
and mortality
Australian Institute of Health and Welfare
and
Cancer Australia
September 2008

© Australian Institute of Health and Welfare 2008 
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ISSN 1039-3307
ISBN 978 1 74024 837 2

Suggested citation 
Australian Institute of Health and Welfare & Cancer Australia 2008. Non-melanoma skin cancer: general practice consultations, hospitalisation and mortality. Cancer series no. 43. Cat. no. 39. Canberra: AIHW.

Australian Institute of Health and Welfare 
Board Chair
Hon. Peter Collins, AM, QC

Director 
Penny Allbon

Any enquiries about or comments on this publication should be directed to:
Melissa Goodwin
Australian Institute of Health and Welfare
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Phone: (02) 6244 1000
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Contents
Acknowledgments
Abbreviations
Summary
1	Introduction
2	General practice patient encounters
3	Hospital inpatient admissions
4	Mortality
5	Conclusions
Appendix: Methodology
References
List of tables
List of figures

Acknowledgments
This report was produced by Melissa Goodwin, Jane Zhou, Shubhada Shukla, David Meere, Chun Chen and John Harding of the Health Registers and Cancer Monitoring Unit of the Australian Institute of Health and Welfare (AIHW). The report has been funded by Cancer Australia as part of Cancer Australia’s National Cancer Data Strategy to support research and planning to reduce the impact of cancer in Australia. Professor David Roder of Cancer Australia provided technical advice to the project.
Thanks are extended to Professor Helena Britt of the Australian General Practice Statistics and Classification Centre at Sydney University, Robert Van der Hoek of the AIHW Population Health Unit and Mr George Bodilsen of the AIHW Hospitals Unit for their comments in reviewing the report.
Abbreviations
ABS		Australian Bureau of Statistics
AIHW		Australian Institute of Health and Welfare
ASGC		Australian Standard Geographical Classification
ASR (A)	age-standardised rate (Australia)
ASR (W)	age-standardised rate (World)
BCC		basal cell carcinoma(s)
BEACH	Bettering the Evaluation and Care of Health
CI		confidence interval
DALY		disability adjusted life years
GP		general practitioner
IRSD	Index of Relative Socioeconomic Disadvantage
NMSC		non-melanoma skin cancer(s)
SACC		Standard Australian Classification of Countries
SCC		squamous cell carcinoma(s)
SEIFA		Socio-Economic Indexes for Areas

Symbols
. .	not applicable
Summary
Non-melanoma skin cancer (NMSC) is by far the most common cancer diagnosed in Australia but, unlike other invasive cancers, is not reportable by law to cancer registries. As a result, incidence and prevalence statistics are not routinely available. 
This report by the Australian Institute of Health and Welfare (AIHW) and Cancer Australia is intended to fill some of the gaps in data availability for NMSC by analysing the impact of these cancers on general practitioner (GP) workload, hospital inpatient admissions and mortality. 
GP–patient encounters are tabulated by age and sex, and over time. Hospital inpatient admissions and mortality are examined by sex, age, country of birth, remoteness of residential area and socioeconomic status.
Key findings
•	It is projected that in 2008 around 434,000 persons (253,000 males, 180,000 females) will be diagnosed with one or more NMSC in Australia.
•	In 2006, 410 persons (276 males, 134 females) died from NMSC in Australia (ABS, 2008).
GP–patient encounters
•	GP encounters for NMSC increased by 14% from an estimated 836,500 per year between April 1998 and March 2000 to an estimated 950,000 per year between April 2005 and March 2007.
•	The proportion of GP encounters for males between April 2002 and March 2007 relating to NMSC was almost twice that of females. This was consistent for the two most common NMSC types—basal cell carcinomas (0.7% of all GP encounters for males, 0.4% for females) and squamous cell carcinomas (0.4% of all GP encounters for males, 0.2% for females).
Hospital inpatient admissions
•	Inpatient separations where the principal diagnosis was NMSC more than doubled between 1993–94 and 2006–07, from 35,833 to 79,792. This represents a 60% increase in separations from 224 to 359 per 100,000. The increase for females (68%) was much greater than the increase for males (53%).
•	In 2006–07 males accounted for 47,247 separations (471 per 100,000) compared with 32,545 (272 per 100,000) for females. 
•	Hospitalisation was significantly higher for Australian-born patients than for overseas-born patients, for people living in Inner Regional areas than for those in other areas, and for people living in high socioeconomic status areas than for those living in low socioeconomic areas.
Mortality
•	Mortality from NMSC was fairly stable from 1998 to 2005 with an average of 382 deaths per year (approximately 3 per 100,000 for males and 1 per 100,000 for females).
•	During 2002–2005, 83% of NMSC deaths were Australian-born people, and 9% were people born in the United Kingdom and Ireland.
•	NMSC mortality rates were significantly higher in Outer Regional areas and significantly lower in the most socioeconomically advantaged areas. 

1	Introduction
The three main types of skin cancer occurring in Australia are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma (Staples et al. 2006; FitzGerald et al. 2006). Other rare types of cancer occasionally affecting the skin include Merkel cell lesions, Kaposi sarcoma and cutaneous lymphoma. 
Data are provided in this report on non-melanoma skin cancer (NMSC). Melanoma is not covered because data on this cancer are widely available through annual reporting of the Australian Institute of Health and Welfare (AIHW) and the Australasian Association of Cancer Registries. 
Although NMSC accounts for just over 1% only of cancer deaths in Australia (AIHW 2007), it is a major public health problem because of the burden its high incidence imposes on the population and health system. Approximately two-thirds of Australians will experience at least one NMSC during their lifetime before the age of 70 years (NCCI 2003; Staples et al. 2006). Approximately five NMSC are diagnosed annually for every one invasive cancer of any other type. 
Population surveys between 1985 and 2002 indicated an increase in NMSC incidence of over 50%, largely because of increases among people over 60 years of age (Staples et al. 2006; Staples et al. 1998; Marks et al. 1993; Giles et al. 1988). Larger percentage increases applied for the more serious SCC than BCC types. Incidence increases recorded since 1985 are likely to be augmented by increased NMSC detection following an increase in numbers of general-practice skin clinics (Askew et al. 2007).      
Although most NMSC is treated in medical practices without hospitalisation, these cancers still account for more hospital admissions than any other cancer type, including breast, large bowel and prostate cancer (AIHW 2007). It is clear from hospital data, and the extent of treatment in community settings, that the impact of NMSC on health-service resource use is large. These cancers can also cause cosmetic ill-effects, including facial disfigurement, which can negatively affect quality of life.        
BCC accounts for at least two-thirds of NMSC in Australia, with most other NMSC comprising SCC (Staples et al. 2006). BCC rarely metastasises to other organs, but it can be highly invasive and cause significant destruction of local tissue. SCC is also invasive and has a greater potential than BCC to metastasise to other parts of the body. Most SCC are thought to follow solar keratoses resulting from excess sun exposure (Marks et al. 1988).      
The strongest NMSC risk factor is exposure to ultraviolet radiation, particularly during childhood and adolescence (Elwood 2004). Most NMSC is attributed to excess sun exposure, such that lesions often occur on sun-exposed areas of the face, ears, neck, scalp, shoulders, back and hands (Staples et al. 2006). Other risk factors include a personal or family history of NMSC or melanoma, the presence of a large numbers of freckles or moles, or having a fair complexion (Elwood 2004; Armstrong & Kricker 2001). Skin types that are prone to burn rather than tan when exposed to the sun are more susceptible. In addition, people immunosuppressed because of organ transplant or from other causes are at increased risk.
NMSC is by far the most common type of cancer in Australia, but it is generally not recorded by cancer registries. Although Tasmania is an exception in registering NMSC (FitzGerald et al. 2006), it is thought to have a comparatively low incidence by Australian standards and has not been used to indicate the national experience (Staples et al. 2006). Instead, national incidence rates have been estimated from medically verified self-reporting in population surveys. The last survey for this purpose was conducted in 2002 (Staples et al. 2006). 
This report by the AIHW and Cancer Australia provides estimates of current NMSC incidence, based on results of the 2002 survey and subsequent population change. It also provides information on the contribution of NMSC to general practitioner (GP) visits, hospital inpatient admissions and mortality. To the extent possible, results have been presented by sociodemographic characteristics of affected people, although the detail provided has depended on the detail available in the source data. Although incidence and GP data were available for SCC and BCC separately, it was not possible to obtain corresponding population-based data for these cancer types from the hospital admission and mortality data sets.  
It is recognised that sociodemographic patterns of health-service use and death from NMSC are affected by many factors apart from incidence. These patterns are provided to show which sectors of the population contribute most to the impact of NMSC on the health system and death rates, rather than to infer underlying incidence patterns, which should be the subject of further investigation.
Overview of the burden of NMSC
•	Over 370,000 Australians are estimated to have been diagnosed and treated for NMSC in 2002 (Table 1.2). This is a vastly higher number than for other common cancers in the same year (12,114 for prostate cases, 12,059 for female breast cancer cases, 9,791 for cutaneous melanoma cases, and 12,483 for colorectal cancer cases).
•	It is estimated from age-specific NMSC incidence rates in 2002, and subsequent population change, that over 430,000 Australians will be diagnosed and treated for NMSC in 2008 (tables 1.1 and 1.3). The estimates may be conservative, given the increase in the number of GP skin clinics (Askew et al. 2007). 
•	In 2002, 415 persons (278 males, 137 females) died from NMSC. In 2006, there were 410 deaths (276 males, 134 females) (ABS 2008). Males had much higher death rates from NMSC than females. 
•	The age-standardised incidence for all NMSC was estimated to be 53% higher in males than females in 2002. This difference was more pronounced for SCC with incidence being 75% higher in males than females compared with 44% higher for BCC (Table 1.1).
•	NMSC incidence increased sharply with age in 2002, such that the incidence rate in people aged 70 years and over was estimated to be 193 times higher than for 20–24 year olds. This difference was more pronounced for SCC than BCC (Table 1.1).  
•	NMSC age-standardised incidence also was higher in people born in Australia than those born overseas and in the more northern residential latitudes (Staples et al. 2006).  
•	Because of its high incidence, NMSC imposed the highest health-system expenditure of any cancer in Australia during 2000–01 at an estimated $264 million. The second leading cancer in expenditure terms was breast cancer at $241 million. The high expenditure for NMSC reflected its high incidence, not the cost per affected person, with NMSC imposing the lowest cost per capita of any cancer type (approximately $700/case) (AIHW 2005).  
•	Cancer imposed the highest DALY burden of any disease category in 2003 (DALY refers to disability-adjusted life years, calculated from estimating the number of years of healthy life lost through premature death or lived with a disability due to illness or injury). The estimated NMSC DALY burden of 4,734 life years in 2003 was similar to DALY estimates for liver, cervical and uterine cancers (Begg et al. 2007).
Table 1.1: Estimated age-specific incidence rates of basal and squamous cell carcinomas of the skin: Australia, 2002
	Basal cell carcinoma		Squamous cell carcinoma		Total	
Age (years)	Males	Females	Persons		Males	Females	Persons		Males	Females	Persons	
0–19	0	0	0		0	0	0		0	0	0	
20–24	89	0	43		0	0	0		89	0	43	
25–29	83	141	114		0	0	0		83	141	114	
30–34	150	231	195		0	0	0		150	231	195	
35–39	491	742	629		0	57	31		491	800	661	
40–44	688	1,058	893		482	223	339		1,170	1,281	1,231	
45–49	1,493	1,602	1,553		597	431	506		2,090	2,033	2,059	
50–54	1,987	2,113	2,055		1,104	808	943		3,090	2,921	2,999	
55–59	3,293	2,014	2,602		1,857	647	1,204		5,150	2,661	3,806	
60–64	5,496	2,224	3,780		1,963	979	1,447		7,458	3,203	5,226	
65–69	4,165	2,849	3,486		2,251	1,900	2,070		6,416	4,749	5,556	
70+	7,051	3,880	5,308		3,979	2,146	2,972		11,030	6,027	8,280	
ASR (A)	1,538	1,068	1,286		771	441	592		2,309	1,510	1,878	
ASR (W)	1,151	825	977		561	323	432		1,712	1,148	1,409	
Notes
1.	ASR (A) refers to age-standardised rate standardised to the 2001 Australian Standard Population.
2.	ASR (W) refers to age-standardised rate standardised to the 2000 WHO World Population.
3.	Rates are expressed per 100,000 population.
4.	Estimates are based on the 2002 survey.
Source: NCCI 2003.

Table 1.2: Estimated number of new cases of basal and squamous cell carcinomas of the skin: Australia, 2002
	Basal cell carcinoma		Squamous cell carcinoma		Total	
Age (years)	Males	Females	Persons		Males	Females	Persons		Males	Females	Persons	
0–19	0	0	0		0	0	0		0	0	0	
20–24	601	0	601		0	0	0		601	0	601	
25–29	571	974	1,545		0	0	0		571	974	1,545	
30–34	1,115	1,748	2,862		0	0	0		1,115	1,748	2,862	
35–39	3,602	5,519	9,121		0	425	425		3,602	5,944	9,546	
40–44	5,169	8,053	13,222		3,618	1,695	5,314		8,788	9,749	18,536	
45–49	10,250	11,129	21,379		4,100	2,996	7,096		14,350	14,125	28,475	
50–54	12,911	13,705	26,616		7,173	5,240	12,413		20,083	18,945	39,028	
55–59	18,113	10,792	28,905		10,218	3,469	13,687		28,331	14,261	42,592	
60–64	23,419	9,323	32,743		8,364	4,102	12,466		31,783	13,426	45,209	
65–69	14,326	10,104	24,430		7,744	6,736	14,480		22,070	16,840	38,910	
70+	53,472	39,818	93,290		30,174	22,027	52,201		83,646	61,845	145,491	
Total	143,550	111,166	254,715		71,390	46,691	118,081		214,940	157,856	372,796	
Note: Estimates are based on the 2002 survey. Minor differences in totals and subtotals are due to rounding.	
Source: NCCI 2003.
Table 1.3: Estimated number of new cases of basal and squamous cell carcinomas of the skin: Australia, 2008
	Basal cell carcinoma		Squamous cell carcinoma		Total	
Age (years)	Males	Females	Persons		Males	Females	Persons		Males	Females	Persons	
0–19	0	0	0		0	0	0		0	0	0	
20–24	649	0	649		0	0	0		649	0	649	
25–29	608	1,032	1,640		0	0	0		608	1,032	1,640	
30–34	1,079	1,679	2,758		0	0	0		1,079	1,679	2,758	
35–39	3,857	5,944	9,801		0	457	457		3,857	6,401	10,258	
40–44	5,164	7,999	13,163		3,615	1,684	5,299		8,778	9,683	18,461	
45–49	11,507	12,464	23,971		4,603	3,356	7,958		16,110	15,819	31,929	
50–54	13,811	14,965	28,776		7,673	5,722	13,395		21,483	20,688	42,171	
55–59	21,331	13,235	34,566		12,033	4,254	16,287		33,363	17,489	50,852	
60–64	31,430	12,626	44,056		11,225	5,555	16,780		42,655	18,181	60,837	
65–69	17,545	12,054	29,598		9,484	8,036	17,519		27,029	20,089	47,118	
70+	62,502	44,532	107,034		35,269	24,635	59,904		97,771	69,167	166,938	
Total	169,483	126,530	296,013		83,901	53,699	137,600		253,384	180,229	433,613	
Note: Estimates are calculated using the age-specific rates obtained from the 2002 survey and the estimated resident population for 2008. Minor differences in totals and subtotals are due to rounding.
Source: NCCI 2003.

2	General practice patient encounters
Introduction
NMSC is largely treated in community settings where national data are not routinely collected. Clinical treatment occurs both in GP and specialist surgical practices. It is possible with the data available from the continuous national study of general practice in Australia known as the BEACH program (Bettering the Evaluation and Care of Health) to estimate the scale of this treatment in the GP sector.
The BEACH program has been running since April 1998. It collects data on the characteristics of patients attending general practices, the health problems managed in these settings, and the management practices used. Data are not available by socioeconomic status or geographic region, but numbers of encounters can be analysed by NMSC type, age and sex of patient, and period of attendance.   
About 1,000 randomly selected GPs provide details of approximately 100,000 GP–patient encounters annually as part of the BEACH program. The program is administered by the General Practice Statistic and Classification Unit (an AIHW collaborating unit within the Family Medicine Research Centre, University of Sydney). 
In this chapter, national age and sex distributions of patients attending GPs with NMSC between April 2002 and March 2007 are estimated from the BEACH data and Medicare Claims information (see Appendix: Methodology).
Problems managed through GP encounters have been classified using the International classification of primary care—version 2 (ICPC-2), a product of the World Organization of Family Doctors. The ICPC-2 code for NMSC is shown in the Appendix, Table A.1.
Trends
•	The estimated annual number of general practice encounters for NMSC increased by 14% from 836,500 during the period from April 1998 to March 2000 to 950,000 encounters during April 2005 to March 2007 (Table 2.1).
•	The annual rate of GP encounters for NMSC also increased over this period, from an estimated 0.8 per 100 GP encounters during the period from April 1998 to March 2000 to 1.0 per 100 GP encounters from April 2005 to March 2007.
•	BCC accounted for 60% of GP encounters for NMSC compared with 30% for SCC. Other or unspecified NMSC type accounted for the remaining 10% of NMSC-related GP encounters.
Age group and sex
•	BCC accounted for approximately 0.6% of all GP–patient encounters, with a higher proportion applying to males (0.7%) than females (0.4%) (Table 2.2). 
•	In comparison, SCC accounted for about 0.3% of all GP–patient encounters, with a higher proportion applying to males (0.4%) than females (0.2%) (Table 2.2). 
•	BCC and SCC encounter rates increased with age, for both males and females, with the highest rates experienced by those aged 80 years and over (Table 2.2). This was more pronounced for SCC than BCC, as seen in the incidence data (Table 1.1).
Table 2.1: Estimated number of NMSC-related GP encounters per year: Australia, 
April 1998–March 2007
Type of cancer	April 1998–
March 2000		April 2000–
March 2002		April 2002–
March 2004		April 2005–
March 2007		
	Number	Rate		Number	Rate		Number	Rate		Number	Rate		
Basal cell carcinoma	511,800	0.5		511,800	0.5		578,300	0.6		570,000	0.6		
Squamous cell carcinoma	262,100	0.4		262,200	0.3		312,200	0.3		285,000	0.3		
Other skin cancer	62,600	0.1		55,300	0.1		67,500	0.1		95,000	0.1		
Total	836,500	0.8		829,300	0.8		958,000	1.0		950,000	1.0		
Note: Rates are the estimated number of GP–patient encounters where the problem managed was NMSC per 100 encounters. 
Sources: BEACH database; Medicare claims benefits.

Table 2.2: NMSC-related GP encounters by age, sex and NMSC type: Australia, 
April 2002–March 2007
Age (years)	Basal cell carcinoma		Squamous cell carcinoma	
	Males	Females	Persons		Males	Females	Persons	
< 34	0.1	0.0	0.1		0.0	0.0	0.0	
35–39	0.3	0.2	0.2		0.1	0.1	0.1	
40–44	0.5	0.4	0.5		0.2	0.0	0.1	
45–49	0.7	0.5	0.6		0.2	0.1	0.2	
50–54	1.1	0.5	0.7		0.5	0.2	0.3	
55–59	1.2	0.7	0.9		0.4	0.2	0.3	
60–64	1.1	0.7	0.9		0.4	0.4	0.4	
65–69	1.1	0.7	0.8		0.7	0.4	0.5	
70–74	1.4	0.7	1.0		0.9	0.5	0.7	
75–79	1.5	0.8	1.1		0.9	0.7	0.8	
80–84	1.7	1.0	1.3		1.2	0.7	0.9	
85+	1.8	1.0	1.3		1.1	0.7	0.9	
Total	0.7	0.4	0.6		0.4	0.2	0.3	
Note: Rates are the number of GP–patient encounters where the problem managed was NMSC per 100 encounters overall. 
Source: BEACH database.
 
3	Hospital inpatient admissions
Introduction
Hospital separations comprise discharges and transfers from hospital, plus deaths in hospital and changes in hospital care type. This chapter shows trends in hospital separations of admitted patients with a principal diagnosis of NMSC from 1993–94 to 2006–07 financial years. In addition, differences in NMSC separations by age, sex, country of birth, remoteness of residence and socioeconomic status are shown for 2006–07. 
Hospital separation rates were calculated using the average of 30 June 2006 and 30 June 2007 population estimates for remoteness areas and quintiles of socioeconomic disadvantage, 
age-standardised to the Australian 2001 population. Rates were also calculated by country of birth using population estimates for 30 June 2004, age-standardised to the Australian 2001 population.
Results show the contribution made by NMSC to hospital separations both in absolute terms and as a proportion of all separations. They also show differences in separation rates for sociodemographic subgroups, after adjusting for age, indicating those sections of the population most at risk of hospital admission because of this cancer. 
Trends
•	The number of separations where the principal diagnosis was NMSC more than doubled from 35,833 in 1993–94 to 79,792 in 2006–07. The crude separation rate for NMSC increased steadily from 7.8 per 1,000 separations in 1993–94 to 10.1 in 2006–07 (Table 3.1, Figure 3.1).
•	Age-standardised separation rates increased significantly for both males and females from 224 per 100,000 in 1993–94 to 320 in 1999–2000 and 359 in 2006–07 (Table 3.2). 
•	The increase for females (68%) from 1993–94 to 2006–07 (161 to 272 per 100,000) was much greater than the increase for males (53%) in the same period (from 309 to 471 per 100,000) (Table 3.2, Figure 3.2).
Age group and sex
•	Males accounted for 47,247 NMSC separations (a crude rate of 13 per 1,000 separations) in 2006–07 compared with 32,545 (a crude rate of 8 per 1,000 separations) for females (Table 3.3). 
•	Separations with a principal diagnosis of NMSC increased with age for both males and females (Table 3.3). 
•	In 2006–07, 89% of NMSC separations occurred in people aged 50 and over, with the median age of 71 years for both males and females. Separations before the age of 30 were uncommon (Table 3.3). 
•	Age-specific separation rates for males increased from 48 per 100,000 for the 30–34 year age group to over 5,000 for those aged 85 and over. For females, there was an increase from 55 per 100,000 for the 30–34 year age group to 2,200 for those aged 85 and over (Table 3.4, Figure 3.3).
•	Separation rates for NMSC were 1.7 times higher for males than females. The age-standardised separation rate was 471 separations per 100,000 for males and 272 per 100,000 for females. The overall separation rate for NMSC was 359 per 100,000 (Table 3.4).
Country of birth
The country of birth classification used in this analysis was the Australian Bureau of Statistics (ABS) Standard Australian Classification of Countries (SACC). Countries were grouped into geographic regions as per the classification in Table A.3 of the Appendix. 
Tables 3.5 and 3.6 present the number of separations, the separation rate, the age-standardised separation rate (ASR) and the 95% confidence interval for the ASR for each country group. In 2006–2007:
•	Australian-born patients accounted for 85% of all separations for NMSC, although people born in Australia represented only 76% of the population in 2004. A further 6% of separations were for people born in the United Kingdom and Ireland (Table 3.5). This is consistent with incidence data which also have shown higher rates in the Australian-born population (Staples et al. 2006).
•	The age-standardised separation rate for NMSC for Australian-born patients (482 per 100,000 people) was significantly higher than for other countries of birth. Relatively high separation rates applied for patients born in New Zealand (318 per 100,000), United States (277), Canada (268), Sub-Saharan Africa (219) and the United Kingdom and Ireland (217) (Table 3.6). 
•	The lowest age-standardised separation rates per 100,000 persons were for people born in North-East Asia (20 per 100,000), South-East Asia (25) and the Middle East (34) (Table 3.6).
Remoteness area
The geographical classification used in this analysis was the 2006 Australian Standard Geographical Classification (ASGC). Details of remoteness classifications are outlined in Table A.4 of the Appendix.
Tables 3.7 to 3.12 present the number of separations, the separation rate and the age-standardised separation rate (ASR) with 95% confidence intervals for each remoteness area for 2006–07. As confidence intervals are wide for Remote and Very Remote locations, these figures must be interpreted with caution.
In 2006–07:
•	Age-standardised separation rates were significantly lower for Remote (269 per 100,000) and Very Remote (258 per 100,000) areas (Table 3.12, Figure 3.4).
•	For males, the age-standardised separation rates were: Major Cities (481 per 100,000 population), Inner Regional (488), Outer Regional (456), Remote (343) and Very Remote (335) (Table 3.8).
•	For females, the age-standardised separation rates were: Major Cities (271 per 100,000 population), Inner Regional (285), Outer Regional (283), Remote (202) and Very Remote (170) (Table 3.10).
Socioeconomic disadvantage
Socioeconomic status was classified in this analysis by population quintile using the ABS Index of Relative Socioeconomic Disadvantage (IRSD) from the Socio-Economic Indexes for Areas (SEIFA) 2006. Details of this index are available in the Appendix.
Tables 3.13–3.18 present for each quintile for 2006–07 the number of separations, the separation rate and the age-standardised separation rate (ASR) with 95% confidence interval.
In 2006–07: 
•	Age-standardised separation rates increased with decreasing socioeconomic disadvantage from 311 per 100,000 for persons usually resident in the 1st quintile (the most disadvantaged quintile) to 417 for persons in the 5th quintile (the least disadvantaged quintile) (Table 3.18, Figure 3.5).
•	For males the age-standardised separation rates were 404 per 100,000 for the 1st quintile (most disadvantaged), 448 for the 2nd quintile, 460 for the 3rd quintile, 498 for the 4th quintile and 557 for the 5th quintile (least disadvantaged) (Table 3.14).
•	For females the age-standardised separation rates were 236 per 100,000 for the 1st quintile (most disadvantaged), 256 for the 2nd quintile, 266 for the 3rd quintile, 282 for the 4th quintile and 314 for the 5th quintile (least disadvantaged) (Table 3.16).

Table 3.1: NMSC hospital separations by sex: Australia, 1993–94 to 2006–07
Year	Male		Female		Persons	
	Number	Rate		Number	Rate		Number	Rate	
1993–94	21,712	10.4		14,121	5.6		35,833	7.8	
1994–95	25,122	11.4		16,493	6.2		41,615	8.5	
1995–96	28,272	12.0		18,868	6.7		47,140	9.1	
1996–97	30,265	12.4		20,040	6.9		50,321	9.4	
1997–98	31,549	12.3		21,675	7.2		53,225	9.6	
1998–99	32,620	12.4		22,059	7.1		54,679	9.5	
1999–00	35,471	13.0		23,971	7.6		59,443	10.1	
2000–01	39,105	13.7		26,587	8.1		65,693	10.7	
2001–02	41,026	13.8		28,108	8.2		69,135	10.8	
2002–03	44,199	14.3		30,083	8.5		74,282	11.2	
2003–04	44,430	13.9		30,229	8.3		74,660	10.9	
2004–05	43,061	13.1		29,573	7.9		72,634	10.3	
2005–06	46,049	13.0		31,672	7.9		77,721	10.3	
2006–07	47,247	12.8		32,545	7.8		79,792	10.1	
Notes
1.	Person numbers include separations where sex not stated.
2.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 1,000 hospital separations.
 Figure 3.1: NMSC hospital separations by sex: Australia, 1993–94 to 2006–07

Table 3.2: NMSC age-standardised hospital separation rates by sex: Australia, 1993–94, 1999–00 and 2006–07
Year	Males		Females		Persons	
	ASR	95% CI		ASR	95% CI		ASR	95% CI	
1993–94	308.7	304.5–313.0		161.4	159.6–163.2		224.1	222.4–225.8	
1999–00	431.7	427.1–436.3		235.7	233.7–237.8		319.6	317.7–321.5	
2006–07	471.0	466.8–475.3		271.9	269.9–274.0		359.2	357.3–361.0	
Note: Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population, age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.
Figure 3.2: NMSC age-standardised hospital separation rates by sex: Australia, 1993–94, 1999–00 and 2006–07
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Hospital Morbidity Database.

Table 3.3: NMSC hospital separations by age and sex: Australia, 2006–07
Age (years)	Males		Females		Persons	
	Number	Rate		Number	Rate		Number	Rate	
0–4	5	0.0		4	0.0		9	0.0	
5–9	7	0.1		5	0.1		12	0.1	
10–14	8	0.1		6	0.1		14	0.1	
15–19	14	0.1		25	0.2		39	0.2	
20–24	54	0.5		46	0.2		100	0.3	
25–29	107	1.0		123	0.5		230	0.6	
30–34	354	2.8		410	1.3		764	1.7	
35–39	657	4.1		714	2.5		1,371	3.1	
40–44	1,143	6.4		1,178	5.0		2,321	5.6	
45–49	1,912	9.0		1,865	7.7		3,777	8.3	
50–54	2,916	11.8		2,383	9.1		5,299	10.4	
55–59	4,235	13.7		2,754	9.6		6,989	11.7	
60–64	5,072	15.4		2,879	10.3		7,951	13.0	
65–69	5,330	16.3		2,983	11.0		8,313	13.9	
70–74	5,829	18.1		3,349	12.1		9,178	15.3	
75–79	6,815	20.5		4,196	14.2		11,011	17.5	
80–84	7,247	28.0		4,642	18.3		11,889	23.2	
85+	5,542	33.8		4,983	21.9		10,525	26.9	
Total	47,247	12.8		32,545	7.8		79,792	10.1	
Note: Rates are the numbers of hospital separations with principal diagnosis of NMSC per 1,000 hospital separations. 
Source: AIHW National Hospital Morbidity Database.

Table 3.4: NMSC age-specific and age-standardised hospital separation rates by age and sex: Australia, 2006–07
Age (years)	Males		Females		Persons	
	Number	Rate		Number	Rate		Number	Rate	
0–4	5	0.7		4	0.6		9	0.7	
5–9	7	1.0		5	0.8		12	0.9	
10–14	8	1.1		6	0.9		14	1.0	
15–19	14	1.9		25	3.6		39	2.7	
20–24	54	7.2		46	6.3		100	6.8	
25–29	107	14.9		123	17.4		230	16.1	
30–34	354	47.9		410	55.1		764	51.5	
35–39	657	85.4		714	91.8		1,371	88.6	
40–44	1,143	150.4		1,178	153.3		2,321	151.9	
45–49	1,912	255.5		1,865	244.9		3,777	250.2	
50–54	2,916	425.8		2,383	344.7		5,299	385.1	
55–59	4,235	666.5		2,754	433.6		6,989	550.0	
60–64	5,072	985.4		2,879	563.6		7,951	775.3	
65–69	5,330	1,359.3		2,983	745.5		8,313	1,049.3	
70–74	5,829	1,902.6		3,349	1,014.6		9,178	1,442.0	
75–79	6,815	2,698.1		4,196	1,405.9		11,011	1,998.2	
80–84	7,247	4,285.8		4,642	1,927.5		11,889	2,900.3	
85+	5,542	5,074.7		4,983	2,222.3		10,525	3,156.5	
All ages	47,247	455.6		32,545	310.3		79,792	382.5	
ASR (A)	. .	471.0		. .	271.9		. .	359.2	
95% CI	. .	466.8–475.3		. .	269.9–274.0		. .	357.3–361.0	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population. 
2.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Figure 3.3: NMSC age-specific hospital separation rates by sex: Australia, 2006–07

Table 3.5: NMSC hospital separations by country of birth: Australia, 2006–07
Country of birth group	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
Australia	39,861	84.4		27,898	85.7		67,759	84.9	
UK/Ireland	3,182	6.7		1,861	5.7		5,043	6.3	
New Zealand	634	1.3		419	1.3		1,053	1.3	
Pacific Island countries	55	0.1		45	0.1		100	0.1	
United States	84	0.2		60	0.2		144	0.2	
Canada	43	0.1		33	0.1		76	0.1	
Western Europe	627	1.3		370	1.1		997	1.2	
Northern Europe	60	0.1		22	0.1		82	0.1	
Southern Europe	528	1.1		263	0.8		791	1.0	
Central and Eastern Europe	652	1.4		437	1.3		1,089	1.4	
North Africa	28	0.1		19	0.1		47	0.1	
Middle East	34	0.1		31	0.1		65	0.1	
South-East Asia	58	0.1		45	0.1		103	0.1	
North-East Asia	27	0.1		34	0.1		61	0.1	
Southern and Central Asia 	53	0.1		34	0.1		87	0.1	
South America	20	0.0		11	0.0		31	0.0	
Central America	6	0.0		4	0.0		10	0.0	
Caribbean	8	0.0		3	0.0		11	0.0	
Sub-Saharan Africa	210	0.4		145	0.4		355	0.4	
Missing/Inadequately described	1,070	2.3		809	2.5		1,879	2.4	
Not classified	7	0.0		2	0.0		9	0.0	
Total	47,247	100.0		32,545	100.0		79,792	100.0	
Notes
1.	Proportions are the number of hospital separations with principal diagnosis of NMSC in each country group. 
2.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Hospital Morbidity Database.

Table 3.6: NMSC age-standardised hospital separation rates by country of birth: Australia, 2006–2007
 Country of birth grouping	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
Australia	522.9	652.0	645.6–658.5		360.6	358.1	353.9–362.4		441.1	481.5	477.8–485.1	
UK/Ireland	525.4	293.8	283.5–304.4		318.0	156.2	148.9–163.8		423.5	217.2	211.1–223.4	
New Zealand	277.6	415.6	379.8–453.5		196.0	238.4	214.7–264.0		238.1	318.2	297.7–339.7	
Pacific Island countries	96.8	152.7	110.0–204.8		72.1	97.3	68.2–133.8		83.9	121.8	96.5–151.2	
United States	259.0	303.1	237.8–380.0		199.2	243.1	179.5–320.1		230.2	277.0	230.1–330.1	
Canada	273.9	323.1	228.5–441.8		200.4	214.3	143.3–306.5		236.3	267.9	208.0–338.9	
Western Europe	470.0	224.8	205.9–244.8		284.1	123.5	110.1–137.9		378.2	165.9	155.1–177.3	
Northern Europe	373.4	266.4	200.4–346.3		138.9	97.0	60.4–147.3		257.0	179.7	142.1–224.1	
Southern Europe	326.0	120.4	109.5–132.0		177.7	61.7	54.1–70.0		255.2	89.7	83.2–96.5	
Central and Eastern Europe	245.5	112.9	104.1–122.3		163.5	73.7	66.6–81.3		204.4	92.3	86.7–98.1	
North Africa	88.0	62.1	41.0–90.1		68.5	46.2	27.3–72.9		78.9	54.9	40.1–73.4	
Middle East	30.1	36.4	23.4–53.2		31.1	33.1	21.9–47.6		30.5	34.2	25.7–44.5	
South-East Asia	21.7	32.8	23.9–43.8		13.5	18.9	13.4–25.9		17.2	24.9	19.8–30.8	
North-East Asia	15.8	20.1	13.0–29.5		17.5	19.5	13.4–27.4		16.7	20.4	15.5–26.3	
Southern and Central Asia 	40.5	60.4	44.9–79.4		29.7	30.1	20.8–42.1		35.5	42.7	34.1–52.8	
South America	58.4	74.1	38.8–123.5		29.2	24.5	11.7–44.6		43.1	42.4	27.2–62.3	
Central America	89.0	236.5	76.6–533.7		56.2	67.4	12.3–185.6		72.2	126.1	53.8–242.6	
Caribbean	371.9	216.6	89.1–434.2		144.6	106.4	21.7–311.5		260.4	168.3	81.1–305.7	
Sub-Saharan Africa	213.5	292.2	250.7–338.2		153.1	162.1	135.8–192.0		183.9	218.5	195.0–243.8	
Notes
1.	Crude rates are the numbers of hospital separations with principal diagnosis of non-melanoma cancer per 100,000 as at 30 June 2004.
2.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Hospital Morbidity Database.
Table 3.7: NMSC hospital separations by region: males, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	2	0	3	0	0	5	
5–9	6	1	0	0	0	7	
10–14	6	0	2	0	0	8	
15–19	7	1	6	0	0	14	
20–24	38	10	5	0	1	54	
25–29	66	22	17	2	0	107	
30–34	237	70	38	5	3	354	
35–39	437	130	66	16	4	657	
40–44	735	244	133	17	8	1,143	
45–49	1,265	371	219	31	15	1,912	
50–54	1,820	691	330	44	21	2,916	
55–59	2,687	923	533	48	32	4,235	
60–64	3,171	1,211	567	78	27	5,072	
65–69	3,297	1,309	624	52	29	5,330	
70–74	3,693	1,453	605	48	18	5,829	
75–79	4,423	1,607	691	49	30	6,815	
80–84	5,026	1,616	552	36	3	7,247	
85+	4,059	1,090	341	39	7	5,542	
All ages	30,975	10,749	4,732	465	198	47,247	
Notes 
1.	Regions are defined according to the ASGC. 
2.	128 separations were undefined for remoteness. Hence the sum of remoteness areas may be less than the national total.
Source: AIHW National Hospital Morbidity Database.

Table 3.8: NMSC age-specific and age-standardised hospital separation rates by region:
 males, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	0.4	0.0	4.6	0.0	0.0	0.7	
5–9	1.3	0.7	0.0	0.0	0.0	1.0	
10–14	1.3	0.0	2.6	0.0	0.0	1.1	
15–19	1.4	0.7	8.8	0.0	0.0	1.9	
20–24	6.9	8.3	8.7	0.0	14.4	7.2	
25–29	12.5	20.8	30.3	17.8	0.0	15.1	
30–34	43.8	58.3	60.3	40.5	41.2	47.6	
35–39	81.6	96.7	95.5	122.4	55.1	86.5	
40–44	140.5	167.6	179.5	128.4	121.7	149.9	
45–49	255.2	246.7	288.4	241.7	240.9	258.0	
50–54	406.1	486.1	462.6	380.2	370.4	429.5	
55–59	645.5	676.4	777.6	451.7	682.3	665.2	
60–64	995.2	1,085.2	1,038.6	998.8	796.7	1,022.6	
65–69	1,357.3	1,446.3	1,425.3	909.0	1,276.5	1,383.8	
70–74	1,914.6	2,033.0	1,827.9	1,218.3	1,319.2	1,925.3	
75–79	2,701.4	2,746.6	2,670.3	1,628.8	2,915.9	2,702.7	
80–84	4,519.3	4,347.0	3,541.3	2,344.2	614.0	4,365.7	
85+	5,733.7	4,799.4	3,571.8	4,084.9	2,154.4	5,312.0	
All ages	 	 	 	 	 	 	
Crude rate	442.4	529.6	473.2	277.7	220.0	459.2	
ASR (A)	480.8	488.4	455.7	343.0	334.6	479.3	
95% CI	475.5–486.3	479.1–497.8	442.6–469.1	310.5–377.8	285.0–389.7	475.0–483.7	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Regions are defined according to the ASGC. 
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Table 3.9: NMSC hospital separations by region: females, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	4	0	0	0	0	4	
5–9	5	0	0	0	0	5	
10–14	4	1	1	0	0	6	
15–19	13	9	3	0	0	25	
20–24	34	3	8	0	0	46	
25–29	92	21	9	0	0	123	
30–34	297	78	29	3	1	410	
35–39	487	124	87	10	3	714	
40–44	784	245	120	13	12	1,178	
45–49	1,267	376	177	24	11	1,865	
50–54	1,563	521	247	24	13	2,383	
55–59	1,812	591	294	32	14	2,754	
60–64	1,854	682	282	34	11	2,879	
65–69	1,844	764	326	29	7	2,983	
70–74	2,170	816	324	22	10	3,349	
75–79	2,724	1,006	422	30	4	4,196	
80–84	3,234	981	391	19	1	4,642	
85+	3,581	976	381	30	6	4,983	
All ages	21,769	7,194	3,101	270	93	32,545	
Notes
1.	Regions are defined according to the ASGC. 
2.	118 separations were undefined for remoteness. Hence the sum of remoteness areas may be less than the national total.
Source: AIHW National Hospital Morbidity Database.

Table 3.10: NMSC age-specific and age-standardised hospital separation rates by region:
 females, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	0.9	0.0	0.0	0.0	0.0	0.6	
5–9	1.2	0.0	0.0	0.0	0.0	0.8	
10–14	0.9	0.7	1.4	0.0	0.0	0.9	
15–19	2.8	6.4	4.9	0.0	0.0	3.6	
20–24	6.3	2.7	15.4	0.0	0.0	6.4	
25–29	17.7	20.1	16.3	0.0	0.0	17.6	
30–34	54.5	63.1	46.3	25.7	14.8	54.7	
35–39	89.9	88.8	127.6	83.9	48.1	93.0	
40–44	147.5	161.8	166.6	112.1	212.8	152.6	
45–49	247.5	245.2	244.7	213.8	208.9	247.3	
50–54	337.3	370.0	374.2	243.0	290.1	348.1	
55–59	425.6	439.0	471.1	380.9	389.0	433.8	
60–64	575.7	616.4	563.0	533.6	428.3	585.5	
65–69	717.6	845.3	810.0	628.4	411.6	757.3	
70–74	1,004.5	1,099.3	1,029.7	635.5	851.3	1,026.2	
75–79	1,347.7	1,520.9	1,540.9	1,093.3	432.1	1,401.8	
80–84	1,960.1	1,909.4	1,907.0	983.2	193.0	1,939.6	
85+	2,383.8	2,097.2	2,042.7	1,658.6	1,397.9	2,289.4	
All ages	 	 	 	 	 	 	
Crude rate	303.8	350.8	322.4	178.5	115.7	312.6	
ASR (A)	271.0	284.6	283.1	202.2	169.8	275.1	
95% CI	267.4–274.7	278.0–291.3	273.1–293.3	178.5–228.2	135.1–210.4	272.1–278.2	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Regions are defined according to the ASGC. 
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Table 3.11: NMSC hospital separations by region: persons, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	6	0	3	0	0	9	
5–9	11	1	0	0	0	12	
10–14	10	1	3	0	0	14	
15–19	20	10	9	0	0	39	
20–24	72	13	13	0	1	100	
25–29	158	43	26	2	0	230	
30–34	534	148	67	8	4	764	
35–39	924	254	153	26	7	1,371	
40–44	1,519	489	253	30	20	2,321	
45–49	2,532	747	396	55	26	3,777	
50–54	3,383	1,212	577	68	34	5,299	
55–59	4,499	1,514	827	80	46	6,989	
60–64	5,025	1,893	849	112	38	7,951	
65–69	5,141	2,073	950	81	36	8,313	
70–74	5,863	2,269	929	70	28	9,178	
75–79	7,147	2,613	1,113	79	34	11,011	
80–84	8,260	2,597	943	55	4	11,889	
85+	7,640	2,066	722	69	13	10,525	
All ages	52,744	17,943	7,833	735	291	79,792	
Notes
1.	Regions are defined according to the ASGC.
2.	246 separations were undefined for remoteness. Hence the sum of remoteness areas may be less than the national total.
Source: AIHW National Hospital Morbidity Database.

Table 3.12: NMSC age-specific and age-standardised hospital separation rates by region:
 persons, Australia, 2006–07
Age (years)	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote	Total 	
0–4	0.7	0.0	2.3	0.0	0.0	0.7	
5–9	1.3	0.4	0.0	0.0	0.0	0.9	
10–14	1.1	0.3	2.0	0.0	0.0	1.0	
15–19	2.1	3.4	7.0	0.0	0.0	2.8	
20–24	6.6	5.6	11.9	0.0	7.3	6.8	
25–29	15.1	20.5	23.4	9.1	0.0	16.4	
30–34	49.2	60.7	53.4	33.4	28.5	51.2	
35–39	85.8	92.7	111.4	104.0	51.9	89.8	
40–44	144.1	164.7	173.2	120.8	163.8	151.3	
45–49	251.3	246.0	267.1	228.7	226.2	252.6	
50–54	371.1	428.3	420.1	317.0	334.9	388.6	
55–59	534.3	558.5	631.5	420.5	555.0	549.7	
60–64	784.3	851.8	811.0	789.8	637.9	805.0	
65–69	1,028.4	1,146.0	1,130.6	783.7	906.2	1,067.0	
70–74	1,433.8	1,557.3	1,438.9	945.7	1,102.7	1,458.9	
75–79	1,953.5	2,096.2	2,089.6	1,373.3	1,739.6	1,996.6	
80–84	2,990.5	2,932.7	2,612.9	1,585.8	397.3	2,933.2	
85+	3,456.8	2,983.4	2,560.4	2,496.8	1,723.8	3,268.8	
All ages	 	 	 	 	 	 	
Crude rate	372.3	439.8	399.3	230.6	170.8	385.5	
ASR (A)	360.2	375.6	365.4	269.4	258.2	364.1	
95% CI	357.2–363.3	370.1–381.2	357.3–373.7	249.8–290.1	227.1–292.1	361.6–366.6	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Regions are defined according to the ASGC. 
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Figure 3.4: NMSC age-standardised hospital separation rates by region: Australia, 2006–07
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Hospital Morbidity Database.

Table 3.13: NMSC hospital separations by socioeconomic status: males, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	3	1	0	1	0	5	
5–9	0	5	0	1	1	7	
10–14	1	1	2	1	3	8	
15–19	6	4	0	2	2	14	
20–24	0	8	19	15	12	54	
25–29	12	28	21	18	28	107	
30–34	37	60	73	108	75	353	
35–39	72	132	121	167	161	653	
40–44	132	212	240	250	303	1,137	
45–49	213	374	392	409	512	1,900	
50–54	320	601	602	666	715	2,904	
55–59	474	899	836	934	1,078	4,221	
60–64	599	1,150	958	1,050	1,289	5,046	
65–69	601	1,265	1,061	1,142	1,235	5,304	
70–74	678	1,404	1,147	1,214	1,363	5,806	
75–79	812	1,664	1,333	1,485	1,493	6,787	
80–84	771	1,674	1,480	1,625	1,670	7,220	
85+	515	1,160	1,110	1,281	1,461	5,527	
All ages	5,246	10,642	9,395	10,369	11,401	47,053	
Notes 
1.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
2.	As some separations were undefined for socioeconomic status, the sum of quintiles may be less than the national total. There were 194 separations not classifiable.
Source: AIHW National Hospital Morbidity Database.

Table 3.14: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: males, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	3.0	0.7	0.0	0.6	0.0	0.7	
5–9	0.0	3.3	0.0	0.6	0.7	1.0	
10–14	1.0	0.6	1.3	0.6	2.1	1.1	
15–19	6.2	2.6	0.0	1.2	1.3	1.9	
20–24	0.0	5.3	12.5	8.3	7.1	7.2	
25–29	13.1	19.8	14.5	10.4	17.7	15.1	
30–34	39.6	40.3	48.1	59.3	44.8	47.5	
35–39	74.9	86.2	77.5	91.2	94.3	86.0	
40–44	135.4	133.7	151.8	139.7	179.1	149.2	
45–49	224.0	237.0	255.4	239.7	312.3	256.4	
50–54	365.3	407.7	430.9	433.4	475.2	427.8	
55–59	572.8	641.2	645.5	656.4	760.2	663.1	
60–64	891.3	1,008.2	949.6	981.1	1,206.8	1,017.4	
65–69	1,118.3	1,330.9	1,327.3	1,431.0	1,611.4	1,377.1	
70–74	1,593.3	1,810.6	1,801.4	1,960.6	2,388.7	1,917.8	
75–79	2,405.1	2,563.6	2,498.9	2,891.7	3,060.7	2,691.7	
80–84	3,704.6	3,993.6	4,226.6	4,734.4	4,922.8	4,349.6	
85+	4,115.4	4,592.1	5,228.2	5,861.6	6,227.4	5,298.1	
All ages	 	 	 	 	 	 	
Crude rate	383.4	477.3	444.0	439.9	514.8	457.4	
ASR(A)	403.6	447.6	459.7	497.9	556.5	477.4	
95% CI	392.6–414.9	439.1–456.3	450.4–469.2	488.2–507.7	546.2–566.9	473.1–481.8	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Table 3.15: NMSC hospital separations by socioeconomic status: females, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	0	0	0	1	3	4	
5–9	2	0	0	2	1	5	
10–14	0	3	0	1	2	6	
15–19	2	8	2	6	7	25	
20–24	6	5	8	11	15	45	
25–29	11	24	25	29	33	122	
30–34	29	73	82	90	133	407	
35–39	68	113	150	184	196	711	
40–44	111	213	228	290	329	1,171	
45–49	192	382	371	385	524	1,854	
50–54	245	468	495	532	626	2,366	
55–59	311	558	542	579	748	2,738	
60–64	299	589	560	650	759	2,857	
65–69	326	739	587	631	683	2,966	
70–74	406	865	626	724	718	3,339	
75–79	508	958	865	926	923	4,180	
80–84	521	1,100	888	1,034	1,077	4,620	
85+	521	1,080	954	1,132	1,280	4,967	
All ages	3,558	7,178	6,383	7,207	8,057	32,383	
Notes 
1.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
2.	As some separations were undefined for socioeconomic status, the sum of quintiles may be less than the national total. There were 162 separations not classifiable.
Source: AIHW National Hospital Morbidity Database.

Table 3.16: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: females, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	0.0	0.0	0.0	0.7	2.3	0.6	
5–9	2.1	0.0	0.0	1.4	0.8	0.8	
10–14	0.0	2.0	0.0	0.7	1.4	0.9	
15–19	2.2	5.4	1.4	3.8	4.6	3.6	
20–24	6.4	3.5	5.5	6.3	9.2	6.2	
25–29	12.1	17.1	17.8	17.1	21.1	17.5	
30–34	31.0	48.8	53.8	49.3	77.6	54.3	
35–39	71.9	72.8	96.5	99.1	110.8	92.6	
40–44	116.9	132.6	144.6	159.1	186.5	151.7	
45–49	205.7	238.3	242.6	220.9	302.6	245.9	
50–54	283.6	317.1	359.7	342.7	397.1	345.7	
55–59	383.0	397.8	429.4	407.1	516.6	431.4	
60–64	464.3	511.7	563.7	611.6	712.1	581.0	
65–69	608.3	754.4	723.8	767.0	864.9	753.0	
70–74	910.3	1,031.4	923.7	1,082.0	1,136.4	1,023.2	
75–79	1,287.9	1,255.2	1,403.8	1,494.6	1,538.9	1,396.5	
80–84	1,748.5	1,862.1	1,829.4	2,070.7	2,072.4	1,930.5	
85+	2,099.5	2,103.7	2,197.5	2,461.2	2,457.3	2,282.1	
All ages	 	 	 	 	 	 	
Crude rate	261.5	317.2	302.0	302.2	352.5	311.2	
ASR(A)	235.5	256.1	266.0	282.4	313.9	273.7	
95% CI	227.8–243.5	250.1–262.1	259.5–272.7	275.9–289.1	306.9–320.9	270.7–276.8	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Table 3.17: NMSC hospital separations by socioeconomic status: persons, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	3	1	0	2	3	9	
5–9	2	5	0	3	2	12	
10–14	1	4	2	2	5	14	
15–19	8	12	2	8	9	39	
20–24	6	13	27	26	27	99	
25–29	23	52	46	47	61	229	
30–34	66	133	155	198	208	760	
35–39	140	245	271	351	357	1,364	
40–44	243	425	468	540	632	2,308	
45–49	405	756	763	794	1,036	3,754	
50–54	565	1,069	1,097	1,198	1,341	5,270	
55–59	785	1,457	1,378	1,513	1,826	6,959	
60–64	898	1,739	1,518	1,700	2,048	7,903	
65–69	927	2,004	1,648	1,773	1,918	8,270	
70–74	1,084	2,269	1,773	1,938	2,081	9,145	
75–79	1,320	2,622	2,198	2,411	2,416	10,967	
80–84	1,292	2,774	2,368	2,659	2,747	11,840	
85+	1,036	2,240	2,064	2,413	2,741	10,494	
All ages	8,804	17,820	15,778	17,576	19,458	79,436	
Notes 
1.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
2.	As some separations were undefined for socioeconomic status, the sum of quintiles may be less than the national total. There were 356 separations not classifiable.
Source: AIHW National Hospital Morbidity Database.

Table 3.18: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: persons, Australia, 2006–07
Age (years)	1st quintile (most disadvantaged)	2nd quintile	3rd quintile	4th quintile	5th quintile (least disadvantaged)	Total 	
0–4	1.6	0.4	0.0	0.7	1.1	0.7	
5–9	1.0	1.7	0.0	1.0	0.7	0.9	
10–14	0.5	1.3	0.7	0.6	1.8	1.0	
15–19	4.3	3.9	0.7	2.5	2.9	2.8	
20–24	3.2	4.4	9.1	7.3	8.1	6.7	
25–29	12.6	18.5	16.1	13.7	19.4	16.3	
30–34	35.3	44.6	51.0	54.3	61.4	50.9	
35–39	73.4	79.5	87.0	95.2	102.7	89.3	
40–44	126.3	133.2	148.2	149.5	182.9	150.4	
45–49	214.9	237.7	249.0	230.2	307.3	251.1	
50–54	324.7	362.4	395.6	387.8	435.2	386.6	
55–59	478.8	519.5	538.8	531.8	637.1	547.4	
60–64	682.4	758.8	758.1	797.0	959.7	800.1	
65–69	863.7	1,038.3	1,023.3	1,093.9	1,232.6	1,061.5	
70–74	1,243.8	1,405.7	1,348.9	1,504.3	1,730.6	1,453.7	
75–79	1,803.1	1,856.5	1,912.0	2,127.8	2,221.4	1,988.7	
80–84	2,552.9	2,746.8	2,834.0	3,155.8	3,198.2	2,921.2	
85+	2,775.2	2,924.3	3,192.9	3,556.5	3,628.1	3,259.3	
All ages	 	 	 	 	 	 	
Crude rate	322.6	396.7	373.0	370.6	432.3	383.9	
ASR (A)	311.0	340.9	351.0	375.2	416.9	362.5	
95% CI	304.5–317.5	335.8–345.9	345.6–356.6	369.6–380.8	411.0–422.9	360.0–365.0	
Notes
1.	Rates are the numbers of hospital separations with principal diagnosis of NMSC per 100,000 population at 30 June 2006. 
2.	Quintiles were defined using the 2006 Index of Relative Socioeconomic Disadvantage.
3.	All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Hospital Morbidity Database.

Figure 3.5: NMSC age-standardised hospital separation rates by socioeconomic status: Australia, 2006–07
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Hospital Morbidity Database.

4	Mortality
Introduction
This chapter presents a sociodemographic profile of people who died between 1998 and 2005 with NMSC recorded as the underlying cause of death. The data are provided by age, sex, country of birth, remoteness of residence and socioeconomic status.
Age-standardised rates were derived using population estimates for remoteness areas for 1998–2005 and 2001 quintiles of socioeconomic disadvantage, age-standardised to the Australian 2001 population. Country of birth was analysed using population estimates for 30 June 2004 as a substitute for 2005 population estimates, age-standardised to the Australian 2001 population.
Overview
•	In 2006, 410 persons (276 males, 134 females) died from NMSC in Australia (ABS 2008).
•	In 2005, the mean age at death from NMSC for all persons was 78 years—76 years for males and 80 years for females (AIHW 2008). The risk of dying of NMSC by age 75 years was estimated to be 1 in 848 for males and 1 in 2955 for females.
•	In 2005, NMSC deaths represented 1.0% of all cancer deaths and 0.3% of deaths from all causes. For males, the corresponding figures were 1.3% and 0.4%. For females, the figures were 0.8% and 0.2% (AIHW 2008).
Trends
•	There was an average of 382 deaths per year from NMSC between 1998 and 2005, with the annual number ranging from 358 deaths in 1998 to 415 deaths in 2002 (Table 4.5). Males accounted for 2,080 deaths from 1998 to 2005, compared with 977 deaths for females (tables 4.1 and 4.3).
•	The age-standardised mortality rate (ASR) of around 3 per 100,000 for males and 1 per 100,000 for females showed little variation between 1998 and 2005 (tables 4.2, 4.4 and 4.6). 
•	Between 1968 and 2005, however, there was a slight decline in mortality rates. The average annual decline overall was 0.2%— 0.1% for males and 0.2% for females (AIHW 2008).
Age group and sex
•	Numbers of deaths from NMSC increased steeply with age for both males and females. In the period 1998–2005, 65% of deaths (59% for males, 78% for females) occurred in people aged 75 and over (tables 4.1, 4.3 and 4.5). 
•	Deaths before the age of 40 were rare. The highest death rates applied to the age range of 85 and over, where the rate for both sexes combined was approximately double the rate for people aged 80–84 years (Table 4.6).
•	Males were more than 3 times as likely as females to die from NMSC. The age-standardised mortality rate for 1998–2005 was 3.2 per 100,000 for males and 1.0 per 100,000 for females (tables 4.2 and 4.4). 
Country of birth
Countries were classified using the ABS Standard Australian Classification of Countries (SACC). They were grouped into geographic regions according to the classification shown in the Appendix, Table A.3. 
Tables 4.7 to 4.10 present the number of deaths, the mortality rate, and the age-standardised mortality rate (ASR) with 95% confidence intervals for each country group.
The data indicate:
•	People born in Australia accounted for 85% of all deaths from NMSC in 1998–2001 and 83% of all deaths in 2002–2005. A further 10% of deaths in 1998–2001 and 9% of deaths in 2002–2005 were people born in the United Kingdom and Ireland (tables 4.7 and 4.8).
•	The NMSC age-standardised mortality rate for people born in Pacific Island countries (11 per 100,000 for 1998–2001; 4 per 100,000 for 2002–2005) was higher than for the overall age-standardised mortality rate (2 per 100,000 for 1998–2001 and 2002–2005). This rate is heavily influenced by the age-standardised mortality rate for NMSC for males born in Pacific Island countries (22 per 100,000 for 1998–2001; 8 per 100,000 for 2002–2005); however, because of the small number of deaths, the 95% confidence intervals are wide, and these rates should be interpreted with caution (tables 4.9 and 4.10). 
•	The age-standardised mortality rate for NMSC for people born in Australia (over 2 per 100,000 for 1998–2001 and  2002–2005) significantly exceeds the overall age-standardised mortality rate (tables 4.9 and 4.10). This is a similar finding to the excess number of NMSC hospital inpatient separations observed in the Australian-born sector compared with the overseas-born sector of the population (Table 3.6). 
Remoteness area
The geographic classification used for remoteness of residential area was the Australian Standard Geographical Classification (ASGC). Tables 4.11 to 4.14 present the number of deaths, the mortality rate and the age-standardised mortality rate (ASR) with 95% confidence intervals for each remoteness area. 
Generally, age-standardised mortality rates were relatively low for Major Cities and higher for Very Remote areas, although confidence intervals were wide for Very Remote areas because of small numbers, and these differences were not statistically significant. In addition, it is possible that residents of Very Remote areas may move residence to increase access to services when they have major health problems, which could affect these trends.
More specific results were:
•	In 2002–2005 the age-standardised mortality rate for persons resident in Outer Regional (2.7 per 100,000 persons) and Inner Regional (2.3) areas were significantly higher than the overall age-standardised mortality rates (1.9). The Outer Regional areas also had a high rate in 1998–2001 (2.9) compared with the overall rate (2.0) (tables 4.12 and 4.14). 
•	The age-standardised mortality rates for 2002–2005 by region were: Major Cities 1.6, Inner Regional 2.3, Outer Regional 2.7, Remote 1.4 and Very Remote 2.7 (Table 4.14). This is contrary to the trend for lower hospital inpatient separation rates for NMSC in the more remote areas (Table 3.12).
•	For males in 2002–2005, the age-standardised mortality rates were: Major Cities 2.5, Inner Regional 3.8, Outer Regional 4.6, Remote 1.7 and Very Remote 3.1 (Table 4.14).
•	For females in 2002–2005, the age-standardised mortality rates were: Major Cities 0.9, Inner Regional 1.2, Outer Regional 1.2, Remote 1.0 and Very Remote 2.1 (Table 4.14).
Socioeconomic disadvantage
Socioeconomic status was classified by population quintile using the Index of Relative Socioeconomic Disadvantage (ISRD) from the Socio-Economic Indexes for Areas (SEIFA) 2001. Tables 4.15 to 4.18 present for each quintile the number of deaths, the mortality rate and the age-standardised mortality rate (ASR) with 95% confidence intervals. Quintiles are ranked from the most disadvantaged to the least disadvantaged populations.
The data indicate:
•	Age-standardised mortality rates decreased progressively with decreasing disadvantage in both the 1998–2001 and 2002–2005 periods (tables 4.16 and 4.18). 
•	For all persons, age-standardised mortality rates decreased from 2.3 per 100,000 population for both 1998–2001 and 2002–2005 in the 1st quintile (most disadvantaged) to 1.5 for 1998–2001 and 1.3 for 2002–2005 in the 5th quintile (least disadvantaged) (tables 4.16 and 4.18).
•	For males, age-standardised mortality rates decreased from 3.4 per 100,000 population for both 1998–2001 and 2002–2005 in the 1st quintile to 2.7 for 1998–2001 and 2.1 for 2002–2005 in the 5th quintile (tables 4.16 and 4.18).
•	For females, age-standardised mortality rates decreased from 1.5 per 100,000 population for 1998–2001 and 1.4 for 2002–2005 in the 1st quintile to 0.8 for 1998–2001 and 0.7 for 2002–2005 in the 5th quintile (tables 4.16 and 4.18).

Table 4.1: NMSC deaths: males, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	Total	
< 30	0	1	0	0	1	1	0	0	3	
30–34	0	0	0	0	0	0	0	0	0	
35–39	0	1	1	1	0	2	0	2	7	
40–44	2	2	2	1	3	3	0	3	16	
45–49	3	4	3	6	4	5	1	7	33	
50–54	7	12	8	5	6	7	6	9	60	
55–59	13	14	12	10	26	16	14	15	120	
60–64	24	12	14	19	23	9	12	8	121	
65–69	27	30	25	29	17	35	20	24	207	
70–74	37	38	37	39	38	35	36	31	291	
75–79	46	56	50	56	55	38	46	48	395	
80–84	29	53	46	39	46	47	53	48	361	
85+	54	47	43	59	59	60	63	81	466	
All ages	242	270	241	264	278	258	251	276	2,080	
Source: AIHW National Mortality Database.
Table 4.2: NMSC age-specific and age-standardised mortality rates: males, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	1998–2005	
< 30	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	
30–34	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	
35–39	0.0	0.1	0.1	0.1	0.0	0.3	0.0	0.3	0.1	
40–44	0.3	0.3	0.3	0.1	0.4	0.4	0.0	0.4	0.3	
45–49	0.5	0.6	0.4	0.9	0.6	0.7	0.1	1.0	0.6	
50–54	1.2	2.0	1.3	0.8	0.9	1.1	0.9	1.3	1.2	
55–59	2.9	3.0	2.4	1.9	4.7	2.7	2.3	2.4	2.8	
60–64	6.5	3.1	3.5	4.6	5.4	2.1	2.6	1.7	3.6	
65–69	8.0	9.0	7.5	8.6	4.9	9.9	5.5	6.4	7.5	
70–74	12.8	12.9	12.4	12.8	12.5	11.6	12.0	10.3	12.2	
75–79	22.9	26.4	22.8	24.6	23.6	15.9	18.8	19.2	21.6	
80–84	26.2	47.1	38.7	30.4	33.7	32.5	34.7	30.2	33.9	
85+	79.2	64.6	55.5	72.0	69.3	68.5	69.9	83.9	70.6	
All ages	 	 	 	 	 	 	 	 	 	
Crude rate	2.6	2.9	2.5	2.7	2.8	2.6	2.5	2.7	2.7	
ASR (A)	3.4	3.6	3.1	3.3	3.4	3.1	2.9	3.1	3.2	
95% CI	3.0–3.9	3.2–4.1	2.7–3.5	2.9–3.7	3.0–3.8	2.7–3.5	2.6–3.3	2.8–3.5	3.1–3.4	
Note: Rates are the numbers of deaths from NMSC per 100,000 males. All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Table 4.3: NMSC deaths: females, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	Total	
< 30	0	0	0	1	0	0	0	0	1	
30–34	1	0	0	0	0	1	0	0	2	
35–39	0	1	0	1	0	0	0	0	2	
40–44	1	0	3	0	1	0	0	1	6	
45–49	1	2	2	1	2	1	1	1	11	
50–54	4	3	1	2	2	2	1	1	16	
55–59	1	2	4	1	7	3	2	4	24	
60–64	0	3	4	4	1	2	2	6	22	
65–69	3	8	6	14	8	3	7	3	52	
70–74	16	5	8	11	14	8	9	12	83	
75–79	10	14	21	18	22	24	9	17	135	
80–84	34	21	22	23	28	21	25	24	198	
85+	45	54	47	47	52	67	53	60	425	
All ages	116	113	118	123	137	132	109	129	977	
Source: AIHW National Mortality Database.
Table 4.4: NMSC age-specific and age-standardised mortality rates: females, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	1998–2005	
< 30	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	
30–34	0.1	0.0	0.0	0.0	0.0	0.1	0.0	0.0	0.0	
35–39	0.0	0.1	0.0	0.1	0.0	0.0	0.0	0.0	0.0	
40–44	0.1	0.0	0.4	0.0	0.1	0.0	0.0	0.1	0.1	
45–49	0.2	0.3	0.3	0.1	0.3	0.1	0.1	0.1	0.2	
50–54	0.7	0.5	0.2	0.3	0.3	0.3	0.2	0.1	0.3	
55–59	0.2	0.4	0.8	0.2	1.3	0.5	0.3	0.6	0.6	
60–64	0.0	0.8	1.0	1.0	0.2	0.5	0.4	1.3	0.7	
65–69	0.9	2.3	1.7	4.0	2.3	0.8	1.9	0.8	1.8	
70–74	4.8	1.5	2.4	3.3	4.2	2.4	2.8	3.7	3.1	
75–79	3.7	5.0	7.3	6.2	7.5	8.1	3.0	5.7	5.8	
80–84	18.7	11.5	11.6	11.4	13.3	9.5	10.9	10.2	12.0	
85+	28.7	32.5	26.8	25.6	27.5	34.7	26.9	29.1	29.0	
All ages	 	 	 	 	 	 	 	 	 	
Crude rate	1.2	1.2	1.2	1.3	1.4	1.3	1.1	1.3	1.2	
ASR (A)	1.1	1.0	1.0	1.1	1.1	1.0	0.8	1.0	1.0	
95% CI	0.9–1.3	0.8–1.2	0.9–1.3	0.9–1.3	1.0–1.4	0.9–1.2	0.7–1.0	0.8–1.2	1.0–1.1	
Note: Rates are the numbers of deaths from NMSC per 100,000 females. All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Table 4.5: NMSC deaths: persons, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	Total	
< 30	0	1	0	1	1	1	0	0	4	
30–34	1	0	0	0	0	1	0	0	2	
35–39	0	2	1	2	0	2	0	2	9	
40–44	3	2	5	1	4	3	0	4	22	
45–49	4	6	5	7	6	6	2	8	44	
50–54	11	15	9	7	8	9	7	10	76	
55–59	14	16	16	11	33	19	16	19	144	
60–64	24	15	18	23	24	11	14	14	143	
65–69	30	38	31	43	25	38	27	27	259	
70–74	53	43	45	50	52	43	45	43	374	
75–79	56	70	71	74	77	62	55	65	530	
80–84	63	74	68	62	74	68	78	72	559	
85+	99	101	90	106	111	127	116	141	891	
All ages	358	383	359	387	415	390	360	405	3,057	
Source: AIHW National Mortality Database.
Table 4.6: NMSC age-specific and age-standardised mortality rates: persons, Australia, 1998–2005
Age (years)	1998	1999	2000	2001	2002	2003	2004	2005	1998–2005	
< 30	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	
30–34	0.1	0.0	0.0	0.0	0.0	0.1	0.0	0.0	0.0	
35–39	0.0	0.1	0.1	0.1	0.0	0.1	0.0	0.1	0.1	
40–44	0.2	0.1	0.3	0.1	0.3	0.2	0.0	0.3	0.2	
45–49	0.3	0.5	0.4	0.5	0.4	0.4	0.1	0.5	0.4	
50–54	0.9	1.2	0.7	0.5	0.6	0.7	0.5	0.7	0.7	
55–59	1.6	1.7	1.7	1.1	3.0	1.6	1.3	1.5	1.7	
60–64	3.2	2.0	2.3	2.8	2.8	1.3	1.6	1.5	2.1	
65–69	4.4	5.6	4.6	6.3	3.6	5.3	3.7	3.5	4.6	
70–74	8.6	6.8	7.1	7.8	8.2	6.8	7.2	6.9	7.4	
75–79	11.9	14.2	14.0	14.2	14.6	11.6	10.1	11.8	12.8	
80–84	21.5	25.0	22.0	18.8	21.3	18.6	20.4	18.3	20.6	
85+	44.0	42.3	35.6	40.0	40.5	45.2	40.4	46.6	41.9	
All ages	 	 	 	 	 	 	 	 	 	
Crude rate	1.9	2.0	1.9	2.0	2.1	2.0	1.8	2.0	2.0	
ASR (A)	2.0	2.1	1.9	2.0	2.1	1.9	1.7	1.9	2.0	
95% CI	1.8–2.3	1.9–2.3	1.7–2.1	1.8–2.2	1.9–2.3	1.7–2.1	1.5–1.9	1.7–2.1	1.9–2.0	
Note: Rates are the numbers of deaths from NMSC per 100,000 population. All-age totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

 Table 4.7: NMSC deaths by country of birth: Australia, 1998–2001
Country of birth group	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
Australia	857	84.3		403	85.7		1,260	84.7	
UK/Ireland	101	9.9		46	9.8		147	9.9	
New Zealand	0	0.0		0	0.0		0	0.0	
Pacific Island countries 	14	1.4		5	1.1		19	1.3	
United States	0	0.0		0	0.0		0	0.0	
Canada	0	0.0		0	0.0		0	0.0	
Western Europe	4	0.4		4	0.9		8	0.5	
Northern Europe	2	0.2		0	0.0		2	0.1	
Southern Europe	1	0.1		0	0.0		1	0.1	
Central and Eastern Europe	2	0.2		0	0.0		2	0.1	
North Africa	3	0.3		1	0.2		4	0.3	
Middle East	0	0.0		0	0.0		0	0.0	
South-East Asia	1	0.1		0	0.0		1	0.1	
North-East Asia	2	0.2		3	0.6		5	0.3	
Southern and Central Asia 	3	0.3		1	0.2		4	0.3	
South America	0	0.0		0	0.0		0	0.0	
Central America	0	0.0		1	0.2		1	0.1	
Caribbean	0	0.0		0	0.0		0	0.0	
Sub-Saharan Africa	3	0.3		0	0.0		3	0.2	
Missing/Inadequately described	9	0.9		2	0.4		11	0.7	
Not classified	15	1.5		4	0.9		19	1.3	
Total	1,017	100.0		470	100.0		1,487	100.0	
Notes
1.	Percentages are the deaths from NMSC as a proportion all deaths. 
2.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Mortality Database.

Table 4.8: NMSC deaths by country of birth: Australia, 2002–2005
Country of birth group	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
Australia	886	83.3		424	83.6		1,310	83.4	
UK/Ireland	101	9.5		44	8.7		145	9.2	
New Zealand	6	0.6		2	0.4		8	0.5	
Pacific Island countries	7	0.7		2	0.4		9	0.6	
United States	3	0.3		0	0.0		3	0.2	
Canada	0	0.0		0	0.0		0	0.0	
Western Europe	10	0.9		6	1.2		16	1.0	
Northern Europe	1	0.1		0	0.0		1	0.1	
Southern Europe	15	1.4		5	1.0		20	1.3	
Central and Eastern Europe	11	1.0		14	2.8		25	1.6	
North Africa	1	0.1		0	0.0		1	0.1	
Middle East	2	0.2		0	0.0		2	0.1	
South-East Asia	5	0.5		1	0.2		6	0.4	
North-East Asia	0	0.0		2	0.4		2	0.1	
Southern and Central Asia 	1	0.1		1	0.2		2	0.1	
South America	1	0.1		1	0.2		2	0.1	
Central America	0	0.0		0	0.0		0	0.0	
Caribbean	0	0.0		0	0.0		0	0.0	
Sub-Saharan Africa	3	0.3		1	0.2		4	0.3	
Missing/Inadequately described	7	0.7		3	0.6		10	0.6	
Not classified	3	0.3		1	0.2		4	0.3	
Total	1,063	100.0		507	100.0		1,570	100.0	
Notes
1.	Percentages are the deaths from NMSC as a proportion all deaths. 
2.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Mortality Database.

Table 4.9: NMSC crude and age-standardised mortality rates by country of birth: Australia, 1998–2001
 Country of birth grouping	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
Australia	3.0	4.3	4.0–4.6		1.4	1.3	1.1–1.4		2.1	2.5	2.3–2.6	
UK/Ireland	4.2	2.7	2.2–3.3		1.9	0.9	0.6–1.2		3.1	1.7	1.4–1.9	
New Zealand	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Pacific Island countries	7.1	21.5	10.7–37.8		2.3	4.9	1.3–11.8		4.6	11.4	6.5–18.4	
United States	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Canada	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Western Europe	0.7	0.6	0.1–1.5		0.8	0.4	0.1–1.0		0.7	0.4	0.2–0.9	
Northern Europe	3.2	2.2	0.2–8.3		0.0	0.0	..		1.6	1.2	0.1–4.4	
Southern Europe	0.1	0.0	0.0–0.3		0.0	0.0	..		0.1	0.0	0.0–0.1	
Central and Eastern Europe	0.2	0.1	0.0–0.4		0.0	0.0	..		0.1	0.1	0.0–0.2	
North Africa	3.1	1.8	0.4–5.2		1.1	0.7	0.0–4.0		2.2	1.3	0.3–3.3	
Middle East	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
South-East Asia	0.1	0.3	0.0–1.6		0.0	0.0	..		0.0	0.1	0.0–0.6	
North-East Asia	0.3	0.8	0.1–2.9		0.5	0.6	0.1–1.7		0.4	0.6	0.2–1.3	
Southern and Central Asia 	0.8	0.7	0.1–2.2		0.3	0.3	0.0–1.7		0.5	0.6	0.1–1.5	
South America	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Central America	0.0	0.0	..		3.5	7.0	0.2–38.8		1.8	4.4	0.1–24.5	
Caribbean	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Sub-Saharan Africa	1.1	2.3	0.4–6.7		0.0	0.0	..		0.5	0.9	0.2–2.6	
Total	2.7	3.4	3.2–3.6		1.2	1.1	1.0–1.2		2.0	2.0	1.9–2.1	
Notes
1.	Crude rates are the number of deaths from NMSC per 100,000.
2.	Age-standardised rates are standardised to the Australian population at 30 June 2001.
3.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Mortality Database.
Table 4.10: NMSC crude and age-standardised mortality rates by country of birth: Australia, 2002–2005
 Country of birth grouping	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
Australia	2.9	3.9	3.7–4.2		1.4	1.2	1.1–1.3		2.1	2.3	2.2–2.4	
UK/Ireland	4.2	2.4	1.9–2.9		1.9	0.8	0.6–1.0		3.1	1.5	1.3–1.8	
New Zealand	0.7	1.6	0.5–3.6		0.2	0.4	0.0–1.3		0.5	0.8	0.3–1.7	
Pacific Island countries	3.1	8.0	2.8–17.3		0.8	1.7	0.2–6.1		1.9	4.2	1.8–8.2	
United States	2.3	3.4	0.7–10.1		0.0	0.0	..		1.2	1.9	0.4–5.6	
Canada	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Western Europe	1.9	0.9	0.4–1.8		1.1	0.5	0.2–1.2		1.5	0.7	0.4–1.2	
Northern Europe	1.6	1.7	0.0–9.4		0.0	0.0	..		0.8	0.7	0.0–4.2	
Southern Europe	2.3	1.1	0.5–1.9		0.8	0.3	0.1–0.7		1.6	0.7	0.4–1.1	
Central and Eastern Europe	1.0	0.6	0.3–1.0		1.3	0.6	0.3–0.9		1.2	0.5	0.3–0.8	
North Africa	0.9	0.5	0.0–2.9		0.0	0.0	..		0.5	0.3	0.0–1.5	
Middle East	0.5	1.1	0.1–4.1		0.0	0.0	..		0.2	0.5	0.1–1.8	
South-East Asia	0.5	1.0	0.3–2.3		0.1	0.2	0.0–0.9		0.3	0.5	0.2–1.1	
North-East Asia	0.0	0.0	..		0.3	0.3	0.0–1.0		0.1	0.1	0.0–0.5	
Southern and Central Asia 	0.2	0.3	0.0–1.7		0.2	0.3	0.0–1.4		0.2	0.3	0.0–1.0	
South America	0.7	1.2	0.0–6.7		0.7	0.9	0.0–4.8		0.7	1.1	0.1–4.1	
Central America	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Caribbean	0.0	0.0	..		0.0	0.0	..		0.0	0.0	..	
Sub-Saharan Africa	0.8	1.6	0.3–4.7		0.3	0.4	0.0–2.3		0.5	0.9	0.3–2.4	
Total	2.7	3.1	2.9–3.3		1.3	1.0	0.9–1.1		2.0	1.9	1.8–2.0	
Notes
1.	Crude rates are the numbers of deaths from NMSC per 100,000 population.
2.	Age-standardised rates are standardised to the Australian population at 30 June 2001.
3.	Country of birth is classified according to the Standard Australian Classification of Countries, ABS cat. no. 1269.0.
Source: AIHW National Mortality Database.

Table 4.11: NMSC deaths by region: Australia, 1998–2001
Region	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
Major Cities	592	58.2		278	59.2		870	58.5	
Inner Regional	250	24.6		119	25.3		369	24.8	
Outer Regional	150	14.7		64	13.7		214	14.4	
Remote	15	1.5		7	1.6		23	1.5	
Very Remote	10	1.0		1	0.2		11	0.7	
Total	1,017	100.0		470	100.0		1,487	100.0	
Notes
1.	Regions are defined according to the ASGC. 
2.	Because some deaths were undefined for remoteness area, the sum of regions may be less than the national total.
3.	Totals may not sum because of rounding caused by restructuring of ASGC boundaries.
Source: AIHW National Mortality Database.

Table 4.12: NMSC crude and age-standardised mortality rates by region: Australia, 1998–2001
Region	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
Major Cities	2.4	3.1	2.8–3.3	 	1.1	0.9	0.8–1.1	 	1.7	1.8	1.7–1.9	
Inner Regional	3.2	3.6	3.1–4.1		1.5	1.2	1.0–1.4		2.3	2.2	2.0–2.5	
Outer Regional	3.7	4.5	3.8–5.3		1.6	1.5	1.1–1.9		2.7	2.9	2.5–3.3	
Remote	2.3	3.7	1.9–6.1		1.2	1.6	0.6–3.2		1.8	2.6	1.6–3.8	
Very Remote	2.6	5.1	2.2–9.6		0.3	0.7	0.0–3.9		1.6	3.0	1.4–5.4	
Total	2.7	3.4	3.2–3.6		1.2	1.1	1.0–1.2		2.0	2.0	1.9–2.1	
Notes
1.	Regions are defined according to the ASGC.
2.	Crude rates are the number of deaths from NMSC per 100,000 population. 
3.	Totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Table 4.13: NMSC deaths by region: Australia, 2002–2005
Region	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
Major Cities	558	52.8		300	59.4		858	54.9	
Inner Regional	312	29.5		135	26.7		447	28.6	
Outer Regional	173	16.4		62	12.3		235	15.1	
Remote	9	0.8		5	0.9		13	0.9	
Very Remote	6	0.5		3	0.7		9	0.6	
Total	1,057	100.0		505	100.0		1,562	100.0	
Notes
1.	Regions are defined according to the ASGC. 
2.	Because some deaths were undefined for remoteness area, the sum of regions may be less than the national total.
3.	Totals may not sum because of rounding caused by restructuring of ASGC boundaries.
Source: AIHW National Mortality Database.

Table 4.14: NMSC crude and age-standardised mortality rates by region: Australia, 2002–2005
Region	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
Major Cities	2.1	2.5	2.3–2.8	 	1.1	0.9	0.8–1.0	 	1.6	1.6	1.5–1.7	
Inner Regional	3.7	3.8	3.4–4.3		1.6	1.2	1.0–1.4		2.7	2.3	2.1–2.5	
Outer Regional	4.2	4.6	3.9–5.4		1.5	1.2	0.9–1.6		2.9	2.7	2.4–3.1	
Remote	1.3	1.7	0.7–3.4		0.8	1.0	0.3–2.2		1.0	1.4	0.7–2.4	
Very Remote	1.5	3.1	0.9–6.9		1.0	2.1	0.4–5.3		1.3	2.7	1.1–5.0	
Total	2.7	3.1	2.9–3.3		1.3	1.0	0.9–1.1		2.0	1.9	1.8–2.0	
Notes
1.	Rates are the numbers of deaths from NMSC per 100,000 population.
2.	Regions are defined according to the ASGC.
3.	Totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Figure 4.1: NMSC age-standardised mortality rates by region: Australia, 1998–2001
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Mortality Database.
Figure 4.2: NMSC age-standardised mortality rates by region: Australia, 2002–2005
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Mortality Database.

Table 4.15: NMSC deaths by socioeconomic status: Australia, 1998–2001
Socioeconomic status	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
1st quintile (most disadvantaged)	200	19.7		122	26.0		322	21.7	
2nd quintile 	255	25.1		100	21.2		354	23.8	
3rd quintile 	214	21.1		90	19.2		304	20.5	
4th quintile 	183	18.0		84	17.8		266	17.9	
5th quintile (least disadvantaged)	165	16.3		74	15.7		239	16.1	
Total	1,016	100.0		470	100.0		1,486	100.0	
Notes
1.	Quintiles were defined using the 2001 IRSD. 
2.	As some deaths were undefined for socioeconomic status, the sum of quintiles may be less than the national total.
3.	Totals may not sum because of rounding caused by restructuring of ASGC boundaries.
Source: AIHW National Mortality Database.

Table 4.16: NMSC crude and age-standardised mortality rates by socioeconomic status: Australia, 1998–2001
Socioeconomic status	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
1st quintile (most disadvantaged)	2.6	3.4	3.0–4.0		1.6	1.5	1.2–1.8		2.1	2.3	2.1–2.6	
2nd quintile 	3.4	4.1	3.6–4.6		1.3	1.2	0.9–1.4		2.4	2.4	2.2–2.7	
3rd quintile 	2.8	3.4	2.9–3.9		1.2	1.0	0.8–1.2		2.0	2.0	1.8–2.2	
4th quintile 	2.4	3.2	2.7–3.7		1.1	1.0	0.8–1.2		1.8	1.9	1.7–2.1	
5th quintile (least disadvantaged)	2.2	2.7	2.3–3.1	 	0.9	0.8	0.6–0.9	 	1.6	1.5	1.3–1.7	
Total	2.7	3.4	3.1–3.6		1.2	1.1	1.0–1.2		2.0	2.0	1.9–2.1	
Notes
1.	Quintiles were defined using the 2001IRSD.
2.	Crude rates are the numbers of deaths from NMSC per 100,000 population. 
3.	Totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Table 4.17: NMSC deaths by socioeconomic status: Australia, 2002–2005
Socioeconomic status	Males		Females		Persons	
	Number	Per cent		Number	Per cent		Number	Per cent	
1st quintile (most disadvantaged)	228	21.5		128	25.2		356	22.7	
2nd quintile 	267	25.2		106	20.9		373	23.8	
3rd quintile 	243	22.9		105	20.8		348	22.2	
4th quintile 	180	17.0		88	17.5		269	17.1	
5th quintile (least disadvantaged)	142	13.4		79	15.6		221	14.1	
Total	1,060	100.0		506	100.0		1,566	100.0	
Notes
1.	Quintiles were defined using the 2001 IRSD. 
2.	As some deaths were undefined for socioeconomic status, the sum of quintiles may be less than the national total.
3.	Totals may not sum because of rounding caused by restructuring of ASGC boundaries.
Source: AIHW National Mortality Database.

Table 4.18: NMSC crude and age-standardised mortality rates by socioeconomic status: Australia, 2002–2005
Socioeconomic status	Males		Females		Persons	
	Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI		Crude	ASR (A)	95% CI	
1st quintile (most disadvantaged)	2.8	3.4	3.0–3.9		1.6	1.4	1.1–1.6		2.2	2.3	2.0–2.5	
2nd quintile 	3.4	3.7	3.3–4.2		1.3	1.1	0.9–1.3		2.4	2.2	2.0–2.5	
3rd quintile 	3.0	3.4	3.0–3.9		1.3	1.0	0.8–1.2		2.2	2.0	1.8–2.3	
4th quintile 	2.2	2.8	2.4–3.2		1.1	0.9	0.7–1.1		1.6	1.7	1.5–1.9	
5th quintile (least disadvantaged)	1.8	2.1	1.8–2.5	 	1.0	0.7	0.5–0.9	 	1.4	1.3	1.1–1.4	
Total	2.7	3.1	2.9–3.3		1.3	1.0	0.9–1.1		2.0	1.9	1.8–2.0	
Notes
1.	Quintiles were defined using the 2001 IRSD.
2.	Rates are the number of deaths from NMSC per 100,000 population. 
3.	Totals are age-standardised to the Australian population at 30 June 2001.
Source: AIHW National Mortality Database.

Figure 4.3: NMSC age-standardised mortality rates by socioeconomic status: Australia, 1998–2001
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Mortality Database.

Figure 4.4: NMSC age-standardised mortality rates by socioeconomic status: Australia, 2002–2005
Note: Bars on columns represent 95% confidence intervals.
Source: AIHW National Mortality Database.
5	Conclusions
This chapter presents comparisons of sociodemographic profiles as indicated by incidence, general practice patient encounters, hospital inpatient separations and mortality.
Trends
Increases over time in age-standardised NMSC rates were evident from the incidence, general practitioner, and hospital inpatient data, but corresponding upward trends in mortality rates were not observed. 
Age
NMSC rates were observed to increase steeply with age in all the data sources (that is, incidence, general practice encounters, hospital separations and mortality). Incidence and general practitioner data indicated that a steeper age gradient applied to SCC than BCC. 
Male to female ratio
The male to female ratio of age-standardised rates exceeded 1.0, with the lowest ratio of 1.5:1.0 applying for incidence data and the highest of 3.2:1.0 for mortality data. Incidence and general practitioner data pointed to a higher male to female ratio for SCC than BCC.  
Basal cell to squamous cell ratio
The ratio of BCC to SCC age-standardised rates was 2.2:1.0 for incidence and 2.0:1.0 for general practice encounters. In other words, around two-thirds of NMSC rates applied to BCC.
Remoteness area
Remote and Very Remote regions presented comparatively low age-standardised NMSC rates for hospital inpatient separations, irrespective of sex, yet populations of these regions did not have a lower risk of mortality from NMSC than other regions.
Socioeconomic disadvantage
The more disadvantaged sectors of the population had lower age-standardised NMSC rates for hospital inpatient separations, irrespective of sex, although their NMSC mortality rates were elevated. The reasons for these contrary trends require further investigation. Unfortunately, incidence data were not available by socioeconomic status.
Country of birth 
Both hospital inpatient data and mortality data showed markedly higher age-standardised NMSC rates for those born in Australia than for those born in other countries. This is consistent with trends observed in incidence data.
Appendix: Methodology
Data sources
General practice patient encounters
Data for general practice patient encounters was obtained from the BEACH (Bettering the Evaluation and Care of Health) database, a continuous cross-sectional national study of general practice activity in Australia which began in April 1998. It is the only continuous randomised study of GP activity in the world, and the only national program directly linking management actions to the problem under management.
A GP is defined by the Royal Australian College of General Practitioners as a medical practitioner who provides primary comprehensive and continuing care to patients and their families within the community.
Problems managed in GP encounters are classified according to the International classification of primary care—version 2 (ICPC-2), a product of the World Organization of Family Doctors. The ICPC-2 code for types of NMSC are detailed in Table A.1.
Table A.1: ICPC-2 codes for NMSC
Non-melanoma skin cancer	ICP code	
Basal cell carcinoma	S77008	
Squamous cell carcinoma	S77006	
Non-basal, non-squamous cancer or 
non-melanoma skin cancer	S77001, S77004, S77005, S77007, S77010, S77011	
All non-melanoma skin cancer	S77006, S77008, S77001, S77004, S77005, S77007, S77010, S77011	

National estimates were calculated by multiplying the encounter rate for each year in the given time period by the estimated total number of general practice services claimed through Medicare for that year to give the estimated annual number of events.

Hospital inpatient admissions
Data for hospital inpatient admissions were sourced from the AIHW National Hospital Morbidity Database (NHMD) for data collected in the 2006–07 financial year. 
The NHMD is a compilation of episode-level records from admitted patient morbidity data collection systems in Australian hospitals. The database contains data relating to admitted patients in almost all hospitals, including public acute hospitals, public psychiatric hospitals, private acute hospitals, private psychiatric hospitals and private free-standing day hospital facilities.
All public hospitals were included for 2006–07, with minor exceptions. The great majority of private hospitals were also included, although a few (mainly private free-standing day facilities) were not included. Counts of separations presented in this report are therefore likely to be slight underestimates of the actual counts.
Records for 2006–07 are for hospital separations (discharges, transfers, deaths or changes in care type) in the period 1 July 2006 to 30 June 2007. A record is included for each separation, not for each patient, so patients who separated more than once in the year have more than one record in the database. Counts exclude separations for which the care type was reported as newborn, hospital boarder or posthumous organ procurement.
Principal diagnosis
Principal diagnosis was classified using the fifth edition of the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). Separations where the principal diagnosis was non-melanoma skin cancer were selected using ICD-10-AM code C44 ‘Other malignant neoplasms of the skin’ (Table A.2). This code is based on the cancer site, not by cancer morphology. Morphology codes are optionally reported to the NHMD, but are not supported by all states and territories, and hence are unreliable at a national level.
Table A.2: ICD-10-AM codes for NMSC
C44 Non-melanoma skin cancer	Description	
C44.0	Malignant neoplasm of skin of lip	
C44.1 	Malignant neoplasm of skin of eyelid, including canthus	
C44.2 	Malignant neoplasm of skin of ear and external auricular canal	
C44.3 	Malignant neoplasm of skin of other and unspecified parts of face	
C44.4 	Malignant neoplasm of skin of scalp and neck	
C44.5 	Malignant neoplasm of skin of trunk	
C44.6 	Malignant neoplasm of skin of upper limb, including shoulder	
C44.7 	Malignant neoplasm of skin of lower limb, including hip	
C44.8 	Overlapping malignant lesion of skin	
C44.9 	Malignant neoplasm of skin, unspecified	

Mortality
Data for mortality statistics were sourced from the AIHW National Mortality Database (NMD) for deaths occurring between 1998 and 2005. Mortality statistics are derived from death registration data documents, including the medical certificate of cause of death. Registration of death is a legal requirement in Australia, and compliance is virtually complete. The registration of death is the responsibility of those registering deaths in their respective state or territory, and the collation and coding of death data are undertaken by the Australian Bureau of Statistics.
An additional source of data is the AIHW GRIM (General Record of Incidence of Mortality) Book for NMSC. The National GRIM Books are a collection of dynamic and interactive workbooks comprising cause-specific Australian mortality information for the most recent years (currently to 2005) and historically, for many causes, to 1907. For NMSC, GRIM Book data are available from 1968 to 2005, but are updated annually with the latest mortality data from the Australian Bureau of Statistics. Data are based on year of registration of death as opposed to year of death.
Although year of death and its registration mostly coincide, deaths at the end of each calendar year may not be registered until the following year, as will deaths whose causes require further examination by a coroner. In recent years, less than 5% of deaths were held over from one year to the next for processing. Subsequently, the number of registrations in 2005 is used as a measure of the number of deaths occurring in 2005.
Underlying cause of death
Underlying cause of death is coded using the International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). Deaths with NMSC as the underlying cause were selected using ICD-10-AM code C44 ‘Other malignant neoplasms of the skin’. Morphology is not recorded in the National Mortality Database.

Population subgroups
Country of birth
Country of birth details were coded to the ABS Standard Australian Classification of Countries (SACC) at time of collection for both hospital separations and mortality. Countries were grouped into geographic regions as detailed in Table A.3.
As 2006 populations by country of birth were unavailable at the time of the analysis, 
age-standardised hospital separation rates by country of birth were calculated using the estimated resident population as at 30 June 2004 and standardised to the Australian 2001 population.
As 2005 populations by country of birth were unavailable at the time of the analysis, 
age-standardised mortality rates by country of birth for 2005 were calculated using the estimated resident populations as at 30 June 2004 and standardised to the Australian 2001 population.
Table A.3: SACC geographic grouping
Geographic grouping	SACC codes	
Australia 	900–909, 1000–1199	
UK/Ireland	2100–2299	
New Zealand	1200–1299	
Pacific Island countries 	1300–1599	
United States	8104	
Canada	8102	
Western Europe	2300–2399	
Northern Europe	2400–2499	
Southern Europe	3100–3199	
Central and Eastern Europe	912–914, 3200–3399	
North Africa 	4100–4199, 	
Middle East 	4200–4299	
South-East Asia	5000–5299	
North-East Asia	6000–6299	
Southern and Central Asia	7000–7299	
South America	8200–8299	
Central America	8300–8399	
Caribbean	8400–8499	
Sub-Saharan Africa	9000–9299	

Remoteness areas
Geographic location was classified according to the ABS Australian Standard Geographical Classification (ASGC) which groups geographical areas into five classes. These classes are based on Census Collection Districts (CDs) and are defined using the Accessibility/Remoteness Index for Australia (ARIA). ARIA is a measure of the remoteness of a location from the services provided by large towns or cities. Accessibility is judged purely on distance to one of the metropolitan centres. A higher ARIA score denotes a more remote location. The five classes of the ASGC, along with a sixth ‘Migratory’ class, are listed in Table A.4. 
The usual residence of a person is provided as the state or territory and statistical local area (SLA). Usual residence SLAs are mapped to CDs and then classified to five categories ranging from Major Cities to Very Remote areas.  
Table A.4: Remoteness areas for the ASGC
Region 	Collection districts within region	
Major Cities of Australia 	CDs with an average ARIA index value of 0 to 0.2	
Inner Regional Australia 	CDs with an average ARIA index value greater than 0.2 and less than or equal to 2.4	
Outer Regional Australia	CDs with an average ARIA index value greater than 2.4 and less than or equal to 5.92	
Remote Australia 	CDs with an average ARIA index value greater than 5.92 and less than or equal to 10.53	
Very Remote Australia 	CDs with an average ARIA index value greater than 10.53	
Migratory 	Areas composed of off-shore, shipping and migratory CDs	

Socioeconomic disadvantage
Socioeconomic classifications are based on the ABS Index of Relative Socioeconomic Disadvantage (IRSD). Geographical areas are assigned a score based on attributes such as low income, low educational attainment, high unemployment, and jobs in relatively unskilled occupations. It does not refer to the socioeconomic situation of a particular individual but instead refers to the area in which a person lives. A low score means an area has many low-income families, people with little training and high unemployment, and may be considered disadvantaged relative to other areas. Areas with high index scores may be considered less disadvantaged relative to other areas. Geographic areas may be excluded where no score is determined because of low populations or high levels of non-response in the underlying census. 
For hospital admissions data, a patient’s socioeconomic status was classified using the patient’s usual residence SLA according to the ABS IRSD for 2006. Quintiles based on the level of the index are used for analysis where the 1st quintile represents the most disadvantaged 20% of the population and the 5th quintile represents the least disadvantaged 20%.
For mortality data, usual residence SLAs were mapped to the 2001 ASGC and assigned to categories of the IRSD, from SEIFA 2001. Quintiles based on the level of the index are used for analysis where the 1st quintile represents the most disadvantaged 20% of the population and the 5th quintile represents the least disadvantaged 20%.
References
ABS (Australian Bureau of Statistics) 2008. Causes of death, Australia, 2006. Cat. no. 3303.0. Canberra: ABS.
AIHW (Australian Institute of Health and Welfare) 2005. Health system expenditures on cancer and other neoplasms in Australia, 2000–01. Health and welfare expenditure series no. 22. Cat. no. HWE 29. Canberra: AIHW. 
AIHW 2007. ACIM (Australian Cancer Incidence and Mortality) books. AIHW: Canberra.
AIHW 2008. GRIM (General Record of Incidence of Mortality) books. Canberra: AIHW.
AIHW & AACR (Australasian Association of Cancer Registries) 2004. Cancer in Australia 2001. Cancer series no. 28. Cat. no. CAN 23. Canberra: AIHW.
AIHW & AACR 2007. Cancer in Australia: an overview, 2006. Cancer series no. 37. Cat. no. CAN 32. Canberra: AIHW.
Armstrong BK & Kricker A 2001. The epidemiology of UV induced skin cancer. Journal of  Photochemistry and Photobiology B 63:8–18.
Askew DA, Wilkinson D, Schluter PJ & Eckert K 2007. Skin cancer surgery in Australia 
2001–2005: the changing role of the general practitioner. Medical Journal of Australia 187:210–4.
Begg S, Vos T, Barker B, Stevenson C, Stanley L & Lopez AD 2007. The burden of disease and injury in Australia 2003. Cat. no. PHE 82. Canberra: AIHW.
DoHA (Department of Health and Ageing) 2007. Medicare statistics 1984/85 to December quarter 2007. Canberra: DoHA.
Elwood JM 2004. Who gets skin cancer—individual risk factors. In: Hill DJ, Elwood JM, English DR (eds). Prevention of skin cancer. Dordrecht: Kluwer.
Fitzgerald KL, Buttner PG & Donovan SA 2006. Nonpigmented skin lesions. How many are nonmelanoma skin cancer? Australian Family Physician 35:555–7.
Giles GG, Marks R, Foley P 1988. Incidence of non-melanocytic skin cancer treated in Australia. BMJ 296: 13-7.
Marks R, Rennie G & Selwood TS 1988. Malignant transformation of solar keratoses to squamous cell carcinoma. Lancet 1:795–7. 
Marks R, Staples M, Giles GG 1993. Trends in non-melanocytic skin cancer treated in Australia: the second national survey. International Journal of Cancer 53: 585-90.
NCCI (National Cancer Control Initiative) 2003. The 2002 national non-melanoma skin cancer survey. A report by the NCCU Non-melanoma Skin Cancer Working Groups. Edited by MP Staples. Melbourne: NCCI.
Staples M, Marks M, Giles G 1998. Trends in the incidence of non-melanocytic skin cancer (NMSC) treated in Australia 1985-1995: are primary prevention programs starting to have an effect? International Journal of Cancer 78: 144-8.
Staples MP, Elwood M, Burton RC, William JL, Marks R & Giles GG 2006. Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985.  Medical Journal of Australia 184:6–10.
List of tables
Table 1.1: Estimated age-specific incidence rates of basal and squamous cell carcinomas of the skin: Australia, 2002
Table 1.2: Estimated number of new cases of basal and squamous cell carcinomas of the skin: Australia, 2002
Table 1.3: Estimated number of new cases of basal and squamous cell carcinomas of the skin: Australia, 2008
Table 2.1: Estimated number of NMSC-related GP encounters per year: Australia,  April 1998–
March 2007
Table 2.2: NMSC-related GP encounters by age, sex and NMSC type: Australia, April 2002–March 2007
Table 3.1: NMSC hospital separations by sex: Australia, 1993–94 to 2006–07
Table 3.2: NMSC age-standardised hospital separation rates by sex: Australia, 1993–94, 1999–00 
and 2006–07
Table 3.3: NMSC hospital separations by age and sex: Australia, 2006–07
Table 3.4: NMSC age-specific and age-standardised hospital separation rates by age and sex: Australia, 2006–07
Table 3.5: NMSC hospital separations by country of birth: Australia, 2006–07
Table 3.6: NMSC age-standardised hospital separation rates by country of birth: Australia, 
2006–2007
Table 3.7: NMSC hospital separations by region: males, Australia, 2006–07
Table 3.8: NMSC age-specific and age-standardised hospital separation rates by region:  males, Australia, 2006–07
Table 3.9: NMSC hospital separations by region: females, Australia, 2006–07
Table 3.10: NMSC age-specific and age-standardised hospital separation rates by region:  females, Australia, 2006–07
Table 3.11: NMSC hospital separations by region: persons, Australia, 2006–07
Table 3.12: NMSC age-specific and age-standardised hospital separation rates by region:  persons, Australia, 2006–07
Table 3.13: NMSC hospital separations by socioeconomic status: males, Australia, 2006–07
Table 3.14: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: males, Australia, 2006–07
Table 3.15: NMSC hospital separations by socioeconomic status: females, Australia, 2006–07
Table 3.16: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: females, Australia, 2006–07
Table 3.17: NMSC hospital separations by socioeconomic status: persons, Australia, 2006–07
Table 3.18: NMSC age-specific and age-standardised hospital separation rates by socioeconomic status: persons, Australia, 2006–07
Table 4.1: NMSC deaths: males, Australia, 1998–2005
Table 4.2: NMSC age-specific and age-standardised mortality rates: males, Australia, 1998–2005
Table 4.3: NMSC deaths: females, Australia, 1998–2005
Table 4.4: NMSC age-specific and age-standardised mortality rates: females, Australia, 1998–2005
Table 4.5: NMSC deaths: persons, Australia, 1998–2005
Table 4.6: NMSC age-specific and age-standardised mortality rates: persons, Australia, 1998–2005
Table 4.7: NMSC deaths by country of birth: Australia, 1998–2001
Table 4.8: NMSC deaths by country of birth: Australia, 2002–2005
Table 4.9: NMSC crude and age-standardised mortality rates by country of birth: Australia, 
1998–2001
Table 4.10: NMSC crude and age-standardised mortality rates by country of birth: Australia, 
2002–2005
Table 4.11: NMSC deaths by region: Australia, 1998–2001
Table 4.12: NMSC crude and age-standardised mortality rates by region: Australia, 1998–2001
Table 4.13: NMSC deaths by region: Australia, 2002–2005
Table 4.14: NMSC crude and age-standardised mortality rates by region: Australia, 2002–2005
Table 4.15: NMSC deaths by socioeconomic status: Australia, 1998–2001
Table 4.16: NMSC crude and age-standardised mortality rates by socioeconomic status: Australia, 1998–2001
Table 4.17: NMSC deaths by socioeconomic status: Australia, 2002–2005
Table 4.18: NMSC crude and age-standardised mortality rates by socioeconomic status: Australia, 2002–2005
Table A.1: ICPC-2 codes for NMSC
Table A.2: ICD-10-AM codes for NMSC
Table A.3: SACC geographic grouping
Table A.4: Remoteness areas for the ASGC

List of figures 
Figure 3.1: NMSC hospital separations by sex: Australia, 1993–94 to 2006–07
Figure 3.2: NMSC age-standardised hospital separation rates by sex: Australia, 1993–94, 1999–00 
and 2006–07
Figure 3.3: NMSC age-specific hospital separation rates by sex: Australia, 2006–07
Figure 3.4: NMSC age-standardised hospital separation rates by region: Australia, 2006–07
Figure 3.5: NMSC age-standardised hospital separation rates by socioeconomic status: Australia, 2006–07
Figure 4.1: NMSC age-standardised mortality rates by region: Australia, 1998–2001
Figure 4.2: NMSC age-standardised mortality rates by region: Australia, 2002–2005
Figure 4.3: NMSC age-standardised mortality rates by socioeconomic status: Australia, 1998–2001
Figure 4.4: NMSC age-standardised mortality rates by socioeconomic status: Australia, 2002–2005