National Drug Strategy
National Drug Strategy

The costs of tobacco, alcohol and illicit drug abuse to Australian Society in 2004/05

Appendix C, Estimation of drug-attributable cases

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This appendix was written by Associate Professor Jim Codde, School of Population Health, University of Western Australia.

Population data

Australian estimated resident population data for June 2004 used to calculate the drug-caused mortality rates shown in this report were obtained from the Australian Bureau of Statistics (ABS) publication Population by Age and Sex, Australian States and Territories, June 2005 (3201.0).

Mortality data

Unit record level national mortality data for 2004 were obtained from ABS, Deaths, Australia, 2004 (3302.0). The total number of deaths registered in that year was 132,508. The causes of death for this data were coded using ICD-10. Alcohol-caused and tobacco-caused deaths were determined on the basis of the major cause of death codes but for many illicit drug-caused deaths, the additional causes of death data were used to determine the specific drug involved if possible.

Morbidity data\

De-identified unit record level data for all public and private hospital discharges that occurred in Australia between 1 July 2004 and 30 June 2005 were obtained from the Australian Institute of Health and Welfare (AIHW) after receiving permission from all states and territories. All of the 7 million records were coded to ICD-10-AM (Third Edition) and grouped to ANDRG Version 4.2. Approximate cost of hospitalisation due to drug abuse was determined from the ANDRGs and the National Hospital Costing Data (Round 8, ANDRG 4.2) produced by the Commonwealth Department of Health and Ageing2.

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Estimation of drug-attributable cases

Conditions and diseases attributed to drug use are shown in Table 58 to Table 60 inclusive. Drug attributed cases were determined by multiplying these cases with an age-, sex- and condition-specific aetiologic fraction. The aetiologic fractions used in this report are largely based on the original work of English et al. (1995)3 and subsequently updated by Ridolfo and Stevenson (2001)4. While, on the whole, the relative risks of diseases associated with drug usage remained the same, for some diseases the aetiologic fractions in these two reports differed due to the use of more current drug usage prevalence data (1989 and 1995 respectively). For the purpose of this report, it was decided to update the aetiologic fractions once more where possible using even more current prevalence information. Furthermore, there was a desire to link more closely with the Australian Burden of Disease (ABOD) work being undertaken by the University of Queensland and the Australian Government Department of Health and Ageing.

As such, a revised list of drug-related diseases and many of the aetiologic fractions cited in this report were based on a recent publication on the burden of disease and injury in Australia5. Due to a different focus, some drug-caused conditions were grouped into a broader category in the ABOD report. For the purposes of the current study, these diseases were more clearly identified as indicated in the following tables, which allows closer comparison with the work of English et al. (1995) and Ridolfo and Stevenson (2001).

On the whole, the alcohol aetiologic fractions derived for the ABOD report (Begg et al., 2007) were based on prevalence information from the 2001 National Health Survey6categorized into the four levels used by English et al., Ridolfo and Stevenson and the NHMRC’s recommendations on alcohol consumption. The relative risks and population attributable fractions were largely drawn from Ridolfo and Stevenson’s report. Due to the long lag time between exposure to tobacco smoke and the occurrence of cancer and chronic respiratory diseases, the proportion of disease attributable to smoking cannot be determined from current smoking prevalence. Consequently Begg et al. used a variety of techniques as outlined in their report. Similarly, determination of the aetiologic fractions associated with illicit drug use was based on a number of data sources that included the 2004 National Drug Strategy Household Survey7 and National Centre in HIV Epidemiology and Clinical Research8.

Table 61 to Table 67 inclusive show the sex- and age-specific aetiologic fractions for each drug-caused disease or condition. Unless stated to the contrary, these figures were obtained
or derived from the ABOD report or personal communications with the authors. Using these aetiologic fractions, the number of cases attributable to drug usage was determined. Based on the derived fraction of cases, the number of potential years of life lost was estimated from death data using the method of Hakulinen and Teppo (1976)9. Similarly, the drug-caused fraction of hospital separations, bed days and hospital costs were determined from the application of aetiologic fractions to the age and gender specific data.

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Table 58, Alcohol-caused conditions and defining ICD-10 codes
Diseases and conditions ICD-10 codes
Oropharyngeal cancer C00-14
Oesophageal cancer C15
Liver cancer C22
Laryngeal cancer C32
Female breast cancer C50
Alcoholic psychosis 10 F10.3-10.9
Alcohol dependence/abuse 9 F10.0-10.2
Alcoholic liver cirrhosis 9 K70
Road injuries V01.1-01.9, V02.1-02.9, V03.1-03.9, V04.1-04.9, V06.1-06.9, V09.2-09.3, V10.4-10.9, V11.4-11.9, V12.4-12.9, V13.4-13.9, V14.4-14.9, V15.4-15.9, V16.4-16.9, V17.4-17.9, V18.4-18.9, V19.4-19.9, V20.4-20.9, V21.4-21.9, V22.4-22.9, V23.4-23.9, V24.4-24.9, V25.4-25.9, V26.4-26.9, V27.4-27.9, V28.4-28.9, V29.4-29.9, V30.5-30.9, V31.5-31.9, V32.5-32.9, V33.5-33.9, V34.5-34.9, V35.5-35.9, V36.5-36.9 ,V37.5-37.9, V38.5-38.9, V39.4-39.9, V40.5-40.9, V41.5-41.9, V42.5-42.9, V43.5-43.9, V44.5-44.9, V45.5-45.9, V46.5-46.9, V47.5-47.9, V48.5-48.9, V49.4-49.9, V50.5-50.9, V51.5-51.9, V52.5-52.9, V53.5-53.9, V54.5-54.9, V55.5-55.9, V56.5-56.9, V57.5-57.9, V58.5-58.9, V59.4-59.9, V60.5-60.9, V61.5-61.9, V62.5-62.9, V63.5-63.9, V64.5-64.9, V65.5-65.9, V66.5-66.9, V67.5-67.9, V68.5-68.9, V69.4-69.9, V70.5-70.9, V71.5-71.9, V72.5-72.9, V73.5-73.9, V74.5-74.9, V75.5-75.9, V76.5-76.9, V77.5-77.9, V78.5-78.9, V79.4-79.9, V80.3-80.5, V80.9, V81.1, V82.1-82.9, V83.0-83.3, V84.0-84.3, V85.0-85.3, V86.0-86.4, V87.0-87.8, V89.2, V89.9, Y85
Alcoholic poly-neuropathy 9 G62.1
Hypertension I11, I13.0, I15
Ischaemic heart disease I20-25
Alcoholic cardiomyopathy 9 I42.6
Supraventricular cardiac dysrhythmias 9 I47.1, I47.8-48.9
Heart failure 9 I50-51, I97.1
Stroke - haemorrhagic/ ischaemic G45, I60-69
Oesophageal varicies 9 I85, I98.2
Gastro-oesophageal haemorrhage 9 K22.6
Alcoholic gastritis K29.2
Unspecified liver cirrhosis 9 K74.3-74.6, K76.0, K76.9
Cholelithiasis 9 K80
Pancreatitis - acute/chronic K85, K86.0-86.1
Alcoholic beverage & other EtOH poisoning 9 X45 or Y15 & T51.0-51.1, T51.9
Fall injuries W00-19, M80-82
Fire injuries X00-19
Drowning W65-74
Aspiration 9 W78-79
Diseases and conditions ICD-10 codes
Occupational and machine injuries V01.0, 02.0, V03.0, V04.0, V05, V06.0, V09.0-09.1, V09.9, V10.0-10.3, V11.0-11.3, V12.0-12.3, V13.0-13.3, V14.0-14.3, V15.0-15.3, V16.0-16.3, V17.0-17.3, V18.0-18.3, V19.0-19.3, V20.0-20.3, V21.0-21.3, V22.0-22.3, V23.0-23.3, V24.0-24.3, V25.0-25.3, V26.0-26.3, V27.0-27.3, V28.0-28.3, V29.0-29.3, V30.0-30.4, V31.0-31.4, V32.0-32.4, V33.0-33.4, V34.0-34.4, V35.0-35.4, V36.0-36.4, V37.0-37.4, V38.0-38.4, V39.0-39.3, V40.0-40.4, V41.0-41.4, V42.0-42.4, V43.0-43.4, V44.0-44.4, V45.0-45.4, V46.0-46.4, V47.0-47.4, V48.0-48.4, V49.0-49.3, V50.0-50.4, V51.0-51.4, V52.0-52.4, V53.0-53.4, V54.0-54.4, V55.0-55.4, V56.0-56.4, V57.0-57.4, V58.0-58.4, V59.0-59.3, V60.0-60.4, V61.0-61.4, V62.0-62.4, V63.0-63.4, V64.0-64.4, V65.0-65.4, V66.0-66.4, V67.0-67.4, V68.0-68.4, V69.0-69.3, V70.0-70.4, V71.0-71.4, V72.0-72.4, V73.0-73.4, V74.0-74.4, V75.0-75.4, V76.0-76.4, V77.0-77.4, V78.0-78.4, V79.0-79.3, V80.0-80.2, V80.6-80.8, V81.0, V81.2-81.9, V82.0, V83.4-83.9, V84.4-84.9, V85.4-85.9, V86.5-86.9, V87.9, V88, V89.0-89.1, V89.3, V90-99, X20-39, X50-58, W20-45, W49-60, W64, W75-99, Y40-84, Y86, Y88.0-88.3
Suicide and self-inflicted injury X60-84,Y87.0
Child abuse 11 & Assault X85-Y09, Y87.1


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Table 59, Tobacco-caused conditions and defining ICD-10 codes

Diseases and conditions ICD-10 codes
Oropharyngeal cancer C00-14
Oesophageal cancer C15
Stomach cancer C16
Pancreatic cancer C25
Laryngeal cancer C32
Lung cancer C33-34
Cervical cancer 12 C53, D06
Endometrial cancer (protective) C54
Bladder cancer C67
Kidney cancer C64-66, C68
Ischaemic heart disease I20-25
Chronic obstructive pulmonary disease J40-44
Tobacco abuse 13 F17, T65.2, Z72.0
Parkinson’s disease (protective) G20-21
Pulmonary circulation disease 12 I26.0, I27-28
Cardiac dysrhythmias 12 I46-49
Heart failure 12 I50-51, I97.1
Stroke I60-69, G45
Peripheral vascular disease I70.0-I70.8, I72-74
Lower respiratory tract infection J10-13, J15-18, J20.0, J20.2-20.9, J21-22
Crohn’s disease K50
Ulcerative colitis K51
Antepartum haemorrhage 11 O20, O44.1, O45-46, P02.0-02.1
Low birthweight P05-07, P22
SIDS R95
Fire injuries X00-19
Asthma (under 15 years) J45-46
Macular degeneration 14 H35.3-52.4
Otitis media 13 H65-66



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Table 60, Illicit drug-caused conditions and defining ICD-10 codes

Diseases and conditions ICD-10 codes
Opiate dependence F11.2-11.4
Opiate abuse F11.0-11.1
Opiate poisoning Y12 & T40.0-40.4*
Accidental opiate poisoning15 X42 & T40.0-40.4*
Cannabis dependence F12.2-12.4
Cannabis abuse F12.0-12.1
Amphetamine dependence F15.2-15.4
Amphetamine abuse F15.0-15.1
Cocaine dependence F14.2-14.4
Cocaine abuse F14.0-14.1
Psychostimulant poisoning Y11 & T43.6*
Accidental poison by psychostimulants 14 X41 & T43.6*
Hallucinogen dependence F16.2-16.4
Hallucinogen abuse F16.0-16.1
Hallucinogen poisoning Y12 & T40.8-40.9*
Other psychotropic drug poisoning X42 & T40.5, T40.7*
Accidental poisoning by hallucinogens 14 X42 & T40.8-40.9*
Anabolic steroid poisoning 16 Y14 & T38.7*
Hepatitis B B16, B17.0, B18.0-18.1
Hepatitis C B17.1, B18.2
HIV/AIDS B20-24, R75, Z20.6, Z21
Infective endocarditis I33
Drug psychoses F11.5-11.9, F12.5-12.9, F13.5-13.9, F14.5-14.9, F15.5-15.9, F16.5-16.9, F18.5-18.9, F19.5-19.9
Maternal drug dependence 15 O35.5
Newborn drug toxicity 15 P04.4, P96.1
Antepartum haemorrhage O20, O44.1, O45-46, O67, P02.0-02.1
Low birth weight P05-07, P22
Road injuries V01.1-01.9, V02.1-02.9, V03.1-03.9, V04.1-04.9, V06.1-06.9, V09.2-09.3, V10.4-10.9, V11.4-11.9, V12.4-12.9, V13.4-13.9, V14.4-14.9, V15.4-15.9, V16.4-16.9, V17.4-17.9, V18.4-18.9, V19.4-19.9, V20.4-20.9, V21.4-21.9, V22.4-22.9, V23.4-23.9, V24.4-24.9, V25.4-25.9, V26.4-26.9, V27.4-27.9, V28.4-28.9, V29.4-29.9, V30.5-30.9, V31.5-31.9, V32.5-32.9, V33.5-33.9, V34.5-34.9, V35.5-35.9, V36.5-36.9 ,V37.5-37.9, V38.5-38.9, V39.4-39.9, V40.5-40.9, V41.5-41.9, V42.5-42.9, V43.5-43.9, V44.5-44.9, V45.5-45.9, V46.5-46.9, V47.5-47.9, V48.5-48.9, V49.4-49.9, V50.5-50.9, V51.5-51.9, V52.5-52.9, V53.5-53.9, V54.5-54.9, V55.5-55.9, V56.5-56.9, V57.5-57.9, V58.5-58.9, V59.4-59.9, V60.5-60.9, V61.5-61.9, V62.5-62.9, V63.5-63.9, V64.5-64.9, V65.5-65.9, V66.5-66.9, V67.5-67.9, V68.5-68.9, V69.4-69.9, V70.5-70.9, V71.5-71.9, V72.5-72.9, V73.5-73.9, V74.5-74.9, V75.5-75.9, V76.5-76.9, V77.5-77.9, V78.5-78.9, V79.4-79.9, V80.3-80.5, V80.9, V81.1, V82.1-82.9, V83.0-83.3, V84.0-84.3, V85.0-85.3, V86.0-86.4, V87.0-87.8, V89.2, V89.9, Y85
Suicide X60-84, Y87.0
Schizophrenia 17 F20-29

Note: Conditions with a code marked with an asterisk examined all cause of death fields.

Tables 61 - 67 are avilable as a PDF file. (PDF 434 KB)

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