One-third of nation's disease burden preventable: AIHW

Almost half of Australians are living with chronic health conditions but over one-third of our nation’s ‘disease burden’ is due to preventable risk factors, such as smoking, excessive alcohol consumption and not getting enough exercise. This is according to the Australian Institute of Health and Welfare’s (AIHW) two-yearly health report card, Australia’s health 2022.

“Today’s report comes at an important time as Australians continue to experience the effects of the COVID-19 pandemic. In 2022, no health issue stands above or has had as wide-reaching impacts on our population and health system, with these effects to be felt for many years to come,” said AIHW Deputy Chief Executive Officer Matthew James.

The report found that 11.6 million (47%) Australians were estimated to have one or more common chronic health conditions, including diabetes, cancer, mental and behavioural conditions, and chronic kidney disease.

Our expanding waistlines are a notable example: 2 in 3 adults (67%) are either overweight or obese, while carrying excess weight is responsible for 8.4% of our total disease burden.

The coronary heart disease death rate steadily increased throughout the first half of the 20th century, but since 1968 has fallen by 89% (from 428 deaths per 100,000 to 49 per 100,000 in 2020). Coronary heart disease remains the leading single cause of death for males and second leading for females.

Seven in 10 (70%) people survived at least 5 years after a cancer diagnosis during 2014–2018 — an improvement from about 5 in 10 (52%) in 1989–1993.

There have, however, been marked improvements in many areas of health, including cancer survival, infant mortality and deaths from coronary heart disease.

Population groups

However, some population groups have different experiences of health than others. Generally, the higher a person’s socio-economic position, the better their health. If all Australians had experienced the same disease burden as people living in the highest socio-economic areas in 2018, the total burden could have been reduced by one-fifth (21%).

In May 2021, almost 3 in 10 adults with disability self-reported their physical health as excellent or very good, compared with 55% of adults without disability.

The AIHW aims to improve the evidence base that supports improved health and wellbeing for all Australians. One example of this, included in Australia’s health 2022, describes insights gleaned from the first large-scale study in Australia to analyse health service costs in the last year of a person’s life.

“Although just 0.7% of the Australian population die each year, 8.0% of the health expenditure in scope was for people in their final year of life. The outlay for hospitalisations was 39 times as high for people in their last year of life compared with those not in their last year,” James said.

Doing well but room for improvement

We are living longer — life expectancy at birth was 83.0 years in 2020, the sixth-highest among the 38 OECD (Organisation for Economic Co-operation and Development) countries, according to the report. Males born in 2018–2020 can expect to live 81.2 years and females 85.3 years, up from 55.2 and 58.8 years, respectively, for those born in 1901–1910.

“Over the last 100 years, there has been a 98% decline in the age-standardised death rate from infectious diseases (such as tuberculosis, polio and diphtheria) due to childhood immunisation and disease control measures.

In the first decade of the 20th century, 1 in 10 children died before their 5th birthday (26% of all deaths, compared with 0.7% in 2020), primarily from infectious diseases.

“But with a population that is living longer, we are now experiencing higher rates of chronic and age-related conditions, such as dementia,” James said.

“For example, we know that older Australians use a higher proportion of hospital and other health services and 54% of all subsidised medicines were dispensed to people aged 65 and over.”

COVID-19 and changes in the health of Australians

Since the emergence of COVID-19 in Australia, there has been extraordinary public interest in the health of Australians, including the efforts made and measures put in place to protect our collective health.

The pandemic has affected, or has the potential to affect, the health of Australians in numerous ways.

“Throughout 2020 and most of 2021, Australia fared well compared with most countries. While Australia has world-leading vaccination rates for two doses, millions of Australians who contracted COVID-19 have experienced the direct impacts through acute illness, with some facing longer-term impacts, such as long-COVID,” James said.

“A range of longer-term health effects remain unknown, highlighting the need to continue to monitor these population health impacts into the future.”

According to ANUPoll surveys, since April 2020, fluctuations in the level of psychological distress and life satisfaction experienced by Australian adults have tracked developments throughout the pandemic, including the introduction and easing of restrictions to limit the spread of COVID-19.

“For people aged 18–44, average levels of psychological distress were higher in 2020, 2021 and 2022 (up to April 2022) than they were before the pandemic, especially for those aged 18–24. However, those aged 45 and above experienced either little change or improvements in their level of psychological distress,” James said.

Average life satisfaction

Average life satisfaction for Australians fell substantially during the early stages of the pandemic (from 6.9 out of 10 in January 2020 to 6.5 in April 2020). By January 2021 the average level of life satisfaction had returned to pre-pandemic levels and this remained the case in April 2021. However, in August 2021 life satisfaction was back to the same level as April 2020. As of April 2022, life satisfaction is yet to return to pre-pandemic levels.

At the onset of the pandemic, there were concerns that any economic downturn could have a significant negative impact on the number of deaths by suicide in Australia.

“The AIHW has compiled data from suicide registers as part of our ongoing work on suicide and self-harm reporting. This has shown that, despite a rise in the use of mental health services and an increase in psychological distress, COVID-19 has not been associated with a rise in suspected deaths by suicide,” James said.

Excess mortality

James said that one way of understanding the impact of the COVID-19 pandemic is through the measure of excess mortality.

Excess mortality shows the difference between the actual number of deaths compared with the expected number based on previous trends. This measure includes both COVID-19 and non-COVID-19 deaths, reflecting both the direct and indirect impact of the pandemic.

Death rates were decreasing before the onset of the pandemic, with this trend continuing in 2020 and 2021. When variation is taken into account, there were 205 fewer deaths than expected in 2020 and 94 more deaths than expected in 2021.

However, there was a marked change in January and February 2022, with 3105 more deaths than expected in those 2 months alone.

For deaths registered by 30 April 2022, age-standardised COVID-19 death rates were nearly three times as high for those living in the lowest socioeconomic area compared with the highest socioeconomic area and 2.5 times as high for people born overseas compared with people who were born in Australia. Of those born overseas, the death rate was highest for people born in North Africa and the Middle East.

Additionally, the rate of severe disease from COVID-19 (ICU admission and/or death) was seven times higher for Aboriginal and Torres Strait Islander people compared with the Australian population overall.

“There is also a need to focus on the medium- and longer-term health effects and health system use among all population groups,” James said.

A national COVID-19 linked dataset

The AIHW is establishing a national COVID-19 linked dataset that will bring together COVID-19 cases collected in state and territory notification systems and existing health datasets, including deaths, hospitals, aged care, immunisation, Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data.

This will provide an asset for use in COVID-19 research into the health effects of COVID-19. The linked dataset will also include research to inform health service planning, monitoring and evaluation, and health policy development at the national and state and territory level.

Image credit: ©stock.adobe.com/au/Chinnapong