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4812.0 - Health Risk Factors, Australia, 2001  
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 15/12/2003   
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INTRODUCTION

A range of factors influence the health outcomes of a given individual or population. These include the interaction of socioeconomic, biomedical and environmental factors which contribute to illness and injury. There are also specific lifestyle behaviours, such as smoking, exercise and dietary habits, which may further impact on one's health. In addition to these lifestyle behaviours there are other risk factors, such as high blood pressure and high cholesterol, that are associated with the increased risk of diseases like coronary heart disease and stroke. Since many behavioural risk factors, such as low exercise and smoking, can be influenced in a population, information concerning them is important to inform the development, implementation and evaluation of policies and programmes designed to reduce the burden of morbidity and mortality.


The 2001 National Health Survey (NHS) included topics on five behavioural risk factors:

  • physical activity
  • body mass
  • fruit and vegetable consumption
  • smoking
  • alcohol consumption.

The 2001 NHS also collected information on the prevalence of two additional risk factors:
  • high blood pressure
  • high cholesterol.

Research indicates that these additional risk factors are related to behavioural risk factors, such as poor diet, and/or hereditary risk factors.


In 1996, it was estimated that risk factors (such as smoking and physical inactivity) accounted for approximately one-third to one-half of the burden of disease and injury in Australia (Mathers et al. 1999). The burden of disease associated with some risk factors is greater than the burden associated with some National Health Priority Areas (NHPA) (see graph 1.1). For example, tobacco use is responsible for approximately 10% of the total burden of disease and injury in Australia, greater than the burden of National Health Priority Areas of injury (8%), diabetes (5%) and asthma (3%). Health interventions directed at promoting healthy behaviours are therefore likely to provide health benefits to the community.

Burden of disease, NHPAs and risk factors(a)
Graph - 1_Intro_DALY graph v2



In this publication, analyses of seven risk factors are presented to highlight the population groups most affected by them, and the relationships between risk factors and health status. In addition, this publication presents the seven risk factors and their relationship between socio-demographics and illness status. While acknowledging that risk factors are not always present in isolation in individuals, this publication does not attempt to explore the relationship between them in great detail.


Data that suggest associations between a given risk factor and certain illnesses should not be interpreted as indicating causal relationships (that is, that the risk factor caused the disease). Several risk factors may interact to cause or promote disease in addition to environmental, socioeconomic, genetic and other influences.


Since many health characteristics are age-related, the age profile of the populations being compared needs to be considered when interpreting the data. To account for the differences in age structure, much of the comparative data contained within this publication are shown as age standardised percentages. For further detail, see paragraph 16 of the Explanatory Notes.



PHYSICAL ACTIVITY

Being physically active is associated with positive health outcomes including reduced risk of cardiovascular disease, some cancers and depression (World Health Organisation (WHO) 2002). Conversely, physical inactivity increases the risk of developing these conditions (Mathers et al. 1999). In 1996, physical inactivity was estimated to have caused 6% of the total disease burden among Australian males and 8% among females (Mathers et al. 1999).


Australians are advised to undertake at least 30 minutes of moderate activity on most days of the week (Department of Health and Ageing (DoHA) 1999). People have the opportunity to be physically active in various areas of their life such as during work, while performing domestic duties, for transport or during their leisure time (WHO 2002). Physically inactive persons may be defined as those who are not active in any of these areas.


In the 2001 NHS, respondents aged 15 years and over were asked about exercise they had undertaken in the two weeks prior to interview through sport, recreation or fitness (including walking). Incidental exercise undertaken for other reasons, such as for work or while engaged in domestic duties was excluded. Based on the frequency, intensity and duration of exercise reported, an exercise score was derived for each respondent (see Glossary) which categorised them into one of the following exercise level groups:

  • physically inactive
  • low
  • moderate
  • high.

PREVALENCE

In 2001, 31% of those aged 15 years and over were physically inactive and 38% exercised at a low level. Almost one-quarter (24%) exercised at a moderate level and 7% at a high level. While the proportion of males and females who were physically inactive was similar (30% and 32% respectively), males were more likely to exercise at a moderate level (26% compared with 23% of females), or at a higher level (10% compared with 4% of females).


With the exception of those persons aged 45-54 years, the proportion of persons who were physically inactive increased with age to include 51% of those aged 75 years and over. While the proportion of persons who exercised at a high level declined with increasing age, this was not demonstrated for those undertaking moderate exercise. Moderate exercise levels began to decrease with age to 23% among those aged 35-44 years before increasing to 29% among those aged 65-74 years.

Proportion of persons who were physically active(a), Persons aged 15 years and over
Graph - 2_activity_time series



Comparing the 2001 NHS results with those from previous surveys demonstrates that more people aged 15 years and over are exercising than in 1989-90 and 1995 (see graph 2.1). In 1989-90, 64% were exercising at a low, moderate or high level compared with 66% in 1995 and 69% in 2001. However, this increase was mainly attributable to an increase in the number of persons undertaking light exercise (such as walking) - low levels of light exercise increased from 33% in 1989-90 to 38% in 2001. The proportion exercising at a moderate to high level showed little change (remaining around 30% over the same period). Adults aged 65-74 years showed the least improvements in physical activity (an increase of 2 percentage points over the period) while those aged 45-54 years had the greatest improvement. Among the 45-54 years age group, the proportion who were physically active increased by 10 percentage points over the period from 58% in 1989-90 to 68% in 2001.


LONG-TERM CONDITIONS AND RISK FACTORS

Compared to physically inactive persons, those who exercised at a moderate to high level were less likely to have some long-term conditions level. For example, 11% of moderate to high exercisers reported having high blood pressure compared with 14% of physically inactive persons and 13% of low exercisers. In addition, 15% of moderate to high exercisers reported arthritis compared with 19% of physically inactive persons.


The prevalence of many selected long-term conditions was similar for physically inactive persons and those who exercised at a low level. For example, among both of these groups, 4% had diabetes mellitus, while 14% of those who were physically inactive, and 13% of those who exercised at a low level, had high blood pressure.


With regard to associated risk factors, adults aged 18 years and over who exercised at moderate to high levels were least likely to be obese (11%) while the prevalence of obesity was similar among physically inactive and low exercising adults (17% and 16% respectively). The proportion who were overweight was similar across the three groups level.


Among both men and women, those who exercised at moderate to high levels demonstrated the most positive dietary habits while those who were physically inactive had the poorest dietary habits. For example, 45% of men who exercised at moderate to high levels had an inadequate fruit intake (one serve or less per day) compared with 62% of physically inactive men. The difference was slightly greater among women with 33% who exercised at moderate to high levels having an inadequate fruit intake compared with 53% of those who were physically inactive.


Men who were moderate to high exercisers were less likely to smoke (22% compared with 36% of physically inactive men). The pattern was similar for women (20% of moderate to high female exercisers were current smokers compared with 27% of physically inactive women).


POPULATION CHARACTERISTICS

Levels of physical inactivity varied across population groups. For example, 40% of adults from the most disadvantaged socioeconomic areas (lowest Socio-Economic Indexes for Areas (SEIFA) quintile) were physically inactive compared with 25% of adults from the least disadvantaged socioeconomic areas (highest SEIFA quintile). With regard to self-assessed health, those adults who reported their health as being excellent or very good were most likely to be physically active (75%) (that is, exercising at low, moderate or high levels) compared with 56% of adults who rated their health as fair or poor.


For both men and women aged 18-64 years, physical inactivity was highest among those not in the labour force (34%) and lowest among the unemployed (24% for men and 23% for women). By comparison, 29% of the employed population aged 18-64 years were physically inactive.



BODY MASS

Overweight and obesity is an increasing health problem worldwide (WHO 2000). Being overweight or obese increases the risk of developing a range of conditions, including coronary heart disease, type 2 diabetes and certain types of cancers (WHO 2000). In 1996, it was estimated that being overweight or obese accounted for approximately 4% of the total disease burden in Australia (Mathers et al. 1999).


In the 2001 NHS, respondents aged 15 years and over provided self-reported height and weight estimates. Based on this information, respondents were classified according to their body mass index (BMI) (calculated as weight in kilograms divided by the square of height in metres). The data provided are considered to be underestimates of overweight and obesity since studies have shown that respondents tend to overestimate height and underestimate weight (ABS 1995).


To produce a measure of the prevalence of being overweight or obesity in adults, BMI values are grouped to enable categories to be reported against both WHO and National Health and Medical Research Council (NHMRC) guidelines.


PREVALENCE

Results from the 2001 NHS showed 30% of persons aged over 15 years were classified as being overweight and 14% classified as obese according to their body mass index (BMI). Males were more likely to be overweight (38% compared with 22% of females) but the proportion of obese persons was similar for both males and females (14% and 15% respectively). Overweight and obesity increased with age peaking among those aged 55-64 years (39% overweight and 20% obese) before declining among the older age groups (65 years and over). The highest proportion of overweight was among males aged 55-64 years (47%) while females in the same age group had the highest overall proportion of obesity (22%).

Proportion of persons who were overweight or obese, Persons aged 15 years and over
Graph - 4_obese_time series



Australians are becoming increasingly more overweight and obese. In 1989-90, 36% of persons aged 15 years and over were overweight or obese. This increased to 39% in 1995 and 44% in 2001. The increase in overweight and obese persons was greater among males (up from 43% in 1989-90 to 52% in 2001) than females (up from 30% in 1989-90 to 37% in 2001). In addition, the increase was stronger among the older age groups. The rate of increase was greatest among those aged 65-74 years, particularly occuring during the period between 1995 and 2001 (up from 45% in 1995 to 56% in 2001 among 65-74 year olds).


LONG-TERM CONDITIONS AND RISK FACTORS

Compared with persons who were overweight or obese, those within the normal/underweight BMI categories were less likely to report certain long-term conditions. For example, 9% of normal/underweight persons reported high blood pressure compared with 13% of overweight persons and 20% of those persons who were obese. Similarly, arthritis was reported among 15% of those within the normal/underweight BMI category compared with 19% of those persons who were overweight or obese. In addition, 2% of normal/underweight persons reported having diabetes mellitus compared with 3% for overweight persons and 7% for persons who were obese.


Females who were obese were most likely to report high blood pressure (23% compared to 9% of females within the normal/underweight BMI category). They were also more likely to report arthritis (27% compared to 17% of females within the normal/underweight BMI category). Among males, those who were obese were more likely to report gout (6% compared with 1% of males within the normal/underweight BMI category).


With regard to other lifestyle related health risk factors, overweight or obese adults aged 18 years and over were less likely to be current smokers (23% compared to the 25% of adults in the normal/underweight BMI category). There were no significant differences across the BMI groups in relation to inadequate daily fruit intake (one serve or less per day). For example, 48% of adults who were overweight or obese had an inadequate fruit intake compared with 46% of adults in the normal/underweight BMI category. However, obese adults were more likely to be physically inactive (36% compared with 30% of persons in the normal/underweight BMI category) and to usually add salt after cooking, especially obese males (37% of obese males compared with 29% of men in the normal/underweight BMI category and 26% of obese females).


Excluding dental consultations, persons who were overweight or obese were more likely to have taken all other health related actions (see Glossary) in the two weeks prior to interview. For example, those persons aged 15 years and over who were obese were most likely to have consulted a doctor (31% of obese persons compared with 25% of overweight persons and 26% of normal/underweight persons). Females who were obese were more likely to have undertaken many of the health related actions. For example, 35% of obese females consulted a doctor compared with 29% of females who were not obese and 25% of obese males.


POPULATION CHARACTERISTICS

Adults living in capital cities were less likely to be overweight or obese (45%) compared with adults living outside capital cities (49%). This was evident across every age group (see graph 3.2) with the largest difference among those aged 18-24 years (25% of persons in this age group living in capital cities were overweight or obese compared with 32% of those living outside capital cities).

Proportion of overweight/obesity among adults
Graph - 5_obese_location



Adults living alone and lone adults with children were least likely to be overweight or obese (42% in both groups). Tertiary educated adults were also less likely to be overweight or obese, with 48% of men and 35% of women who were tertiary educated being classified as overweight or obese. This compares to 57% of men with either a diploma or vocational qualification, 38%of women with a diploma, and 39% of women with a vocational qualification being overweight or obese.



FRUIT AND VEGETABLE CONSUMPTION

A varied and well balanced diet is essential for providing the range and level of nutrients required for good health and wellbeing. Regular consumption of fruit and vegetables play a key role in providing the nutrients required for a balanced diet. The National Health and Medical Research Council (NHRMC) reports substantial evidence of the protective effects of fruits and vegetables against non-communicable chronic diseases, due to the presence of nutrients and 'phytochemicals' in plant foods. People who regularly eat diets high in fruit and vegetables (and legumes) have substantially lower risks of coronary heart disease, stroke, several major cancers, and possibly hypertension and type 2 diabetes mellitus (NHMRC 2003). Levels of fruit and vegetable consumption therefore contribute to indicators of a persons' health and the extent to which they are at risk of developing certain diseases.


RECOMMENDED INTAKE OF FRUIT AND VEGETABLES

The intake of fruit and vegetables required will vary slightly according to body size and activity level, but in general the NHRMC recommends consumption for adults of at least two servings of fruit and five of vegetables each day. The recommended servings are higher for both pregnant and breastfeeding women. For adolescents aged 12-18 years, the recommended average servings are for at least three servings of fruit and three servings of vegetables/legumes each day.


In the 2001 NHS, respondents aged 12 years and over were asked how many serves of vegetables (excluding legumes) they usually consumed per day, and then how many serves of fruit they usually consumed each day. The responses for both food types were categorised into '1 serve or less', '2-3 serves','4-5 serves', '6 serves or more', and 'Don't eat vegetables'/'Don't eat fruit'. These NHS categories therefore provide information that is broadly indicative of fruit and vegetable consumption.


See Glossary for measurement issues.


PREVALENCE

In recognition of the importance of a good diet in reducing risk of disease, this section concentrates on the levels of fruit and vegetable intake as reported in the population which fall below the servings recommended by the NHRMC.


Overall, almost half (47%) of the Australian population aged 12 years and over reported a fruit intake of one serve or less daily, and the majority (70%) reported a vegetable intake of three serves or less daily. Over one-third (37%) of those aged 12 years and over had a fruit intake of one serve or less per day and a vegetable intake of three serves or less per day. In general it was more common for respondents to report an inadequate vegetable intake (of three serves or less) than an inadequate fruit intake (of one serve or less).


Males were more likely to report an inadequate fruit and vegetable intake than females, with 42% having a fruit intake of one serve or less and a vegetable intake of three serves or less per day, compared to 32% of females reporting these intake levels.


For both males and females, those aged 18-24 years reported the lowest levels of fruit and vegetable intake. Among this age group, 80% reported a daily vegetable intake of three serves or less, 57% had a fruit intake of one serve or less, and almost half (48%) reported both fruit and vegetable intakes at these low levels. Fruit and vegetable intake increased with age for those aged 25 years and over. Only 24% of those aged 75 years and over reported both an inadequate fruit intake (one serve or less) and an inadequate vegetable intake (three serves or less).


LONG-TERM CONDITIONS AND RISK FACTORS

For most selected long-term conditions, there was little difference between persons who reported either an adequate or inadequate fruit and vegetable intake. The observation of similar disease prevalences among both those groups may be partly accounted for by people making some dietary modifications after being diagnosed with a particular condition.


With regard to risk factors, adults aged 18 years and over who reported an inadequate fruit and vegetable intake were more likely to be physically inactive (39% compared with 22% of those with an adequate intake), to usually add salt after their cooking (33% compared with 22%) and were more likely to currently smoke (31% compared with 18%). However, the proportion of overweight and obesity was comparable across both groups (45%).


POPULATION CHARACTERISTICS

The proportion of persons aged 18 years and over with an inadequate fruit and vegetable intake was higher among groups with particular population characteristics. For example, 39% of persons living within Major cities of Australia reported an inadequate intake compared with 32% of persons living within Remote or very Remote areas of Australia. Among men, the proportion who consumed fruit and vegetables at adequate levels increased with increasing remoteness (44% of men living in Major cities consumed inadequate fruit and vegetables compared with 36% of men in Remote or very Remote areas) (see graph 4.1).

Proportion of persons with an inadequate fruit and vegetable intake(a), By location(b)(c)
Graph - 9_fruit&veg_remoteness



In addition, 41% of persons from the most disadvantaged socioeconomic areas (lowest SEIFA quintile) reported an inadequate fruit and vegetable intake compared with 35% of adults from the least disadvantaged socioeconomic areas (highest SEIFA quintile). Those persons who lived alone were most likely to have an inadequate intake (45%), especially men (52% compared with 36% of women living alone), while persons living as a couple with children were least likely (35%) to have an inadequate intake. For adults aged 18-64 years those who were unemployed were more likely to have an inadequate intake (46%) while those not in the labour force were least likely (38%).



SMOKING

In 1996, tobacco smoking was the risk factor responsible for the greatest disease burden in Australia (12%) (Mathers et al. 1999). Worldwide, smoking is estimated to cause almost five million premature deaths each year (WHO 2002) while in Australia it is estimated that around 19,000 people died as a result of smoking in 1998 (Riddolfo & Stevenson 2001). Among other conditions, smoking is associated with increased risk of coronary heart disease, stroke, and lung cancer (Australian Institute of Health and Welfare (AIHW) 2001a).


In the 2001 NHS, adults aged 18 years and over were asked whether they currently smoked (and if so, whether they smoke regularly), or have ever smoked regularly. Based on their responses, they were categorised into one of four smoker status categories:

  • daily smoker (current regular smoker)
  • not regular smoker (current but not regular)
  • ex-regular smoker
  • never smoked regularly.

PREVALENCE

Overall, 24% of the total adult population reported that they were current smokers (comprising 22% daily smokers and 2% not-regular smokers), 26% were ex-smokers and 49% had never smoked. While the proportion of current smokers decreased with age (being highest in the 18-44 year age groups), the proportion of ex-smokers increased with age (particularly at 45 years and over) (see graph 5.1).

Smoker status — 2001
Graph - Smoker status 2001



Males were more likely than females to report that they were daily smokers (25% and 20% respectively). The proportion of males and females who reported that they smoked on a non-regular basis was similar (2%) while a greater proportion of males reported that they were ex-smokers (30%) compared with females (22%).


Since 1989-90, the proportion of adults who were current smokers declined (down from 28% to 24% in 2001). Smoking was consistently higher among men over the period 1989-90 to 2001. Of all women, those aged 18-24 years experienced the greatest reduction in smoking (down from 36% in 1989-90 to 27% in 2001), while women aged 35-44 years experienced an increase (up from 25% to 27%), the only age group to do so. Men across all age groups experienced a reduction in smoking over the 1989-90 to 2001 period.


In 1989-90, just over half (52%) of all adults reported they had ever smoked (i.e. current smokers and ex-smokers), and of this group, 45% had quit smoking. Similarly in 2001, 51% of all adults reported they had ever smoked. However a greater proportion of this group (52%) had quit smoking at the time of the survey compared to 1989-90. The increase in those who had quit smoking was evident across every age group with the exception of those aged 25-34 years (see graph 5.2).

Proportion of adults who had quit smoking –—1989–90 and 2001
Graph - Proportion of ex-smokers



The proportion of those who had quit smoking increased for both males and females over the period. In 1989-90, of the 43%of females who had ever smoked, 42% had quit smoking, while in 2001 of the 44% of females who had ever smoked, 52% had quit smoking (see graph 5.3).

Proportion of females who had quit smoking –—1989–90 and 2001
Graph - Proportion of female ex-smokers



Of the 61% of males who had ever smoked in 1989-90, 47% had quit smoking, while in 2001, 58% of males had ever smoked and 52% had quit smoking (see graph 5.4).

Proportion of males who had quit smoking –—1989–90 and 2001
Graph - Proportion of male ex-smokers



The proportion of adults who quit smoking was generally similar for both years across the 18-44 year age groups. However the proportion of adults who quit smoking was higher for the 45 years and over age groups in 2001 relative to 1989-90. For both survey years, the proportion of adults who had quit smoking continued to increase with age to 80% of those aged 75 years and over in 1989-90 and 87% of those aged 75 years and over in 2001.


While the proportion of adult ex-smokers increased between 1989-90 and 2001, the proportional change was greater for females. The proportion of female ex-smokers increased from 18% in 1989-90 to 22% in 2001, while the proportion of male ex-smokers increased from 29% to 30% over this period.


LONG-TERM CONDITIONS AND RISK FACTORS

A higher proportion of current smokers reported a mental or behavioural problem (14% compared with 10% of ex-smokers and 9% of adults who had never smoked) as well as bronchitis or emphysema (6% compared with 4% of ex-smokers and 3% of adults who had never smoked).


Adults who were current smokers were more likely to display other risk factors compared with adults who were not current smokers. The exception to this observation was that current smokers were less likely to be overweight or obese than both ex-smokers and those who had never smoked. For example, 42% of current smokers were overweight or obese compared with 45% of adults who had never smoked and 51% of ex-smokers. Current smokers also demonstrated the poorest dietary habits. In particular, most current smokers consumed inadequate daily intakes of fruit (63% compared with 47% of ex-smokers and 41% of adults who had never smoked, see graph 5.5). Male current smokers were more likely to consume inadequate daily intakes of fruit (66% compared with 58% of female current smokers).

Inadequate daily fruit intake(a) by smoker status, Australia2001
Graph - 7_smoker x low fruit



POPULATION CHARACTERISTICS

Smoking was more prevalent among adults with particular population characteristics. For example, smoking was more prevalent among adults from the more disadvantaged socioeconomic areas. Of adults from the most disadvantaged socioeconomic areas (lowest SEIFA quintile), 34% smoked compared with 17% of adults from the least disadvantaged socioeconomic areas (highest SEIFA quintile, see graph 5.6). Smoking was more common among adults of lower levels of educational attainment. Of those who were tertiary educated, 13% were current smokers compared with 20% of adults with a diploma and 26% of adults with a vocational qualification.


Adults living alone or in sole parent families with dependent children were more likely to smoke (33% and 34% respectively) while adults living as a couple with dependent children were least likely (21%). Smoking was also more likely among adults who were unemployed (40% among those aged 18-64 years compared with 26% of those employed). In particular, unemployed males had a high prevalence of smoking (46%) compared with unemployed females (32%).

Current smokers(a) by relative socioeconomic advantage(b), Proportion of adult current smokers
Graph - 8_smoker x SEIFA




ALCOHOL CONSUMPTION

Alcohol is consumed widely in Australia, with the majority of adults (62%) in the 2001 NHS reporting they had consumed alcohol in the previous week. As a health issue, alcohol consumption is associated with both positive and negative health outcomes. While low to moderate alcohol consumption has been shown to provide a level of protection from certain cardiovascular conditions (WHO 2002), harmful levels of alcohol consumption are associated with increased risk of chronic disease, injury and premature mortality (AIHW 2001a).


In the 2001 NHS, respondents aged 18 years and over were categorised as consuming alcohol at low, risky or high risk levels based on the guidelines of the National Health and Medical Research Council (NHMRC 2001) which outline alcohol risk levels for harm in the long-term (see Glossary).


Those respondents who did not drink in the seven days prior to interview were categorised as either having last consumed alcohol more than one week to less than 12 months ago, last consumed alcohol 12 months or more ago, or having never consumed alcohol. In this publication, respondents in these categories were combined into 'did not consume' alcohol.


PREVALENCE

In 2001, the majority of adults consumed alcohol at a level which posed a low risk to health or they did not consume alcohol in the seven days prior to their interview (89%). The proportion of adults who consumed alcohol at levels which would be risky or a high risk to their health if continued was 11% (7% risky and 4% high risk). Risky to high risk drinking increased with age to 45-54 years (12%) before declining to 5% among those aged 75 years and over.


While the proportion of men and women consuming alcohol at risky levels was similar (both 7%), men were more likely to drink at high risk levels compared with women (6% and 2% respectively). Among men, those aged 25-34 years were most likely to drink at high risk levels (8%) while among women, high risk drinking was most common among the 35-44 and 45-54 year age groups (3%).


An estimated 62% of adults reported that they had consumed alcohol in the previous week. Of this group, the day of the week most respondents drank was Saturday (42%), while 23% of those who had consumed alcohol in the previous week consumed alcohol on all seven days of the week. Most of the adults who consumed alcohol drank wine or champagne (38%) followed by full strength beer (27%) and spirits and liquors (19%).


LONG-TERM CONDITIONS AND RISK FACTORS

For some selected long-term conditions, there was little difference between those adults who did not consume alcohol or did so at low risk levels, and adults who drank at risky to high risk levels. However, those respondents who consumed alcohol at risky to high risk levels were more likely to report a mental or behavioural problem (13% compared with 10%) as well as gout (5% compared with 2%).


Some lifestyle related health risk factors were considerably more prevalent among risky to high risk drinkers compared with those who did not consume alcohol or did so at low risk levels. For example, 61% had an inadequate daily fruit intake (compared with 46% among those who did not consume or were low risk drinkers) and 40% were current smokers (compared with 22% who did not consume alcohol or were low risk drinkers).


Risky and high risk drinkers were also more likely to have received injuries than those who were in the low risk and non-drinker population. Of those who consumed alcohol at high risk levels, 15% reported an injury event in the four weeks prior to interview compared with 11% of risky drinkers and 10% of those who did not consume alcohol or did so at low risk levels. The difference was also greater among women (19% of high risk drinking women reported an injury event compared with 10% of risky drinkers and 9% of women who did not consume alcohol or did so at low risk levels) (see graph 6.1).

Alcohol risk and proportion of people injured—2001
Graph - 10_alcohol x injury



POPULATION CHARACTERISTICS

Levels of risky to high risk drinking varied across groups with different socio-demographic characteristics. For example, 12% of adults living outside capital cities consumed alcohol at risky to high risk levels compared with 10% of adults within the capital city areas. This difference was more evident among adult males (16% compared with 12%). With regard to income, persons within the highest income quintile were more likely to drink at risky to high risk levels (15%) when compared to persons within the lowest income quintile (9%). Those adults living alone were also more likely to drink at risky to high risk levels (14%) while single persons living with children were least likely (8%).


Of those adults aged 18-64 years, the proportion who consumed alcohol at risky to high risk levels was similar among the employed and unemployed (13% and 12% respectively). However, differences between these groups were evident when males and females were analysed separately. While 10% of employed females were in the risky to high risk drinking categories, 15% of employed males reported drinking at risky to high risk levels.


Reported drinking behaviour also varied with age and employment status. Among those aged 18-24 years, risky to high risk drinking was almost twice as likely among the unemployed (27% compared with 15% of employed adults, see graph 6.2). In contrast, among adults aged 45 years and over, high risk drinking was more prevalent among the employed population.

Proportion of risky/high risk drinkers(a), By employment status
Graph - 11_alcohol x LFS x age




HIGH BLOOD PRESSURE

According to guidelines of the World Health Organisation (1999), people are considered to have high blood pressure (hypertension) if:
  • their systolic blood pressure (see Glossary) is greater than or equal to 140mmHg, and/or
  • their diastolic blood pressure (see Glossary) is greater than or equal to 90mmHg.

It is estimated that high blood pressure is responsible for more than 5% of the total disease burden among Australians (Mathers et al. 1999). High blood pressure is recognised as being a major risk factor for coronary heart disease, stroke and heart failure among other conditions with the risk of disease increasing as high blood pressure increases (AIHW 2001b).


In the 2001 NHS, respondents were asked whether they had ever been told by a doctor or nurse that they had a heart or circulatory condition (including high blood pressure). If so, they were asked whether their condition was long-term (that is, had lasted or was expected to last six months or more). The proportion of persons with high blood pressure as a long-term condition includes those respondents who control their high blood pressure with medication.


A small proportion of respondents to the 2001 NHS with high blood pressure (1%) did not report that a doctor or nurse told them they had the condition. However, they did report high blood pressure as a long-term condition.


PREVALENCE

It is estimated that more than two and a half million people aged 15 years and over had been told by a doctor or nurse at some time during their lives that they had high blood pressure, with around 1.9 million people aged 15 years and over (13%) currently having high blood pressure as a long-term condition.


For both males and females, high blood pressure was much more prevalent among the older age groups (those aged 55 years and over). For example, while 14% of persons aged 45-54 years reported high blood pressure, this increased to 26% among those within the 55-64 year age group. High blood pressure continued to increase with age to 42% among those aged 75 years and over.


The following analyses refers to adults aged 18 years and over with high blood pressure.


LONG-TERM CONDITIONS AND RISK FACTORS

Compared to adults without high blood pressure, those with high blood pressure were more likely to have certain long-term conditions. For example, adults with high blood pressure had a much higher prevalence of high cholesterol (20% compared with 6% among those without high blood pressure). In addition, they were more than twice as likely to have diabetes (7% compared with 3% of adults without high blood pressure) and over five times more likely to report oedema (7% compared with 1% of adults without high blood pressure).


To reduce high blood pressure, people are advised to lower their weight if necessary, undertake sufficient exercise, limit alcohol intake and reduce the amount of salt in their diets (AIHW 2001b). Adults with high blood pressure were more than twice as likely to be obese compared with adults without high blood pressure (29% and 13% respectively, see graph 7.1). Obesity was especially higher among women with high blood pressure (33%) compared with men with high blood pressure (26%). Of those with high blood pressure, 37% were physically inactive, compared with 31% of those without high blood pressure. In addition, 16% of adults with high blood pressure reported risky to high risk alcohol consumption, compared to 11% of those without high blood pressure. There was little difference between those with or without high blood pressure and whether respondents added salt after cooking (28% with high blood pressure and 27% without high blood pressure).

Blood pressure levels among adults who are obese
Graph - 12_high bp x obesity



Some 35% of adults with high blood pressure consulted a doctor in the two weeks prior to interview compared with 25% of those without high blood pressure. Respondents were also asked whether they took any medications to treat their high blood pressure and if so, which medications these were. The data showed that most persons aged 18 years and over with high blood pressure used a pharmaceutical medication to treat the condition in the two weeks prior to interview (86%).


POPULATION CHARACTERISTICS

High blood pressure levels varied among adults with different socio-demographic characteristics. For example, 16% of adults from the most disadvantaged socioeconomic areas (lowest SEIFA quintile) had high blood pressure compared with 12% of adults from the least disadvantaged socioeconomic areas (highest SEIFA quintile). With regard to household composition, those adults living in one person households with children were most likely to report high blood pressure (17%) and those adults living in a couple household with or withut children were least likely (13%). High blood pressure was also more common among adults with a health care card (15%) and in particular, among those who reported their overall health as being fair or poor (19%).



HIGH CHOLESTEROL

High cholesterol is associated with increased risk of coronary heart disease and stroke, with diets high in saturated fat the likely cause of high cholesterol in most people (AIHW 2001b). In 1996, high cholesterol was estimated to account for 3% of the total disease burden among Australian males and 2% among females (Mathers et al. 1999).


Total blood cholesterol levels above 5.5 mmol/L are considered to increase the risk of developing coronary heart disease and levels above 6.5 mmol/L are considered to place people within a high risk category (AIHW 2001b).


In the 2001 NHS, respondents were asked whether they had ever been told by a doctor or nurse that they had a heart or circulatory condition (including high cholesterol). If so, they were asked whether their condition was long-term (that is, had lasted or was expected to last six months or more). The proportion of persons with high cholesterol as a long-term condition included those respondents who controlled their high cholesterol with medication.


A small proportion of respondents with high cholesterol (less than 1%) did not report that a doctor or nurse told them they had the condition. However, they did report high cholesterol as a long-term condition.


PREVALENCE

It is estimated that over 1.7 million people had been told by a doctor or nurse at some time during their lives that they had high cholesterol. The proportion of persons who reported that they currently had high cholesterol as a long-term condition was 8% among those persons aged 15 years and over.


High cholesterol increased with age and in particular, was more prevalent among those aged 45 years and over. For example, 3% of those aged 35-44 years had high cholesterol compared with 9% among the 45-54 year age group. High cholesterol was highest among those aged 65-74 years (21%) before declining among those aged 75 years and over (17%).


LONG-TERM CONDITIONS AND RISK FACTORS

Adults with high cholesterol were more likely to have particular long-term conditions. For example, 7% also reported having ischaemic heart disease compared with 2% of those without high cholesterol. In addition, 9% of those with high cholesterol also reported diabetes compared with 3% of adults without high cholesterol.


Almost 30% of adults with high cholesterol also had high blood pressure in comparison with 11% of adults without high cholesterol. High blood pressure was greater among those adults with high cholesterol across every age group (see graph 8.1).

High blood pressure and cholesterol levels among adults
Graph - 13_high chol x high bp



Adults with high cholesterol were more likely to display other risk factors when compared with adults without high cholesterol. For example, 56% of adults with high cholesterol consumed low daily amounts of fruit compared with 48% of those without high cholesterol. The proportion of adults who were overweight was highest among men with high cholesterol (55% compared with 40% of men without high cholesterol). Women with high cholesterol were more likely to be obese (24% compared with 15% of women without high cholesterol).


Respondents were also asked whether they took any medications to treat their high cholesterol and if so, which medications these were. The data showed that 62% of adults aged 18 years and over with high cholesterol used a pharmaceutical medication to treat the condition in the two weeks prior to interview.


POPULATION CHARACTERISTICS

The proportion of adults with high cholesterol was similar between selected population characteristic groups. For example, 5% of employed adults aged 18-64 years reported having high cholesterol compared with 6% of unemployed adults. Among females, those within the lowest income quintile were more likely to report having high cholesterol (9% compared with 5% among women in the highest income unit quintile). However, among males, the proportion with high cholesterol was similar across the lowest and highest income quintiles (9% and 11% respectively).



BIBLIOGRAPHY

Australian Bureau of Statistics (ABS) 1995, National Nutrition Survey: Selected Highlights Australia, cat. no. 4802.0, ABS, Canberra.


Australian Institute of Health and Welfare (AIHW) 2001a, Chronic diseases and associated risk factors in Australia, AIHW, Canberra, AIHW cat. no. PHE 33.


Australian Institute of Health and Welfare (AIHW) 2001b, Heart, stroke and vascular diseases - Australian facts 2001, AIHW, Heart Foundation of Australia, National Stroke Foundation of Australia, Canberra, AIHW cat. no. CVD13.


Blakiston's Gould Medical Dictionary 1972, McGraw-Hill, USA.


Commonwealth Department of Health and Ageing (DoHA) & National Health and Medical Research Council (NHMRC) 2003, Food for Health: Dietary Guidelines for Australians, Canberra.


Commonwealth Department of Health and Ageing (DoHA) 1999, National physical activity guidelines for Australians, Canberra.


Commonwealth Department of Health and Ageing (DoHA) 1998, The Australian guide to healthy eating: background information for nutrition educators, DoHA, Canberra.


Mathers, C, Vos, T & Stevenson, C 1999, The burden of disease and injury in Australia, AIHW, Canberra, AIHW cat. no. PHE 17.


National Health and Medical Research Council (NHMRC) 2001, Australian Alcohol Guidelines: Health Risks and Benefits, .


National Health and Medical Research Council (NHMRC) 2003, Dietary Guidelines for Australian Adults, Commonwealth of Australia, Canberra.


Riddolfo, B & Stevenson, C 2001, The quantification of drug-caused mortality and morbidity in Australia, 1998, AIHW, Canberra.


World Health Organisation (WHO) 1999, 'International Society of Hypertension guidelines for the management of hypertension - guidelines subcommittee', Journal of Hypertension 17: pp. 151-183.


World Health Organisation (WHO) 2000, Obesity: preventing and managing the global epidemic, WHO Technical Series: No. 894, WHO, Geneva.


World Health Organisation (WHO) 2002, The World health report 2002, WHO, Geneva.


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