The World Health Organization (WHO) defines health as “... a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity”. Aspects of the physical and mental health of a population can be assessed by examining the prevalence of diseases (i.e. the total number of cases of a disease in a given population at a specific time), as well as disability and mortality rates. Assessing the social and mental wellbeing of a population is more subjective, although the ABS can partly meet these information needs through instruments such as the SF-12 questions on self-assessed health and bodily pain, and the K10 questions that determine levels of psychological distress.
The SF-12 is a short-form health survey with 12 questions that provide data on physical and mental health and wellbeing. The K10 is a 10-item questionnaire that provides a global measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent four-week period (the Kessler Psychological Distress Scale). Data for the SF-12 were collected from people aged 15 years and over, while the K10 was asked of people 18 years and over.
This section presents general wellbeing data from these question sets in the 2007–08 National Health Survey (NHS), along with data for selected long–term health conditions in Australia in 2007–08. Long-term conditions are defined as medical conditions or injuries that were current at the time of reporting and had lasted, or were expected to last, for at least six months. In most cases, respondents were asked about conditions that had been medically diagnosed. The section includes an overview of the most prevalent conditions and more detailed data for the Australian national health priority areas.
The ABS classifies data on health conditions according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
The data presented in this section are as reported by respondents to the 2007–08 NHS. The reported data may underestimate or overestimate actual prevalence. For example, some people may not realise that they are suffering from a condition, or may not have understood their diagnosis correctly. Biomedical data from the 2012–13 Australian Health Survey will be invaluable in measuring some of this uncertainty.
WELLBEING
Self-assessed health
In 2007–08, the majority of people aged 15 years and over considered themselves to be in good health, with 85% reporting their health status as good, very good or excellent. The proportion of people reporting fair or poor health increased with age, from 7% of those aged 15–24 years to 39% of those aged 75 years and over (graph 11.1).
Bodily pain
One in ten people aged 15 years and over in 2007–08 reported feeling severe (8%) or very severe (2%) pain in the four weeks prior to being surveyed. One in five (19%) reported moderate pain and 39% had mild or very mild bodily pain. Rates of experiencing moderate to very severe pain increased steadily with age, from 18% of people aged 15–24 years to 43% of people aged 75 years and over. Females were slightly more likely than males to report any bodily pain in the previous four weeks (69% compared with 65%). A third of people 15 years and over felt no bodily pain in the previous four weeks (33%).
Bodily pain did not necessarily correlate with feelings of poor health. Four out of five people (81%) who reported any bodily pain in the previous four weeks rated their general health as good to excellent, as did nearly half (46%) of people who reported experiencing very severe pain in this time. On the other hand, 33% of people with very severe pain rated their health as poor, compared with the average of 4%.
Levels of psychological distress
In 2007–08, around 12% of people aged 18 years and over experienced high or very high levels of psychological distress and a further 21% experienced moderate levels of psychological distress (similar to 2001 and 2004–05 rates). Women were more likely than men to experience psychological distress, with 14% of women and 10% of men experiencing high or very high levels of distress, and 23% of women and 19% of men experiencing moderate levels.
People with high or very high levels of psychological distress were much more likely to rate their general health as only fair or poor (42% compared with 9% of those with low distress levels – see graph 11.2).
LONG-TERM HEALTH CONDITIONS
In 2007–08, three-quarters of people (of all ages) reported (or had reported on their behalf) having a long-term health condition. Just over one in four people were long-sighted (26% or 5.3 million people), and a further 23% were short-sighted (4.7 million people). Arthritis and Hayfever and allergic rhinitis each affected one in seven people (15% or 3.1 million people), similar to Back pain and disc disorders (14% or 2.8 million). Around one in ten people was affected by each of the following conditions:
Mental and behavioural problems (11% or 2.3 million people)
Complete or partial hearing loss (10% or 2.1 million people)
Asthma (10% or 2 million people)
Hypertensive disease (9% or 1.9 million people).
Other commonly reported conditions were High cholesterol and Migraine (both 6% or 1.2 million people); Heart, stroke and vascular diseases (5% or 1 million); Diabetes mellitus (4% or 818,000 people); Disorders of thyroid gland (2% or 486,000 people); and Malignant neoplasms (cancer) (2% or 327,000 people). Graph 11.3 shows rates for these conditions by sex.
The prevalence of long-term health conditions rose steadily with age, from 37% of people under 15 years of age, to 99% of people aged 55 years and over. Females were slightly more likely to have one or more long-term health conditions than males (78% compared with 73%), which may be partly due to the fact that there are more women in the older age ranges (In 2007–08, 54% of people over the age of 65 years were women).
Interestingly, 83% of people with a long-term health condition felt that their general health was good, very good or excellent.
NATIONAL HEALTH PRIORITY AREAS
The Australian Government National Health Priority Areas (NHPA) initiative focuses on conditions that contribute most to the burden of disease in the community, particularly where this can be significantly reduced through health policy or programs. The burden of disease and injury is a measurement of time lost due to premature death, and years of healthy life lost due to disability; however, the NHPAs also represent a considerable economic and social burden.
This section presents data on arthritis and musculoskeletal conditions, asthma, cancer, conditions of the circulatory system, diabetes, injuries and mental health. The remaining NHPA, obesity, is discussed in HEALTH RISK FACTORS later in this chapter.
Wellbeing of people with NHPA conditions
People aged 18 years and over with NHPA conditions were more likely to report experiencing severe or very severe levels of bodily pain, general health that was only fair or poor, and higher levels of psychological distress than average, as shown in the graphs 11.4, 11.5 and 11.6.
Arthritis and other musculoskeletal diseases
Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. Although they are not immediately life threatening and have low associated mortality, they have substantial influence on people's quality of life and impose a heavy economic burden on the community. In 2004–05, total health expenditure attributable to musculoskeletal diseases was $4.0 billion, which accounted for 8% of allocated health system expenditure in Australia (AIHW, 2010a).
In 2007–08, 15% of people reported that they currently had arthritis (13% of males and 18% of females). Of people with arthritis, 51% had osteoarthritis and 14% rheumatoid arthritis. The proportion of people with arthritis increased with age, from 2% of people under 35 years to 53% of people aged 75 years and over.
Around 1% of males and 6% of females had osteoporosis (3% overall). Rates of osteoporosis also increased with age, from less than 1% of people under 35 years to 16% of people aged 65 and over (graph 11.7).
Arthritis and musculoskeletal diseases were the underlying cause for 1,078 registered deaths or 0.8% of all deaths registered in Australia in 2009, and were identified as either an underlying cause or associated cause of death for 6,410 deaths registered in Australia in that year.
Of all deaths due to arthritis and musculoskeletal diseases in 2009, 761 (71%) were female, predominantly in the age group 75 to 94 years. The median age at death for deaths due to these diseases was 83 years (80.9 years for males and 84.0 years for females).
Asthma
By international standards,the prevalence of asthma is relatively high in Australia, with more than two million people (10%) reporting having the disease in 2007–08. Asthma was the most prevalent chronic illness in children under 15 years of age (10%). Boys (12%) were more likely than girls (8%) to have asthma, although this was reversed for people aged 15 years and over, with 12% of females and 8% of males having the condition.
Asthma is more likely to be reported by people living in more disadvantaged areas than those in less disadvantaged areas (graph 11.8).
People with asthma can experience reduced quality of life and require a range of health services to manage their condition. Asthma is a common cause of absenteeism from school and also affects family, work and recreation (AIHW, 2011a). In 2004–05, the condition accounted for 1.2% of allocated health system expenditure in Australia, while respiratory diseases as a whole accounted for $3.3 billion, or 6% of allocated health expenditure.
In 2007–08, just over a quarter (26%) of adults aged 18 years and over with asthma rated their health as only 'fair' or 'poor' compared with 15% of adults without asthma (graph 11.5). Asthmatics also reported higher levels of psychological distress, with 20% of asthmatics aged 18 years and over reporting high or very high levels of psychological distress in the previous four weeks, compared with 11% of people without asthma (graph 11.6).
Around 22% of people with asthma reported that their asthma had become worse or out of control in the previous year. Of those people, 42% went to hospital for treatment. Children tended to have higher rates of hospitalisation than adults – 64% of children whose asthma got worse or out of control in the previous year had been to hospital for their asthma, compared with 33% of people aged 15 years and over. One-fifth (21%) of people with asthma had a written asthma action plan.
Asthma symptoms are usually reversible with treatment, but death can sometimes result if a severe asthmatic episode is not managed properly. In 2009, asthma was the underlying cause for 411 registered deaths, or 0.3% of all deaths in Australia, and was identified as either an underlying cause or associated cause of death for 1,344 deaths in this time.
Women were twice as likely to have asthma as an underlying cause of death as men, with 100 female deaths for every 46 male deaths. The median age at death for deaths due to asthma was 73.1 years for males, 80.2 years for females and 77.9 years overall.
Cancer
In 2007–08, an estimated 1.6% of people reported that they had a medically diagnosed malignant neoplasm (cancer). Rates of cancer increased with age, from less than 1% of people aged under 15 years to around 5% of people aged 65 years and over. It should be noted that the 2007–08 National Health Survey excluded people in hospitals, nursing and convalescent homes and hospices, which may have a greater effect on cancer data than on other conditions.
Of people aged 18 years and over with cancer:
17% reported experiencing severe or very severe bodily pain in the previous four weeks (compared with the national average of 10%, see graph 11.4)
47% felt that their general health was only fair or poor (much higher than the national average of 15%, see graph 11.5) and
20% experienced high or very high levels of psychological distress in the previous four weeks (compared with the national average of 12%, see graph 11.6).
Cancer accounted for $3.8 billion (7%) of Australia's expenditure on health in 2004–05; however, it was responsible for nearly a fifth (19%) of premature death and disability in that year.
In 2009, cancer was the underlying cause of death for 41,952 registered deaths, accounting for 30% of all registered deaths. Cancer contributed to a total of 48,165 deaths as either an underlying or associated cause of death. The standardised death rate for cancer was 175.6 per 100,000 population in 2009, with 130 male deaths per 100 female deaths for the reference year. The median age of people dying from cancer was 75.1 (75.0 years for men and 75.4 years for women).
Conditions of the circulatory system
Although death rates for conditions of the circulatory system have declined in recent decades, this group of diseases continues to be one of the biggest health problems in Australia, and its health and economic burden continues to exceed that of any other disease (AIHW, 2011b). In 2004–05, the highest health expenditure of all disease groups was for conditions of the circulatory system at $5.9 billion, or 11% of total allocated health expenditure.
Many Australians are at increased risk of developing some form of circulatory disease due to risk factors such as cigarette smoking, high blood pressure, high cholesterol level, being overweight or leading a sedentary lifestyle. High cholesterol levels were reported by 6% of people, rising with age to 17% of people aged 65 years and over. Data for other risk factors are presented in HEALTH RISK FACTORS in this chapter.
In 2007–08, 16% of people reported one or more long-term conditions of the circulatory system, with the most common being hypertension (high blood pressure) at 9%. One in ten people aged 45–54 years reported having hypertension, increasing to 35% of people aged 65 years and over.
Circulatory conditions were mostly experienced by people in middle and older age groups. Almost one in five (19%) people aged 45–54 years had a current long-term circulatory condition, rising progressively to 62% of people aged 75 years and over. The circulatory conditions that form the most significant health and economic burden are heart, stroke and vascular diseases (including ischaemic heart disease, cerebrovascular disease, oedema, heart failure, and diseases of the arteries, arterioles and capillaries). Around 7% of people reported having a heart, stroke or vascular disease in 2007–08 (8% of males and 6% of females).
Ischaemic heart disease was the leading cause of death in 2009, with 12,047 male and 10,476 female deaths (115 male deaths per 100 female deaths). In 2007–08, around a quarter of people who had a heart, stroke or vascular disease (25%) reported experiencing severe or very severe levels of bodily pain in the last 4 weeks, compared with the national average of just under 10% (graph 11.4).
Overall, conditions of the circulatory system accounted for 46,106 deaths in 2009, or 33% of all deaths, contributing to 80,375 deaths overall as either an underlying or associated cause of death. The general decrease in deaths from these conditions since the 1960s (graph 11.9) is due in part to a reclassification of underlying causes of death (with some deaths shifting from Cerebrovascular diseases to Vascular dementia). The median age of people dying from circulatory conditions was 81.3 years for males and 87.2 years for females.
Diabetes mellitus
Diabetes is a costly disease associated with substantial morbidity and mortality, mostly from cardiovascular complications, eye and kidney diseases, and limb amputations. In 2004–05, total health expenditure attributable to diabetes was nearly $1.0 billion, accounting for 2% of allocated health system expenditure.
In the 2007–08 NHS, 4% of people reported having diabetes as a long-term condition, rising from 2.4% in 1995. More males than females had the condition (5% and 3% respectively). Diabetes rates also increased with age, particularly after the age of 45 years (graph 11.10).
Over half of all people aged 18 years and over with diabetes felt that their general health was only fair or poor (52%), compared with the national average of 15% (graph 11.5).
The majority of people with diabetes (88%) reported that they had Type 2 diabetes. Type 2 diabetes is associated with a number of risk factors, such as excess weight, poor diet, inactivity and smoking. For example, of people aged 35 years and over, those who were obese were about twice as likely to have Type 2 diabetes as those in other weight ranges (51% compared with 27% after adjusting for age). People in this age group who were sedentary or exercised at low levels were also more likely to have diabetes than people who exercised at high or moderate levels (8% and 6% after adjusting for age).
Diabetes was the underlying cause for 4,170 (3%) deaths registered in Australia in 2009, and contributed to 14,286 (10%) deaths as either an underlying or associated cause of death. The standardised death rate for this condition was 17.1 per 100,000 population in 2009 (20.6 per 100,000 males, and 14.2 per 100,000 females), an increase from 16.0 per 100,000 population in 2000.
The median age at death was 80.9 years (78.5 years for men and 83.3 years for women). Type 2 diabetes accounted for 1,772 deaths, or 42% of all diabetes deaths.
Injuries
Injuries (including poisoning) are associated with high morbidity, and are a leading cause of premature mortality in Australia. They can result in fatalities, survival with ongoing dysfunction or the onset of secondary conditions (such as osteoarthritis in injured joints). In 2009, just over 6% of people with a disability reported injury or accident as their main disabling condition.
The terms ‘injury’ and ‘poisoning’ encompass the adverse effects on the human body that result from particular events. These can be accidental such as falls, vehicle accidents and exposure to chemicals, or intentional such as suicide attempts and assaults by other people. Injury patterns vary significantly by age and sex. Near-drowning and drowning, for example, are major causes of injury and death in early childhood, while self-harm and road crashes are primary causes of injury in young adulthood. Falls are the most common cause of death caused by injury among the elderly. Incidence rates of serious injury are higher for males than females, both overall and for most types of injury (AIHW, 2010b).
In 2004–05, total health expenditure attributable to injuries was $3.4 billion, accounting for 7% of allocated health system expenditure.
In 2007–08, injuries accounted for over 1 in 20 (426,000) hospitalisations in Australia (AIHW, 2010b). About 2.4 million people had a long-term condition caused by an injury. Almost half (47%) of disc disorders and 30% of back pain/problems were caused by an injury, as were 15% of arthropathies (joint diseases) and 10% of partial deafness/hearing loss cases. Nearly 80,000 people had an amputation as a result of an injury.
Most people who had a long-term condition as the result of an injury acquired it at work (1 million people or 41%), followed by participation in exercise and sport (531,000 people or 22%). A further 410,000 people (17%) had a long-term condition as the result of a motor vehicle accident, and 334,000 people (14%) injured themselves at home. Men were more likely to acquire a long-term condition as a result of a work injury, whereas women were more likely to acquire their long-term injury at home or in a motor vehicle accident (graphs 11.11 and 11.12).
In 2009, injuries due to external causes accounted for 8,884 deaths, or 6.3% of all registered deaths. The standardised death rate for injuries was 38.6 per 100,000 of population (55.1 per 100,000 for males and 23.2 per 100,000 for females).
Over time, more men than women have died from external causes, and at younger ages. Consistent with previous years, around two-thirds of the total number of deaths resulting from external causes in 2009 were males (5,886, or 66%). Median age at death for injuries was 47.4 years for males, 66.7 years for females and 51.8 years overall.
Mental health
The designation of mental health as one of the national health priority areas recognises its enormous social and public health importance. Mental health is one of the leading contributors to the non-fatal burden of disease and injury in Australia. It is associated with increased exposure to health risk factors, greater rates of disability, poorer physical health and higher rates of death from many causes including suicide. Mental health problems incur high direct and indirect costs, result in a high number of hospitalisations and impose a heavy burden of human suffering (AIHW, 2011c).
In 2004–05, mental health accounted for 8% of allocated health system expenditure, at $4.1 billion, but by 2008–09 this figure had increased to more than $5.8 billion, or $272 per person (up from $225 per person in 2004–05) (AIHW, 2010a).
In 2009–10, the Australian Government paid $755 million in benefits for Medicare Benefits Schedule (MBS) subsidised mental health related services, around 4.9% of all MBS subsidies. Subsidies for psychologist services made up $287 million of the expenditure. Around 9.7% of subsidies for prescription medication were spent on prescriptions for mental health conditions (equivalent to $35 per Australian) (AIHW, 2011d).
In the 2007 ABS Survey of Mental Health and Wellbeing (SMHWB), mental health condition status was assessed through a diagnostic instrument (the World Health Organization Composite International Diagnostic Interview (CIDI)). Of the 16 million Australians aged 16–85 years in 2007, almost half (45% or 7.3 million) were assessed as having had a mental disorder at some time in their life. One in five (20% or 3.2 million) were assessed as having a current mental health disorder (having had symptoms of that disorder in the 12 months prior to interview).
Women were more likely to experience anxiety disorders (18% compared with 11% for men) and affective disorders (7% compared with 5% for men). Men had twice the rate of substance use disorders (7% compared with 3% for women). Prevalence varied by age, with people in younger age groups experiencing higher rates of disorder (graph 11.13)
Adolescence and young adulthood is a critical stage of transition in physical and mental development, and vulnerability to mental illness is heightened at this time. Around three-quarters (76%) of people who experience mental disorder during their lifetime will first develop a disorder before the age of 25 years. In 2007, just over a quarter of all young people aged 16–24 years had a mental disorder in the previous year (approximately 26% or 671,000 young people). Young women were more likely than young men to have had a mental disorder (30% compared with 23%).
Around 21% of young people with a mental disorder had experienced high or very high levels of psychological distress in the previous 4 weeks, compared with 32% of people over 25 with a mental disorder, and 4% of people with no mental disorder. However, over half (56%) of young people with a mental disorder were pleased or satisfied with the general quality of their life, and 16% were delighted with it.
Overall, one in ten people with a mental disorder reported being delighted with the quality of their life, compared with 20% of people without a mental disorder. However, almost half (48%) of the people who reported a mental health condition in 2007–08 also reported high or very high levels of psychological distress in the previous four weeks – around four times the national average of 12% (graph 11.6). In 2007, almost 2% of people with a 12-month mental disorder reported that they had attempted suicide, and 8% had thought about it sometime in the previous year.
In 2007, 38% of all people with a mental disorder (or 1.2 million people) had two or more mental disorders. A mix of mood and anxiety disorders was the most common combination, making up 39% of all co-morbidity cases (472,000 people), with people with more than one anxiety disorder making up a further 27% (331,000 people).
Around 59% of people with a mental disorder also had a physical condition, compared with 48% of those without a mental disorder. After adjusting for age differences in the populations with and without mental disorders, the gap between the rates of those with physical conditions further widened (from 11 to 17 percentage points). Co-morbidity with physical conditions was most common for people with mood disorders, 64% of whom also had a physical condition (Australian Social Trends, March 2009, 4102.0).
In 2007, 1.9 million Australians aged 16–85 years (12%) accessed services for mental health problems in the previous year. Around a third of people with a current, long-term mental disorder (35%) accessed these services, with more females doing so than males (41% and 28% respectively).
Mental health disorders were identified as the underlying cause of 6,522 registered deaths in 2009, representing 4.6% of all registered deaths in Australia in that year. (Dementia accounted for 89% of these deaths.) In total, 21,384 deaths were due to, or associated with, mental health disorders.
The prevalence of mental health disorders as an underlying cause has increased significantly over the last ten years. In 2009, the standardised death rate for mental health disorders was 25.2 per 100,000 of population, an increase from 16.5 per 100,000 population in 2000.
In 2009, more than half the deaths due to mental health disorders were females (4,130 or 63%). The median age at death was higher for females at 88.9 years, compared with 84.6 years for males
Statistics contained in the Year Book are the most recent available at the time of preparation. In many cases, the ABS website and the websites of other organisations provide access to more recent data. Each Year Book table or graph and the bibliography at the end of each chapter provides hyperlinks to the most up to date data release where available.
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This page first published 24 May 2012, last updated 11 November 2015
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HEALTH STATUS
The World Health Organization (WHO) defines health as “... a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity”. Aspects of the physical and mental health of a population can be assessed by examining the prevalence of diseases (i.e. the total number of cases of a disease in a given population at a specific time), as well as disability and mortality rates. Assessing the social and mental wellbeing of a population is more subjective, although the ABS can partly meet these information needs through instruments such as the SF-12 questions on self-assessed health and bodily pain, and the K10 questions that determine levels of psychological distress.
The SF-12 is a short-form health survey with 12 questions that provide data on physical and mental health and wellbeing. The K10 is a 10-item questionnaire that provides a global measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent four-week period (the Kessler Psychological Distress Scale). Data for the SF-12 were collected from people aged 15 years and over, while the K10 was asked of people 18 years and over.
This section presents general wellbeing data from these question sets in the 2007–08 National Health Survey (NHS), along with data for selected long–term health conditions in Australia in 2007–08. Long-term conditions are defined as medical conditions or injuries that were current at the time of reporting and had lasted, or were expected to last, for at least six months. In most cases, respondents were asked about conditions that had been medically diagnosed. The section includes an overview of the most prevalent conditions and more detailed data for the Australian national health priority areas.
The ABS classifies data on health conditions according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).
The data presented in this section are as reported by respondents to the 2007–08 NHS. The reported data may underestimate or overestimate actual prevalence. For example, some people may not realise that they are suffering from a condition, or may not have understood their diagnosis correctly. Biomedical data from the 2012–13 Australian Health Survey will be invaluable in measuring some of this uncertainty.
WELLBEING
Self-assessed health
In 2007–08, the majority of people aged 15 years and over considered themselves to be in good health, with 85% reporting their health status as good, very good or excellent. The proportion of people reporting fair or poor health increased with age, from 7% of those aged 15–24 years to 39% of those aged 75 years and over (graph 11.1).
Bodily pain
One in ten people aged 15 years and over in 2007–08 reported feeling severe (8%) or very severe (2%) pain in the four weeks prior to being surveyed. One in five (19%) reported moderate pain and 39% had mild or very mild bodily pain. Rates of experiencing moderate to very severe pain increased steadily with age, from 18% of people aged 15–24 years to 43% of people aged 75 years and over. Females were slightly more likely than males to report any bodily pain in the previous four weeks (69% compared with 65%). A third of people 15 years and over felt no bodily pain in the previous four weeks (33%).
Bodily pain did not necessarily correlate with feelings of poor health. Four out of five people (81%) who reported any bodily pain in the previous four weeks rated their general health as good to excellent, as did nearly half (46%) of people who reported experiencing very severe pain in this time. On the other hand, 33% of people with very severe pain rated their health as poor, compared with the average of 4%.
Levels of psychological distress
In 2007–08, around 12% of people aged 18 years and over experienced high or very high levels of psychological distress and a further 21% experienced moderate levels of psychological distress (similar to 2001 and 2004–05 rates). Women were more likely than men to experience psychological distress, with 14% of women and 10% of men experiencing high or very high levels of distress, and 23% of women and 19% of men experiencing moderate levels.
People with high or very high levels of psychological distress were much more likely to rate their general health as only fair or poor (42% compared with 9% of those with low distress levels – see graph 11.2).
LONG-TERM HEALTH CONDITIONS
In 2007–08, three-quarters of people (of all ages) reported (or had reported on their behalf) having a long-term health condition. Just over one in four people were long-sighted (26% or 5.3 million people), and a further 23% were short-sighted (4.7 million people). Arthritis and Hayfever and allergic rhinitis each affected one in seven people (15% or 3.1 million people), similar to Back pain and disc disorders (14% or 2.8 million). Around one in ten people was affected by each of the following conditions:
Other commonly reported conditions were High cholesterol and Migraine (both 6% or 1.2 million people); Heart, stroke and vascular diseases (5% or 1 million); Diabetes mellitus (4% or 818,000 people); Disorders of thyroid gland (2% or 486,000 people); and Malignant neoplasms (cancer) (2% or 327,000 people). Graph 11.3 shows rates for these conditions by sex.
The prevalence of long-term health conditions rose steadily with age, from 37% of people under 15 years of age, to 99% of people aged 55 years and over. Females were slightly more likely to have one or more long-term health conditions than males (78% compared with 73%), which may be partly due to the fact that there are more women in the older age ranges (In 2007–08, 54% of people over the age of 65 years were women).
Interestingly, 83% of people with a long-term health condition felt that their general health was good, very good or excellent.
NATIONAL HEALTH PRIORITY AREAS
The Australian Government National Health Priority Areas (NHPA) initiative focuses on conditions that contribute most to the burden of disease in the community, particularly where this can be significantly reduced through health policy or programs. The burden of disease and injury is a measurement of time lost due to premature death, and years of healthy life lost due to disability; however, the NHPAs also represent a considerable economic and social burden.
This section presents data on arthritis and musculoskeletal conditions, asthma, cancer, conditions of the circulatory system, diabetes, injuries and mental health. The remaining NHPA, obesity, is discussed in HEALTH RISK FACTORS later in this chapter.
Wellbeing of people with NHPA conditions
People aged 18 years and over with NHPA conditions were more likely to report experiencing severe or very severe levels of bodily pain, general health that was only fair or poor, and higher levels of psychological distress than average, as shown in the graphs 11.4, 11.5 and 11.6.
Arthritis and other musculoskeletal diseases
Osteoarthritis, rheumatoid arthritis and osteoporosis are the most commonly occurring musculoskeletal conditions. Although they are not immediately life threatening and have low associated mortality, they have substantial influence on people's quality of life and impose a heavy economic burden on the community. In 2004–05, total health expenditure attributable to musculoskeletal diseases was $4.0 billion, which accounted for 8% of allocated health system expenditure in Australia (AIHW, 2010a).
In 2007–08, 15% of people reported that they currently had arthritis (13% of males and 18% of females). Of people with arthritis, 51% had osteoarthritis and 14% rheumatoid arthritis. The proportion of people with arthritis increased with age, from 2% of people under 35 years to 53% of people aged 75 years and over.
Around 1% of males and 6% of females had osteoporosis (3% overall). Rates of osteoporosis also increased with age, from less than 1% of people under 35 years to 16% of people aged 65 and over (graph 11.7).
Arthritis and musculoskeletal diseases were the underlying cause for 1,078 registered deaths or 0.8% of all deaths registered in Australia in 2009, and were identified as either an underlying cause or associated cause of death for 6,410 deaths registered in Australia in that year.
Of all deaths due to arthritis and musculoskeletal diseases in 2009, 761 (71%) were female, predominantly in the age group 75 to 94 years. The median age at death for deaths due to these diseases was 83 years (80.9 years for males and 84.0 years for females).
Asthma
By international standards, the prevalence of asthma is relatively high in Australia, with more than two million people (10%) reporting having the disease in 2007–08. Asthma was the most prevalent chronic illness in children under 15 years of age (10%). Boys (12%) were more likely than girls (8%) to have asthma, although this was reversed for people aged 15 years and over, with 12% of females and 8% of males having the condition.
Asthma is more likely to be reported by people living in more disadvantaged areas than those in less disadvantaged areas (graph 11.8).
People with asthma can experience reduced quality of life and require a range of health services to manage their condition. Asthma is a common cause of absenteeism from school and also affects family, work and recreation (AIHW, 2011a). In 2004–05, the condition accounted for 1.2% of allocated health system expenditure in Australia, while respiratory diseases as a whole accounted for $3.3 billion, or 6% of allocated health expenditure.
In 2007–08, just over a quarter (26%) of adults aged 18 years and over with asthma rated their health as only 'fair' or 'poor' compared with 15% of adults without asthma (graph 11.5). Asthmatics also reported higher levels of psychological distress, with 20% of asthmatics aged 18 years and over reporting high or very high levels of psychological distress in the previous four weeks, compared with 11% of people without asthma (graph 11.6).
Around 22% of people with asthma reported that their asthma had become worse or out of control in the previous year. Of those people, 42% went to hospital for treatment. Children tended to have higher rates of hospitalisation than adults – 64% of children whose asthma got worse or out of control in the previous year had been to hospital for their asthma, compared with 33% of people aged 15 years and over. One-fifth (21%) of people with asthma had a written asthma action plan.
Asthma symptoms are usually reversible with treatment, but death can sometimes result if a severe asthmatic episode is not managed properly. In 2009, asthma was the underlying cause for 411 registered deaths, or 0.3% of all deaths in Australia, and was identified as either an underlying cause or associated cause of death for 1,344 deaths in this time.
Women were twice as likely to have asthma as an underlying cause of death as men, with 100 female deaths for every 46 male deaths. The median age at death for deaths due to asthma was 73.1 years for males, 80.2 years for females and 77.9 years overall.
Cancer
In 2007–08, an estimated 1.6% of people reported that they had a medically diagnosed malignant neoplasm (cancer). Rates of cancer increased with age, from less than 1% of people aged under 15 years to around 5% of people aged 65 years and over. It should be noted that the 2007–08 National Health Survey excluded people in hospitals, nursing and convalescent homes and hospices, which may have a greater effect on cancer data than on other conditions.
Of people aged 18 years and over with cancer:
Cancer accounted for $3.8 billion (7%) of Australia's expenditure on health in 2004–05; however, it was responsible for nearly a fifth (19%) of premature death and disability in that year.
In 2009, cancer was the underlying cause of death for 41,952 registered deaths, accounting for 30% of all registered deaths. Cancer contributed to a total of 48,165 deaths as either an underlying or associated cause of death. The standardised death rate for cancer was 175.6 per 100,000 population in 2009, with 130 male deaths per 100 female deaths for the reference year. The median age of people dying from cancer was 75.1 (75.0 years for men and 75.4 years for women).
Conditions of the circulatory system
Although death rates for conditions of the circulatory system have declined in recent decades, this group of diseases continues to be one of the biggest health problems in Australia, and its health and economic burden continues to exceed that of any other disease (AIHW, 2011b). In 2004–05, the highest health expenditure of all disease groups was for conditions of the circulatory system at $5.9 billion, or 11% of total allocated health expenditure.
Many Australians are at increased risk of developing some form of circulatory disease due to risk factors such as cigarette smoking, high blood pressure, high cholesterol level, being overweight or leading a sedentary lifestyle. High cholesterol levels were reported by 6% of people, rising with age to 17% of people aged 65 years and over. Data for other risk factors are presented in HEALTH RISK FACTORS in this chapter.
In 2007–08, 16% of people reported one or more long-term conditions of the circulatory system, with the most common being hypertension (high blood pressure) at 9%. One in ten people aged 45–54 years reported having hypertension, increasing to 35% of people aged 65 years and over.
Circulatory conditions were mostly experienced by people in middle and older age groups. Almost one in five (19%) people aged 45–54 years had a current long-term circulatory condition, rising progressively to 62% of people aged 75 years and over. The circulatory conditions that form the most significant health and economic burden are heart, stroke and vascular diseases (including ischaemic heart disease, cerebrovascular disease, oedema, heart failure, and diseases of the arteries, arterioles and capillaries). Around 7% of people reported having a heart, stroke or vascular disease in 2007–08 (8% of males and 6% of females).
Ischaemic heart disease was the leading cause of death in 2009, with 12,047 male and 10,476 female deaths (115 male deaths per 100 female deaths). In 2007–08, around a quarter of people who had a heart, stroke or vascular disease (25%) reported experiencing severe or very severe levels of bodily pain in the last 4 weeks, compared with the national average of just under 10% (graph 11.4).
Overall, conditions of the circulatory system accounted for 46,106 deaths in 2009, or 33% of all deaths, contributing to 80,375 deaths overall as either an underlying or associated cause of death. The general decrease in deaths from these conditions since the 1960s (graph 11.9) is due in part to a reclassification of underlying causes of death (with some deaths shifting from Cerebrovascular diseases to Vascular dementia). The median age of people dying from circulatory conditions was 81.3 years for males and 87.2 years for females.
Diabetes mellitus
Diabetes is a costly disease associated with substantial morbidity and mortality, mostly from cardiovascular complications, eye and kidney diseases, and limb amputations. In 2004–05, total health expenditure attributable to diabetes was nearly $1.0 billion, accounting for 2% of allocated health system expenditure.
In the 2007–08 NHS, 4% of people reported having diabetes as a long-term condition, rising from 2.4% in 1995. More males than females had the condition (5% and 3% respectively). Diabetes rates also increased with age, particularly after the age of 45 years (graph 11.10).
Over half of all people aged 18 years and over with diabetes felt that their general health was only fair or poor (52%), compared with the national average of 15% (graph 11.5).
The majority of people with diabetes (88%) reported that they had Type 2 diabetes. Type 2 diabetes is associated with a number of risk factors, such as excess weight, poor diet, inactivity and smoking. For example, of people aged 35 years and over, those who were obese were about twice as likely to have Type 2 diabetes as those in other weight ranges (51% compared with 27% after adjusting for age). People in this age group who were sedentary or exercised at low levels were also more likely to have diabetes than people who exercised at high or moderate levels (8% and 6% after adjusting for age).
Diabetes was the underlying cause for 4,170 (3%) deaths registered in Australia in 2009, and contributed to 14,286 (10%) deaths as either an underlying or associated cause of death. The standardised death rate for this condition was 17.1 per 100,000 population in 2009 (20.6 per 100,000 males, and 14.2 per 100,000 females), an increase from 16.0 per 100,000 population in 2000.
The median age at death was 80.9 years (78.5 years for men and 83.3 years for women). Type 2 diabetes accounted for 1,772 deaths, or 42% of all diabetes deaths.
Injuries
Injuries (including poisoning) are associated with high morbidity, and are a leading cause of premature mortality in Australia. They can result in fatalities, survival with ongoing dysfunction or the onset of secondary conditions (such as osteoarthritis in injured joints). In 2009, just over 6% of people with a disability reported injury or accident as their main disabling condition.
The terms ‘injury’ and ‘poisoning’ encompass the adverse effects on the human body that result from particular events. These can be accidental such as falls, vehicle accidents and exposure to chemicals, or intentional such as suicide attempts and assaults by other people. Injury patterns vary significantly by age and sex. Near-drowning and drowning, for example, are major causes of injury and death in early childhood, while self-harm and road crashes are primary causes of injury in young adulthood. Falls are the most common cause of death caused by injury among the elderly. Incidence rates of serious injury are higher for males than females, both overall and for most types of injury (AIHW, 2010b).
In 2004–05, total health expenditure attributable to injuries was $3.4 billion, accounting for 7% of allocated health system expenditure.
In 2007–08, injuries accounted for over 1 in 20 (426,000) hospitalisations in Australia (AIHW, 2010b). About 2.4 million people had a long-term condition caused by an injury. Almost half (47%) of disc disorders and 30% of back pain/problems were caused by an injury, as were 15% of arthropathies (joint diseases) and 10% of partial deafness/hearing loss cases. Nearly 80,000 people had an amputation as a result of an injury.
Most people who had a long-term condition as the result of an injury acquired it at work (1 million people or 41%), followed by participation in exercise and sport (531,000 people or 22%). A further 410,000 people (17%) had a long-term condition as the result of a motor vehicle accident, and 334,000 people (14%) injured themselves at home. Men were more likely to acquire a long-term condition as a result of a work injury, whereas women were more likely to acquire their long-term injury at home or in a motor vehicle accident (graphs 11.11 and 11.12).
In 2009, injuries due to external causes accounted for 8,884 deaths, or 6.3% of all registered deaths. The standardised death rate for injuries was 38.6 per 100,000 of population (55.1 per 100,000 for males and 23.2 per 100,000 for females).
Over time, more men than women have died from external causes, and at younger ages. Consistent with previous years, around two-thirds of the total number of deaths resulting from external causes in 2009 were males (5,886, or 66%). Median age at death for injuries was 47.4 years for males, 66.7 years for females and 51.8 years overall.
Mental health
The designation of mental health as one of the national health priority areas recognises its enormous social and public health importance. Mental health is one of the leading contributors to the non-fatal burden of disease and injury in Australia. It is associated with increased exposure to health risk factors, greater rates of disability, poorer physical health and higher rates of death from many causes including suicide. Mental health problems incur high direct and indirect costs, result in a high number of hospitalisations and impose a heavy burden of human suffering (AIHW, 2011c).
In 2004–05, mental health accounted for 8% of allocated health system expenditure, at $4.1 billion, but by 2008–09 this figure had increased to more than $5.8 billion, or $272 per person (up from $225 per person in 2004–05) (AIHW, 2010a).
In 2009–10, the Australian Government paid $755 million in benefits for Medicare Benefits Schedule (MBS) subsidised mental health related services, around 4.9% of all MBS subsidies. Subsidies for psychologist services made up $287 million of the expenditure. Around 9.7% of subsidies for prescription medication were spent on prescriptions for mental health conditions (equivalent to $35 per Australian) (AIHW, 2011d).
In the 2007 ABS Survey of Mental Health and Wellbeing (SMHWB), mental health condition status was assessed through a diagnostic instrument (the World Health Organization Composite International Diagnostic Interview (CIDI)). Of the 16 million Australians aged 16–85 years in 2007, almost half (45% or 7.3 million) were assessed as having had a mental disorder at some time in their life. One in five (20% or 3.2 million) were assessed as having a current mental health disorder (having had symptoms of that disorder in the 12 months prior to interview).
Women were more likely to experience anxiety disorders (18% compared with 11% for men) and affective disorders (7% compared with 5% for men). Men had twice the rate of substance use disorders (7% compared with 3% for women). Prevalence varied by age, with people in younger age groups experiencing higher rates of disorder (graph 11.13)
Adolescence and young adulthood is a critical stage of transition in physical and mental development, and vulnerability to mental illness is heightened at this time. Around three-quarters (76%) of people who experience mental disorder during their lifetime will first develop a disorder before the age of 25 years. In 2007, just over a quarter of all young people aged 16–24 years had a mental disorder in the previous year (approximately 26% or 671,000 young people). Young women were more likely than young men to have had a mental disorder (30% compared with 23%).
Around 21% of young people with a mental disorder had experienced high or very high levels of psychological distress in the previous 4 weeks, compared with 32% of people over 25 with a mental disorder, and 4% of people with no mental disorder. However, over half (56%) of young people with a mental disorder were pleased or satisfied with the general quality of their life, and 16% were delighted with it.
Overall, one in ten people with a mental disorder reported being delighted with the quality of their life, compared with 20% of people without a mental disorder. However, almost half (48%) of the people who reported a mental health condition in 2007–08 also reported high or very high levels of psychological distress in the previous four weeks – around four times the national average of 12% (graph 11.6). In 2007, almost 2% of people with a 12-month mental disorder reported that they had attempted suicide, and 8% had thought about it sometime in the previous year.
In 2007, 38% of all people with a mental disorder (or 1.2 million people) had two or more mental disorders. A mix of mood and anxiety disorders was the most common combination, making up 39% of all co-morbidity cases (472,000 people), with people with more than one anxiety disorder making up a further 27% (331,000 people).
Around 59% of people with a mental disorder also had a physical condition, compared with 48% of those without a mental disorder. After adjusting for age differences in the populations with and without mental disorders, the gap between the rates of those with physical conditions further widened (from 11 to 17 percentage points). Co-morbidity with physical conditions was most common for people with mood disorders, 64% of whom also had a physical condition (Australian Social Trends, March 2009, 4102.0).
In 2007, 1.9 million Australians aged 16–85 years (12%) accessed services for mental health problems in the previous year. Around a third of people with a current, long-term mental disorder (35%) accessed these services, with more females doing so than males (41% and 28% respectively).
Mental health disorders were identified as the underlying cause of 6,522 registered deaths in 2009, representing 4.6% of all registered deaths in Australia in that year. (Dementia accounted for 89% of these deaths.) In total, 21,384 deaths were due to, or associated with, mental health disorders.
The prevalence of mental health disorders as an underlying cause has increased significantly over the last ten years. In 2009, the standardised death rate for mental health disorders was 25.2 per 100,000 of population, an increase from 16.5 per 100,000 population in 2000.
In 2009, more than half the deaths due to mental health disorders were females (4,130 or 63%). The median age at death was higher for females at 88.9 years, compared with 84.6 years for males