Population groups with different disease burdens

Burden of disease changes throughout life

As people age, they are more likely to develop one or more chronic conditions (Figure 9). This is due a combination of ageing processes and exposure to risk factors for disease throughout life.^[1]

In the ACT, data is available to show the leading causes of disease burden for 3 life stages:

• 0 to 24 years
• 25 to 74 years
• 75 years and over.

Total burden of disease as measured by disability-adjusted life years at each life stage in the ACT was consistent with national trends.^[2]

Figure 9. Total burden of disease (disability-adjusted life years) by age group and leading cause, ACT, 2018

Source: Australian Institute of Health and Welfare (AIHW) (2018) ‘Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018’, Australian Burden of Disease Series no. 23, catalogue number BOD 29, AIHW, Australian Government.

Leading causes of disease burden for people aged 0 to 24 years

In 2018 in the ACT, the leading causes of total burden of disease for those aged 0 to 24 years were consistent with national data:

1. anxiety disorders
2. suicide and self-inflicted injuries
3. asthma.^[2]

Nationally, while the leading causes were the same, asthma ranked second after anxiety disorders, with suicide and self-inflicted injuries third.^[2]

Children and young people who have good health in early life are more likely to enjoy better education, work and health outcomes as adults.^[3]

In 2018, the leading risk factors contributing to total burden nationally for children and young people aged under 15 were low birthweight and short gestation.^[2]

The leading risk factor for young people aged 15 to 24 was alcohol use for males and child abuse and neglect for females.^[2]

Mental illness tends to emerge early in life. About three quarters of people with mental illness first experience symptoms before age 25.^[4] This shows the importance of identifying risk factors and treating mental illness early.

Alongside efforts to identify problems early, there are many ways to improve the mental health of children and young people in our community. This includes measures that support children and young people in:

• getting enough sleep
• having a healthy diet
• doing regular physical activity
• having long-lasting, safe and secure relationships
• living in stable accommodation
• having parents with stable income
• having good family functioning.^[5]

Leading causes of disease burden for people aged 25 to 74 years

In 2018 in the ACT, the leading causes of total burden of disease for those aged 25 to 74 years were consistent with national data:

1. back pain
2. musculoskeletal conditions other than back pain
3. anxiety disorders.^[2]

While this broad age group was not divided further for the ACT, nationally the data can be viewed for people aged 25 to 44 and 45 to 74 years.

At the national level, mental health conditions and substance use disorders were the main cause of burden for those aged 25 to 44 years.^[2] The leading risk factors contributing to the total burden for males aged 25 to 44 were alcohol use and illicit drug use, while child abuse and neglect and illicit drug use were the top risk factors for females.^[2]

For those aged 45 to 74, back pain and problems and cancer were the leading causes of total burden.^[2] The leading risk factors contributing to total burden for this age group were tobacco use, overweight and obesity and diet.^[2]

Leading causes of disease burden for people aged 75 years and over

In 2018 in the ACT, the leading causes of total burden of disease for those aged 75 and over were consistent with national data:

1. dementia
2. coronary heart disease
3. chronic obstructive pulmonary disease.^[2]

Burden of disease for older people reflects the cumulative impact of ageing and lifestyle risk factors.^[1]

In general, the leading modifiable risk factors contributing to total burden for adults aged 65 to 84 years nationally were tobacco use, overweight and obesity and high blood pressure.^[2] In Australians aged over 85, the leading modifiable risk factor was high blood pressure.^[2]

While the progression of ageing cannot be stopped, a healthier lifestyle can reduce the risk of experiencing the above chronic conditions.^[2]

For example, factors which make people less likely to develop dementia include environments which support them in:

• keeping physically active
• maintaining social relationships
• maintaining a healthy weight
• avoiding tobacco smoking
• avoiding excessive alcohol use
• protecting hearing
• maintaining a normal blood pressure in midlife.^[6]

Burden of disease and inequity

Burden of disease is not experienced equally across our community. Certain groups experience higher rates of chronic disease and injury due to inequities or systemic issues.^[7]

These groups include, but are not limited to:

• Aboriginal and Torres Strait Islander people
• Culturally and linguistically diverse (CALD) communities
• Lesbian, gay, bisexual, transgender, intersex, queer or questioning, and other sexuality and gender diverse people (LGBTIQ+)
• people with mental illness
• people of low socioeconomic status
• people with disability
• rural, regional and remote communities.^[8]

The experiences of people within these groups are diverse. Some people identify as belonging to multiple groups and experience intersecting issues that impact on their health and wellbeing.

Australia and the ACT lacks data and information related to burden of disease in many of these priority populations.

People from low socioeconomic backgrounds experience greater burden of disease

In 2018, if all Australians had experienced the same burden of disease as people living in the highest socioeconomic areas, the total disease burden could be reduced by about one fifth (21%).^[9]

People in lower socioeconomic groups are at risk of experiencing chronic disease or injury and having a shorter life expectancy.^[10]

Canberra has relatively low socioeconomic disadvantage compared with the rest of Australia.^[11] However, socioeconomic disadvantage in the ACT can be hidden because many of those who are disadvantaged in Canberra live in areas which are classified as high socioeconomic areas.^[12]

Pockets of poor health and shorter life expectancy can also be hidden in a population with good overall health and life expectancy.

Aboriginal and Torres Strait Islander people in the ACT report above average burden of disease

The health and wellbeing of Aboriginal and Torres Strait Islander peoples is impacted by a broad range of factors including a long history of colonisation, racism and discrimination.^[13]

The health impact of these issues is not captured in burden of disease studies.

Nationally, Aboriginal and Torres Straight Islanders continue to experience a greater burden of disease than non-Aboriginal and Torres Straight Islanders, however the gap is narrowing.^[14]

Between 2003 and 2018, the national gap in burden of disease rates between Aboriginal and Torres Strait Islanders and non-Indigenous Australians narrowed by 16%.^[14] This is a decrease of 41 years of healthy life lost due to disease, injury or premature death (DALY) per 1,000 people.

The narrowed gap was driven by a 28% decrease in the burden due to premature death and a 6.6% increase in the burden due to living with disease or injury.

Data specific to the ACT is not available in the 2018 Australian Burden of Disease Study due to small population sizes.

The types of diseases causing the greatest gap in the burden of disease nationally were:

1. mental and substance use disorders
2. cardiovascular disease
3. injuries
4. respiratory diseases.^[14]

In 2018–19, Aboriginal and Torres Strait Islander people living in the ACT reported the second highest proportion of people nationally living with one or more chronic conditions at 57.1%.^[14] Tasmania had the highest with 58.7% and Northern Territory had the lowest with 31.6%.^[14]

Higher reported rates of chronic illness could reflect better access to healthcare, not necessarily higher rates of illness. However, it is unclear whether this explains ACT’s higher rates of chronic disease. It is important to consider how we can better understand this in future.

The most common types of chronic conditions Aboriginal and Torres Strait Islander peoples reported experiencing in the ACT in 2018–19 were:

1. eye diseases (46.8%)
2. respiratory system diseases (40.3%)
3. mental and behavioural conditions (39.7%).^[14]

Eye and respiratory system diseases were the 2 most common nationally. Musculoskeletal system and connective tissue diseases were third most prevalent conditions nationally.^[14]

Mental and behavioural conditions were more prevalent for Aboriginal and Torres Strait Islander people in the ACT than any other Australian state or Territory.^[14] The ACT had slightly lower proportion of eye diseases and a higher proportion of respiratory diseases than the national average.

Eye diseases includes short and long sightedness. Nationally, Aboriginal and Torres Straight Islanders experience more vision impairment, blindness and vision loss than non-Aboriginal and Torres Straight Islanders.^[15] This vision loss is mostly preventable and is influenced by a complex range of factors including:

• age
• diet
• education
• employment
• accessibility and availability of services
• living conditions.^[15]

References