Where in Australia is chronic disease most prevalent?

The burden of chronic disease weighs heavy in Australia.
 
It is estimated that over $38 billion per year is spent on care for people with chronic health conditions.
 
The largest contributors to Australia’s disease burden are cardiovascular disease (CVD), type 2 diabetes and chronic kidney disease (CKD), accounting for 14%, 2.2% and 1.4% of the overall burden in 2015, respectively.
 
And unsurprisingly, rates of chronic conditions are higher for people living in lower socioeconomic areas.
 
To map the distribution of the impact of CVD, type 2 diabetes and CKD, the Australian Institute of Health and Welfare (AIHW) has released a new report on geographical variation of each across states and territories, Primary Health Networks (PHNs) and Population Health Areas (PHAs).
 
The report details prevalence, hospitalisation and death rates of each disease for people aged 18 years and over, summarising the impacts, local health-risk profile and population characteristics at each geographic level.
 
Dr Marguerite Tracy, GP, senior lecturer at the University of Sydney’s School of Public Health, and RACGP Expert Committee – Quality Care member, told newsGP she is not surprised by the AIHW’s latest findings.
 
‘There are extensive data which have shown the social gradient in terms of health exists across the full spectrum of society. So unfortunately, these data do not come as a surprise,’ she said. 
 
‘The prevalence of chronic diseases likely map areas where social determinants of health have a high impact. These are likely to map to poorer access to healthcare, higher unemployment, poor access to affordable, healthy food, etcetera.’
 
With Australia’s disease burden placing significant strain on the healthcare system and individuals, Dr Tracy said the big question is, what needs to be done to decrease the burden?
 
‘Many of the factors associated with these chronic diseases are heavily influenced by factors outside the control of the individual,’ she said.
 
‘There are system factors we know help prevent some chronic disease.
 
‘[For example,] taxation on cigarettes and plain packaging have dramatically reduced smoking rates in Australia. Population interventions are one way to address underlying issues of high salt and energy in Australian diets with benefits in reducing CKD, CVD and type 2 diabetes.’
 
Improving education and health literacy across geographical areas disadvantaged by the burden of chronic disease is also an important factor, according to Dr Tracy.
 
‘Health literacy is associated with poor general literacy; however, lower levels of health literacy occur across the whole community,’ she said.
 
‘Implementing “universal precautions” for health literacy is therefore a useful step. Explaining concepts in easy-to-understand language takes time but is necessary to ensure understanding.’
 
Key findings from the AIHW for 2017−18 for each of the three diseases across geographical areas are detailed below.
 
Chronic kidney disease
Not including dialysis and acute kidney injury, prevalence of biomedical signs of CKD was similar across states and territories, with PHN rates ranging from 7.8–12.6% across PHNs.
 
By PHAs, the proportion of adults with biomedical signs of CKD ranged from 3.9–17.2%, with the highest age-adjusted rates at greater socioeconomic disadvantage and higher health-risk profiles, compared with the respective state/territory.
 
Hospitalisation rates with CKD as the principal and/or additional diagnosis averaged more than 1000 per day, ranging from 952 per 100,000 population in the Australian Capital Territory (ACT) to 4100 per 100,000 population in the Northern Territory (NT).
 
Type 2 diabetes
The rate of type 2 diabetes was highest in the NT at 7.4%, and lowest in the ACT at 4.5%. By PHN, the proportion of adults with type 2 diabetes ranged from 3.8−8.1%, with overall age-adjusted rates higher in regional areas than metropolitan. The PHAs with the highest age-adjusted rates also displayed higher health-risk profiles and proportions of people living in socioeconomically disadvantaged areas.
 
There were more than 2900 hospitalisations per day with type 2 diabetes as the principal and/or additional diagnosis, with rates ranging from 2400 per 100,000 population in the ACT to 6800 in the NT.
 
Cardiovascular disease
Across jurisdictions, the proportion of adults with self-reported heart, stroke and vascular disease ranged from 2.9% in the NT to 7.7% in Tasmania. By PHN, rates ranged from 2.9–8.4%, with age-adjusted rates generally higher in regional than in metropolitan PHN areas.
 
Rates ranged from 1.8–11.9% across PHAs, with the highest age-adjusted rates displaying higher health-risk profiles than their respective state/territory and higher proportions living in socioeconomically disadvantaged areas than the national average.
 
Hospitalisation rates with CVD listed as the principal diagnosis were around 1600 per day, ranging from 1400 per 100,000 population in the ACT to 2600 per 100,000 population in Queensland. 
 
Dr Tracy said it is well-known that hospitalisations can be avoided through better access and funding for primary care, which the RACGP continues to lobby for, to move chronic disease management more into the hands of GPs and other primary healthcare providers.
 
‘Again, there are extensive data that show that investment in primary healthcare reduces the need for tertiary interventions,’ she said.
 
‘Primary care is our next line of defence − early detection, monitoring and treating risk factors for chronic conditions. 
 
‘We need to reduce the stigma on individuals whilst also supporting people to make the best choices they can for their health. Primary care/general practice is ideally placed to do this.’
 
Log in below to join the conversation.

chronic disease social determinants of health