Burden of disease

Introduction

This section summarises the health burden of disease groups based on over 200 specific conditions. Burden of disease is a complex analytical method to measure the gap between the ideal of everyone living to old age in good health and people’s experience of illness and early death. Burden of disease analysis uses multiple data sources to estimate health impacts based on:

• the causes and progression of diseases
• life expectancy
• population size
• modifiable risk factor exposure.

These are updated continuously with the latest health evidence. To understand changes in burden over time, results from prior years are updated based on latest health evidence.

The analysis generates three measures of health burden:

• the total estimate of health loss, measured as disability adjusted life years (DALYs)
• loss due to early death, measured as years of life lost (YLL)
• loss due to living with illness or disability, measured as years lived with a disability (YLD).

DALYs are the sum of YLLs and YLDs. All three measures can be reported as a count, an age-standardised rate (ASR, or standardised rate), or a crude rate.

The Australian Institute of Health and Welfare (AIHW) conducts the Australian Burden of Disease Study (ABDS) applying the best current health evidence for the Australian context.¹ National results are updated regularly with periodic updates for regions within Australia and modifiable risk factors.

The most recent national ABDS study was in 2022. The most recent jurisdictional, remoteness, socioeconomic areas and risk factor results are for 2018.²

The 2022 ABDS results cannot be compared to other burden of disease studies such as:

• the Global Burden of Disease because it was developed for the global health context
• earlier ABDS studies due to changes in health evidence and the addition of new diseases based on social and disease priorities, and emerging conditions.

Recent additions to ABDS include:

• 2018
  • specific conditions added: scabies, asbestosis, silicosis and other pneumoconiosis
  • risk factors: bullying victimisation, low birthweight and short gestation. Perpetrator type and sex were added to homicide and violence reporting.
• 2022–COVID-19.

National ABDS results were recalculated for 2003, 2011, 2015 and 2018 using the 2022 methods. For jurisdictions and other small area analyses, the 2018 ABDS recalculated results from 2011.

This section focuses on the most recent 2022 ABDS with a subset of 2018 ABDS jurisdictional results.

2022 Australian Burden of Disease Study

From 2003 to 2022, the health burden (DALYs):

• overall increased from 4.2 to 5.5 million years of healthy life lost
• the standardised rate decreased from 209.3 to 186.3 per 1,000 persons.

This inverse relationship between total burden and standardised rate results, in part, from increasing population size and changing age distributions. The standardised rate increased from 2018 (182.8 per 1,000 persons) to 2022 (186.3 per 1,000 persons) which is likely the effect of the COVID-19 pandemic.¹

The proportion of life lost due to illness/disability in Australia is increasing—from 46.9% in 2003 to 51.7% in 2022. This change reflects greater gains in preventing early deaths than in preventing illness and disability.¹ This is driven by gains for females in the proportion of total burden attributable to disability. While an increasing proportion of disability burden is also evident in males, fatal burden still outweighs disability burden.

Increasing disability burden shows the impact of an aging population. In future, greater effort will be required for hearing and vision disorders, arthritis and gout which impact mobility, and managing neurological disorders including dementia. Results also show the higher burden of chronic and disabling conditions that affect many young adults and middle-aged people including mental health disorders and musculoskeletal conditions such as back pain.

Health loss by disease group

In 2022, the leading disease group for health loss in Australia was cancer and other neoplasms, where almost all the burden was due to early death (Table 1). Musculoskeletal conditions, cardiovascular diseases, mental health and substance use disorders followed closely. Together these four disease groups explained more than half the total burden.

Musculoskeletal conditions, mental health and substance use disorders have relatively high disability burden while cancers, injury and cardiovascular diseases have high fatal burden. Changes in the leading disease groups from 2003 to 2022 were:¹

• cancer and other neoplasms: 21.1% increase in DALYs but a 24.1% decline in standardised rate
• musculoskeletal disorders: 38.2% increase in number of DALYs but a 5.9% decline in standardised rate
• cardiovascular diseases: 9.0% decrease in number of DALYs and a 45.4% decline in standardised rate
• mental and substance use: 35.5% increase in number of DALYs and a 6.5% increase in standardised rate
• neurological conditions: 86.8% increase in number of DALYs and a 14.1% increase in standardised rates.

Over this period the burden for infectious diseases increased (164.8% increase in number of DALYs), largely driven by the 2018 to 2022 increase from the COVID-19 pandemic.

Health loss by select specific causes

In 2022, the leading specific causes of health loss were:

• coronary heart disease
• dementia
• back pain and problems
• COPD
• anxiety disorders (Table 2).¹

These and others in the top 20 specific causes accounted for 54.7% of the total disease burden. About half of these leading conditions had a high disability burden, indicating that management will require ongoing, long-term care. This is the nature of the changing health burden—the dominance of chronic conditions, impacting the wellbeing of the individual and driving demand for ongoing health support services.

There was a substantial increase in health burden due to dementia, osteoarthritis, hearing loss, falls, asthma, COPD, back pain, suicide and rheumatoid arthritis since 2003—again reflecting an ageing population and the emergence of disabling/non-fatal problems.¹

The greatest improvements in reducing burden have been achieved for coronary heart disease and stroke. This can be attributed to success in primary prevention through better monitoring of blood pressure and cholesterol, reduced smoking rates, and advances in treatment and early clinical intervention.

Australian males lost more years of healthy life than females—accounting for 52.7% of the total burden. More than half the years lost to premature death were for males (58.7% of fatal total) but less than half of the years lost to illness/disability (47.1% disability burden).¹

Although rates of burden increased with age, substantial health burden were experienced in younger age groups, especially as disability burden (Figure 1). Delaying the onset of chronic diseases would have long-term benefits to individuals and the healthcare sector as younger people aged.

Burden of disease due to COVID-19

Nationally in 2022, the total burden of disease from COVID-19 was 151,388 years of healthy life lost (87,143 for men and 64,245 for women), accounting for 2.7% of the total burden. Most of the burden was from premature mortality (73.3%) with males contributing more to the years of healthy life lost (57.6%).¹

The emergence of COVID-19 drove the increase in burden. While trends in total burden standardised rates were declining from 2003 to 2018, the rate increased from 2018 to 2022, attributable to burden introduced by COVID-19.

2018 Australian Burden of Disease Study

National comparisons

In 2018 (most recent Queensland estimate), Queenslanders lost more than 1.0 million years of healthy life.² In 2018, the total burden standardised rate in Queensland (189.6 per 1,000 population) was similar to most other jurisdictions except the Northern Territory (Figure 2) which was higher.

In Queensland, the standardised rate of burden decreased from 2011 to 2018—from 196.6 to 189.6 DALYs per 1,000 persons.² The proportion of life lost due to illness/disability in Queensland increased and in 2018, was 52.0% disability burden.²

Remoteness and socioeconomic differences

In Australia, the standardised rate of total burden in remote and very remote areas in 2018 was 1.4 times higher than in major cities.² If all areas had the same rates of burden as major cities, the total burden in Australia would have been 4.4% lower. Kidney and urinary diseases were the most prominent disease groups contributing to this difference. Injury, infectious diseases, endocrine disorders and cardiovascular diseases also played a part. The fatal burden was 75.2% higher in remote areas than major cities, while the disability burden was 12.8% higher.

Socioeconomic disadvantage was also a significant contributor to total burden. If all areas in Australia had the same rates of burden as the least disadvantaged areas the total burden in 2018 would have been 21.4% lower.² The burden rate in the most disadvantaged areas was 1.6 times higher than in the least disadvantaged areas.

Endocrine disorders contributed greatly to this socioeconomic difference (2.3 times higher in most disadvantaged areas), along with injuries (2.0 times higher) and kidney and urinary diseases (1.9 times higher). Fatal burden rates in the most disadvantaged areas were 86% higher than in the least disadvantaged areas, while the disability burden rate was 35.5% higher.

This would indicate there is much to be gained in reducing fatal outcomes for remote and/or disadvantaged populations, many of which also have a higher prevalence of modifiable risk factors such as tobacco use, higher alcohol consumption, unhealthy weight and poor diets.

Risk factor burden

In Australia (jurisdictional results not available), 37.5% of the total disease burden in 2018 could be attributed to the joint effect of a range of largely preventable risk factors (Table 3).³

Tobacco use (including second hand smoke) was the leading risk factor in 2018 and accounted for 12.9% of deaths in Australia (Table 3). Despite the success of anti-smoking campaigns, tobacco use continues to dominate because of its very substantial contribution to fatal outcomes, particularly lung cancer and COPD, and the long lag between smoking exposure and developing tobacco-related health conditions. Preventing the uptake of smoking in young people has been a critical factor in reducing smoking rates and associated disease in Australia. Smoking cessation, especially reducing the age that people quit, also plays an important role.

Overweight and obesity was the second largest risk, evidence of the growing prevalence of unhealthy weight in children and adults, with increases particularly evident during the late 1990s and 2000s. It now accounts for 10.3% of deaths in Australia with its impact evident in a range of diseases including cardiovascular disease and cancer and is a leading cause of health loss.

Dietary risks combined are a significant contributor to health loss. The full range of dietary risks and their relative impact are described in more detail by AIHW.

There is limited capacity to assess the broad scope of environmental and climate effects on health burden due to data limitations and the expanding evidence base. Currently air pollution is included and in 2018 accounted for 2.0% of deaths nationally (3,236 deaths) and 1.3% of total burden. High sun exposure accounted for 1.2% of deaths and 0.7% of total burden. Occupational exposures and hazards accounted for 1.1% of deaths and 1.8% of total burden.²

The joint effect of the included risk factors accounted for 95.9% of the burden of endocrine disorders in Australia in 2018—74.2% of burden due to kidney and urinary diseases, 67.7% of the cardiovascular disease burden, 51.5% of the respiratory disease burden, 44.6% of the injury burden and 42.2% of cancer burden.² There is, therefore, great potential to improve health outcomes through a continuing focus on prevention.

Some risk factors had impacts across quite a number of disease groups and specific conditions. Tobacco use contributed to the burden for nine disease groups, including:

• 39.3% of respiratory diseases
• 21.5% of cancer
• 10.7% of cardiovascular diseases
• 6.2% of infectious diseases
• 3.2% of endocrine disorders.²

Overweight and obesity contributed to a range of disease groups, including:

• 44.1% of the burden for endocrine disorders
• 31.1% for kidney and urinary diseases
• 21.8% for cardiovascular diseases
• 8.9% for musculoskeletal conditions
• 7.0% for cancer.²

International comparisons

The Global Burden of Disease Study (GBD) 2019⁴ is used to compare Australia with other countries and regions. Australian GBD results will differ from those in the ABDS. Considering developed countries, Australia had the 10th lowest rate of disease burden of all OECD countries and was lower than the OECD average.²

Australia ranked 6th lowest for fatal burden of all OECD countries. Conversely, Australia was ranked 26th of all OECD countries for rate of disability burden and was similar to the OECD average. The leading causes of health loss in Australia were similar to other high-income countries in the OECD and globally—cancers, cardiovascular disease, musculoskeletal disorders and mental disorders.⁴

Additional information

Data and statistics

Where presented, ratios were calculated using higher precision estimates than those that are displayed within the report.

Visit the AIHW website for more information about the Australian Burden of Disease studies:

• Burden of disease overview
• Australian Burden of Disease Study 2022
• Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018
• Australian Burden of Disease Study 2018: Interactive data on risk factor burden.

Visit the Institute of Health Evaluation and Metrics website for more information about Global Burden of Disease (GBD).

Section technical notes

Technical information for ABDS is available on the AIHW website:

• Australian Burden of Disease Study: Methods and supplementary material 2018
• Australian Burden of Disease Study 2022 Technical notes

References

1. Australian Institute of Health and Welfare. 2022. Australian Burden of Disease Study 2022. doi: 10.25816/E2V0-GP02.
2. Australian Institute of Health and Welfare. 2021. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018. doi: 10.25816/5PS1-J259.
3. Australian Institute of Health and Welfare. 2021. Australian Burden of Disease Study 2018: Interactive data on risk factor burden.
4. GBD Collaborative Network 2020. 2022. Global Burden of Disease Study 2019: results. Accessed: 26 October 2022.