COVID cuts more from Australians’ life than leading causes of death

Anastasia Tsirtsakis

23/07/2020 5:26:24 PM

A new AIHW report highlights the fact older people and the critically ill are not the only ones at risk.

Man and woman in masks
Preliminary calculations for Australia found the average years of life lost per person as a result of COVID-19 was 17 years for men and 14 for women.

While the long-term health effects of COVID-19 are largely unknown, the Australian Institute of Health and Welfare’s (AIHW) latest two-yearly report card provides new insight into the virus’ potential risks.
Data from the first four months of the pandemic, from the first reported case on 25 January to the end of May, shows that COVID-19 has the potential to seriously affect not only particularly vulnerable cohorts, but also those not considered to be at the highest risk.
AIHW Deputy CEO Matthew James said this was evident when looking at how many years of life it cost the victim based on expected lifespan.
‘There is perception that the majority of COVID-19 deaths are among people who did not have a long expected lifespan prior to developing the disease,’ he said.
‘However, the Australians who died lost more years of their expected lifespan on average than those who died of our three leading causes of death: coronary heart disease, dementia and stroke.’
The median age at death for COVID-19 was 80 years, compared to 84 for coronary heart disease, 88 for dementia, and 86 for stroke. It was also lower than the median age of deaths from pneumonia (89 years) and influenza (82 years), the report said.
Preliminary calculations for Australia found the average years of life lost per person was 17 years for men and 14 for women.
Australia’s estimates are higher compared to other countries, the report said, indicating a lower proportion of deaths in older people, possibly due to fewer outbreaks in aged care facilities.
‘This suggests there is a strong possibility that the COVID-19 deaths were among people that, on average, would not have been expected to die soon,’ the report found.
While the majority of cases were mild to moderate and managed at home, the report found 13% of diagnosed cases had been admitted to hospital, indicating more severe disease.
If th country had experienced the same COVID-19 case and death rates as Canada, Sweden or the UK, the report estimates Australia would have had between eight and 14 times the number of cases, and around 5000 to 14,000 extra deaths.
The report revealed that Australians are living longer, with more years of good health, with the ninth highest life expectancy for males born in 2016–2018 (80.7 years), and seventh highest for women for women born in the same period (84.9 years) among the 36 Organisation for Economic Co-operation and Development (OECD) countries.
Daily smoking rates have dropped considerably in recent decades, down 25% in 1991 to 11.6% in 2019. And while coronary heart disease remains the leading single cause of death for Australians, the rate has fallen 82% since 1980.
This improvements are reflective of Australia’s health measures, which fair better than most other OECD countries – but the report did find room for improvement, particularly when it comes to rates of overweight and obesity , as well as mental health.
Overweight and obesity
Australia has the fifth highest rate of obesity out of 23 OECD countries. Around two-thirds (67%) of adults and one-quarter (25%) of children and adolescents were overweight or obese in 2017–18.
Leanne Wells, CEO of the Consumers Health Forum, said the figures raise concern.
‘Australia’s overweight and obesity rates for adults are significantly higher than the average for developed nations,’ she said.
‘The obesity trend increases our future risk of chronic conditions like heart disease and diabetes. That’s a matter of more immediate consequence now given the increased vulnerability of those with chronic disease who contract COVID-19.’
The report found an estimated one in two adults (55%) did not participate in sufficient physical activity, more common among women.
Ms Wells suggested that the 10 Year National Preventative Health Strategy be obesity-focused, and that its development be accelerated.
‘So much of our relatively good population health is thanks to preventive health policies of past decades in Australia,’ she said.
‘It is obvious that Australia can and need to do so much more to discourage unhealthy foods and encourage active lifestyle.’

Around two-thirds (67%) of Australian adults and one-quarter (25%) of children and adolescents were overweight or obese in 2017–18. (World Obesity image bank)

Chronic disease
The report revealed that almost half (47%, or more than 11 million people) of Australians have at least one of 10 selected chronic conditions, such as heart disease, cancer, stroke, diabetes, arthritis, asthma or a mental health condition.

In 2017–18, the most common conditions by age group were:

  • 15–44 years – mental and behavioural conditions (22%)
  • 45–64 years – back pain and problems, and arthritis (25% each)
  • 65 and over – arthritis (49%).
As the leading cause of death, coronary heart disease alone accounts for about $2.2 billion a year in healthcare costs, and was the primary cause of almost 161,800 hospitalisations in 2017–18.
One in three Australians was found to have a chronic obstructive pulmonary disease (COPD) in 2017–18. The prevalence tended to increase with age, and was most common among middle-aged and older people.
Asthma affected one in 10 Australians, and was most common among women aged 55 and over.
One in 20 (4.9%, or 1.2 million) Australians had diabetes, and the prevalence increased with age from about one in 20 (4.5%) aged 45–54 to almost one in five (19%) aged 75 and over.
It is estimated that about 145,500 new cases of cancer will be diagnosed in Australia in 2020, an average of almost 400 people a day. Prostate cancer is expected to be the most common cancer diagnosed among men, and breast cancer for women.
However, survival rates have improved thanks to cancer screening programs, improvements in treatment and care, and avoidance of known risk factors,. Almost seven in 10 (69%) people survived at least five years after a cancer diagnosis during 2012–2016, compared to about five in 10 (51%) between 1987–91.

Dementia was found to be the second leading cause of death in 2018, and the leading cause of death for females. It is estimated more than 400 Australians live with the neurodegenerative disease, a number that is expected to exceed 550,000 by 2030 in line with Australia’s ageing population.
But disparities were noted across some population groups.
‘Often, people living in rural and remote and/or lower socioeconomic areas, people with disability, and Aboriginal and Torres Strait Islander people experience higher rates of illness, hospitalisation and death than other Australians,’ AIHW Deputy CEO Matthew James said. 
‘For example, people living in remote and very remote areas are 1.2 times as likely to have diabetes as people in major cities; people living in the lowest socioeconomic areas are twice as likely to have diabetes as people in highest socioeconomic area; and [Aboriginal and Torres Strait Islander] Australians are 2.9 times as likely to have diabetes as non-Indigenous Australians.’
Two-thirds of Aboriginal and Torres Strait Islander people report a long-term health condition, with chronic diseases causing 64% of the total disease burden among this patient group.
Some improvements were noted in the health of Aboriginal and Torres Strait Islander people, including a fall in the death rate across all age groups, except for those aged 75 and over, between 2008–2018, as well as a decrease in ear disease among children.
Chronic diseases among all Australians were found to be largely preventable. The most common risk factors related to Australia’s total burden of disease in 2015 were:
  • tobacco use (9.3% of total burden)
  • overweight and obesity (8.4%)
  • dietary risks (7.3%)
  • high blood pressure (5.8%)
  • high blood plasma glucose, including diabetes (4.7%).
Mental health
Mental health emerged as a key concern in the report, with one in five Australians reporting that they had a mental health condition in 2017–18.
Females and people aged 15–24 were most likely to report having a current long-term mental or behavioural condition.
Mental and substance use disorders made up 12% of the total health burden.
Suicide and self-inflicted injuries were the third-leading cause of premature death from injury or disease in Australia in 2015.
Suicide was found to be the leading cause of death for those aged 15–44 in 2016–18., there were 3046 deaths by suicide registered in Australia in 2018, of which more than three-quarters were males.
Healthcare sector
An estimated 83% of Australians aged 15 and over saw at least one GP in the previous 12 months in 2018–19, an average of 430,000 daily visits.  
The most commonly reported health concerns managed by GPs were:
  • psychological (65%)
  • musculoskeletal (40%)
  • respiratory (39%).
Most people reported positive experiences with their GP, with 76% feeling the consultation time was adequate, and 75% feeling their GP always listened to them carefully.  
Australia’s health sector has grown faster than the rest of the economy and population over the past two decades. Out of 36 OECD countries, Australia had the eighth highest expenditure on healthcare relative to gross domestic product (GDP).
‘In the 20-year period to 2017–18, total health expenditure in Australia increased from $77.5 billion to $185.4 billion in real terms, and spending per person increased from $4200 to $7490,’ Mr James said.
‘As a proportion of GDP, health expenditure increased from 7.6% in 1997–98 to a peak of 10.3% in 2015–16. It has since declined to 10% in 2017–18.’
Governments funded about two-thirds (68%) of health spending in 2017–18, with funds primarily raised through tax revenue.
Over the past five years, the proportion of health spending funded by individuals declined and in both 2016–17 and 2017–18, personal spending on health reflected less than 0.4% of individual wealth, the lowest proportion since 2000–01.
Of the total funding injected into the health system, 34% went to primary healthcare.
Need for real-time data
The report comes at an important time, with Australians focused on their health more than ever.
Mr James said health data has played a critical role in understanding the impacts of COVID-19, and that he expected the demand for ‘near real-time’ data to increase as a result.
‘The AIHW’s future planning will consider our capacity to deliver information more quickly, while maintaining quality and accuracy,’ he said.
But Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA), said there is a need for that data now, arguing that the report, while useful, is outdated.
‘COVID-19 has exposed many cracks in our health system,’ Ms Verhoeven said.
‘We want to know what impact COVID-19 is having on particular population groups. We want to know the numbers of COVID patients being treated in acute care, intensive care and primary care, and the impact this is having on the availability of workforce and resources.
‘We want to know more details about the current use of telehealth during the pandemic, and for what conditions. This will help in planning for telehealth post-COVID-19.
‘This kind of information is more useful in our current circumstances than how long we could expect to live if we were born two to four years ago.’
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