Australia bucked global mortality trend in 2020: AIHW

A newly published report has shone on a light on health outcomes in one of the most challenging years in living memory for general practice in Australia. 
 
‘The first year of COVID-19 in Australia’, released by the Australian Institute of Health and Welfare (AIHW), assessed the direct and the indirect impacts of the COVID-19 pandemic on health in 2020.
 
It found a lower-than-expected number of doctor-certified deaths compared to the previous five years, in contrast to much of the rest of the world where the pandemic has caused widespread excess mortality.
 
The fall in the mortality rate is described in the report as ‘statistically significant’ in winter last year, largely driven by a reduction in deaths from respiratory diseases, including influenza and pneumonia. The greatest fall in pure numerical terms is understood to be among deaths caused by lower respiratory disease.
 
The report also says cancer, coronary heart disease (CHD), cerebrovascular disease and dementia had lower death rates in 2020 compared to the average rates in preceding years.
 
‘It does show the impact that the social restrictions had on some other health challenges,’ AIHW spokesperson Dr Lynelle Moon told newsGP. ‘There are some quite significant, more positive [health] impacts of all the restrictions.’
 
Broad details of the pandemic’s impact on general practice are outlined in the report, including the catalysing effect of the pandemic on telehealth, which accounted for 36% of all consultations by the end of April last year.
 
The report indicates that without telehealth, services for review of care would have been 16% lower compared to the previous year.
 
‘Telehealth services made a large contribution to maintaining the levels of care for people with chronic conditions,’ the authors write.
 
Dr Michael Tam, a clinical academic specialist GP at the University of New South Wales in Sydney, says the report reflects a ‘difficult time’ for general practice in 2020.
 
‘It required a massive change in the way general practice operated in terms of how to care for patients,’ he told newsGP.
 
‘Very substantial changes [were needed] in practice, in expectations, in how staff worked, particularly reception staff – but of course all necessary in the context of a public health emergency.’
 
Medicare items for chronic disease management fell at the start of the pandemic, then rose to above previous levels of use by the end of the year, the AIHW report found.
 
The number of injuries due to falls and road traffic accidents also dropped, particularly in the early part of the pandemic. Less positively, the AIHW reports increased levels of psychological distress, particularly for adults aged 18–45.
 
As for those impacted by COVID-19 so far, the report indicates lower socioeconomic groups are notably more likely to be affected.
 
There were almost four times as many deaths attributed to the lowest socioeconomic group compared to the highest, a figure that remained significant (2.6 times as high) when adjusted for age.
 
Dr Moon said the reasons for those inequalities are complicated, with most deaths being in aged care facilities. However, she believes the socioeconomic differences do not appear to be driven by over-representation of that group.
 
‘That was new analysis, where we did some analysis of the ABS death data – and was important to note,’ Dr Moon said. ‘[Parts of the population] are more exposed and probably more vulnerable too if they do contract the virus.’
 
The report notes, however, that the mortality rates do not include data from coroners’ reports. The Actuaries Institute estimates these at around 20,000, which would account for between 10–15% of all deaths.
 
According to the Australian Bureau of Statistics, there were 140,363 doctor-certified deaths between 1 January and 29 December 2020, compared to an average of 140,471 in the previous five years – with the recent numbers unadjusted for population increases.
 
For Dr Tam the increase in telehealth is likely one to be one of the enduring changes prompted by COVID-19.
 
‘Telehealth really is part of the landscape now – but what that will look like moving forward is a little less clear,’ Dr Tam said.
 
‘Clearly there are roles for telehealth in certain domains, particularly mental health care provision and chronic disease care on an ongoing basis.’
 
Dr Moon also identified telehealth as the most striking impact of the pandemic year on GPs.
 
‘If it hadn’t been for telehealth, it’s quite possible there would have been a large drop-off in general practice presentation,’ she told newsGP, noting the number of consultations that took place in April.
 
‘That’s really a large proportion so quickly after the new measures were put in place.’
 
Dr Tam said that while it is difficult to predict how much of an anomaly the year 2020 will prove to be, he believes general practice adapted well and that the impact of the pandemic will continue for some time.
 
‘I think GPs did rise to the challenge of providing as good care as they could,’ he said. ‘Often in difficult medical circumstances – and difficult business circumstances as well.’
 
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