Burden of COVID and dementia set to grow: AIHW report

The good news contained in the latest Australian Institute of Health and Welfare (AIHW) health report is we are likely to live longer. The more sobering finding is that the burden of chronic disease is continuing to grow, a trend now being fuelled by COVID-19 and rising dementia rates.
 
Such is the snapshot of the nation’s health in the 18th report of its kind from the AIHW.
 
Released to the public this week, it reports life expectancy for a girl born between 2018–20 as 85.3 years, with 81.3 years the equivalent figure for boys.
 
That is up from 80.1 and 73.9 respectively in 1990, with the increase of 7.4 years among boys (almost 10%) notably narrowing the difference.
 
The report does, however, highlight significant and predictable inequities, with life expectancy among Aboriginal and Torres Strait Islanders being almost 10 years lower than non-Indigenous residents at 75.6 years for females and 71.6 years for males.
 
Impact of COVID
One of the main focuses of the report is the increasing impact of COVID-19 in Australia, with data from early this year showing the disease’s prevalence is driving higher mortality rates. There were 3105 more deaths than expected in just the first two months of 2022 alone, the AIHW reports.
 
Notwithstanding the huge day-to-day disruptions, Australians had been mostly shielded from the impacts of COVID-19 in mortality terms during 2020 and 2021, although the AIHW does report a rise in the use of mental health services – a trend familiar to many working in general practice.
 
Decreasing death rates continued in both 2020 and 2021, years which saw 205 and 94 fewer deaths than expected respectively once statistical variations were accounted for, according to the AIHW.
 
Previously, figures have shown that Australia’s death rate reached its lowest ever rate during 2020 – an age-standardised mortality rate of 487.7 deaths per 100,000 – with restrictions introduced to stop the spread of the virus likely to have been key.
 
Again, the AIHW highlights the heightened risks according to socioeconomic status, with COVID-19 mortality rates in the poorest areas three times as high as those in the most advantaged neighbourhoods. The report also singles out the disproportionate burden on migrants, a trend that shows no sign of easing according to the latest Australian Bureau of Statistics (ABS) data.
 
Chronic disease burden
Coronary heart disease continues to be the leading cause of disease burden and death, despite the death rate per 100,000 falling dramatically over the past decades – from 428 deaths per 100,000 in 1968 to 49 per 100,000 in 2020.
 
For men, the five leading causes of death in 2020 in descending order were: coronary heart disease, dementia including Alzheimer’s disease, lung cancer, cerebrovascular disease and prostate cancer.
 
For women they were: dementia including Alzheimer’s disease, coronary heart disease, cerebrovascular disease, lung cancer and breast cancer.
 
In those aged over 85, dementia was by far the most significant cause of death, with the report warning that the ‘number of Australians living with dementia – and consequent mortality – is projected to continue to increase, with more Australians living to older ages’.
 
It also states that almost half of the population – at 47% or 11.6 million people – had at least one chronic condition in 2020–21, including arthritis, asthma, back problems, diabetes and mental and behavioural conditions.  
 
‘Over one-third of disease burden was potentially preventable – that is, it could have been prevented had Australians reduced or avoided exposure to certain risk factors,’ the AIHW report states.
 
It pinpoints tobacco use, overweight and obesity, dietary risks, high blood pressure and alcohol use as the five most significant risk factors.
 
General practice
A slightly decreasing proportion of people had at least one Medicare GP service in 2020–21, the report indicates – a total of 85% compared to 87% in 2019–20.
 
The AIHW states there were 171 million GP attendances in 2020–21, with around 108 million of them being a Level B consultation lasting less than 20 minutes, and women more likely to see their GP then men.
 
It also says a smaller proportion of people delayed or did not see their GP due to cost compared to the previous year (2.4% compared to 3.7%, although that number rose to 3.1% for people with a long-term health condition).
 
Of the 16.6 million patients who used a prescription for medicine in 2020–21, around a third of medications were to treat cardiovascular conditions, and there was a total of $12.9 billion spent on subsidised pharmaceuticals, with $11.9 billion used for other medications.
 
In 2020–21, the AIHW reports $17 billion was spent on Medicare for primary care services, with the majority of this ($8.8 billion, or 51%) on GP attendances followed by $4.2 billion on diagnostic imaging.

Editor's note: This article was updated on 07 July 2022 to remove a statistical reference taken from the original report that has since been corrected by AIHW. 
 
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