Dementia soon to be Australia’s biggest killer

Ischaemic heart disease has long held the unfortunate title of Australia’s biggest killer, but that is on the brink of change as dementia-related deaths claim more lives than ever before.
 
According to new data from the Australian Bureau of Statistics (ABS), ischaemic heart disease was still the nation’s leading cause of death in 2023, but dementia fatalities are rapidly catching up.
 
Last year, there were only 237 cases separating the top two leading causes of death – the closest the two have ever been.
 
‘In fact, over the past 50 years the mortality rate for ischaemic heart disease has decreased by 87.9% while the rate for dementia has increased by 842.8%,’ the ABS said. 
 
‘There is an expectation that if mortality continues to follow expected trajectories, dementia will be the leading cause of death in Australia in coming years.’
 
In 2023, heart diseases caused 9.2% of deaths, while dementia, which includes Alzheimer’s disease, accounted for 9.1%.
 
In its peak in 1968, ischaemic heart disease accounted for 30.5% of deaths, while in the same year, dementia was responsible for just 0.2% of deaths.
 
And for the first time, dementia is now the leading cause of death in New South Wales, as well as in South Australia and the Australian Capital Territory.
 
The ABS puts this change in mortality down to improved healthcare and medical interventions for ischaemic heart disease, but for dementia, Australia’s ageing population has led to its increase.
 
Dr Marita Long, a Victorian GP with a special interest in dementia and honorary medical advisor with Dementia Australia, said the data highlights Australia’s need to ‘get its skates on’ when it comes to brain health.
 
‘We’re getting much more savvy, much more clued into preventing heart disease – we have so many public health campaigns, little kids do Jump Rope for Heart, we have a heart health check in primary care,’ she told newsGP.
 
‘Heart disease is recognised as a significant illness that we need to work on and we’re seeing a lot of people who are surviving and living with heart failure, having pacemakers put in, so we’re seeing a lot more progress in that space.
 
‘And nearly half of the cases of dementia globally can be prevented, or at least delayed, by putting in some preventive health measures, and that’s got to be from a public perspective, it can’t just be left to GPs again.’
 
Stroke was the third leading cause of death, and rounding out the top 10 were lung cancer, chronic lower respiratory diseases, diabetes, bowel cancer, blood and lymph cancers, COVID-19, and urinary diseases.
 
However, the ABS found that for Aboriginal and Torres Strait Islander people, the top causes of death are significantly different.
 
Ischaemic heart diseases remain the top killer, followed by, in order, chronic lower respiratory diseases, diabetes, malignant neoplasm of trachea, bronchus and lung, and intentional self-harm in fifth place.
 
Nationwide, dementia has been the leading cause of death for women since 2016, and now accounts for 12.2% of female deaths, as well as 6.4% of male deaths.
 
Dr Long said dementia remains one of the most feared conditions for patients around the world, with many people, including doctors, still wrongly believing it is a normal part of ageing.
 
‘We need to start focusing on brain health as opposed to dementia, we need to start to put a bit more of a positive spin on it,’ she said,
 
‘We have these brains that are amazing, and there’s actually all these things that we know we can do to optimise our brain health.
 
‘If we optimise our brain health, that then gives us an increased brain reserve and cognitive reserve that will resist the pathology that causes dementia.’
 
Last month, the Australian Institute of Health and Welfare released updated dementia-specific data, finding that in 2023 there were 411,100 Australians living with the disease.
 
It found that each year, there are 26,300 hospitalisations due to dementia in Australia with the average length of stay being 15.5 days, which is significantly longer than an average stay.
 
With similar statistics facing populations globally, some countries are already rolling out widespread public health campaigns to shift thinking about brain health, especially among younger people.
 
In Scotland, the My Amazing Brain program has already reached more than 10,000 primary school students and was designed to empower children to know how they can protect themselves against dementia.
 
In Australia, Dementia Australia’s free BrainTrack app is already available to patients, as well as the CogDrisk program, a 20-minute assessment which helps a person understand their dementia risk profile.
 
These preventive measures come just months after the 2024 Lancet Commission study found that 45% of dementia cases could be prevented or delayed by addressing 14 risk factors starting in childhood.
 
These risk factors include vision and hearing loss, high low-density lipoprotein cholesterol, smoking, obesity, hypertension, depression, physical inactivity, and excessive alcohol.
 
Dr Long said that while doctors must turn their attention to brain health, it must be in conjunction with public awareness.
 
‘We now have very clear understandings that the pathology starts 20 to 30 years before, so mid-life – whole of life is important to be addressing health, but mid-life is critical,’ she said.
 
‘The exciting thing is that there is a lot we can do and even for someone who’s diagnosed with dementia, and we certainly want to be looking at diagnosing people as early as possible, if we optimise their brain health, it will slow the progression of the disease.
 
‘Whilst there are more treatments and more diagnostic tests becoming available in Australia, the take-home message at this point in time has to be that prevention is better than cure, but when there is no cure, prevention is everything.’
 
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ABS Alzheimer’s disease Australian Bureau of Statistics dementia heart disease