Chronic conditions
Chronic conditions are complex, long lasting, and are a leading cause of illness, disability, and death in Australia (AIHW 2023).
Various factors can influence a person’s likelihood of developing a chronic condition. This can include the socioeconomic areas in which they live, and access to medical care (AIHW 2021).
Some risk factors associated with chronic conditions are considered preventable, including poor diet, physical inactivity, obesity, tobacco smoking, at-risk alcohol consumption, illicit drug use, and unsafe sexual practices (AIHW 2023).
The major chronic physical condition groups investigated as part of the NPHDC were asthma, arthritis, back problem, cardiovascular disease, diabetes, pulmonary disease, chronic kidney disease, osteoporosis and cancer. Mental health conditions, also a group of chronic conditions, are reported in Mental health and self-harm.
This section includes self-reported findings from prison entrants about chronic physical conditions. Information about people in prison taking prescribed medication for chronic conditions can be found in Medication.
Past diagnosis of a chronic condition for prison entrants
Prison entrants were asked whether they had ever been told by a doctor or nurse that they had any of the chronic physical health conditions investigated as part of the NPHDC and whether a condition was current.
Self-reported data rely on the respondents’ accurate recall and are likely to be an underestimate of true prevalence. Further, some prison entrants might have existing health conditions that have yet to be diagnosed because they have not accessed health services. This might be especially true for First Nations entrants, and those living in remote areas, where access to health services can be limited.
Just over half (52%) of prison entrants reported they had ever been told they had a chronic physical condition (Indicator 1.2.1)
The most common chronic physical conditions reported were asthma (27%) and back pain (27%) (Figure 3.1). Of the entrants who reported a chronic physical condition, more than 2 in 5 (42%) reported their chronic condition was current when they entered prison.
Almost two-thirds (61%) of female prison entrants reported a past diagnosis of a chronic physical condition, compared with half (50%) of male prison entrants. Almost 1 in 2 (45%) female entrants, and about 2 in 5 (41%) male entrants, reported the chronic physical condition was current when they entered prison.
Non-Indigenous entrants (54%) were more likely than First Nations entrants (49%) to report a past diagnosis of a chronic physical condition. However, the difference was slightly larger for those reporting a current chronic physical condition – Almost 2 in 5 (38%) of First Nations prison entrants, and almost half (45%) of non-Indigenous entrants.
Figure 3.1: Prison entrants, past diagnosis of a chronic physical condition, by selected chronic physical conditions and sex, 2022
Notes
- Proportions are representative of this data collection only, and not the entire prison population.
- Excludes Victoria, which did not provide data for this item.
- ‘Any chronic condition’ does not represent a sum of the conditions, as 1 prison entrant might have multiple conditions.
Source: Entrants form, 2022 NPHDC.
Asthma is a common chronic inflammatory condition of the airways that can be managed, but not cured.
In 2020–21, 1 in 9 (11%) Australian adults had asthma (Figure 3.2) – females (13%) in Australia had a higher rate than males (9.5%) (ABS 2022).
More than one-quarter (27%) of prison entrants reported being told they had asthma at some stage in their lives. Nearly 1 in 5 (18%) stated that the condition was current when they entered prison (Figure 3.2). Females (33%) were more likely to report a prior diagnosis of asthma than males (26%).
Arthritis is an umbrella term for a wide range of inflammatory conditions affecting the bones, muscles and joints. This often results in pain, stiffness, swelling and redness in affected joints.
In 2020–21, 1 in 6 Australian adults (16%) suffered from arthritis (Figure 3.2), with more females (18%) diagnosed with arthritis than males (13%) (ABS 2022).
In 2022, 1 in 8 (12%) prison entrants reported a past diagnosis of arthritis; 1 in 9 (11%) reported a current diagnosis of arthritis (Figure 3.2). Female prison entrants (13%) had slightly higher rates than male prison entrants (11%) of a reported previous diagnosis of arthritis.
First Nations prison entrants (13%) were more likely to report a previous diagnosis of arthritis than non-Indigenous prison entrants (10%).
For current arthritis, the reported prevalence was lower for prison entrants aged 18–24 (0%) than for prison entrants aged 45 and over (26%).
Back problem refers to a range of conditions related to the bones, joints, connective tissue, muscles, and nerves of the back. Back pain and problems were the second leading cause of disease burden in Australia, with 1 in 5 Australian adults (20%) reporting a back problem (ABS 2022) (Figure 3.2).
In 2022, more than one-quarter (27%) of prison entrants reported a past diagnosis of a back problem, with slightly fewer (23%) entrants reporting a current back problem (Figure 3.2). Male (27%) and female (28%) entrants were similarly as likely to report ever having a back problem.
Non-Indigenous entrants (27%) were more likely to report having a current back problem than First Nations entrants (18%). The difference was smaller for ever having a back problem – almost 1 in 3 (30%) non-Indigenous prison entrants compared with almost 1 in 4 (24%) First Nations entrants.
Back problems were more prevalent with age, with 2 in 5 (40%) entrants aged 45 and over reporting a past diagnosis of a back problem.
Cancer encompasses a group of diseases where cells in the body grow and spread uncontrollably. In 2018, cancer was the leading cause of burden of disease in Australia (ABS 2022). About 3 in 10 deaths in Australia are attributable to cancer (AIHW 2022).
In 2020–21, about 1 in 50 (2.1%) adults in Australia had cancer (Figure 3.2). The prevalence increased with age, with those aged 65 and over (5.6%) having the highest rates of cancer (ABS 2022).
In 2022, 1 in 50 (2.4%) prisons entrants reported a past diagnosis of cancer, and 0.3% of entrants reported a current cancer diagnosis (Figure 3.2).
About 1 in 16 (6.1%) entrants aged 45 and over reported a previous cancer diagnosis, and about 1 in 80 (1.2%) reported a current diagnosis of cancer. This compared with about 1 in 80 (1.4%) entrants aged 18–44 reporting a past diagnosis of cancer, and no prison entrants in that age group reporting a current cancer diagnosis.
Cardiovascular disease is the leading cause of death in Australia and worldwide, and is second only to cancer in its contribution to the burden of disease in Australia (AIHW 2021). Risk factors include obesity, tobacco smoking, high blood pressure, high blood cholesterol, physical inactivity, poor diet and diabetes (AIHW 2021).
In 2020–21, about 1 in 20 (5.2%) adults in Australia had cardiovascular disease (Figure 3.2). The prevalence was slightly greater among Australian males (6.4%) than females (4.0%) (ABS 2022).
In 2022, 1 in 8 (13%) prison entrants reported a prior diagnosis of cardiovascular disease; 1 in 12 (8.1%) reported a current diagnosis (Figure 3.2). Male entrants (13%) were similarly as likely to report a past diagnosis of cardiovascular disease as female entrants (12%).
Cardiovascular disease in First Nations prison entrants (15%) was fairly similar to that reported in non-Indigenous prison entrants (11%). The difference was slightly less in those reporting a current diagnosis – 1 in 10 (9.8%) First Nations entrants reported a current cardiovascular disease diagnosis compared with 1 in 15 (6.5%) non-Indigenous entrants.
Previous diagnosis and current self-reported cardiovascular disease increased with age, as did rates in the general population (ABS 2022). Almost 1 in 3 (30%) prison entrants aged 45 or over reported being told they had cardiovascular disease at some stage in their lives.
Chronic kidney disease refers to all conditions of the kidney affecting the filtration and removal of waste from the blood for 3 months or more. It is identified by reduced filtration by the kidney and/or by the leakage of protein or albumin from the blood into the urine.
In 2020–21, 1.3% of Australian adults reported having chronic kidney disease (ABS 2022) (Figure 3.2).
In 2022, 2.7% of prison entrants reported a chronic kidney disease diagnosis at some stage in their lives; 1.9% of entrants reported having a current chronic kidney disease (Figure 3.2).
Female entrants (6.7%) were more likely to report a chronic kidney disease diagnosis at some point in their lives than male entrants (1.9%).
Overall, there was a low rate of current chronic kidney disease with First Nations entrants (2.7%) having a similar rate to that of non-Indigenous entrants (1.1%).
Diabetes mellitus (diabetes) is marked by high levels of glucose in the blood. It is caused by the body’s inability to produce insulin, or the body not being able to use insulin effectively, or by both factors.
There are 3 main types of diabetes:
- Type 1 diabetes is an autoimmune disease with usual onset in childhood or early adulthood.
- Type 2 diabetes is the most prevalent form of diabetes. It generally has a later onset than type 1, and is considered to be largely preventable due to lifestyle risk factors.
- Gestational diabetes involves higher-than-normal blood glucose levels during pregnancy.
In 2020–21, about 1 in 20 (6.8%) Australians had diabetes (ABS 2022) (Figure 3.2). The rate of diabetes increased with age, from 1.4% of people aged 25–34 to 16.9% of those aged 65 and over (ABS 2022).
In 2022, 1 in 13 (7.5%) prison entrants reported a previous diagnosis of diabetes; 1 in 17 (5.9%) reported a current diagnosis (Figure 3.2).
First Nations entrants (9.3%) were fairly similar to non-Indigenous entrants (6.0%) in reporting a past diagnosis of diabetes.
The self-reported prevalence of a prior diabetes diagnosis increased with age, from 3.5% of entrants aged 25–34, to about 1 in 4 (16%) entrants aged 45 and over. For current diabetes, the self-reported prevalence rose from 2.8% of entrants aged 25–34 to 1 in 7 (15%) entrants aged 45 and over.
Osteoporosis is a chronic condition characterised by a person’s bones becoming fragile and brittle, with an increased risk of fractures.
In 2020–21, 1 in 20 (4.6%) of Australian adults had osteoporosis (Figure 3.2). The prevalence was more common among Australian females (7.5%) than Australian males (1.5%) (ABS 2022).
In 2022, a very small number (1.3%) of prison entrants reported being diagnosed with osteoporosis at some stage in their lives; 1.1% of entrants reported current osteoporosis (Figure 3.2).
Female entrants (3.3%) were similar to male entrants (1.0%) in reporting a past diagnosis of osteoporosis. Female entrants and male entrants were similarly as likely to currently have osteoporosis (1.7% and 1.0%, respectively).
About 1 in 45 (2.2%) non-Indigenous entrants reported being diagnosed with osteoporosis at some stage in their lives, and less than 1.0% of First Nations entrants reported the same diagnosis. The findings were similar for non-Indigenous (1.6%) and First Nations entrants (0.5%) with a current osteoporosis diagnosis.
Pulmonary disease is a chronic condition that includes chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, chronic pneumonia, chronic bronchitis and emphysema.
In 2020–21, 1 in 50 (1.9%) Australian adults had COPD (Figure 3.2). The prevalence was slightly more common among Australian females (2.6%) than Australian males (1.1%) (ABS 2022).
Of prison entrants in 2022, 1 in 13 (7.8%) reported having a past diagnosis of pulmonary disease. Fewer than 1 in 20 (3.5%) entrants reported currently having pulmonary disease (Figure 3.2).
A history of COPD was more common among female entrants (11.7%) than male entrants (7.1%).
Chronic conditions comparisons with general community
Figure 3.2 shows that back problem, asthma, cardiovascular disease and pulmonary disease were more common among prison entrants than the general community. Arthritis, osteoporosis, cancer and diabetes were more common among the general community than prison entrants.
Direct comparisons between the general community and the prison population cannot be made due to non-random survey sampling and differences in the demographic profile of the populations. However, some conditions that are more common among older people (for example, arthritis or osteoporosis) may be more prevalent in the general community due to the prison population’s having a younger age profile.
Figure 3.2: Prison entrants (2022) and the general community (2020–21), current chronic physical condition, by selected chronic physical conditions
Notes
- Proportions are representative of this data collection only, and not the entire prison population.
- Excludes Victoria, which did not provide data for this item.
Source: AIHW analysis of ABS 2022, Table 1; Entrants form, 2022 NPHDC.
ABS (Australian Bureau of Statistics (2022) Health conditions prevalence, ABS website, accessed 31 May 2023.
AIHW (Australian Institute of Health and Welfare) (2021) Australian burden of disease study: impact and causes of illness and death in Australia 2018, AIHW website, accessed 17 April 2023.
—— (2022) Cancer, AIHW website, accessed 31 May 2023.
—— (2023) Chronic conditions and multimorbidity, AIHW website, accessed 2 August 2023.