Chronic conditions are an ongoing cause of substantial ill health, disability and premature death, making them an important global, national and individual health concern. Also referred to as chronic diseases, non-communicable diseases or long-term health conditions, chronic conditions are generally characterised by their long-lasting and persistent effects.

Chronic conditions often have complex and multiple causes. They are not usually immediately life-threatening but tend to develop gradually, becoming more common with age. Once present, they often persist throughout a person’s life, so there is generally a need for long-term management by individuals and health professionals.

Many people with chronic conditions do not have a single, predominant condition, but rather they experience multimorbidity—the presence of 2 or more chronic conditions in a person at the same time. People living with multimorbidity often have complex health needs and report poorer overall quality of life.

For health service providers, multimorbidity can make treatment more complex and can require ongoing management and coordination of specialised care across multiple parts of the health system. This places a heavy demand on Australia’s health care system, and requires substantial economic investment. A key focus of the Australian health system, therefore, is the prevention and better management of chronic conditions to improve health outcomes (Department of Health 2019).

Selected chronic conditions

Although the term ‘chronic conditions’ covers a diverse group of conditions, 10 chronic conditions are the focus of analysis on this page: arthritis, asthma, back pain and problems, cancer, cardiovascular diseases (selected heart, stroke and vascular diseases; excluding hypertension), chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, mental and behavioural conditions (including mood disorders, alcohol and drug problems and dementia), and osteoporosis.

These conditions were selected because they are common, pose significant health problems, and have been the focus of ongoing national surveillance efforts (ABS 2018). In many instances, action can be taken to prevent these conditions, making them an important focus for preventative health initiatives (Department of Health 2020).

Self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey (NHS) provide estimates of the number of Australians affected by 1 or more of the 10 selected chronic conditions, and how living with chronic conditions affects their lives (ABS 2018, 2019).

Findings on this page are largely based on analysis of NHS data as these data enable us to look at the co‑occurrence of the selected chronic conditions across the Australian population to produce estimates of multimorbidity. Estimates presented here may differ from those reported elsewhere due to differences in the data source used, including differences in the method of data collection (for example, self-report survey or diagnostic survey), and the specific chronic conditions included in analysis. Multimorbidity estimates presented here are of multimorbidity associated with the 10 selected chronic conditions only, and do not estimate the prevalence of multimorbidity more broadly.

For further detail on some of the most common chronic conditions see Bone and joint health, Cancer, Chronic kidney diseaseChronic respiratory conditions, Coronary heart disease, Dementia, Diabetes, Mental health.

How common are chronic conditions?

Almost half of Australians (47%, or more than 11 million people) were estimated to have 1 or more of the 10 selected chronic conditions in 2017–18 (ABS 2018).

Mental or behavioural conditions; back pain and problems; and arthritis were the most common of the 10 selected chronic conditions. Based on self-reported information from the 2017–18 NHS, it was estimated that about:

  • 4.8 million (20%) people had a mental or behavioural condition, which was the most commonly reported chronic condition for both males and females (Figure 1)
  • 4 million (16%) had back pain and problems, which includes sciatica, disc disorders, and curvature of the spine
  • 3.6 million (15%) had arthritis, with females (18%) more likely than males (12%) to have the condition.

The most common chronic conditions varied by age group. Of the 10 selected conditions in 2017–18:

  • mental and behavioural conditions were the most common conditions among people aged 15–44 (22%)
  • back pain and problems, and arthritis were the most common conditions among people aged 45–64 (25% each)
  • almost half (49%) of people aged 65 and over were estimated to have arthritis—the most common chronic condition among people in this age group (ABS 2018).

Four in 5 Australians aged 65 and over (80%) were estimated to have 1 or more of the selected chronic conditions in 2017–18 (ABS 2018).

 

The most common chronic conditions for all Australians are mental and behavioural conditions, back problems, arthritis, asthma and diabetes. This chart ranks the top 5 chronic conditions by sex and age, with horizontal bars showing the proportion of each of these conditions in the population. The chart shows that 18% of males and 22% of females had mental and behavioural conditions in 2017–18. Males and females had similar rates of back problems (17% and 16%, respectively).

How common is multimorbidity?

It is estimated that 20% of Australians (4.9 million people) had 2 or more of the 10 selected chronic conditions in 2017–18, a state of health known as multimorbidity (ABS 2019).

Females were more likely to have multimorbidity than males (23% compared with 18%) (ABS 2019) (Figure 2). This difference remained after adjusting for differences in the age structure between females and males.

Multimorbidity becomes more common with age. In 2017–18, people aged 65 and over were more likely to have 2 or more of the selected conditions compared with people aged 15–44 (51% compared with 12%) (Figure 2).

 

The horizontal bar chart shows the proportion of people with no chronic conditions, 1 chronic condition and 2 or more chronic conditions (multimorbidity) in 2017–18. The proportion of people who had multimorbidity was higher in females (23%) than in males (18%) however, the proportion of males and females with 1 chronic condition was similar (28% and 26% respectively). By age group, the chart shows that while the risk of having multimorbidity increases with age, the proportion of people with 1 chronic condition is relatively similar across age groups (29% among people aged 15–44, 30% among people aged 45–64 and 29% among people aged 65 and over).

Variation between population groups

Certain groups of people are more likely to experience multimorbidity than others. In 2017–18, the prevalence of multimorbidity tended to increase with increasing socioeconomic disadvantage, ranging from 14% in the highest socioeconomic areas to 24% in the lowest socioeconomic areas. However, the prevalence of multimorbidity was similar across remoteness areas (ranging from 18% in Major cities and Remote areas to 21% in Inner and Outer regional areas) (Figure 3). These findings adjust for differences in the age structure of the populations being compared. See Rural and remote health for more information on the health of these population groups.

This horizontal bar chart shows the age-standardised proportion of people with no chronic conditions, 1 chronic condition and 2 or more chronic conditions (multimorbidity) by remoteness (Major cities, Inner regional, Outer regional and Remote) and socioeconomic area (Groups 1–5). The proportions of people who had no chronic conditions, 1 chronic condition, or who had multimorbidity were similar across each of the remoteness areas. While the proportion of people with 1 chronic condition was also similar across socioeconomic areas, the proportion of people who had multimorbidity increased progressively from the highest socioeconomic area (least disadvantaged) to the lowest socioeconomic area (most disadvantaged).

Impact

Living with chronic conditions can have a substantial impact on an individual’s health and their health service use. Analysis of the National Hospitals Morbidity Database, National Mortality Database and Australian Burden of Disease Study 2015 data shows the 10 selected chronic conditions:

  • were involved in 5 in 10 hospitalisations (51%) in 2017–18
  • contributed to nearly 9 in 10 deaths (89%) in 2018
  • contributed to around 66% of the total burden of disease (fatal and non-fatal) in Australia in 2015 (excluding burden associated with osteoporosis which is not available within current burden of disease estimates) (AIHW 2019). See Burden of disease for more information on definitions and the burden of disease associated with these conditions.

Living with chronic conditions can also affect a person’s quality of life and have social and economic effects. The impact is even greater for people living with multimorbidity. Based on self-reported data from the 2017–18 NHS, people with multimorbidity were less likely to be in the labour force (working or seeking work) than people with no chronic conditions. Of all people aged 18–64 with multimorbidity, 71% were working or seeking work compared with 86% of people aged 18–64 with no chronic conditions (ABS 2019).

Compared with those with no long-term conditions, people aged 18 and over with multimorbidity also had higher levels of:

  • disability, restriction or limitation (50% of people aged 18 and over with multimorbidity experienced disability, restriction or limitation compared with 7.9% of people of the same age with no long-term conditions)
  • high or very high psychological distress (35% compared with 4.3%)
  • bodily pain experienced in the previous 4 weeks (88% compared with 55%)
  • fair or poor health (32% compared with 5.3%) (ABS 2019).

These comparisons adjust for differences in the age structure of the populations being compared.

Risk factors

Many chronic conditions share common risk factors that are largely preventable or treatable, for example: tobacco smoking, physical inactivity, poor diet , overweight and obesity and other biomedical risk factors such as high blood pressure. Preventing or modifying these risk factors can reduce the risk of developing a chronic condition and result in large population and individual health gains by reducing illness and rates of death.

As with chronic conditions, these risk factors tend to be more prevalent in the lowest socioeconomic areas and in regional and remote areas (see: Health across socioeconomic groups and Rural and remote health).

Treatment and management

Most care for chronic conditions is provided in the primary health care setting by general and allied health practitioners. Mental and behavioural conditions (including anxiety, depression and mood disorders), musculoskeletal (including arthritis), respiratory (including asthma) and endocrine and metabolic conditions (including diabetes) were the most common health concerns managed by general practitioners in 2019 (RACGP 2019). Effective primary health care can help prevent unnecessary hospitalisations and improve health outcomes (AMA 2017; OECD 2017). See: Primary health care and Potentially preventable hospitalisations.

Within Australia, it is recognised that multimorbidity increases the complexity of patient care (Harrison & Siriwardena 2018). People living with multiple chronic conditions have more medical appointments and medications to manage (RACGP 2019), yet historically there has been a lack of coordination and communication between different parts of the Australian health care system (Department of Health 2018; RACGP 2019).

The Australian Government has implemented a number of approaches with the aim of improving coordination and care for people with chronic conditions, including:

  • access to care plans and assessments through the Medicare Benefits Schedule for the planning and management of chronic conditions
  • subsidies through the Pharmaceutical Benefits Scheme for a range of medicines used in the treatment of chronic conditions
  • trialling Health Care Homes where patients are enrolled with a specific general practice or Aboriginal Community Controlled Health Service to coordinate their care and to facilitate services by a care team. The care team can include a range of health professionals (for example, general practitioners, specialists, allied health professionals and practice nurses) (Department of Health 2018).

In 2017, all Australian health ministers endorsed the National Strategic Framework for Chronic Conditions (the Framework). The Framework provides guidance for the development and implementation of policies, strategies, actions and services to tackle chronic conditions. It moves away from a disease-specific approach and better caters for shared health determinants, risk factors and multimorbidities across a broad range of chronic conditions.

The Framework outlines 3 objectives that focus on preventing chronic conditions, and thus minimising multimorbidities; providing efficient, effective and appropriate care to manage them; and targeting priority populations (AHMAC 2017). The Framework will be complemented by the development of a 10-year National Preventative Health Strategy announced by the Minister for Health in June 2019 (Department of Health 2019).

Where do I go for more information?

For further information on chronic conditions and multimorbidity, see:

 Visit Chronic disease for more on this topic.

References

ABS (Australian Bureau of Statistics) 2018. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

ABS 2019. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on detailed Microdata analysis. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015—summary report. Australian Burden of Disease Study series no. 18. Cat. no. BOD 21. Canberra: AIHW.

AHMAC (Australian Health Ministers’ Advisory Council) 2017. National Strategic Framework for Chronic Conditions. Canberra: Australian Government.

AMA (Australian Medical Association) 2017. General practice in primary health care—2016 . Viewed 30 January 2020.

Department of Health 2018. Health Care Homes. Canberra: Department of Health. Viewed 30 August 2019.

Department of Health 2019. National Preventive Health Strategy. Canberra: Department of Health. Viewed 6 January 2020.

Harrison C and Siriwardena A 2018. Multimorbidity: editorial. Australian Journal of General Practice. Volume 47(1–2). Viewed 30 August 2018.

OECD (Organisation for Economic Co-operation and Development) 2017. Health at a glance 2017: OECD indicators. Paris: OECD.

RACGP (The Royal Australian College of General Practitioners) 2019. General practice: health of the nation 2019. Melbourne: RACGP.