Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.
Analysis of the National Mortality Database and Australian Burden of Disease Study 2018 data show the 10 selected chronic conditions contributed to nearly 9 in 10 deaths (89%) in 2020 and contributed to around 66% of the total burden of disease (fatal and non-fatal) in 2018 (excluding burden associated with osteoporosis which is not available within current burden of disease estimates) (AIHW 2021). See Burden of disease for more information on definitions and the burden of disease associated with these conditions.
Living with chronic conditions can have a substantial impact on an individual’s health, affect their 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 (AIHW analysis of 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%) (AIHW analysis of ABS 2019).
These comparisons adjust for differences in the age structure of the populations being compared.
Many chronic conditions share common risk factors that are largely preventable or treatable, for example: tobacco smoking, insufficient 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).
Most care for chronic conditions is provided in the primary health care setting by general and allied health practitioners. Effective primary health care can help prevent unnecessary hospitalisations and improve health outcomes (AMA 2021; OECD 2021). 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 2021.
See also: General practice, allied health and other primary care services and Potentially preventable hospitalisations.
Analysis of the National Hospitals Morbidity Database shows the 10 selected chronic conditions were involved in 5.8 million hospitalisations (52% of all hospitalisations) in 2019–20.
In 2019–20, the number of hospitalisations in Australia decreased by 2.8% compared with 2018–19, whereas previous year-to-year changes indicated a consistent upward trend (AIHW 2022). This decrease was driven by hospitalisations that did not involve the 10 selected chronic conditions, which were 4.6% lower in 2019–20 (5.3 million in 2019–20 compared with 5.5 million in 2018–19). In contrast, hospitalisations that involved the selected conditions were relatively stable in the same period, with 1.1% fewer hospitalisations in 2019–20.
For further detail on health service use for the selected chronic conditions, including the possible impact of COVID-19, see: Cancer screening, Chronic kidney disease, Chronic musculoskeletal conditions, Chronic respiratory conditions, Coronary heart disease, Dementia, Diabetes, and Mental health. See ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights for information on the indirect effects of COVID-19 in terms of foregone and delayed health care, including early evidence of changes to health outcomes for specific chronic conditions.
See also: Australia’s hospitals.
Within Australia, it is recognised that multimorbidity increases the complexity of patient care and can require ongoing management and coordination of specialised care across multiple parts of the health system (Harrison and Siriwardena 2018). This places a heavy demand on Australia’s health care system, and requires substantial economic investment.
People living with multiple chronic conditions have more, and longer, medical appointments and more medications to manage (RACGP 2019, 2021), yet historically there has been a lack of coordination and communication between different parts of the Australian health care system (AHMAC 2017; RACGP 2021). 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 2021a).
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 new approaches to support coordinated care for people with chronic and complex health conditions such as Health Care Homes to inform ongoing improvements.
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 is complemented by the development of a 10-year National Preventive Health Strategy launched by the Minister for Health in December 2021 (Department of Health 2021b).
Where do I go for more information?
For further information on chronic conditions and multimorbidity, see:
Visit Chronic disease for more on this topic.
ABS (Australian Bureau of Statistics) (2018) National Health Survey: first results, 2017–18, ABS website, accessed 14 February 2022.
ABS (2019) Microdata: National Health Survey, 2017–18, AIHW analysis of detailed microdata, accessed 7 February 2020.
ABS (2022a) Health conditions prevalence, ABS website, accessed 21 March 2022.
ABS (2022b) Table 2: Long-term health conditions by age and sex [data set], Health conditions prevalence, ABS website, accessed 21 March 2022.
ABS (28 June 2022) 2021 Census data: over 8 million Australians have a long-term health condition [media release], ABS, accessed 28 June 2022.
AHMAC (Australian Health Ministers’ Advisory Council) (2017) National Strategic Framework for Chronic Conditions, AHMAC, Australian Government, accessed 15 February 2022.
AIHW (Australian Institute of Health and Welfare) (2021) Australian Burden of Disease Study: interactive data on disease burden, AIHW, Australian Government, accessed 14 February 2022.
AIHW (2022) Admitted Patients, AIHW website, accessed 9 March 2022.
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Department of Health (2021b) National Preventive Health Strategy 2021–2030, Department of Health website, accessed 11 February 2022.
Harrison C and Siriwardena A (2018) ‘Multimorbidity: editorial’, Australian Journal of General Practice, 47(1–2):7, doi:10.31128/AJGP-11-17-4404.
NSW Health (New South Wales Ministry of Health) (2021) Medically at-risk and influenza, NSW Health website, accessed 11 February 2022.
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RACGP (2021) General practice: health of the nation 2021, RACGP website, accessed 11 February 2022.
WHO (World Health Organization) (2021) Coronavirus disease (COVID-19), WHO website, accessed 11 February 2022.