Chronic conditions and multimorbidity is an Australia's health topic

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.

People with chronic conditions can also be more vulnerable to the effects of certain communicable diseases, including Influenza and COVID-19. While most people will only experience relatively mild/moderate symptoms after contracting these diseases, people with chronic conditions including cardiovascular disease, diabetes, chronic respiratory disease and cancer can develop more serious illness (NSW Health 2021; OECD 2021; WHO 2021).

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. See Chronic condition multimorbidity for further detail.

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 problems; cancer; chronic kidney disease; chronic obstructive pulmonary disease (COPD); diabetes; mental and behavioural conditions (including mood disorders, alcohol and drug problems and dementia); osteoporosis; selected heart, stroke and vascular diseases.

These 10 conditions were selected because they are common, pose significant health problems, and have been the focus of ongoing national surveillance efforts (ABS 2018). See the NHS Users' Guide 2017–18 for more information.

In many instances, action can be taken to prevent these conditions, making them an important focus for preventive health initiatives (Department of Health 2021a).

Chronic condition data

Chronic condition prevalence data for 2020–21 is based on self-reported data from the Australian Bureau of Statistics (ABS) 2020–21 National Health Survey (NHS).

Previous versions of the NHS have primarily been administered by trained ABS interviewers and were conducted face-to-face. The 2020–21 NHS was conducted during the COVID-19 pandemic. To maintain the safety of survey respondents and ABS interviewers, the survey was primarily collected via online, self-completed forms.

Non-response is usually reduced through interviewer follow up of households who have not responded. As this was not possible during lockdown periods, there were lower response rates than previous NHS cycles, which impacted sample representativeness for some sub-populations. Additionally, the impact of COVID-19 and lockdowns might also have had direct or indirect impacts on people’s usual behaviour over the 2020–21 period.

Due to these changes, comparisons to previous NHS data over time are not recommended.

Detailed analysis of multimorbidity, including comparisons between population groups and how living with multimorbidity affects the lives of individuals are based on data from the NHS 2017–18 (ABS 2018).

Multimorbidity estimates presented here therefore provide baseline information on chronic condition multimorbidity in Australia, before the COVID-19 pandemic.

How common are chronic conditions?

Almost half of Australians (47%, or 11.6 million people) were estimated to have one or more of the 10 selected chronic conditions in 2020–21 (ABS 2022a).

Mental or behavioural conditions; back problems; and arthritis were the most common of the 10 selected chronic conditions. Based on self-reported information from the 2020–21 NHS, it was estimated that about:

  • 5.0 million (20%) people had a mental or behavioural condition, which was the most commonly reported chronic condition for both males and females.
  • 3.9 million (16%) had back problems, which include sciatica, disc disorders, and curvature of the spine.
  • 3.1 million (12%) had arthritis, with females (15%) more likely than males (10%) to have the condition (Figure 1).

The most common chronic conditions varied by age group. Of the 10 selected conditions in 2020–21:

  • Mental and behavioural conditions were the most common conditions among people aged 15–44 (25%).
  • Back problems were the most common conditions among people aged 45–64 (23%).
  • 41% of people aged 65 and over were estimated to have arthritis – the most common chronic condition among people in this age group (ABS 2022b).
     

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 17% of males and 23% of females had mental and behavioural conditions in 2020–21. Males and females had similar rates of back problems (15% and 16%, respectively).


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

Long-term health conditions in the 2021 Census

The 2021 Census conducted by the Australian Bureau of Statistics (ABS) contained a new item on long-term health conditions. People were asked if they have been told by a doctor or nurse that they have one or more of the following conditions: arthritis, asthma, cancer, dementia, diabetes, heart disease, kidney disease, lung conditions, mental health conditions, stroke, or any other long-term health condition not listed on the form.

Over 8 million Australians reported having at least 1 long-term health condition in the 2021 Census.

The Census is one of several ABS sources of long-term health conditions data. Census estimates of the number of people with a long-term health condition may differ from other data sources due to differences in how the question is asked and the conditions included; the scope, size, and characteristics of the sample; and the collection methodology.

Large sample health surveys, including the NHS, the National Aboriginal and Torres Strait Islander Health Survey and the National Study of Mental Health and Wellbeing, are the definitive and correct source for national prevalence rates (ABS 28 June 2022). The long-term health conditions question in the Census allows for the analysis of long-term health condition data at more detailed geographic and sub-population levels (including country of birth and service in the Australian Defence Force) compared with other ABS health surveys.

Find out more: on the ABS website Health: Census.

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 (AIHW analysis of ABS 2019).

Females were more likely to have multimorbidity than males (23% compared with 18%) (AIHW analysis of 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 10 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 (areas 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

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.

Risk factors

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).

Treatment and management

Primary care

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.

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.

Coordinated approaches

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.

References

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.

AMA (Australian Medical Association) (2021) Primary health care—2021, AMA website, accessed 11 February 2022.

Department of Health (2021a) About preventive health in Australia, Department of Health website, accessed 11 February 2022.

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.

OECD (Organisation for Economic Co-operation and Development) (2021) Health at a glance 2021: OECD indicators, OECD website, accessed 11 February 2022.  

RACGP (Royal Australian College of General Practitioners) (2019) General practice: health of the nation 2019, RACGP website, accessed 24 February 2022.

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.