Socioeconomic factors are important determinants of health. Having access to material and social resources and being able to participate in society are important for maintaining good health. Social inequalities and disadvantage are the main reason for unfair and avoidable differences in health outcomes and life expectancy across groups in society.

Generally, people in lower socioeconomic groups are at greater risk of poor health, have higher rates of illness, disability and death, and live shorter lives than people from higher socioeconomic groups (Mackenbach 2015). The higher a person’s socioeconomic position, the healthier they tend to be—a phenomenon often termed the ‘social gradient of health’. See Social determinants of health and Social determinants and Indigenous health.

This page compares socioeconomic groups on health measures across 4 key health areas, focusing on people in the lowest and highest socioeconomic groups, where differences are usually large. It highlights that for almost all health measures, people from lower socioeconomic groups in Australia fare worse.

Measuring socioeconomic position—the Index of Relative Socio-economic Disadvantage

Socioeconomic position can be measured using an individual characteristic, such as a person’s level of income, education or occupation, or it may be constructed as a composite measure using a range of socioeconomic information.

In the AIHW’s reporting on health across socioeconomic groups, a composite measure of socioeconomic position known as the Index of Relative Socio-economic Disadvantage (IRSD) is frequently used (ABS 2018).

The IRSD classifies individuals according to the socioeconomic characteristics of the area in which they live. It scores each area by summarising attributes of the population, such as low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. Areas can then be ranked according to their score. The population living in the 20% of areas with the greatest overall level of disadvantage is described as the ‘lowest socioeconomic areas’. The 20% at the other end of the scale—the top fifth—is described as the ‘highest socioeconomic areas’.

Note that the IRSD reflects the overall or average level of disadvantage of the population of an area; it does not show how individuals living in the same area differ from each other in their socioeconomic position.

Health risk factors

On most health risk factors, adults living in the lowest socioeconomic areas fared worse than adults in the highest socioeconomic areas. Based on the Australian Bureau of Statistics 2017–18 National Health Survey, it is estimated that adults in the lowest socioeconomic areas were:

  • 3.3 times as likely to smoke daily (AIHW 2020) (Figure 1)
  • 1.6 times as likely to be obese (AIHW 2019k)
  • 1.3 times as likely to be insufficiently active (AIHW 2019i)
  • 1.2 times as likely to have uncontrolled high blood pressure (AIHW 2019g).

Adults in the lowest socioeconomic areas were at similar lifetime risk of harm from drinking alcohol to adults in the highest socioeconomic areas (AIHW 2020).

More recent data for daily tobacco smoking and alcohol consumption levels, including for people living in the highest and lowest socioeconomic areas , is available in the National Drug Strategy Household Survey 2019.

This chart shows that the proportion of adults who smoked daily in 2017–18 decreased across 5 socioeconomic groups—22.8% of people living in the lowest socioeconomic areas smoked daily, compared with 7.0% of people in the highest socioeconomic areas.

Chronic conditions

Rates of chronic conditions were also higher for adults in the lowest socioeconomic areas, compared with adults in the highest socioeconomic areas. In particular, it is estimated that adults in the lowest socioeconomic areas were:

  • 2.3 times as likely to have chronic obstructive pulmonary disease in 2017–18, among people aged 45 and over (AIHW 2019e)
  • 2.3 times as likely to have chronic obstructive pulmonary disease in 2017–18, among people aged 45 and over (AIHW 2019e)
  • 2.2 times as likely to have diabetes in 2017–18 (AIHW 2019f)
  • 1.7 times as likely to be newly diagnosed with lung cancer in 2010–2014, among people of all ages (AIHW 2019b) (Figure 2)
  • 1.6 times as likely to have biomedical signs of chronic kidney disease in 2011–12 (AIHW 2019d)
  • 1.3 times as likely to have heart, stroke and vascular disease in 2017–18 (AIHW 2019c).

This chart shows that the incidence of lung cancer during 2010–2014 decreased across 5 socioeconomic groups, from 54.2 per 100,000 in the lowest socioeconomic areas to 31.5 per 100,000 in the highest socioeconomic areas.

Deaths

In 2018, people in the lowest socioeconomic areas were 1.5 times as likely to die as people in the highest areas (Figure 3). They were 2.3 times as likely to die from potentially avoidable causes in 2018—this being a premature death that could have been avoided with timely and effective health care.

The mortality rate of people in the lowest socioeconomic areas for all causes of death was 615 per 100,000 population, compared with 554 in the second group, 494 in the third, 451 in the fourth, and 405 for people in the highest socioeconomic areas.

Disease-specific death rates were generally higher for people in the lowest socioeconomic areas, compared with people in the highest areas. In particular, adults in the lowest socioeconomic areas were:

  • 2.4 times as likely to die from chronic obstructive pulmonary disease in 2014–2018
  • 2.0 times as likely to die from lung cancer in 2014–2018
  • 1.6 times as likely to die from coronary heart disease in 2014–2018
  • 1.2 times as likely to die from cerebrovascular disease (mostly stroke) in 2014–2018
  • 1.1 times as likely to die from dementia and Alzheimer’s disease in 2014–2018 (AIHW 2019j).
     

This chart shows that the all-cause mortality rate in 2018 decreased across 5 socioeconomic groups, from 615 per 100,000 in the lowest socioeconomic areas, to 405 per 100,000 in the highest socioeconomic areas.

Males and females in the lowest socioeconomic areas in 2015 lived, on average, 6.4 and 4.1 years less than males and females in the highest socioeconomic areas (AIHW 2019b).

See Causes of death.

Burden of disease

Burden of disease analysis combines estimates of the fatal and non-fatal impact of disease (see Burden of disease).

In 2015, the overall burden rate for people in the lowest socioeconomic areas was 1.5 times as high as the rate for people in the highest socioeconomic areas (Figure 4).

Compared with people in the highest socioeconomic areas, people in the lowest socioeconomic areas experienced burden of disease that was estimated to be:

  • 2.5 times as high for type 2 diabetes
  • 2.0 times as high for lung cancer
  • 1.4 times as high for anxiety disorders
  • 1.4 times as high for stroke.

Adults in the lowest socioeconomic areas experienced a similar burden of disease for dementia to adults in the highest socioeconomic areas.

In terms of population impact, if all Australians had experienced the same burden as people in the highest socioeconomic areas in 2015, the total disease burden could have been reduced by one-fifth (20%) (AIHW 2019a).
 

This chart shows that the total burden of disease in 2015 decreased across 5 socioeconomic groups, from 220 DALY per 1,000 in the lowest socioeconomic areas to 145 DALY per 1,000 in the highest socioeconomic areas.

Other measures of socioeconomic position

Statistical linkage of health and welfare data sets can provide additional information on wealth, education, employment and other individual socioeconomic characteristics. This allows for a more accurate assessment of socioeconomic position. It also helps us to better understand the associations of socioeconomic characteristics with health outcomes, and the pathways through the health system for persons in different socioeconomic groups.

The following figure uses linked data to show social gradients in mortality for each of 3 measures—equivalised household income, highest educational attainment and housing tenure (Figure 5).

In each instance, people in lower socioeconomic groups had higher rates of mortality. The steepness of the gradient from low to high socioeconomic group, however, varied by sex, cause of death and measure of socioeconomic position.
 

These charts show that mortality rates for cardiovascular disease, chronic kidney disease and diabetes were higher among lower socioeconomic groups in 2011–12, when socioeconomic position was assessed using levels of income, education and housing tenure.

Where do I go for more information?

For more information on health across socioeconomic groups, see:

References

ABS (Australian Bureau of Statistics) 2018. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2016. ABS cat. no. 2033.0.55.001. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019a. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019b. Cancer in Australia 2019. Cat. no. CAN 123. Canberra: AIHW.

AIHW 2019c. Cardiovascular disease. Cat. no. CVD 83. Canberra: AIHW.

AIHW 2019d. Chronic kidney disease . Cat. no. CDK 16. Canberra: AIHW.

AIHW 2019e. Chronic obstructive pulmonary disease. Cat. no. ACM 35. Canberra: AIHW.

AIHW 2019f. Diabetes. Cat. no. CVD 82. Canberra: AIHW.

AIHW 2019g. High blood pressure. Cat. no. PHE 250. Canberra: AIHW.

AIHW 2019h. Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease. Cat. no. CDK 12. Canberra: AIHW.

AIHW 2019i. Insufficient physical activity. Cat. no. PHE 248. Canberra: AIHW.

AIHW 2019j. Mortality Over Regions and Time (MORT) books. Cat. no. PHE 229. Canberra: AIHW.

AIHW 2019k. Overweight and obesity: an interactive insight. Cat. no. PHE 251. Canberra: AIHW.

AIHW 2020. Alcohol, tobacco & other drugs in Australia. Cat. no. PHE 221. Canberra: AIHW.

Mackenbach JP 2015. Socioeconomic inequalities in health in high-income countries: the facts and the options. In: Detels R, Gulliford M, Karim QA & Tan CC (eds). Oxford textbook of global public health. Vol. 1. 6th edn. Oxford: Oxford University Press.