Australian Burden of Disease Study 2024

What is burden of disease?

Burden of disease analysis measures the impact of disease and injury in a population by estimating the years of life lost (YLL, fatal burden) and years lived with disability (YLD, non-fatal burden). The sum of non-fatal and fatal burden equates to the total burden (disability-adjusted life year, DALY).

Burden of disease studies allow the impact of both deaths and living with illness to be compared and reported in a consistent manner. The health impacts and distribution of diseases and injuries contribute to the evidence base to inform health policy and programs, and service delivery.

How are burden of disease estimates (DALY, YLD, YLL) calculated?

Disability-adjusted life years (DALY) are estimated by combining the years of life lost (YLL) with the years lived with disability (YLD) in a single reference year for each sex, age group and disease or injury.

YLL equals the sum of the number of deaths due to the disease at each age multiplied by the number of remaining years that a person would on average expected to have lived according to an aspirational life expectancy.

YLD is estimated by multiplying the point prevalence of all sequelae (that is, consequences of a disease) by a disability weight which reflects the severity of the health state. A health state reflects a combination of signs and symptoms that result in health loss (for example, end stage of chronic liver disease). The disability weights used in ABDS 2024 were sourced from the Global Burden of Disease Study 2013 (GBD 2013 Collaborators 2015). Point prevalence is defined as the number of people with a condition at a particular point in time, for a reference year.

For 2024, burden estimates were mostly based on trends from previous ABDS reference years, and subsequent years up to 2022 where data were available and appropriate. Further detail about the trend analyses can be found in the Technical notes. 

How is health-adjusted life expectancy calculated?

Health-adjusted life expectancy (HALE) extends the concept of life expectancy by considering the time spent living with ill health from disease and injury. HALE is measured using the morbidity and mortality experienced by the population for a particular reference year. 

In the ABDS, Sullivan’s method was used to calculate HALE (see Jagger et al. 2014). Further information can be found in the Australian Burden of Disease Study 2018: methods and supplementary material report.

Sullivan’s method requires a current life table. For ABDS 2024, a life table for 2024 was derived by the AIHW using a log-linear regression model including the latest ABS provisional deaths. HALE was then calculated using the projected 2024 life expectancy and projected 2024 YLD rates. For more information see HALE in the Technical notes. 

Which diseases are included in the Australian Burden of Disease Study?

Burden of disease analysis provides estimates for an extensive list of diseases and injuries, and the list of diseases has been devised to be mutually exclusive (non-overlapping).

The ABDS 2024 disease list comprises 220 specific diseases or conditions (such as coronary heart disease, stroke, lung cancer or bowel cancer), grouped into 17 disease groups of related diseases or conditions (such as cardiovascular diseases or cancer). Estimates for injuries are calculated from two perspectives—external cause of injury (such as road traffic accident) and nature of injury (such as traumatic brain injury).

Conditions that could not be individually specified are included in a residual category for each disease group (such as ‘other cardiovascular conditions’). 

COVID-19 is a disease under the Infectious diseases group in the ABDS 2024. Further information on the data and methods used for COVID-19 is provided in the Technical notes.

More information on the diseases included in the Australian Burden of Disease studies can be found in the Australian Burden of Disease Study: methods and supplementary material 2018 report.

Are risk factors included in the Australian Burden of Disease Study 2024? 

The ABDS 2024 includes updated data on burden attributable to risk factors. Updated estimates are included for the reference years 2003, 2011, 2015, 2018 and 2024. The 20 risk factors included are the same as those in the Australian Burden of Disease Study: impact and causes of illness and death in Australian 2018 report.

Which risk factors are included in the Australian Burden of Disease Study?

There are 40 risk factor components or exposures included in this report (such as cannabis and cocaine use) that combine into 20 individual risk factors (such as illicit drug use). The risk factors are categorised as behavioural, dietary, environmental and metabolic/biomedical risks. While this list is extensive, it does not cover all potential risk factors.

Behavioural risks

• Alcohol use
• Bullying victimisation
• Child abuse & neglect
• Illicit drug use
• Opioid use
• Amphetamine use
• Cocaine use
• Cannabis use
• Other illicit drug use
• Unsafe injecting practices
• Intimate partner violence
• Physical inactivity
• Tobacco use
• Unsafe sex

Metabolic/Biomedical risks

• High blood plasma glucose (including diabetes)
• High blood pressure
• High cholesterol
• Impaired kidney function (including chronic kidney disease)
• Iron deficiency
• Low bone mineral density
• Low birth weight & short gestation
• Overweight (including obesity)

Dietary risks

• Diet high in processed meat
• Diet high in red meat
• Diet high in sodium
• Diet high in sugar sweetened beverages
• Diet low in fish & seafood
• Diet low in fruit
• Diet low in legumes
• Diet low in milk
• Diet low in nuts and seeds
• Diet low in polyunsaturated fat
• Diet low in vegetables
• Diet low in whole grains & high fibre cereals

Environmental risks

• Air pollution
• UV sun exposure
• Occupational exposures & hazards. 

How is attributable burden calculated?

The basic steps for estimating attributable burden are described as follows: 

• Select linked diseases for which there is convincing or probable evidence in the literature that the risk factor has a causal association.
• Define the exposure to the risk factor that is not associated with increased risk of the linked disease (the theoretical minimum risk exposure distribution or TMRED). 
• Estimate the population attributable fractions (PAFs) by either the comparative risk assessment method or the direct method:
  • Comparative risk assessment involves using the amount of increased risk (relative risk) of linked disease morbidity or mortality due to exposure to the risk factor and an estimate of exposure to each risk factor in the population. For most risk factors, exposure to the risk factor was estimated using high-quality survey data. For information about the quality of data inputs, see Australian Burden of Disease Study: Methods and supplementary material 2018.
  • The direct method uses comprehensive data sources such as registries to estimate the amount of the linked disease due to the risk factor.
  • Estimate the attributable burden by multiplying the PAFs by the disease burden (fatal and non-fatal) for each linked disease.

The risk factors where past exposure or any exposure during the life course contributes to the calculation of attributable burden are tobacco use, child abuse & neglect, intimate partner violence, high UV exposure, occupational exposures & hazards, alcohol use, illicit drug use, unsafe sex and low birthweight & short gestation. For these risk factors, the onset of linked diseases may not occur until years after initial exposure. For example, the methods for tobacco use incorporated a measure of current smoking where the onset of linked diseases are given a 5-year lag from the time of exposure. Similarly for other risk factors, burden over the lifetime of certain linked diseases is said to be attributable to past exposure, such as depression and anxiety for childhood experiences of abuse and neglect.

See Supplementary data tables and Calculation of risk factor specific estimates for information on the data sources used to estimate attributable burden.  

What are attributable deaths and why aren’t they estimated in 2024?

Attributable deaths are estimated in the same way that disease burden attributable to risk factors is calculated. 

An estimate of the number of attributable deaths is not provided for 2024, as data on deaths in 2024 were not available at the time of analysis. However, an approximate percentage of attributable deaths is provided for 2024, estimated based on projected YLL for 2024 and the mean remaining life expectancy for each age group. 

Where attributable deaths are reported (for 2003, 2011, 2015 and 2018), attributable deaths are based on deaths that have been redistributed, as such the number of deaths may not align with other reporting of causes of death. Information on the redistribution of deaths can be found in the Australian Burden of Disease Study: methods and supplementary material 2018 report. 

How does the Australian Burden of Disease Study 2024 differ from previous studies?

To provide burden of disease estimates best matched to the public health context for the Australian population, previous Australian Burden of Disease Studies started when the key data resources became available for most included diseases. The complexity of the process (including reviewing and improving disease-specific methods and resources, data extraction, analysis and checking) results in a 3–year to 4–year delay between the reference period and release of results.

To address challenges such as timeliness and completeness of available data, the burden estimates for the ABDS 2024 are projections largely based on historical trends rather than gathering data for a specific reference period, as was done for previous studies. Trend analysis is a method used to evaluate the pattern of burden estimates over time and to predict burden estimates for the period of interest. It allows for burden to be estimated for the current year (2024), based on the assumption that past trends have continued. The ABDS 2022 was the first study where burden was estimated for the year of release (AIHW 2022). The years of data included in the trend analyses for ABDS 2024 was dependent on data availability as well as other considerations (such as data quality, changes in disease coding over time and the impact of the COVID-19 pandemic) which varied to some extent for fatal and non-fatal burden and by disease and injury. Table S4 presents information about the years of data included in trend analyses for each disease or injury, as well as the type of projection model used. Estimates from the trend analysis should be interpreted with caution, as the changes in burden due to factors outside disease epidemiology, such as new public health interventions, were not accounted for in this analysis.

This Study includes estimates for COVID-19. Burden from COVID-19 and lower respiratory infections (including influenza and pneumonia) were estimated from 2024 data available at the time of analysis (further detail is provided in the Technical notes). These estimates may be revised in the future, as more data become available. Note that burden from COVID-19 is not attributed to any of the risk factors included in ABDS 2024. 

The ABDS 2024 does not include subnational estimates. The most recent estimates are presented in the Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018 report and interactive data for disease burden and risk factors.

Further information on the data and methods used in ABDS 2024 can be found in the Technical notes. 

Which data sources are used in the Australian Burden of Disease Study 2024?

Mortality data to calculate YLL estimates for 2024 were sourced from the AIHW National Mortality Database (NMD) (deaths occurring from 2011 to 2022 (excluding 2020) were used in trend analysis) and the ABS provisional death registration data for January to June in 2024 (used to validate projected deaths for 2024 and make adjustments where required). 

Deaths due to COVID-19 and lower respiratory infections (including influenza and pneumonia) were mainly sourced from the ABS provisional deaths for available months in 2024, with deaths for the remainder of 2024 modelled based on monthly trends (see Technical notes for further detail). 

The YLL estimates for 2024 should be interpreted with caution. Some cause of death information used in the analysis is subject to change pending the status of coroner investigation. The ABS revisions process is described in detail elsewhere (ABS 2023). The YLL estimates presented may be revised for the next Study when more information becomes available for 2024. 

For YLD estimates, there is no single comprehensive and reliable source of data for the incidence, prevalence, severity and duration of all non-fatal health conditions. Morbidity estimates were drawn from a wide variety of data sources, and generally based on the best single source. This included administrative data, national surveys, disease registers and epidemiological studies. Potential sources for disease-specific morbidity data were required to: 

• have case definitions appropriate to the disease being analysed 
• be relevant to the Australian population 
• be timely, accurate, reliable and credible. 

YLD estimates for 2024 were calculated using trend analysis based on YLD data for previous ABDS reference years (2003, 2011, 2015, 2018), 2019 (calculated as part of ABDS 2022), 2020 (calculated as part of ABDS 2023) and prevalence data for 2022 where available (for example, hospitalisation and cancer incidence data  and data from the National Survey of Mental Health and Wellbeing) and appropriate (for example, for diseases that were not largely impacted by COVID-19 and the pandemic restrictions such as the pause on non-essential surgeries). 

Data inputs for the risk factor component of ABDS 2024, such as relative risks, linked diseases and theoretical minimum risk exposure distribution (TMRED), are largely sourced from GBD 2019. Estimates of population distributions of risk factor exposure have been based on a variety of data sources. Risk factor exposure estimates have been updated where possible for ABDS 2024 using the latest data from sources such as:

• ABS National Health Survey 2022
• National Drug Strategy Household Survey 2022–2023
• Work-related Traumatic Injury Fatalities 2022
• Workers Compensation Statistics 2022–23 preliminary  
• ABS Census of Population and Housing 2021
• ABS Personal Safety Survey 2021–22.

Most risk factors had updated data available for some, or all, of their components in ABDS 2024. See Supplementary data tables and Calculation of risk factor specific estimates for more information on the data sources used to estimate attributable burden. Further information on the data and methods used in ABDS 2024, as well as differences between the ABDS 2024 and the ABDS 2018, can be found in the Technical notes. The overarching methods used for previous studies, and more information on the redistribution of deaths, can be found in the Australian Burden of Disease Study: methods and supplementary material 2018 report. 

Why use estimates from the Australian Burden of Disease Study 2024 instead of the Australian Burden of Disease Study 2018?

The ABDS 2024 was undertaken to build on the AIHW’s previous burden of disease studies and current disease monitoring work. The ABDS 2024 provides an update of burden of disease estimates using the infrastructure developed as part of ABDS 2011, 2015 and 2018. 

The ABDS 2024 provides national burden of disease and attributable burden estimates relevant to the public health context for the Australian population for 2024. It includes estimates for the year of release (2024) and burden estimates for COVID-19.

Due to different methods used in the ABDS 2024 compared to previous studies, estimates from the ABDS 2024 are not directly comparable, and may differ from, published estimates in previous Australian burden of disease studies.

For further information on the differences between ABDS 2024 and previous studies see ‘How does the Australian Burden of Disease Study 2024 differ from previous studies?’

Why use estimates from the Australian Burden of Disease Study 2024 instead of the Australian Burden of Disease Study 2023?

The ABDS 2024 builds on work from the ABDS 2022 and ABDS 2023. The ABDS 2022 was the first ABDS to estimate burden for the year of release based on historical trends and to include burden due to COVID-19. Since the ABDS 2022, methods for estimating burden due to COVID-19 have been refined and some estimates from previous years were revised due to updates in key data sources, such as the National Survey of Mental Health and Wellbeing 2020–21. Therefore, estimates from the ABDS 2024 are not directly comparable, and may differ from, published estimates in previous Australian burden of disease studies. However, estimates for different reference years within the ABDS 2024 are comparable.

For further information on the differences between ABDS 2024 and previous studies see ‘How does the Australian Burden of Disease Study 2024 differ from previous studies?’

Where do I find subnational estimates, such as by state/territory?

The ABDS 2024 includes national estimates only. For subnational (state/territory, remoteness area, socio-economic group) estimates, see the Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018 report. Subnational estimates may not add up to the national estimates. Updated subnational estimates are expected to be included in the next major update of the Australian Burden of Disease Study in late 2026.

How does Australia compare to other countries?

International comparisons are important and can provide a useful perspective of global disease burden. The Global Burden of Disease (GBD) studies and the WHO’s Global Health Estimates help to inform comparisons that show how health challenges differ globally and regionally. Comparisons are best made with data that are based on consistent definitions and that have similar collection methods and population coverage. In practice, this means that results are comparable within a study but not between studies. Hence, the GBD and WHO results for Australia cannot be compared with results produced in this study.

Australian estimates can be compared with those for other countries and regions using data from the GBD (see visualisations of country comparisons from the GBD 2021). 

Why do some diseases have no fatal or non-fatal estimates?

Some diseases do not have YLL or YLD estimates as either mortality does not occur from that disease (such as hearing loss disorders), or the disease is only fatal and as such there is no morbidity (such as sudden infant death syndrome). For some rare infections, there were no deaths or morbidity associated with the disease in certain reference years.

What population data were used?

All Australian population-based rates for 2018 were calculated using populations rebased to the 2016 Census (ABS 2022).   

Population-based rates for 2015, 2011 and 2003 were calculated using the latest available population estimates from the ABS.

Population data for 2024 were sourced from population projections by the Centre for Population (2022).    

The 2001 Australian Standard Population was used for all age-standardisation, as per AIHW and ABS standards (ABS 2016).

What information is available about the quality of estimates in the Australian Burden of Disease Study 2024? 

The ABDS 2024 estimates were produced using the best data available in the scope and time frame of the Study. 

Disease burden estimates for 2024 were largely based on projecting historical trends. Uncertainty assessments were also conducted alongside trend analysis. To provide information on the quality of input estimates from previous reference years (2003, 2011, 2015 and 2018), a quality index was developed to rate estimates according to the relevance and quality of source data, and methods used to transform data into a form required for this analysis. Generally, the higher the rating, the more relevant and accurate the estimate. For disease burden due to COVID-19 and lower respiratory infections (including influenza and pneumonia), this approach to rating data quality was used to reflect uncertainty.

To report on the reliability of projected burden of disease measures, the inclusion of confidence intervals associated with regression estimates was explored. However, these were not presented as these relate to the regression models and do not reflect the underlying uncertainty associated with data inputs that inform prevalence estimates. Other outputs of the regression models may indicate the best fit projection based on the set of YLL and YLD crude rates available for each age-sex-cause group. However, these do not necessarily represent the most appropriate projections in the context of the overall epidemiology of a given disease or injury, especially when considering impacts of the COVID-19 pandemic.

Fatal burden (YLL) estimates were considered to have the highest rating for both data and methods used, whilst non-fatal burden (YLD) estimates varied depending on the disease or injury and the data sources used.

Survey and administrative data sets were primary sources of risk factor exposure data. In the absence of good-quality survey or administrative data, epidemiological studies were used to determine exposures distributions. The quality of the attributable burden estimates in 2024 vary depending on the exposure data source used. 

The quality of input estimates in the ABDS 2024 for earlier reference years (2003, 2011, 2015 and 2018) are the same as the quality presented in the ABDS 2018. Therefore, refer to Appendix B in the Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018 report (AIHW 2021a) and the Australian Burden of Disease Study: methods and supplementary material 2018 report (AIHW 2021b) for more detail on the quality of the YLD estimates, attributable burden estimates and the data and methods used for the earlier reference years. The quality statements for COVID-19 and lower respiratory infections (including influenza and pneumonia) for 2024 are presented in the Technical notes. 

Where can I get more information on methods used in Australian Burden of Disease Study 2024?

Information about the methods used for 2024 burden of disease estimates are presented in the Technical notes. Aside from COVID-19 and lower respiratory infections (including influenza and pneumonia), the methods used for the earlier reference years to inform the trend for 2024 are the same as methods used in the ABDS 2018. For information about methods used for specific diseases and risk factors for earlier reference years (2003, 2011, 2015 and 2018), refer to the Australian Burden of Disease Study: methods and supplementary material 2018 report.

Where can I find information about disease burden in relation to disease expenditure?

Information about disease expenditure for 2022–23 has been published in the Health system spending on disease and injury in Australia 2022–23 report (AIHW 2024). This report uses the same disease groupings as the ABDS and includes a section comparing disease burden to disease expenditure.

Where can I find more information about the Australian Burden of Disease Studies? 

Information and reports about burden of disease in Australia, including for First Nations people, are available on the AIHW website.

For further information or for customised data requests please contact the AIHW Burden of Disease team ([email protected]).