Burden of cardiovascular disease

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What is burden of disease?

Burden of disease is a measure of the years of healthy life lost from living with, or dying from disease and injury.

The measure used is the ‘disability adjusted life year’ (DALY). This combines health loss from living with illness and injury (non-fatal burden, or YLD) and dying prematurely (fatal burden, or YLL) to estimate total health loss (total burden, or DALY).

Burden of disease estimates seek to capture both the quantity and health-related quality of life, and to reflect the magnitude, severity and impact of disease and injury within a population. Burden of disease does not quantify the social or financial consequences of disease and injury.

Further information can be found in Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015.

 

In 2018, Australians lost an estimated 646,000 years of healthy life (DALY) due to all forms of cardiovascular disease (CVD), equivalent to 21.7 per 1,000 population (AIHW 2021).

CVD as a disease group accounted for almost 13% of the total burden of disease (15% males, 11% females), ranking third behind cancer and other neoplasms, and muskuloskeletal conditions (Figure 1)
             (AIHW 2021).

  • Most of the burden from CVD (76%) came from years of life lost to premature death (YLL), with the remainder (24%) from years lived with illness (YLD).

Figure 1: Cardiovascular disease and other burden of disease groups, 2018

 

The tree map shows the contribution of the major disease groups to the total burden of disease in Australia in 2018. CVD ranks third behind cancer and other neoplasms and musculoskeletal conditions. Within the CVD disease group, coronary heart disease and stroke represent the major contributors to disease burden. 

Age and sex

In 2018, the burden from CVD:

  • for males (28.2 DALY per 1,000 population) was 1.8 times as high as for females (15.6 DALY per 1,000 population)
  • was low in childhood and increased with age. CVD was the major cause of burden of disease in older Australians aged 75 and over
  • was higher for males than females at all ages, except for the very old (aged 100 and over) (Figure 2).

​Figure 2: Burden of disease for cardiovascular disease, by age group and sex, 2018

The bar chart shows the burden of disease for cardiovascular disease in 2018 increased with age, and was higher among males than females in all age groups, except for those aged 100 and over.

Population groups

In 2018, the burden from CVD:

  • for people living in the lowest socioeconomic areas was 1.8 times as high as for the highest areas (29.0 and 15.9 DALY per 1,000 population)—42% of DALY in the lowest socioeconomic areas could have been avoided if the burden was the same as the highest areas
  • in Remote and very remote areas was 1.9 times as high as in Major cities (37.9 and 20.2 DALY per 1,000 population)—49% of DALY in Remote and very remote areas could have been avoided if the burden was the same as in Major cities.

​Trends

  • The burden from CVD fell by 41% between 2003 and 2018—age-standardised rates of 36 and 22 DALY per 1,000 population.

  • The fall in the burden from CHD between 2003 and 2018 (50%) was higher than for stroke (44%).

  • The 12% fall in the burden from CVD between 2003 and 2018 (–90,000 DALY) was driven by change in the amount of disease (–51%), by population growth (+23%) and by population ageing (+16%).

Leading causes

Leading causes contributing to the CVD burden of disease in 2018 include coronary heart disease, stroke and atrial fibrillation (Figure 1).

Congenital heart disease was a leading contributor to the burden of disease among infants aged less than 1 year.

Coronary heart disease

  • 312,000 years of healthy life were lost in 2018, equivalent to 10.4 DALY per 1,000 population
  • CHD was the leading individual cause of burden for males, and fifth leading cause for females (Figure 3), accounting for 6.3% of the total burden (7.9% for males and 4.4% for females)
  • The contribution of CHD to the total burden of CVD was greater in males (54%) than females (40%)
  • 80% of the burden from CHD in males and 74% in females was due to premature death (YLL). Years of healthy life lost due to poor health or disability (YLD) accounted for the remainder—20% for males and 26% for females.

Stroke

  • 125,000 years of healthy life were lost in 2018, equivalent to 4.2 DALY per 1,000 population
  • stroke ranked tenth in the leading diseases causing burden, accounting for 2.5% of total burden (2.4% males, 2.7% females)
  • The contribution of stroke to the total burden of CVD was greater in females (24%) than males (16%)
  • 85% of the burden from stroke in males and 88% in females was due to premature death (YLL). Years of healthy life lost due to poor health or disability (YLD) accounted for the remainder—15% for males and 12% for females.

Atrial fibrillation

  • 59,000 years of healthy life lost in 2018, equivalent to 1.9 DALY per 1,000 population
  • AF accounted for 1.2% of total burden (1.2% for males, 1.2% for females)
  • The contribution of AF to the total burden of CVD was greater in females (10.4%) than males (8.1%)
  • 23% of the burden from AF in males and 34% in females was due to premature death (YLL). Years of healthy life lost due to poor health or disability (YLD) accounted for the remainder—77% for males and 66% for females.

Congenital heart disease

  • congenital heart disease is a leading cause of burden of disease among infants aged under 1 year, contributing 8.1% in 2018
  • the burden from congenital heart disease fell by 20% between 2003 and 2018, from 14,900 to 12,000 DALY.

Figure 3: Leading causes of total burden of disease, by age group and sex, 2018 (‘000 DALY, % age group)

The table shows coronary heart disease was the leading cause of total disease burden for males from the age of 45 and over. Coronary heart disease was the second leading cause of disease burden among females aged 75 and over. Stroke was a top 5 cause of disease burden for males and females aged 75–84 and 85 and over.

Aboriginal and Torres Strait Islander people

Burden of disease estimates are available for Aboriginal and Torres Strait Islander Australians for the year 2011 (AIHW 2016):

  • CVD accounted for 12% (24,000 DALY) of total burden in Indigenous Australians in 2011 (13% males, 11% females), making it the disease group with the third greatest contribution, behind mental and substance use disorders (19%) and injuries (including suicide) (15%)
  • coronary heart disease accounted for 58% of CVD DALY and stroke 14%. In terms of overall DALY, coronary heart disease caused the most of any disease or injury (7% of total DALY) and stroke ranked 15th (2% of total DALY)
  • 88% of the burden from CVD among Indigenous Australians was fatal, and 12% non-fatal. The disease that had the highest proportion of fatal burden among Indigenous Australians was cardiomyopathy (98% fatal)
  • the rate of DALY for CVD among Indigenous males was 2.6 times that of non-Indigenous males, compared with 3.2 times for Indigenous and non-Indigenous females
  • CVD was responsible for 19% of the total health gap between Indigenous and non-Indigenous Australians
  • the rate of DALY for rheumatic heart disease among Indigenous Australians was 6.6 times as high as the rate among non-Indigenous Australians (2.8 and 0.4 DALY per 1,000 population). The rate for CHD was 3.1 times as high (41.3 and 13.4 DALY per 1,000 population).

Contribution of risk factors

A portion of burden of disease is preventable, being due to modifiable health risk factors. The Australian Burden of Disease Study 2018 has estimated the disease burden which can be attributed to these modifiable risk factors (AIHW 2021).

Of the total burden of CVD in Australia in 2018, 68% was attributable to the risk factors included in the study.

The leading risk factors contributing to the total CVD burden in 2018 include high blood pressure (36%), dietary risks (31%), overweight (including obesity) (22%), high cholesterol (21%) and tobacco use (11%) (Figure 4).

Note that as each risk factor was analysed separately, percentages cannot be added together, and do not add up to the joint effect of all risk factors.

Figure 4: Proportion of cardiovascular disease DALY attributed to selected risk factors, 2018

The bar chart shows high blood pressure was the leading risk factor attributed to the burden of cardiovascular disease in 2018, followed by dietary risks, overweight and obesity and high cholesterol.

Estimations of the contribution of risk factors varied across individual cardiovascular conditions (AIHW 2021):

  • coronary heart disease—air pollution 8.6%, alcohol use 3.7%, dietary risks 51%, high blood plasma glucose 6.5%, high blood pressure 42%, high cholesterol 37%, impaired kidney function 6.4%, overweight and obesity 28%, physical inactivity 16%, tobacco use 13%.
  • stroke—air pollution 8.3%, alcohol use 5.9%, dietary risks 26%, high blood plasma glucose 5.8%, high blood pressure 39%, high cholesterol 16%, impaired kidney function 6.3%, overweight and obesity 24%, physical inactivity 9.2%, tobacco use 11%.
  • atrial fibrillation—alcohol use 9.8%, dietary risks 6.0%, high blood pressure 31%, overweight and obesity 29%, tobacco use 7.8%.