Age and sex
The rate of hospitalisations with comorbidity of CVD, diabetes and/or CKD increases with age.
In 2018–19, for example, people aged 45–64 were 8.6 times as likely to have a combination of CVD and diabetes recorded on their hospital record as people aged 18–44 (730 and 85 per 100,000 population). For those aged 65 and over, this difference increased to more than 40 times the rate of those aged 18–44 (3,600 and 85 per 100,000 population.
Men were more likely to be hospitalised with comorbidity than women. After adjusting for age, the rate of hospitalisation where all 3 diseases were recorded was 1.6 times as high for men as for women (625 and 379 per 100,000 population).
Hospital comorbidity in the Aboriginal and Torres Strait Islander population
In 2018–19, there were 89,100 non-dialysis hospitalisations of Indigenous people aged 18 and over where CVD, diabetes or CKD was present as a principal diagnosis and/or additional diagnoses.
Of these hospitalisations, 33,100 (37%) recorded 2 or 3 of the diseases—8,200 (9.2%) recorded diabetes and CVD together, 1,900 (2.1%) recorded CVD and CKD, 13,600 (15%) recorded CKD and diabetes, and 9,300 (10%) recorded all 3 diseases.
A higher proportion of Indigenous adults had CVD, diabetes and CKD hospital comorbidity, compared with non-Indigenous adults (37% and 22%). The proportion of Indigenous hospitalisations with all 3 diseases (10.5%) was also higher than that in the non-Indigenous population (5.0%).
After adjusting for age differences in the populations, the rate of hospitalisation of Indigenous people recording all 3 diseases was 2.3 times as high as the rate of non-Indigenous people (22,000 and 9,400 per 100,000 population).
Deaths from CVD, diabetes and CKD
Often, more than 1 disease contributes to a death. Along with the underlying cause of death, a medical practitioner or coroner will also record associated causes on a death certificate. The most complete representation of cause-of-death will consider the contribution of both underlying and associated causes (Harding et al. 2014).
Whereas CVD is a common underlying cause of death, diabetes and CKD are more likely to be recorded as associated causes of death. Both diabetes and CKD are known to be under-reported in national mortality statistics, and can be omitted from death certificates as contributory causes of death (Sypek et al. 2018, McEwen et al. 2011).
Association of CVD, diabetes and CKD deaths
Of the 165,000 deaths registered among persons aged 18 and over in Australia in 2019, CVD, diabetes and CKD were listed as underlying or associated causes in 93,300 of these.
CVD was listed as either an underlying or associated cause of death in 85,800 (52% of adult deaths), while diabetes (17,100) and CKD (17,600) were each associated with about 10%. In total, 57% of adult deaths had at least 1 of these diseases recorded.
At least 2 of CVD, diabetes and CKD were recorded as causes of death in 24,000 death certificates, representing 14% of all adult deaths. CVD and diabetes occur together in half of these, contributing to 10,100 (6.1%), while CVD and CKD was associated with 9,400 deaths (5.7%). Diabetes and CKD (800 deaths) accounted for less than 1% of adult deaths. About 2% of adult deaths (3,500) in 2019 had all 3 diseases recorded (Figure 3).