The health of Australia’s females

A person’s health status is a general measure combining physical, social, emotional and mental health and wellbeing. A person’s overall level of health can be measured through:

• self-assessment
• burden of disease analysis
• the health impact of disease
• injury in a population
• presence of chronic conditions and comorbidities
• mental health
• sexual health
• life expectancy.

Self-assessed health status

Self-assessed health status reflects a person’s perception of their own health at a particular point in time (ABS 2018b). It can give a broad picture of the population’s overall health (ABS 2018b).

In 2020–21, 55% of females rated their health as excellent or very good. The proportion of females who rate their health as excellent or very good varies by age group. Over two-thirds of females aged 15–24 (69%) rate their health as excellent or very good, compared with 32% of females aged 75 and over (ABS 2022d).

Burden of disease is a measure of the years of healthy life lost from living with, or dying from, disease and injury. The summary measure ‘disability-adjusted life years’ (DALY) measures the years of healthy life lost from premature death (fatal burden) and ill health (non-fatal burden).

In 2022 (AIHW 2022k):

• Australian females experience a smaller share of the total disease burden (47%) than males (53%).
• Females lose more healthy years of life from living with disease and injury (58%) than from dying prematurely (which accounted for the remaining 42%).
• The highest proportion of total burden for females is due to these top 5 disease groups; cancer (16%), musculoskeletal disorders (16%), mental and substance use disorders (12%), cardiovascular (11%), and neurological diseases (10%) (Figure 1).
• Females experience a greater share than males of the total burden from some disease groups including reproductive & maternal conditions (94%), blood & metabolic disorders (which includes iron-deficiency anaemia) (59%), neurological conditions (which includes dementia) (57%), and musculoskeletal conditions (56%).

Figure 1: Leading causes of ill health and death (% DALY) by disease group, females, 2022

Note:

DALY = Disability Adjusted Life–Year. This is a measure of healthy life lost, either through premature death or living with disability due to ill health. It is the basic unit used to measure the burden of a disease.

Source: AIHW analysis of AIHW 2022k

http://www.aihw.gov.au

Ill health and death also vary across age groups for females. For females aged 15–44, anxiety disorders are the leading condition. For those aged 45–64, back pain and problems is the leading condition, while for those aged 65 and over, dementia is a leading condition causing the highest ill health (Figure 2).

For more information see Australian Burden of Disease Study 2022.

Figure 2: Leading causes of ill health and death (total burden (DALY’000; proportion) among those aged 15 and over, females, 2022

Notes:

1. DALY = Disability Adjusted Life–Year. This is a measure of healthy life lost, either through premature death or living with disability due to ill health. It is the basic unit used to measure the burden of a disease.
2. COPD = chronic obstructive pulmonary disease.
3. Disease rankings exclude ‘other’ residual conditions from each disease group; for example ‘other musculoskeletal conditions’.

Source: AIHW analysis of AIHW 2022k

Chronic conditions pose significant health problems and have a range of potential impacts on individual circumstances. Data in this section focus on 10 common chronic conditions including:

• arthritis
• asthma
• back problems
• cancer
• chronic obstructive pulmonary disease
• diabetes
• heart, stroke and vascular disease
• chronic kidney disease
• osteoporosis
• mental health conditions.

For more information see Chronic conditions.

Among Australian females aged 15 and over, 56% are estimated to have one or more of the 10 selected common chronic conditions. About 1 in 3 females aged 15 and over have one condition (31%), 14% have two, and 11% have three or more (ABS 2022d). Prevalence of the 10 selected most conditions is shown in Table 1 (ABS 2022d, AIHW 2022q).

The self-reported prevalence of the most common chronic conditions increases with age (ABS 2022d):

• 46% of females aged 18–44 have at least one chronic condition.
• 59% of females aged 45–64 have at least one chronic condition.
• 77% of females aged 65 and over have at least one chronic condition.

Notes:

1. This data is self-reported and likely to either over or under report the true prevalence of chronic conditions.
2. Percentage is calculated out of the total female population aged 15 and over.
3. Includes harmful use or dependence on alcohol and/or drugs, mood (affective) disorders, anxiety related disorders, organic mental disorders, and other mental and behavioural conditions.
4. Includes sciatica, disc disorders, back pain/problems not elsewhere classified and curvature of the spine.
5. Includes rheumatoid arthritis, osteoarthritis, other and type unknown.
6. Includes osteopenia.
7. Includes Type 1 and Type 2 diabetes mellitus and type unknown. These estimates include persons who reported they had diabetes mellitus but that it was not current at the time of interview.
8. Includes angina, heart attack, other ischaemic heart diseases, stroke and other cerebrovascular diseases, oedema or heart failure, and diseases of the arteries, arterioles and capillaries. Estimates include persons who reported they had angina, heart attack, other ischaemic heart diseases, stroke and other cerebrovascular diseases or heart failure but that these conditions were not current at the time of interview.
9. Includes chronic bronchitis, emphysema and chronic airflow limitation. Asthma is reported separately.

Source: ABS 2022d, AIHW 2022q

For more detailed information on chronic conditions, see Chronic conditions.

Cancer

In 2022, the estimated number of new cancer cases in females of all ages is around 73,200, which accounts for 48% of all cases. The most common cancer diagnosis in females of all ages is breast cancer, followed by colorectal cancer, melanoma of the skin, and lung cancer (AIHW 2022m). The risk of Australian females being diagnosed with cancer is 1 in 4 by the age of 75, and 1 in 2 by the age of 85 (AIHW 2019a).

The most common cancer diagnosis among females varies by age. In 2022, leukaemia and colorectal cancer were the most common for females aged under 20. Breast cancer and melanoma were the most common for females aged 20–59, and breast and lung cancer were most common for females aged 60–79. The estimated age-specific incidence of all cancers increases sharply from age 35. The associated mortality rate is delayed and increases sharply from age 60 (Figure 3) (AIHW 2022m).

Figure 3: Estimated age-specific incidence and mortality rate for all cancers, females, 2022

For more information, see Cancer.

A lifetime mental health disorder refers to people who met the diagnostic criteria for having a disorder at some time in their life. This does not imply that a person has had a disorder throughout their entire life. Based on the 2020–21 National Study of Mental Health and Wellbeing (NSMHW) (ABS 2022j):

• 45% of females aged 16–85 and over report having a mental disorder at some point in their lifetime
• the most common disorders experienced are anxiety (35%) and mood (affective) (18%) disorders.

A 12-month mental health disorder refers to the people who met the diagnostic criteria for having a disorder at some time in their life and had sufficient symptoms of that disorder in the 12 months prior to the survey. Based on the 2020–21 NSMHW, for females aged 16–85:

• one in 4 (25%) had any 12-month mental disorder (ABS 2022j)
• 21% reported an anxiety disorder within the 12 months prior, higher than males at 12% (ABS 2022j)
• 12-month mental health disorders varied by age, with almost half (47%) of females aged 16–24 having a 12-month mental health disorder, compared to 21% of those aged 35–44, and 13% of those aged 65–74 (ABS 2022k).

Dementia

Dementia is a significant and growing health and aged care issue in Australia. It has a substantial impact on the health and quality of life of females with the condition, as well as their family and friends. Dementia is the leading cause of ill health and premature death in females overall. It is also the leading cause of death, accounting for 13% of all female deaths in 2020.

Estimates indicate that about 251,700 Australian females aged 30 and over are living with dementia, which is equivalent to 19.2 per 1,000 females. This estimate is projected to increase to 533,800 in 2058 (AIHW 2023b). Significantly more females of all ages are living with dementia (63%) than males (37%).

Age is a main risk factor for dementia, with the estimated prevalence of females living with dementia increasing as age increases (Figure 4) (AIHW 2023b). Other modifiable risk factors recognised as having strong evidence for increased risk of developing dementia include low level of education in early life and hearing loss in midlife (AIHW 2023b).

The two leading health risk factors measured by the Australian Burden of Disease Study for dementia are overweight (including obesity) and physical inactivity, which contributed to 19% and 12% respectively to ill health and premature death due to dementia (AIHW 2023b).

For more information on Dementia and its associated risk factors, see Dementia in Australia.

Figure 4. Prevalence of dementia by age group (per 1,000 population), females, 2022

Sexual health is a state of physical, mental and social wellbeing in relation to sexuality. Measures of sexual health include the prevalence of sexual difficulties and sexually transmissible infection rates (WHO 2022a).

Sexual difficulties

In a sub-study of the Australian Longitudinal Study of Health and Relationships in 2011, of the 2,300 females (aged 20–64) surveyed, 66% indicated that they had experienced at least 1 of the following sexual difficulties in the 12 months prior to the survey (Smith, et al. 2012):

• lacked interest in having sex (50%)
• unable to climax (21%)
• took too long to orgasm (21%)
• had trouble with vaginal dryness (20%)
• did not find sex pleasurable (17%)
• felt anxious about ability to perform sexually (12%)
• physical pain during intercourse (10%)
• came to orgasm too quickly (5%).

For more information, see Sexual and reproductive health.

Sexually transmissible infections

Sexually transmissible infections (STIs) are a subset of communicable diseases known to be transmitted through sexual contact. More than 30 different viruses, bacteria and parasites are known to be transmitted sexually (WHO 2022b). While some STIs can be cured, a person can have an STI without symptoms of disease. If left untreated, these infections can have serious consequences for long-term health.

Nationally notifiable diseases which are sexually transmissible include chlamydia, gonococcal infection, syphilis, human immunodeficienty virus (HIV), donovanosis, hepatitis B and hepatitis C. It should be noted that HIV, hepatitis B and C are also transmissible via other routes such as exposure to unsafe injecting drug use.

In 2021, there were 58,426 notifications of chlamydia, gonococcal infection, syphilis, hepatitis B and hepatitis C for females, which accounted for less than half (44%) of all notifications in both females and males for these selected diseases which are sexually transmissible (Table 2) (DoHAC 2022).

In 2021, there were 64 new cases of HIV for females. After adjusting for age, the rate of HIV notifications decreased by 44% since 2012 (UNSW 2022).

Table 2: Number, proportion and rate of selected nationally notifiable STI notifications, females, 2020 and 2021

Note:

1. Total cases include all persons, excludes cases where sex was missing.
2. Hepatitis B and C notifications include both newly acquired and unspecified cases and could have been transmitted through other routes.
3. Syphilis notifications include syphilis of less than 2 years duration (infectious) and excludes syphilis of more than 2 years or unknown duration (unspecified).
4. There are no new cases of donovanosis for females in 2020 and 2021.

After adjusting for age, notification rates in females for viral hepatitis B and C have decreased by 35% and 41%, respectively, over 2012 to 2021. In 2021, rates for hepatitis B and C are the highest in females aged 30–39 (33 per 100,000 population and 30 per 100,000 population, respectively) (DoHAC 2022).

There has been an increase in rates of gonococcal infection and syphilis notifications from 2012 to 2021 (Figure 5). After adjusting for age, compared with 2012, rates of these infections in 2021 for females were:

• 1.7 times higher for gonococcal infection, with the highest rate seen in females aged 20–24
• 6.4 times higher for syphilis, with the highest rates seen in females aged 20–24.

For chlamydia, age-standardised notification rates in females decreased by 12% from 2012 to 2021. In 2021, the highest rate was seen in those aged 20–24. Chlamydia remains the most frequently notified STI in Australia in both females and males.

Figure 5: Age-standardised rate per 100,000 population of gonococcal infection, syphilis and chlamydia notifications, females, 2012 to 2021

For more information, see HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2022, and the Department of Health and Aged Care National Notifiable Disease Surveillance System.

Reproductive health issues surrounding contraception, unwanted pregnancy, miscarriage, endometriosis, fertility, pregnancy difficulties, menopause and service provision have an impact on economic productivity, quality of life and the physical and mental health of females.

Contraceptive use

Contraceptive choices are complex, and choices made by females may change due to differing circumstances over the life course. A longitudinal study of 17,000 females showed that (Loxton, et al. 2021):

• 60% of females aged 18–23 reported using the contraceptive pill while 45% reported using condoms.
• The use of the oral contraceptive pill decreases from 60% to 34% among females aged 18–23 to those aged 24–29, respectively.
• The use of condoms decreases from 45% to 31% among females aged 18–23 to those aged 24–29, respectively.
• Use of the long-acting reversible contraceptive doubles as females age, increasing from 10% of females aged 28–33 to 24% of those aged 40–45.
• 9% of females aged 18–23 report using no contraception.

Endometriosis

Endometriosis is a chronic condition that can be painful, affect fertility and lead to reduced participation in school, work and sporting activities. Around 1 in 9 (11.1%) females born in 1973–78 are estimated to have been diagnosed with endometriosis by age 40–44 (Rowlands, et al. 2021). Among females born in 1989–1995, around 1 in 15 (6.6%) females are estimated to have been diagnosed with endometriosis by age 25–29 (AIHW 2019b). It takes an average of 5 years for an Australian female to receive a diagnosis after first seeing a doctor (Armour, et al. 2020).

There were around 43,800 endometriosis-related hospitalisations according to the AIHW National Hospital Morbidity Database (NHMD) in 2020­–21, a rate of 340 hospitalisations per 100,000 females. Just over half of these (52%) had endometriosis as the principal diagnosis. Around 4 in 5 (82%) endometriosis-related hospitalisations were among females aged 15–44, which are generally regarded as a woman’s reproductive years. This accounts for around 30 out of every 1,000 hospitalisations among females aged 15–44.

Data from the AIHW National Hospital Morbidity Database (NHMD) show rates of endometriosis-related hospitalisations varied by population group, after adjusting for age:

• Females living in Inner regional areas had the highest rate of endometriosis-related hospitalisations (490 per 100,000 females), followed by females living in Major cities (410 per 100,000), Outer regional areas (375 per 100,000) and Remote and very remote areas (265 per 100,000).
• Females living in the highest socioeconomic areas had higher rates of endometriosis-related hospitalisations compared to females in the lowest socioeconomic areas (450 and 335 per 100,000 females, respectively).
• Non-Indigenous females had higher rates of endometriosis-related hospitalisations than Indigenous females (405 and 320 per 100,000 females, respectively).

The reasons for these differences are not known. They could reflect potential variations in access to health services or differences in health-seeking behaviour between population groups, rather than a difference in disease prevalence.

Mothers

An important life stage for many Australians is when they become a parent. For mothers, her health and that of her baby can be affected by a mother’s age, where she lives, the socioeconomic conditions in which she lives, the presence of pre-existing or pregnancy-related medical conditions, and risky behaviours such as smoking and drinking alcohol during pregnancy (Bywood, et al. 2015, UNSW 2022, WHO 2015).

The health and lifestyle behaviours of mothers can have important ongoing implications on both mother and baby. Among Australian females:

• Almost 1 in 10 mothers (9.2%) report smoking at some time during their pregnancy in 2020, a decrease from 14% in 2010 (AIHW 2022j).
• 79% of mothers received antenatal care in the first trimester; 95% had 5 or more care visits (AIHW 2022f).
• Based on pre-pregnancy BMI (calculated based on self-reported height and weight, or measured at first antenatal visit), almost half (48%) of females who gave birth in 2020 were living with overweight or obesity (27% overweight and 22% obese) (AIHW 2022h).
• Most females do not consume alcohol in the first 20 weeks of pregnancy; females are more likely to consume alcohol in the first 20 weeks of pregnancy if they live in Remote (4.6%) or Very remote (9.9%) areas, are Indigenous (8.2%), or are teenage mothers (aged under 20) (4.5%) (AIHW 2022e).

About 292,000 Australian females gave birth to around 296,000 babies in 2020. The rate of females aged 15–44 giving birth was lower than a decade ago (56 per 1,000 females in 2020 compared with 64 per 1,000 in 2010).

The majority of mothers (74%) live in Major cities, 20% of mothers are from the lowest socioeconomic areas, and 36% of mothers are born overseas (AIHW 2022u).

Average maternal age has risen for both first-time mothers (from 30 years in 2010 to 30.9 in 2020) (AIHW 2022g), and those who have given birth previously (from 31.3 years in 2010 to 32 in 2020). The highest proportion of all mothers were aged between 30 and 34 (more than one-third (36%) of all mothers) (AIHW 2022d).

The rate of females giving birth in older age groups has also increased over time. Since 1999 (AIHW 2021h):

• those aged 35–39 giving birth increased by almost 1.5 times, from 47 per 1,000 females in 1999 to 68 per 1,000 females in 2019.
• those aged 40–44 giving birth almost doubled, from 8.4 per 1,000 females in 1999 to 15.5 per 1,000 females in 2019.
• those aged 45–49 giving birth almost quadrupled, from 0.3 per 1,000 females in 1999 to 1.1 per 1,000 females in 2019.

Almost 2 in 3 (63%) mothers had vaginal births, and the remaining 1 in 3 (37%) had caesareans. Caesarean sections were more common among females who were aged 40 and over (56%), and who were overweight (39%) or obese (46%) (AIHW 2022i).

For more information see Mother and babies.

Menopause

During menopause, there are changes to the levels of the hormones, oestrogen and progesterone, and it marks the end of the reproductive years.

The effects of these changes in hormonal levels however, are not just limited to reproduction but can extend to overall health and mental wellbeing. Menopause is associated with an increase in health risk factors and some chronic conditions including (Lancet 2022, Nappi and Simonici 2021):

• cholesterol
• high blood pressure
• overweight and obesity
• coronary heart disease
• diabetes
• osteoporosis
• dementia
• cancer.

Menopause generally occurs at around the age of 50 but can happen earlier.

Certain socio-economic, demographic, lifestyle, reproductive, social, and environmental elements are risk factors associated with premature menopause (earlier than 40 years) and early menopause (40–44 years) (Loxton, et al. 2021). These risk factors include smoking, age at which female had first period, females who experience intimate partner violence and underweight females.

For more information see, Jean Hailes for Women’s Health page on Menopause.

Life expectancy is expressed as either the number of years a newborn baby is expected to live, or the expected years of life remaining for a person at a given age.

Chart: AIHW. Source: AIHW 2022r.

Life expectancy at birth in Australia has improved dramatically for both sexes in the last century, and shows some variation between population groups:

• Females born in Australia in 2019–2021 can expect to live to the age of 85.4 years on average, an increase of 1.2 years in the past 10 years (ABS 2022h).
• International comparisons of life expectancy at birth indicate that Australian females have the sixth highest life expectancy in the world. Japan ranks first, at 87.7 years (OECD 2021).

For more information, see: Deaths in Australia: Life expectancy.

Health Adjusted Life Expectancy

Health Adjusted Life Expectancy (HALE) reflects the length of time an individual at a specific age could, on average, expect to live in full health. It can be measured at any age but is typically reported:

• From birth.
• At age 65, describing health in an ageing population.

Life expectancy in Australia for females born in 2022 is 85.3 years, while the average number of healthy years (HALE) for these babies is 74.1 years. The difference between life expectancy and HALE (that is, the time expected in less than full health) is 11.3 years. This means that females can expect to spend 87% of their lives in full health (AIHW 2022k).

Females born in 2022 are expected, on average, to live 4.1 years longer than males, and are expected to have 2.5 more years of healthy life than males (AIHW 2022k).

Life expectancy in 2022 for females aged 65 is 23.0 years, that is they could expect to live to the age of 88. At age 65, females can expect on average 16.8 healthy years of life, and 6.2 years in less than full health (AIHW 2022k).

Between 2003 and 2022, life expectancy and HALE at birth changed little for females. Females gained 2.3 years in life expectancy (from 83.0 in 2003 to 85.3 in 2022) and 1.3 years in HALE (from 72.8 to 74.1 years) (AIHW 2022k).

For more information see Australian Burden of Disease Study.

Mortality

Looking at how many people die and what caused their deaths can provide vital information about the health of a population. Patterns and trends in deaths can help explain differences and changes in the health of a population (AIHW 2022r).

Causes of death information can be used to:

• assess the success of interventions to improve disease outcomes
• signal changes in community health status and disease processes
• highlight inequalities in health status between population groups.

In 2021, about 82,000 Australian females died. The median age at death was 84.8, and the leading cause of death was dementia including Alzheimer’s disease (13%), followed by coronary heart disease (9%), and cerebrovascular disease (6.8%) (Figure 6). Leading causes of death for females vary by age group, with suicide being the leading cause for females aged 15–44 (Figure 7) (AIHW 2021a).

The median age at death for females also varies by population group:

• It decreases from 85 in Major cities to 66 in Very remote areas (AIHW 2022x).
• It decreases from 87 in the highest socioeconomic area to 83 in the lowest socioeconomic area (AIHW 2022y).

For more information see Deaths in Australia: Leading causes of death.

Figure 6: Leading causes of death, females of all ages, 2021

Notes:

1. Year refers to year of registration of death. Deaths registered in 2021 are based on the preliminary version of cause of death data and are subject to further revision by the Australian Bureau of Statistics (ABS).
2. Rates are calculated using the sum of estimated resident populations at 30 June for each year. Estimated resident populations for 2020 and 2021 have been impacted by COVID-19.            
3. Leading causes of death are based on underlying causes of death and classified using an AIHW-modified version of Becker et al. 2006.
4. International Statistical Classification of Diseases (ICD-10) codes are presented in parentheses.

Figure 7: Leading 3 underlying causes of death (number, %), by age group, females, 2019–21

Notes:

1. Year refers to year of registration of death. Deaths registered in 2019 are based on the revised version, deaths registered in 2020 and 2021 are based on the preliminary version. Revised and preliminary versions are subject to further revision by the Australian Bureau of Statistics.
2. Leading causes of death are based on underlying causes of death and classified using an AIHW-modified version of Becker et al. 2006.
3. Data by causes of death have been adjusted for Victorian additional death registrations in 2019. A time series adjustment has been applied to causes of death to enable a more accurate comparison of mortality over time. When the time series adjustment is applied, deaths are presented in the year in which they were registered (that is, removed from 2019 and added to 2017 or 2018). For more detail please refer to Technical note: Victorian additional registrations and time series adjustments in Causes of death, Australia, 2019 (ABS Cat. no. 3303.0). 
4. Per cents have been calculated using the adjusted number of deaths due to all causes (see note 2) as the denominator, however the number of deaths due to all causes presented in the table have not been adjusted.

Premature and potentially avoidable deaths

Premature mortality or death refers to deaths occurring before the age of 75. Nearly 3 in 10 (27%) of all deaths are premature in females, and females account for 38% of all premature deaths. The mortality rate varies between population groups in 2020. After adjusting for age, which removes the effects of age when comparing rates between population groups with different age structures (AIHW 2022w):

• 66% of female deaths are premature in Very remote areas compared to 26% in Major cities. The premature mortality rate in females also increases as remoteness increases, with rates in Very remote areas 2.3 times higher (315 deaths per 100,000 people) than the rate in Major cities (132 per 100,000 people).
• Around 3 in 10 (31%) deaths are premature in the lowest socioeconomic areas compared to 23% in the highest socioeconomic areas. The premature mortality rate in females in the lowest socioeconomic areas (199 deaths per 100,000 people) is nearly twice the rate in the highest socioeconomic areas (102 per 100,000).

Potentially avoidable deaths refer to deaths before the age of 75 from conditions that are potentially preventable through individualised care and/or treatable through existing primary or hospital care. Potentially avoidable deaths account for 13% of total deaths in females, and 47% of all premature deaths in females. The proportion of premature deaths that are potentially avoidable and the rate of potentially avoidable deaths varies between population groups. After adjusting for age (AIHW 2022x, AIHW 2022y):

• Females in Very remote areas have a higher proportion of premature deaths that are potentially avoidable (58%), compared to females in Major cities (45%). The rate of potentially avoidable deaths in Very remote areas (181 deaths per 100,000 people) is almost 3 times that of the rate in Major cities (61 per 100,000).
• The proportion of premature deaths that are potentially avoidable did not differ greatly between the lowest socioeconomic areas (48%) and the highest (46%). However, females in the lowest socioeconomic areas have twice the rate of potentially avoidable deaths per 100,000 population compared with females in the highest socioeconomic areas (98 and 48 per 100,000, respectively).

For more information see: Mortality Over Regions and Time.