Health status and outcomes

Health risk factors

Health risk factors are attributes, characteristics or exposures that increase the likelihood of a person developing a disease or health disorder. Many health problems can be prevented by reducing exposure to modifiable risk factors such as:

  • tobacco smoking
  • poor eating patterns
  • risky alcohol consumption
  • not getting enough exercise.

For more information see Risk factors.

Based on self-reported data from the ABS National Health Survey (NHS) 2017–18, after adjusting for age, the prevalence of many risk factors was higher for Inner regional and Outer regional and remote areas than for Major cities (Figure 1).

Smoking

  • People living outside of Major cities had higher rates of current daily smoking. About 1 in 5 in Outer regional and remote (19.6%) and Inner regional (16.5%) areas smoked tobacco daily, compared with 12.8% in Major cities.

Overweight and obesity

  • More adults in Inner regional (71%) and Outer regional and remote (70%) areas were overweight or obese, compared with Major cities (65%), based on measured height and weight.

Diet

  • People living in Inner regional and Outer regional and remote areas (53%) were less likely to eat the recommended number of serves of fruit per day, compared with Major cities (48%).

  • Less than 1 in 10 people ate the recommended serves of vegetables in all remoteness areas.

  • People in Outer regional and remote areas were more likely to consume sugar sweetened drinks daily (14%) than Major cities (8.3%).

Alcohol consumption

  • People in Outer regional and remote (24%) and Inner regional (19%) areas were more likely to consume alcohol at levels that put them at risk of lifetime harm, compared with Major cities (15%).

Physical activity

  • Just under half of people met the physical activity guideline in all remoteness areas.

High blood pressure

  • The proportion of people (about one quarter) with measured high blood pressure (hypertension) was similar across all remoteness areas.

Figure 1: Prevalence of health risk factors, by area of remoteness, 2017–18

This horizontal bar chart shows the prevalence of health risk factors from highest to lowest including, inadequate vegetable intake, overweight or obese, insufficient physical activity, inadequate fruit intake, high blood pressure, exceeding lifetime alcohol risk guideline, current daily smoking and daily sugar drink consumption. For nearly all risk factors, the prevalence was higher in Inner regional and Outer regional and remote areas compared with Major cities. Some risk factors were the exception. These were vegetable intake, insufficient physical activity and high blood pressure which were similar across all remoteness areas.

Notes

  1. Proportions were age standardised to the 2001 Australian standard population.
  2. Excludes Very remote areas.

Source: AIHW analysis of ABS 2019; Table S4.

Chronic conditions

Based on self-reported data from the ABS NHS, the prevalence of many chronic conditions was similar across all remoteness areas in 2017–18, after adjusting for differences in population age structure.

There were exceptions:

  • mental and behavioural problems were higher in Inner regional areas (26%) compared with Outer regional and remote areas (22%) and Major cities (21%)
  • arthritis was higher in Inner regional areas (21%) and Outer regional and remote areas (20%) compared with Major cities (17%)
  • asthma was higher in Inner regional and Outer regional and remote areas (13%) compared with Major cities (11%)
  • diabetes was higher in Outer regional and remote areas (7.0%) compared with Major cities (5.6%) (Figure 2).

Figure 2: Prevalence of the population with selected chronic conditions, by area of remoteness, 2017–18

This horizontal bar chart shows the prevalence of selected chronic conditions by remoteness area including, mental and behavioural conditions, back pain and problems, arthritis, asthma, osteoporosis, heart stroke and vascular disease, diabetes and chronic obstructive pulmonary disease. Overall, there was little difference in the prevalence of most chronic conditions across remoteness area. Exceptions were arthritis, asthma, mental and behavioural conditions and diabetes. The prevalence of arthritis was between 3 to 4%25 higher in Inner regional and Outer regional and remote areas than in Major cities. The prevalence of asthma was higher in Inner regional and Outer regional and remote areas, at 13%25 compared with 11%25 in Major cities. The prevalence of mental and behavioural conditions was higher in Inner regional areas, at 26%25 compared with 21%25 in Major cities. The prevalence of diabetes was higher in Outer regional and remote areas, at 7.0%25 compared with Major cities at 5.6%25.

Notes

  1. Proportions were age standardised to the 2001 Australian Standard Population.
  2. Excludes Very remote areas.

Source: AIHW analysis of ABS 2019; Table S5.

Cancer

The incidence of all cancers combined was highest in Inner regional and Outer regional areas in 2010–2014 (513 and 511 per 100,000 people, respectively), after adjusting for age. Incidence was:

  • slightly lower in Remote areas (490) and Major cities (488);
  • lowest in Very remote areas (445) (AIHW 2019b).

The lower incidence rate in Remote and Very remote areas may be partly due to lower population screening participation rates, later detection of a cancer and lower life expectancy due to death from other causes (Fox & Boyce 2014; AIHW 2019d).

However, the 5-year observed survival rate for all cancers combined decreased with increasing remoteness, from 62% for Major cities to 55% for Very remote areas.

Types of cancers diagnosed also varied by area, with people in rural and remote areas more likely to be diagnosed with low survival cancers, such as lung and unknown primary site cancers (AIHW 2019b).

For more information see: Cancer in Australia 2019.

Family, domestic and sexual violence

Family, domestic and sexual violence is a major health and welfare issue in Australia. The Australian Bureau of Statistics 2016 Personal Safety Survey estimated that 2.2 million adults had been victims of physical and/or sexual violence from a partner since the age of 15 (ABS 2017).

People living outside Major cities were 1.4 times as likely to have experienced partner violence than those living in Major cities. Additionally, people living in Remote and Very remote areas were 24 times as likely to be hospitalised for domestic violence as those in Major cities (AIHW 2019c).

For more information see: Family, domestic and sexual violence in Australia.

Burden of disease

Burden of disease measures the impact of disease and injury in a population. The summary measure ‘disability-adjusted life years’ (DALY) combines the years of healthy life lost due to living with and dying prematurely from disease and injury.

In 2015, after adjusting for age, the total burden of disease increased with increasing remoteness. Major cities experienced the least burden per population, whilst Remote and very remote areas experienced the most. The total burden rate in Remote and very remote areas was 1.4 times as high as that for Major cities.

This pattern was mostly driven by fatal burden (years of life lost due to premature death). In Remote and very remote areas, rates were 1.7 times as high as Major cities, while non-fatal burden was 1.2 times as high.

For most disease groups, total burden rates increased with increasing remoteness. There was some variation by disease. A clear trend of greater burden rates was seen with increasing remoteness for:

  • coronary heart disease
  • chronic kidney disease
  • chronic obstructive pulmonary disease (COPD)
  • lung cancer
  • stroke
  • suicide
  • self-inflicted injuries
  • type 2 diabetes.

In contrast, anxiety disorders, dementia and depressive disorders showed lower rates of burden in more remote areas (AIHW 2019a).

For more information see: Australian Burden of Disease Study 2015.

Deaths

People living in rural and remote areas are more likely to die at a younger age than their counterparts in Major cities. They have higher mortality rates, higher rates of potentially avoidable deaths and lower life expectancy than those living in Major cities.

In 2017, age-standardised mortality rates increased as remoteness increased for males and females:

  • males living in Very remote areas had a mortality rate 1.4 times as high as those living in Major cities (Table 1a)
  • females living in Very remote areas had a mortality rate 1.8 times as high as those living in Major cities (Table 1b).

Overall, the difference in mortality rates between Major cities and regional and remote areas remained similar for the period 2013 to 2017.

Median age at death also decreased with increasing remoteness for males and females (tables 1a and 1b).

Table 1a: Median age at death, mortality rate and rate ratio for males, by remoteness area, 2017

 

Major cities

Inner regional

Outer regional

Remote

Very remote

Median age at death (years)

79

78

76

73

68

Age-standardised rate
(deaths per 100,000)(a)

592

662

722

763

822

Rate ratio(b)

1.0

1.1

1.2

1.3

1.4
  1. Rates are age-standardised to the 2001 Australian standard population.
  2. Rate ratio is the age-standardised mortality rate for each area divided by the age-standardised rate for Major cities.

Source: AIHW 2019d.

Table 1b: Median age at death, mortality rate and rate ratio for females, by remoteness area, 2017

 

Major cities

Inner regional

Outer regional

Remote

Very remote

Median age at death (years)

85

84

82

79

69

Age-standardised rate
(deaths per 100,000)(a)

426

477

486

505

748

Rate ratio(b)

1.0

1.1

1.1

1.2

1.8
  1. Rates are age-standardised to the 2001 Australian standard population.
  2. Rate ratio is the age-standardised mortality rate for each area divided by the age-standardised rate for Major cities.

Source: AIHW 2019d.

Potentially avoidable deaths

The rate of potentially avoidable deaths increased as remoteness increased.

These are deaths among people aged 75 and under from conditions considered potentially preventable through individualised care, and/or treatment through existing primary or hospital care. For example, transport accidents and cancers that can be detected early through screening programs (such as breast, cervical and colorectal cancers).

For more details on examples and definitions of potentially avoidable deaths see: Potentially avoidable deaths International Classification of Disease (ICD–10) codes.

In 2017, potentially avoidable deaths made up 17% of all deaths in Australia. For males and females, the rate increased with remoteness. The rate for:

  • females in Very remote areas was 3.3 times as high as Major cities (216 per 100,000 population compared with 67)
  • males in Very remote areas was 2.3 times as high as Major cities (275 per 100,000 population compared with 118) (Figure 3).

Figure 3: Potentially avoidable deaths per 100,000, by remoteness area and sex, 2017

This vertical bar chart shows the rate of potentially avoidable deaths per 100,000 population by sex and area of remoteness. Potentially avoidable deaths increased with increasing remoteness for males and females. For males and females rates were between 1.3 and 1.5 times as high in Inner regional and Outer regional areas compared with Major cities. Whilst the rate steeply increased in Very remote areas to 2.3 times as high for males and 3.3 times as high for females, compared with Major cities.

Note: Rates are age-standardised to the 2001 Australian standard population.

Source: AIHW 2019d.

Leading causes of death

Figure 4 shows the 10 leading causes of death for each remoteness area for the period 2013–2017, with comparison to mortality rates for Australia overall (AIHW 2019d).

In this period:

  • The top 7 causes of death were the same for Major cities, Inner regional and Outer regional areas.
  • Coronary heart disease was the leading cause of death across all remoteness areas. Age-standardised rates were higher in Very remote (1.5 times) and Remote areas (1.3 times) than for Australia overall.
  • People living in Remote and Very remote areas were more likely to die from diabetes (1.8 and 3.5 times respectively), compared with Australia overall.
  • Suicide was one of the top 10 leading causes of death in Outer regional, Remote and Very remote areas. Australians living in Remote and Very remote areas were about twice as likely to die from suicide when compared with Australia overall. The rate of suicide was 11 per 100,000 population in Major cities and increased with remoteness and was highest for Remote (19) and Very remote areas (24).
  • Land transport accidents were a leading cause of death in Remote and Very remote areas. The rate of dying due to land transport accidents was nearly 3 times as high for Remote areas and nearly 4 times as high for Very remote areas, compared with Australia overall (AIHW 2019d) (Figure 4).

Figure 4: Leading cause of death by remoteness area, with comparison mortality rates with Australia overall, 2013–2017

This diagram shows the top 10 leading causes of death by remoteness area. It is colour coded based on relative rate ratio difference to the Australian population. The top leading cause of death for all areas was coronary heart disease. The rates for this disease were 1.5 to 1.9 times as high in Remote and Very remote areas compared with the whole of Australia. Rates were also higher for coronary heart disease, between 1.25 and 1.49, in regional areas compared with the whole of Australia. Similarly, dementia and Alzheimer disease, cerebrovascular disease, lung cancer, chronic obstructive pulmonary disease, colorectal cancer and diabetes were leading causes of death across all areas. However, their ranking differed by area of remoteness. Deaths from suicide, land and transport accidents, liver disease and cancer of unknown primary site were only leading causes of death in Remote and Very remote areas. Death from diabetes was 1.8 times as high in Remote areas and 3.5 times as high in Very remote areas compared with Australia.

Notes

  1. Rates are age-standardised to the 2001 Australian standard population.
  2. Leading causes of death are listed in order of number of deaths in each remoteness area from 2013–2017.
  3. Boxes are coloured based on the rate ratio comparing each region to Australia overall.

Source: AIHW 2019d.

For more information see: Mortality Over Regions and Time (MORT) books.

Life expectancy

Estimates of life expectancy at birth represent the average number of years that a newborn baby can expect to live, assuming current age-specific death rates are experienced through their lifetime.

In 2015–2017, life expectancy at birth varied with remoteness and sex. Within each remoteness area, females had a higher life expectancy than males. For both sexes, life expectancy decreased as remoteness increased (Table 2) (ABS 2018).

Table 2: Life expectancy at birth, 2015–2017

 

Major Cities

Inner and outer regional

Remote and very remote

Males

81 years

79 years

76 years

Females

84 years

83 years

80 years

Source: ABS 2018.

References

ABS (Australian Bureau of Statistics) 2017. Personal safety, Australia, 2016. ABS cat. no. 4906.0. Canberra: ABS.

ABS 2018. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–2017. ABS cat. no. 3302.0.55.003. Canberra: ABS.

ABS 2019. Microdata: National Health Survey 2017–18. ABS cat. no. 4324.0.55.001. 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. Cancer series no. 119. Cat. no. CAN 123. Canberra: AIHW.

AIHW 2019c. Family, domestic and sexual violence in Australia: continuing the national story 2019. Cat. no. FDV 3. Canberra: AIHW.

AIHW 2019d. MORT (Mortality Over Regions and Time) books: Remoteness area, 2013–2017. Cat. no. PHE 229. Canberra: AIHW.

Fox P & Boyce A 2014. Cancer health inequality persists in regional and remote Australia. The Medical Journal of Australia 201:445–446.