Introduction

This research is the fourth in a series of publications that analyse the use of health services by ex-serving Australian Defence Force (ADF) members from 1 July 2013 to 30 June 2020. The series of publications provide a picture of mental and physical health service use and the factors associated with variations in health service use (see Health services use by ex-serving Australian Defence Force members).

The purpose of this report is to examine chronic conditions among ex-serving ADF members and compare that with the total adult Australian population. This provides insights on the health status of ex-serving ADF members and the characteristics and patterns for this population group.

The primary data source for this report is the AIHW-developed VHD. Based on the VHD, the scope of this research was ex-serving ADF members with 1 day or more of service since 1 January 1985 as identified from Department of Defence personnel data for 1 July 2013 to 30 June 2020. This cohort was used due to limitations in emergency department (ED) data in earlier years. In the latest year of the analysis period there were 227,800 ex-serving ADF members in scope. More information on the data sources, research methods and limitations are included in the Technical notes.

About this report

Chronic conditions (also known as chronic diseases) are long lasting conditions with persistent effects. Their social and economic consequences can impact on peoples’ quality of life. Chronic conditions are common, pose significant health problems, and, in many instances, action can be taken to prevent or at least delay their occurrence.

For more information see Chronic disease Overview.

This report aims to analyse the prevalence of selected chronic conditions in ex-serving ADF members (see Technical notes for classifications and codes used to identify the conditions). The focus was chronic conditions that are commonly reported on by AIHW, which can be found at Chronic disease Overview. In comparison the 2021 ABS Census collected data on long-term health condition.

  • VHD

    •    asthma and COPD
    •    cancer
    •    cardiovascular disease
    •    chronic kidney disease
    •    dementia 
    •    diabetes
    •    mental health conditions
    •    musculoskeletal disease

  • Census

    •    arthritis
    •    asthma
    •    cancer
    •    dementia
    •    diabetes
    •    heart disease
    •    kidney disease
    •    lung condition
    •    mental health
    •    stroke
    •    any other condition

Identifying chronic conditions

AIHW generally reports on the prevalence of chronic conditions using information collected by the ABS. The ABS regularly collects self-reported information on people with health conditions through the National Health Survey (NHS), but has also collected information on long-term health conditions through the 2021 Census and the National Study of Mental Health and Wellbeing.

Due to the small size of the ex-serving member population compared with the total Australian population, ABS surveys can provide less accurate estimates of condition prevalence for this cohort. Conversely, the ABS Census includes everyone but is only conducted every 5 years so is not viable for timely monitoring of chronic conditions and information on chronic conditions in the Census was not collected prior to 2021, prohibiting trend analysis. Importantly, the Census is also known to underestimate the prevalence of chronic conditions compared with the NHS (Comparing ABS long-term health conditions data sources).

This report was therefore an exploration to consider the potential to estimate prevalence of chronic conditions for ex-serving members using information that is captured through people’s use of health services. AIHW used information on medication dispensing and hospital diagnosis data from ED and admitted patient care to identify ex-serving members with selected chronic conditions.

AIHW acknowledges that estimates of the number of people with chronic conditions can vary with the number of conditions included in the analysis, as well as the source of data used (AIHW 2024). However, previous research has shown that use of health services data can provide valuable insights on the prevalence of some chronic conditions (Purkiss et al. 2020).

Estimating prevalence through health service use focuses on people who have received recent treatment for the condition, as opposed to people who have had a condition at any point but are currently not using (in-scope) treatment for the condition. Condition prevalence sourced from health service use data may therefore be an underestimate in comparison with self-report information from the Census, as this is not limited to people seeking current treatment for a health condition. However, ABS also notes that the Census underestimates chronic condition prevalence (Comparing ABS long-term health conditions data sources).

To produce estimates of condition prevalence based on health service use, AIHW analysed health service use based on a 1-year look-back period for each financial year from 1 July 2013 to 30 June 2020. The health services data that was used included the Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (RPBS) to capture medications as well as the national hospital datasets. See Technical notes for more information on the methods used to identify chronic conditions and the data sources.

AIHW has also compared prevalence of chronic conditions from analysis of health services use with prevalence from the 2021 Census to compare with estimates from health service use. Further, the report includes comparisons with the total adult Australian population to analyse whether there are conditions that are more or less prevalent in the ex-serving member population.

AIHW produced age-standardised estimates to enable comparisons of the prevalence of chronic conditions across the ex-serving member population over the analysis period and with the overall Australian population. Box 1 highlights key data and methodology limitations that influence the findings from this report. More detail is included in the Technical notes.

Box 1: Key data and methodology limitations

  • Diagnosis of a chronic condition is based on health service use in the reference year. For example, based on the financial year ending June 2020 if a person was diagnosed with a chronic condition prior to July 2019, they would only be included as having a chronic condition if they also used a condition-specific medication or were diagnosed in a hospital setting with the condition during 2019–20.
  • Hospital services will only record chronic conditions listed as a principal or additional diagnosis if it affected their care. This means that hospitalisations of people with no or minor symptoms of a chronic condition that are less likely to affect care may not be identified as having that condition.
  • Measurement of chronic conditions through medication dispensing did not include over-the-counter medication or medicine on private prescriptions due to data limitations.
  • Health services funded by Defence or non-Government organisations were not analysed. Additionally, prevalence estimates do not include chronic conditions that have been diagnosed and/or treated in private hospitals or by a GP or other medical specialist, such as through a chronic disease management plan. Consequently, any data these services might have on the prevalence of chronic conditions is not included in this analysis.
  • Ex-serving members may have greater access to health services which could mean there is a bias present when making comparisons based on health service use with the Australian population.

See the Technical notes for more information on data and methodology limitations.

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