Chronic conditions among ex-serving ADF members

Chronic conditions are long lasting conditions with persistent effects. Chronic conditions are common and become more common with age. Chronic conditions pose health problems, and, in many instances, action can be taken to prevent or at least delay their occurrence.

Ex-serving Australian Defence Force (ADF) members are an older population. According to the 2021 Australian Bureau of Statistics (ABS) Census, 53% of ex-serving ADF members were aged 65 years and over, compared with 21% of persons who had never served in the ADF and were aged 17 and over (the eligibility age for ADF service). As a result, a greater proportion of ex-serving members are likely to be living with chronic conditions compared with Australians.

AIHW has previously analysed the prevalence of mental health conditions in ex-serving ADF members (see Health of veterans). However, prior to the 2021 Census there was limited knowledge on the prevalence of chronic conditions for ex-serving ADF members.

The 2021 Census was the first to ask all Australians whether they had served in the ADF and whether they had any long-term health conditions. This report presents findings from the 2021 Census on selected health conditions.

This report also presents prevalence estimates of chronic conditions using information that is captured through people’s use of health services. Estimating prevalence through health service use focuses on people who have received recent treatment (based only on health services that were available for analysis in this report) for the condition, as opposed to people who were living with a condition at any point but are currently not requiring treatment for the condition or used other health services that were not available for this analysis.

AIHW used information on medication dispensing and hospital diagnosis data from emergency department and admitted patient care to identify ex-serving members with selected chronic conditions. AIHW also analysed the prevalence of conditions in the adult Australian population to make comparisons with ex-serving members.

This report is part of a series of publications that analyse the use of health services by ex-serving members over the decade to 30 June 2020. The publications provide a comprehensive 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).

Chronic conditions are common and more common at older age

Results from the 2021 Census showed that 57% of ex-serving members identified themselves as living with a selected long-term health (or chronic) condition. However, this proportion is influenced by the older age of the ex-serving member population. When age-standardised to compare with the Australian population, 39% of ex-serving members lived with at least one selected long-term health condition. This was similar to the 40% for all Australians in 2019–20.

AIHW analysis of health service use by ex-serving members showed that 39.4% (or around 102,000) of ex-serving members were living with a selected chronic condition in 2019–20. The prevalence of people living with a condition had increased from 37.2% in 2013–14. Female ex-serving members had a higher prevalence of living with a condition (41.2%) than males (38.7%) in 2019–20.

In comparison, a similar proportion (39.5%) of the age-standardised Australian population were living with a selected chronic condition in 2019–20. Female Australians similarly had a higher prevalence (40.9%) than males (38.2%) in 2019–20.

Ex-serving members who were older were more likely to be living with a chronic condition than younger ex-serving members. Ex-serving members aged 65 and over were five times more likely to have a condition than those aged 17–24 (77.9% compared with 15.2%) in 2019–20. A similar pattern was observed for Australians aged 65 and over in 2019-20 (85.8% compared with 15.6%).

Cardiovascular disease was the most common chronic condition

Analysis of chronic conditions based on ex-serving members’ use of health services focused on the conditions that are commonly reported by AIHW. The chronic conditions analysed were:

• asthma and chronic obstructive pulmonary disease (COPD)
• cancer
• cardiovascular disease
• chronic kidney disease
• dementia
• diabetes (including type 1, type 2 and other diabetes)
• mental health conditions
• select musculoskeletal conditions (including arthritis, back problems and osteoporosis).

The most common chronic condition among ex-serving members when age-standardised in 2019–20 was cardiovascular diseases (21.1%), mental health conditions (20.0%) and select musculoskeletal conditions (9.2%).

In comparison, the most common chronic condition for the Australian population in 2019–20 was cardiovascular diseases (21.8%), mental health conditions (17.7%) and select musculoskeletal conditions (8.1%).

The chronic conditions analysed based on health service use differed to those captured in the 2021 Census. For instance, while AIHW report on select musculoskeletal conditions including arthritis, the Census reported on arthritis by itself. The most common condition among ex-serving members was mental health conditions (17.4%), arthritis (13.1%) and any other long-term health conditions (12.0%) based on the Census results.

Some ex-serving members had higher prevalence of chronic conditions

This report also analysed whether ADF service characteristics were associated with higher prevalence of chronic conditions. In 2019–20 characteristics of ADF ex-serving members that were associated with a higher age-standardised prevalence of conditions were:

• Army or Navy service (compared with Air Force): mental health
• Involuntary medical separation: mental health, select musculoskeletal conditions, cardiovascular diseases and diabetes
• longer service length: cancer, cardiovascular and select musculoskeletal conditions
• longer time since separation from the ADF: asthma/chronic obstructive pulmonary disease (COPD) and diabetes
• other rank (compared with officer rank): asthma/COPD, cardiovascular, diabetes, select musculoskeletal conditions, mental health
• Department of Veterans’ Affairs (DVA) clients (compared with non-DVA clients): mental health, select musculoskeletal conditions, cancer and cardiovascular diseases.

Prevalence estimates can vary based on the data source

Comparing prevalence estimates using different approaches and data sources is complex due to varying data collection methods and differences in how conditions are defined or diagnosed. However, overall 39% of ex-serving members were living with a selected chronic condition based on both the 2021 Census and the Veteran Health Dataset (VHD) in 2019–20 when age-standardised. For more information on the VHD see Health services use by ex-serving Australian Defence Force members. 

When comparing the most similar condition types included in both the Census and VHD, the VHD reports a higher age-standardised prevalence of mental health conditions at 20% in 2019–20 while it was 17% from the Census. However, prevalence of cancer, chronic kidney disease and dementia was lower based on the VHD in comparison with Census (for example 2.4% compared with 4.5% for cancer). Similar patterns of prevalence for chronic conditions emerge for the Australian population.

Prevalence estimates based on health service information are likely an underestimate. This could be due to not capturing people who were not under active care or who were underdiagnosed or because they presented to private hospitals (which was out of scope for this report) whereas self-reporting can capture individuals who are not actively seeking treatment for a condition or are seeking treatment that is not captured in this report. On the other hand, the higher prevalence for mental health conditions based on the VHD could be due to underreporting in the Census.

It should be noted that generally the AIHW reports on most chronic conditions based on the Australian Bureau of Statistics (ABS) National Health Survey (NHS) which found that 50% of Australians had at least one chronic condition in 2022 (compared with 40% in the Census). The Census underestimates the prevalence of conditions in comparison to the NHS (Comparing ABS long-term health conditions data sources). However, the small sample of ex-serving members within the NHS means that the NHS likely provides less accurate estimates of condition prevalence than the Census. As a result, this report focuses on the Census as well as estimates from the VHD.

This report shows that using health services information to identify chronic conditions can provide insight on prevalence, particularly for those who are receiving treatment. VHD and 2021 Census are valuable data sources that can be used to report on chronic conditions among ex-serving ADF members, even though they may both underestimate prevalence. However, using health service information in contrast with self-reported information has differing advantages and biases.