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1301.0 - Year Book Australia, 2007  
Previous ISSUE Released at 11:30 AM (CANBERRA TIME) 24/01/2007   
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Contents >> Health >> Article - Chronic conditions and disability

CHRONIC CONDITIONS AND DISABILITY

Chronic conditions account for more of the burden of disease in Australia than conditions that are resolved more quickly, such as most infectious diseases. This is a result of medical advances in treating and preventing infectious diseases; increases in life expectancy and an ageing population; and the prevalence of behavioural risk factors such as smoking. (End note 1) Increasingly, chronic conditions are major contributors to the burden of disease worldwide (End note 2) In 2005, the Australian Health Ministers established the National Chronic Disease Strategy to encourage coordinated action in response to the growing impact of chronic conditions. (End note 1) In 2006, the Council of Australian Governments agreed to a package of measures to address prevention and early detection of avoidable chronic disease. (End note 3)

DATA SOURCE AND DEFINITIONS

The 2004-05 National Health Survey, conducted by the Australian Bureau of Statistics (ABS), collected information on the health status of the population, including the prevalence of long-term conditions. The survey was confined to people in private dwellings - people in health establishments, such as hospitals or nursing homes, or in other non-private dwellings, were not covered (see National Health Survey: Summary of Results, 2004-05 (4364.0)).

The 2003 Survey of Disability, Ageing and Carers (SDAC), conducted by the ABS, collected information on the characteristics of people with a disability, older people and carers. It involved people living in private and non-private dwellings, including health establishments such as hospitals or nursing homes (see Disability, Ageing and Carers, 2003: Summary Results (4430.0)).

Chronic health condition is a condition which has lasted, or is expected to last, six months or more (also referred to in this article as long-term health condition or chronic disease).

Disability is a limitation in everyday activities, restriction in participation in education or employment, or physical impairment, which has lasted, or is likely to last, for six months or more.

People with more severe disability are those who have a profound or severe core activity limitation: they sometimes or always need help with mobility or self-care, or have difficulty communicating.

Disability type causing most problems is the person's sole disability or the one nominated as causing most problems for the person.

Main condition is the long-term health condition causing most problems for a person with a disability (or is the person's sole long-term health condition). It is as reported in response to a question about which condition was causing most problems.

Conditions are classified according to an adaptation of the International Classification of Diseases, 10th revision (ICD-10).

CHRONIC CONDITIONS

In 2004-05, over three-quarters (77%) of the 19.7 million people living in private dwellings had at least one chronic health condition. The proportion of the population with at least one condition increased with age, from 41% of children aged under 15 years to almost 100% of people aged 65 years and over. These high proportions partly reflect the large number of people with some very common but less serious conditions. For example, the most commonly reported conditions were long sightedness (27%), short sightedness (22%) and hayfever and allergic rhinitis (16%).

However, other chronic conditions had the potential for more serious effects on a person's wellbeing. The more serious long-term conditions reported in 2004-05 included some prioritised by the Australian Health Ministers. (End note 4) These comprise some large groups of conditions - circulatory conditions (reported by 18% of the population living in private dwellings), mental and behavioural disorders (11%) and cancer (2%), as well as some more specific conditions - asthma (10%), diabetes (4%), arthritis (15%) and osteoporosis (3%). Injury prevention and control is also a priority area and 16% of the population reported that they had long-term effects of injury (graph 9.14).

Some conditions are present from birth (e.g. congenital conditions like Down syndrome) while others often appear in childhood (e.g. asthma) or later in life (e.g. hypertension). Asthma was the most common condition among children (12%) and hayfever and allergic rhinitis among youth (19%). Among people aged 25-64 years the leading conditions were sight problems (63%) and back problems (23%). Among people aged 65 years and over, the most common conditions were sight problems (96%), arthritis (49%), hypertension (39%) and hearing loss (34%).

9.14 SELECTED CHRONIC CONDITIONS - 2004-05


CHRONIC CONDITIONS AND DISABILITY

One of the ways people with chronic disease may be affected by their illness is through disability. That is, they may be limited in being able to carry out at least one everyday activity, or in participating in education or employment, or have a physical impairment. The disability people experience results from several factors, including the combination of conditions they have, the severity of these conditions and external factors such as the physical environment, the attitudes of others, and the assistance available to them.

In 2003, 20% of the Australian population, or 4 million people, had a disability. This included 6% of the population (1.2 million people) with more severe disability. These were people who sometimes or always needed help with everyday tasks like walking or dressing, or who had difficulty communicating. The rates of disability increased with age and more severe disability accounted for a greater proportion of all disability at older ages.

People with disability usually had more than one chronic health condition. While there are various approaches to analysing the relationship between the health conditions and the disabilities reported, a simple question 'What is the condition causing most problems?' was included in the 2003 SDAC. The most common specific main condition was a musculoskeletal condition - back problems, reported by 610,000 people. When combined, the ten leading specific main conditions were reported by 53% of all people with a disability (table 9.15).


9.15 PEOPLE WITH A DISABILITY, By leading main conditions(a) - 2003

Condition group and specific conditions(b)
'000
%

Musculoskeletal conditions
1,355.1
34.2
Back problems
610.5
15.4
Arthritis and related disorders
561.3
14.2
Mental and behavioural disorders
636.9
16.1
Depression/mood affective disorders
110.9
2.8
Circulatory system conditions
349.8
8.8
Hypertension
80.8
2.0
Stroke
69.8
1.8
Diseases of the ear/mastoid process
275.9
7.0
Deafness/hearing loss(c)
218.8
5.5
Nervous system conditions
259.6
6.6
Migraine
92.3
2.3
Injuries and poisoning
259.4
6.6
Leg/knee/foot damage
115.0
2.9
Respiratory conditions
240.5
6.1
Asthma
148.9
3.8
Endocrine/nutritional/metabolic conditions
115.5
2.9
Diabetes
86.2
2.2
Other conditions
465.7
11.8
Total
3,958.3
100.0

(a) Conditions reported as the condition causing most problems for a person with a disability (or which were the person's sole condition).
(b) The eight leading condition groups (e.g. musculoskeletal conditions) reported as main conditions for people with a disability and the ten leading specific conditions (e.g. back problems).
(c) Complete or partial.
Source: ABS data available on request, 2003 Survey of Disability, Ageing and Carers.


Musculoskeletal conditions

The 1.4 million people reporting a musculoskeletal condition as the condition causing most problems comprised 34% of the 4 million people with a disability. Back problems and arthritis were the most common main conditions within this group, reported by 15% and 14% of people with a disability respectively. They were also the most common specific main conditions reported out of any condition group.

The types of disability which caused most problems for people with musculoskeletal conditions as the main condition were: chronic or recurring pain or discomfort (39%); restriction in physical activities (23%); and difficulty gripping or holding things (11%).

Mental and behavioural disorders

People with a mental or behavioural disorder as their main condition comprised 16% of people with a disability. The most common main conditions within this group were depression/mood (affective) disorders, reported as a main condition by 3% of people with a disability, followed by developmental disorders (2%) and nervous tension or stress (2%). The disability types causing most problems when mental and behavioural disorders were the main condition were: being slow at learning or understanding (33%); mental illness (20%); nervous or emotional conditions (18%); and speech difficulties (8%).

Circulatory conditions

People reporting circulatory conditions as their main condition accounted for 9% of people with a disability. The specific circulatory conditions most commonly reported as main conditions were: hypertension (2%); stroke (2%); and heart disease (2%). The types of disability that people with circulatory conditions as their main condition reported as causing most problems were: restriction in physical activities or work (28%); loss of hearing (13%); breathing difficulties (11%); and chronic or recurring pain or discomfort (9%).

MORE SEVERE DISABILITY

Mental and behavioural conditions were more prominent as main conditions for more severe disability than for disability as a whole (table 9.16). They were reported as the conditions causing most problems for 23% of people with profound or severe core activity limitations compared with 16% of all people with disability. Nevertheless, musculoskeletal conditions were the most commonly reported main conditions for people with more severe disability (30%) as they were for all people with disability (34%).

Depression was one of the leading ten specific main conditions for more severe disability and disability as a whole. Three other specific mental and behavioural disorders were among the leading ten specific main conditions for more severe disability although they ranked lower for all disability. These were dementia, attention deficit/hyperactivity disorder (AD/HD) and autism and related disorders. (The three conditions that ranked among the leading ten for all disability but not for more severe disability were leg damage, migraine and hypertension.) Stroke ranked fourth among main conditions for more severe disability and tenth for disability as a whole.

Overall, 31% of all people with a disability had more severe disability. However, almost all of the 58,600 people with disability and with dementia as the main condition had more severe disability. Another leading main condition which was strongly associated with more severe disability was stroke - 49,500 of the 69,800 people who had a disability and who reported stroke as the main condition had more severe disability (71%). Of people with AD/HD as the main condition, 44% had more severe disability. Similarly, 30% of people with disability and depression/mood (affective) disorders as the main condition, and 30% of people with arthritis and related disorders as the main condition, had more severe disability.


9.16 PEOPLE WITH MORE SEVERE DISABILITY, By leading main conditions(a) - 2003

Condition group and specific conditions(b)
'000
%

Musculoskeletal conditions
376.1
30.2
Arthritis and related disorders
168.8
13.6
Back problems
149.0
12.0
Mental and behavioural disorders
290.6
23.3
Dementia
58.6
4.7
Depression/mood affective disorders
33.6
2.7
Mental retardation/intellectual disability
31.6
2.5
Attention deficit disorder/hyperactivity (AD/HD)
25.9
2.1
Circulatory system conditions
116.5
9.4
Stroke
49.5
4.0
Nervous system conditions
84.9
6.8
Respiratory conditions
68.3
5.5
Asthma
32.4
2.6
Injuries and poisoning
65.4
5.3
Leg/knee/foot/hip damage
31.9
2.6
Diseases of the ear and mastoid process
49.7
4.0
Deafness/hearing loss(c)
33.9
2.7
Diseases of the eye and adnexa
35.6
2.9
Other conditions
157.4
12.1
Total
1,244.5
100.0

(a) Chronic conditions reported as the condition causing most problems for a person with more severe disability (or which were the person's sole chronic condition).
(b) The eight leading condition groups (e.g. musculoskeletal conditions) reported as main conditions for people with more severe disability and the ten leading specific main conditions (e.g. back problems).
(c) Complete or partial.
Source: ABS data available on request, 2003 Survey of Disability, Ageing and Carers.

9.17 PROPORTION OF PEOPLE WITH SEVERE DIABILITY, By main condition - 2003

END NOTES

1. National Health Priority Action Council, 2006, National Chronic Disease Strategy, Australian Government Department of Health and Ageing, Canberra.
2. World Health Organisation, Global Strategy on Diet, Physical Activity and Health, last viewed May 2006,
<
http:// www.who.int/dietphsyicalactivity/strategy/eb11344/strategy_english_web.pdf>.
3. Department of Health and Ageing, Australian Better Health Initiative: promoting good health, prevention and early intervention, last viewed May 2006, <http://www.health.gov.au/internet/wcms/publishing.nsf/Content/feb2006coag03.htm>.
4. Department of Health and Ageing, Health priorities, last viewed May 2006,
<
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/Health+Priorities-1>.

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