Friday, 27 January 2017

Disadvantage, discrimination, disability, despair and distance still negatively impact on health outcomes for Australians - but as a population we are living longer

# People living in the lowest socioeconomic areas are more likely to have poor health and to have higher rates of illness, disability and death than people who live in the highest socioeconomic areas. If all Australians had the same death rates as the 20% of Australians living in the highest socioeconomic area, there would have been about 54,200 fewer deaths in 2009–2011.

# On a range of health measures, people living in the lowest socioeconomic areas (that is, areas of most disadvantage) tend to fare worse than people living in the highest socioeconomic areas (that is, areas of least disadvantage). For example, according to AIHW analysis of the ABS Australian Health Survey, in 2011–12, people living in the lowest socioeconomic areas were 1.6 times as likely to have chronic kidney disease and 2.2 times as likely to have coronary heart disease as people living the highest socioeconomic areas.

# There have been some improvements in Aboriginal and Torres Strait Islander health in recent years, including decreases in smoking and infant mortality and in avoidable deaths from circulatory and kidney diseases. However, there is still a significant gap in health outcomes, including life expectancy at birth, between Indigenous and non-Indigenous Australians. The causes of this gap are complex, and include differences in the social determinants of health, risk factors, and access to appropriate health care.

# In 2013, 29% of the Australian population lived in regional and remote areas: 18% in Inner regional areas, 8.9% in Outer regional areas, 1.4% in Remote areas and 0.9% in Very remote areas. Australians living outside Major cities tend to have higher rates of disease and injury than people in Major cities, and they are also more likely to engage in health behaviours that can lead to adverse health outcomes.

# Australians living in rural and remote areas tend to have lower life expectancy and higher rates of disease and injury than people living in Major cities (see 'Chapter 5.11 Rural and remote health').
In 2009–2011, people living in Remote and Very remote areas had mortality rates 1.4 times as high as people living in Major cities. For nearly all causes of death, rates were higher for people living outside Major cities, with people in Remote and Very remote areas faring the worst. For example, the rate of dying due to a land transport accident was more than 4 times as high in Remote and Very Remote areas as in Major cities.
People in regional and remote areas are more likely to die prematurely than their Major city counterparts. While fewer than 3 in 10 people (29%) live in regional and remote areas, deaths in these areas accounted for almost 2 in 5 (38%) of premature deaths in 2011–13.
The premature mortality rate among people living in Remote areas was 1.6 times as high as the rate among people in Major cities, and in Very remote areas it was 2.2 times as high (see 'Chapter 3.2 Premature mortality').
Disease prevalence is generally higher in rural and remote areas of Australia than in Major cities. In 2014–15, based on self-reported data from the NHS, people living in Inner regional and Outer regional/Remote areas of Australia were more likely than people in Major cities to have arthritis, asthma, COPD, and a number of other chronic health conditions (ABS 2015e).
People living in rural and remote areas are, on average, also more likely than their urban counterparts to engage in lifestyle behaviours that can lead to adverse health outcomes (such as smoking, insufficient physical activity, and risky alcohol consumption). These poorer health outcomes may also reflect a range of social and other factors that can be detrimental to health, including a level of disadvantage with regard to educational and employment opportunities; income; and access to goods and services.

# Just under 1 in 5 Australians (4.2 million people) reported having a disability in 2012. People with disability experience significantly poorer health than people without disability. Over half (51%) of people aged 15–64 with severe or profound limitation(s) in communication, mobility or self-care reported 'poor' or 'fair' health compared with 5.6% of those without such limitations. A higher proportion of people aged 15–64 with these limitations had mental health conditions (50% compared with 7.7% for those without).

# Unemployed people have a higher risk of death and have more illness and disability than those of similar age who are employed (Mathers & Schofield 1998). The psychosocial stress caused by unemployment has a strong impact on physical and mental health and wellbeing (Dooley et al. 1996). For some, unemployment is caused by illness, but for many it is unemployment itself that causes health problems through its psychological consequences and the financial problems it brings.

# In 2014–15, 50% of patients were admitted within 35 days of being placed on the elective surgery waiting list, 90% were admitted within 253 days and 1.8% waited more than 1 year. The median waiting time is lower than it was between 2010–11 and 2013–14 (36 days).
The median waiting time for Indigenous Australians (42 days) was higher than for other Australians (35 days), and a higher proportion of Indigenous Australians waited more than a year for elective surgery than other Australians (2.3% and 1.8%, respectively).
The longest median waiting times were for the surgical specialties Ear, nose and throat surgery; Ophthalmology; and Orthopaedic surgery (73, 70, and 64 days, respectively). Cardio-thoracic surgery had the shortest median waiting time (18 days).

# Hospital elective surgery waiting lists…. 2015-16…uncontactable/died [before hospital admission] 7,295…Excludes data for the Australian Capital Territory, which were not available at the time of publication.
Not contactable/died:
NSW 2,234
VIC 2,234
QLD 703
WA 1,003
SA 611
TAS 361
ACT n.a.
NT 141

# In 2013, more than 1 in 3 deaths (34%) in Australia were 'premature' (that is, they occurred before the age of 75)—substantially lower than the 43% in 1997 (AIHW 2015b).
The three leading causes of premature death for all Australians were coronary heart disease, lung cancer and suicide. Nearly 1 in 5 deaths (18%) among people aged 25–44 were due to suicide (AIHW 2015b).
The rate of premature deaths among Indigenous Australians is higher than among non-Indigenous Australians for both males and females across every age group. Between 2009 and 2013, 81% of all Indigenous deaths were of people aged under 75, compared with 34% for non-Indigenous Australians (ABS 2015b) (see 'Chapter 3.2 Premature mortality').

# after adjusting for differences in age structure, in the period from 2009 to 2013, the mortality rate for Indigenous Australians who died from all potentially avoidable causes was more than 3 times the rate for non-Indigenous Australians (351 and 110 deaths per 100,000 population, respectively) (see 'Chapter 5.7 How healthy are Indigenous Australians?').

# The rate of premature mortality varied considerably between states and territories in 2011–2013 (Figure 3.2.3). After adjusting for diff­erences in age structure, the Australian Capital Territory had the lowest rate (173 deaths per 100,000 people aged under 75), followed by Victoria (192) and Western Australia (205). The age-standardised premature mortality rate in the Northern Territory (388) was more than twice as high as the rate in the Australian Capital Territory. The Northern Territory has the highest proportion of Indigenous residents (about 30%) of all Australian states and territories and the majority of the Northern Territory's land mass is classified as remote (Taylor & Bell 2013). The following section, 'Inequalities in premature mortality', describes the impact of remoteness of residence and Indigenous status on premature death.

# The majority of Australians live in Major cities, with fewer than 3 in 10 people (29% of the population) living in Regional and Remote areas (see 'Chapter 5.11 Rural and remote health'). Despite this, in 2011–2013, deaths in Regional and Remote areas accounted for 38% of premature deaths. Premature mortality rates increased with remoteness. The premature mortality rate among people living in Remote areas was 1.6 times as high as the rate among people in Major cities, and in Very remote areas it was 2.2 times as high.

# Nearly 2 in 5 people (39%) who died in 2013 were aged 85 and over….The most common cause of death in 2013 for people aged 85 and over was coronary heart disease (17%), followed by dementia (12%).

# Life expectancy at birth in Australia has climbed steadily over time, and is now more than 30 years longer than it was in the late 1800s (Figure 1.3.1). For example, life expectancy for males and females born in 2014 was 80.3 years and 84.4 years respectively (ABS 2015c), whereas males and females born in 1890 could expect to live to 47.2 years and 50.8 years respectively (ABS 2014b)…..
In 2012, a newborn boy in Australia could expect to live 62.4 years without disability and another 17.5 years with some form of disability, and a newborn girl 64.5 years without disability and 19.8 years with some form of disability (see Glossary) (AIHW 2014b). Between 1998 and 2012, the disability-free life expectancy for males rose by 4.4 years, which was more than the gain in male life expectancy over that period (4 years). However, the increase in years free of disability for females was 2.4 years, compared with a 2.8 years gain in female life expectancy (AIHW 2014b).

#A man turning 85 in 2013 could expect to live another 6.1 years, and a woman the same age could expect another 7.1 years.

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