Criterios de la selección de las UFS

Chronic diseases are responsible for the largest proportion of illness and death in both women and men. To illustrate the extent that the leading non-communicable diseases affect Australian women burden of disease statistics for cardiovascular disease, cancer, chronic respiratory disease and type 2 diabetes is outlined. There are a number of metrics used to quantify burden of disease, in this section prevalence, age standardised mortality rates and years of life lost (YLLs) are presented. Years of life lost quantify premature mortality by weighting younger deaths more than older deaths (Institute for Health Metrics and Evaluation, 2014).

Cardiovascular disease

Cardiovascular disease is an umbrella term that refers to a range of diseases that affect the heart and blood vessels. Two diseases of particular concern are ischaemic heart disease and hypertension. Ischaemic heart disease (CHD) refers to disease of the small coronary arteries that supply the heart muscle with blood, where the arteries become narrow and hardened (atherosclerosis). This often leads to chest pain (angina) and heart attack caused by plaque rupture and blood clot formation within a coronary artery (myocardial infarction) (Australian Institute for Health and Welfare, 2014). In the most recent AIHW report based on 2011-12 health data collected by the Australian Bureau of Statistics, an estimated 427 people per 100,000 had ischaemic heart disease, with the condition more common in men than women (2014). Ischaemic heart disease is the leading cause of death in both men and women (2014) with an age standardised death rate of 53.6/100,000 for women in 2012 (9,139 deaths) (Australian Bureau of Statistics, 2014a). The ABS estimates that the years of potential life lost (YLL) due to coronary heart disease in 2012 for females was 14,203 (2014a).

On a positive note, death rates have fallen dramatically (73%) in the last three decades due to improved medical and surgical treatments for coronary artery disease.

However, the decline varies over time and with age groups, where compared to those aged 70 years and over, death rates in the 55 to 69 year age bracket have plateaued in the last 5 years (Australian Institute for Health and Welfare, 2014). The AIHW also highlights that the burden of disease is higher in lower-socioeconomic groups and especially Aboriginal and Torres Strait Islander people with rates of heart attack 2.5 times higher than the general population (2014).

Hypertension or high blood pressure affects 10.2% of the population and is the most common chronic condition managed by general practitioners in Australia (Australian Institute for Health and Welfare, 2014). Hypertension not only contributes to coronary heart disease but also to cerebro-vascular disease and stroke.

Cerebrovascular disease was the third leading cause of death in females in 2012, with an age standardised death rate of 38.9/100,000 for females (6,534 deaths) (Australian Bureau of Statistics, 2014a).

Cancers

There are many types of cancer, but broadly ‘cancer’ refers to diseases in which a genetic mutation occurs and the resulting malignant cells divide without control, often invading nearby tissues or spreading to other parts of the body through the blood and lymphatic system (Australian Institute for Health and Welfare, 2014).

Cancer is a major cause of illness in Australia, with the incidence in 2012 lower in women (406 per 100,000 population) compared to men (585 per 100,000) (Australian Institute for Health and Welfare, 2014). Mortality from all cancers in women was 131 per 100,000 population (Australian Bureau of Statistics, 2014a), with five year survival rates of 65% overall (Australian Institute for Health and

Welfare, 2014). Cancer can develop at any age but is more common as people age, with 70% of all cancers diagnosed in those aged 60 and over. Breast cancer is the most common cancer diagnosed in Australian women and the sixth leading cause of death in females in 2012 (2,795 deaths) (Australian Institute for Health and Welfare, 2014). Following breast cancer, the next most common cancers in women are bowel, melanoma, lung and uterine cancer (Australian Institute for Health and Welfare &

Australasian Association of Cancer Registries, 2012). Cancer of the trachea, bronchus and lung cancer were the fourth leading cause of death in females in 2012 (3,255 deaths) (Australian Bureau of Statistics, 2014a). The ABS estimates that the years of potential life lost (YLL) due to cancer in 2012 for females was 143,109 (2014a).

Chronic respiratory diseases

Chronic respiratory disease includes illnesses such as asthma and chronic obstructive pulmonary disease (COPD). Asthma is a chronic inflammatory condition of the airways that leads to episodes of wheezing, coughing, shortness of breath and chest tightness (National Asthma Council Australia, 2014). Asthma varies in severity and acute episodes are often triggered by factors such as allergies to dust or pollen or upper respiratory tract infections. COPD includes conditions such as chronic bronchitis and emphysema where there are permanent structural changes in the lungs and airways leading to diminished lung function and symptoms such as shortness of breath, chronic cough, excess sputum, wheezing, fatigue and weight loss (Global Initiative for Chronic Obstructive Lung Disease, 2014).

In 2011-12 approximately 10% of the Australian population had asthma, with a fewer number affected by COPD (2%) (Australian Institute for Health and Welfare, 2014). The age standardised death rate for Australian women in 2012 from chronic

lower respiratory diseases was 20.7/100,000 with most of those deaths being attributed to COPD (Australian Bureau of Statistics, 2014a). In 2012, COPD was the fifth leading cause of death in females (3,107 deaths) with years of potential life lost due to chronic respiratory disease being 11,091 (Australian Bureau of Statistics, 2014a).

Type 2 diabetes

Type 2 diabetes is a chronic condition characterised by high levels of glucose in the blood, caused by the inability of the pancreas to produce insulin or the inability of the body to use insulin that it does produce (insulin resistance) (Australian Institute for Health and Welfare, 2014). Unlike type 1 diabetes that is an autoimmune disease, type 2 diabetes is largely preventable and is usually associated with behavioural risk factors including unhealthy eating, physical inactivity and overweight and obesity (Australian Institute for Health and Welfare, 2014). Diabetes is a complex condition that may lead to a range of serious complications including cardiovascular disease, renal failure, blindness and lower limb amputation (Australian Institute for Health and Welfare, 2014).

Type 2 diabetes is becoming more common, largely due to increasing rates of overweight and obesity both globally and in Australia (World Health Organization, 2011b). Diabetes more than doubled between 1989-90 and 2011-12; with 5.1% of adults having diabetes in 2011-12 and a further 3.1% having impaired fasting glucose levels, indicating high risk of diabetes (Australian Bureau of Statistics, 2014d). The ABS has pointed out that this is likely to be an underestimate with type 2 diabetes often being undiagnosed (2014d). In the 2011-12 Australian Health Survey an estimated 1 million people in Australia have diabetes, with 85% being type 2

diabetes (Australian Bureau of Statistics, 2014d). Diabetes is also more common in men (6%) than women (4%) and in older age groups.

Diabetes was the eighth leading cause of death in Australian women in 2012 (2,040 deaths), however it was an associated cause of death in a further 10,900 deaths that had multiple causes. The age standardised death rate from diabetes in 2012 was 13/100,000 with years of potential life lost 6,507 (Australian Bureau of Statistics, 2014a).

While this description of leading chronic diseases that affect Australian women is not exhaustive, it illustrates the burden these diseases place not only on individuals but also the community. Although it is beyond the scope of this literature review to discuss all chronic diseases, it is worth noting that other illnesses such as heart failure and chronic kidney disease, are also a significant cause of mortality and morbidity in Australia. In the following section, the socio-demographic and health risk factors that contribute to the development of chronic diseases are discussed.