Burden of disease
On this subject
- Key points
- Life expectancy at birth
- Life expectancy at birth by Health Area
- Life expectancy at 65 years
- Life expectancy at 65 years by Health Area
- Deaths from all causes
- Deaths from all causes by Health Area
- Causes of death
- Premature deaths
- Potentially avoidable deaths with projections
- Causes of potentially avoidable death
- Causes of potentially avoidable death in Health Area
- Potentially avoidable deaths by Health Area
- Potentially avoidable deaths from preventable causes by Health Area
- Potentially avoidable deaths from causes amenable to health care by Health Area
- Potentially avoidable deaths in Health Area
- Potentially avoidable deaths by Local Government Area
- Deaths potentially avoidable by primary prevention by Local Government Area
- Deaths potentially avoidable by health care interventions by Local Government Area
- Infant mortality
- Hospitalisations for all causes with projections and persons hospitalised
- Causes of hospitalisation
- Hospitalisations by Health Area
- Hospitalisations in Health Area
- Causes of hospitalisation in Health Area
- Self-rated health
- Disability adjusted life years in Australia and NSW
- Disability adjusted life years and risk factors
- Hospitalisations for ambulatory care sensitive conditions
- Hospitalisations for ambulatory care sensitive conditions by Health Area
- Hospitalisations for ambulatory care sensitive conditions in Health Area
- Types of ambulatory care sensitive conditions
- Types of ambulatory care sensitive conditions in Health Area
- Ambulatory care sensitive conditions by Local Government Area
- International rankings of life expectancy
- International rankings of infant mortality
- Arthritis and other musculoskeletal conditions
- Dementia
Introduction
Burden of disease refers to the health burden that diseases, injuries and risk factors place on populations. This chapter examines the major trends in burden of disease in NSW and the contribution of various diseases, conditions and causes of injury to this loss of life and disability.
Traditional indicators used to quantify the burden of disease include life expectancy, mortality, hospitalisation and the self-rated health status. The major limitation of traditional indicators is that the impact of conditions, which cause substantial suffering or disability, that don't result in death or hospitalisation is underestimated. The global burden of disease approach aims to address this limitation, by using a summary health gap measure called the 'disability adjusted life year' (DALY), and by comprehensively assessing the complete spectrum of disease that occurs in a population.
The DALY aims to quantify the amount of full health lost due to disease or injury occurring in a particular period. It is calculated as the sum of the years of life lost due to premature death in the population, and the equivalent years of 'healthy' life lost due to poor health or disability arising from incident (new) cases of disease and injury. An estimate of relative severity of disability caused by the condition, known as the disability weight, the duration of the loss of health and a discounting factor, which reflects the greater importance people place on the loss of health in the near future compared with the distant future: disability weight, are all incorporated into the calculation. The disability weight is measured on a scale of zero to one, and is constructed so that zero means full health and one means death. The duration of loss of health or loss of life is limited by an 'ideal' life expectancy from a life table chosen for each study. The methodology used in Australia does not use age-weighting, where different weights based on the economic and social welfare value of people at different ages are incorporated into the calculation of DALYs.
The DALY for a cause of disease or injury is calculated separately for each age group defined and for each sex. The total burden of that disease is the sum of the DALYs for all age groups and both sexes. This additive feature of DALYs is central to its application to different aggregations and disaggregations of populations and causes of disease or injury.
The study The burden of disease and injury in Australia, 2003 (Begg et al., 2007) calculated total and age and sex-specific DALYs for 176 diseases, injuries and risk factors, in a complete assessment of the burden of disease in the Australian population. The DALY calculated for NSW and Australia are presented in the report.
Other newer measures of burden of disease used in this chapter are potentially avoidable mortality and ambulatory care sensitive conditions.
Potentially avoidable mortality refers to premature deaths (persons aged under 75 years) that, theoretically, could have been avoided given current understanding of causation, and available disease prevention and health care (ABS, 2006; Page et al., 2006; Tobias and Jackson, 2001).
Potentially avoidable deaths can be further differentiated into conditions where death can be averted by prevention ('preventable') or by treatment ('amenable'). Amenable conditions are defined as those from which it is reasonable to expect death to be averted even after the condition has developed, for example, through early detection and effective treatment (such as cervical cancer). Preventable conditions include those for which there are effective means of preventing the condition from occurring, for example, where the aetiology is to a considerable extent related to lifestyle factors (such as smoking).
Ambulatory care sensitive conditions are those for which hospitalisation is considered potentially avoidable through preventive care and early disease management, usually delivered in an ambulatory setting, such as primary health care (for example by general practitioners or community health centres).
Hospitalisation rates for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. Other factors that influence rates include disease prevalence in the community, hospital admission and coding practices, and personal choices about seeking health care. The conditions reported here as ambulatory care sensitive are presented in three categories: vaccine-preventable conditions, acute conditions and chronic conditions.
Diabetes with complications, angina, chronic obstructive pulmonary disease, asthma and congestive heart failure usually account for around half of all ambulatory care sensitive hospitalisations in NSW. More information about these conditions can be found in other chapters of this report.
This chapter also includes international comparisons of selected indicators. An indicator on arthritis and other musculoskeletal conditions and another one on dementia complete the chapter.
More information on the methods used for calculating measures discussed above can be found in the Methods section.
The values for life expectancy that appear in this report may differ slightly from those published by the Australian Bureau of Statistics due to differences between methods of calculation.
The ICD-10 and ICD-9 codes used for each indicator are included in the disease and procedure codes appendix.
For more information
Australian Institute of Health and Welfare. Australia's health 2008. Cat. no. AUS 99. Canberra: AIHW, 2008. Available at: www.aihw.gov.au/publications/index.cfm/title/10585
Australian Bureau of Statistics.Deaths, Australia 2006. Catalogue no. 3302.0. Canberra: ABS, 2008. Available at www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0.
Australian Institute of Health and Welfare. Australian hospital statistics 2006-07. Health services series no. 31. Cat. No. HSE 55. Canberra: AIHW, 2008. Available at www.aihw.gov.au/publications/hse/ahs06-07/ahs06-07.pdf
Begg S, Vos T, Barker B. et al. The burden of disease and injury in Australia, 2003. PHE 82. Canberra: AIHW, 2007. Available at www.aihw.gov.au/publications/index.cfm/title/10317
Victorian Government Department of Human Services. The Victorian Ambulatory Care Sensitive Conditions Study, 2001-02. Melbourne: VGDHS, 2004. Available at www.dhs.vic.gov.au/health/healthstatus/acsc/finalreport.htm..
Page A, Ambrose S, Glover J, Hetzel D. Atlas of avoidable hospitalisations in Australia: ambulatory care-sensitive condition. Adelaide: PHIDU, University of Adelaide and AIHW, 2007. Available at www.publichealth.gov.au/publications/atlas-of-avoidable-hospitalisations-in-australia%3a-ambulatory-care-sensitive-conditions.htm
NSW Department of Health. Integrated Primary and Community Health Policy 2007-2012. Sydney: NSW Department of Health, 2006. Available at www.health.nsw.gov.au/policies/pd/2006/PD2006_106.html
Organization for Economic Cooperation and Development. OECD health data 2008. Paris: OECD, 2008.
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Suggested citation
Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/publichealth/chorep/. Accessed (insert date of access).
Produced by
Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.
Last updated on 17 December 2008
