Australian heart disease statistics 2015

Transcription

1 Australian heart disease statistics 2015 Mortality Morbidity Treatment Smoking Diet Physical activity Alcohol Cholesterol Blood pressure Overweight and obesity Diabetes Mental health

2 Suggested citation: Nichols M, Peterson K, Herbert J, Alston L, Allender S. Australian heart disease statistics Melbourne: National Heart Foundation of Australia, ISBN National Heart Foundation of Australia ABN This work is copyright. No part of this publication may be reproduced in any form or language without prior written permission from the National Heart Foundation of Australia (national office). Enquiries concerning permissions should be directed to Disclaimer: This document has been produced by the National Heart Foundation of Australia for the information of health professionals. The statements and recommendations it contains are, unless labelled as expert opinion, based on independent review of the available evidence. Interpretation of this document by those without appropriate medical and/or clinical training is not recommended, other than at the request of, or in consultation with, a relevant health professional. While care has been taken in preparing the content of this material, the Heart Foundation and its employees cannot accept any liability, including for any loss or damage, resulting from the reliance on the content, or for its accuracy, currency and completeness. The information is obtained and developed from a variety of sources including, but not limited to, collaborations with third parties and information provided by third parties under licence. It is not an endorsement of any organisation, product or service. This material may be found in third parties programs or materials (including, but not limited to, show bags or advertising kits). This does not imply an endorsement or recommendation by the National Heart Foundation of Australia for such third parties organisations, products or services, including their materials or information. Any use of National Heart Foundation of Australia materials or information by another person or organisation is at the user s own risk. RES-115 B Australian Heart Disease Statistics 2014 The National Heart Foundation of Australia

3 Australian heart disease statistics 2015 HeartStats The National Heart Foundation of Australia/ Deakin University Heart Disease Statistics Project Melanie Nichols, Karen Peterson, Jessica Herbert, Laura Alston and Steven Allender National Heart Foundation of Australia Australian Heart Disease Statistics 2015

4 Foreword A challenge lies before us While this compendium, Australian heart disease statistics 2015, reveals that cardiovascular death rates have been decreasing since the 1970s, cardiovascular disease remains a major cause of death and disability across the globe. In Australia, cardiovascular disease was responsible for 43,603 deaths in Ischaemic heart disease (the cause of heart attack) resulted in more Australian deaths than any other single cause for both men and women. Of concern, hospitalisations for heart failure have risen steadily in men and women over the last 10 years. Cardiovascular disease is a leading cause of death and there is significant variation in heart disease deaths across Australia. Some regions have death rates from heart disease that are at least double the national average. This occurs mostly in regional and rural areas, highlighting the poorer heart health that many people in these regions experience. Similarly, there is significant variation between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians. Aboriginal and Torres Strait Islander peoples experience double the rate of heart attack, while the age standardised death rates due to ischaemic heart disease are up to 2.5 times higher for Aboriginal and Torres Strait Islander peoples. Ongoing efforts to address the factors that contribute to inequalities in the incidence and outcome of heart disease remain a priority. Cardiovascular disease continues to impose a heavy burden on the Australian community with a total of 71.8 million prescriptions for and $1.6 billion or 17% of all Pharmaceutical Benefits Scheme (PBS) benefits paid in was for cardiovascular medicines. More than 540,000 major procedures for cardiovascular disease were performed in While Australia has led the world in reducing smoking prevalence, smoking rates among Aboriginal and Torres Strait Islander peoples more than double those among non-indigenous Australians. Despite a reduction from 49% (2002) to 42% ( ), these high rates of smoking represent a significant risk for the development of cardiovascular disease. Although smoking rates are declining, little progress has been made in reducing other major significant risk factors. In , only 7.9% of males and 9.6% of females consumed enough fruit and vegetables to meet National Health and Medical Research Council guidelines. Among secondary students, 38% of boys and 22% of girls consumed four or more cups of sugar-sweetened drinks per week. Likewise, most Australians (58%) were either sedentary or engaged in low levels of physical activity, and only 30% of children met physical activity recommendations. The prevalence of diabetes across Australia remains very high, and the proportion of our population who are obese is increasing alarmingly. This compendium provides a valuable record of what we have achieved and the significant challenges that lie before us. We have much work to do if we are to continue to make inroads into the death and disability caused by heart disease in Australia. Professor Leonard Kritharides Chair, Cardiovascular Health Advisory Committee ii Australian heart disease statistics 2015 National Heart Foundation of Australia

5 Contents Foreword.... ii Tables and figures... iv Preface... xiii Acknowledgements.... xiv Summary of key findings... xv Introduction Part A Overview Chapter 1 Mortality... 3 Feature 100 years of cardiovascular disease in Australia Chapter 2 Morbidity Chapter 3 Treatment Part B Behavioural risk factors Chapter 4 Smoking Chapter 5 Diet Chapter 6 Physical activity Chapter 7 Alcohol Part C Medical risk factors Chapter 8 Cholesterol Chapter 9 Blood pressure Chapter 10 Overweight and obesity Chapter 11 Diabetes Chapter 12 Mental health Abbreviations and acronyms References National Heart Foundation of Australia Australian heart disease statistics 2015 iii

6 Tables and figures Part A Overview Chapter 1 Mortality Deaths from major causes Table 1.1 Deaths from major causes, by sex and state or territory, all ages, Figure 1.1a Proportion of deaths from major causes, men and boys, Figure 1.1b Proportion of deaths from major causes, women and girls, Deaths from cardiovascular disease Table 1.2 Premature deaths (<75 years) from cardiovascular causes, by sex and state or territory, Figure 1.2a Proportion of premature deaths (<75 years) from cardiovascular causes, men and boys, Figure 1.2b Proportion of premature deaths (<75 years) from cardiovascular causes, women and girls, Table 1.3 Number and proportion of deaths from major cardiovascular causes, by cause and age group, Table 1.4 Death rates from cardiovascular disease, ischaemic heart disease and stroke, by sex and state or territory, Table 1.5 Deaths from ischaemic heart disease, by sex and state or territory, 2004 to Table 1.6a Age-specific death rates from cardiovascular diseases, Australia, by sex and age, 2002 to Table 1.6b Age-specific death rates from ischaemic heart disease, Australia, by sex and age, 2002 to Table 1.6c Age-specific death rates from stroke, Australia, by sex and age, 2002 to Figure 1.6a Trends in age-standardised death rates from cardiovascular diseases, all ages, men and boys, 2002 to Figure 1.6b Trends in age-standardised death rates from cardiovascular diseases, all ages, women and girls, 2002 to Figure 1.6c Trends in age-standardised premature death rates from cardiovascular diseases, men and boys under age 75 years, 2002 to Figure 1.6d Trends in age-standardised premature death rates from cardiovascular diseases, women and girls under age 75 years, 2002 to Ischaemic heart disease deaths in Aboriginal and Torres Strait Islander peoples Table 1.7 Deaths and standardised death rates from ischaemic heart disease, by Indigenous status, sex and state or territory (NSW, NT, QLD, SA, WA), 2009 to 2013 (pooled) Geographic variation in cardiovascular disease death rates Table 1.8a Geographic regions (SA3) with highest and lowest age-standardised rates of cardiovascular disease mortality, by sex and state or territory, 2009 to 2012 (pooled)...16 Table 1.8b Geographic regions (SA3) with highest and lowest age-standardised rates of ischaemic heart disease mortality, by sex and state or territory, 2009 to 2012 (pooled)...18 Figure 1.8a Geographic variation in age-standardised rates of cardiovascular disease mortality, men and boys, by Statistical Area Level 3, 2009 to 2012 (pooled) Figure 1.8b Geographic variation in age-standardised rates of cardiovascular disease mortality, women and girls, by Statistical Area Level 3, 2009 to 2012 (pooled) Figure 1.8c Geographic variation in age-standardised rates of ischaemic heart disease mortality, men and boys, by Statistical Area Level 3, 2009 to 2012 (pooled) Figure 1.8d Geographic variation in age-standardised rates of ischaemic heart disease mortality, women and girls, by Statistical Area Level 3, 2009 to 2012 (pooled) iv Australian heart disease statistics 2015 National Heart Foundation of Australia

7 International comparisons Table 1.9a International comparison of total ischaemic heart disease deaths, Australia and selected countries, by sex, 2002 to Table 1.9b International comparison of age-standardised ischaemic heart disease death rates, Australia and selected countries, by sex, 2002 to Table 1.9c International comparison of ischaemic heart disease as a proportion of all deaths, Australia and selected countries, by sex, 2002 to Figure 1.9a Trends in age-standardised death rates from ischaemic heart disease, men and boys, Australia and selected countries, 2002 to Figure 1.9b Trends in age-standardised death rates from ischaemic heart disease, women and girls, Australia and selected countries, 2002 to Feature 100 years of cardiovascular disease in Australia Figure F1 Total number of deaths from cardiovascular disease, all ages, by sex, 1913 to Figure F2 Age-standardised death rates from cardiovascular disease, all ages, by sex, 1913 to Chapter 2 Morbidity Prevalence of heart disease Table 2.1 Prevalence of self-reported diagnosed heart, stroke and vascular disease, adults aged 35 years and over, by type of condition, sex and age, Table 2.2 Prevalence of self-reported heart, stroke and vascular disease, by sex and state or territory, Table 2.3 Trends in prevalence of self-reported heart disease, adults aged years, by sex and age, 2010 to Figure 2.3 Trends in prevalence of self-reported heart disease, adults aged years, by sex, 2010 to Hospitalisations for heart disease Table 2.4 Number of hospital separations for cardiovascular diseases, by sex and age, Table 2.5 Number of hospital separations for cardiovascular diseases, by sex, to Figure 2.5a Trends in hospital separations for specific cardiovascular causes, men and boys, to Figure 2.5b Trends in hospital separations for specific cardiovascular causes, women and girls, to Figure 2.5c Proportion of total hospitalisations due to cardiovascular diseases, by sex, to Table 2.6 Average length of stay in hospital for cardiovascular diseases, by condition and sex, to Table 2.7 Total number of hospital bed days for cardiovascular diseases, by condition and sex, to Incidence of heart disease Table 2.8 Incidence of acute coronary events, adults aged 25 years and over, by sex and age, 2007 to Figure 2.8 Age-standardised incidence of acute coronary events, adults aged 25 years and over, by sex, 2007 to Table 2.9 History of angina in the last 5 years, adults aged years, by sex and age, 2010 to Figure 2.9 History of angina in the last 5 years, adults aged years, by sex, 2010 to Table 2.10 History of heart attack in the last 5 years, adults aged years, by sex and age, 2010 to Figure 2.10 History of heart attack in the last 5 years, adults aged years, by sex, 2010 to Case-fatality rates following acute myocardial infarction Table 2.11 Admission-based, age-standardised case-fatality rate within 30 days following acute myocardial infarction, Australia and selected countries, by sex, 2000 to National Heart Foundation of Australia Australian heart disease statistics 2015 v

8 Figure 2.11a Trends in admission-based, age-standardised case-fatality rate after acute myocardial infarction, men, Australia and selected countries, 2000 to Figure 2.11b Trends in admission-based, age-standardised case-fatality rate after acute myocardial infarction, women, Australia and selected countries, 2000 to Heart disease in Aboriginal and Torres Strait Islander peoples Table 2.12 Prevalence of self-reported diagnosed heart, stroke and vascular disease, Aboriginal and Torres Strait Islander peoples, by type of condition, sex and age, Table 2.13 Age-standardised incidence of heart attacks (acute myocardial infarction), adults aged 25 years and over, by Indigenous status, 2007 to Chapter 3 Treatment Procedures performed for cardiovascular diseases Table 3.1 Number of major procedures for cardiovascular diseases performed in hospitals, by sex and age, Table 3.2 Number of major procedures for cardiovascular diseases performed in hospitals, by sex, to Figure 3.2a Number of major procedures for cardiovascular diseases performed in hospitals, men and boys, to Figure 3.2b Number of major procedures for cardiovascular diseases performed in hospitals, women and girls, to Prescription medicines for cardiovascular diseases Table 3.3 Total and per capita number of prescriptions for cardiovascular system, by state or territory, to Figure 3.3a Trends in per capita prescription rates for cardiovascular system, by state or territory, to Figure 3.3b Per capita prescription rates for cardiovascular system, by state or territory, to Table 3.4 Pharmaceutical Benefits Scheme benefits paid for cardiovascular system prescriptions, by state or territory, to Figure 3.4 Proportion of total Pharmaceutical Benefits Scheme benefits that were paid for cardiovascular system prescriptions, Australia, to Table 3.5 Trends in heart disease medicine use among people who self-reported having heart disease, adults aged years, by sex and age, 2010 to Table 3.6 Per capita healthcare expenditure on cardiovascular diseases, by sex and age, Part B Behavioural risk factors Chapter 4 Smoking Prevalence of smoking Table 4.1 Prevalence of smoking, people aged 12 years and over, by sex and age, Table 4.2 Prevalence of smoking, people aged 15 years and over, by sex, age and state or territory, Figure 4.2a Prevalence of smoking, men and boys aged 15 years and over, Figure 4.2b Prevalence of smoking, women and girls aged 15 years and over, Table 4.3 Prevalence of smoking and proportion who have never smoked, adolescents aged years, by sex and age, Figure 4.3 Proportion of adolescents who have never smoked tobacco, by sex and age, Table 4.4 Trends in prevalence of smoking, people aged 15 years and over, by sex and age, 2001 to Figure 4.4 Trends in prevalence of smoking, people aged 15 years and over, by sex, 2001 to Table 4.5 Trends in prevalence of daily smoking, adults, by state or territory, 1998 to vi Australian heart disease statistics 2015 National Heart Foundation of Australia

9 Smoking and heart disease Table 4.6 Prevalence of self-reported cardiovascular disease, adults, by age and smoking status, Sociodemographic distribution of smoking Table 4.7 Age-standardised prevalence of smoking, people aged 14 years and over, by sociodemographic characteristics, Trends in tobacco consumption Table 4.8 Average number of cigarettes smoked per smoker per week, adults, by sex and age, 2010 and International comparisons Table 4.9 Age-standardised prevalence of current tobacco smoking in adults, Australia and selected countries, Figure 4.9 Age-standardised prevalence of current tobacco smoking in adults, Australia and selected countries, Smoking in Aboriginal and Torres Strait Islander peoples Table 4.10 Prevalence of smoking, people aged 15 years and over, by sex, age and Indigenous status, Table 4.11 Trends in prevalence of smoking, Aboriginal and Torres Strait Islander peoples aged 15 years and over, by sex and age, 2002 to Table 4.12 Trends in prevalence of smoking, Aboriginal and Torres Strait Islander peoples aged 15 years and over, by remoteness and age, 2002 to Table 4.13 Prevalence of self-reported cardiovascular disease, Aboriginal and Torres Strait Islander adults, by age and smoking status, Chapter 5 Diet Vegetable and fruit consumption Table 5.1 Usual daily vegetable consumption, by sex and age, Figure 5.1a Usual daily vegetable consumption, men and boys, by age, Figure 5.1b Usual daily vegetable consumption, women and girls, by age, Table 5.2 Usual daily fruit consumption, by sex and age, Figure 5.2a Usual daily fruit consumption, men and boys, by age, Figure 5.2b Usual daily fruit consumption, women and girls, by age, Table 5.3 Self-reported daily intake of vegetables and fruit, adults aged years, by sex and state or territory, Table 5.4 Proportion of people eating adequate amounts of vegetables and fruit, by sex and age, Nutrition in children Table 5.5 Prevalence of specific dietary patterns, adolescent students, by sex and school year level, Table 5.6a Children s consumption of vegetables and fruit in past 24 hours at different ages, by sex, 2004 to Table 5.6b Children s consumption of high-fat foods and sweet drinks in the past 24 hours at different ages, by sex, 2004 to Figure 5.6a Children s consumption of high-fat foods in past 24 hours at different ages, boys, 2004 to Figure 5.6b Children s consumption of high-fat foods in past 24 hours at different ages, girls, 2004 to Figure 5.6c Children s consumption of sweet drinks in past 24 hours at different ages, boys, 2004 to Figure 5.6d Children s consumption of sweet drinks in past 24 hours at different ages, girls, 2004 to National Heart Foundation of Australia Australian heart disease statistics 2015 vii

10 Specific nutrient intakes Table 5.7a Mean daily intake of energy, macronutrients, sodium and fibre, by sex and age, Table 5.7b Proportional contribution to energy intake from protein, fat, carbohydrate, dietary fibre and alcohol, by sex and age, Table 5.7c Proportional daily energy obtained from major food groups, by sex and age, Table 5.8a Frequency of adding salt to food during and after cooking, by sex and age, Table 5.8b Trends in usually adding salt to food after cooking, adults, by sex and age, 1983 to Figure 5.8 Trends in usually adding salt to food after cooking, adults, by age, 1983 to International comparisons Table 5.9 Total per capita energy consumption, Australia and selected countries, 1992 to Figure 5.9 Total per capita energy consumption, Australia and selected countries, 1992 to Table 5.10 Average per capita vegetable and fruit consumption, Australia and selected countries, 1992 to Figure 5.10a Average per capita vegetable consumption, Australia and selected countries, 1992 to Figure 5.10b Average per capita fruit consumption, Australia and selected countries, 1992 to Table 5.11 Fat consumption per capita, total fats and animal fats, Australia and selected countries, 1992 to Figure 5.11a Total per capita fat consumption, Australia and selected countries, 1992 to Figure 5.11b Per capita animal fat consumption, Australia and selected countries, 1992 to Nutrition in Aboriginal and Torres Strait Islander peoples Table 5.12 Usual daily vegetable consumption, Aboriginal and Torres Strait Islander peoples, by sex and age, Figure 5.12a Usual daily vegetable consumption, Aboriginal and Torres Strait Islander adults, by sex and age, Figure 5.12b Usual daily vegetable consumption, Aboriginal and Torres Strait Islander children, by sex and age, Table 5.13 Usual daily fruit consumption, Aboriginal and Torres Strait Islander peoples, by sex and age, Figure 5.13a Usual daily fruit consumption, Aboriginal and Torres Strait Islander adults, by sex and age, Figure 5.13b Usual daily fruit consumption, Aboriginal and Torres Strait Islander children, by sex and age, Table 5.14 Proportion of Aboriginal and Torres Strait Islander peoples meeting dietary recommendations for vegetables and fruit, by sex and age, Chapter 6 Physical activity Physical activity and sedentary behaviour levels Table 6.1 Physical activity levels in adults, by sex and age, Figure 6.1a Physical activity levels, men, by age, Figure 6.1b Physical activity levels, women, by age, Table 6.2 Average hours per week spent in physical activity and sedentary behaviour, adults, by sex and age, Table 6.3 Average hours spent in physical activity and sedentary behaviour on survey day, children, by sex and age, Table 6.4 Proportion of children meeting physical activity and screen-time recommendations on all seven days prior to interview, by sex and age, Table 6.5 Pedometer-measured physical activity levels, by sex and age, Table 6.6 Pedometer-measured physical activity levels, children and adults, by state or territory, viii Australian heart disease statistics 2015 National Heart Foundation of Australia

11 Trends in physical activity and sedentary behaviours Table 6.7 Trends in physical activity levels, adults, excluding walking for transport, by sex and age, 1995 to Figure 6.7a Trends in physical activity levels, men, 1995 to Figure 6.7b Trends in physical activity levels, women, 1995 to Table 6.8 Trends in number of times participated in sport and physical recreation as a player in the previous year, by sex and age, to Figure 6.8a Trends in number of times participated in sport and physical recreation as a player in the previous year, men and boys, to Figure 6.8b Trends in number of times participated in sport and physical recreation as a player in the previous year, women and girls, to Active transport Table 6.9 Method of travel to work on census day, employed persons, by sex, 2001 to Figure 6.9a Method of travel to work on census day, employed men, 2001 to Figure 6.9b Method of travel to work on census day, employed women, 2001 to Table 6.10 Average minutes per day spent in active transport, children, by age and sex, Physical activity levels in Aboriginal and Torres Strait Islander peoples Table 6.11 Physical activity levels in Aboriginal and Torres Strait Islander adults, by sex and age, Table 6.12 Prevalence of meeting recommendations for physical activity, Aboriginal and Torres Strait Islander adults, by sex and age, Chapter 7 Alcohol Levels of alcohol consumption Table 7.1 Prevalence of alcohol consumption patterns, people aged 12 years and over, by sex and age, Table 7.2 Trends in risky alcohol consumption, people aged 12 years and over, by sex and age, 2007 to Figure 7.2a Trends in risky alcohol consumption, men and boys aged 12 years and over, by age, 2007 to Figure 7.2b Trends in risky alcohol consumption, women and girls aged 12 years and over, by age, 2007 to Table 7.3 Prevalence of risky drinking and proportion who have never consumed alcohol, adolescents aged years, by sex and age, Figure 7.3 Proportion of adolescents who have never consumed alcohol, by sex and age, Alcohol consumption and heart disease Table 7.4 Prevalence of self-reported cardiovascular disease, adults, by sex, alcohol risk category and Indigenous status, Sociodemographic distribution of risky alcohol consumption Table 7.5 Prevalence of risky alcohol consumption, people aged 14 years and over, by sociodemographic characteristics, Trends in per capita consumption of alcohol Table 7.6 Trends in annual adult per capita consumption of alcohol, Australia, by type, to Figure 7.6 Trends in annual adult per capita consumption of alcohol, Australia, by type, to International comparisons Table 7.7 Trends in annual adult per capita consumption of alcohol, Australia and selected countries, 2000 to Alcohol consumption in Aboriginal and Torres Strait Islander peoples Table 7.8 Trends in prevalence of alcohol consumption patterns, Aboriginal and Torres Strait Islander adults, by sex and age, to National Heart Foundation of Australia Australian heart disease statistics 2015 ix

12 Part C Medical risk factors Chapter 8 Cholesterol Prevalence of self-reported high cholesterol Table 8.1 Prevalence of self-reported diagnosed high cholesterol, adults aged years, by sex, age and state or territory, Table 8.2 Trends in prevalence of self-reported diagnosed high cholesterol, adults aged years, by sex and age, 2010 to Figure 8.1a Prevalence of self-reported diagnosed high cholesterol, men aged years, by age and state or territory, Figure 8.1b Prevalence of self-reported diagnosed high cholesterol, women aged years, by age and state or territory, Prevalence of measured high cholesterol Table 8.3 Prevalence of abnormal measured lipid levels, adults, by sex and age, Sociodemographic distribution of high cholesterol Table 8.4 Prevalence of abnormal measured lipid levels, adults, by lipid type and sociodemographic characteristics, Figure 8.4a Prevalence of abnormal measured lipid levels, adults, by lipid type and Index of Relative Socioeconomic Disadvantage, Figure 8.4b Prevalence of abnormal measured lipid levels, adults, by lipid type and remoteness, Table 8.5 Prevalence of medicated and unmedicated dyslipidaemia, adults, by sex and age, International comparisons Table 8.6 Age-standardised prevalence of raised total cholesterol, adults, Australia and selected countries, by sex, Figure 8.6 Age-standardised prevalence of raised total cholesterol ( 5.0 mmol/l), adults, Australia and selected countries, by sex, Cholesterol in Aboriginal and Torres Strait Islander peoples Table 8.7 Prevalence of self-reported diagnosed high cholesterol, adults, by age or sex and Indigenous status, Chapter 9 Blood pressure Prevalence of self-reported high blood pressure Table 9.1 Prevalence of self-reported diagnosed high blood pressure, adults aged years, by sex, age and state or territory, Table 9.2 Trends in prevalence of self-reported diagnosed high blood pressure, adults aged years, by sex and age, 2010 to Figure 9.1a Prevalence of self-reported diagnosed high blood pressure, men aged years, by age and state or territory, Figure 9.1b Prevalence of self-reported diagnosed high blood pressure, women aged years, by age and state or territory, Prevalence of measured high blood pressure Table 9.3 Prevalence of measured high blood pressure, adults, by sex and age, Table 9.4 Trends in prevalence of measured high blood pressure, by sex and age, 1980 to Figure 9.4 Trends in prevalence of measured high blood pressure, adults aged years, by sex, 1980 to Sociodemographic distribution of high blood pressure Table 9.5 Prevalence of self-reported hypertension, by sex and sociodemographic characteristics, x Australian heart disease statistics 2015 National Heart Foundation of Australia

13 International comparisons Table 9.6 Prevalence of hypertension, adults, Australia and selected countries, by sex, Figure 9.6 Prevalence of hypertension, adults aged 25 years and over, Australia and selected countries, by sex, Blood pressure in Aboriginal and Torres Strait Islander peoples Table 9.7 Trends in prevalence of self-reported diagnosed high blood pressure, Aboriginal and Torres Strait Islander peoples, by remoteness, 2001 to Table 9.8 Prevalence of measured blood pressure categories, adults, by sex, age and Indigenous status, Chapter 10 Overweight and obesity Prevalence of overweight and obesity Table 10.1 Prevalence of weight status categories, by sex and age, Figure 10.1 Prevalence of overweight and obesity, by age, Table 10.2 Trends in prevalence of overweight and obesity, adults, by sex and age, 1980 to Figure 10.2 Trends in prevalence of overweight and obesity, adults, by sex, 1980 to Sociodemographic distribution of overweight and obesity Table 10.3 Prevalence of overweight and obesity, children and adults, by sex and quintile of socioeconomic status, Figure 10.3a Prevalence of overweight and obesity, adults aged 18 years and over, by sex and socioeconomic status, Figure 10.3b Prevalence of overweight and obesity, children aged 2 17 years, by sex and socioeconomic status, Table 10.4 Prevalence of overweight and obesity, adults, by decile of equivalised household income and sex, Figure 10.4 Prevalence of overweight and obesity, adults, by decile of equivalised household income, Table 10.5 Prevalence of BMI categories, adults, by sex and ASGS remoteness area categories, Figure 10.5 Prevalence of BMI categories, adults, by sex and ASGS remoteness area categories, Overweight and chronic disease Table 10.6 Prevalence of self-reported chronic disease, adults, by sex and BMI category, Table 10.7 Prevalence of clinical risk factors for chronic disease, adults, by sex and BMI category, International comparisons Table 10.8 Prevalence of overweight and obesity in adults aged 20 years and over, Australia and selected countries, by sex, Overweight and obesity in Aboriginal and Torres Strait Islander peoples Table 10.9 Prevalence of overweight and obesity, adults, by sex, age and Indigenous status, and Figure 10.9a Prevalence of overweight and obesity, Aboriginal and Torres Strait Islander men, by age, and Figure 10.9b Prevalence of overweight and obesity, Aboriginal and Torres Strait Islander women, by age, and Table Prevalence of overweight and obesity, children, by sex, age and Indigenous status, National Heart Foundation of Australia Australian heart disease statistics 2015 xi

14 Chapter 11 Diabetes Prevalence of diabetes Table 11.1 Prevalence of self-reported diagnosed diabetes, by type and age then sex, and Figure 11.1 Prevalence of self-reported diagnosed diabetes (total), by age, and Table 11.2 Trends in prevalence of self-reported diagnosed diabetes, by sex, to Figure 11.2 Trends in prevalence of self-reported diagnosed diabetes, by sex, to Table 11.3 Prevalence of biomarkers for diabetes, by age or sex, Figure 11.3a Prevalence of diabetes according to measured fasting plasma glucose level, by age, Figure 11.3b Prevalence of diabetes according to measured HbA1c level, by age, Incidence of diabetes Table 11.4 Incidence (number and rate) of insulin-treated diabetes, by type, sex and state or territory, 2000 to 2009 (pooled) Figure 11.4a Age-standardised incidence of insulin-treated type 1 diabetes per 100,000 population, by state or territory, 2000 to Figure 11.4b Age-standardised incidence of insulin-treated type 2 diabetes per 100,000 population, by state or territory, 2000 to Table 11.5 Trends in incidence (number and rate) of insulin-treated diabetes, by type and sex, 2000 to Table 11.6 Trends in incidence of type 1 diabetes by state or territory of usual residence, children, 2000 to Table 11.7 Annual incidence of diabetes according to baseline glucose tolerance and baseline weight status, by sex, Table 11.8 Proportion of persons with diabetes who have taken insulin in past two weeks, by age then sex, to Figure 11.8 Proportion of persons with diabetes who have taken insulin in past two weeks, by age then sex, to Diabetes in Aboriginal and Torres Strait Islander peoples Table 11.9 Prevalence of diabetes, by Indigenous status and age, then sex, Table Incidence of insulin-treated type 2 diabetes by sex and population characteristics, Australia, Chapter 12 Mental health Prevalence of mental disorders Table 12.1 Prevalence of 12-month mental disorders, by sex, age and disorder group, Table 12.2 Prevalence of 12-month mental disorders, by specific type of disorder and sex, Figure 12.2 Prevalence of 12-month mental disorders by specific type of disorder and sex, Prevalence of psychological distress Table 12.3 Trends in prevalence of psychological distress, adults, by sex, age and severity of distress, 2001 to Figure 12.3a Trends in prevalence of psychological distress, men, by age, 2001 to Figure 12.3b Trends in prevalence of psychological distress, women, by age, 2001 to Mental health in Aboriginal and Torres Strait Islander peoples Table 12.4 Prevalence of self-reported mood disorders, Aboriginal and Torres Strait Islander peoples, by sex and age, Table 12.5 Prevalence of psychological distress among Aboriginal and Torres Strait Islander adults, by sex and age, 2008 and xii Australian heart disease statistics 2015 National Heart Foundation of Australia

15 Preface Solid progress, but the job is far from done The Heart Foundation s second annual compendium of Australian heart disease statistics presents a series of data simultaneously worthy of celebration and a cause for serious concern. Our project partners at Deakin University have worked diligently to present data from a range of leading sources that present a compelling story about heart disease in Australia. The Heart Foundation was founded 57 years ago to coordinate and correlate efforts in the causes, diagnosis, prevention and treatment of diseases of the heart with a view to reducing deaths from heart disease in Australia. The data presented in this compendium provide a detailed snapshot of heart and related diseases in contemporary Australia. Particularly encouraging is the continued and significant decrease in deaths from heart disease in recent decades. Since the 1970s, mortality from heart disease has decreased by 70% in Australia. Nearly half of this is due to lifestyle changes and the increased use and development of medications to treat risk factors such as high blood pressure and cholesterol, and the rest is due to better treatment of acute heart attacks, strokes and other heart problems in the health system. All of these have come about, to a greater or lesser extent, as a consequence of the Heart Foundation s leadership and investment in research and advocacy for the prevention and better treatment of heart disease. Although there are successes to celebrate, we cannot rest on our laurels. Even more lives would have been saved over the last few decades were it not for adverse trends in some risk factors, especially obesity and its consequences, such as diabetes. Heart disease continues to result in more Australian deaths than any other single cause for both men and women. It remains the leading cause of death for Aboriginal and Torres Strait Islander peoples, who experience death rates 2.5 times higher than the rest of the population. It continues to place a heavy burden on our already stretched health system, with cardiovascular disease demanding the highest expenditure for any individual disease group at $7.7 billion in , and $1.6 billion paid in Pharmaceutical Benefit Schedule (PBS) benefits for cardiovascular system medicines in alone. Despite heart disease being largely preventable through simple lifestyle modifications, most Australians continue to engage in either sedentary behaviour or low levels of physical activity. Rates of obesity among Australian adults have almost tripled in the last two decades. Our ageing community and the success in treating previously fatal heart conditions means that although fewer people are dying from heart disease at a young age, more people than ever before are living with heart diseases, particularly heart failure, heart rhythm disturbances and atrial fibrillation, which is a major cause of stroke and eventually dementia, much of which is vascular in origin. The economic modelling figures found in the supplement to this compendium, Australian heart disease statistics: Overweight, obesity and cardiovascular disease past, present and future, also paint a grim picture of Australia s future heart health and present a resounding motive for urgent action. Illustrating the devastating impact of continuing the status quo, the number of obese Australian adults is expected to double to 41% of the population by , while cardiovascular disease and type 2 diabetes are estimated to cost the government $58 billion in expenditure on health services if recent trends continue. This compendium and its supplement bring us face to face with the reality of heart disease in Australia and we cannot continue to overlook the story these alarming figures repeatedly convey. The Heart Foundation has driven a great deal of change over the past few decades. But we can only do so much. Governments must also play their part. For too long, the narrative has been ignored, and heart disease remains a national priority in name only. The development and application of a nationally funded action plan to drive improved prevention, treatment and research is needed and needed now. Investment will pay big dividends. It has the potential to save countless lives, improve national productivity and ease the pressure on our hard-pressed hospitals. While we have made huge strides in tackling the burden of heart disease in Australia, the battle is far from won. Our strategy will continue to target inequalities where they exist, support an improved quality of life for those living with heart disease, and build on this work by tackling the root causes of heart disease through funding innovative research. However, we need to see strong government, industry and community leadership, and lasting change that can help all Australians lead longer, healthier and more productive lives. Professor Garry Jennings AO CEO National, Heart Foundation National Heart Foundation of Australia Australian heart disease statistics 2015 xiii

16 Acknowledgements This compendium, although primarily the work of the authors, would not have happened without contributions from the HeartStats Executive Committee and Heart Foundation staff. The HeartStats Executive Committee provided strategic oversight, advice and support for the compendium. In addition to the compendium authors, the committee included: Professor Lee Astheimer, Deputy Vice-Chancellor (Research), Deakin University Professor Rachel Davey, Director, Centre for Research and Action in Public Health, University of Canberra Associate Professor John Goss, Centre for Research and Action in Public Health, University of Canberra Mr Bill Stavreski, National Director Data and Evaluation, Heart Foundation. The following people also provided valuable contributions to this project, either by supporting the Executive Committee or during the production of the compendium: Mr Rohan Greenland, National Director Government Relations, Heart Foundation Ms Leonie Scott, General Manager, Health Outcomes, Heart Foundation Mr Kevin Pyle, National Publications and Content Editor, Heart Foundation. The HeartStats team gratefully acknowledges all individuals and organisations involved in collecting and managing the various datasets referenced in this compendium. xiv Australian heart disease statistics 2015 National Heart Foundation of Australia

17 Summary of key findings Cardiovascular disease was responsible for 43,602 deaths in Australia in 2013, including 19,765 deaths from ischaemic heart disease. Ischaemic heart disease resulted in more Australian deaths than any other single cause for both men and women. Ischaemic heart disease was the leading cause of death for Aboriginal and Torres Strait Islander peoples in all states and territories, with death rates up to two and a half times higher than the rest of the population. Of all Australians aged years, 8.8% reported living with heart, stroke or vascular disease and prevalence increases with age. The self-reported rate of heart, stroke or vascular disease was 17.1% among those aged years, 26.0% among those aged and 39.5% among those aged 85 years and over. Of Aboriginal and Torres Strait Islander peoples aged 55 years and over, 19.5% reported having been diagnosed with heart, stroke or vascular disease. In 2011, the incidence of heart attack (acute myocardial infarction) was two and a half times higher in Aboriginal and Torres Strait Islander peoples than non-indigenous Australians. The Pharmaceutical Benefits Scheme (PBS) paid approximately $558 million for cardiovascular system medicines in , which represented 31% of all PBS benefits paid in that year. In , about $1.6 billion was paid for cardiovascular system medicines, representing just 17% of total PBS benefits paid in that year. Of Australians aged over 12 years in 2013, 12% reported being daily smokers, 23% were former smokers and 61% were never smokers. In all age groups, smoking rates were higher in men and boys than women and girls. Smoking rates among Aboriginal and Torres Strait Islander peoples were more than double those among non-indigenous Australians. However, smoking rates among Aboriginal and Torres Strait Islander peoples have decreased substantially in the past decade (down from 49% in 2002 to 42% in ). Only 8% of men and boys consumed enough fruit and vegetables to meet National Health and Medical Research Council (NHMRC) guidelines, while 9.6% of women and girls did. The prevalence of meeting recommendations was much higher in children under age 12 years than in any age group from 12 years onward. Among secondary students, 38% of boys and 22% of girls consumed four or more cups of sugar-sweetened drinks per week. Forty-nine per cent of boys and 36.4% of girls reported consuming fast food at least once per week. Most Australians (58%) were either sedentary or engaged in low levels of physical activity. This was higher in women (62%) than in men (53%). Adults spent an average of 38.9 hours per week in sedentary behaviour. Children spent an average of 2.3 hours per day engaged in screen-based activity and 1.5 hours per day engaged in physical activity. Only 30% of children met physical activity recommendations, and only 10% met both physical activity and screen-time recommendations. Meeting recommendations for both physical activity and screen-time was slightly more common in boys (11%) than in girls (10%). Since 2007, the prevalence of risky alcohol consumption fell among all people aged years. Risky consumption remained stable in people aged 40 years and over. An increasing proportion of Australians identified as abstainers between 2007 and Of adults between ages 30 and 65 years, 33% reported having been diagnosed with high cholesterol. Of adults between ages 30 and 65 years, 32% reported having been diagnosed with high blood pressure. Rates were somewhat higher in men than in women (36% versus 28%, respectively). One in four Aboriginal and Torres Strait Islander peoples had high measured blood pressure, while one in five non-indigenous Australians had high measured blood pressure. More than two-thirds of men were classified as overweight or obese in , as were 56% of women. One-quarter of children aged 2 17 years were classified as overweight or obese. The measured prevalence of diabetes among Australian adults was more than 5%, while blood glucose and HbA1c levels showed a further 3 5% of people were at increased risk of diabetes. The prevalence of mental disorders in 2007 was 17.6% in men and 22.3% in women, with an overall prevalence of 20%. National Heart Foundation of Australia Australian heart disease statistics 2015 xv

18 xvi Australian heart disease statistics 2015 National Heart Foundation of Australia

19 Introduction Australian heart disease statistics 2015 is the second edition in a series of annual updates produced for the National Heart Foundation of Australia by the Heart Foundation/Deakin University Heart Disease Statistics Project. The reports will contain regularly updated relevant statistics about heart disease and associated risk factors for Australians. The aim of Australian heart disease statistics 2015 is to document the current and recent burden of heart disease in Australia, including risk factors and comorbidities, and present the statistics in a manner that is both informative and accessible to a range of audiences. The report is designed to be useful to health professionals, policy makers, health and medical researchers and others with an interest in the heart health and wellbeing of the Australian population. The report is divided into three parts and 12 chapters. Part A is made up of three chapters that provide an overview of the key issues directly related to heart disease in Australia: mortality, morbidity and treatment. Part B contains four chapters that focus on the key behavioural factors associated with heart disease: smoking, diet, physical activity and alcohol. Finally, part C contains five chapters that cover medical risk factors associated with heart disease. These include three clinical risk factors, cholesterol, blood pressure and obesity, and two major comorbid risk factors, diabetes and mental health. Each chapter provides a brief introduction to the topic and its relevance to heart disease, and a summary of the key facts contained in the chapter. Then follow tables and figures that illustrate in more detail the patterns and trends in the topic. The scope of this report covers the topics described above in relation to heart disease (and specifically, to coronary or ischaemic heart disease) in Australia. In some cases, statistics relating to cardiovascular diseases as a whole, or to other conditions (e.g. stroke, common cancers) have been presented for comparison; however, these are not the primary focus of the publication. The data sources included have been selected in order to strike a balance between high-quality, informative, upto-date and comparable data sources, both over time and between geographic regions. To present a current picture of heart disease in Australia, primarily data sets that were updated in the past 10 years have generally been included; however, some older data have been added to more recent statistics in order to provide historical comparisons and trends over time. The data in this report have been drawn from a wide range of Australian and international sources, including major data collections by Commonwealth and state government departments and agencies and nongovernment organisations, as well as some national, international and state-based surveys. Every effort has been made to ensure that the data are presented accurately and that major limitations or caveats to interpretation are highlighted; however the original sources should be consulted for further information. In preparation for this series of reports, a wide-ranging audit of available data sources was conducted. The results of that process highlighted some limitations in the data available in Australia to monitor heart disease and its risk factors. The best data availability was found for mortality, with frequently updated and very high coverage of age-, sex- and cause-specific death rates along with sociodemographic variables. Treatment data, including hospital statistics and prescription medicines, were found to have similarly high coverage. Australian hospital statistics provide a complete picture of all episodes of care in both public and private hospitals. Conversely, a major limitation to the data available for most risk factors is the lack of ongoing monitoring or surveillance, leading to a reliance on one-off or ad hoc surveys, and a lack of clarity around time trends in behaviours and biomedical risk factors. Further, there is variability in the data collection methods, indicators used and geographic coverage among many of these surveys. Surveys of physical activity and mental health in particular use a wide range of questions and scales to describe population characteristics, and comparability of estimates may be limited. The purpose of this report is to present the best and most up-to-date data in a clear and factual manner. Where possible and appropriate, data have been presented according to sex, age group, state or territory, and other sociodemographic groupings. This format allows some comparisons among groups; however, no statistical tests have been applied to these data. Thus differences, especially small differences, may be an artefact of the study sampling or design, and should be interpreted with caution. Print copies of this report can be obtained by contacting the Heart Foundation Research Program on (03) or ing research@heartfoundation.org.au. Electronic copies are available for download from the Heart Foundation website at National Heart Foundation of Australia Australian heart disease statistics