Mental health conditions and substance use disorders a leading cause of disease burden in 2023

Cancer remains the leading cause of ill-health and premature death among Australians, according to a report released by the Australian Institute of Health and Welfare (AIHW).

The Australian Burden of Disease Study 2023 also shows mental health conditions and substance use disorders is now the second biggest group of diseases causing illness and premature death among Australians, ahead of musculoskeletal disorders and cardiovascular diseases.  

The burden of disease study estimates the millions of years of healthy life Australians lose because of injury, illness or premature death. Disability-adjusted life years (DALY) are used to calculate the impact of living with poor health (the non-fatal burden of disease) and dying prematurely (fatal burden).

‘In 2023, Australians lost an estimated 5.6 million years of healthy life due to living with disease (54%) and dying prematurely (46%),’ said AIHW spokesperson Michelle Gourley.

‘Adjusted for population ageing, there was an 11% decline in the rate of total disease burden between 2003 and 2023. This was driven by a 27% decrease in the rate of fatal burden, as the non-fatal burden rate increased by 6.3%. 

‘Australians are, on average, living longer and spending more years in full health (meaning no disease or injury). 

‘However, years lived in ill health are also growing, resulting in little change in the proportion of life spent in full health and contributing to growing demands on the health system and other services.’

As in previous years, cancer was the leading cause of disease burden (17% in 2023), with 91.4% of this burden fatal and 8.6% non-fatal. 

‘Due to the availability of new data, we were able to estimate that mental health conditions and substance use disorders were the second-leading disease group causing total burden in 2023 (15%) and the leading disease group causing non-fatal burden (26%), which is higher than previous estimates,’ Ms Gourley said. 

‘The disease burden from mental health conditions and substance use disorders was 1.7% fatal and 98.3% non-fatal. 

‘Anxiety disorders, depressive disorders and bipolar disorder accounted for over half (54%) of the burden in this disease group. Alcohol use and substance use disorders accounted for a further 14%. Disease burden due to anxiety disorders increased by 33% between 2003 and 2023 (from 3.0% to 3.9% of total burden).’

In addition to cancer and mental health conditions and substance use disorders, the 5 leading disease groups causing burden in 2023 included musculoskeletal conditions (13%), cardiovascular diseases (12%) and neurological conditions (8%).

Mental health conditions and substance use disorders dominated the first half of the life course as a leading cause of disease among Australians aged 5-44 years. Musculoskeletal conditions, cardiovascular diseases and cancer featured more prominently among Australians aged 45 and over.

The 5 leading individual causes of disease burden in 2023 were coronary heart disease (5.4%), dementia (4.4%), back pain and problems (4.3%), anxiety disorders (3.9%) and chronic obstructive pulmonary disease (3.6%).

COVID‑19 ranked 30th among the specific diseases causing burden in 2023, accounting for 0.9% of total burden and 1.5% of all fatal burden. The burden from COVID‑19 was predominantly fatal (83%). Given the dynamic and ongoing nature of the COVID 19 pandemic, these estimates may be revised in the future as more data become available for the latter part of 2023. 

Overall and for most age groups, males experienced more total burden than females. This was driven by males having higher rates of fatal burden. The leading causes of burden also differed for males and females.

In 2023, the leading causes of total burden among males were coronary heart disease, back pain and problems, and suicide and self-inflicted injuries. Among females, the leading cause was dementia, followed by anxiety disorders, and back pain and problems.

Suicide and self-inflicted injuries was the leading cause of disease burden in males aged 15 to 34 years, while anxiety disorders was the leading cause of burden in females of the same age. Lung cancer featured in the top 5 causes of disease burden for males aged 45 and over while breast cancer was the third leading cause of burden among women aged 45 to 64 years. Dementia was the leading cause of disease burden for males and females aged 85 and over.

Burden of disease is the gold standard approach for measuring the impact of illness, injury and death. Information on burden of disease and injuries is important for monitoring population health and provides an evidence base to inform health policy and service planning. 

The Australian Bureau of Statistics will release the National Health Survey 2022: First Results on Friday 15 December, including information on health behaviours, conditions prevalence and risk factors in Australia.

Note: mental health conditions and substance use disorders have historically been grouped together in Australian and global burden of disease studies. In the future, they may be reported separately in Australia. 

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