Quality of life / burden of disease

The First Nations Burden of Disease Study 2022:

• Respiratory diseases were respnsible for 7.8% of total disease burden
• Asthma was the 7th leading cause of disease burden in First nations people with9,651 DALY or 3.1% of the total burden (11th leading cause when age standardised), up from 8th leading cause in 2018
• Asthma was the 10th leading cause in males (11th when age-standardised) representing 1.4% of total burden
• Asthma was the 5th leading cause in females (8th when age-standardised) representing 1.7% of total burden

The DALY rate is particularly high for females 40-60 years of age (see graphs below)

According to self-reported data from the NHS 2022, amongst people with asthma aged 18 and over:
– 19% reported that asthma interfered with daily activities 2 or more times in the past 4 weeks (vs 23% in 2017-18), including going to school or work, playing with friends, exercising, getting around places etc.
– 8.8% experienced very high level of psychological distress in the past 4 weeks compared to 11% in 2017-18
– 9.4% considered themselves to be in poor health compared to 7.6% in 2017-18.

Information from the burden of Disease study 2024:(ref 1)

In 2024, Asthma was the 10th leading contributor to the total burden of disease in Australia with a disability-adjusted life years (DALY) rate of 5.35 per 1,000 population (143,782 DALY, crude number), similar to 2023
– After adjustment for age structure, asthma was the 8th leading cause of total burden, with an age-standardised DALY rate of 5.3 DALY per 1,000, similar to 2023 (8th) but up from 9th in 2018 and 2015, and 10th in 2011 and 2003, with an increase by 8.5% in the last 21 years (from 4.9 per 1,000 in 2003; 4.4 in 2011; 5.0 in 2015; 5.2 in 2018; 5.3 in 2023 and 5.3 in 2024)
– 5.7% of the total asthma burden was fatal, 94.3% was non-fatal

By gender:
– Asthma ranked 6th in females of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 5.7 DALY per 1,000, up from 7th in 2018 and a 4.3% increase since 2003, but unchanged compared to 2023
– Asthma ranked 10th in males of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 4.9 DALY per 1,000, down from 9th in 2018 and a 13.5% increase since 2003, but unchanged compared to 2023

By age groups (age-specific DALY per 1,000), asthma ranked as leading cause of total burden of disease:
– Under 5 year-olds (0-4): 5th in females ( accounting for 2.9% of total burden) and in males (3.4% of total burden)
– under 1 year-olds: ranking 25th overall (24th in males, not in top 25 for females)
– 1-4 year-olds: ranking 1st in boys, girls and overall
– 5-9 year-olds: 1st in females, 2nd in males after Autism spectrum disorder, ranking 1st overall
– 10-14 year-olds: 2nd in females, 2nd in males and 2nd overall
– 5-14 year olds: 1st in females (accounting for 10.7% of burden) and 2nd in males (accounting for 12.8% of burden)
– 15-19 year-olds: 6th in females, 5th in males, 4th overall
– 20-24 year-olds: 5th in females, 8th in males, 6th overall
– 25-44 year olds: 4th in females (accounting for 4.7% of burden), not in the top 5 for males
For asthma burden for other age groups, see Fig 3.4 (Rank by number) on AIHW web report.

Note: to compare epidemiological data, it is usually preferred to use age-standardised statistics to ensure the differences are not caused by variations in age structure and an ageing population, unless the data is for specific age ranges in which case “crude” age-specific statistics are used.

Figure 3.5: Disease- or injury-specific summary of disease burden in Australia: Asthma

Risk factors attributable burden of asthma: it was estimated that in 2024
– 36% of asthma total burden was due/attributed to all risk factors combined
– 24% was due/attributed to being overweight (including obesity)
– 7% was due/attributed to tobacco use
– 5% was due/attributed to occupational exposures and hazards
Air pollution, although not directly linked to asthma burden, was linked to other respiratory conditions and was estimated to contribute 7.5% to the burden of Chronic Obstructive Pulmonary Disease.

Additional information reported in AIHW Asthma webpage: (ref 2)

In 2024, asthma accounted for:

• 2.5% of total disease burden (DALY), 4.3% of non-fatal burden (YLD) and 0.3% of fatal burden (YLL)
• within the respiratory disease group, it accounted for 35% of total disease burden, 51% of non-fatal burden and 5.3% of fatal burden

The rate of burden from asthma was higher in females vs males (1.2 times higher with 5.8 vs 4.9 DALY per 100,000 population)

Trends over time:

The age-adjusted rate of burden due to asthma increased between 2003 and 2024 from 4.9 to 5.3 DALY per 100,000. The increase was driven by non-fatal burden.

Age-standardised DALY rates due to asthma, 2003 to 2024:

People with asthma are more likely to report a poor quality of life. This is more pronounced among people with severe or poorly controlled asthma.

In 2023, Asthma was the 10th leading contributor to the total burden of disease in Australia with a disability-adjusted life years (DALY) rate of 5.34 per 1,000 population (141,621 DALY, crude number).
– After adjustement for age structure, asthma was the 8th leading cause of total burden, with an age-standardised DALY rate of 5.3 DALY per 1,000, up from 9th in 2018 and 2015, and 10th in 2011 and 2003, an increase by 8.4% in the last 20 years (from 4.9 per 1,000 in 2003; 4.4 in 2011; 5.0 in 2015; 5.2 in 2018 and 5.3 in 2023)
– 5.7% of the total asthma burden was fatal, 94.3% was non-fatal

By gender:
– Asthma ranked 6th in females of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 5.7 DALY per 1,000, up from 7th in 2018 and a 4.1% increase since 2003
– Asthma ranked 10th in males of all ages for total burden (after adjusting for age) with an age-standardised DALY rate of 4.9 DALY per 1,000, down from 9th in 2018 and a 13.8% increase since 2003

By age groups (age-specific DALY per 1,000), asthma ranked as leading cause of total burden of disease:
– Under 5 year-olds (0-4): 5th in females ( accounting for 3% of total burden) and in males (3.5% of total burden), ranking 5th overall — however, ranking 1st in boys, girls and overall for the age group 1-4
– 5-14 year-olds: 1st in females (11.1% of total burden) and 2nd in males (12.8% of total burden) after Autism spectrum disorder, ranking 1st overall
– 15-24 year-olds: 5th in females (5.1% of total burden) and in males (4.7% of total burden), ranking 4th overall
– 25-44 year-olds: 4th in females (4.7% of total burden) and 9th in males (5th overall)
– In 45-64 year-olds: 8th in females and 15th in males (12th overall)
– In 65-84 year-olds: 17th in females and beyond 20th in males (20th overall)
– In 85 year-olds and older: beyond 20th for females, males and overall

Note: to compare epidemiological data, it is usually preferred to use age-standardised statistics to ensure the differences are not caused by variations in age structure and an ageing population, unless the data is for specific age ranges in which case “crude” age-specific statistics are used.

AIHW report providing summary of epidemiological data in First Nations peoples with asthma (prevalence, risk factors, quality of life, burden of disease, mortality, hospitalisations, ED). This report provides a nice summary and a single reference.

Prevalence (2018-2019 National Aboriginal and Torres Strait Islander Health survey (NATSIHS):
– Around 128,000 First Nations people reported having asthma (16%), down from 18% in 2012-13, making asthma the third most prevalent long-term condition reported in 2018-19.
– higher in females (18%) compared to males (13%)
– increased with age, from 12% in children aged 0–14 to 26% in those aged 55 and over
– 1.6 times as high for boys compared with girls (aged 0–14) (14% and 8.6%, respectively)
– 2.1 times as high for females compared with males aged 55 and over (34% and 16%, respectively)
– 1.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (18% and 11% age-standardised prevalence respectively)
– Prevalence decreased with increasing remoteness: 19% in Major Cities, 12% in Remote areas and 7% in Very remote areas
– Prevalence by states: 25% in ACT, 23% in SA, 22% in TAS, 19% in NSW, 18% in VIC, 14% in QLD, 13% in WA, 6% in NT

Hospitalisation rates (2021-2022):
– 1,800 hospitalisations with asthma as principal diagnosis in 2021-22 (Covid pandemic year), an hospitalisation rate of 200 per 100,000; a decrease by 30% compared to 2018-19 (non Covid-pandemic year; 290 per 100,000)
– highest for females aged 45–54 (469 per 100,000) and higher for females overall compared to males (250 vs 155 per 100,000)
– 1.8 times higher for boys compared to girls aged 0-14 (318 vs 173 per 100,000)
– 2.1 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (205 vs 100 per 100,000, age-adjusted)

Emergency Departments visits (2021-2022 Non-admitted Patient Emergency Department Care database):
– 5,400 ED presentations for asthma in 2021-22 (605 per 100,000 population, decreased by 14% compared to 700 per 100,000 in 2018-19)
– Highest for females 35-44 (1,063 per 100,000) then females 45-54 (1,014 per 100,000) then boys 0-14 (883 per 100,000)
– 1.6 times higher in boys vs gilrs aged 0-14 (883 vs 558 per 100,000)
– 1.4 times higher in females vs males overall (about 710 vs 500 per 100,000)
– 2.6 times higher in First Nations people compared to non-Indigenous Australians after adjusting for age structure (about 600 vs 230 per 100,000; age-standardised)

Mortality (2017-2021):
– 65 deaths over the 5 years, corresponding to a mortality rate of 1.7 deaths per 100,000 population (decreasing from 2.1 per 100,000 in 2015-2019)
– Mortality rate increases with age and is 1.6 times higher in females
– Mortality rates adjusted for age structure are 1.9 times higher in First Nations people compared to non-Indigenous Australians

Burden of Disease (Australian Burden of Disease Study 2018):
– 7th leading cause of disease burden in First Nations people, contributing 3.4% to the total burden
– Burden of asthma is greater in females (4.3%) compared to males (2.5%)
– 4th leading cause of non-fatal disease burden (5.7% of total non-fatal burden)

Risk factors for First Nations people with asthma compared to those without asthma (2018–2019 NATSIHS):
– Similar likelihood to be a current daily smoker (43% vs 40%)
– More likely to be insufficiently active (93% vs 87%)
– 1.3 times more likely to live with obesity (55% vs 43%)

Quality of life (2018–2019 NATSIHS) for adult First nations people with asthma compared to those without asthma:
– 2.5 times more likely to have poor health (18% vs 7.2%)
– 1.5 times more likely to experience high or very high levels of psychological distress (42% vs 28%)
– 62% had at least one other chronic condition – the top 3 comorbidities were arthritis (51%), mental and behavioural conditions (46%), and back problems (37%)

Asthma Management in First Nations people with asthma (2018–2019 NATSIHS):
– 56% reported using asthma medication within the last 2 weeks
– 32% had a written asthma action plan (32% of those in non-remote areas vs 27% of those in remote areas)

Asthma was the 8th leading contributor to the total burden of disease in Australia in 2022, with a disability-adjusted life years (DALY) age-standardised rate of 5.2 per 1,000 population (138,048 DALY) compared to 9th in 2018 and 10th in 2003. This represents a 7.8% change since 2003. In, 2022, 5.9% of the asthma burden was fatal (8,087 years of life lost), and 94.1% was non-fatal (129,954 years lived with disability). Asthma contributed 2.5% to the total burden in Australia.

By sex and age groups, asthma ranked (age-specific DALY rates):
– 5th leading cause of total burden for children under 5 boys (3.5% of total burden) and girls (3.0% of total burden)
– 1st leading cause of total burden in children 5-14 for boys (14.2% contribution) and girls (11.7% contribution)
– 5th leading cause for boys (4.9% contribution) and 4th leading cause for girls (6.2% contribution) aged 15-24
– 4th leading cause for girls aged 25-44 (4.9% contribution)

Cohort study of people aged up to 18 years old hospitalised for asthma during 2005-2018 in NSW, Australia, looking at school performance.
Findings:

• young males hospitalised with asthma had a 13% and 15% higher risk of not achieving the national minimum standard for numeracy and reading respectively, a 51% higher risk of not completing year 10, and around 20% higher risk of not completing year 11 or 12, compared to peers.
• Young females with asthma presented no difference in achieving national minimum standard in numeracy and reading, but a 21% higher risk of not completing year 11 and a 33% higher risk of not completing year 12.

Conclusions: Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students.

Asthma was the 9th leading contributor to the total burden of disease in Australia in 2018, with a disability-adjusted life years (DALY) rate of 5.2 per 1,000 population, compared to 10th in 2003. Asthma was the 4th leading cause of non-fatal disease burden in 2018 (from 5th in 2003). The equivalent of 130,886 years of healthy life were lost due to asthma in 2018, including 123,315 of these due to years lived with a disability.

Asthma was the leading cause of total burden in children aged 5-14, contributing to 14% and 11% of the total burden in boys and girls, respectively. It was the leading cause of non-fatal burden for children aged under 5.

By age groups, asthma’s total burden of disease ranked: 5th in children aged under 5; 1st in all children aged 5-14 (1st in males and 2nd in females); 5th in males and 4th in females aged 15-24; 8th in males and 4th in females aged 25-44; 10th in males and 6th in females aged 45-54; 10th in females aged 55-64; higher than 10th in males aged over 54 and females aged over 64. (see Fig 2.6 and 2.7 for DALY rates and proportions)

By age groups, asthma’s non-fatal burden of disease ranked: 1st in children aged under 5; 1st in males and 2nd in females aged 5-14; 3rd in males and 4th in females aged 15-24; 6th in males and 4th in females aged 25-44; 5th in both males and females aged 45-54; 8th in males and 6th in females aged 55-64; 8th in females aged 65-74; higher than 10th in males aged over 64 and females aged over 74.

Asthma was the 10th leading cause of fatal burden in males and 7th in females aged 5-14.

Note that the report also contains data specific to states, remoteness and socioeconomic groups.

According to the Australian Burden of Disease Study 2018, asthma was, in First Nations people: (ref 1)
– 7th leading cause of disease burden in First Nations people, contributing 3.4% to the total burden (crude rate, NOT age-standardised)
– Burden of asthma was greater in females (4.3%) compared to males (2.5%)
– 4th leading cause of non-fatal disease burden (5.7% of total non-fatal burden)

Comment: Note important variation between age-standardised (below) and crude (above) burden of disease ranking for First Nations people, due to the differences in age structure between First Nations (younger population) and non-Indigenous Australians.

Key findings from the Australian Burden of Disease Study (ABDS) 2018 also include:
– Asthma ranked 11th in 2018 as leading specific cause of total burden (age-standardised, fatal and non-fatal burden) in First Nations people, compared to 17th in 2003 and 13th in 2011, an increase of 36.4% compared to 2003. (ref 2,3)
– In Aboriginal and Torres Strait Islander children aged 5-14 years old, asthma was the third leading cause of total burden of disease in 2018, contributing 8.7% to the total burden.(ref 4)
– the aged-standardised DALY (disability-adjusted life years) rate for asthma was 11.4 DALY per 1,000 people in 2018 compared to 8.3 in 2003 (ref 2)
– Asthma was the leading cause of respiratory disease burden among Aboriginal and Torres Strait Islander people aged under 45 in 2018 (contributing 80% of respiratory burden).(ref 4)
– Respiratory diseases contributed to 7% of total burden (DALY) in 2018 for both indigenous and non-indigenous Australians (ref 2)
– the gap in (all-cause) total burden has narrowed between indigenous and non-indigenous Australian between 2003 and 2018, with 49% of the burden of disease in indigenous Australian being preventable in 2018 (ref 2)
– gap: the contribution of asthma to total burden of disease in 2018 was 2.2 times higher for Aboriginal and Torres Strait Islander people compared to other Australians, with a difference of 6.3 years lost to premature death or living with an illness or injury. (ref 4)
– gap: asthma contributed 1.6% to the burden of disease difference between Aboriginal and Torres Strait Islander people and other Australian in males, and 4.1% in females in 2018. (ref 4)
– the risk factors contributing to the most (all-cause) burden of disease in 2018 were tobacco use (12%), alcohol use (10%), overweight (9.7%), illicit drug use (6.9%) and dietary factors (6.2%) (ref 2)

An Australian study to estimate the annual burden of mortality and the associated health costs attributable to air pollution from wood heaters in Armidale, a regional Australian city (population, 24 504) with high levels of air pollution in winter caused by domestic wood heaters, 1 May 2018 – 30 April 2019. The health impact (excess annual mortality and financial costs) was assessed based upon atmospheric PM2.5 measurements.
Results:
– 14 premature deaths/year (95% CI, 12–17 deaths), corresponding to 210 years of life lost (95% CI, 172–249) are attributable to long term exposure to wood heater PM2.5 pollution in Armidale.
– The estimated financial cost is $32.8 million (95% CI, $27.0–38.5 million), or $10 930 (95% CI, $9004–12 822) per wood heater per year.
Conclusions: The substantial mortality and financial cost attributable to wood heating in Armidale indicates that effective policies are needed to reduce wood heater pollution, including public education about the effects of wood smoke on health, subsidies that encourage residents to switch to less polluting home heating (perhaps as part of an economic recovery package), assistance for those affected by wood smoke from other people, and regulations that reduce wood heater use (eg, by not permitting new wood heaters and requiring existing units to be removed when houses are sold).

Research article in MJA, single study
Australian study by Dorothy Robinson. A Podcast is also available with the article where she discusses the study findings.

According to the Burden of Disease report, at least 3,000 deaths (equivalent to about 28,000 years of life lost) per year in Australia are attributable to air pollution.

Overweight and obesity is responsible for approximately 24% of the burden of disease due to asthma in 2015.

Self-reported GP visits in 2014-15, or other actions taken.

note: data is percentage (%)

Note: table 7 also contains information on:

• consultation with a specialist or other HCP
• asthma action plan
• time away from school, study or work
• hospital and ED visits
• interference with daily activities
• medication use by medications

Asthma was the 10th leading contributor to the overall burden of disease in Australia in 2015 (5th leading cause of non-fatal disease burden). The equivalent of 120,774 years of health life were lost due to asthma in 2015. 113,129 of these due to years lived with a disability and 7,645 due to premature death.
Asthma was the leading cause of burden of disease for people aged 5-14 years.

According to the National Health Survey 2017-2018, for adults aged 18 years and over with asthma, their self-assessed health was generally regarded more poorly when compared to the total population. Only one in ten (10.1%) people with asthma rated themselves as having excellent health, half that of the total population (20.2%).

In 2014/15
– 42.4% of children aged 0-14 had to take time of school due to their asthma.
– Asthma interfered with daily activities at least once in a four week period for 67.7% of Australians. This was highest for people aged 35-44 (76%)

People with asthma have the lowest overall health literacy according to a first-of-its-kind national health survey conducted by the Australian Bureau of Statistics (ABS). Alongside people with mental health and behaviour problems, those with asthma indicated they struggle more with managing their health and engaging with healthcare providers than those with other long-term health conditions.
Just 12.3 per cent of those with asthma said they were able to actively manage their own health, and only 5.4 per cent felt understood and supported by healthcare providers.

Experience of asthma in the Australian health system from first symptoms, diagnosis, treatment and future expectations, a qualitative study 2019:

Mixed method study of 100 people with asthma
Most participants had poorly controlled asthma (74%) (score of between 5 and 19)
Flare ups:
– Frequent flare-ups (n=36, 36.00%): having a flare-up or asthma attacks once a month or more frequently,
– Occasional flare-ups (n=41, 41.00%): those that had a flare-up once a month to once every three months,
– Infrequent flare-ups (n=23, 23.00%): those that had a flare-up once or twice a year,

Report includes sections on: symptoms and diagnosis, decision-making, treatment and health service provision, communication and information, care and support, quality of life and experience in the health system, and expectations.

Refer to section 5 for information on treatment and medications.

People with asthma are absent from work on average 2.1 days more per year than people without asthma.