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Latest release

Australian Health Survey: Biomedical Results for Chronic Diseases

Information on biomarkers of chronic disease, including prevalence rates for risk factors for cardiovascular disease, diabetes and kidney function

Reference period
2011 - 2012
Released
5/08/2013
Next release Unknown
First release

Key findings

Results in this publication contain information from the National Health Measures Survey (NHMS), the biomedical component of the 2011–13 Australian Health Survey (AHS). Around 11,000 respondents aged 5 years and over across Australia voluntarily provided blood and/or urine samples, which were tested for a range of chronic disease and nutrition biomarkers. This publication is the first release of information from the NHMS and focuses on the test results for chronic diseases, including:

  • Diabetes
  • Cardiovascular disease
  • Chronic kidney disease
  • Liver function
     

Refer to Appendix A for the full list of tests conducted.

Diabetes

  • In 2011–12, 5.1% of people aged 18 years and over had diabetes.
  • This comprised 4.2% with known diabetes and 0.9% with diabetes newly diagnosed by the blood test results. This suggests that there was approximately one newly diagnosed case of diabetes for every four diagnosed cases.
  • Men were more likely than women to have diabetes (6.3% compared with 3.9%). This was the case for both known diabetes and newly diagnosed diabetes.
  • A further 3.1% of Australian adults were identified by their test results to be at high risk of diabetes.
     

Cardiovascular disease

    • Around one in three Australian adults (32.8%) had high levels of total cholesterol according to their blood test results, yet only 10.1% of this group self-reported high cholesterol as a current health condition.
    • One in three Australian adults (33.2%) had high levels of LDL 'bad' cholesterol and 23.1% had lower than normal levels of HDL 'good' cholesterol.
    • In 2011–12, 13.9% of people aged 18 years and over had high triglycerides.
    • Three in every four adults (76.4%) aged 45 years and over had dyslipidaemia. That is, they were taking cholesterol-lowering medication or had one or more of high total cholesterol, low HDL cholesterol, high LDL cholesterol or high triglyceride levels based on their test results.
       

    Chronic kidney disease

      • In 2011–12, one in ten (10.0%) Australian adults had test results that showed signs of chronic kidney disease, with similar rates for men and women.
      • Around 4% of all adults were in Stage 1, 2.5% were in Stage 2 and less than 1% were in Stages 4–5.
         

      Liver function

      A range of factors, including fatty liver disease, infections and excessive alcohol consumption can prevent the liver from functioning properly. The NHMS included two tests for liver function: gamma glutamyl transferase (GGT) and alanine aminotransferase (ALT). These tests check the liver’s health and can detect liver damage.

      • In 2011–12, 11.0% of Australian adults had abnormal levels of ALT in their blood, with men more likely to have the condition than women (13.8% compared with 8.3%).
      • Around 2.1 million (or 12.4%) people aged 18 years and over were estimated to have abnormal levels of GGT.
         

      Exposure to tobacco smoke

        • In 2011–12, the pattern for cotinine exposure was very similar to that for self-reported smoking for most age groups.
        • 87.0% of current smokers aged 18 years and over had cotinine levels indicating exposure to tobacco smoke, compared with only 5.7% of those who were ex-smokers and 0.3% of those who had never smoked.
           

        Anaemia

          Anaemia is caused from a decrease in either the number of red blood cells in the body or the quantity of haemoglobin within red blood cells. When a person is anaemic, their heart has to work harder to ensure that muscles and organs get the oxygen they need.

          • In 2011–12, 4.5% of people aged 18 years and over had haemoglobin levels indicating a risk of anaemia, with women more likely to be at risk than men (6.4% compared with 2.5%).

          Diabetes

          Diabetes is a chronic condition where insulin, a hormone that controls blood glucose levels, is no longer produced or not produced in sufficient amounts by the body.¹ If left undiagnosed or poorly managed, diabetes can lead to coronary heart disease, stroke, kidney failure, limb amputations or blindness. In 2011, diabetes was the sixth leading cause of death in Australia.²

          The National Health Measures Survey (NHMS) provides an objective measurement of the number of people with diabetes in Australia. It included two tests to measure diabetes: a fasting plasma glucose test and a glycated haemoglobin test (commonly referred to as HbA1c).

          Fasting plasma glucose measures the level of sugar in the person's blood at the time of testing. Participants were required to fast for 8 hours prior to the test in order to get an accurate reading. HbA1c, on the other hand, measures what the person's average blood glucose level has been in the previous three months. Participants were not required to fast for this test. A set of cut-offs are used for each test to determine whether a person has diabetes or is at high risk of diabetes. The cut-offs used in the NHMS are shown below.

          Cut-offs for diabetes in the NHMS

           Fasting plasma glucose (mmol/L)(a)HbA1c (%)(b)
          Has diabetes≥7.0≥6.5
          At high risk of diabetes6.1 to <7.06.0 to <6.5
          No diabetes<6.1<6.0
          a. Based on World Health Organization cut-offs for fasting plasma glucose.
          b. An HbA1c level of greater than or equal to 6.5% is the WHO recommended cut-off point for diabetes.
           

          Endnotes

          1. Diabetes Australia, Sept 2011, What is Diabetes?, http://www.diabetesaustralia.com.au/en/Understanding-Diabetes/What-is-Diabetes, Last accessed 02/07/2013.
          2. Australian Bureau of Statistics, Mar 2013, Causes of Death Australia, ABS cat. no. 3303.0, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Chapter42011, Last accessed 02/07/2013.
          3. World Health Organization 2006, Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia, http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf, Last accessed 16/07/2013.
          4. World Health Organization 2011, Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus, http://www.who.int/diabetes/publications/report-hba1c_2011.pdf, Last accessed 16/07/2013.

          Measuring diabetes - definitions

          In the National Health Measures Survey (NHMS), two blood tests for diabetes were performed: fasting plasma glucose and glycated haemoglobin (commonly referred to as HbA1c). The tables available in the Data downloads section of this publication present diabetes prevalence rates for both tests, including a comparison of the two tests in table 3. However, as fasting plasma glucose is the current standard test for diabetes in Australia, the results presented in the publication commentary focus on fasting plasma glucose only.

          Read more

          Diabetes prevalence was derived using a combination of blood test results and self-reported information on diabetes diagnosis and medication use.

          A person was considered to have known diabetes if:

          • they had ever been told by a doctor or nurse that they have diabetes and they were taking diabetes medication (either insulin or tablets); OR
          • they had ever been told by a doctor or nurse that they have diabetes and their blood test result for fasting plasma glucose was greater than or equal to the cut off point for diabetes (that is, ≥7.0 mmol/L).
             

          Note: people who had been told by a doctor or nurse that they have diabetes, but who were not taking medication for diabetes and did not have a fasting plasma glucose level ≥7.0 mmol/L, were classified as not having diabetes.

          People with known diabetes were further classified as having Type I, Type II or Type unknown, based on the type of diabetes that a doctor or nurse told them they had. Women with gestational diabetes were excluded.

          • A person was considered to have newly diagnosed diabetes if they reported no prior diagnosis of diabetes but had a fasting plasma glucose value ≥7.0 mmol/L.
             

          Total persons with diabetes was defined as the total of known diabetes and newly diagnosed diabetes.

          • A person was considered to be at high risk of diabetes if they did not currently have diabetes, but had an impaired fasting plasma glucose result, that is, a fasting plasma glucose level ranging from 6.1 mmol/L to less than 7.0 mmol/L.¹
             

          The NHMS diabetes classification is outlined in Figure 1. More information on diabetes prevalence is presented in Tables 1, 2, 3, 8, 9, 11 and 15 in the Data downloads section of this publication.

          Information on diabetes prevalence using this same definition but based on HbA1c test results are also shown in Tables 1, 2, 3, 8, 9, 12 and 15. The relevant cut-offs for HbA1c are as follows:

          • Indicates diabetes: ≥6.5%
          • At high risk of diabetes: 6.0% to <6.5%
          • Does not indicate diabetes: <6.0%.
             

          Figure 1: 2011-12 NHMS diabetes classification

          Flow diagram showing the derivation of diabetes prevalence using combinations of blood test results and self-reported diabetes diagnosis and medication use.

          Figure 1: 2011-12 NHMS diabetes classification

          Flow diagram showing the derivation of diabetes prevalence using combinations of blood test results and self-reported diabetes diagnosis and medication use.
          There are five stages in the classification of diabetes.
          Stage 1: NHMS blood test.
          State 2: Diabetes test results. The results will either:
          • Indicate diabetes;
          • whether at high risk of diabetes; or
          • does not indicate diabetes.
          Stage 3: Doctor diagnoses. Defines whether the patient has been told or not told the results of the diabetes test
          Stage 4: Medication status. Defines whether those at risk of diabetes and those whose test did not indicate diabetes whether they are taking medication or not.
          Stage 5: NHMS diabetes classification containing the following:
          If the blood test indicates diabetes and the patient has previously been told/diagnosed then it is classified as known diabetes.
          If the blood test indicates diabetes and the patient has not previously been told/diagnosed then it is classified as newly diagnosed diabetes.
          If the blood test indicates a high risk of diabetes and the patient has previously been told/diagnosed, and they are taking medication it is classified as known diabetes.
          If the blood test indicates a high risk of diabetes and the patient has previously been told/diagnosed, and they are not taking medication it is classified as having a high risk of diabetes.
          If the blood test indicates a high risk of diabetes and the patient has not previously been told/diagnosed, it is classified as having a high risk of diabetes.
          If the blood test does not indicate diabetes and the patient has previously been told/diagnosed, and the patient is taking medication, it is classified as known diabetes
          If the blood test does not indicate diabetes and the patient has previously been told/diagnosed but they are not taking medication, it is classified as not having diabetes
          If the blood test does not indicate diabetes and the patient has not been told/diagnosed then it is classified as not having diabetes

          * Cut-offs for FPG: Indicates diabetes ≥7.0 mmol/L; At high risk of diabetes 6.1 to <7.0 mmol/L; Does not indicate diabetes <6.1 mmol/L.
          Cut-offs for HbA1c: Indicates diabetes ≥6.5%; At high risk of diabetes 6.0% to <6.5%; Does not indicate diabetes <6.0%.
           

          Endnotes

          1. World Health Organization 2006, Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia, http://www.who.int/diabetes/publications/Definition%20and%20diagnosis%20of%20diabetes_new.pdf, Last accessed 16/07/2013.

          Diabetes prevalence

          Diabetes prevalence was derived using a combination of blood test results and self-reported information on diabetes diagnosis and medication use. See the Measuring diabetes - definitions section for a detailed description.
           

          Data source and definitions

          Fasting plasma glucose is the current standard test for diabetes in Australia. The information on diabetes in the following sections is based on fasting plasma glucose results only. Information on diabetes prevalence using glycated haemoglobin (commonly referred to as HbA1c) test results is shown in Tables 1, 2, 3, 8, 9, 12 and 15 in the Data downloads section of this publication.

          In order to get an accurate reading for the fasting plasma glucose test, people were required to fast for 8 hours or more beforehand. The results presented here refer only to those people who did fast (approximately 79% of adults who participated in the National Health Measures Survey (NHMS)).

          In 2011–12, 5.1% of Australians aged 18 years and over had diabetes. This comprised 4.2% with known diabetes and 0.9% with diabetes newly diagnosed from their test results. This indicates that there was approximately one newly diagnosed case of diabetes for every four diagnosed cases. A further 3.1% of adults had impaired fasting plasma glucose results, which indicates that they were at high risk of diabetes. This means that there were an extra three people at high risk of diabetes for every four people who had been diagnosed.

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          There was an additional 1% of people aged 18 years and over who did not have abnormal fasting plasma glucose test results and who were not taking diabetes medication, but self-reported having ever been told by a doctor or nurse that they had diabetes. This group was classified as not having diabetes.

          Diabetes was more common for men than women in 2011–12 (6.3% compared with 3.9%). This was the case for both known diabetes (4.9% compared with 3.4%) and newly diagnosed diabetes (1.4% compared with 0.4%).

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          Overall, the prevalence of diabetes increased with age, with people aged 65–74 years having the highest rate (15.0%). Similarly, people aged between 55 and 74 years had the highest rates of newly diagnosed diabetes (2.3%). The proportion of people at high risk of diabetes also increased steadily with age, with the most 'high risk' group being those aged 75 years and over (7.5%).

          One of the main risk factors for developing diabetes is being overweight or obese.¹ Excess body weight can interfere with the body's production of, and resistance to, insulin.² In 2011–12, people who were obese had much higher rates of diabetes (11.2%) than those who were overweight (4.1%) or normal weight or underweight (1.6%). A similar pattern was also evident for those at high risk of diabetes, with 5.8% of obese people being at high risk of diabetes compared with 0.9% of those of normal weight or underweight.

          People with a family history of diabetes were also more likely to have the disease. The NHMS showed that over half of all people with diabetes (54.4%) and 39.9% of those at high risk of diabetes had a close family member who had the condition.

          People with diabetes were more likely than those without diabetes to have signs of other chronic conditions. This was particularly the case with kidney disease, of which diabetes is a major cause.³ In 2011–12, 22.5% of people with diabetes had albuminuria, an early indicator of kidney disease, compared with 6.7% of those without diabetes. A further 12.8% had abnormal eGFR results, which measure how well the kidneys filter waste from the bloodstream, compared with 3.1% of those without diabetes. People at high risk of diabetes were also more likely than those without diabetes to have abnormal eGFR (7.2% compared with 3.1%).

          Diabetes is also a major risk factor for cardiovascular disease.¹ Diabetes increases the risk of developing atherosclerosis, which is the build up of fatty deposits in the blood vessels.⁴ This was reflected in the NHMS results, where people with diabetes were more than twice as likely as those without diabetes to have abnormal levels of HDL 'good' cholesterol (48.6% compared with 21.7%) and high levels of triglycerides (31.5% compared with 12.5%). People who were at high risk of diabetes were also more likely than those without diabetes to have abnormal HDL cholesterol and triglyceride levels.

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          More information on diabetes prevalence is presented in tables 1, 2, 3, 8, 9, 11 and 15 in the Data downloads section of this publication.

          Endnotes

          1. Baker IDI Heart & Diabetes Institute, The Australian Diabetes Obesity and Lifestyle Study (AusDiab), 2005 https://www.baker.edu.au/-/media/documents/impact/ausdiab/reports/ausdiab-report-2005.pdf?la=en, Last accessed 24/06/2013.
          2. Kahn, B.B & Flier, J.S., 2000, 'Obesity and insulin resistance'. The Journal of Clinical Investigation, http://www.jci.org/articles/view/10842, Last accessed 24/06/2013.
          3. Kidney Health Australia, Jun 2013, Fast Facts on CKD in Australia http://www.kidney.org.au/KidneyDisease/FastFactsonCKD/tabid/589/Default.aspx, Last accessed 24/06/2013.
          4. Australian Institute of Health and Welfare, 2012, Australia's Health http://www.aihw.gov.au/publication-detail/?id=10737422172, Last accessed 24/06/2013.

          Diabetes management

          Glycated haemoglobin (HbA1c) is used to measure how well a person is managing their diabetes. This test gives an indication of the person's average blood glucose levels over the previous three months. The optimum management target for HbA1c for people with diabetes is a level of 7.0% or less. Maintaining this level decreases a person's risk of developing a range of complications from their diabetes, including problems with their circulation, kidneys, eyes and feet, and lowers the risk of heart attack and stroke. There is also a range of other optimum targets for diabetes management, including those for cholesterol levels, Body Mass Index (BMI) and blood pressure.¹ These are listed in the data source and definitions section below.

          Data source and definitions

          In the National Health Measures Survey (NHMS), information on diabetes management is presented for those with known diabetes. See the Measuring diabetes - definitions section for information on how this population is defined. The information in this section is based on fasting plasma glucose results only. Information on diabetes management using glycated haemoglobin (commonly referred to as HbA1c) test results is shown in table 14 in the Data downloads section of this publication.

          Goals for optimum diabetes management, as defined by the 2012–13 Diabetes Management in General Practice Guidelines¹, are as follows:

          • Fasting blood glucose levels between 4.0–6.0 mmol/L
          • HbA1c levels less than or equal to 7.0%
          • Total cholesterol less than 4.0 mmol/L
          • HDL 'good' cholesterol greater than 1.0 mmol/L
          • LDL 'bad' cholesterol less than 2.0 mmol/L
          • Non-HDL-C cholesterol less than 2.5 mmol/L
          • Triglycerides less than 2.0 mmol/L
          • Albumin creatinine ratio (a test relating to level of kidney damage) less than 3.5 mg/mmol for women and less than 2.5 mg/mmol for men
          • Blood pressure less than or equal to 130/80 mmHg
          • 'Normal' Body Mass Index (i.e. a BMI score of between 18.0 and 24.9)
          • Non-smoker
          • Alcohol intake less than or equal to 2 standard drinks per day*
          • At least 30 minutes of physical activity 5 days per week*
             

          *Note information on alcohol and physical activity targets have not been included in this release, as data for these variables are not available for all persons in the NHMS. However, this information can be sourced from the National Health Survey component and will be available at a later date.

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          In 2011–12, over half (55.7%) of people aged 18 years and over with known diabetes were effectively managing their condition, that is, they had an HbA1c test result of 7.0% or less. Older people were more likely than younger people to meet the HbA1c target, with 70.4% of those aged 75 years and over meeting the target. Overall, there was no significant difference in HbA1c levels between males and females.

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          1. HbA1c levels less than or equal to 7.0%.
             

          Controlling other aspects of health, such as cholesterol and blood pressure, is also important for effective diabetes management. Among those with known diabetes in 2011–12, 37.9% met the management target for total cholesterol and 37.2% met the target for blood pressure. The majority of those with known diabetes met the management targets for triglycerides (70.0%) and albumin creatinine ratio, which measures levels of kidney damage (71.1%).

          The diabetes management guidelines also outline optimum targets for health behaviours. While the majority of people with known diabetes met the management target for smoking in 2011–12 (85.6% were non-smokers), only 12.8% met the target for a normal Body Mass Index (i.e. a BMI score of between 18.0 and 24.9).

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          For more information on diabetes management, see Table 13 in the Data downloads section of this publication.

          Endnotes

          1. Diabetes Australia, August 2012, Diabetes Management in General Practice. Guidelines for Type 2 Diabetes. http://www.diabetesaustralia.com.au/Documents/DA/What's%20New/12.10.02%20Diabetes%20Management%20in%20General%20Practice.pdf, Last accessed 20/06/2013.

          Cardiovascular disease

          Cardiovascular disease remains one of the leading causes of death worldwide. In 2011, ischaemic heart disease, which includes angina, blocked arteries of the heart and heart attacks, was the leading cause of death for all Australians, representing 14.6% of all deaths registered in 2011.¹ The onset of cardiovascular disease can be delayed or prevented through reducing risk factors such as lowering cholesterol, following a healthy diet and avoidance of smoking.

          The main indicators of cardiovascular disease that were measured in the National Health Measures Survey (NHMS) were cholesterol, including total, high density lipoprotein (HDL) and low density lipoprotein (LDL), and triglycerides.

          Blood pressure is also an important measure of cardiovascular risk and was measured for all persons in the Australian Health Survey (AHS). Detailed information on the prevalence of high blood pressure and hypertension for all Australians can be found in Australian Health Survey: Updated Results.

          Endnotes

          1. Australian Bureau of Statistics, Mar 2013, Causes of Death Australia, ABS cat. no. 3303.0, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Chapter42011, Last accessed 02/07/2013.

          Cholesterol

          Cholesterol is a type of fat that circulates in the blood. It is essential for many metabolic processes, including the production of hormones and building cells. There are two main types of cholesterol: high density lipoprotein (HDL) and low density lipoprotein (LDL). HDL cholesterol is known as 'good' cholesterol, as it picks up excess cholesterol in the blood and takes it to the liver where it is broken down, helping to prevent blockages. Low levels of HDL may increase the risk of heart disease. LDL cholesterol, on the other hand, is known as 'bad' cholesterol, as high levels in the bloodstream can lead to fatty deposits developing in the arteries, increasing the risk of heart attack or stroke.

          Data source and definitions

          Cholesterol levels are measured using a blood test. Abnormal cholesterol levels are defined as follows:

          • Total cholesterol greater than or equal to 5.5 mmol/L
          • HDL cholesterol less than 1.0 mmol/L for men and less than 1.3 mmol/L for women
          • LDL cholesterol greater than or equal to 3.5 mmol/L

          In order to get an accurate reading for the LDL cholesterol, people were required to fast for 8 hours or more beforehand. The results presented here refer only to those people who did fast (approximately 79% of adults who participated in the National Health Measures Survey (NHMS)).

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          Total cholesterol

          Total cholesterol is a measure of all the different types of fats in the blood. Abnormal or high total cholesterol is a major risk factor for coronary heart disease and stroke.¹

          In 2011–12, one in three Australians aged 18 years and over (32.8% or 5.6 million people) had abnormal or high total cholesterol levels according to their blood test results. Yet only 10.1% of this group self-reported having high cholesterol as a current long-term health condition, which suggests that the majority of people with high cholesterol results were either unaware that they had the condition or did not consider it to be a long-term or current problem. A further 19.1% of adults had a total cholesterol level that was close to the abnormal cut off (i.e. in the 5.0–5.4 mmol/L range).

          The proportion of people with high total cholesterol levels increased with age, peaking at 55–64 years (47.8%), before decreasing in late adulthood. Overall there was no significant difference in rates of total cholesterol for men and women.

          The NHMS also collected cholesterol information for children. Of those aged 12–17 years, 3.5% had high total cholesterol levels in 2011–12.

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          Research shows that certain lifestyle risk factors, such as smoking and obesity, are associated with high cholesterol.² In 2011–12, current smokers were more likely to have high cholesterol than people who never smoked (38.1% compared with 30.4%). Similarly, adults who were obese were more likely to have high cholesterol than those who were normal weight or underweight (37.0% compared with 25.8%).

          People with high total cholesterol were also likely to have other indicators of cardiovascular disease. For example, 84.7% of those with high total cholesterol also had high LDL 'bad' cholesterol. They were also more likely than those with normal total cholesterol levels to have high triglycerides (22.9% compared with 9.5%). Similarly, people with high blood pressure had higher rates of total cholesterol that those with normal blood pressure (40.8% compared with 31.0%).

          LDL cholesterol

          LDL cholesterol is the measure of 'bad' cholesterol in the blood. Over time, LDL cholesterol can build up in the blood vessels and arteries, blocking the passage of blood flow.³

          In 2011–12, one in three Australian adults (33.2%) had abnormal or high LDL cholesterol. High levels of LDL cholesterol were more common among men (35.0%) than women (31.6%).

          Like total cholesterol, people aged 55–64 years had the highest rates of LDL cholesterol (45.7%). Rates then sharply declined from 65 years onwards. One in twenty children aged 12–17 years (5.2%) had high LDL cholesterol in 2011–12.

          The associations between LDL cholesterol and health risk factors were very similar to that for total cholesterol, with higher rates of abnormal LDL cholesterol among smokers and those who were overweight or obese.

          People with high LDL cholesterol were more likely to have high triglycerides than those with normal LDL levels (15.7% compared with 11.7%). However, there was no association between high LDL cholesterol and lower than normal HDL 'good' cholesterol.

          HDL cholesterol

          HDL cholesterol is the measure of 'good' cholesterol. HDL picks up excess cholesterol in the blood and takes it to the liver where it is broken down.³

          In 2011–12, 23.1% of Australian adults had abnormal or low levels of HDL cholesterol. Abnormal HDL cholesterol was more prevalent for women (27.2%) than men (18.9%).

          Unlike the other measures of cholesterol, levels of low HDL cholesterol remained fairly stable across all age groups at between 21.0% and 24.7%.

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          People with low HDL cholesterol had a greater likelihood of also having signs of other chronic diseases. For example, 10.5% of those with low levels of HDL cholesterol also had diabetes, compared with 3.4% of those with normal levels. They were also more likely than those with normal HDL cholesterol to have high triglycerides and abnormal alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) levels, increasing their risk of heart and liver diseases.

          For more information on cholesterol, see tables 1, 2, 3, 4, 8, 9 and 15 in the Data downloads section of this publication.

          Endnotes

          1. Australian Institute of Health and Welfare, 2013, High blood cholesterol, http://www.aihw.gov.au/high-blood-cholesterol, Last accessed 18/06/2013.
          2. National Heart Foundation of Australia, 2007, Policy paper: Tobacco and cardiovascular disease, http://www.heartfoundation.org.au/SiteCollectionDocuments/TobaccoandCardiovascularDiseasePolicyPaper.pdf, Last accessed 08/07/2013.
          3. National Heart Foundation of Australia, 2013, Cholesterol, http://www.heartfoundation.org.au/SiteCollectionDocuments/NAHU-Cholesterol.pdf, Last accessed 08/07/2013

          Triglycerides

          Like cholesterol, triglycerides are a fatty substance in the blood. However, triglycerides work more like a type of fuel, circulating in the bloodstream to be used as energy by the cells. Research shows that high blood triglycerides are an independent risk factor for heart disease as they contribute to the development of atherosclerosis, which is the build up of fatty deposits in the blood vessels.¹ High triglycerides are typically caused by a diet high in fat or kilojoules, but can also become elevated as a result of having other conditions, such as diabetes and kidney disease.

          Data source and definitions

          Triglycerides are measured using a blood test. Abnormal triglyceride levels were defined as greater than or equal to 2.0 mmol/L.

          In order to get an accurate reading for triglycerides, people were required to fast for 8 hours or more beforehand. The results presented here refer only to those people who did fast (approximately 79% of adults who participated in the National Health Measures Survey).

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          In 2011–12, 13.9% of people aged 18 years and over had high triglyceride levels. High triglycerides were more common among men (19.0%) than women (9.0%).

          The proportion of people with high triglycerides steadily increased with age until middle adulthood, before gradually declining in older age. Overall, rates were highest among those aged 45–54 years (18.5%).

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          Being overweight or obese, tobacco smoking and having high blood pressure were all associated with higher levels of triglycerides. In 2011–12, overweight or obese adults were more than three times as likely to have high triglyceride levels than those who were normal weight or underweight (19.1% compared with 5.3%). Likewise, people with high blood pressure had a greater likelihood of having high triglycerides levels (20.9%) than those with normal blood pressure (11.9%). Current smokers (20.6%) and ex-smokers (15.7%) were also more likely to have high triglycerides than people who had never smoked (11.4%).

          Research shows that the risk of heart disease increases when high triglycerides accompany high LDL or 'bad' cholesterol.² In 2011–12, 54.2% of adults with high triglycerides also had high total cholesterol. People with high triglycerides also had a greater likelihood of having low levels of 'good' HDL cholesterol (45.2%) and high levels of 'bad' cholesterol (37.6%) compared with people with normal triglyceride levels (20.0% and 32.5% respectively).

          High levels of triglycerides are also associated with diabetes.³ In 2011–12, people with high triglycerides were nearly three times as likely as those with normal triglycerides to have diabetes (11.5% compared with 4.1%).

          Similarly, high triglycerides are a known risk factor for liver disease. In 2011–12, 21.5% of adults with high triglycerides had abnormal alanine aminotransferase (ALT) levels (which measures liver function) compared with 9.6% of those with normal triglycerides.

          For more information on triglycerides, see tables 1, 2, 3, 4, 8. 9 and 15 in the Data downloads section of this publication.

          Endnotes

          1. Talayero, BG and Sacks, FM, 2011, 'The Role of Triglycerides in Atherosclerosis', Current Cardiology Reports, http://link.springer.com/article/10.1007%2Fs11886-011-0220-3#page-1, Last accessed 24/06/2013.
          2. World Heart Federation, 2013, Cardiovascular disease risk factors: Cholesterol, http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/cholesterol, Last accessed 24/06/2013.
          3. Tirosh, A et al. 2008, 'Changes in Triglyceride Levels Over Time and Risk of Type 2 Diabetes in Young Men', Diabetes Care, http://care.diabetesjournals.org/content/31/10/2032.full, Last accessed 24/06/2013.
          4. Marchesini, G et al. 2001, 'Nonalcoholic Fatty Liver Disease: A Feature of the Metabolic Syndrome', Diabetes, http://diabetes.diabetesjournals.org/content/50/8/1844.full, Last accessed 08/01/2013.

          Dyslipidaemia

          Dyslipidaemia refers to a number of different lipid disorders (that is, conditions where there are too many fats in the blood). Estimates of dyslipidaemia from the National Health Measures Survey (NHMS) can be used to determine how many Australians have at least one lipid disorder and therefore have an increased risk of heart disease. 

          Data source and definitions

          In the NHMS, a person was classified as having dyslipidaemia if they had one or more of the following:

          • Taking cholesterol-lowering medication 
          • Total cholesterol greater than or equal to 5.5 mmol/L 
          • HDL cholesterol less than 1.0 mmol/L for men and less than 1.3 mmol/L for women 
          • LDL cholesterol greater than or equal to 3.5 mmol/L 
          • Triglycerides greater than or equal to 2.0 mmol/L.

          In 2011–12, 63.2% of people aged 18 years and over had dyslipidaemia. This comprised 13.8% who took some form of cholesterol-lowering medication and 49.4% who took no medication but had either high total cholesterol, low HDL cholesterol, high LDL cholesterol or high triglyceride levels based on their test results. There was no significant difference in rates of dyslipidaemia between men and women (63.7% compared with 62.8%). 

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          The risk of heart disease generally increases with age, particularly after the age of 45. In 2011–12, 76.4% of people aged 45 years and over had dyslipidaemia. However, rates were also high for those aged under 45 years, with nearly half (49.8%) of those aged 18–44 having at least one lipid disorder. 

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          For more information on dyslipidaemia, see table 10 in the Data downloads section of this publication.

          Chronic kidney disease

          Kidney disease is a chronic disease in which a person's kidney function is reduced or damaged. This affects the kidney's ability to filter blood and therefore control the body's water and other hormone levels, leading to increased fluid and waste within the body. This can cause high blood pressure, anaemia, and uremia. Kidney disease is also associated with several other chronic diseases such as diabetes and cardiovascular disease, and was the 10th leading cause of death in Australia in 2011.¹

          The indicators of kidney disease that were measured in the National Health Measures Survey (NHMS) were estimated glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (ACR). Chronic kidney disease stages were also determined through a combination of participants' eGFR and ACR results.

          It is important to note that while abnormal eGFR or ACR results in the NHMS may indicate impaired kidney function, they cannot provide a diagnosis for kidney disease based on a single test alone. Kidney disease can only be confirmed if albuminuria or eGFR of less than 60 mL/min/1.73 m² is persistent for at least three months.²

          Endnotes

          1. Australian Bureau of Statistics, Mar 2013, Causes of Death Australia, ABS cat. no. 3303.0, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Chapter42011, Last accessed 02/07/2013.
          2. Kidney Health Australia, Jun 2013, Chronic Kidney Disease (CKD) Management in General Practice. 2nd Edition 2012 http://www.kidney.org.au//LinkClick.aspx?fileticket=vfDcA4sEUMs%3d&tabid=635&mid=1584, Last accessed 02/07/2013.

          Kidney disease biomarkers

          The National Health Measure Survey (NHMS) measured two aspects of kidney function: estimated glomerular filtration rate (eGFR) and the presence of albuminuria. eGFR uses a formula to estimate the amount of blood the kidneys filter per minute, which indicates if and to what extent kidney function is impaired. Albuminuria occurs when albumin (a protein) leaks into the urine from the blood through the kidneys.¹ While abnormal levels on either test indicate the presence of some form of kidney damage, they alone cannot diagnose kidney disease.

          Data source and definitions

          The NHMS included two tests for kidney function: estimated glomerular filtration rate (eGFR) and the presence of albuminuria.
          eGFR

          • eGFR was measured via a blood test. Abnormal kidney function using eGFR is defined as a reading of less than 60 mL/min/1.73m².

          Albuminuria

          • Presence of albuminuria was measured via a urine test. The presence of albuminuria is defined as an albumin creatinine ratio (ACR) reading of greater than or equal to 2.5 mg/mmol for males and greater than or equal to 3.5 mg/mmol for females.

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          Impaired estimated glomerular filtration rate (eGFR)

            Estimated glomerular filtration rate measures the rate at which the kidneys filter wastes from the blood, and is considered to be the best measure of kidney function.² Impaired eGFR levels indicate that the kidneys are not working properly.

            In 2011–12, 3.6% or around 620,000 people aged 18 years and over had impaired eGFR, with no significant difference between men (3.3%) and women (3.9%). Rates of impaired eGFR were very low for people aged under 54 years (less than 1%) but then markedly increased to 29.6% of people aged 75 years and over.

            Around one in ten adults (10.9%) with impaired eGFR self-reported that they had kidney disease as a current and long-term health condition.

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            High blood pressure is an important risk factor for chronic kidney disease as high blood pressure can damage the blood vessels supplying the kidneys.³ People who had high blood pressure in 2011–12 were more likely than those with normal blood pressure to have impaired eGFR (7.2% compared with 2.7%). The NHMS also showed that obesity, which is another risk factor for kidney disease, is also related to eGFR. In 2011-12, people who were obese had higher rates of impaired eGFR than those of normal weight or underweight (4.2% compared with 2.7%).

            Impaired eGFR was associated with a number of other biomarkers of chronic disease. This was particularly the case for diabetes, which is a major cause of kidney disease. In 2011–12, 17.5% of people with impaired eGFR had diabetes compared with only 4.6% of those with normal eGFR. Kidney disease was also associated with anaemia, as kidney malfunction can reduce the number of red blood cells produced by the body.² One in five (19.7%) people with impaired eGFR were at risk of anaemia in 2011–12 compared with 4.0% of those with normal eGFR.

            Overall, 31.2% of those with impaired eGFR also had albuminuria.

            Presence of albuminuria

            Albuminuria is the presence of albumin (a type of protein) in the urine.³ Low levels of albumin in the urine are normal, but elevated levels may occur when kidney damage is present.¹

            In 2011–12, 1.3 million (or 7.7%) people aged 18 years and over had albuminuria, with higher rates for men than women (8.5% compared to 6.9%).

            Like eGFR, the prevalence of albuminuria sharply increased from the age of 65 years, with people aged 75 years and over having the highest rates (22.5%).

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            The relationship between albuminuria and the other chronic disease biomarkers was similar to that for eGFR. For example, people who had albuminuria were more likely than those without albuminuria to have diabetes (15.1% compared with 4.0%), and to be at risk of anaemia (10.1% compared with 4.0%).

            People who had high blood pressure were also more likely to have albuminuria than those who did not have high blood pressure (13.8% compared with 6.2%).

            For more information on kidney disease biomarkers, see tables 1, 2, 3, 6, 8, 9, and 15 in the Data downloads section of this publication.

            Endnotes

            1. Department of Health, Victoria, Australia, Nov 2012, The Victorian Health Monitor, 2009-2010 http://docs.health.vic.gov.au/docs/doc/CC6A20C055B5AA75CA257A80001A7128/$FILE/VHM%20report.pdf, Last accessed 24/06/2013.
            2. Kidney Health Australia, Jun 2013, Chronic Kidney Disease (CKD) Management in General Practice. 2nd Edition 2012 http://www.kidney.org.au/HealthProfessionals/CKDManagementinGeneralPractice/tabid/789/Default.aspx, Last accessed 24/06/2013.
            3. Australian Institute of Health and Welfare, Jun 2013, An overview of Chronic Kidney Disease in Australia, 2009 http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459911, Last accessed 24/06/2013.

            Chronic kidney disease stages

            Chronic kidney disease has a number of stages, ranging in severity from Stage 1 to Stage 5, with the early stages often showing no symptoms. An individual's kidney function can improve or regress during the early stages of the disease but once Stages 4 and 5 are reached, also known as end stage kidney disease, kidney function is unlikely to improve. A person with end stage kidney disease is generally reliant on kidney replacement therapy in the form of dialysis or kidney transplant.

            Data source and definitions

            Chronic kidney disease stages were determined by combining the participants' estimated glomerular filtration rate (eGFR) results with their albumin creatinine ratio (ACR) results. The different stages were defined as follows:

            • No indicators of chronic kidney disease - eGFR ≥60 mL/min/1.73 m² and no presence of albuminuria
            • Stage 1 - eGFR ≥90 mL/min/1.73 m² & albuminuria
            • Stage 2 - eGFR 60–89 mL/min/1.73 m² & albuminuria
            • Stage 3a - eGFR 45–59 mL/min/1.73 m²
            • Stage 3b - eGFR 30–44 mL/min/1.73 m²
            • Stage 4–5 - eGFR <30 mL/min/1.73 m²

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            In 2011–12, around 1.7 million people (10.0%) aged 18 years and over had indicators of chronic kidney disease, with similar rates for men (10.3%) and women (9.8%). Around 4% of all adults were in Stage 1, 2.5% were in Stage 2 and less than 1% were in Stages 4–5.

            Among those who had indicators of chronic kidney disease in the National Health Measures Survey (NHMS), only 6.1% self-reported having the condition. However, this is not unexpected as unlike other tests for chronic disease, results for albuminuria or abnormal eGFR alone cannot provide a diagnosis for kidney disease and could indicate the presence of an acute kidney condition or infection instead. Kidney disease can only be confirmed if albuminuria or eGFR of less than 60 mL/min/1.73 m² are persistent for at least three months.¹ The majority (65.3%) of people with indicators of chronic kidney disease who self-reported the condition had test results that indicated they were in Stages 3 to 5.

            Like the patterns seen for the individual kidney disease biomarkers, the prevalence of chronic kidney disease markedly increased with age, with only 5.5% of people aged under 55 years having indicators of the disease compared with 42.2% of people aged 75 years and over.

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            For more information on chronic kidney disease stages, see tables 6 and 15 in the Data downloads section of this publication.

            Endnotes

            1. Kidney Health Australia, Jun 2013, Chronic Kidney Disease (CKD) Management in General Practice. 2nd Edition 2012 http://www.kidney.org.au//LinkClick.aspx?fileticket=vfDcA4sEUMs%3d&tabid=635&mid=1584, Last accessed 02/07/2013.

            Liver function

            The liver works as the body's filter, removing toxins from the blood, processing nutrients and regulating its metabolism. A range of factors, including fatty liver disease, infections and excessive alcohol consumption can prevent the liver from performing these functions and if left untreated, can lead to liver damage.¹ When the liver is inflamed or damaged, enzymes including alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) leak from the liver cells into the bloodstream. As a result, elevated levels of ALT and GGT in the bloodstream can indicate the presence of liver disease.

            Data source and definitions

            The National Health Measures Survey (NHMS) measured the levels of two blood enzymes related to liver function: gamma glutamyl transferase (GGT) and alanine aminotransferase (ALT). While elevated levels for either test may indicate liver damage, they cannot diagnose the presence of liver disease.

            Abnormal liver function as measured by ALT is defined as:

            • an ALT reading of greater than 40 U/L for males and greater than 30 U/L for females

            Abnormal liver function as measured by GGT is defined as:

            • a GGT reading of greater than 30 U/L for children aged 12–14 years
            • a GGT reading of greater than 40 U/L for males aged 15–17 years, and greater than 50 U/L for males aged 18 years and over.
            • a GGT reading of greater than 35 U/L for females aged 15 years and over.

            Alanine aminotransferase (ALT)

            ALT is an enzyme found mainly in the liver that helps the liver metabolise food into energy. Elevated levels of ALT in the blood can occur when the liver is damaged or diseased.²

            In 2011–12, around 1.9 million (11.0%) people aged 18 years and over had abnormal or elevated levels of ALT in their blood. Men were more likely than women to have elevated ALT (13.8% compared with 8.3%).

            The proportion of people with abnormal ALT remained relatively steady through early and middle adulthood, peaking at 13.5% among people aged 45–54 years. Rates then significantly declined to a low of 1.9% among people aged 75 years or over.

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            Excess body fat is recognised as a risk factor for liver disease.³ This was reflected in the NHMS results, with 19.5% of those who were obese and 11.6% of people who were overweight having elevated ALT, compared with 4.6% of those who were of normal weight or underweight.

            In 2011–12, many people with abnormal ALT also had risk factors for cardiovascular disease. They were more likely than those with normal ALT to have high total cholesterol (40.9% compared with 32.3%) and low HDL cholesterol (35.7% compared with 21.9%), as well as high triglycerides (26.6% compared with 12.3%). They were also more likely to have diabetes (9.2% compared with 4.6%). About two in five people (40.4%) who had elevated ALT also had high GGT.

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            Gamma glutamyl transferase (GGT)

            The enzyme GGT is found in many tissues in the body. It exists in a relatively high concentration in the liver but is also found in the tissues of the kidneys, bile duct, pancreas, gallbladder, spleen, heart, and brain. When any of these tissues are damaged or diseased, GGT leaks from the tissue into the bloodstream. High GGT levels may therefore be indicative of a broader range of conditions and not just liver disease.⁴ 

            In 2011–12, around 2.1 million people aged 18 years and over (12.4%) had abnormal or elevated levels of GGT in their blood. Unlike ALT, the proportion of people with abnormal GGT results generally increased with age, peaking at 20.5% among those aged 55–64 years. Overall, rates were similar for males and females (13.3% compared with 11.6%).

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            Similar to ALT, excess body fat increased the likelihood of having abnormal GGT. Around one in five (21.6%) people who were obese had abnormal GGT compared with 12.2% of people who were overweight and 6.0% who were of normal weight or underweight.

            However, unlike ALT, GGT was also associated with blood pressure and smoking. In 2011–12, people with high blood pressure were more likely to have abnormal GGT than people with normal blood pressure (20.2% compared to 10.3%). Similarly, 18.1% of current smokers had abnormal GGT compared with only 9.6% of people who had never smoked.

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            People with abnormal GGT were more likely than those with normal GGT to have other chronic disease risk factors, including high total cholesterol (43.7% compared with 31.7%), high triglycerides (32.4% compared with 11.2%), and high LDL 'bad' cholesterol (39.0% compared with 32.4%). They were also more likely to have diabetes (11.5% compared with 4.2%) and to have abnormal results for the chronic kidney disease biomarkers, including albuminuria (12.2% compared with 7.0%) and eGFR (5.9% compared with 3.4%).

            For more information on ALT and GGT, see tables 1, 2, 3, 7, 8 and 9 in the Data downloads section of this publication.

            Endnotes

            1. Angulo, P and Lindor, KD, 2002, 'Non-alcoholic fatty liver disease', Journal of Gastroenterology and Hepatology, http://www.gastrohep.com/conreports/bangkok/jghs2.pdf, Last accessed 01/08/2013.
            2. Schindhelm, RK, et al. 2006, 'Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease', Diabetes/Metabolism Research and Reviews, http://dare.ubvu.vu.nl/bitstream/handle/1871/13286/21810_Schindhelm_proefschrift_V3.pdf?sequence=1#page=95, Last accessed 08/01/2013.
            3. Farrell, GC et al. 2006, 'Nonalcoholic fatty liver disease: From steatosis to cirrhosis', Hepatology, http://onlinelibrary.wiley.com/doi/10.1002/hep.20973/full, Last accessed 08/01/2013.
            4. Lee, DS, et al. 2007, 'Gamma Glutamyl Transferase and Metabolic Syndrome, Cardiovascular Disease, and Mortality Risk: The Framingham Heart Study', Arteriosclerosis, Thrombosis, and Vascular Biology, http://atvb.ahajournals.org/content/27/1/127.full, Last accessed 08/01/2013.
            5. Ruttman, E, et al. 2005, 'Gamma-Glutamyltransferase as a Risk Factor for Cardiovascular Disease Mortality: An Epidemiological Investigation in a Cohort of 163 944 Austrian Adults', Circulation: Journal of the American Heart Association, http://circ.ahajournals.org/content/112/14/2130.full, Last accessed 08/01/2013.

            Exposure to tobacco smoke

            The National Health Measures Survey (NHMS) included a test for cotinine as an objective measure of smoking status. The body produces cotinine in the process of breaking down, or metabolising, nicotine from tobacco smoke.¹ Levels of cotinine are generally proportionate to the amount of tobacco exposure a person receives through smoking, or in some cases, through exposure to second hand smoke. However, cotinine levels only remain elevated for around 20 hours after exposure to tobacco smoke, therefore it can only provide a measure of short-term exposure.

            Data source and definitions

            Levels of cotinine were measured via a blood test. In the NHMS, cotinine levels of 140 nmol/L or greater indicate exposure to tobacco smoke.

            The Australian Health Survey results for self-reported smoking show that 16.1% of Australians aged 18 years and over were current daily smokers in 2011–12.²

            In the NHMS, the pattern for cotinine exposure was very similar to that for the self-reported smoking data for most age groups. Small differences were evident in the younger age groups, with people aged 18–24 years having slightly higher rates of cotinine exposure compared with their self-reported smoking status. However, the opposite was true for those aged 25–34 years, where the proportion of self-reported smokers was slightly higher than the proportion exposed to cotinine.

            Overall, 87.0% of current smokers aged 18 years and over had cotinine levels indicating exposure to tobacco smoke, compared with only 5.7% of those who were ex-smokers and 0.3% of those who had never smoked.

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            For more information on cotinine, see table 8 in the Data downloads section of this publication.

            Endnotes

            1. Benowitz, NL, 1996, Cotinine as a Biomarker of Environmental Tobacco Smoke Exposure, Epidemiologic Reviews http://epirev.oxfordjournals.org/content/18/2/188.citation, last accessed 02/07/2013.
            2. Australian Bureau of Statistics, Jun 2013, Australian Health Survey: Updated Results, 2011–2012, ABS cat. no 4364.0.55.003 https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.003, Last accessed 02/07/2013.

            Anaemia

            Anaemia is caused by a decrease in either the number of red blood cells in the body or the quantity of haemoglobin within red blood cells. When a person is anaemic, their heart has to work harder to ensure that muscles and organs get the oxygen they need. Haemoglobin is a protein found in red blood cells. It contains a large amount of iron and helps transport oxygen from the lungs to the rest of the body. The National Health Measures Survey (NHMS) measured the concentration of haemoglobin in the blood, which can help diagnose anaemia.

            In Australia in 2011–12, around 760,000 people aged 18 years and over (4.5%) were at risk of anaemia, with women more likely to be at risk than men (6.4% compared with 2.5%).

            The risk of anaemia was highest among older Australians, with rates rapidly increasing after the age of 65 years. People aged 75 years and older were more likely to be at risk of anaemia than all other Australians, with 16.0% in the at risk range compared with 3.6% of Australians aged less than 75 years.

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            Research has shown that anaemia is associated with diabetes and chronic kidney disease.² This was reflected in the NHMS results, where 12.6% of those at risk of anaemia had diabetes compared with 4.7% of those not at risk. They were also more likely to have abnormal eGFR, which is a measure of kidney function (16.1% compared with 3.1%).

            For more information on haemoglobin, see tables 1, 2, 3, 8 and 9 in the Data downloads section of this publication.

            Data source and definitions

            Haemoglobin levels were measured using a blood test. Abnormal levels of haemoglobin indicating a risk of anaemia are defined differently for males and females, young people, and pregnant women, as based on World Health Organization guidelines¹:

            • Less than 120 g/L for people aged 12-14 years and females aged 15 years or older who are not pregnant
            • Less than 130 g/L for males aged 15 years or older
            • Less than 110 g/L for pregnant women

            Endnotes

            1. World Health Organization (WHO) 2011, Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity, Vitamin and Mineral Nutrition Information System, http://www.who.int/vmnis/indicators/haemoglobin/en/, Last accessed 26/06/2013.
            2. Mehdi, U & Toto, RD 2009, 'Anemia, Diabetes, and Chronic Kidney Disease', Diabetes Care, http://care.diabetesjournals.org/content/32/7/1320.short, Last accessed 02/07/2013.

            Comparisons with other Australian surveys

            The National Health Measures Survey (NHMS) is the first ABS survey to include a voluntary blood and urine collection. However, biomedical results have been collected at the population level in Australia before, most recently at the national level by BakerIDI Heart and Diabetes Institute and for Victoria only by the Victorian Department of Health. There is strong interest in how the results from the NHMS compare with these two studies.

            The 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) was conducted by BakerIDI. This was a national cross-sectional survey of around 11,000 people aged 25 years and over and was primarily designed to measure the prevalence of diabetes and associated risk factors.¹

            The 2009–10 Victorian Health Monitor (VHM) was conducted by the Victorian Department of Health. This was a cross-sectional, statewide survey of around 3,600 Victorians aged 18–75 years and included biomedical measures for diabetes, cardiovascular disease and indicators of chronic kidney disease.²

            A summary of the surveys is shown below.

            Summary of surveys

             AusDiabVictorian Health MonitorNHMS
            Year1999–20002009–102011–12
            ScopeAdults aged 25 years and over in 99 Collection Districts in all states and in the Northern Territory. Excludes the ACT and Very Remote areas.Adults aged 18–75 years in 50 randomly selected Collection Districts in metropolitan and rural areas of Victoria.Adults and children aged 5 years and over in 2,700 Collection Districts across Australia, randomly selected as part of the Australian Health Survey. Excludes persons in Very Remote areas.
            Sample sizeApprox 11,000Approx 3,600Approx 11,000
            Note: A Collection District (CD) is the second smallest geographic area defined in the Australian Standard Geographical Classification (ASGC), the smallest being the Mesh Block. The CD was designed for use in the Census of Population and Housing as the smallest unit for collection and processing.
             


            The following sections outline how the results from these two surveys compare with those from the NHMS.

            Diabetes

            The NHMS and VHM both used fasting plasma glucose blood tests to determine diabetes status. For a detailed description of how diabetes was defined in the NHMS, see the Measuring diabetes - definitions section of this publication.

            As shown in the table below, the results from the two surveys were very similar. The NHMS found that 4.3% of people aged 18–75 years in Victoria had diabetes compared with 4.6% found in VHM. VHM had a slightly higher number of people with impaired fasting plasma glucose - 4.3% compared with 3.1% in the NHMS - however the overlapping confidence intervals for these two estimates suggest that this difference is not statistically significant.

            Persons aged 18-75 years in Victoria: comparison of diabetes results for NHMS and VHM

             NHMS 2011–12(a)VHM 2009–10(b)
             
            %
            95% CI
            %
            95% CI
            Known diabetes(c)
            3.5
            2.2 – 4.8
            3.4
            2.6 – 4.5
            Newly diagnosed diabetes(d)
            0.9
            0.2 – 1.5
            1.2
            0.7 – 1.9
            Total with diabetes
            4.3
            3.0 – 5.7
            4.6
            3.7 – 5.7
            Impaired fasting plasma glucose(e)
            3.1
            2.0 – 4.2
            4.3
            3.3 – 5.7
            a. Based on the fasting population. Estimates are not age-standardised.
            b. Data sourced from Department of Health 2012, The Victorian Health Monitor, State Government of Victoria, Melbourne. Estimates are age-standardised to the 2006 population.
            c. A person was considered to have known diabetes if they had ever been told by a doctor or nurse that they have diabetes and they were taking diabetes medication (either insulin or tablets); OR had ever been told by a doctor or nurse that they have diabetes and their blood test result for fasting plasma glucose was greater than the cut off point for diabetes (that is, ≥7.0 mmol/L).
            d. A person was considered to have newly diagnosed diabetes if they reported no prior diagnosis of diabetes but had a fasting plasma glucose value ≥7.0 mmol/L.
            e. A person was considered to have impaired fasting plasma glucose if they did not currently have diabetes, but had a fasting blood glucose level ranging from 6.1 mmol/L to less than 7.0 mmol/L.
             


            The 1999–2000 AusDiab study used an Oral Glucose Tolerance Test (OGTT), together with self-reported information on doctor diagnosis and medication use, to determine diabetes. An OGTT involves an initial fasting plasma glucose blood test, followed by a drink of a solution containing 75g of glucose. The person's blood sugar levels are then checked again two hours later. Participants who reported a history of physician diagnosed diabetes and who were 1) taking oral hypoglycemic tablets or insulin injections or 2) had a fasting plasma glucose (FPG) level ≥7.0 mmol/L or 2-hour plasma glucose (2hPG) level ≥11.1 mmol/L were classified as having known diabetes. Participants not reporting diabetes and who had FPG ≥7.0 mmol/L or 2hPG ≥11.1 mmol/L were classified as having newly diagnosed diabetes.³

            BakerIDI has supplied the ABS with previously unpublished 1999–2000 AusDiab diabetes figures based on FPG test results alone. This allows for a more direct comparison with the NHMS results. The FPG rate for AusDiab was slightly lower than that for the NHMS (5.5%), although this is unlikely to be a significant difference given that the confidence intervals overlap.

            The largest difference between the surveys was for newly diagnosed diabetes. More people had newly diagnosed diabetes in AusDiab than in the NHMS, even when using the FPG test.

            Persons aged 25 years and over(a): comparison of diabetes results for NHMS and AusDiab

             NHMS 2011–12(b)AusDiab 1999–2000
             FPG testFPG test(c)OGTT(c)(d)
             
            %
            95% CI
            %
            95% CI
            %
            95% CI
            Known diabetes
            4.5
            3.9 – 5.1
            3.1
            2.3 – 4.0
            3.7
            2.8 – 4.6
            Newly diagnosed diabetes
            1.0
            0.7 – 1.3
            1.8
            1.4 – 2.3
            3.7
            3.0 – 4.4
            Total with diabetes
            5.5
            4.9 – 6.1
            4.9
            3.8 – 6.1
            7.4
            5.9 – 8.8
            a. Based on the fasting populations.
            b. Estimates age-standardised to the 2001 standard population.
            c. Estimates are not age-standardised. Data has been weighted to match the age and sex distribution of the 1998 estimated resident population of Australia aged 25 years and over.
            d. Data sourced from Dunstan et al 2002, The Rising Prevalence of Diabetes and Impaired Glucose Tolerance, The Australian Diabetes, Obesity and Lifestyle Study, Diabetes Care 25: 829–834.
             


            For other NHMS diabetes results, including for all Australians aged 18 years and over, see the Diabetes prevalence section of this publication.

            Cardiovascular disease

            The NHMS and VHM included several blood tests for risk factors of cardiovascular disease, including cholesterol levels and triglycerides. Both surveys used the same cut-offs for normal and abnormal tests results and included the same definition of dyslipidaemia.

            Again, there was little difference in the results between the two surveys for people aged 18–75 years in Victoria, particularly for total cholesterol and LDL cholesterol. The VHM had slightly higher rates of abnormal triglycerides and lower rates of abnormal HDL cholesterol than the NHMS.

            Persons aged 18-75 years in Victoria: comparison of cardiovascular test results for NHMS and VHM

             NHMS 2011–12(a)VHM 2009–10(b)
             
            %
            95% CI
            %
            95% CI
            Abnormal total cholesterol (≥5.5 mmol/L)
            33.6
            30.8 – 36.3
            35.6
            33.4 – 37.9
            Abnormal LDL cholesterol (≥3.5 mmol/L)(c)
            32.5
            28.8 – 36.3
            32.3
            29.6 – 35.1
            Abnormal HDL cholesterol (<1.0 mmol/L for men and <1.3 mmol/L for women)
            22.3
            19.2 – 25.4
            15.4
            13.0 – 18.2
            Abnormal triglycerides (≥2.0 mmol/L)(c)
            10.5
            8.2 – 12.9
            14.0
            12.5 – 15.8
            Dyslipidaemia(c)
            58.6
            54.2 – 62.9
            56.8
            53.7 – 59.9
            a. Estimates are not age-standardised.
            b. Data sourced from Department of Health 2012, The Victorian Health Monitor, State Government of Victoria, Melbourne. Estimates are age-standardised to the 2006 population.
            c. Based on the fasting population.
             


            AusDiab also included tests for cholesterol and triglycerides, using these same thresholds. The prevalence of abnormal total cholesterol and abnormal LDL cholesterol was higher in AusDiab than for the NHMS. AusDiab also had a higher proportion of people with elevated triglycerides. Rates of HDL cholesterol could not be compared due to the use of different cut-offs.

            Persons aged 25 years and over: comparison of cardiovascular test results for NHMS and AusDiab

             NHMS 2011–12(a)AusDiab 1999–2000(b)
             
            %
            95% CI
            %
            95% CI
            Abnormal total cholesterol (≥5.5 mmol/L)
            35.7
            34.3 – 37.1
            51.2
            48.9 – 53.6
            Abnormal LDL cholesterol (≥3.5 mmol/L)(c)
            35.5
            33.8 – 37.3
            45.7
            43.6 – 47.8
            Abnormal triglycerides (≥2.0 mmol/L)(c)
            15.2
            13.9 – 16.6
            20.6
            18.0 – 22.9
            a. Estimates are age standardised to the 2001 standard population.
            b. Data sourced from International Diabetes Institute 2001, Diabesity & Associated Disorders in Australia - 2000. The Accelerating Epidemic, The Australian Diabetes, Obesity and Lifestyle Study (AusDiab), Melbourne.4 Estimates are not age standardised. Data has been weighted to match the age and sex distribution of the 1998 estimated resident population of Australia aged 25 years and over.
            c. Based on the fasting population.
             


            For other NHMS cholesterol and triglycerides results, including for all Australians aged 18 years and over, see the Cardiovascular disease section of this publication.

            Kidney function

            The NHMS and VHM included estimated glomerular filtration rate (eGFR) and presence of albuminuria as measures of kidney function. The prevalences of abnormal eGFR and albuminuria for people aged 18–75 years in Victoria were similar for both surveys.

            Persons aged 18-75 years in Victoria: comparison of kidney function test results for NHMS and VHM

             NHMS(a)VHM(b)
             
            %
            95% CI
            %
            95% CI
            Abnormal eGFR(c)
            2.1
            0.9 – 3.2
            3.5
            2.7 – 4.6
            Presence of albuminuria(d)
            6.0
            4.2 – 7.7
            6.4
            5.3 – 7.6
            a. Estimates are not age-standardised.
            b. Data sourced from Department of Health 2012, The Victorian Health Monitor, State Government of Victoria, Melbourne. Estimates are age-standardised to the 2006 population.
            c. Abnormal kidney function using eGFR is defined as a reading of less than 60 mL/min/1.73m².
            d. The presence of albuminuria is defined as an albumin creatinine ratio (ACR) reading of ≥2.5 mg/mmol for males and ≥3.5 mg/mmol for females.
             


            The NHMS also included information on chronic kidney disease stages, using a combination of participants' eGFR and urinary albumin creatinine ratio (ACR) results. The AusDiab Kidney Study shows that the prevalence for chronic kidney disease based on the CKD-EPI equation was 11.5%. This was similar to the corresponding rate in the NHMS for people aged 25 years and over (10.4%).

            Persons aged 25 years and over: comparison of chronic kidney disease results for NHMS and AusDiab

             NHMS(a)AusDiab 1999–2000(b)
             
            %
            95% CI
            %
            95% CI
            Chronic kidney disease
            10.4
            9.7 – 11.1
            11.5
            9.4 – 14.1
            a. Estimates are age-standardised to the 2001 standard population.
            b. Data sources from White et. al. 2010, Comparison of the Prevalence and Mortality Risk of CKD in Australia Using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR Estimating Equations: The AusDiab (Australian Diabetes, Obesity and Lifestyle) Study. Estimates are not age standardised. Data has been weighted to match the age and sex distribution of the 1998 estimated resident population of Australia aged 25 years and over.
             


            For other NHMS kidney function results, including for all Australians aged 18 years and over, see the Chronic kidney disease section of this publication.

            Endnotes

            1. Dunstan et al. 2002, The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) – methods and response rates, Diabetes Research and Clinical Practice 57:119–129.
            2. Department of Health 2012, The Victorian Health Monitor, http://docs.health.vic.gov.au/docs/doc/CC6A20C055B5AA75CA257A80001A7128/$FILE/VHM%20report.pdf, Last accessed 05/07/2013.
            3. Dunstan et al. 2002, The Rising Prevalence of Diabetes and Impaired Glucose Tolerance, The Australian Diabetes, Obesity and Lifestyle Study, Diabetes Care 25: 829–834.
            4. Diabetes Institute 2001, Diabesity & Associated Disorders in Australia - 2000. The Accelerating Epidemic, The Australian Diabetes, Obesity and Lifestyle Study (AusDiab), https://baker.edu.au/-/media/documents/impact/ausdiab/reports/ausdiab-report-2000.pdf?la=en, Last accessed 05/07/2013.
            5. White et al. 2010, Comparison of the Prevalence and Mortality Risk of CKD in Australia Using the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study GFR Estimating Equations: The AusDiab (Australian Diabetes, Obesity and Lifestyle) Study, http://www.kidney.org/news/keep/pdf/adr2010/2_Stevens_KEEP_2010.pdf, Last accessed 05/07/2013.

            About the National Health Measures Survey

            The 2011–13 Australian Health Survey (AHS) is the largest and most comprehensive health survey ever conducted in Australia. The survey, conducted throughout Australia, collected a range of information about health related issues, including health status, risk factors, health service usage and medications. In 2011–13, the AHS incorporated the first ABS biomedical collection, the National Health Measures Survey (NHMS). It involved the collection of a range of blood and urine tests from over 11,000 participants across Australia, which were then tested for various chronic disease and nutrient biomarkers.

            The AHS also included an additional representative sample of Aboriginal and Torres Strait Islander people. The Aboriginal and Torres Strait Islander Health Measures Survey will provide the first biomedical results for Aboriginal and Torres Strait Islander people aged 18 years and over at the population level and provides a unique opportunity to compare results with the non-Indigenous population. Results for the Aboriginal and Torres Strait Islander population will be released progressively from the end of 2013.

            This publication is the first release of information from the NHMS. It focusses on biomarkers of chronic disease, including cardiovascular disease, diabetes and kidney disease. Information on nutrition biomarkers, such as vitamin D, iron and iodine, will be released in late 2013.

            The NHMS has been made possible by additional funding from the Australian Government Department of Health and Ageing as well as the National Heart Foundation of Australia, and the contributions of these two organisations to improving health information in Australia through quality statistics are greatly valued.

            The 2011–13 AHS, and particularly the NHMS component, was developed with the assistance of several advisory groups and expert panels. Members of these groups were drawn from Commonwealth and state/territory government agencies, non-government organisations, relevant academic institutions and clinicians. The valuable contributions made by members of these groups are greatly appreciated.

            Finally, the success of the 2011–13 AHS was dependent on the very high level of cooperation received from the Australian public. Their continued cooperation is very much appreciated; without it, the range of statistics published by the ABS would not be possible. Information received by the ABS is treated in strict confidence as required by the Census and Statistics Act 1905.

            Structure of the Australian Health Survey

            This publication is one of several ABS releases for the 2011–13 Australian Health Survey (AHS) and is the first publication of biomedical results.

            The AHS is the largest, most comprehensive health survey ever conducted in Australia. It combines the existing ABS National Health Survey (NHS) and the National Aboriginal and Torres Strait Islander Health Survey together with two new elements - a National Nutrition and Physical Activity Survey (NNPAS) and a National Health Measures Survey (NHMS).

            The following diagram shows how the various elements combine to provide comprehensive health information for the overall Australian population. The content for each component survey is listed along with the ages of respondents for which topics were collected.

            Structure of the 2011-13 Australian Health Survey

            Venn type diagram showing the components and content of the Australian Health Survey

            Structure of the 2011-13 Australian Health Survey

            A Venn diagram like image showing the components, flow and content of the Australian Health Survey (AHS). The Venn diagram comprises of 4 components:

            The first component relates to the centre circle with arrows pointing left and right. This circle provides information on the AHS Core Content. During this part of the survey, a total of 25,000 households and 32,000 persons were surveyed based on: Household information, Demographics, Self-assessed health status (persons who were 15 years or over were counted), Self-assessed body mass (persons who were 15 years or over were counted), Smoking (persons who were 15 years or over were counted), Physical measures (including: height, weight, waist and Body Mass Index), Physical activity (persons who were 18 years or over were counted), Dietary behaviours blood pressure (persons who were 5 years or over were counted), Female life stage (persons who were 10 years or over were counted), and Selected conditions.

            The second component relates to the left arrow, where it provides information on the 15,500 households who were surveyed during the National Health Survey (NHS). A total of 20,500 persons were surveyed based on: Detailed conditions, Medication and supplements, Health related actions, Days of reduced activity, Social and emotional wellbeing (persons who were 18 years or over were counted), Physical activity (persons who were 15 years or over were counted), Private health insurance status (persons who were 18 years or over were counted), Breastfeeding (persons who were between the age of 0-3 were counted), Disability status, Alcohol consumption (persons who were 15 years or over were counted), Family stressors (persons who were over 15 years or over were counted), Personal income persons who were 15 years or over were counted), and financial stress. From this component, there is a black arrow which points to the fourth, and final component.

            The third component relates to the right arrow, where it provides information on the 9,500 households who were surveyed during the National Nutrition Activity Survey (NNPAS). A total of 12,000 persons were surveyed based on: Food security, Food avoidance, Dietary recall, and Physical activity. This component also includes a box within this square, which provides information on the NNPAS telephone follow-up comprising of: 2nd dietary recall, and 8-day pedometer (persons who were 5 years or over were counted). From this component, there is a black arrow which points to the fourth, and final component.

            The final component relates to the green box which the second and third component refer to. This component relates to the information obtained from the 11,000 persons, who were 5 years or older, surveyed during the National Health Measures Survey (NHMS). The 11,000 volunteers were surveyed based on: Key blood tests (persons who were 12 years or older were counted) and urine tests (persons who were 5 years or older were counted) of nutritional status and chronic disease markers.

            As shown in the above diagram, the AHS is made up of 3 components:

            • the National Health Survey (NHS);
            • the National Nutrition and Physical Activity Survey (NNPAS); and
            • the National Health Measures Survey (NHMS)
               

            All people selected in the AHS were selected in either the NHS or the NNPAS, however data items in the 'Core' were common to both surveys and therefore information for these data items is available for all persons in the AHS. All people aged 5 years and over were then invited to participate in the voluntary NHMS. This sample design allows comparisons across a wide range of information about people's health, as well as use of this information in the estimation process.

            The NHMS had approximately 11,000 participants aged 5 years and over across Australia. Respondents voluntarily provided blood and urine samples, which were then analysed for specific chronic disease and nutrition biomarkers. See Appendix A for the full list of tests conducted.

            Information for Aboriginal and Torres Strait Islander people

            The AHS also includes an additional representative sample of around 13,000 Aboriginal and Torres Strait Islander people, which was collected between April 2012 and July 2013. This is a separate collection of Aboriginal and Torres Strait Islander people living in remote and non-remote areas, including discrete communities. The structure is the same as outlined above, comprised of the National Aboriginal and Torres Strait Islander Health Survey component, the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey component and the National Aboriginal and Torres Strait Islander Health Measures Survey component. The Aboriginal and Torres Strait Islander Health Measures Survey will provide the first biomedical results for Aboriginal and Torres Strait Islander people at the population level and provides a unique opportunity to compare results with the non-Indigenous population.

            The results from these surveys will be released progressively from November 2013. For more information on future releases see Release schedule.

            Release schedule

            Results from the Australian Health Survey have been released progressively from October 2012 and will continue into 2015. Please see the Australian Health Survey: Users' Guide (cat. no. 4363.0.55.001) and the Australian Aboriginal and Torres Strait Islander Health Survey: Users' Guide (cat. no .4727.0.55.002) for more information on the release schedule.

            Data downloads

            Table 1: Chronic disease biomarkers by age then sex — Australia

            Table 2: Chronic disease biomarkers by state and territory

            Table 3: Chronic disease biomarkers by chronic disease biomarkers

            Table 4: Cardiovascular disease biomarkers

            Table 5: Diabetes biomarkers

            Table 6: Kidney disease biomarkers

            Table 7: Liver function biomarkers

            Table 8: Chronic disease biomarkers by selected health risk factors

            Table 9: Chronic disease biomarkers by selected population charcteristics

            Table 10: Prevalence of dyslipidaemia

            Table 11: Prevalence of diabetes (fasting plasma glucose)

            Table 12: Prevalence of diabetes (HbA1c)

            Table 13: Diabetes management (fasting plasma glucose)

            Table 14: Diabetes management (HbA1c)

            Table 15: Selected self-reported conditions by chronic disease biomarkers

            Survey material

            To view the AHS Biomedical Results brochure click here

            To view the AHS - Cholesterol infographic click here

            To view the AHS - Chronic disease biomarkers national prevalence rates click here

            History of changes

            Show all

            27/04/2015 - Amendment made to release schedule page to direct users to the release schedules in the AATSIHS and AHS Users' Guide.

            26/09/2014 - This release contains replacement content on the Diabetes Management and Glossary pages. The phrase albumin creatinine ratio (ACR), which measures kidney function has been revised to albumin creatinine ratio (ACR), which measures levels of kidney damage.