tag:theconversation.com,2011:/au/topics/how-australians-die-27613/articlesHow Australians Die – The Conversation2016-06-09T20:09:48Ztag:theconversation.com,2011:article/578742016-06-09T20:09:48Z2016-06-09T20:09:48ZHow Australians Die: cause #5 – diabetes<figure><img src="https://images.theconversation.com/files/121843/original/image-20160510-20717-n8wmk9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diabetes is characterised by higher than normal levels of glucose in the blood.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/FZeiyMSWsn8">Leon Ephraim/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>This is the final in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Previous series articles were on <a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">heart diseases</a> and stroke, <a href="https://theconversation.com/how-australians-die-cause-2-cancers-58063">cancers</a>, <a href="https://theconversation.com/how-australians-die-cause-3-dementia-alzheimers-57341">dementia</a> and <a href="https://theconversation.com/how-australians-die-cause-4-chronic-lower-respiratory-diseases-58926">chronic lower respiratory</a> diseases.</em></p>
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<p>Diabetes is rapidly emerging as a <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">leading cause of death</a> among Australians. It is also a leading cause of heart attacks, strokes, amputations, kidney failure, depression, dementia and severe infections – all of which themselves contribute to premature death. </p>
<p>It never used to be this way. Thirty years ago, around 250,000 Australians had diabetes. Today that figure is around <a href="https://www.diabetesaustralia.com.au/diabetes-in-australia">two million</a>. </p>
<p>Around the world in 2013, <a href="http://www.diabetesatlas.org">more than five million people</a> between the ages of 20 and 79 died from diabetes, accounting for 8.4% of deaths among people in this age group. This translates to one death due to diabetes every six seconds. Tragically, nearly <a href="http://www.diabetesatlas.org">half of these</a> were in people under 60.</p>
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<p>These figures likely underestimate the major role of diabetes in death as it frequently goes unreported as a cause of death. One study showed that only 35% to 40% of people with diabetes who died had the disease listed on their death certificate, while only about 10% to 15% had diabetes listed as the <a href="http://www.diabetes.org/diabetes-basics/statistics">underlying cause of death</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=192&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=192&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=192&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=241&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=241&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=241&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<h2>Which type of diabetes is worst?</h2>
<p>Diabetes is characterised by higher than normal levels of glucose in the blood, caused by having insufficient insulin production or function to keep glucose levels under control.</p>
<p>This can come about if the immune system inadvertently destroys the insulin producing cells of the pancreas. This is called <a href="http://theconversation.com/explainer-what-is-diabetes-11842">type 1 diabetes</a>. It can occur at any age, but is most common in children and young adults.</p>
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<p>Ectopic fat – fat that accumulates outside the typical stores underneath your skin – can also reduce insulin production and cause resistance to its glucose lowering effects. This is called <a href="http://theconversation.com/explainer-what-is-diabetes-11842">type 2 diabetes</a> and accounts for 95% of all diabetes cases. It can occur at any age, but is most common in older adults.</p>
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<p>Because of its substantially higher frequency and the older age of its sufferers, type 2 diabetes kills many more people than type 1 . However, both kinds of diabetes can shorten lives. </p>
<p>For example, the life expectancy of someone with type 1 diabetes in Australia is <a href="http://link.springer.com/article/10.1007/s00125-015-3857-4/fulltext.html">12 years less</a> than observed in the general population. </p>
<p>Equally, a man in his fifties with type 2 diabetes is <a href="http://care.diabetesjournals.org/content/37/9/2579.long">twice as likely</a> to die in the next five years than one without diabetes. </p>
<p>Deaths due to diabetes are substantially higher in some settings and populations. For instance, the impact of diabetes on mortality may be at least <a href="http://www.aihw.gov.au/diabetes-indicators/deaths">five times higher</a> in Aboriginal and Torres Strait Islander people as in non-Indigenous Australians.</p>
<h2>Pre-diabetes</h2>
<p>On average, the higher the blood glucose, the greater the risk from complications of diabetes and premature mortality. Consequently, lowering glucose levels is an essential component of diabetes care and can substantially improve the <a href="http://jama.jamanetwork.com/article.aspx?articleid=2088851">survival of people with diabetes</a> in the long term. </p>
<p>However, the <a href="http://www.bmj.com/content/343/bmj.d4169">lack of success</a> in short to medium-term studies shows the <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMe0807625">long shadow</a> of diabetic complications and the importance of both early identification and long-term treatment.</p>
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<img alt="" src="https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121840/original/image-20160510-20721-52qfta.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Diabetes is characterised by higher than normal levels of glucose in the blood.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>One in five Australians have moderately high glucose levels; not high enough to be called diabetic but still <a href="http://circ.ahajournals.org/content/116/2/151.abstract">enough to increase their risk</a> of dying too soon. This is called pre-diabetes and well over 60% of these people will ultimately develop diabetes without intervention. </p>
<p>Because there are many more people with pre-diabetes than have diabetes, it has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/17098083">estimated that most deaths</a> due to elevated blood glucose levels actually don’t occur in people with diabetes. Such data further suggests the true ranking of elevated blood glucose levels as a cause of death in Australians is likely much higher than number five.</p>
<h2>Changing causes of death in diabetes</h2>
<p>Diabetes has always been a killer. In the second century AD, Greek physician <a href="http://www.ncbi.nlm.nih.gov/pubmed/22450352">Aretaeus of Cappadocia described diabetes mellitus</a> as a rare but fatal disease characterised by “the wasting of flesh and limbs into urine”. </p>
<p>Modern diabetes treatment has now abolished the idea of emaciation caused by the excessive loss of glucose into the urine. In its place, diabetes has transformed into a wholly different kind of killer.</p>
<p>Heart disease and stroke account for about a <a href="http://care.diabetesjournals.org/content/37/9/2579.long">third of deaths</a> in people with diabetes. Consequently, <a href="http://care.diabetesjournals.org/content/38/Supplement_1/S49.full">reducing risk factors for heart disease</a> – including cholesterol and blood pressure levels, stopping smoking, dietary change, increasing physical activity and weight reduction – are cornerstones of diabetes care.</p>
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<span class="caption">Increasing physical activity as a cornerstone of diabetes care.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>There is evidence that improvements in the management of diabetes have led to a <a href="http://care.diabetesjournals.org/content/early/2016/04/20/dc15-2308.full.pdf+html">substantial reduction</a> in the frequency of deaths from heart disease and strokes over the past 30 years. Unfortunately, the rising prevalence of diabetes has outstripped much of these gains, the result of which is that diabetes is now the leading cause of heart disease in many countries, including Australia.</p>
<p>With the decline of deaths due to heart disease, cancer has now emerged as the <a href="http://care.diabetesjournals.org/content/early/2016/04/20/dc15-2308.full.pdf+html">leading cause of death in Australians with diabetes</a>. Indeed, diabetes is now considered an important <a href="http://care.diabetesjournals.org/content/33/7/1674">risk factor</a> for many cancers such as liver, pancreatic, endometrial, colon, breast, and bladder cancers. </p>
<h2>Where to from here?</h2>
<p>At least <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587,70161-5/abstract">two out of every five adults</a> will develop type 2 diabetes in their lifetime. Yet it is preventable and may even be reversible in its earliest stages.</p>
<p>It is clear that simple measures, such as improving diet, weight loss and regular physical activity, can have profound and ongoing effects to not only <a href="http://www.ncbi.nlm.nih.gov/pubmed/24731674">reduce the risk of developing type 2 diabetes</a>, but also subsequent mortality.</p>
<p>Given the importance of diabetes, it is up to every person, society and country to recognise the disease as a major threat to well-being and actively take opportunities for diabetes prevention or face an overwhelming health crisis. Here in Australia, the recently released <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/nds-2016-2020">National Diabetes Strategy</a> outlines many of the first steps needed.</p><img src="https://counter.theconversation.com/content/57874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merlin Thomas receives funding from NHMRC and JDRF</span></em></p><p class="fine-print"><em><span>Paul Zimmet does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Diabetes is a leading cause of death as well as of heart attacks, strokes, amputations, kidney failure, depression and severe infections – all of which themselves contribute to premature death.Merlin Thomas, Adjunct Professor of Preventive Medicine, Baker Heart and Diabetes InstitutePaul Zimmet, Professor (Hon) at Monash University, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/589262016-06-08T20:09:47Z2016-06-08T20:09:47ZHow Australians Die: cause #4 – chronic lower respiratory diseases<figure><img src="https://images.theconversation.com/files/123510/original/image-20160523-9565-qwyae1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic obstructive pulmonary disease (COPD) is responsible for the majority of deaths from chronic lower respiratory diseases.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This is the fourth in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the fifth leading cause of death: diabetes. You can read yesterday’s piece on dementia <a href="https://theconversation.com/how-australians-die-cause-3-dementia-alzheimers-57341">here</a>.</em></p>
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<p>Chronic lower respiratory diseases are a group of conditions affecting the lungs. The group is <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">the fourth leading cause of death</a> in Australia. </p>
<p>The three main contributors to the death rate from chronic respiratory diseases are: chronic obstructive pulmonary disease (COPD), asthma and bronchiectasis or permanent damage to the airways. </p>
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<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is number 3, respiratory diseases number 4 and diabetes number 5.</figcaption></figure>
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<h2>Lung basics</h2>
<p>The lung is like an upside-down tree where the wind pipe (trachea) is the trunk and the bronchi are the branches that get smaller as they branch out deep into the lung. Chronic lower respiratory diseases affect the branches.</p>
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<img alt="" src="https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The lung is like an upside-down tree.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Damage to these from toxins, chronic infection or inflammation affects the function of the whole lung. Millions of tiny air sacs (alveoli) are like the leaves surrounded by a network of tiny blood vessels (capillaries). These transport oxygen from the lung to the body via the circulatory system.</p>
<p>If air can’t reach the alveolar air sacs, oxygen can’t be absorbed, body tissues can’t be fuelled and waste gases can’t be expelled efficiently. As compensation, the brain sends signals to increase our breathing, which we experience as feeling short of breath.</p>
<h2>Chronic obstructive pulmonary disease (COPD)</h2>
<p>Chronic obstructive pulmonary disease (COPD) is responsible for the majority of deaths from chronic lower respiratory diseases. In 2014, nearly 7,000 deaths were attributable to COPD and emphysema combined, compared to 411 from asthma. Around 7.5% of people over 40 are <a href="http://www.ncbi.nlm.nih.gov/pubmed/23418694">estimated to have COPD</a> in Australia.</p>
<p>Although factors like pollution can influence the development of COPD, in Australia, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">cigarette smoke is the largest contributor</a> and it is often thought of as smoker’s lung disease. </p>
<p>COPD is characterised by irreversible narrowing of the bronchi. Chronic inflammation scars and thickens the bronchial walls, obstructing the air flow in and out of the lung. Emphysema is technically a description of the destruction of the alveolar sacs, while COPD is the name given to the disease as a whole, which includes both the bronchial narrowing and the emphysema.</p>
<p>The majority of people with COPD will actually die <a href="http://www.ncbi.nlm.nih.gov/pubmed/16236937">from heart disease</a> – which is the biggest killer in Australia as a whole and is particularly common in people with COPD. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16807258">COPD as cause of death</a> is also likely to be under-reported. </p>
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<p>Even with the under-reporting, the rate of death from COPD is increasing, as opposed to the rate of death from heart disease, which <a href="http://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">has decreased</a> over the last few decades. In 2014, <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02014?OpenDocument">COPD accounted for</a> 4.5% of all deaths, compared to 3.7% in 2005.</p>
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<p>This is mainly due to COPD being associated with ageing, so it’s expected death rates will increase as our population ages. But the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/tobacco/">main preventable risk</a> factor for COPD is cigarette smoking. And while levels in Australia are at a record low, there is a long lag effect, which means we are still seeing results of past high smoking rates coming through. </p>
<p>Lastly, we still have no effective treatments that decrease death from COPD, just those that help with symptoms. The only intervention shown conclusively to reduce death from COPD is quitting smoking. Thankfully, this intervention also reduces the risk of death from other diseases such as heart disease and stroke – which will help people with COPD live longer.</p>
<h2>Asthma</h2>
<p>Compared to COPD, the death rate due to asthma is very low. Asthma is also a disease of the bronchi characterised by acute episodes or “attacks” of bronchial narrowing and obstruction of air flow. </p>
<p>About <a href="http://www.aihw.gov.au/asthma/prevalence/">10% of Australians</a>, or around 2.3 million people, suffer from asthma. Long-standing asthma – which usually begins in childhood – can lead to permanent or irreversible narrowing of the bronchi, particularly if inadequately treated. It may then begin to resemble COPD.</p>
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<a href="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=702&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=702&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=702&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=882&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=882&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=882&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Preventer puffers are the main line of treatment for chronic asthma.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>While the rate of asthma cases has increased over the last few decades, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18827152">rate of death</a> from asthma has decreased. Preventer puffers containing steroid medication are the main line of treatment for chronic asthma. They decrease inflammation inside the asthmatic lung and have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/10922423">shown to prevent</a> death from asthma, as well as improve symptoms and maintain normal lung function. </p>
<p>Death from asthma in Australia now accounts for less than 0.3% of all deaths, or only 1.5 deaths per 100,000 people in 2014. This represents a success story in the management of chronic lower respiratory diseases.</p>
<h2>Bronchiectasis</h2>
<p>Bronchiectasis (from the Greek <em>ektasis</em>, or stretching) is different to bronchitis, which is just inflammation of the bronchi commonly caused by viruses. Brochiectasis occurs when damage to supporting tissue structures of the bronchi make the walls go floppy and enlarge, instead of maintaining their small tubular structure. Dilated bronchi operate inefficiently as mucus collects inside them rather than being expelled, creating an ideal environment for infections. </p>
<p>The disease is characterised by chronic moist cough with phlegm, recurrent infections and breathlessness. Death is often due to complications of the disease, such as infection or major bleeding from the lungs.</p>
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<p>In the general Australian community, bronchiectasis accounts for only 0.2% of all deaths, or 1.3 deaths per 100,000 people. In the Aboriginal and Torres Strait Islander population, the death rate is <a href="http://www.thoracic.org.au/">around six times</a> that of non-indigenous Australians. </p>
<p>Early respiratory infection in Aboriginal and Torres Strait Islanders probably explains its higher prevalence there; partly as a result of bacterial accumulation in the nasal passage from living in close quarters, general social disadvantage and poor access to health care.</p>
<h2>Can we drive down the death rate?</h2>
<p>Finding effective treatments is essential if we want to decrease the death rate from COPD. Until then, prevention – mainly by reducing smoking rates – remains the only hope. </p>
<p>Continuing our success in driving down the asthma death rate relies on encouraging people with asthma to take their prescribed treatments, which are proven to be effective at reducing death, and by addressing the disease’s underlying causes.</p>
<p>Finally, addressing the disparity in death due to bronchiectasis between our Indigenous and non-Indigenous communities by improving living standards and access to health care must be a high priority.</p><img src="https://counter.theconversation.com/content/58926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Milne receives funding from the National Health and Medical Research Council</span></em></p>The lung is like an upside-down tree where the wind pipe is the trunk and the bronchi are the branches. Chronic lower respiratory diseases affect these branches.Stephen Milne, Respiratory and Sleep Medicine Physician, Researcher, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/573412016-06-07T20:19:06Z2016-06-07T20:19:06ZHow Australians Die: cause #3 – dementia (Alzheimer’s)<figure><img src="https://images.theconversation.com/files/123325/original/image-20160520-4484-j763ej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dementia can affect the ability to perform tasks such as dressing, showering and eating.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This is the third in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the fourth leading cause of death: chronic lower respiratory diseases. You can read yesterday’s piece on cancers <a href="http://theconversation.com/how-australians-die-cause-2-cancers-58063">here</a>.</em></p>
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<p>In Australia, dementia is the third leading cause of death after heart disease and cancers. Typically, people with dementia deteriorate gradually and eventually die from complications such as respiratory failure – from pneumonia for instance – or other infections. Dementia will in these cases be registered as the underlying cause of death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=192&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=192&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=192&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=241&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=241&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=241&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>Dementia is a general term for severe disorders with mental decline. Subtypes include Lewy body dementia, vascular dementia (with cerebrovascular disease) and fronto-temporal dementia. Of these types, Alzheimer’s disease is the most <a href="http://cargocollective.com/ritamaldonadobranco/Visualising-dementia">common diagnosis of dementia</a>, accounting for 50-75% of all cases. As such, Alzheimer’s disease and dementia are often used interchangeably.</p>
<p>As the population ages, the number of people with dementia is expected to rise, as is the number of deaths caused by the disease.</p>
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<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is number 3, respiratory diseases number 4 and diabetes number 5.</figcaption></figure>
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<h2>History of Alzheimer’s dementia</h2>
<p>Alzheimer’s disease <a href="http://info-centre.jenage.de/assets/pdfs/library/stelzmann_et_al_alzheimer_CLIN_ANAT_1995.pdf">was first reported</a> by German psychiatrist Alöis Alzheimer in 1906. After comparing autopsy reports of some of his patients, he described the presence of two abnormal brain structures made up of accumulated clusters of sticky proteins between nerve cells. </p>
<p>These abnormally accumulated proteins are considered the classic pathological hallmarks of the disease. </p>
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<img alt="" src="https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1118&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1118&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120646/original/image-20160429-20160-1ix10ki.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1118&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Alzheimer’s disease is named after psychiatrist Alois Alzheimer.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AAlois_Alzheimer_003.jpg">Wikimedia Commons</a></span>
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<p>About 5% of <a href="http://www.mayoclinic.org/alzheimers/art-20048356">dementia cases show early onset</a> or familial inheritance, where dementia develops before the age of 65, sometimes in adults as young as 35. However, the disease most commonly presents as the age-related dementia with which we are familiar. </p>
<p>The frequency of the disease is markedly increased in adults over 65. After this age, <a href="https://www.alz.org/downloads/facts_figures_2012.pdf">it doubles every six-and-a-half years</a>. It ultimately affects one-third of those older than 85. </p>
<h2>Dementia signs and symptoms</h2>
<p>Dementia can take several years to develop. It is often categorised as mild (early stage), moderate (mid stage) and advanced (late stage). Symptoms include:</p>
<ul>
<li><p>cognitive impairment: problems with memory, communication, comprehension and ability to recognise familiar objects and people</p></li>
<li><p>psychiatric or behavioural symptoms: severe depression, delusions and hallucinations (visual and auditory), and increased aimless wandering, agitation and confusion</p></li>
<li><p>dysfunction in daily living activities: in the earlier stages of dementia, the ability to perform routine tasks such as shopping may be disrupted. Dementia in the later stages can affect the ability to perform more basic tasks such as dressing, showering and eating.</p></li>
</ul>
<p>People living with dementia may have different symptoms at various times, depending on the person and the parts of the brain affected. </p>
<p>There is no single established screening test to accurately diagnose dementia. Neurologists use reports from physical examinations, memory or cognitive tests, caregiver interviews, questionnaires, medical histories, genetic tests and brain scans.</p>
<p>Risks of dementia include having a family history of the disorder, a <a href="https://fightdementia.org.au/sites/default/files/20070900_Nat_NP_13DemRiskRedEvidence.pdf">history of repeated head trauma</a> and lifestyle factors, such as hypertension, uncontrolled diabetes, high cholesterol, <a href="https://www.sciencedaily.com/releases/2014/03/140310102208.htm">poor cardiovascular fitness</a> and atherosclerosis. Moderate exercise and controlled weight <a href="https://www.sciencedaily.com/releases/2013/12/131209181059.htm">can reduce the risks</a> of cognitive impairment and dementia.</p>
<p>Studies <a href="https://books.google.com.au/books?id=L4YQ50SbBnsC&pg=PA249&lpg=PA249&dq=Longitudinal+effects+of+estrogen+replacement+therapy+on+PET+cerebral+blood+flow+and+cognition&source=bl&ots=1XzLNsUXXE&sig=Kh4tz_CF7pib-GKoDnptDj0g4Zo&hl=en&sa=X&ved=0ahUKEwjkjY6F2KnMAhUDMKYKHVRaCcAQ6AEINTAF#v=onepage&q=Longitudinal%20effects%20of%20estrogen%20replacement%20therapy%20on%20PET%20cerebral%20blood%20flow%20and%20cognition&f=false">have also shown being female</a> can put you at higher risk of cognitive decline. The exact reasons for this are somewhat controversial. It could be because risk increases with age and women tend to outlive men. </p>
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<p>But some evidence shows that the risk increases parallel to a reduction in female hormone production after menopause, so the incidence is <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">slightly higher</a> in women after the age of 75. Female hormones are known to <a href="https://books.google.com.au/books?id=L4YQ50SbBnsC&pg=PA249&lpg=PA249&dq=Longitudinal+effects+of+estrogen+replacement+therapy+on+PET+cerebral+blood+flow+and+cognition&source=bl&ots=1XzLNsUXXE&sig=Kh4tz_CF7pib-GKoDnptDj0g4Zo&hl=en&sa=X&ved=0ahUKEwjkjY6F2KnMAhUDMKYKHVRaCcAQ6AEINTAF#v=onepage&q=Longitudinal%20effects%20of%20estrogen%20replacement%20therapy%20on%20PET%20cerebral%20blood%20flow%20and%20cognition&f=false">play a protective role</a> in cardiovascular function, cognition and memory.</p>
<h2>Disease burden</h2>
<p>It is <a href="http://www.alz.co.uk/research/world-report-2015">estimated that, in 2015</a>, 47 million people had dementia globally. These numbers are projected to double every two decades and reach 131.5 million by 2050.</p>
<p>In the United States, dementia was the second leading cause of death after heart disease in 2014. While the <a href="http://www.cdc.gov/nchs/products/databriefs/db233.htm">number of deaths from dementia</a> increased by 119% from the year 2000, rates of deaths from heart disease dropped by 24% over the same period. </p>
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<p>The number of Australians living with dementia is more than <a href="https://fightdementia.org.au/about-us/media/key-facts-and-statistics">353,800</a> (around 1.5% of the total population). This is <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">projected to increase to 553,000</a> by 2030. The projections may be conservative as the current number is actually higher than the number (329,243) projected <a href="https://fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf">in 2011</a>.</p>
<p>The <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422943">total direct cost</a> of dementia to the Australian health and aged care system was estimated to be more than A$4.9 billion in the 2009-10 financial year. <a href="http://apo.org.au/resource/residential-aged-care-australia-2008-09">Nearly 59%</a> of residential aged care expenditure was spent on dementia patients in June 2009.</p>
<p>A firm diagnosis usually occurs three years after noticeable symptoms are manifested and noticed by family members. This is often at the early to mid stage of the disease. From this stage, the only management available is the possible alleviation of symptoms with prescription drugs – although depending on the person and disease severity, these might help little.</p>
<p>It is critical we identify those at risk so that timely medical interventions can be provided before dementia onset, with the possibility of delaying the onset. This would considerably reduce the time people live with dementia and the overall associated disease burden. It’s estimated a delay of dementia onset by five years would reduce the <a href="http://www.alzheimersresearchuk.org/treatment-to-delay-dementia-by-five-years-would-reduce-cases-by-33/">number of cases by a third</a>. </p>
<p>The best current approach to the dementia epidemic is to promote a healthy lifestyle from an early age as poor cardiovascular fitness in teenage years is <a href="https://www.sciencedaily.com/releases/2014/03/140310102208.htm">predicted</a> to increase dementia risk.</p>
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<p><em>Correction: a decimal point was missing from the prevalence of dementia in Australia so it read 15% instead of 1.5%. This has now been amended.</em></p><img src="https://counter.theconversation.com/content/57341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siva Purushothuman receives funding from National Health and Medical Research Council (NHMRC) & Australian Research Council (ARC). </span></em></p>Dementia is the third leading cause of death in Australia. As the population ages, the number of people with dementia is expected to rise, as is the number of deaths from dementia.Siva Purushothuman, NHMRC Postdoctoral Fellow, Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/580632016-06-06T20:06:44Z2016-06-06T20:06:44ZHow Australians Die: cause #2 – cancers<figure><img src="https://images.theconversation.com/files/122434/original/image-20160513-27184-134upnp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Age-standardised cancer death rates have been falling in Australia.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This is the second in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the third leading cause of death: Alzheimer’s. You can also read our first article on <a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">heart diseases and stroke</a>.</em></p>
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<p>Described as <a href="http://www.amazon.com/The-Emperor-All-Maladies-Biography/dp/1439170916">“The Emperor of All Maladies”</a> by Pulitzer Prize-winning author and researcher <a href="http://authors.simonandschuster.com/Siddhartha-Mukherjee/49784674">Siddartha Mukherjee</a>, cancer is often seen as a modern disease. But scientists have found evidence of it in <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131/">dinosaur fossils</a> and human cases appear in literature spanning four millennia. </p>
<p>The Egyptian physician Imhotep <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997531/">vividly described advanced breast cancer</a> in 2600 BC as “<a href="https://books.google.com.au/books?id=hgx0sJvphNkC&pg=PA40&lpg=PA40&dq=cool+hard+dense+as+hemat+fruit&source=bl&ots=1FQSiRjT-C&sig=ZgjwyopC7l-WgIh-xJF1s6IVGfM&hl=en&sa=X&ved=0ahUKEwjZ_emD3pLNAhVJo5QKHV1JBYkQ6AEIHDAA#v=onepage&q=cool%20hard%20dense%20as%20hemat%20fruit&f=false">a bulging mass in the breast</a>”: cool, hard and spreading beneath the skin. Under the section “Therapy”, Imhotep solemnly recorded: “<a href="https://books.google.com.au/books?id=hgx0sJvphNkC&pg=PA40&lpg=PA40&dq=cool+hard+dense+as+hemat+fruit&source=bl&ots=1FQSiRjT-C&sig=ZgjwyopC7l-WgIh-xJF1s6IVGfM&hl=en&sa=X&ved=0ahUKEwjZ_emD3pLNAhVJo5QKHV1JBYkQ6AEIHDAA#v=onepage&q=%22there%20is%20none%22&f=false">There is none.</a>”</p>
<p>An early modern <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128854/pdf/medcht00065-0003.pdf">publication on cancer comes from 1818</a>. Written by physician George Wagstaff, it includes a number of gruesome case studies such as that of “fungus haematodes”, or blood fungus in the lungs. </p>
<p>Since then, more than three million scientific papers have been published on the subject, 159,000 of them in 2015 alone.</p>
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<p>Between 1968 and 2013 <a href="http://www.aihw.gov.au/acim-books/">cancer deaths in Australia</a> increased from 17,032 to 44,308, a rise of 160%. However, taking into account the increase in population (94%) and the increase in average age (34%) over the same period, there has been a decline in the age-standardised cancer death rate overall in Australia. The chance of a cancer death before the age of 75 in 1968 was 12.8%. This has fallen to 9.4% in 2013.</p>
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<p>Cancer is made up of around 200 distinct illnesses united by the uncontrolled growth of human cells. The diversity of mechanisms by which different cancer types both grow and evade treatment means that many separate breakthroughs will be required to combat all cancers.</p>
<p>Currently, seven cancer types are listed in the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">top 20 causes of death</a> in Australia. These are cancers of the lung, blood and lymph, bowel, prostate, breast, pancreas and skin.</p>
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<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is number 3, respiratory diseases, number 4 and diabetes, number 5.</figcaption></figure>
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<h2>Lung cancer</h2>
<p>This is the number one cancer killer, ranking number four in overall causes of death. <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129555176">Most (80%) lung cancers are still attributable to tobacco smoking</a>, either directly or through passive smoking. Australia is leading the world in reducing smoking rates and fewer than 13% of <a href="http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-3-prevalence-of-smoking-adults">Australian adults now smoke</a>, with fewer lung cancer cases as a result.</p>
<p>Sadly, lung cancer survival remains poor due in part to late detection. Less than 15% of people are still alive five years after diagnosis although new <a href="http://bmcpulmmed.biomedcentral.com/articles/10.1186/1471-2466-12-77">immunotherapy treatments</a> that help the immune system destroy cancer cells are prolonging survival for some patients. </p>
<p>Also, <a href="http://www.ncbi.nlm.nih.gov/pubmed/26763803">trials screening people at high risk</a>, particularly smokers, using chest CT scans are showing promise in catching the disease earlier and at a more curable stage.</p>
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<img alt="" src="https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/122435/original/image-20160513-27184-hjnzfw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most lung cancers are attributable to tobacco smoke.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/kylesatori/4650255057/in/photolist-85VLPk-6zcf1r-pCJrZ7-8P8iX-7jzoZ8-55ZgRD-bmiUwX-caLjtm-bV7KzN-8ZDpWJ-6hzGDX-nzVzhZ-6hzGKD-nu9cJ-5THWVF-csEp2u-pcbutn-cx35sj-GGW4-RmCwd-ouvRb4-6txjrq-nk8yxk-cQjrzu-6LkHp3-fhGr8v-qYBCkY-9E8Ros-DcrJk-cepTSU-cPCph5-9P6oma-a7q6zT-Btw3To-9sRHm4-64L1oM-8JBeip-7Xutv2-dpHHp4-ptDVJf-jtjAc-aaR9Af-jtjAb-6TPX8J-7jz8aF-5FDUvv-dm6vt-67K1Ww-a8Bf8a-9vhUju">Bruno de Souza Leão/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Blood and lymph cancer (including leukaemia)</h2>
<p>Cancers of the lymph glands (lymphomas) affect the body’s infection fighting mechanism and come in two types: Hodgkin and Non Hodgkin lymphoma. Blood cancers are called leukaemia and classified as either acute (fast growing) or chronic (slow growing). </p>
<p>Combined, these cancers are referred to as haematological cancers and they caused 4,275 deaths in Australia in 2013 (made up mostly of lymphoma and leukaemia caused deaths). For each, there are <a href="http://www.nhs.uk/ipgmedia/national/Lymphoma%20Association/Assets/Leukaemiaandlymphoma-thedifference.pdf">sub types with different features</a>, treatments and survival rates. Little is known about the causes of these cancers but survival is improving for many types.</p>
<h2>Large bowel cancer</h2>
<p>In 2014, 4,169 people died of bowel cancer (0.9% chance of death before age 75) compared to 2,500 in 1968 (1.9%). These cancers can often be treated successfully if found early through faecal blood testing such as in the <a href="http://www.cancerscreening.gov.au/bowel">National Bowel Cancer Screening Program</a>. </p>
<p>However, since the program began in 2006, <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/nbcsp-fact-sheet">only 40% of those invited have done the test</a>. Despite men being diagnosed more, at a later stage and being more likely to die from bowel cancer, they are less likely than women to participate.</p>
<hr>
<iframe src="https://datawrapper.dwcdn.net/BXwCm/3/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="530"></iframe>
<hr>
<h2>Prostate cancer</h2>
<p>In 2014, 3,102 Australian men died of prostate cancer, up from 963 in 1968. Diagnosis and death are rare for those under 50 but the disease becomes increasingly common in older men with over half of prostate cancer deaths occurring after 80. Causes are unknown making preventative options hard to identify.</p>
<p>Although diagnosis is common, only one in six men who are diagnosed die of prostate cancer. The five year <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545133">survival rates exceed 90%</a>, giving prostate cancer the reputation of being a disease one dies with rather than from. However the large number of cases, particularly in much older men, mean it remains a major cancer killer.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=719&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=719&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=719&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=904&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=904&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125248/original/image-20160605-11620-1340d2z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=904&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More breast cancers are not being detected at a curable stage.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Surgery and <a href="http://www.cancer.org.au/about-cancer/after-a-diagnosis/after-a-diagnosis-of-prostate-cancer.html">radiotherapy are the most common</a> treatments. Hormone therapy, recently combined at the beginning with chemotherapy, can often control more widespread disease for long periods. </p>
<h2>Breast cancer</h2>
<p>Perhaps the highest-profile cancer, progress in breast cancer has been strong. However, 2,844 Australians, including about 30 men, still died of breast cancer in 2014 in Australia. </p>
<p>Breast cancer is now divided into <a href="https://www.bcna.org.au/understanding-breast-cancer/types-of-breast-cancer/">different sub-types</a>, each with its own behaviour. Understanding this has allowed more personalised therapy for many patients, which has improved treatment outcomes.</p>
<p>Mammographic screening has <a href="http://www.abc.net.au/health/features/stories/2014/03/14/3962769.htm">attracted some controversy</a> because of possible over-diagnosis. But with participation rates well above 50%, and more cancers being detected at more curable stages, it has likely contributed to the rise of five year survivals to 90%.</p>
<h2>Pancreatic cancer</h2>
<p>Little progress has been made in pancreatic cancer that took 2,547 Australians in 2014, compared to <a href="http://www.aihw.gov.au/acim-books/">797 in 1968</a>. Smoking, obesity and some pesticides can contribute to pancreatic cancer risk. </p>
<p>An absence of signs and tests make early detection uncommon and little progress has been made in identifying important drivers of pancreatic cancer growth. As diagnosis often occurs at an advanced stage and focused treatments are lacking, outcomes are poor with a <a href="http://www.cancer.org.au/about-cancer/types-of-cancer/pancreatic-cancer.html">five year survival rate of only 5%</a>.</p>
<h2>Skin cancers</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=722&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=722&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=722&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=908&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=908&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125249/original/image-20160605-11620-re3k4r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=908&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Melanoma is the leading cause of skin cancer deaths.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Of the 2,067 skin cancer deaths, approximately 1,600 were due to melanoma while non-melanoma skin cancer (NMSC), a far more common but less lethal form, claimed the others in 2014. Excessive ultraviolet radiation from sunlight remains the main cause for both.</p>
<p>Recently, New Zealand surpassed Australia <a href="http://www.jidonline.org/article/S0022-202X%2816%2900488-7/pdf">as the number one skin cancer nation</a> in the world. Melanoma cases are falling in Australia, probably due to prevention efforts.</p>
<p>Generally, treatment of early stage disease is highly successful with a greater than 95% five year survival rate. Even for advanced melanoma, <a href="http://www.cancerresearch.org/cancer-immunotherapy/impacting-all-cancers/melanoma">new immunotherapy treatments are increasing survival times</a>.</p><img src="https://counter.theconversation.com/content/58063/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terry Slevin works for Cancer Council WA and serves as a spokesperson for Cancer Council Australia. He has been an investigator on various cancer research projects funded by state and national research funding organisations.
</span></em></p><p class="fine-print"><em><span>Andrew Redfern receives funding from the Cancer Council WA and the Health Department of WA.</span></em></p>Currently, seven cancer types are listed in the top 20 causes of death in Australia. These are cancers of the lung, blood and lymph, bowel, prostate, breast, pancreas, skin and some childhood cancers.Terry Slevin, Adjunct Professor, School of Psychology and Speech Pathology, Curtin University; Education and Research Director, Cancer Council WA; Chair, Occupational and Environmental Cancer Committee, Cancer Council AustraliaAndrew Redfern, Senior Lecturer, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/574232016-06-05T20:13:25Z2016-06-05T20:13:25ZHow Australians Die: cause #1 – heart diseases and stroke<figure><img src="https://images.theconversation.com/files/121141/original/image-20160504-17469-fbouxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coronary heart disease is almost always a consequence of atherosclerosis; a build-up of cholesterol and other material in the walls of our arteries.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/vew82/5910555470/in/photolist-a1i9dN-8MeYS-5itxYQ-8Mf6N-ntvCBZ-8MfeT-8Mf9L-dJ3ZVb-XuYAA-8Mf51-d3Xmsd-8vnBTK-bcCkNt-7TZXuM-e7iHvG-bfRdFr-m6AhLv-ebeA5u-8MeVC-dzPTir-8Mfc6-8WbJw1-atLYqg-54KNnr-bo7gek-dFdHyG-bwaPai-aEefJM-g6kg18-dQwzs2-ZDFqM-ak4hWX-dRRK7S-2LPkBE-5TG7MD-87yj3r-c5p7Eh-Kwtws-7yQgJG-8RathX-oZPprA-7RrcWR-ejqjh3-dhJHxb-sac6fL-7XoAQs-9UKpqH-5ySRtD-5ySRTF-5ySRiz">Heart Attack Heaven/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>This is the first in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the second leading cause of death: cancers.</em></p>
<hr>
<p>Diseases of the heart and the vessels running to and from it are the number one reason people die in Australia, and we’re not alone. They are the number one cause of death in the world. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=192&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=192&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=192&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=241&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=241&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=241&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>According to the Australian Bureau of Statistics, ischaemic heart disease (IHD) is the leading <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">cause of death in Australia</a>. In 2014, 20,173 people died from it. </p>
<p>But ischaemic heart disease is not really the disease itself. Rather, it is the term used to cover the clinical manifestations of coronary heart disease such as heart attacks and angina. </p>
<hr>
<iframe src="https://datawrapper.dwcdn.net/bYUpC/3/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="930"></iframe>
<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is third, respiratory diseases fourth and diabetes fifth.</figcaption></figure>
<hr>
<h2>Coronary heart disease</h2>
<p>Coronary heart disease is almost always a consequence of atherosclerosis. This is a build-up of cholesterol and other material in the walls of our arteries (tubes that carry blood and oxygen to the heart). The build-up can cause heart attack and block access to the brain, leading to stroke – another of Australia’s top killers.</p>
<p>Ischemia describes insufficient oxygen supply to the heart muscle. Lack of oxygen can cause discomfort in the chest, <a href="http://heartfoundation.org.au/your-heart/heart-conditions/angina">such as a tightness or squeezing</a> known as angina. This is most often brought on by exercise but is more serious when it happens at rest.</p>
<p>Persistence of angina over time, particularly at rest, can lead to death of some heart muscle. This is called an acute coronary syndrome, or colloquially, a heart attack. We used to call this myocardial infarction. No wonder people find the terminology confusing.</p>
<hr>
<iframe src="https://datawrapper.dwcdn.net/PqXaH/3/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="525"></iframe>
<hr>
<p>The Australian Bureau of Statistics <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">classifies ischaemic heart disease</a> as the leading cause of death in Australia. Cerebrovascular diseases (stroke) are the third, heart failure is at number seven; hypertensive diseases are at 13, and cardiac arrythmias at 19.</p>
<p>But there is considerable overlap among these, which is why this article has combined them under one umbrella. Hypertension (high blood pressure), for instance, is a major cause of stroke and a risk factor for coronary disease. At least half of heart failure is due to coronary heart disease, while the most common cardiac arrhythmia (irregular heartbeat), atrial fibrillation, is often caused by hypertension, heart failure or coronary heart disease. Further, atrial fibrillation is the cause of about one-third of strokes. </p>
<p>Although ischaemic heart disease is responsible for 20,173 deaths in 2014, the number of deaths due to the above circulatory diseases in 2014 was 38,741.</p>
<h2>History of heart disease</h2>
<p>Heart disease is not new. CT <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1034676/">scans of Egyptian mummies</a> who lived 3,500 years ago show they had narrowings in their arteries, which means they had coronary heart disease. Pharaoh Merneptah, for instance, who died in 1203 BC, had severe coronary disease. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=853&fit=crop&dpr=1 600w, https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=853&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=853&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1072&fit=crop&dpr=1 754w, https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1072&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/120489/original/image-20160428-30950-1mg4r3b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1072&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">CT scans show Pharaoh Merneptah had atherosclerosis.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/9/9b/Merneptah_mummy.png">G. Elliot Smith/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/7419332">real and documented epidemic of heart disease</a> occurred after the second world war. This could in part be explained by higher rates of smoking, blood pressure and poor diets after and during the war. Rates increased for three decades at this time. </p>
<p>Then they fell; first in Australia and the United States, and then in other developed countries. Half of this fall could be attributed to public health measures such as tobacco control and availability of blood pressure and cholesterol treatments; the other half to better treatment of people with heart disease.</p>
<p>A province of Finland, North Karelia, initially held the dubious record for the highest rates of heart disease in the world. In the early 1970s, the region had <a href="http://www.ncbi.nlm.nih.gov/pubmed/9803593">around 672 per 100,000 people</a> dying from heart disease. The mantle then passed to <a href="http://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/">Eastern Europe and Russia</a> where rates are currently 320 per 100,000 people. This is astounding compared to Australia where the rate is 54 per 100,000.</p>
<p>In 1990, heart disease was the third-highest cause of death in developing countries, but by 2013 it was number one. The rates rose from 70 per 100,000 people to 91 per 100,000 people in those years respectively. This is because the developing world acquired the habits of the developed world. There are now <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30054-X/abstract">more people in the world</a> who are overweight than underweight.</p>
<p>Hypertensive diseases are rising in most developing countries, together with diabetes, while smoking remains common. Infections and trauma used to cause death in people too young to have heart disease, but that is no longer the case due to antibiotics, immunisations and better safety standards. </p>
<p>In 1990, there were 12.3 million deaths globally from heart disease. By 2013, this <a href="http://www.world-heart-federation.org/heart-facts/fact-sheets/">had risen to 17.3 million</a>. Most of this 40.8% increase occurred in developing countries and in disadvantaged people in developed countries like Australia.</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=549&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=549&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=549&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=690&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=690&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123959/original/image-20160525-25213-uhv0yu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=690&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2014~Main%20Features~Summary%20of%20Findings~1">ABS Causes of Death, Australia, 2014</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
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<p>Every country in the world is at some point in the transition from low to high to medium rates of heart disease related to their stage of development. There is nothing inevitable about heart disease being the number one cause of death in Australia or the world as a whole.</p>
<p>The stereotype of a harassed executive having a heart attack no longer applies. Heart disease has become a blue-collar disease or one seen initially in urban populations in developing countries.</p>
<h2>Where to from here?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=321&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=321&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=321&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=403&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=403&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121142/original/image-20160504-9426-122ukqq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=403&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The documented epidemic of heart disease occurred after the second world war.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/vew82/5910555470/in/photolist-a1i9dN-8MeYS-5itxYQ-8Mf6N-ntvCBZ-8MfeT-8Mf9L-dJ3ZVb-XuYAA-8Mf51-d3Xmsd-8vnBTK-bcCkNt-7TZXuM-e7iHvG-bfRdFr-m6AhLv-ebeA5u-8MeVC-dzPTir-8Mfc6-8WbJw1-atLYqg-54KNnr-bo7gek-dFdHyG-bwaPai-aEefJM-g6kg18-dQwzs2-ZDFqM-ak4hWX-dRRK7S-2LPkBE-5TG7MD-87yj3r-c5p7Eh-Kwtws-7yQgJG-8RathX-oZPprA-7RrcWR-ejqjh3-dhJHxb-sac6fL-7XoAQs-9UKpqH-5ySRtD-5ySRTF-5ySRiz">AV Dezign | www.avdezign.ca/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Today (and for the foreseeable future) global rates of heart disease are driven by development, inequality and prosperity. The rate of heart disease deaths was <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">almost double for Australians</a> in the lowest socioeconomic group compared to the highest socioeconomic group, and 20% more for those living in remote to very remote regions compared to those in major cities. They were 40% higher for Indigenous Australians compared to their non-Indigenous counterparts.</p>
<p>For years, we have been comforted by falling rates of heart disease deaths in Australia. But as the population increases, ages and people survive diseases such as cancer earlier in life, the burden on the health system has not been falling to the extent that rates would suggest.</p>
<p>Alarmingly, in people aged 55-69 both rates and the absolute number of people dying from heart disease have increased, according to the latest data.</p>
<p>As Australia has become one of the fattest nations in the world, with rates of diabetes increasing and other metabolic consequences leading to heart disease, overweight and sedentary men and women with multiple risk factors have replaced the thin male smokers who died of heart disease in the 50s.</p><img src="https://counter.theconversation.com/content/57423/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Garry Jennings receives funding from the National Health and Medical Research Council. He is affiliated with Baker IDI Heart & Diabetes Institute, The National Heart Foundation, Alfred Health and Monash University. </span></em></p>Global deaths from heart disease rose from 12.3 million in 1990 to 17.3 million in 2013. Most of the increase occurred in developing countries and in disadvantaged people in developed countries.Garry Jennings, Chief Medical Advisor at National Heart Foundation of Australia; Senior Director, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.