Abstract and Background
Abstract
Background: An increasing proportion of Australia's chronic disease burden is carried by the ageing male. The aim of this study was to determine the prevalence of asthma, cancer, diabetes, angina and musculoskeletal conditions and their relationship to behavioural and socio-demographic factors in a cohort of Australian men.
Methods: Self-reports of disease status were obtained from baseline clinic visits (August 2002 – July 2003 & July 2004 – May 2005) from 1195 randomly selected men, aged 35–80 years and living in the north-west regions of Adelaide. Initially, relative risks were assessed by regression against selected variables for each outcome. Where age-independent associations were observed with the relevant chronic disease, independent variables were fitted to customized multiadjusted models.
Results: The prevalence of all conditions was moderately higher in comparison to national data for age-matched men. In particular, there was an unusually high rate of men with cancer. Multiadjusted analyses revealed age as a predictor of chronic conditions (type 2 diabetes mellitus, angina, cancer & osteoarthritis). A number of socio-demographic factors, independent of age, were associated with chronic disease, including: low income status (diabetes), separation/divorce (asthma), unemployment (cancer), high waist circumference (diabetes), elevated cholesterol (angina) and a family history of obesity (angina).
Conclusion: Socio-demographic factors interact to determine disease status in this broadly representative group of Australian men. In addition to obesity and a positive personal and family history of disease, men who are socially disadvantaged (low income, unemployed, separated) should be specifically targeted by public health initiatives.
Background
Almost four out of five Australians have at least one long-term health condition. National expenditure on chronic disease and associated care now accounts for over two thirds of the entire health care budget. Many of these diseases are preventable through the modification of the risk factors that contribute to their development. In Australia, the National Chronic Disease Strategy (NCDS) has driven a renewed focus on the determinants and settings that promote the development of chronic conditions, particularly those that relate to the designated National Priority Areas of asthma, cancer, cardiovascular disease, diabetes and musculoskeletal conditions. Much of this focus has centred on eliminating many of the health inequalities that persist in our population. To date however, the disproportionate disease burden carried by men, particularly the ageing male, has received little attention.
In Australia, as elsewhere, men display poorer health outcomes when compared with women. The problems of male health in Australia reflect those increasingly noted in other developed nations. Men in Australia have a lower life expectancy than women (76.6 years compared with 82.0 years) with higher rates of mortality at all ages, a discrepancy that begins from birth. There is a disproportionate level of chronic physical and psychological disease in Australian men and higher rates of illness-related disability. In addition, men display a higher prevalence of the major risk factors – smoking, lack of physical activity, poor nutrition and alcohol abuse – linked to the development of most major chronic diseases. When combined with a reduced likelihood of adopting a healthy lifestyle and a resistance to public health messages, the health and behaviour of ageing males in Australia should be an urgent concern.
Of the disease groups targeted by the NCDS, only musculoskeletal conditions have a lower prevalence in men at all ages as compared to Australian women (with current indications that the incidence of rheumatoid- and osteo-arthritis in men aged over 60 is increasing faster than that of age-matched females). Cardiovascular disease (CVD), the leading cause of death and disability in Australia, strikes more men than women across the entire age spectrum, with death rates among males aged 25–74 years two to three times that of females. The rates of asthma in Australia are amongst the highest in the world and whilst the prevalence is greater in males than females during childhood, this reverses through the adult years. Men, however, aged 65 years and over in Australia are more likely to suffer disability and death as a result of their asthma. Three times as many men as women over the age of 65 report some type of cancer, including a higher prevalence of those sex-independent cancers nominated as national priorities (colorectal cancer, lung cancer, melanoma, non-melanoma skin cancers and non-Hodgkin's lymphoma). Men also present a significant challenge in the global diabetes epidemic, showing a higher prevalence of diabetes overall and an increased rate of mortality and complications arising from the condition.
Despite all these disparities, the health of men and the related changes in biological, psychological and social settings through ageing remains one of the most understudied areas of health research in Australia. Recognition of this is feeding a groundswell of support for men's health issues and policy initiatives in Australia, including a call by a number of peak and government bodies for a comprehensive men's health longitudinal study. The Florey Adelaide Male Ageing Study (FAMAS) is a multi-disciplinary population cohort study of 1195 men, aged 35–80 years at recruitment and living in the north-west regions of Adelaide, Australia. We report here, in an analysis of the baseline cross-sectional data of the men in the cohort, the relationships between biological, social and demographic factors and the presence a number of chronic conditions considered to be of national priority.