What are common risk factors related to the development of chronic disease?

The prevention of chronic disease is a major health priority of Australian, state and territory governments. Over the last few years large investments have been made to improve healthy lifestyle behaviours, such as increasing physical activity and improving diet, as well as reducing risky behaviours, such as smoking and excess body weight.

This report examines negative health determinants, known as risk factors, and provides insights into their prevalence. It examines the most common combinations of risk factors in the community, and highlights the potential for lifestyle behaviour changes that may lead to health gains for individuals and the population.

It provides the most comprehensive picture to date of Australian lifestyle behaviours that can contribute to chronic disease.

Key findings

Prevalence of risk factors is high: Overall, most people have at least one risk factor. Most (just over 90%) fail to consume the recommended amounts of vegetables each day and about 50% do not consume the recommended amounts of fruit. This is important because people with low intakes of fruit and vegetables have higher risks of certain chronic diseases.

Almost 60% of Australians do not undertake sufficient physical activity to incur health benefits, such as maintaining healthy body weight and a healthy musculoskeletal system. Sufficient activity is defined as at least 150 minutes in 1 week over at least 5 sessions.

A sedentary lifestyle is increasingly recognised as being detrimental to health, as it can contribute to many chronic diseases as well as an increased risk of mortality. More than 80% of Australians spend more than 3 hours each day sitting during their leisure time, regardless of whether they undertake sufficient physical activity.

More risk factors can mean more chronic disease: More males than females have five or more risk factors (17% compared with 11%). This analysis shows that as the number of risk factors increases, so does the likelihood of having some chronic diseases. For example, males with five or more risk factors are three times more likely to report chronic obstructive pulmonary disease than males with two or fewer risk factors. Females with five or more risk factors are three times more likely to report stroke, and two and a half times more likely to report depression, than females with two or fewer risk factors.

Common combinations of risk factors: Looking at what combinations of risk factors people have can assist those who advise about lifestyle behaviours. This report shows that those who consume alcohol at risky levels are more likely to report daily smoking than those who don’t. Daily smoking is also more commonly reported by those who have insufficient levels of physical activity. For people who are obese, high blood pressure is more common as a co-risk factor than for people who are not obese.

Social gradient with risk factor behaviours: The analysis shows that people who live in areas of more socioeconomic disadvantage are more likely to take part in risky health behaviours, and this is also true for combinations of risk factor behaviours.

While the number of chronic conditions a person has tends to increase with age, more often than not, conditions occur together because there is some association between them. A number of chronic conditions share common risk factors, or one disease may be a risk factor in itself for another (AIHW 2016a). Diabetes is a well-known risk factor for cardiovascular disease, possibly due to diabetes increasing atherosclerosis (thickening of blood vessel walls with plaque deposits), which is the underlying cause of most cardiovascular disease in Australia (Woo et al. 2008).

At the individual level, a number of biomedical and behavioural risk factors can affect the likelihood of developing chronic conditions (AIHW 2016b). Biomedical characteristics that contribute to the development of chronic conditions include overweight and obesity, high blood pressure, dyslipidaemia (high blood cholesterol) and a person’s genetic make-up. Biomedical risk factors are often influenced by behavioural risk factors. Behavioural risk factors include physical inactivity, poor nutrition, smoking tobacco and risky alcohol consumption. As with chronic conditions, many of these behavioural risk factors tend to be more prevalent in the lowest socioeconomic areas and in regional and remote areas (AIHW 2020a, AIHW 2020b).

The relationship between behavioural risk factors and multimorbidity is complex. Research based on data collected at a single point in time has found that the more chronic conditions a person reports, the more risk factors they are likely to have (AIHW 2012). However, without information on exposure to risk factors over time and the timing of chronic condition onset, the presence of chronic conditions cannot be attributed to the number of risk factors a person has. This is because the onset of some chronic conditions may motivate a person to change their behaviour for the better. For example, a diagnosis of COPD may motivate a person to quit smoking. In contrast, the onset of a chronic condition may result in an individual being less able to participate in physical activity.

Longitudinal research can help to understand the interacting complexities of risk factors and multimorbidity. A study of multimorbidity in Australian women has shown overweight and obesity, physical inactivity and social inequality to be risk factors common to a number of patterns of multimorbidity (Jackson et al. 2016).

At the societal level, the availability of health services, vaccination programs and a clean and healthy environment can promote good health and reduce the risk of developing, or exacerbating existing, chronic conditions. Aspects of the natural and built environment, including the availability of healthy food, building design, access to green space, exposure to advertising, portion sizes of prepared food and the convenience of pre-packaged, calorie dense food also contribute to overweight and obesity (AIHW 2017), which are risk factors for the development of chronic conditions.

Many of the individual and societal risk factors for chronic conditions are largely modifiable or treatable (AIHW 2016). Changes in behaviour, together with timely and effective medical treatments, can reduce the risk of developing chronic conditions, and multimorbidity, resulting in large population health gains.

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