Cardiovascular diseaseCardiovascular disease (CVD) is the leading cause of death in Australia, and after cancer is the second leading burden of disease at 18 per cent (mainly due to premature death).38
The prevalence of CVD is significantly higher in females at 55 per cent, compared to 45 per cent in males.39 However, a national survey conducted on behalf of the National Heart Foundation found that 97 per cent of Australians are unaware that the heart disease is the leading cause of death for women.40
Sex and gender interact to heighten the risk of cardiovascular disease for women. Heart disease has traditionally been seen as a man's disease and women have been under-represented in studies. However, sex differences exist in the symptoms women and men experience during a heart attack. Women are more likely to have less recognised symptoms of coronary heart disease (CHD).41 While chest pain, pressure, or tightness are leading signs of heart attack for both sexes, women are more likely to report atypical symptoms such as non-specific chest pain, mid-back pain, nausea, palpitations and indigestion which are more difficult for a physician to recognise and can therefore lead to delayed diagnosis.42
Sex differences in the size of the coronary arteries may explain women's and men's different experience of heart disease. Differences in hormonal make-up may also contribute to differences in how men and women respond to stress.43
Women and men respond differently to treatment of CVD.44 To date, a significant amount of research on CVD has not included women. This has resulted in treatments being offered to women based on the research results of men.
The perception that CVD is more common in men affects the outcomes for women who develop CVD. Women tend to delay seeking treatment for their cardiac-related events45, possibly leading to worse outcomes. It has also been shown that, when presented with male and female patients presenting identical symptoms, there is a tendency among physicians to ascribe women's symptoms to psychogenic rather than organic causes.46
For Indigenous Australians the self-reported prevalence of coronary heart disease was two and a half times higher than that of the general population in major cities, at almost four times the rate.47
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Smoking, obesity, lack of physical exercise and poor diest are individual risk factors for heart disease for which some groups of women are at higher risk than men. Many diseases (especially lifestyle-related diseases) have in common certain risk factors, and these are closely tied to socioeconomic status.
DiabetesDiabetes prevalence has at least doubled in the past two decades48 and is a National Health Priority Area. While there is a higher prevalence of Type 2 diabetes amongst males (with an age standardised rate of 7.6 per cent compared to 6.5 per cent)49, diabetes is still a major concern for women.
Gestational diabetes (a temporary form of diabetes that occurs during pregnancy) is increasingly prevalent with significant associated risks to both mother and baby.
Gestational diabetes is diagnosed in between 5 and 12 per cent of pregnant women, who then have a 50 per cent risk of developing Type 2 diabetes within five years.50
While diabetes rates have increased for the whole population, particular groups of women have higher rates. Diabetes is more common in wormen who are obese. The lifetime risk for diabetes for women of normal weights is 17.1 per cent, increasing to 35.4 per cent in overweight women, 54.6 per cent in obese women and 74.7 per cent in very obese women.51
Females living in regional and remote areas were significantly more likely to report diabetes than those in major cities.52 Decreasing socioeconomic position is associated with an increasing prevalence of diabetes and a rising diabetes-related mortality rate.53
Aboriginal and Torres Strait Islander women were four times more likely to have diabetes/high sugar levels than non-Aboriginal and Torres Strait Islander women (adjusted for age difference).54 The death rate from diabetes for Aboriginal and Torres Strait Islander people was almost 12 times higher than for non-Aboriginal and Torres Strait Islander people.55
People born overseas also self-report higher rates of diabetes than those born in Australia56, and also have a slightly higher death rate from diabetes than those born in Australia.57
CancerCancer is another of the National Health Priority Areas, and is the leading cause of Australia's disease burden at 19 per cent.58 Based on 2006 data, the risk for a female being diagnosed with cancer before age 75 was one in four, and before age 85 was on in three.59 The most common cancers in females are breast, bowel, melanoma and lung cancers.60 In Australia, all cancer survival has increased significantly between diagnoses made in 1982-1986 and those made in 1998-2004. For women, it increased from 53 to 64 per cent.61
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Breast cancer accounts for over 28 per cent of all diagnoses in females, which has more than double the number of diagnoses of the second most common cancer (bowel). In 2006, the lifetime risk of a woman developing breast cancer before the age of 85 was 1 in 9. Around 12,600 new cases of breast cancer were diagnosed in Australia in 2006. In 2007, 2,680 women died from breast cancer in Australia, making breast cancer the second highest cause of cancer deaths in women behind lung cancer (2,911 deaths).62
Bowel cancer is the second most common cancer in women, which made up 13.3 per cent of all cancer diagnoses in women in 2005.63 The risk of developing bowel cancer increases from the age of 40 years onwards, but rises sharply and progressively from the age of 50 years. Bowel cancer is the most common cancer for women aged 76 to 95.64 Despite the trend towards better survival, bowel cancer remains an important cause of premature death in Australian women.
Differences between women and men exist in the presentation of lung cancer symptoms and this can lead to women being under-diagnosed or misdiagnosed. Women with lung cancer tend to have more asymptomatic presentations and experience a wider range of types of lung cancer than men, making it more difficult to diagnose and provide treatment.
Each year, over 4,000 Australian women are diagnosed with a gynaecological cancer.65 As some gynaecological cancers do not show early signs or symptoms, diagnosis and early treatment can be challenging. Gynaecological cancers were responsible for 1,502 female deaths in 2007.66 It is projected that in 2010 there will be 4,683 women diagnosed with a gynaecological cancer and 1,800 related deaths.67
Cervical cancer incidence and mortality rates have declined by 48 per cent and 53 per cent respectively since the National Cervical Screening Program was introduced in 1991.68
In 2005, more than 1,200 new cases of ovarian cancer in Australian women were diagnosed69 and 60 per cent of women diagnosed with ovarian cancer in 1998-2004 died within five years of diagnosis.70
Alcohol and smoking are risk factors for many cancer. In 2005, there were an estimated 11,308 new cases of cancer and 8,155 deaths from cancer that can be attributed to smoking. This represents over 11 per cent of cases and nearly 21 per cent of cancer deaths.71 In 2001, cancer attributed to smoking accounted for 7.8 per cent of all new cases of cancer in femails.72 There were an estimated 2,997 new cases of cancer and 1,376 deaths from cancer attributed to excessive alcohol consumption in 2005. This represents 3 per cent of cases and 3.5 per cent of cancer deaths.73 In 2001, the lifetime risk of cancers attributable to alcohol consumption was 1 in 17 for females.74 between 1991 and 2001, the rate for cancers attibuted to alcohol consumption in females increased by an average of 1.2 per cent per annum, while the male rate decreased by an average of 0.3 per cent per annum.75
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The forms of cancer experienced by women also vary according to location. Women under the age of 65 in rural and remote areas have higher rates of lung cancer, melanoma and cervical cancer.76,77 Melanoma is responsible for 60 per cent of the excess new cases of cancer outside major cities-for example, 236 of the 258 excess new cases of cancer for females in inner regional areas.78 There is also a higher incidence of breast cancer in the least disadvantaged areas compared to the most disadvantaged areas, and higher rates in major cities compared to very remote areas.79
Between 2000 and 2004, cancer incidence (among the most common cancers) for Aboriginal and Torres Strait Islander women was higher for lung cancer, cancers of the mouth and the throat and cancer of unknown primary site. Aboriginal and Torres Strait Islander women have more than double the occurrence of cervical cancer and more than four times the death rate from it.80,81 They access breast cancer screening less than non-Aboriginal and Torres Strait Islander women, and although no statistics are available, it is thought they also access screening for cervical cancer less often.82
Respiratory diseaseWomen with a history of partner violence are less likely to have adequate health screening. The submission from Women's Health Australia suggested that there is a need to identify ways of encouraging women with a history of partner violence to undertake regular screening particularly for cervical cancer.
The Australian Longitudinal Study on Women's Health found the prevalence of asthma to be much higher in younger women than mid-aged and older wormen.83
Australians living in inner regional areas also have a significantly higher prevalence of asthma than those in major cities.84 Indigenous Australians in rural and remote areas were also significantly more likely to report asthma than people in major cities.85