New data from the Australian Bureau of Statistics (ABS) on deaths in Australia has some good news, of sorts. Total deaths numbered 183,131 in 2023, a 4.1% drop from the previous year. The main reason for the decline was that the number of deaths from COVID-19 fell from 9,862 in 2022 to 5,001 last year. However, all the other leading causes of death decreased too, with the exception of bowel cancer.
These numbers are deceptive though. The ABS thinks that there was about 5% excess mortality in 2023. In plain English, that means there were higher than expected deaths. The ABS says that with an increasing and ageing population, the number of people dying should increase, yet improvements in health care should also mean that mortality rates fall. While the mortality rate for last year was lower than 2022, it was higher than that of 2020 and 2021.
Source: ABS
Dementia to become our biggest killer
The big news from the data is that dementia is about to overtake heart disease as the leading cause of death.
In 2023, heart disease caused 9.2% of deaths, while dementia, which includes Alzheimer’s disease, accounted for 9.1% of deaths. It’s expected dementia will become our number one killer either this year or next.
For those unaware, dementia and Alzheimer’s can cause death by damaging the brain, eventually affecting areas of the brain that control the body, causing systems to go wrong and shut down.
Dementia is already the leading cause of death for women and has been since 2016. It makes up over 12% of female deaths compared to 6.4% for men. The reason for the disparity is that women have longer life expectancies than men and are more likely to live to an age when they have a heightened risk of developing dementia.
Dementia is already the leading cause of death in South Australia, the ACT, and for the first time in 2023, New South Wales.
In a separate study last month, the Australian Institute of Health and Welfare found that there were 411,000 Australians living with dementia in 2023. It revealed there were 26,300 hospitalisations due to dementia last year, with an average stay of 16 days, far longer than the average stay.
A historic change
Heart disease has held the unfortunate mantle of being the leading cause of death since 1968, so dementia overtaking it is a big deal.
Between 1968-1978, heart disease accounted for 30% of all deaths in Australia. That’s fallen to less than 10% today.
Meantime, dementia contributed to just 0.2% of deaths in 1968, and that’s now risen to 9.1%. It wasn’t until 2006 that dementia first appeared in the top five leading causes of death.
How it’s happened
The big question is why this change has happened. The fall in deaths from heart disease is likely due to several factors. For decades, there have been public health campaigns focused on the prevention of heart disease. I’m sure some of you may remember programs such as ‘Jump Rope for Heart’ in primary schools.
It’s not only preventative programs which have helped. Technological advances such as pacemakers have also allowed people to survive and live with heart failure.
Conversely, public health campaigns for dementia are only starting to be rolled out. A recent Lancet Commission study found that 45% of dementia cases could be prevented or delayed by addressing 14 risk factors starting in childhood.
Programs overseas are beginning to address brain health. In Scotland, the ‘My Amazing Brain’ program has reached thousands of primary school children, teaching them how to best protect themselves against dementia.
In Australia, Dementia Australia has several useful tools. It has a free Braintrack app as well as the CogDrisk program – a short assessment to help people understand their risk of dementia.
New drugs are also appearing to fight dementia. In July this year, the FDA approved Eli Lilly’s Alzheimer’s drug Kisunla, also called donanemab, for use in the US. It follows trials that showed the drug can modestly slow a decline in memory and thinking abilities.
An age-old debate
During COVID, there was divisive debate about whether people were dying from COVID or with COVID. It should be noted that a similar, albeit less public, debate is taking place in the medical community with dementia. Is dementia the real cause of death, or is it organ failure that’s secondary to vascular disease impacting the brain, body and so on? I’m sure we’ll hear more on this as dementia becomes more prevalent.
Premature causes of death
Talking about death is sad though talking about premature death is sadder still. One of the numbers that still stands out is that of suicides. There were 3,214 people who died by suicide in 2023, about 1.8% of total deaths. Men made up about three quarters of those deaths.
The median age for people who died by suicide was 46, making suicide the leading cause of premature death.
Another ‘silent’ killer is alcohol. There were almost 1,700 deaths from alcohol last year. Over the past six years, the alcohol death rate has risen from 4.7 per 100,000 people to 5.6.
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My article this week looks into the puzzle of how so many wealth families through history have squandered their fortunes and the lessons that can be learned about the best ways to make and keep money.
James Gruber
Also in this week's edition...
Family trusts are widely used in Australia due to their commercial and tax benefits. Greg Russo provides an overview of how these trusts work, their advantages and disadvantages, and whether they may have a place in your individual investment strategy.
The makeup of stock markets changes all the time - companies come and go, through buyouts, mergers, acquisitions, delistings and so on. But how do indexes and the ETFs which track them adjust these changes? Vanguard's Tony Kaye has the answers.
Everyone seemingly loves AI and any businesses with exposure to it. Yet, there are other asset classes with significant structural growth opportunities that aren't getting the same attention and are fetching a fraction of the price. Jan de Vos of Resolution Capital focuses on one of these asset classes and the stocks he likes.
How can we prepare for the next market crash and the inevitable emotions that come with it? Geoff Saab thinks there's a lot that we can learn from the ancient Stoics and their idea of “premeditatio malorum”—the premeditation of evils.
Is it too late to buy bonds? Capital Group's Haran Karunakaran thinks not, given the impending US rate cutting cycle and that bonds are again proving to be a genuine diversifier with investment portfolios.
It may not be just bonds that benefit from US rate cuts. Samuel Bentley and Yuan Yiu Tsai believe emerging markets could be the biggest winners from monetary easing. And they address the elephant in the room: whether China's recent uptick is for real or just another head-fake.
Lastly, in this week's whitepaper, and given the recent hurricane in Florida, Franklin Templeton offers a timely introduction to catastrophe bonds.
Curated by James Gruber and Leisa Bell
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