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Injury includes both physical harm to a person's body and non-physical harm, including grief, loss and suffering , but in public health practice attention is almost entirely confined to physical harm . Even restricted to physical harm, assessing the total impact of injury is difficult because the vast majority of injuries do not result in hospitalisation or death and there are few systematic data  other than those collected as part of population surveys, such as the ABS national health surveys (NHS). As a result, many injuries are not brought to the attention of health policy-makers and program managers.
The classification of injury has generally followed the WHO's ICD, which includes particular attention to the external cause and intention of the injury .1 Understanding injury in an Indigenous context needs to take into consideration a diverse range of issues, including: disruption to culture, environmental and lifestyle variables; socioeconomic disadvantage; geographical isolation; increased road usage; exposure to hazardous environments; substance use; violence; social and familial dysfunction; risky behaviour; risky home environments; and limited access to health and social support services .
The most recent source of detailed information about injury among Indigenous people is the 2004-2005 NATSIHS, which found that health conditions 'as a result of an injury or accident' were reported more frequently by Indigenous people than by non-Indigenous people across all age-groups (except for the 0-14 years age-group) .2 Reporting of injury-caused health conditions increased substantially among Indigenous people over the age of 25 years, and was highest in the 35-44 and 45-54 years age-groups. Within these age-groups, 24% of Indigenous people reported a health condition as a result of an injury or accident. After age-adjustment, a long-term condition as a result of an injury or accident was 1.4 times more common for Indigenous people than for non-Indigenous people, with the ratio for males (1.5) being slightly higher than that for females (1.3).
In view of the higher levels of health conditions reported as a result of an injury or accident among Indigenous than among non-Indigenous people, it is somewhat surprising that the proportion of Indigenous people who reported having had an injury in the four weeks prior to the 2004-2005 NATSIHS was slightly less than that for non-Indigenous people (15% compared with 19%) . Indigenous people were 2.8 times as likely as non-Indigenous people to report a recent injury that was the result of an attack by another person and 4.5 times as likely to report being under the influence of alcohol or other substances at the time of injury.
In relation to violence, almost one-quarter (23%) of Indigenous people reported to the 2008 NATSISS that that they had been a victim of physical or threatened violence in the previous 12 months . Victimisation was higher among younger Indigenous people, with males and females aged 15-24 years having the highest reported proportions (29% and 31%, respectively) . Victimisation levels were highest among Indigenous people in the 15-24 years age-group across all levels of remoteness. For Indigenous males, victimisation was highest in major cities and remote/very remote areas (both 31%), followed by non-remote areas (28%) and regional areas (26%). Across all levels of remoteness, more than 30% of Indigenous females experienced victimisation.
According to the 2008 NATSISS, 74% of Indigenous people aged 15 years or over reported problems in their neighbourhood or community, with around one-quarter reporting family violence (25%) or assault (23%) . WA had the highest proportion of Indigenous people reporting family violence as a problem (34%), followed by the NT (32%). For assault, the NT had the highest proportion (31%), followed by WA (30%). Indigenous people living in remote areas reported family violence (38%) and assault (37%) more frequently than those living in non-remote areas (22% and 19%, respectively).
There were 26,426 hospital separations for injuries for Indigenous people in 2011-12, representing 13% of all Indigenous separations (excluding those for dialysis) . After age-adjustment, the separation rate for injury was twice as high for Indigenous people than for other Australians. The leading external causes of injury-related hospitalisations in 2011-12 were ICD 'Complications of medical and surgical care' (25%), assault (18%), falls (17%), and exposure to mechanical forces (14%).
Detailed information on Indigenous injury-related hospitalisation is not available for 2011-12, but in the two-year period July 2008 to June 2010, age-standardised hospitalisation rates for injury for Indigenous males (52 per 1,000) and females (42 per 1,000) living in NSW, Vic, Qld, WA, SA and the NT were twice those for non-Indigenous males and females .
In terms of remoteness, hospitalisation rates for injury for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT increased with remoteness in 2008-09 . The rate increased from 32 per 1,000 in major cities to 71 per 1,000 in remote areas. Hospitalisation rates were higher in remote areas than major cities for a number of principal diagnoses:
Assaults account for a higher proportion of injury-related hospitalisations among Indigenous people than among non-Indigenous people; in 2011-12, 18% of injury-related hospitalisations among Indigenous people were for assaults compared with 2% among other people . The most recent detailed information for males and females is available for the two-year period July 2008 to June 2010, when assault was responsible for 21% of all hospitalisations for Indigenous males and 28% for Indigenous females living in NSW, Vic, Qld, WA, SA and the NT . Indigenous males and females were 8 and 34 times, respectively, more likely to be hospitalised for assault than were non-Indigenous males and females.
There were more hospitalisations from family violence-related assaults among Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2008-09 than among their non-Indigenous counterparts . After age-adjustment, Indigenous people were hospitalised for assaults relating to family violence at 23 times the rate of non-Indigenous people. The hospitalisation rates from family violence-related assaults were highest for Indigenous females aged 25-34 years (15.1 per 1,000) and for Indigenous males aged 35-44 years (5.5 per 1,000). The hospitalisation rates for Indigenous people increased with remoteness, from 2.1 per 1,000 in major cities to 10.4 per 1,000 in remote areas (compared with 0.1 and 0.3 per 1,000, respectively, for other Australians).
Injury was the third leading cause of death among Indigenous people living in NSW, Qld, WA, SA and the NT in 2012, accounting for 15.4% of all Indigenous deaths . Important specific causes of injury deaths were intentional self-harm (117 deaths, 4.7% all Indigenous deaths) and land transport accidents (88 deaths, 3.6%). After age-adjustment, deaths from intentional self-harm were around twice as common for Indigenous people than for other Australians, and those from land transport accidents more than three times as common. After age-adjustment, the death rate for injury from assault was 8.9 times higher (8.9 per 100,000) than for non-Indigenous people (1.0 per 100,000).
The most recent detailed information for death from injury is available for the five-year period 2006-2010, in which period there were 1,667 Indigenous deaths in NSW, Qld, WA, SA and the NT, representing 15% of all Indigenous deaths . Indigenous people died from injury at 2.3 times the rate of non-Indigenous people. Death rates for injury were particularly high among Indigenous people aged 25-34 years (122 per 100,000) and 35-44 years (124 per 100,000 respectively). After age-adjustment, the death rates from injury were 2.3 times higher for Indigenous males and females than those for their non-Indigenous counterparts.