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Australian Indigenous HealthBulletin
 

Injury

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Injury

Injury includes both physical harm to a person's body and non-physical harm, including grief, loss and suffering [1], but in public health practice attention is almost entirely confined to physical harm [2]. 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 [3] other than those collected as part of population surveys, such as the ABS national health surveys.

The classification of injury has generally followed the WHO's ICD, which includes particular attention to the external cause and intention of the injury [4].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; 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 [1][3].

Extent of injury among Aboriginal and Torres Strait Islander people
Prevalence

The 2012-2013 AATSIHS reported that 2.5% of Aboriginal and Torres Strait Islander people had a long-term condition caused by injury with the highest reported levels in the 35-44 and 45-54 years age-groups [5][6]. Long-term conditions caused by injury were reported more frequently by Aboriginal and Torres Strait Islander people than by non-Indigenous people across all age-groups except for the 55+ years age-group [5]. After age-adjustment, Aboriginal and Torres Strait Islander people were 1.2 times more likely than non-Indigenous people to report a long-term condition as a result of an injury; the rate ratio for females (1.3) was slightly higher than for males (1.1) [6].

In relation to violence, almost one-quarter (23%) of Aboriginal and Torres Strait Islander people reported in the 2008 NATSISS that they had been a victim of physical or threatened violence in the previous 12 months [7]. Victimisation was higher among younger Aboriginal and Torres Strait Islander people, with males and females aged 15-24 years having the highest reported proportions (29% and 31%, respectively) [8]. Victimisation levels were highest among Aboriginal and Torres Strait Islander people in the 15-24 years age-group across all levels of remoteness except for regional areas where the highest level was for the 25-34 years age-group. For Aboriginal and Torres Strait Islander males in the 15-24 years age-group, victimisation was highest in major cities and remote/very remote areas (both 31%), followed by regional areas (26%). Across all levels of remoteness, more than 30% of Aboriginal and Torres Strait Islander females aged 15-24 years experienced victimisation.

According to the 2008 NATSISS, 74% of Aboriginal and Torres Strait Islander people aged 15 years or over reported problems in their neighbourhood or community, with 25% reporting family violence and 23% reporting assault [9]. WA had the highest proportion of Aboriginal and Torres Strait Islander 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%). Aboriginal and Torres Strait Islander 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).

Hospitalisation

There were 28,402 hospital separations for injuries for Aboriginal and Torres Strait Islander people in 2013-14 [10]. The leading external causes of injury-related hospitalisations were ICD 'Complications of medical and surgical care' (27%), falls (17%), assault (16%), and exposure to mechanical forces (14%). After age-adjustment, the separation rate for injury was more than twice as high for Aboriginal and Torres Strait Islander people than for other Australians.

In 2012-13, the age-standardised hospitalisation rates for injury for Aboriginal and Torres Strait Islander males (51 per 1,000) and females (42 per 1,000) living in NSW, Vic, Qld, WA, SA and the NT were nearly twice (rate ratio 1.9) those for non-Indigenous males and females [11]. In terms of age, the greatest disparity between Aboriginal and Torres Strait Islander and non-Indigenous people was in the 30-34 years age-group, where the rate of injury was 3.6 times higher. The highest proportion of injury, however, was in the 25-44 years age-group (42% for Aboriginal and Torres Strait Islander females, 36% for Aboriginal and Torres Strait Islander males). Rates of hospitalised injury are consistently higher for Aboriginal and Torres Strait Islander people in the middle years, however from about 65+ years, the rates are high for both Aboriginal and Torres Strait Islander people and non-Indigenous people [12].

In terms of remoteness, hospitalisation rates for injury for Aboriginal and Torres Strait Islander people living in NSW, Vic, Qld, WA, SA and the NT increased with remoteness in 2012-13 [11]. The rate increased from 35 per 1,000 in major cities to 77 per 1,000 in remote and very remote areas. Hospitalisation rate ratios (Aboriginal and Torres Strait Islander/non-Indigenous) were higher in remote areas than major cities for a number of principal diagnoses, including:

Assaults account for a higher proportion of injury-related hospitalisations among Aboriginal and Torres Strait Islander people than among non-Indigenous people; in 2013-14, 16% of injury-related hospitalisations among Aboriginal and Torres Strait Islander people were for assaults compared with 2% among other Australians [10].

The most recent data for assaults on Aboriginal and Torres Strait Islander males and females is for the period 2012-13. Assault was responsible for 19% of all hospitalisations for Aboriginal and Torres Strait Islander males and 27% for Aboriginal and Torres Strait Islander females living in NSW, Vic, Qld, WA, SA and the NT [11]. Aboriginal and Torres Strait Islander males and females were 9 and 34 times, respectively, more likely to be hospitalised for assault than non-Indigenous males and females.

Rates of hospitalisations due to family violence-related assaults among Indigenous people living in NSW, Vic, Qld, WA, SA and the NT were higher than their non-Indigenous counterparts in 2012-13 [11]. After age-adjustment, Indigenous people were hospitalised for assaults relating to family violence at 33 times the rate of non-Indigenous people. The hospitalisation rates from family violence-related assaults were highest for Indigenous females aged 25-34 years (18 per 1,000) and for Indigenous males aged 35-44 years (5 per 1,000). The hospitalisation rates from family violence-related assaults for Indigenous people increased with remoteness, from 2.0 per 1,000 in major cities to 15 per 1,000 in remote areas (14 and 42 times respectively the rates for non-Indigenous people).

Mortality

Injury was the third leading cause of death among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT in 2013, accounting for 15% of all Aboriginal and Torres Strait Islander deaths [13]. Important specific causes of injury deaths were intentional self-harm (138 deaths, 5.2% of all Aboriginal and Torres Strait Islander deaths), land transport accidents (72 deaths, 2.7% of all Aboriginal and Torres Strait Islander deaths), and assault (33 deaths, 1.2% of all Aboriginal and Torres Strait Islander deaths). After age-adjustment, deaths from intentional self-harm were 2.2 times as common for Aboriginal and Torres Strait Islander people than for non-Indigenous people, and those from land transport accidents 2.4 times as common. After age-adjustment, the death rate for injury from assault was 6.0 times higher (5.5 per 100,000) than for non-Indigenous people (0.9 per 100,000).

The most recent detailed information for death from injury is available for the five-year period 2008-2012, in this period there were 1,766 Aboriginal and Torres Strait Islander deaths from injury in NSW, Qld, WA, SA and the NT, representing 15% of all Aboriginal and Torres Strait Islander deaths [14]. Aboriginal and Torres Strait Islander people died from injury at twice the rate of non-Indigenous people. Death rates for injury were particularly high among Aboriginal and Torres Strait Islander people aged 25-34 years (107 per 100,000), 35-44 years (103 per 100,000) and 75+ years (171 per 100,000 respectively).

Important specific causes of injury deaths during 2008-2012 remained relatively similar in NSW, Qld, WA, SA and the NT, with intentional self-harm, land transport accidents, accidental poisoning by and exposure to noxious substances and assault being the leading causes of death for both Aboriginal and Torres Strait Islander males (6.4, 4.8, 2.0 and 1.8 percent of total deaths, respectively) and females (2.9, 2.8, 1.4 and 1.4 percent of total deaths, respectively) [15].

References

  1. National Public Health Partnership (2005) The national Aboriginal and Torres Strait Islander safety promotion strategy. Canberra: National Public Health Partnership
  2. National Public Health Partnership (2005) The national injury prevention and safety promotion plan: 2004-2014. Canberra: National Public Health Partnership
  3. Clapham K, O’Dea K, Chenhall R (2007) Interventions and sustainable programs. In: Carson B, Dunbar T, Chenhall RD, Bailie R, eds. Social determinants of Indigenous health. Crows Nest, NSW: Allen and Unwin: 271-295
  4. World Health Organization (2015) International Statistical Classification of Diseases. Retrieved 2015 from http://apps.who.int/classifications/icd10/browse/2015/en#/XIX/
  5. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 6 [data cube]. Retrieved 26 March 2014 from
  6. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 5 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%205%20long-term%20conditions%20by%20sex%20by%20indigenous%20status,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&5C97CE7DA7059C06CA257C2F00145D5A&0&2012-13&27.11.2013&Latest
  7. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008. Retrieved 11 April 2011 from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4714.0?OpenDocument
  8. Australian Bureau of Statistics (2009) National Aboriginal and Torres Strait Islander social survey, 2008: law and justice [data cube]. Retrieved 30 October 2009 from http://www.abs.gov.au/AUSSTATS/SUBSCRIBER.NSF/log?openagent&law%20and%20justice%20-tables%201-11.xlsx&4714.0&Data%20Cubes&26DE78465527D0A2CA2577FA0011C50E&0&2008&16.12.2010&Latest
  9. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  10. Australian Institute of Health and Welfare (2015) Admitted patient care 2013–14: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  11. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  12. Pointer S (2015) Trends in hospitalised injury, Australia: 1999-00 to 2012-13. Canberra: Australian Institute of Health and Welfare
  13. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. Canberra: Australian Bureau of Statistics
  14. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014: data tables. Retrieved 11 June 2015 from http://www.aihw.gov.au/indigenous-data/health-performance-framework/
  15. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  16. Moller J (1996) Understanding national injury data regarding Aboriginal and Torres Strait Islander peoples. Australian Injury Prevention Bulletin; 14(December): 1-8

Endnotes

  1. This system is followed in this section, but it has its limitations (for more details, see [16]).
 

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    Last updated: 17 March 2016
     
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