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Injury from a variety of sources presents a significant burden of ill-health for Indigenous people [1]. 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 [2]. 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 [3]. This system is followed in this section, but it has its limitations (for more details, see [4]).
Understanding injury within an Indigenous context needs to take a diverse range of issues into consideration including: disruption to cultural, 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 [1][2].
According to the 2004-2005 NATSIHS, 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 [5]. Reporting of injury-caused health conditions increased substantially among Indigenous adults 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 adjusting for differences in the age structures of the two populations, a long-term condition as a result of an injury or accident was 1.4 times higher 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 non-Indigenous people, it is somewhat surprising that proportion of Indigenous people who reported having had an injury in the four weeks prior to being interviewed in the 2004-2005 NATSIHS was slightly less for non-Indigenous people (15% compared with 19%) [6]. Indigenous people were almost three times as likely as non-Indigenous people to report a recent injury that was the result of an attack by another person (rate ratio 2.8) and almost five times as likely to report being under the influence of alcohol or other substances at the time of injury (rate ratio 4.5).
According to the 2008 NATSISS, almost one-quarter (23%) of Indigenous people reported that they had been a victim of physical or threatened violence in the previous 12 months, a level similar to that reported for the 2002 NATSISS (24%) [7]. Victimisation was higher among younger Indigenous people, with males and females aged 15-24 years having the highest reported proportions (29% and 31%, respectively) [8]. Self-reported 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%). Over 30% of Indigenous females experienced victimisation in all levels of remoteness.
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%) [9]. 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 with 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).
In 2009-10, injuries were responsible for 22,701 hospital separations for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT, accounting for 14% of all Indigenous separations (excluding those for dialysis) [10]. The separation rate of 46 per 1,000 for Indigenous people was almost twice that of 24 per 1,000 for other Australians.
In 2008-09, Indigenous males (52 per 1,000) and females (42 per 1,000) living in NSW, Vic, Qld, WA, SA and the NT had higher hospitalisation rates for injury than did other Australian males (28 per 1,000) and females (20 per 1,000) [11]. Indigenous people were hospitalised for injury at 1.9 times the rate of other Australians. Hospitalisation rates for injury increased slightly between 2004-5 and 2008-09 for both Indigenous people (from 42 to 47 per 1,000) and for non-Indigenous people (from 22 to 24 per 1,000).
Assault was the most frequent cause of hospitalisation for injury of Indigenous people in NSW, Vic, Qld, WA, SA and the NT in 2008-09, responsible for 21% of Indigenous male admissions for injury and for 28% of Indigenous female admissions for injury [11]. The numbers of admissions of Indigenous people for assault were very much higher than the numbers expected from non-Indigenous rates – 6.9 times higher for males and 32.3 times higher for females.
In the two-year period from July 2006 to June 2008, assault was responsible for around 2% of all hospitalisations for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT [9]. The hospitalisation rate for assault for Indigenous people was 11.6 times higher than the rate for other Australians. The highest rates for Indigenous people were among those aged 25-34 years (23 per 1,000, rate ratio of 13.0) and 35-44 years (22 per 1,000, rate ratio of 18.4). Indigenous males aged 35-44 years were hospitalised at 11.1 times the rate of other males, and Indigenous females aged 25-34, 35-44, and 45-54 years were hospitalised at over 40 times the rate of other females. Hospitalisation rates for assault were highest for Indigenous people living in the NT (23 per 1,000), followed by WA (18 per 1,000), and SA (17 per 1,000). Rates of hospitalisation for assault were highest for Indigenous people in remote areas (26 per 1,000), followed by very remote areas (23 per 1,000), and outer regional areas (10 per 1,000).
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 [11]. Indigenous people were hospitalised for assaults relating to family violence at 23 times the rate of other people (4.6 compared with 0.2 per 1,000). The hospitalisation rates from family violence-related assaults were highest for Indigenous males aged 35-44 years (5.5 per 1,000) and for Indigenous females aged 25-34 years (15.1 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 people).
In NSW, Vic, Qld, WA, SA and the NT in 2008-09, the next most common causes of injury hospitalisation for Indigenous males after assault were falls (18%), and exposure to inanimate mechanical forces (15%) [11]. The next most common causes of injury hospitalisation for Indigenous females after assault were falls (18%), and complications of medical and surgical care (14%). Transport accidents ranked fourth for Indigenous males (12%), and sixth for Indigenous females (6.8%).
Hospitalisation rates for injury for Indigenous people in NSW, Vic, Qld, WA, SA and the NT in 2008-09 increased with remoteness, from 32 per 1,000 in major cities to 71 per 1,000 in remote areas [11]. Hospitalisation rates were: 4.6 times higher in remote areas than in major cities for assault (23 compared with 5.0 per 1,000); almost twice as high in remote areas than in major cities for falls (12 compared with 6.9 per 1,000); almost twice as high in remote areas than in major cities for complications of medical and surgery care (10 compared with 5.5 per 1,000); and nearly two times higher in remote areas than in major cities for transport accidents (5.1 compared with 3.0 per 1,000).
Injury was the third most common cause of death among Indigenous people living in NSW, Qld, WA, SA and the NT in 2004-2008, after CVD (27% of all deaths) and cancer (18%) [12]. Injury accounted for 15% of all Indigenous deaths in this period, compared with 5.7% of the deaths of non-Indigenous people; deaths from injury occurred at a rate around 2.4 times higher for Indigenous people than for non-Indigenous people.
Intentional self-harm was the leading cause of death from injury for Indigenous people living in NSW, Qld, WA, SA and the NT in 2004-2008, responsible for 27% of Indigenous deaths from injury (439 deaths) [12]. Transport accidents were responsible for 27% of Indigenous deaths from injury (432 deaths). Other important causes of Indigenous deaths from injury were: accidental poisoning, responsible for 9% of Indigenous deaths from injury (141 deaths); assault 9% (139 deaths); and accidental drowning 7%. Indigenous people died from intentional self-harm at a rate twice that of non-Indigenous people, and from transport accidents at a rate three times that of non-Indigenous people.
In the five-year period 2004-2008, there were 139 Indigenous deaths from assault in NSW, Qld, WA, SA and the NT, representing about 1.3% of all Indigenous deaths [9]. Indigenous people in those jurisdictions died from assault at 8.6 times the rate of non-Indigenous people. Rates were highest for Indigenous males aged 35-44 years (16 per 100,000, rate ratio of 10.6), and for Indigenous females aged 25-34 years (14 per 100,000, rate ratio of 17.4). Death rates of Indigenous people from assault were highest in the NT (17 per 100,000) and WA (12 per 100,000).
Helping to 'close the gap' by providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health
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