Injury
Injury from a variety of sources presents a significant burden
of ill-health among Indigenous people. Assessing the total impact
of injury is difficult, however. The vast majority of injuries do
not result in hospitalisation or death and there are few systematic
data on them other than those collected as part of population surveys,
such as the ABS National Health Surveys. As a result, they may not
be brought to the attention of health policy-makers and program
managers [1-3].
Even for injuries that are serious enough to be recorded in the
routine data collections or are identified by specific studies,
there are some issues with their classification. The classification
of injury has generally followed the World Health Organization’s
International Classification of Diseases (ICD), which includes particular
attention to the external cause and intention of the injury. This
system is followed in this section, but it has its limitations (for
more details, see [4]).
Understanding of the proximal factors contributing to most types
of injury among Indigenous people is limited, but the levels and
types of injury need to be seen within a broad context including:
disruption to cultural, environmental, and lifestyle variables;
socioeconomic disadvantage; geographical isolation; increased road
usage; exposure to hazardous environment(s); substance abuse; violence;
social and familial dysfunction; risky behaviour; risky home environments;
and limited access to health and social support services [1, 2,
5-7].
Extent of injury among Indigenous people
Data from the 2004-2005 NATSIHS indicate that self-reported 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 [8]. Reporting of injury increased substantially in Indigenous adults over the age of 25 years, and was highest in the 35-44 and 45-55 years age groups.
Reporting of injury increased significantly in Indigenous adults over the age of 25 years, and peaked among Indigenous adults between the ages of 35-54 years. Within this age range, 24% of Indigenous and around 16% of non-Indigenous people reported a health condition as a result of an injury or an accident.
Overall, the reporting of 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).
One-quarter of Indigenous people reported in the 2002 NATSISS that
they had been a victim of physical or threatened violence in the
previous 12 months, a level nearly double that reported in the 1994
NATSIS (13%) [9].1 After taking account
of the different age structures of the two populations, the level
of victimisation among Indigenous people was more than twice the
level among non-Indigenous people [10]. Victimisation was mainly
among younger Indigenous people, with males aged 15-24 years having
the highest reported level (36%).
In 2004-05, injuries were responsible for almost 13,200 hospital
separations for Indigenous people living in Queensland, WA, SA and the NT - almost 8% of all Indigenous separations (excluding those for renal
dialysis) [11]. The separation rate of 51 per 1,000 for Indigenous
people was more than twice that 23 per 1,000 for non-Indigenous people. Assault was the most frequent external cause of the hospitalisation of Indigenous people for injury Australia-wide in 2003-04, being responsible for 20% of Indigenous male admissions for injury and for 28% of Indigenous female admissions [12]. The next most common causes of injury hospitalisation were accidental falls (males 18%, females 16%) and transport-related injury (males 11%, females 7%). The numbers of admissions of Indigenous people for assault were very much higher than the numbers expected from non-Indigenous rates - 7 times higher for males and 31 times higher for females.
Injury was the underlying cause of death for 16% of all Indigenous
deaths registered in Australia in 2004, compared with 6% of non-Indigenous
deaths [12].2 The number of deaths of Indigenous males from external causes of injury was 2.7 times the number expected from the rates for non-Indigenous, and the number for Indigenous females 3.2 times the number expected from the rates for non-Indigenous females.
Death rates from injury for Indigenous males and females were higher than those for their non-Indigenous counterparts in every age group [12]. An indication of the enormous impact of injury on Indigenous females is the fact that their age-specific rates were higher generally than those for non-Indigenous males.
Table 1 Injury: numbers of Indigenous deaths and SMRs, by sex, Qld, WA, SA and the NT in 1999-20032
| Injury type | Males | Females | ||
| Number | SMR | Number | SMR | |
| Land transport (V01-V89) | 130 | 2.7 | 70 | 4.4 |
| Intentional self-harm (X60-X84) | 180 | 3.0 | 44 | 2.6 |
| Assault (X85-Y09) | 37 | 6.3 | 18 | 3.0 |
| Other external causes | 130 | 2.7 | 51 | 2.8 |
| All types | 498 | 3.1 | 206 | 3.7 |
Source: Derived from [14 ]
Note:
-
SMRs (standardised mortality ratios) have been calculated by dividing the numbers of Indigenous deaths for each sex by the numbers expected from the rates for non-Indigenous people of the same sex
- SMRs for assault are for Qld, WA and SA only, as data for the NT are incomplete
Intentional self-harm was responsible for 36% of the deaths from injury of Indigenous males living in Qld, WA, SA and the NT in 1999-2003, transport accidents for 25% and assault for 18% (Table 1) []. Transport accidents were responsible for 34% of the deaths of Indigenous females from injury, assault for 9% and intentional self-harm for 21%. The numbers of Indigenous deaths were much higher than expected from non-Indigenous rates - for all injury categories and for both sexes (see SMRs in Table 1).
References
1 Harrison J, Miller E, Weeramanthri T, Wakerman J, Barnes T (2001)
Information sources for injury prevention among Indigenous Australians:
status and prospects for improvements. Canberra: Australian
Institute of Health and Welfare
2 Moller J, Thomson N, Brooks J (2004) Injury prevention activity
among Aboriginal and Torres Strait Islander peoples: Volume 1, Current
status and future directions. Canberra: Department of Health
and Ageing
3 Thomson N, Brooks J (2003) Injury. In: Thomson N, ed. The
health of Indigenous Australians. South Melbourne: Oxford University
Press:442-466
4 Moller J (1996) Understanding national injury data regarding Aboriginal
and Torres Strait Islander peoples. Australian Injury Prevention
Bulletin;14(December):1-8
5 Brice GA (2000) Australian Indigenous road safety: a critical
review and research report, with special reference to South Australia,
other Indigenous populations, and countermeasures to reduce road
trauma [draft]. Adelaide: A report to the Aboriginal Health
Council of South Australia & Transport SA supported by the Safety
Strategy, Transport SA Urban Planning & the Arts
6 Gordon S, Hallahan K, Henry D (2002) Putting the picture together,
inquiry into response by government agencies to complaints of family
violence and child abuse in Aboriginal communities. Perth:
Department of Premier and Cabinet
7 Memmott P, Stacy R, Chambers C, Keys C (2001) Violence in
Indigenous communities: full report. Canberra: Crime Prevention
Branch, Attorney-General's Department
8 Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey, Australia 2004-05. (ABS Cat. no. 4715.0) Canberra: Australian Bureau of Statistics
9 Australian Bureau of Statistics (2004) National Aboriginal
and Torres Strait Islander Social Survey, 2002. (ABS Cat. no.
4714.0) Canberra: Australian Bureau of Statistics
10 Australian Bureau of Statistics (2003) General Social Survey:
summary results, Australia, 2002. (ABS Cat. no. 4159.0) Canberra:
Australian Bureau of Statistics
11 Australian Institute of Health and Welfare (2004) Australian
hospital statistics 2002-03. (AIHW cat. no. HSE 32) Canberra:
Australian Institute of Health and Welfare
12 Australian Bureau of Statistics, Australian Institute of Health
and Welfare (2005) The health and welfare of Australia's Aboriginal
and Torres Strait Islander peoples 2005. (ABS Cat no.4704.0) Canberra: Australian Bureau of Statistics
13 Australian Bureau of Statistics (2003) Deaths Australia 2002.
(Cat no. 3302.0) Canberra: Australian Bureau of Statistics
14 Standing Committee on Aboriginal and Torres Strait Islander Health, Statistical Information Management Committee (2006) National Summary of the 2003 and 2004 jurisdictional reports against the Aboriginal and Torres Strait Islander health performance indicators. (AIHW category no. IHW 16) Canberra: Australian Institute of Health and Welfare
Endnote
1 It is possible that some of this increase may reflect under-reporting by respondents to the 1994 NATSIS.
2 Caution needs to be exercised in interpretation of the various death rates presented in this report, most of which are based on the numbers of deaths registered as Indigenous. These numbers underestimate the actual numbers of Indigenous deaths, with the level of underestimation varying by jurisdiction (see ‘Limitations of the sources of Indigenous health information’). The ‘projected’ death rates take into account the estimated incompleteness of Indigenous identification in each jurisdiction. It is likely that the true death rates for Indigenous people will be closer to these rates than to those based solely on death registrations.
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