Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.03 Hospitalisation for injury and poisoning

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Why is it important?:

Accidental and intentional injury and self-harm is the third leading cause of death for Indigenous Australians. Injury and poisoning is responsible for 15% of the health gap between Indigenous and non-Indigenous Australians (Vos et al. 2007). Injuries can cause long-term disadvantage for Aboriginal and Torres Strait Islander peoples including: loss of cultural knowledge and wisdom, and the chance of a full life; the burden on caregivers for people with disabilities; decreased workplace productivity; and continuation of the cycle of grief among families, friends and communities. Hurt, loss and suffering can increase the risk of physical injury, especially if the feelings are severe, prolonged, or widespread in a community. There is a need to base injury prevention efforts on evidence, ensure that they are culturally appropriate, that they build on resilience, and they address systemic issues that reduce people’s capacity to make health-enhancing choices and the likelihood they will do so (Anderson 2008; Ivers et al. 2008; Berger et al. 2009; Berry et al. 2009).

Findings:

Hospitalisations for injury reflect hospital attendances for the condition rather than the extent of the problem in the community. Hospitalisations for injury and poisoning are the second most common reason for hospital admission for Indigenous Australians (behind hospitalisation for dialysis). Hospitalisation for injury for Aboriginal and Torres Strait Islander peoples occur at twice the rate of other Australians, accounting for around 20,000 hospitalisations each year.

For other Australians, injury hospitalisation rates are much higher in the elderly (aged 65 and over) than in younger age groups. This mainly reflects much higher rates of falls for elderly people. For people aged under 65 years, injury hospitalisation rates for males are much higher than for females.

Injury hospitalisation has a very different pattern for Indigenous Australians: severe injury has a much greater impact on the young and middle-aged; female hospitalisation rates are similar to male rates in most age groups; and rates peak in early adult age groups for both males and females.

Between 2001–02 and 2007–08 for Queensland, Western Australia, South Australia and the Northern Territory combined, the hospitalisation rate for injury and poisoning for Aboriginal and Torres Strait Islander peoples showed no significant change. Between 2004–05 and 2007–08, based on data from the above jurisdictions and New South Wales and Victoria combined, the rate increased by 5%, which was significant. There were similar increases for other Australians in both series, and consequently there has been no substantial change in the gap between Indigenous and non-Indigenous rates.

Assault is the leading cause of injury requiring hospitalisation for Indigenous Australians, responsible for 23% of injury hospitalisations for males and 31% for females in the two years to June 2008. Hospitalisation rates for injuries caused by assault are much higher for Aboriginal and Torres Strait Islander men (7 times as high) and women (36 times) than other Australian men and women. Indigenous Australians are also more likely to be re-admitted to hospital for interpersonal violence than other Australians (Meuleners et al. 2008; Berry et al. 2009). Hospitalisation rates for Aboriginal and Torres Strait Islander people for other causes of injury are between 1.1 and 2.5 times as high as those for other Australians, and there is much less difference between males and females in these ratios. Other leading causes of injury include accidental falls (18%), exposure to inanimate mechanical forces (12%), complications of medical care (11%) and transport accidents (9%). Rates vary across jurisdictions, with the highest rates in the Northern Territory and Western Australia.

Over the period 2004–08, the third most common cause of death among Indigenous Australians was external causes (injury and poisoning); Indigenous Australians died from injury and poisoning at 2.4 times the rate of other Australians. The most common type of external cause of mortality among Indigenous Australians was intentional self-harm (439 deaths), followed by transport accidents (432 deaths) accidental poisoning (141 deaths) and assault (139 deaths). Indigenous Australians died from intentional self-harm and transport accidents at 2 and 3 times the rate of non-Indigenous Australians respectively. Indigenous Australians died from assault at 9 times the rate of other Australians.

Implications:

All causes of injury have a greater impact on hospitalisation rates for Aboriginal and Torres Strait Islander peoples than for other Australians. Intentional self-harm is the leading cause of death from external causes which highlights the need for interventions focused on social and emotional wellbeing (see measure 1.16), followed by transport related accidents. Assault is the most important injury prevention issue in relation to hospitalisations, followed by accidental falls.

The Indigenous Family Safety Agenda (July 2010) and the National Aboriginal and Torres Strait Islander Safety Promotion Strategy includes injury prevention and safety promotion issues specific to Indigenous communities, including intentional and unintentional injury, violence, alcohol-related injuries, self-harm and harm to others. The National Injury Prevention and Safety Promotion Plan 2004–2014 provides a whole of society, systems, and population health approach which focuses on encouraging the development of partnerships, and investing in prevention and safety promotion initiatives specific to Aboriginal and Torres Strait Islander peoples, rural and remote populations, and throughout different stages of life.

An objective of the National Road Safety Strategy 2001–2010 is to improve equity in safety among road users. Initiatives designed to close this gap include the convening of biennial Indigenous Road Safety Forums to support the national commitment and to recommend practical and locally relevant initiatives.

Figure 9 – Age-standardised hospitalisation rates for injury and poisoning, Aboriginal and Torres Strait Islander peoples and other Australians, Qld, WA, SA and NT, 2001-02 to 2007–08; NSW, Vic., Qld, WA, SA and NT, 2004–05 to 2007–08


Figure 9 – Age-standardised hospitalisation rates for injury and poisoning, Aboriginal and Torres Strait Islander peoples and other Australians, Qld, WA, SA and NT, 2001-02 to 2007–08; NSW, Vic., Qld, WA, SA and NT, 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 9 (TXT 1KB)

Figure 10 – Age-specific hospitalisation rates for a principal diagnosis of injury and poisoning, by Indigenous status and sex, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008


Figure 10 – Age-specific hospitalisation rates for a principal diagnosis of injury and poisoning, by Indigenous status and sex, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 10 (TXT 1KB)

Table 7 – Age-standardised hospitalisations for external causes of injury and poisoning for Aboriginal and Torres Strait Islander peoples by sex, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008

External Cause:
Males
Females
Persons
%
Rate
Ratio
%
Rate
Ratio
%
Rate
Ratio
Assault
22.5
10.8
7.0*
30.7
10.9
35.5*
26.1
10.9
11.6*
Falls
17.7
9.2
1.4*
18.1
8.7
1.2*
17.9
9.1
1.3*
Exposure to inanimate mechanical forces
14.8
6.0
1.4*
8.1
2.5
1.9*
11.9
4.2
1.5*
Complications of medical and surgical care
8.7
6.1
1.4*
12.8
6.6
1.8*
10.5
6.4
1.6*
Transport accidents
11.5
4.8
1.2*
6.7
2.2
1.4*
9.4
3.5
1.3*
Other accidental exposures
7.3
3.4
1.0
5.6
2.2
1.3*
6.6
2.8
1.1*
Intentional self-harm
4.8
2.4
2.7*
8.1
2.8
2.0*
6.3
2.6
2.3*
Exposure to animate mechanical forces
5.0
2.0
2.0*
3.1
1.0
2.6*
4.1
1.5
2.2*
Exposure to electric current/smoke/ fire/animals/nature
4.2
1.8
2.5*
2.8
0.9
2.5*
3.6
1.3
2.5*
Accidental poisoning by and exposure to noxious substances
1.8
0.7
1.6*
2.2
0.8
1.6*
2.0
0.8
1.6*
Other external causes
1.5
0.7
2.5*
1.8
0.6
2.5*
1.6
0.7
2.5*
Total
100.0
47.9
1.7*
100.0
39.3
2.1*
100.0
43.6
1.9*
Total number of hospitalisations for injury or poisoning: 22,263 17,311 39,574
Source: AIHW analysis of National Hospital Morbidity Database

Table 8 – Age-standardised hospitalisations for external causes of Injury and Poisoning for Aboriginal and Torres Strait Islander peoples by sex and jurisdiction, NSW, Vic., Qld, WA, SA and NT, July 2006–June 2008

Male
Female
Persons
Number
Rate
Ratio
Number
Rate
Ratio
Number
Rate
Ratio
New South Wales
5,649
38.7
1.4*
3,677
27.1
1.5*
9,326
33.0
1.5*
Victoria
1,036
31.8
1.2*
650
22.6
1.1*
1,686
27.3
1.1*
Queensland
6,076
43.9
1.5*
4,168
32.8
1.7*
10,244
38.4
1.6*
Western Australia
4,245
64.1
2.6*
3,687
58.9
3.4*
7,932
61.6
2.9*
South Australia
1,468
59.1
2.2*
1,376
53.7
2.8*
2,844
56.2
2.4*
Northern Territory
3,789
63.5
2.2*
3,753
61.9
3.7*
7,542
62.8
2.7*
Australia
22,263
47.9
1.7*
17,311
39.3
2.1*
39,574
43.6
1.9*
(a) Per 1,000 persons, directly age-standardised using the Australian 2001 standard population.
* Represents results with statistically significant differences in the Indigenous/other comparisons at the p<.05 level.
Source: AIHW analysis of National Hospital Morbidity Database

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