Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.03 Injury and poisoning

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

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 including: loss of 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.

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 Aboriginal and Torres Strait Islander peoples (behind hospitalisation for dialysis). Hospitalisations for injury among Indigenous Australians occur at twice the rate of non-Indigenous Australians, accounting for 44,067 hospitalisations in the two years from July 2008 to June 2010.

For non-Indigenous Australians, hospitalisation rates for injury were much higher in the elderly (aged 65 years and over) than in younger age groups. This mainly reflects higher rates of falls for elderly people. Among non-Indigenous people aged less than 65 years, injury hospitalisation rates for males were higher than for females. Injury hospitalisation rates had a very different pattern for Indigenous Australians: injury had a much greater impact on the young and middle-aged; and rates peaked in early adult age groups. Rates varied across jurisdictions, with the highest rates in WA and the NT.

Between 1998–99 and 2009–10 for Qld, WA, SA and the NT combined, the hospitalisation rate for injury and poisoning for Aboriginal and Torres Strait Islander peoples showed no change. During this period the non-Indigenous hospitalisation rate for injury and poisoning increased by 9%. Between 2004–05 and 2009–10, based on data from the above jurisdictions and also NSW and Victoria, the Aboriginal and Torres Strait Islander hospitalisation rate for injury and poisoning increased by 14%. This was greater than the increase for non-Indigenous Australians (9%).

Top of pageAssault is the leading cause of injury requiring hospitalisation for Aboriginal and Torres Strait Islander peoples and was responsible for 21% and 28% of injury hospitalisations for males and females respectively in the two years to June 2010. Hospitalisation rates for injuries caused by assault are much higher for Aboriginal and Torres Strait Islander men (eight times as high) and women (34 times) than for non-Indigenous men and women. Indigenous Australians are also more likely to be re-admitted to hospital as a result of interpersonal violence than other Australians (Meuleners et al. 2008; Berry et al. 2009). Hospitalisation rates for Aboriginal and Torres Strait Islander peoples for other causes of injury are between 1.1 and 3.2 times as high as those for non-Indigenous Australians. Other leading causes of injury include accidental falls (18%), exposure to inanimate mechanical forces (12%), complications of medical care (12%) and transport accidents (9%).

BEACH survey data collected from April 2006 to March 2011 suggest that 5% of all problems managed by GPs among Indigenous Australians were for injury. Overall the management rate was slightly higher for Indigenous Australians (72 per 1,000 encounters) compared with other Australians (67 per 1,000 encounters). The most common injuries managed among Indigenous Australians were musculoskeletal and skin injuries.

Over the period 2006–10, in the five jurisdictions with adequate data for reporting (NSW, Qld, WA, SA and the NT combined), the third most common cause of death among Indigenous Australians was external causes (injury and poisoning). Indigenous Australians died from external causes (including injury) at twice the rate of other Australians. The most common type of external cause of mortality among Indigenous Australians was intentional self-harm (491 deaths), followed by transport accidents (463 deaths), assault (178 deaths) and accidental poisoning (167 deaths). Indigenous Australians died from intentional self-harm and transport accidents at two and three times the rate of non-Indigenous Australians respectively. Indigenous Australians died from assault at nine times the rate of other Australians.

Implications:

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Intentional self-harm is the leading cause of death from external causes, followed by transport-related accidents. The relatively high rates of intentional self-harm highlight the need for interventions focused on social and emotional wellbeing (see measure 1.16). Assault is the most important injury prevention issue in relation to hospitalisations, followed by accidental falls.

There is a need to ensure that injury prevention efforts are based on evidence, that they are culturally appropriate, and that they build on resilience. Such efforts should also address systemic issues that reduce people's capacity to make health-enhancing choices and the likelihood that they will do so (Anderson 2008; Ivers et al. 2008; Berger et al. 2009; Berry et al. 2009).

The Indigenous Family Safety Agenda (July 2010) and the National Aboriginal and Torres Strait Islander Safety Promotion Strategy (July 2005) address 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 2011–2020 is to ensure Indigenous people have substantially improved access to graduated driver licensing and to vehicles with high safety ratings. As a priority, the strategy calls for the implementation of programs that help Indigenous learner drivers gain more driving practice; and for road safety education programs that are locally relevant and culturally appropriate.

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Figure 17—Age-standardised hospitalisation rates for injury and poisoning, by Indigenous status

Figure 17—Age-standardised hospitalisation rates for injury and poisoning, by Indigenous status
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 18—Age-specific hospitalisation rates for injury and poisoning, by Indigenous status and sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
Males
Figure 18—Age-specific hospitalisation rates for injury and poisoning, by Indigenous status and sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010 (Males)

Females
Figure 18—Age-specific hospitalisation rates for injury and poisoning, by Indigenous status and sex, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010 (Females)
Source: AIHW analysis of National Hospital Morbidity Database
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Table 4—Age-standardised hospitalisations for external causes of injury and poisoning for Aboriginal and Torres Strait Islander peoples by sex and external cause, NSW, Victoria, Qld, WA, SA and the NT, July 2008–June 2010
External CauseMale %Male Rate(a)Male RatioMale %Male Rate(a)Male RatioMale %Male Rate(a)Male Ratio
Assault
21.0
10.9
7.5*
28.0
10.6
34.4*
24.1
10.7
12.2*
Falls
18.1
10.3
1.5*
18.2
9.3
1.2*
18.1
9.9
1.3*
Exposure to inanimate mechanical forces
14.8
6.5
1.5*
8.8
3.0
2.2*
12.2
4.7
1.7*
Complications of medical and surgical care
9.8
7.5
1.7*
14.1
7.4
1.9*
11.6
7.4
1.8*
Transport accidents
11.5
5.2
1.4*
6.7
2.4
1.5*
9.4
3.8
1.5*
Intentional self-harm
5.0
2.6
2.9*
8.7
3.2
2.1*
6.6
2.9
2.4*
Other accidental exposures
7.4
3.7
1.1*
5.1
2.1
1.2*
6.4
2.9
1.1*
Exposure to animate mechanical forces
4.7
2.0
2.1*
2.9
1.0
2.3*
3.9
1.5
2.1*
Exposure to electric current/ smoke/ fire/ animals/ nature
3.4
1.5
2.3*
2.8
0.9
2.7*
3.2
1.2
2.5*
Accidental poisoning by and exposure to noxious substances
1.9
0.9
2.0*
2.4
0.8
2.1*
2.1
0.9
2.1*
Other external causes
2.1
1.1
3.4*
2.1
0.8
3.0*
2.1
0.9
3.2*
Total
100.0
52.2
1.9*
100.0
41.6
2.1*
100.0
46.9
2.0*
Total number of hospitalisations for injury or poisoning:
24,923
19,144
44,067
(a)Per 1,000 persons, directly age-standardised using the Australian 2001 standard population.
*Represents results with statistically significant differences in the Indigenous/other
Source: AIHW analysis of National Hospital Morbidity Database
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Table 5—Age-standardised hospitalisations for external causes of injury and poisoning for Aboriginal and Torres Strait Islander peoples by sex and jurisdiction, July 2008–June 2010


Male Number

Male Rate

Male Ratio

Female Number

Female Rate

Female Ratio

Persons Number

Persons
Rate

Persons
Ratio

New South Wales

6,399

42.5

1.6*

4,225

30.1

1.6*

10,624

36.3

1.6*

Victoria

1,216

37.2

1.4*

805

27.4

1.4*

2,021

32.4

1.4*

Queensland

6,862

49.1

1.7*

4,612

34.8

1.7*

11,474

41.9

1.7*

Western Australia

4,651

67.4

2.6*

4,145

63.1

3.3*

8,796

65.2

2.9*

South Australia

1,672

63.2

2.5*

1,447

52.9

2.8*

3,119

57.6

2.6*

Northern Territory

4,123

68.0

2.3*

3,910

61.8

3.3*

8,033

64.7

2.7*

Tasmania

289

14.9

0.7

225

12.7

0.9

514

13.8

0.8

Australian Capital Territory

141

24.9

1.2

116

23.5

1.4*

257

24.6

1.3*

Total(b)

24,923

52.2

1.9*

19,144

41.6

2.1*

44,067

46.9

2.0*
(b)Total excludes Tasmania and the ACT
*Represents results with statistically significant differences in the Indigenous/other
Source: AIHW analysis of National Hospital Morbidity Database
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