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

Tier 1—Health conditions—1.03 Injury and poisoning

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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:

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.

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

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

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 Cause	Male %	Male Rate(a)	Male Ratio	Male %	Male Rate(a)	Male Ratio	Male %	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

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*

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