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1.03 Injury and poisoning

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 disability and disadvantage including reduced opportunities in education and employment, communication impairment and burden on caregivers (Stephens et al. 2014). Evidence shows that acquired brain injury (from substance misuse or external trauma) leading to cognitive impairment is associated with contact with the criminal justice system (Haysom et al. 2014).

Findings

Over the period 2008–12, 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). Rates for Indigenous males were twice the rate for females. There has been no significant change since 1998. Indigenous Australians died from external causes at twice the non-Indigenous rate. The most common external causes of Indigenous mortality were intentional self-harm (561 deaths), followed by transport accidents (452 deaths), accidental poisoning (196 deaths) and assault (189 deaths). Indigenous Australians died from intentional self-harm (suicide) and transport accidents at 1.9 and 2.5 times the rate of non-Indigenous Australians respectively. Indigenous Australians died from assault at 7 times the non-Indigenous rate.

Based on the 2012–13 Health Survey, 19% of Indigenous Australians had experienced injuries in the 4 weeks prior to the survey. Among Indigenous Australians who were injured, the most common events causing injury were falls (45%) and hitting or being hit by something (19%). The main types of injuries were open wounds (35%) and bruising (28%). Action was taken by 46% of those injured with 18% attending a community clinic or hospital. Of those who had their injuries treated, 11% were injured while under the influence of alcohol/drugs (for those aged 15 years and over). Of those with a long-term health condition, 27% reported that it was as a result of injury or an accident. In 2012–13, 7% of Indigenous Australians aged 15 years and over experienced stress due to a serious accident, 1.8 times the non-Indigenous rate.

Hospitalisations for injury reflect hospital attendances for the condition rather than the extent of the problem in the community. Injury was the second most common reason for hospitalization for Indigenous Australians (54,079 separations) in the two years to June 2013 (after hospitalisations for dialysis). The hospitalisation rate for injury among Indigenous Australians was 1.8 times the non-Indigenous rate. For non-Indigenous Australians, hospitalisation rates for injury were much higher for those aged 65 years and over than in younger age groups. This reflects higher rates of falls for elderly people. There was a different pattern for Indigenous Australians: injury had a 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.

Hospitalisation rates for injury among Indigenous Australians have increased by 32% since 2004–05 in the six jurisdictions with adequate data for trend reporting (NSW, Vic, Qld, WA, SA and the NT combined). Rates increased faster for Indigenous Australians compared with non-Indigenous Australians, resulting in an increase in the difference between Indigenous and non-Indigenous rates. Assault was the leading cause of injury requiring hospitalisation for Indigenous Australians and was responsible for 20% and 27% of injury hospitalisations for males and females respectively in the two years to June 2013. After adjusting for age differences between the two populations, hospitalisation rates for injuries caused by assault were much higher for Indigenous men (8 times as high) and women (32 times) than for non-Indigenous men and women. Rates of hospitalisation for assault for Indigenous Australians were highest in remote (28 per 1,000) and very remote areas (23 per 1,000) and lowest in major cities and inner regional areas (both 4 per 1,000). Indigenous Australians are also more likely to be re-admitted to hospital as a result of interpersonal violence than other Australians (Berry et al. 2009; Meuleners et al. 2008). Hospitalisation rates for Indigenous Australians for other causes of injury are between 1 and 2.6 times as high as those for non-Indigenous Australians. Other leading causes of injury include accidental falls (19%), exposure to inanimate mechanical forces (12%), complications of medical care (12%) and transport accidents (9%).

Henley & Harrison (2013), found that between 2005–06 to 2009–10, 60% of transport-related fatal injuries among Indigenous Australians involved car occupants and 26% involved pedestrians. Indigenous Australians were 3.3 times as likely as non-Indigenous Australians to die of a transport-related injury as a car occupant.

Based on a survey of GPs collected from April 2008 to March 2013, injuries accounted for 5% of all problems managed by GPs among Indigenous patients. The rate of injuries managed per 1,000 GP encounters was similar between Indigenous Australians (66 per 1,000 encounters) and other Australians (65 per 1,000 encounters). The most common injuries managed for both populations were musculoskeletal and skin injuries.

Implications

Among Indigenous Australians, intentional self-harm is the leading cause of death from external causes, followed by transport accidents. The relatively high rates of intentional selfharm highlight the need for interventions focused on social and emotional wellbeing (see measure 1.18). Assault is the most important injury prevention issue in relation to hospitalisations, followed by falls. Alcohol and substance use has been found to be a factor in suicide deaths (Robinson et al. 2011) and transport accidents (West et al. 2014) as well as assault (Mitchell 2011). There is a need to ensure that injury prevention efforts are evidence based, relevant and address systemic issues that reduce people's capacity to make health- enhancing choices (Anderson 2008; Berger et al. 2009; Berry et al. 2009). An objective of the National Road Safety Strategy 2011–2020 is to ensure Indigenous Australians 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 programmes that help Indigenous learner drivers gain more driving practice and for road safety education programmes that are locally relevant and culturally appropriate.

Figure 1.03-1 Age-standardised hospitalisation rates for injury and poisoning, by Indigenous status, 1998–99 to 2012–13
chart showing age-standardised hospitalisation rates

Figure 1.03-1 shows age-standardised hospitalisation rates for injury and poisoning by Indigenous status (rate per 1,000 population). Data is presented for Aboriginal and Torres Strait Islander peoples in Queensland, WA, SA and NT from 1998-99 to 2012–13; Aboriginal and Torres Strait Islander peoples in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13; non-Indigenous Australians in Queensland, WA, SA and NT from 1998-99 to 2012–13; and non-Indigenous Australians in NSW, Victoria, Queensland, WA, SA and NT from 2004-05 to 2012–13. Hospitalisation rates for injury among Indigenous Australians have increased by 32% since 2004–05 in the six jurisdictions with adequate data for trend reporting (NSW, Vic, Qld, WA, SA and the NT combined). Rates increased faster for Indigenous Australians compared with non-Indigenous Australians, resulting in an increase in the difference between Indigenous and non-Indigenous rates.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.03-2 Age-specific hospitalisation rates for injury and poisoning, by Indigenous status and sex, July 2011–June 2013
chart showing age-specific hospitalisation rates

Figure 1.03-2 shows age-specific hospitalisation rates for a principal diagnosis of injury and poisoning by Indigenous status and sex (rate per 1,000 population). Data is presented for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians in NSW, Victoria, Queensland, WA, SA and NT from July 2011 to June 2013. Data is presented for the following age groups: 0-4 years; 5-14 years; 15-24 years; 25-34 years; 35-44 years; 45-54 years; 55-64 years; and 65 years and over. Data is presented separately for males and females.

Source: AIHW analysis of National Hospital Morbidity Database

Table 1.03-1 Age-standardised hospitalisations for external causes of injury and poisoning for Aboriginal and Torres Strait Islander peoples by sex and cause, July 2011–June 2013
External Cause: Males Females Persons
% Rate(a) Ratio % Rate(a) Ratio % Rate(a) Ratio
Assault 19.5 9.5 8.0* 26.7 10.1 32.4* 22.7 9.8 13.0*
Falls 19.7 10.5 1.4* 18.9 9.4 1.1* 19.3 10.0 1.2*
Exposure to inanimate mechanical forces 15.3 6.3 1.4* 8.7 2.9 1.9* 12.4 4.6 1.5*
Complications of medical and surgical care 10.0 6.8 1.4* 14.7 7.5 1.7* 12.1 7.2 1.6*
Transport accidents 10.6 4.4 1.3* 6.0 2.0 1.2* 8.5 3.2 1.2*
Intentional self-harm 5.1 2.5 2.9* 10.1 3.6 2.3* 7.3 3.0 2.5*
Other accidental exposures 7.0 3.3 1.0* 5.3 2.1 1.1* 6.2 2.7 1.0*
Exposure to animate mechanical forces 5.4 2.3 2.2* 2.8 1.0 1.9* 4.3 1.6 2.0*
Exposure to electric current/smoke/fire/animals/nature 3.5 1.5 2.3* 2.7 0.9 2.5* 3.1 1.2 2.3*
Accidental poisoning/exposure to noxious substances 2.2 1.0 2.3* 2.5 0.9 2.4* 2.3 0.9 2.4*
Other external causes 1.7 0.8 3.1* 1.7 0.7 3.0* 1.7 0.7 3.1*
Total 100.0 49.0 1.7* 100.0 41.0 1.9* 100.0 45.0 1.8*
Total number of hospitalisations for injury or poisoning: 30,000 24,079 54,079

Note: Per 1,000 persons, directly age-standardised using the Australian 2001 standard population.

* Represents results with statistically significant differences in the Indigenous/other comparisatons at the p<.05 level.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.03-3 Age-standardised death rates for external causes, by Indigenous status and sex, 2008–12
chart showing age-standardised death rates

Figure 1.03-3 shows the most common external causes of Indigenous mortality were intentional self-harm (561 deaths), followed by transport accidents (452 deaths), accidental poisoning (196 deaths) and assault (189 deaths). Indigenous Australians died from intentional self-harm (suicide) and transport accidents at 1.9 and 2.5 times the rate of non-Indigenous Australians respectively. Indigenous Australians died from assault at 7 times the non-Indigenous rate.

Source: AIHW analysis of National Hospital Morbidity Database

Figure 1.03-4 Age-standardised hospitalisations for external causes of injury and poisoning by Indigenous status and jurisdiction, July 2011–June 2013
chart showing age-standardised hospitalisations

Figure 1.03-4 shows hospitalisations for external causes of injury and poisoning varied across jurisdictions, with the highest rates in WA and the NT.

Source: AIHW analysis of National Hospital Morbidity Database