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1301.0 - Year Book Australia, 2004  
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Injuries

Introduction

The Australian Health Ministers' Conference has endorsed injury prevention and control as one of seven National Health Priority Areas, a policy initiative that seeks to focus on diseases and conditions of particular importance for the health of Australians. The focus on injury has arisen because although a greater proportion of Australians now live into old age than at any time in the past, each year significant numbers are hurt or die as a result of injury. Most injuries are not fatal. In 2001, 7,876 Australians died from injury, while 2.25 million people reported being injured (over a four-week period). Injuries not resulting in death range in severity from minor cuts and bruises to permanent impairment and disability. An important aspect of both fatal and non-fatal injuries is that many of them are preventable.

Understanding who is most at risk and the circumstances that surround injuries can assist in injury prevention and management. Some groups within society, such as the young, the elderly and those employed in certain occupations, tend to be more at risk from injury. For example, injury remains the main cause of death among young people, and, while older Australians are injured at a lower rate than other age groups, they are more likely to die of injury than any other age group.

This article draws on data from three sources. Data on injury-related deaths come from the Australian Bureau of Statistics (ABS) Causes of Deaths Collection, which compiles information from death certificates. Data on injuries come from the ABS 2001 National Health Survey (NHS). Data on Aboriginal and Torres Strait Islander peoples' injuries come from the Indigenous component of the ABS 2001 NHS.

An injury is a trauma, poisoning, or other condition of rapid onset to which factors and circumstances external to the person contributed significantly. External causes of injury may be physical, chemical or psychological (AIHW & DHFS 1998). Injuries may be unintentional, for example, as a result of motor vehicle accidents, sporting injuries and accidental poisonings. Some injuries may be intentional, for example, those resulting from assault. Definitions or more precise descriptions of other terms used in this article such as 'injury-related deaths', 'recent injuries' and 'long-term conditions resulting from injury' can be found in National Health Survey: Injuries, Australia, 2001 (4384.0).

Injury-related deaths and recent injuries

In 2001 suicide, with 2,454 recorded deaths, was the leading cause of death from injury in Australia, accounting for 31% of all injury-related deaths. Transport accidents were the next most common cause of injury-related death, 2,004 or 25%. Accidental poisoning and falls each caused 8% of injury-related deaths, while assault caused 4% of injury-related deaths (graph S9.1).

Open wounds and bruises were the most common types of recent injuries reported in the 2001 NHS (63% of people reporting recent injuries). Other relatively common injuries were sprains, strains or tears (18% of people with recent injuries), and burns and scalds (6%) (graph S9.2). In 2001, low falls (one metre or less) were the leading cause of recent injury, around 31% of people reporting recent injuries from low falls. Collisions or being struck by an object were also relatively common (19% of those injured), and were also the most common event causing concussion (37% of concussed people) (table S9.3).

Graph - S9.1 Selected causes of injury related deaths - 2001


Graph - S9.2 Persons who reported a recent injury, Selected injuries - 2001

S9.3 PERSONS WHO REPORTED A RECENT INJURY(a),
Selected causes of injury - 2001

%

Low fall (one metre or less)
31.0
Collision/struck by object
18.6
Bite or sting
8.6
High fall (greater than one metre)
2.6
Vehicle accident
2.1
Exposure to fire
2.0
Assault
2.0
Total(b)
100.0

(a) Most recent injury in the past four weeks.
(b) Includes recent injuries not specified above.
Source: ABS data available on request, 2001 National Health Survey.


Effects of injuries

Many injuries have a relatively minor impact on health. Of those people reporting a recent injury in 2001, less than 9% attended hospital. While injuries such as fractures and concussions were less common than some other types of injury, they often required a visit to the hospital. In 2001, 55% of people with a fracture and 37% of concussed people attended hospital, compared with 6% of people with open wounds (the most common type of recent injury).

However, injuries may result in longer-term adverse health affects. In 2001, 2.26 million Australians reported a long-term health condition which was due to an injury. The most commonly reported long-term health conditions arising from injury were back or disc problems. These accounted for half (50%) of the people reporting long-term conditions arising from injury (graph S9.4). Joint injuries were the next most common type of long-term health condition arising from injury (12%), followed by amputation and knee injuries (each 4%).

Graph - S9.4 Persons with long-term health condition rising from injury, Selected conditions - 2001


Who experiences injury?

Males of all ages are more likely to die from injury than females (graph S9.5). In 2001, the age-standardised death rate from injury for males was 59 per 100,000 population, compared with 23 for females. This partly reflects differences in the behaviour of males and females. Methods of self-harm typically chosen by males (e.g. hanging or firearms) are generally more lethal than those typically chosen by females (e.g. ingestion of poisons) (Commonwealth Department of Human Services and Health 1995).

Graph - S9.5 Age-specific death rates from external causes - 2001


Males of all ages are generally more likely than females to experience injury (graph S9.6). This reflects differences in the activities in which males and females typically engage, such as the type of work men and women commonly perform. In 2001, the manufacturing industry employed the greatest number of full-time male workers aged 15 years and over (719,200 or 78% of full-time workers in that industry). Just under 8% of these men reported being injured while working. In contrast, the health and community services industry employed the greatest number of full-time female workers in the same age group (322,800 women or 67% of full-time workers in that industry). Under 2% of these women reported being injured while working (see also Australian Social Trends 2002, 'Work-related injuries').

Similarly, because more males participate in organised sport, they are more at risk of sustaining sport-related injuries than females. In 2001, 27% of men participated in organised sport, compared with 20% of women. Boys aged 5-14 years were more likely to participate in organised sport than girls in the same age group (66% and 52% respectively) (ABS 2001). Overall, males of all ages were more than twice as likely as females to report being injured playing organised sport (3% of males compared with 1% of females). Differences in the type of sports played by males and females may also affect the rate, nature and severity of sporting injuries.

Age-related differences in injury rates are also linked to differences in behaviour and physical characteristics. Young children may have less knowledge of risks and be less able to avoid injury, and young adults are less experienced and tend to take more physical risks than older people (see Australian Social Trends, 2002, 'Selected risks faced by teenagers'). In keeping with this, the rate of recent injury was highest among children aged 0-14 years (18%) and people aged 15-24 years (17%), and lowest among older Australians aged 65 and over (6%). However, the rate of injury-related death was highest among older Australians, reflecting their physical vulnerability when injured.


Graph - S9.6 Rates of recent injuries, By age group - 2001

Although young people are less likely to die from injury than older people, injury accounts for the greatest number of deaths among people aged 15-24 years (79% of all deaths among men, and 60% of deaths among women in this age group in 2001). This is partly because young people are less likely than older people to die from other causes, such as health conditions that may develop over long periods of time (e.g. cancers and heart disease).

People of different ages also experience and die from different kinds of injuries. Children aged 0-14 years were more likely to die from drowning or other accidental threats to breathing, such as choking, suffocation and strangulation (31%), and in transport accidents (37%), than from other causes of injury. Of all types of recent injuries, children aged 0-14 were most likely to be injured in low falls (53%), or from collisions or being struck by an object (14%).

More people aged 15-24 years died in transport accidents than from other causes of injury (45% of all injury-related deaths experienced by this group), while the most common recent injuries in this age group were from low falls, or from collisions or being struck by an object (22% and 23% respectively). While suicide was a major cause of death for young people aged 15-24 years (30% of all injury-related deaths in this age group), the suicide rate was highest among people aged 25-34 years (21 per 100,000 population) in 2001. This age group was also more likely to die from suicide than other causes of injury (43% of injury-related deaths).

Falls made up a higher proportion of injury-related deaths for people aged 65 years and over, than they did for other age groups. This group was also more likely to be injured from a fall than from other types of injury.

Circumstances of recent injuries

Information about the locations in which injuries occur, and about the activities people are undertaking at the time of injury, can assist in managing the risk of injury in the community. In 2001, injuries most commonly occurred in people's homes - their own or someone else's (46% of all people reporting recent injuries) (graph S9.7). The most common type of injury in and around the home was an open wound, such as a cut which could occur from a sharp knife or tool (45% of those people injured in and around a home). Sports facilities or athletics fields or parks were the second most common venue for injuries (15% of people reporting recent injuries), where the most common type of injury reported at this location was a dislocation, sprain, or strained or torn muscle or ligament. Over three-quarters (77%) of people injured at a sports facility, field or park sustained the injury participating in organised sport, while a further 17% were injured using these areas informally for leisure.

Graph - S9.7 Persons who reported a recent injury, Location of injury - 2001


Of a range of activities associated with recent injuries, most people were injured during their leisure time (26% of people reporting recent injuries), followed by working (21%), domestic activities (20%) and organised sport (15%). In 2001, the majority of people reporting a current long-term condition arising from injury sustained that injury at work or school (one million people, or 46% of people with an injury-related long-term health condition), and most of these injuries were reported as being work-related (79%). Injuries from motor vehicle accidents, or sport or exercise participation, also left large numbers of people with a long-term health condition (495,300 and 545,200, respectively).

The consumption of alcohol at high levels (i.e. an average of more than five standard drinks per day for men or more than three standard drinks per day for women) is a well known contributing factor in a range of health conditions (Mathers et al. 1999). In addition, there is an association between alcohol consumption and the risk of injury (NIPAC 1999). In 2001, the likelihood of people reporting an injury increased with their drinking risk level. For example, 6% of non-drinkers reported an injury in the four weeks prior to interview, compared with 15% of high risk drinkers (graph S9.10). People who drank at risky or high risk levels were more than twice as likely to report a high fall than were people who did not drink or who drank at a low risk level. They were also more than five times as likely to have been injured as a result of being attacked.

Graph - S9.10 Alcohol risk and proportion of people injury - 2001


Injuries to Aboriginal and Torres Strait Islander peoples

In 2001, injury (classified as external causes of death and including accidents, assault and intentional self-harm) accounted for over twice the number of deaths in the Indigenous population compared to the total Australian population. The Standardised Mortality Ratio (SMR), which calculates the ratio of observed deaths to expected deaths within a population, indicates that Indigenous persons are 2.2 times more likely to die from injury than the Australian population as a whole. Of deaths registered in 2001, 17% of Indigenous deaths and 6% of all deaths were caused by injury. The most common types of injury-related deaths amongst Indigenous persons were suicide (31%) and transport accidents (24%). While this pattern is similar for the entire population, it should be noted that it is likely that a proportion of Indigenous deaths are not registered as Indigenous and therefore these figures are likely to be an underestimate of the true number of Indigenous deaths due to injury.

The Indigenous supplement to the 2001 NHS found that 14% of Indigenous males and 11% of Indigenous females reported suffering an injury which led to a health-related action in the four weeks preceding the survey. Indigenous males appear more likely to suffer injury than Indigenous females. This feature is particularly apparent in the 25-34 year age group, where 18% of Indigenous males compared to only 7% of Indigenous females reported an injury. The most common types of recent injuries reported were open wounds (48%) followed by bruising (32%), a pattern similar to that for the non-Indigenous population. The leading cause of these injuries was low falls (one metre or less) which accounted for 36% of recent injuries, with collisions or being struck by an object the second most common cause of recent injury of Indigenous persons (22%). Nearly two-thirds (64%) of reported recent injuries occurred in the home of either the Indigenous respondent or someone they knew.

Among the Indigenous population who reported a recent injury in 2001, 21% reported they attended a hospital due to their injury compared to 8% of the non-Indigenous population. Proportionally, those Indigenous persons who reported suffering a fracture were also more likely to report attending a hospital for medical attention (63%), followed by those who reported a sprain, strain or tear (34%). While open wounds and bruising was the most common recent injury reported among Indigenous persons in 2001, 16% of Indigenous persons who reported these injuries also reported attending a hospital for medical attention. This compared to 6% of non-Indigenous respondents who received open wounds and bruising.

References

ABS (Australian Bureau of Statistics) 2001, National Health Survey: Injuries, Australia, cat. no. 4384.0, ABS, Canberra.

AIHW (Australian Institute of Health and Welfare) and DHFS (Department of Health and Family Services) 1998, National Health Priority Areas Report, Injury Prevention and Control, AIHW Cat. No. PHE 3, AIHW, Canberra.

Commonwealth Department of Human Services and Health 1995, Youth Suicide in Australia: a background monograph, AGPS, Canberra.

Mathers, C, Vos, T & Stevenson, C 1999, The burden of disease and injury in Australia, AIHW, Canberra.

NIPAC (National Injury Prevention Advisory Council) 1999, Directions in Injury Prevention, Report 1: Research needs, Commonwealth Department of Health and Aged Care, Canberra.

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