A total of 9,924 community injury deaths occurred in Australia in 2003–04, 63% of which were males. The age-standardised rate was 66.8 deaths per 100,000 population for males and 31.6 per 100,000 for females. Rates were highest for young and middleaged males in the age band 20–44 years (64.5 per 100,000 population) and for older males aged 70 years and over (267.3 per 100,000).
The most common cause of injury death was Unintentional falls, which accounted for 30% of all community injury deaths that occurred in 2003–04. This was followed by Suicide which accounted for 22% of community injury deaths.
A slight downward trend in injury deaths, evident over the past few years, continued in 2003–04. This trend was more marked for males than females. Under-ascertainment of injury deaths in the source data file may have contributed to this.
Rates were highest for Tasmania and the Northern Territory. The latter had an ageadjusted rate of 111.4 per 100,000 population. The Australian Capital Territory had the lowest age-adjusted rate (34.4 per 100,000).
Three states had rates that differed at a statistically significant level from the Australian rate of 48.5 per 100,000 population—New South Wales, Western Australia and South Australia.
Age-adjusted rates of injury mortality increased according to the remoteness of the deceased’s zone of residence. The rate was more than 2.5 times greater in the Very Remote zone than it was in Major cities.
There was strong evidence of undercounting of cases in some external cause categories on 2003–04. This was particularly evident in the sections related to transport and homicide where the reported totals were significantly less than those reported by other agencies. Other sections where there was a suspicion of under-counting included suicide, drowning and smoke, fire and flames, heat and hot substances.
Since the trend in death rate for all community injury cases remained relatively unchanged, there was suspicion that the undercounting in the external cause categories mentioned above was compensated for by some over-counting in other external cause categories. This was evident to some degree for the sections on poisoning and other unintentional deaths.
1,724 deaths during 2003–04 were as a result of transport-related injury. Males accounted for 73% of these deaths.
Age-adjusted rates for large population states were similar, varying from 7.5 per 100,000 population for New South Wales to 10 per 100,000 population for Western Australia. The rate for the Northern Territory (18.5) was more than double the rate for Australia (8.6), while the rate for Tasmania (13.0) was just over 50% higher than the national rate. The rate for the Australian Capital Territory (4.7) was by far the lowest, being just over 50% of the national rate.
The most common types of injuries sustained in transport-related deaths were fractures and intracranial injuries whilst the most common locations for injuries were the head and the thorax region.
1,482 of all transport-related deaths resulted from on-road collisions in which a motor vehicle was involved. Of these 1,482 cases, 64% were motor vehicle occupants. Of the remainder, pedestrians accounted for 15%, motorcyclists 12% and pedal cyclists 2%. Drivers represented almost two-thirds of vehicle occupant deaths and over three times as many drivers were male.
By far the largest proportion of vehicle occupants died while driving a car. The involvement of occupants of heavy transport vehicles and pickup trucks or vans, was also very evident.
2,960 deaths during 2003–04 were fall-related, representing an age-adjusted rate of 14 deaths per 100,000 population and accounting for 30% of all community injury deaths.
Fall rates were concentrated in the older age groups and were particularly high among both males and females aged 85 years and over. Males generally had moderately higher rates than females across most age groups.
Rates appear to differ across jurisdictions. South Australia was the only jurisdiction to record a rate significantly lower than the national rate while the rate for the Northern Territory was more than double the national rate. However, these apparent differences should be interpreted cautiously because of variations in collection and coding might contribute to the differences.
By far the most common type of injury sustained in fall-related deaths is a fracture with a large proportion of these being hip fractures.
260 unintentional drowning deaths occurred in 2003–04. These deaths accounted for 3% of all injury deaths. 3.2 times as many men as women drowned during 2003–04 (Males 198; Females 62). 14% (n=36) of unintentional drowning deaths occurred to children aged 0–4 years.
Overall, the age-adjusted rate of unintentional drowning fell by 29% between 1997–98 and 2003–04. Between 2002–03 and 2003–04, the age-adjusted rate fell by 11%.
Two states, Victoria (low) and the Northern Territory (high) had rates that were statistically significantly different from that for Australia as a whole (1.3 per 100,000 population).
Age-adjusted rates rose slightly according to the remoteness of the deceased person’s residence.
The most common circumstances for unintentional drowning were drowning in bodies of natural water (36%), watercraft or road transport-related drowning (15%), swimming pool drowning (14%), or drowning in bathtubs (6%).
Swimming pool drownings occurred most frequently in the 0–4 year age group. The all-Australia age-adjusted rate of unintentional drowning in swimming pools for this age group was 0.09 per 100,000 population. Queensland and New South Wales had the highest rates of swimming pool drownings for children aged 0–4 years (0.12 and 0.11 per 100,000 population, respectively). Other states and territories all had 3 or fewer cases. Annual rates of swimming pool drowning have fluctuated, partly as a consequence of fairly small case numbers. Overall, there was no discernible trend for the seven year period 1997–98 to 2003–04.
Unintentional poisoning by drugs
824 deaths during 2003–04 involved poisoning by drugs, representing Unintentional poisoning by drugs 824 deaths during 2003–04 involved poisoning by drugs, representing an age-adjusted rate of 4.1 deaths per 100,000 population. Close to two-thirds of these deaths involved males. Rates were highest for males aged 20–44 years with this age group accounting for 73% of all male unintentional drug deaths.
Rates varied significantly between jurisdictions, possibly reflecting differences in availability of drugs within each jurisdiction.
The most commonly specified family of drugs was narcotics, which were associated with 56% of the deaths in this category. Just over a third of narcotics-related deaths involved heroin.
A smaller group of unintentional poisoning deaths were associated with other substances. This group represented 304 deaths during 2003–04. Close to three-quarters of these deaths involved males.
Rates for these deaths were significantly higher in the Northern Territory when compared to the other jurisdictions and in very remote areas. Of the 17 deaths occurring in the Northern Territory, 13 were recorded as Aboriginal and/or Torres Strait Islander.
The two most common agents associated with this group of deaths were alcohol, and gases and vapours.
Smoke, fire and flames, heat and hot substances
135 deaths occurred in 2003–04 as the result of unintentional burns, or exposure to smoke, fire or hot substances. 55 (41%) of these occurred in a building or structure. The major mechanisms for all deaths in this category are shown in Table 2.6.2.
The all-ages male adjusted rate of death due to unintentional exposure to smoke, fire, flames, heat and hot substances was 1.7 times the equivalent female rate. Rates were highest in the older age groups. Males had consistently lower rates of deaths due to exposure to smoke, fire, flames, heat and hot substances in all years during the period 1997–98 to 2003–04. Rates peaked slightly in 1998–99 and 2002–03, but were fairly constant over the entire period.
Victoria had the lowest age-adjusted rate of deaths due to exposure to smoke, fire, flames, heat and hot substances with a rate of 0.4 deaths per 100,000 population during 2003–04, and Tasmania had the highest (2.3 per 100,000). The rate for both states differed at a statistically significant level from the all Australia rate of 0.7.
Where a burn had occurred, the affected body part was not specified in 70 (52%) cases. 27 (20%) cases received a code indicating that burns had been classified according to the extent of the body surface involved. In 22 (81%) of the latter group, burns had involved 90% or more of the body surface.
47 (35%) cases received a code indicating that a toxic effect of carbon monoxide or other gases, fumes and vapours had contributed to the death.
2,173 deaths that occurred during 2003–04 have been coded as being the result of intentional self-harm. Suicide was responsible for 22% of all injury deaths in 2003–04, at an age-adjusted rate of 10.8 deaths per 100,000. Suicide accounted for more deaths than transport related accidents, which had an age-adjusted rate of 8.6 per 100,000 population.
Males had higher rates than females in all age groups. The overall male age-adjusted rate of 17.4 per 100,000 population in 2003–04 was almost 4 times the female rate of 4.6 deaths per 100,000. The excess of male rates over female rates was greatest for young and middle-aged adults aged 20–44, and in those aged 80 years and over.
Overall, there has been a steady downward trend in the age-adjusted suicide rate for persons between 1997–98 and 2003–04, based on available data. However, the problem of under-ascertain mentioned above and in section 1.4 probably contributed to this apparent decline. The rate fell from 1.8 per 100,000 population at the beginning of the period to 0.7 per 100,000 in 2003–04. The decline in annual age-adjusted rates was slightly slower for females than for males. Over the period 1997–98 to 2003–04, the male age-adjusted rate fell by 29% and the female rate by 24%.
Age-adjusted rates for Victoria, Queensland, Western Australia and South Australia were fairly similar (between 10.0 and 15.0 per 100,000 population). New South Wales, the most populous state, had the lowest rate at 8.6 per 100,000 population, and Tasmania and the Northern Territory had the highest (17.3 and 24.7 per 100,000 population, respectively). The rates for New South Wales, Queensland, Tasmania and the Northern Territory differed, at a statistically significant level, from the rate for Australia as a whole (10.8 per 100,000 population).
Age adjusted rates of suicide mortality increased according to the remoteness of the deceased person’s zone of residence. Major cities had the lowest age-adjusted rate and the Very remote zone had the highest. The age-adjusted rate for the Very remote zone was more than 2.3 times greater than that for Major cities.
The two most commonly coded diagnoses in cases of suicide death were asphyxiation and injuries to the head. 46% of all cases of suicide death had been assigned a diagnosis code indicating that asphyxiation had contributed to the death. 82% of these cases involved males. A head injury diagnosis code was assigned in 10% of suicide cases. 93% of these cases were male.
The most frequently coded mechanism of suicide in 2003–04 was ICD-10 X70 Hanging, strangulation and suffocation (46% of suicide deaths). This was followed by poisoning (31%) and use of a firearm (9%).
Age-adjusted rates fell for suicide due to all major mechanisms over the period 1997–98 to 2003–04: Suicide deaths due to hanging fell by 22%, poisoning-related suicide by 37%, and firearm-related suicide by 35%.
Age-adjusted rates of suicide increased consistently with the remoteness of the zone of residence of the deceased person. Rates ranged between 9.9 per 100,000 population in Major cities to 22.7 per 100,000 in Very remote areas. There was, however, variation in the distribution of rates between remoteness zones according to the mechanism of death. For example, self-inflicted hanging deaths were 3.6 times more frequent in Very remote areas than in Major cities whereas suicide due to poisoning was 1.6 times more common in Very remote areas than in Major cities.
215 deaths during 2003–04 involved assault by another person, representing an ageadjusted rate of 1.1 deaths per 100,000 population.
Males were almost twice as likely as females to be a victim of homicide. 58% of male homicides and 50% of female homicides occurred in the age range 20–44 years. 14 (10%) of homicide deaths involved children: 11 were at ages 0–4 years, 2 at ages 5–9 years and 1 at ages 10–14 years.
For both male and female victims, the most frequently used means of assault was a sharp object, accounting for 47% and 30% respectively. A firearm was used in just over 16% of homicides.
As in previous years, the rate of homicide for the Northern Territory was well above the national rate. Of the 12 deaths occurring in the Northern Territory, 10 were recorded as Aboriginal and/or Torres Strait Islander.
An apparent decline of rates in recent years is at least partly due to underascertainment of this type of case in the source data.
Complications of medical and surgical care
1,764 deaths during 2003–04 involved complications of surgical and medical care, representing an age adjusted rate of 8.5 deaths per 100,000 population.
Higher death rates are concentrated in older age groups and increase almost exponentially in both males and females from about 60 years of age onwards.
In terms of types of injury, just over half of these deaths were classified to Complications of procedures, not elsewhere classified and 15% were classified to Complications of cardiac and vascular prosthetic devices, implants and grafts.
In terms of external causes of death, almost 84% of these deaths were classified to Surgical operation and other surgical procedures as a cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure.