INJURIES IN YOUNG PEOPLE

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1 INJURIES IN YOUNG PEOPLE Introduction Injury is the leading cause of mortality among young people aged years, with the rate at which these events occur being far higher than for other age groups [233]. During 2 24, on average, 29 young people each year died as the result of an injury, as compared to 98 children per year during the same period [22]. When compared to children, a different set of causes are also seen, with more than a third of all injury deaths in young people being the result of self-harm. An equivalent proportion of deaths arise when young people are the occupants in a vehicle in a crash, many of which are traffic related events on public roads. Further deaths result from motorcycle and pedestrian crashes both on and off road. Considerable concern has been focused on the high rate of mortality and morbidity from MVTC in this age group [234]. Hospitalisation for injury among this age group is also comparatively high, with the top four reasons for admission being the result of inanimate mechanical forces (for example, being struck by or caught between objects), falls, as occupants of vehicles, and from assault [234]. Risk factors among those hospitalised included age, gender, ethnicity and deprivation. Risk factors evident for vehicle occupants are being male, Māori and from an area of higher deprivation [97]. Motorcycle and pedal cycle risk factors include being male and European, with pedal cyclists also more likely to be from less deprived areas. Pedal cyclists are also more commonly younger than motorcyclists and vehicle occupants. Among non-transport injury events, with the exception of gender, risk factors are less evident [234]. The following section reviews injuries in young people using data from the National Minimum Dataset and the National Mortality Collection. The section concludes with a brief overview of local policy documents and evidence-based reviews which consider the prevention of childhood injuries at the population level. Data Sources and Methods Indicator 1. Hospital Admissions for Injuries in Young People Aged Years Numerator: National Minimum Dataset: Hospital admissions in young people aged years with a primary diagnosis of Injury (ICD-1-AM S T79). Causes of injury were assigned using the ICD-1-AM primary external cause code (E code). The following were excluded: 1) Admissions with an E code in the Y4 Y89 range (complications of drugs/medical/surgical care and late sequelae of injury). 2) Admissions with an Emergency Medicine Specialty code (M5 M8) on discharge. Causes of injury were assigned using the primary E code (hospital admissions) or the main underlying cause of death as follows: Pedestrian (V1 V9), Cyclist (V1 V19), Motorbike (V2 29), Vehicle Occupant (V4 79), Other Land Transport (V3 39, V8 89); Other Transport (V9 V99); Falls (W W19), Mechanical Forces: Inanimate (W2 W49), Mechanical Forces: Animate (W5 64), Drowning/Submersion (W65 74), Accidental Threat to Breathing (W75 W84), Electricity/Fire/Burns (W85 X19), Accidental Poisoning (X4 X49), Intentional Self-Harm (X6 84), Assault (X85 Y9), Undetermined Intent (Y1 Y34). Broader Categories included Land Transport Injuries (V1 V89) and Unintentional Non-Transport Injuries (W W74, W85 X19) Denominator: Statistics NZ Estimated Resident Population (with linear extrapolation being used to calculate denominators between Census years). 2. Mortality from Injuries in Young People Aged Years Numerator: National Mortality Collection; Deaths in young people aged years where the main underlying cause of death was an injury (V1 Y36). Causes of injury were assigned using the codes listed above. Denominator: Statistics NZ Estimated Resident Population (with linear extrapolation being used to calculate denominators between Census years). Notes on Interpretation Note 1: Because of regional inconsistencies in the uploading of Emergency Department cases to the National Minimum dataset (see Appendix 3) all hospital admissions with an Emergency Department specialty code on discharge have been excluded. In addition, because of the potential for these inconsistencies to impact significantly on time series analysis, any reviews of long term trends have been restricted to mortality data, with hospital admission data being used to explore cross sectional associations between demographic factors and different injury types. Despite these restrictions, the reader must bear in mind the fact that differences in the Injuries in Young People - 365

2 way different DHBs upload their injury cases to the NMDS may also impact on the regional vs. New Zealand analyses presented (see Appendix 3 for a fuller explanation of these issues). Note 2: 95% confidence intervals have been provided for the rate ratios in this section and where appropriate, the terms significant or not significant have been used to communicate the significance of the observed associations. Tests of statistical significance have not been applied to other data in this section, and thus (unless the terms significant or non-significant are specifically used) the associations described do not imply statistical significance or non-significance (see Appendix 2 for further discussion of this issue). All Injuries New Zealand Trends In New Zealand during 2 28, mortality from land transport injuries fluctuated, while mortality from unintentional non-transport injuries and accidental poisoning remained relatively static (Figure 128). Figure 128. Mortality from Unintentional Injuries in Young People Aged Years by Main Underlying Cause of Death, New Zealand Mortality per 1, Other Causes Accidental Poisoning Unintentional Non-Transport Land Transport Source: Numerator: National Mortality Collection (Assault and suicide excluded); Denominator: Statistics NZ Estimated Resident Population. New Zealand Distribution by Cause In New Zealand during 26 21, inanimate mechanical forces and falls were the leading causes of injury admissions in young people, although as a group transport injuries also made a significant contribution. In contrast, during 24 28, intentional self-harm and vehicle occupant injuries were the leading causes of injury related mortality in young people (Table 119). Nelson Marlborough and South Canterbury Distribution by Cause In Nelson Marlborough and South Canterbury during 26 21, inanimate mechanical forces and falls were also the leading causes of injury admissions in young people, although as a group transport injuries again made a significant contribution. In contrast, during vehicle occupant injuries and intentional self-harm were the leading causes of injury related mortality in both DHBs (Table 12, Table 121). Injuries in Young People - 366

3 Table 119. Hospital Admissions (26 21) and Mortality (24 28) from Injuries in New Zealand Young People Aged Years by Main External Cause of Injury Main External Cause of Injury Total per 5 Year Period New Zealand Annual Average Injury Admissions Years, Rate per 1, Percent (%) Mechanical Forces: Inanimate 11,539 2, Mechanical Forces: Animate 3, Falls 9,913 1, Transport: Vehicle Occupant 5,293 1, Transport: Motorbike 2, Transport: Cyclist 1, Transport: Pedestrian Transport: Other Land Transport 1, Transport: Other Transport Electricity / Fire / Burns Accidental Poisoning Accidental Threat to Breathing <.1 Drowning / Submersion Assault 5,49 1, Intentional Self-Harm 3, Undetermined Intent No External Cause Listed <.1 Other Causes 3, New Zealand Total 51,736 1, , Injury Mortality Years, Intentional Self-Harm Transport: Vehicle Occupant Transport: Motorbike Transport: Pedestrian Transport: Cyclist Transport: Other Land Transport Transport: Other Transport Assault Accidental Poisoning Drowning / Submersion Falls Mechanical Forces: Inanimate Mechanical Forces: Animate <3 s s s Electricity / Fire / Burns Accidental Threat to Breathing Undetermined Intent Other Causes New Zealand Total 1, Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: s: suppressed due to small numbers. Injuries in Young People - 367

4 Table 12. Hospital Admissions (26 21) and Mortality (24 28) from Injuries in Nelson Marlborough Young People Aged Years by Main External Cause of Injury Main External Cause of Injury Total per 5 Year Period Nelson Marlborough Annual Average Injury Admissions Years, Rate per 1, Percent (%) Mechanical Forces: Inanimate Mechanical Forces: Animate Falls Transport: Vehicle Occupant Transport: Motorbike Transport: Cyclist Transport: Pedestrian Transport: Other Land Transport Transport: Other Transport Electricity / Fire / Burns Accidental Poisoning Accidental Threat to Breathing <3 s s s Drowning / Submersion <3 s s s Assault Intentional Self-Harm Undetermined Intent No External Cause Listed <3 s s s Other Causes Nelson Marlborough Total 1, , Injury Mortality Years, Intentional Self-Harm Transport: Vehicle Occupant Transport: Pedestrian Accidental Poisoning All Other Causes Nelson Marlborough Total Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: s: suppressed due to small numbers. Injuries in Young People - 368

5 Table 121. Hospital Admissions (26 21) and Mortality (24 28) from Injuries in South Canterbury Young People Aged Years by Main External Cause of Injury Main External Cause of Injury Total per 5 Year Period South Canterbury Annual Average Injury Admissions Years, Rate per 1, Percent (%) Mechanical Forces: Inanimate Mechanical Forces: Animate Falls Transport: Vehicle Occupant Transport: Motorbike Transport: Cyclist Transport: Pedestrian Transport: Other Land Transport Transport: Other Transport <3 s s s Electricity / Fire / Burns Accidental Poisoning Assault Intentional Self-Harm Undetermined Intent No External Cause Listed <3 s s s Other Causes South Canterbury Total , Injury Mortality Years, Intentional Self-Harm Transport: Vehicle Occupant All Other Causes South Canterbury Total Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: s: suppressed due to small numbers. Land Transport Injuries Nelson Marlborough and South Canterbury vs. New Zealand Distribution In Nelson Marlborough and South Canterbury during 26 21, hospital admissions for land transport injuries in young people were significantly higher than the New Zealand rate. During however, mortality from land transport injuries in young people was not significantly different from the New Zealand rate in either DHB (Table 122). Nelson Marlborough and South Canterbury Distribution by Season In Nelson Marlborough and South Canterbury during 26 21, hospital admissions for land transport injuries in young people were generally lower during the cooler months (Figure 129). Injuries in Young People - 369

6 Table 122. Hospital Admissions (26 21) and Mortality (24 28) from Land Transport Injuries in Young People Aged Years, Nelson Marlborough and South Canterbury vs. New Zealand DHB Total per 5 Year Period Annual Average Rate per 1, Land Transport Injuries Rate Ratio Hospital Admissions in Young People Aged Years, % CI Nelson Marlborough South Canterbury New Zealand 11,519 2, Mortality in Young People Aged Years, Nelson Marlborough South Canterbury New Zealand Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Figure 129. Average Number of Hospital Admissions for Land Transport Injuries per Month in Young People Aged Years, Nelson Marlborough and South Canterbury Average No. Land Transport Admissions per Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: National Minimum Dataset Nelson Marlborough South Canterbury New Zealand Distribution by Age Age and : In New Zealand during 26 21, hospital admissions for land transport injuries in males increased rapidly during late childhood and adolescence, to reach a peak at 19 years of age. While similar patterns were evident for females, the rate of increase was much slower prior to fifteen years of age. At all ages (with the exception of infants <1 year) admission rates were higher for males than for females. Mortality during demonstrated a similar pattern, with rates peaking at 18 years in both genders (Figure 13). Injuries in Young People - 37

7 Figure 13. Hospital Admissions (26 21) and Deaths (24 28) from Land Transport Injuries in New Zealand Children and Young People 24 Years by Age and 7 6 Admissions per 1, Male Land Transport Mortality Female Land Transport Mortality Male Land Transport Admissions Female Land Transport Admissions Mortality per 1, Age (Years) Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population Figure 131. Hospital Admissions for Transport Injuries in Children and Young People Aged 24 Years by Age and Injury Type, New Zealand Transport: Cyclist Transport: Motorbike Transport: Vehicle Occupant Transport: Pedestrian Admissions per 1, Age (Years) Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population Injuries in Young People - 371

8 Age and Cause: In New Zealand during 26 21, hospital admissions for vehicle occupant injuries increased rapidly after 13 years of age, with rates reaching a peak at 19 years, before declining again. Motorbike injury admissions also increased during adolescence, with rates being highest amongst those in their late teens and early twenties. In contrast, cycle injury admissions increased during childhood to reach a peak amongst those aged years, while pedestrian injuries were more evenly distributed across childhood/adolescence/early adulthood (Figure 131). New Zealand Distribution by Ethnicity, NZDep Index Decile and Pedestrian Injuries: In New Zealand during 26 21, hospital admissions for pedestrian injuries were significantly higher for males, for Māori > European > Asian/Indian young people and those from more deprived (NZDep deciles 7 8 and 1) areas (Table 123). Table 123. Hospital Admissions for Pedestrian and Cyclist Injuries in Young People Years by, Ethnicity and, New Zealand Variable Rate Rate Ratio 95% CI Variable Rate Rate Ratio 95% CI New Zealand Pedestrian Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Cyclist Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population. Note: Rate is per 1,; Ethnicity is Level 1 Prioritised. Decile is NZDep21. Injuries in Young People - 372

9 Cyclist Injuries: In New Zealand during 26 21, hospital admissions for cycle injuries were significantly higher for males and European > Māori > Pacific > Asian/Indian young people. Admissions were also significantly higher in those from the least deprived (NZDep decile 1) areas, when compared to those from more deprived (NZDep decile 8 1) areas (Table 123). Motorbike Injuries: In New Zealand during 26 21, hospital admissions for motorbike injuries were significantly higher for males, and for European > Māori > Pacific and Asian/Indian young people. No consistent social gradients were evident however by NZDep index decile (Table 124). Table 124. Hospital Admissions for Motorbike and Vehicle Occupant Injuries in Young People Aged Years by, Ethnicity and, New Zealand Variable Rate Rate Ratio 95% CI Variable Rate Rate Ratio 95% CI New Zealand Motorbike Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Vehicle Occupant Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population. Note: Rate is per 1,; Ethnicity is Level 1 Prioritised; Decile is NZDep21. Injuries in Young People - 373

10 Vehicle Occupant Injuries: In New Zealand during 26 21, hospital admissions for vehicle occupant injuries were significantly higher for males, Māori > European > Pacific > Asian/Indian young people and those from average-to-more deprived (NZDep decile 4 1) areas (Table 124). New Zealand Mortality Trends by Ethnicity In New Zealand during 2 28, mortality from land transport injuries was consistently higher for Māori young people than for young people of other ethnic groups (Figure 132). Figure 132. Mortality from Land Transport Injuries in Young People Aged Years by Ethnicity, New Zealand Māori European 4 Pacif ic Asian/Indian 35 Transport Mortality per 1, (15 24 Years) Source: Numerator: National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: Ethnicity is Level 1 Prioritised Unintentional Non-Transport Injuries Nelson Marlborough & South Canterbury vs. New Zealand Distribution In Nelson Marlborough during 26 21, hospital admissions for unintentional nontransport injuries in young people were similar to the New Zealand rate, while in South Canterbury admissions were significantly higher. Mortality from unintentional non-transport injuries in Nelson Marlborough during was not significantly different from the New Zealand rate, while in South Canterbury small numbers precluded a valid analysis (Table 125). Nelson Marlborough and South Canterbury Distribution by Season In Nelson Marlborough and South Canterbury during 26 21, there were no consistent seasonal variations in hospital admissions for unintentional non-transport injuries in young people (Figure 133). New Zealand Distribution by Age In New Zealand during 26 21, after peaking at one year of age and again at five years, hospital admissions for unintentional non-transport injuries declined in both males and females. For males, admissions reached a nadir at ten years of age, before increasing again, to reach a further peak at 19 years. For females, rates continued to decline until around fifteen years, after which time they became static. Mortality during Injuries in Young People - 374

11 demonstrated a similar pattern, with rates for males being consistently higher than for females from 12 years onwards (as they were during the preschool years) (Figure 134). While admissions for injuries arising from inanimate mechanical forces and falls tended to be higher in children, they were also prominent causes of injury admission in young people aged years (Figure 135). Table 125. Hospital Admissions (26 21) and Mortality (24 28) from Unintentional Non-Transport Injuries in Young People Aged Years, Nelson Marlborough and South Canterbury vs. New Zealand DHB Total per 5 Year Period Annual Average Rate per 1, Unintentional Non-Transport Injuries Rate Ratio Hospital Admissions in Young People Aged Years, % CI Nelson Marlborough South Canterbury New Zealand 25,856 5, Mortality in Young People Aged Years, Nelson Marlborough South Canterbury <3 s s s s New Zealand Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: s: suppressed due to small numbers. Figure 133. Average Number of Hospital Admissions for Unintentional Non-Transport Injuries per Month in Young People Years, Nelson Marlborough and South Canterbury Average No. Non-Transport Admissions per Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: National Minimum Dataset Nelson Marlborough South Canterbury Injuries in Young People - 375

12 Figure 134. Hospital Admissions (26 21) and Deaths (24 28) from Unintentional Non-Transport Injuries in New Zealand Children and Young People Aged 24 Years by Age and Admissions per 1, Male Non-Transport Mortality Female Non-Transport Mortality Male Non-Transport Admissions Female Non-Transport Admissions Mortality per 1, Age (Years) Source: Numerators: National Minimum Dataset and National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population Figure 135. Hospital Admissions for Falls and Mechanical Force Type Injuries in Children and Young People Aged 24 Years by Age and Injury Type, New Zealand Falls 8 Mechanical Forces: Inanimate Mechanical Forces: Animate 7 Admissions per 1, Age (Years) Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population Injuries in Young People - 376

13 New Zealand Distribution by Ethnicity, NZDep Index Decile and Falls: In New Zealand during 26 21, hospital admissions for falls were significantly higher for males, Pacific > European and Māori > Asian/Indian young people and those from more deprived (NZDep deciles 7 and 9 1) areas (Table 126). Electricity/Fire/Burns: In New Zealand during 26 21, hospital admissions for injuries arising from electricity/fire/burns were significantly higher for males, Māori > European > Pacific > Asian/Indian young people and those from more deprived (NZDep decile 5 1) areas (Table 126). Table 126. Hospital Admissions for Falls and Electricity/Fire/Burn Injuires in Young People Years by, Ethnicity and, New Zealand Variable Rate Rate Ratio 95% CI Variable Rate New Zealand Falls Years Rate Ratio Decile Decile % CI Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Electricity / Fire / Burn Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population. Note: Rate is per 1,; Ethnicity is Level 1 Prioritised; Decile is NZDep21. Injuries in Young People - 377

14 Inanimate Mechanical Forces: In New Zealand during 26 21, hospital admissions for injuries arising from inanimate mechanical forces were significantly higher for males, Pacific and Māori > European > Asian/Indian young people and those from average-tomore deprived (NZDep decile 3 1) areas (Table 127). Animate Mechanical Forces: In New Zealand during 26 21, hospital admissions for injuries arising from animate mechanical forces were significantly higher for males, Pacific > Māori > European > Asian/Indian young people and those from more deprived (NZDep decile 8 1) areas (Table 127). Table 127. Hospital Admissions for Injuries Arising from Inanimate and Animate Mechanical Forces in Young People Aged Years by, Ethnicity and NZ Deprivation Index Decile, New Zealand Variable Rate Rate Ratio 95% CI Variable Rate Rate Ratio 95% CI New Zealand Mechanical Forces: Inanimate Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Mechanical Forces: Animate Injuries Years Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Decile Prioritised Ethnicity Decile European Decile Māori Decile Pacific Decile Asian/Indian Female Male Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population. Note: Rate is per 1,; Ethnicity is Level 1 Prioritised; Decile is NZDep21. Injuries in Young People - 378

15 New Zealand Mortality Trends by Ethnicity In New Zealand during 2 28, there were no consistent ethnic differences in mortality from unintentional non-transport injuries in young people (Figure 136). Figure 136. Mortality from Unintentional Non-Transport Injuries in Young People Aged Years by Ethnicity, New Zealand Non-Transport Mortality per 1, (15 24 Years) Pacif ic Māori European Asian/Indian Source: Numerator: National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population. Note: Ethnicity is Level 1 Prioritised Summary In New Zealand during 26 21, inanimate mechanical forces and falls were the leading causes of injury admissions in young people, although as a group transport injuries also made a significant contribution. In contrast, during 24 28, intentional self-harm and vehicle occupant injuries were the leading causes of injury related mortality. During 2 28, mortality from land transport injuries fluctuated, while mortality from unintentional non-transport injuries and accidental poisoning remained relatively static. In Nelson Marlborough and South Canterbury during 26 21, inanimate mechanical forces and falls were also the leading causes of injury admissions in young people, although as a group transport injuries again made a significant contribution. In contrast, during vehicle occupant injuries and intentional self-harm were the leading causes of injury related mortality in both DHBs. Injuries in Young People - 379

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