Mortality estimates for years up to 2005 are based on Australian Bureau of Statistics death registration data. Data from 2006 onwards were provided by the Australian Coordinating Registry, Cause of Death Unit Record File; the data for the most 2 recent years are preliminary (SAPHaRI, Centre for Epidemiology and Evidence, NSW Ministry of Health)
Categories of injury were classified using the underlying cause of death. Please see the Methods tab for an explanation of "Exposure to unspecified factor".
Only NSW residents are included. Deaths were classified using ICD-10. Rates were age-adjusted using the Australian population as at 30 June 2001.
Counts of deaths for the latest years of data include an estimate of the number of deaths occurring in that year but registered in the next year. Data on late registrations were unavailable at the time of production.
LL/UL 95%CI = lower and upper limits of the 95% confidence interval for the point estimate.
In NSW in 2017-2018, deaths from injury and poisoning were the fifth leading cause of death, at 6%. In 2014-2018, the leading identifiable causes of death from injury and poisoning were suicide (27.5%), falls (19.1%), poisoning (14.3%), and motor vehicle transport (11.8%).
Death from 'exposure to an unspecified factor' was also one of the leading causes of death from injury or poisoning (14%). A discussion of this cause of death can be found in the Methods tab.
The major causes of injury and poisoning death varied by age group. In 2014-2018, the leading causes of death from injury and poisoning in the 0-14 year age group were motor vehicle crashes (30%) and drowning (17%). Suicide was the leading cause of death in both the 15-44 year (43.9%) and 45-64 year age groups (39.5%). Motor vehicle crashes and unintentional poisonings were also important in these age groups. Falls (38.7%) were the main contributor to deaths from injury and poisoning in persons aged 65 years and over.
Most of the analyses are based on the place of residence of the person, rather than the place they were treated, or, in the case of an injury, the place the injury occurred. It should be noted that the injury that led to a person's hospitalisation might not have occurred in the area in which the person resided. For example, metropolitan residents may be injured in motor vehicle crashes while travelling in regional or remote areas. The location where injury was sustained is not routinely recorded in hospitalisation statistics.
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) (NCCH 2006) groups injury according to the body region which is affected by injury (head, neck chest etc) and the type of injury (superficial, fracture, amputation etc). Relevant codes are ICD-10: S00 to T98. Another way of categorising injury is by the circumstances of injury or the activity being undertaken when injured (transport accidents, assaults, intentional self-harm etc). This group is covered by ICD-10 codes U50-Y98 called ‘external causes’ (NCCH 2006).
In HSNSW hospitalisations and deaths due to injury are classified by the external cause of injury. This is because this classification is the most important in prevention planning.
In HealthStats NSW, injury hospitalisation data exclude records with source of referral being a transfer from another hospital or a type change admission in order to reduce multiple counting of hospitalisation episodes relating to the same injury incident. Some injury and poisoning hospitalisations require subsequent hospitalisations for rehabilitation. To avoid counting multiple hospitalisations following one injury event, rehabilitation is generally excluded. However, in order to demonstrate the burden of injury, specific comparisons that include rehabilitation are also presented.
Injury in primary diagnosis and external cause of injury
The majority of injury and poisoning hospitalisations have a principal diagnosis of injury and poisoning, but there is also a substantial number of hospitalisations where injury or poisoning is in an additional diagnosis (about 20%-30% of total records with injury and poisoning anywhere on record). Some of these hospitalisations are linked to a prior episode of hospitalisation with an injury in principal diagnosis, that has not been counted, due to the methods used to minimise multiple-counting of hospitalisations following one injury event, as explained in 'Rules for excluding records in analysis of hospitalisation for injury'.
Consequently, it is important to note whether an analysis included any hospitalisation records with external cause of injury or only those records that had injury and poisoning as the principal diagnosis.
Injury deaths may be reported following a method which takes account of multiple causes of death (Henley G et al. 2007). The multiple causes of death method includes a death as an injury death if:
• the underlying cause of death was coded to ICD-10 V01–Y36, Y85–Y8, or Y89, or
• there is any cause of death coded to ICD-10 S00–T75 or T79 (AIHW Cat. no. AUS 122 2010) (see above for the categories of codes).
The resulting count is called injury-related deaths and has been adopted in the Australia’s health 2010 report by the AIHW (AIHW Cat. no. AUS 122 2010).
The difference in count depending on the method applied could be as high as 25% in the same year (8,000 injury deaths in Australia in 2005 according to a straightforward method and 10,000 using the multiple causes of death).
In this report a straightforward method of counting injury death has been used and the resulting count is based solely on the underlying cause of death coded to ICD-10 V01–Y36, Y85–Y8, or Y89 and the corresponding ICD-9 codes.
Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468376
Henley G, Kreisfeld R, Harrison J. Injury deaths, Australia 2003-04.. Injury research and statistics series no. 31. AIHW cat. no. INJCAT 89. Adelaide: AIHW, 2007. Available at
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Australian Coding Standards. Sydney: NCCH, 2006.
In order to complete a death registration in Australia, the death must be certified by either a doctor using the Medical Certificate of Cause of Death, or by a coroner. Natural causes are predominantly certified by doctors, whereas External and Unknown causes or unaccompanied deaths are usually certified by a Coroner. Approximately 85-90% of deaths each year are certified by a doctor and the remainder is reported to a Coroner. The death is registered in the state in which the death occurred, rather than the state in which the person resides. The Australian Cause of Death Statistics System is outlined by the Australian Bureau of Statistics (ABS) at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument
The ABS have implemented a revision process for Coroner certified deaths. Data are deemed preliminary when published for the first time, revised when published the following year and final when published two years after initial publication. This revision process, and the impact on specific causes are described at https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3303.0Explanatory%20Notes12018?OpenDocument.
The ABS publishes two publications every September concerning deaths in the previous calendar year: Deaths, Australia (Catalogue Number 3302.0) and Causes of death, Australia (Catalogue Number 3303.0), which include breakdowns at the State and Territory level. These are usually published nine months following the most recent reported year.
Prior to 2008, the NSW Ministry of Health obtained data on causes of death of all NSW residents from the Australian Bureau of Statistics (ABS). This covers deaths registered from 1964 to 2005.
For deaths registered from 2006 onwards, the NSW Ministry of Health receives coded cause of death data from the Australian Coordinating Registry (ACR). The ACR is an agency appointed to coordinate access of coded cause of death unit record data on behalf of the Registrars of Births Deaths and Marriages in each state or territory as well as the Australian Bureau of Statistics and National Coronial Information System. The coordinating registry undertakes the coordination and management of the designated activity. The underlying legal responsibility is retained by the collective Registrars. The coding of the causes of death is still undertaken by the ABS but the process to obtain the data is administered by the ACR.
The ACR provides the NSW Ministry of Health with a unit record file of all deaths, either occurring in NSW or to NSW residents who died interstate, approximately sixteen to seventeen months following the most recent reported year to allow a detailed analysis of deaths data. This analysis includes comparisons of causes of death in NSW by sub-state geographies (e.g. by Local Health District or Local Government Area) and by other dimensions and sub-populations, such as remoteness categories and socioeconomic groups. Causes of death data are also used throughout the NSW public health system for a variety of health system planning, reporting, research and evaluation needs.
There are differences in how deaths data are reported in HealthStats NSW and by the ABS, including differences in how deaths are allocated to specific years and differences in the populations used for calculating rates.
1. Death count by year of registration and by year of occurrence
There is usually an interval between the occurrence and registration of a death which is related to the time of year or whether a death is referred to a Coroner. The registration of deaths which occur in November and December are likely to be delayed until the following year, for example, of all deaths in NSW registered in 2013, 6.9% had occurred in 2012 or earlier (ABS 3302.0).Deaths data reported by the ABS for the latest year are based on the year of registration therefore do not include deaths which occurred in that year but where registration was delayed.
Deaths data reported in HealthStats NSW are based on the year of occurrence of the death to provide a better match for the population denominator when calculating rates. Estimates of missing deaths for the latest year due to delayed registration (i.e. due to time of year or Coronial cases) are imputed for each cause and included in the count reported in HealthStats NSW. A small percentage of death registrations may be delayed for more than one year. All deaths figures reported in HealthStats NSW are updated historically (e.g. in trends) when new data becomes available.
2. Different population projection data
For the calculation of rates, the NSW Ministry of Health uses population projection estimates from the NSW Department of Planning, Industry, and Environment. The estimated residential populations which are not projected are the same as those published by the ABS and are currently based on the 2016 Census. See Methods associated with indicators in topics Demography (or Population) for further discussion of population estimates.
Australian Bureau of Statistics. Deaths, Australia, latest year. 3302.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0
Australian Bureau of Statistics. Causes of Deaths, Australia, latest year. 3303.0. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0
Australian Bureau of Statistics. Multiple Cause of Deaths, Australia, 1997-2001. 3319.0.55.001. Canberra: ABS, . Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3319.0.55.001
Classifying injury by the external cause of injury aims to inform planning in injury prevention. The external code ICD-10 X59: code Exposure to unspecified factor is not helpful for this purpose. It is known as a ‘dump’ code (Henley G et al. 2007) and it is used in assessments of injury data quality (Lu et al. 2007).
A high proportion of deaths coded to unspecified factor category have a fracture as an associated cause of death (also called: a contributing cause of death), and it is likely that a large number of these deaths are in fact due to falls (Henley et al, 2007). Including these records with fracture in the total fall count increases deaths due to falls in Australia by 90-80% (Henley G et al. 2007) (Henley et al. 2009).
The count in this indicator is based solely on the underlying cause of death and the records with X59 as the underlying cause of death are not re-distributed on the basis of the associated cause of death.
There are two indicators where associated causes of death are considered in addition to underlying cause of death. These indicators are covering deaths due to diabetes and death due to falls. The records with X59 as the underlying cause of death are included in the analysis of death from falls. They are not included in the analysis of death from diabetes, because X59 is an external cause of injury which does not refer to diabetes. In general, the deaths where the condition of interest is the underlying cause of death are clearly differentiated from the deaths where the condition is an associated cause of death and from the total to avoid confusion in relevant indicators.
See Methods: Injury and poisoning for further discussion of coding of injury- related deaths and Methods: Diabetes-related deaths.
Over the years Exposure to unspecified factor has been responsible for the second or third largest proportion of injury hospitalisations, just above or below motor vehicle transport. Falls have been the leading cause of injury hospitalisation.
Since 1998-99 the proportion of falls has been increasing in hospitalisation data in NSW (from around 34% to 42% in the ensuing 20 years), however the proportion of hospitalisations coded to Exposure to unspecified factor has not changed and remains around 10-11% of all records. This suggests that allocation of a more precise final code may not be easy to achieve.
Currently, almost a half of hospitalisations with Exposure to unspecified factor in external cause of injury code are day only admissions in NSW, which suggests time constraints as the main reason for the lack of better quality information. It is also possible that less attention is paid to recording details of less serious cases.
Exposure to unspecified factor has not been investigated in national injury hospitalisations yet and only the identifiable causes have been reported up to May 2011 (Kreisfeld et al. 2010).
In this report, hospitalisation records with X59 as the principal diagnosis are not re-distributed on the basis of additional diagnoses.
Henley G, Kreisfeld R, Harrison J. Injury deaths, Australia 2003-04.. Canberra: 2007. Available at https://www.aihw.gov.au/getmedia/2daac948-ec7f-4a7d-bc22-889f5a54c8ab/injcat89.pdf.aspx?inline=true
Henley G, Harrison JE. Injury deaths, Australia 2004-05. Cat.no. INJCAT 127. Canberra: AIHW, 2009. Available at https://www.aihw.gov.au/getmedia/caa49268-97b8-404b-913b-f8e7ff9a830d/injcat-127-10777.pdf.aspx?inline=true
Kreisfeld R, Harrison JE. Hospital separations due to injury and poisoning 2005-06. Cat. no. INJCAT 131. Canberra: AIHW, 2010. Available at http://www.aihw.gov.au/publication-detail/?id=6442468389&tab=2
Lu TH, Walker S, Anderson RN, McKenzie K, Bjorkenstam C and Hou WH. "Proportion of injury deaths with unspecified external cause codes: a comparison of Australia, Sweden, Taiwan and the US". Injury Prevention 2007. Vol13 (4): 276-81.
|Description||ICD-10 & ICD-10-AM||Comments|
|Air transport injury||V95-V97||
This indicator uses underlying cause of death only.
All records are included for NSW residents only
|Burns and scalds||X00-X19|
|Complications of care injury||Y40-Y84, Y88|
|Cutting or piercing injury (unintentional)||W25-W29,W45|
|Drowning||W65-W74, V90, V92|
|Exposure to unspecified factors injury||X59|
|Firearm injury (unintentional)||W32-W34|
|Interpersonal violence||X85-Y09, Y87.1|
|Machinery injury||W24, W30. W31|
|Motor vehicle crash injury||V02-V04, V09.0, V09.2, V12-V14, V19.0-V19.6,V20-V79, V80.3-V80.5, V81.0, V81.1, V82.0, V82.1, V83,V84-V86,V87.0-V87.5,V87.7-V87.8, V88.0-V88.5,V88.7-V88.8, V89.0, V89.2,Y85|
|Natural/environmental factors injury||W42-43, W53-64, W92-99, X20-X39, X51-57|
|Overexertion/repetitive movement injury||X50|
|Rail transport injury||V05, V15, V80.6, V81.2-V81.9|
|Struck by/against injury||W20-W22, W50-W52|
|Suicide/Self harm||X60-X84, Y87.0|
|Threats to breathing injury (unintentional)||W75-W84|
|Water transport injury||V91, V93, V94|
|Other injuries||All remaining codes within V00-X99, Y00-Y39, Y85-Y87, Y89|
• There were around 3,000 injury-related deaths in 2017 and 188,103 injury-related hospitalisations in 2018-19 in NSW.
• Injury and poisoning is the leading cause of death among people aged 5 to 44 years.
• Males have much higher rates of death and hospitalisation than females for all major injury causes, except for falls among older people.
• The rate of hospitalisation for injury and poisoning in Aboriginal people was 1.7 times that of non-Aboriginal people in NSW in 2018-19.
• Rates of death and hospitalisation from injury and poisoning are higher in remote and regional areas than in metropolitan areas.
Injury can be described by the single or multiple body regions which are affected by the injury, by the type of injury itself or by an agency which caused the injury.
Examples of the injuries described by body regions are: injuries to the head, injuries to the hip and thigh or injuries involving multiple body regions.
Types of injury are: superficial injury (such as abrasion, contusion, insect bite), open wound (animal bite, cut, laceration, puncture wound), fracture (closed or open, which refers to the surface of skin), dislocation, sprain or strain, injury to nerves and spinal cord, injury to blood vessels, injury to muscles, fascia and tendon, crushing injury, traumatic amputation, injury to internal organs.
Examples of environmental events and circumstances causing injury, poisoning or other adverse events are: transport accidents, falls, exposure to electrical current, exposure to forces of nature, assaults, intentional self-harm, complications of medical and surgical care. This classification of injury and poisoning is the most important in prevention planning. These events are also known as 'external causes' of the injury.
Injury has a major, but often preventable, influence on Australia’s health. It affects Australians of all ages and is the greatest cause of death in the first half of life. It leaves many with serious disability or long-term conditions. Injury was estimated to account for 8.5% of the burden of disease in 2015.
For each person who dies of injuries there are several thousand individuals who survive and are left with permanent disabilities. Hospitalisation data provide an indication of the incidence of the more severe injuries.
Injury prevention involves the collaboration of governments, the private sector and communities in order to create safer environments and cultures.
Effective injury prevention strategies have been developed for a wide range of potential causes of injury. For example, balance and strength training is effective in reducing falls in older people, fencing around private swimming pools has reduced childhood drownings, and seat-belt and drinking-driving legislation together with measures relating to vehicle and road design have greatly increased road safety.
New South Wales Injury Risk Management Research Centre at http://www.irmrc.unsw.edu.au
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare at http://www.aihw.gov.au
WorkCover NSW at http: www.workcover.nsw.gov.au
Youthsafe at http://www.youthsafe.org
Kidsafe NSW at http://www.kidsafensw.org
Sportsafe at http://www.sma.org.au
Water Safety at http://www.watersafety.nsw.gov.au/
NSW Falls Prevention Network at http://fallsnetwork.neura.edu.au/
healthdirect at http://www.healthdirect.gov.au
NSW Falls Prevention Program: NSW Clinical Excellence Commission: http://www.cec.health.nsw.gov.au/patient-safety-programs/adult-patient-safety/falls-prevention