Falls from ladders in Australia: comparing occupational and non‐occupational injuries across age groups

Objective : To examine national ladder‐related fall injury patterns and trends, and compare the changes over time in occupational and non‐occupational falls across age groups. Methods : Analysis of national hospital morbidity data to examine trends over time and differences between groups. Results : There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder‐related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non‐occupational falls increased significantly over the ten year period. Conclusions : With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder‐related falls. Implications : This study demonstrates the significant burden that ladder‐related falls are continuing to have on the community, both in the occupational and domestic setting.     

Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital.

OBJECTIVES: Most research on hospital falls has focused on predictors of falling, whereas less is known about predictors of serious fall-related injury. Our objectives were to characterize inpatients who fall and to determine predictors of serious fall-related injury. METHODS: We performed a retrospective observational study of 1,082 patients who fell (1,235 falls) during January 2001 to June 2002 at an urban academic hospital. Multivariate analysis of potential risk factors for serious fall-related injury (vs no or minor injury) included in the hospital's adverse event reporting database was conducted with logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CI95) RESULTS: The median age of patients who fell was 62 years (interquartile range, 49-77 years), 50% were women, and 20% were confused. The hospital fall rate was 3.1 falls per 1,000 patient-days, which varied by service from 0.86 (women and infants) to 6.36 (oncology). Some (6.1%) of the falls resulted in serious injury, ranging by service from 3.1% (women and infants) to 10.9% (psychiatry). The most common serious fall-related injuries were bleeding or laceration (53.6%), fracture or dislocation (15.9%), and hematoma or contusion (13%). Patients 75 years or older (aOR, 3.2; CI95, 1.3-8.1) and those on the geriatric psychiatry floor (aOR, 2.8; CI95, 1.3-6.0) were more likely to sustain serious fall-related injuries. CONCLUSIONS: There is considerable variation in fall rates and fall-related injury percentages by service. More detailed studies should be conducted by floor or service to identify predictors of serious fall-related injury so that targeted interventions can be developed to reduce them.     

The cost of fall-related injuries among older people in NSW, 2006-07

This study aimed to establish comprehensive estimates of the cost of fall-related injury among older people in NSW. A health service utilisation approach was used to estimate the cost of hospital treatment, residential care and ambulance transport. Other costs were estimated by deriving ratios of inpatient costs to other services from the literature. In the 2006-07 financial year, 251,000 (27%) of older people fell at least once and suffered, in total, an estimated 507,000 falls. An estimated 143000 medically treated fall-related injuries among older people resulted in lifetime treatment costs of $558.5 million. Although only 18% of these injuries resulted in hospital admission, the cost of care associated with these cases accounted for 84.5% of the total cost. The cost of fall-related injury among older people in NSW in 2006-07 is a significant increase over earlier estimates and underscores the urgent need for effective preventive efforts across the state.     

National trends and coding patterns in fall-related mortality among the elderly in the United States

Because good information on deaths caused by a fall would be important for prevention policies, we analyzed the influence of coding differences on variability in state-level fall death rates in the elderly. We examined state differences in the number of cause of death codes on death certificates, death certifiers, completeness of E-coding, and indicators of specificity of coding. We found that state-specific fall mortality rates ranged from 13.9 to 140.4 in people aged 65 years and above. States employing a coroner to investigate injury deaths had 14 per cent fewer recorded fall deaths than those where a medical examiner conducted the investigations. Each unit increase in the median number of cause of death codes was associated with a 10 per cent increase in the number of falls. For each 1 per cent increase in the use of unspecified codes for the underlying cause of death, the number of falls dropped by 2 per cent. Current fall mortality data do not appear to identify all instances of falls. Variability in unintentional fall-related death rates among states may be partly explained by death certification coding practices. Standardization of coding and training for documentation of fall events and death certificate reporting could help uncover the actual fall mortality burden in the elderly.     

A selection strategy was developed for fracture reduction programs in frail older people

ObjectivesThe aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.Study Design and SettingTwo thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.ResultsOur fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.ConclusionThe index could help rationalize fracture prevention programs for frail older people.     

Characteristics of fall-related injuries attended by an ambulance in Sydney, Australia: a surveillance summary

In NSW, fall-related injury costs the health system more than any other single cause of injury. A public health surveillance database containing information routinely recorded by the Ambulance Service of NSW was used to define the epidemiology and characteristics of fall-related calls in the Sydney metropolitan area in 2008. The dataset contained 37488 fall-related calls, representing a crude rate of ambulance call-outs for falls of 843 per 100000 population. Females accounted for 57% of all fall-related calls, and the female rate of injury to the 'hip to foot' region increased with age. Males in all age groups reported 'head and neck' injury most often. In an analysis of a random sample of 1200 calls, 70% of ambulance dispatches were to a home or residential institution. The findings of this study on the risks for fall-related injury can be used to guide policy for ambulance service delivery. Expansion of data linkage to emergency department and admitted patient databases would provide information to further describe the epidemiology of falls in NSW.     

湖北麻城市居民1987—2008年意外跌落死亡趋势分析

目的了解湖北省麻城市居民1987—2008年意外跌落死亡分布特征及其变化趋势,为制定干预措施提供参考依据。方法收集1987—2008年麻城市居民病伤死亡登记报告中的意外跌落死亡数据,按年份、性别、年龄和居住地分别计算死亡率和死因构成比,并进行χ2检验和χ2趋势检验。结果麻城市居民1987—2008年意外跌落死亡率为4.97/10万,其中男性死亡率为6.87/10万,高于女性的2.90/10万(χ2=193.11,P<0.000 1);1987—1988、1989—1993、1994—1998、1999—2003、2004—2008年居民意外跌落死亡率分别为6.28/10万、5.11/10万、6.33/10万、4.25/10万、3.78/10万,死亡率随着年份的增加呈下降趋势(χ2趋势=49.90,P<0.001);0～、15～、25～、35～、45～、55～、≥65岁年龄组居民意外跌落死亡率分别为2.08/10万、3.04/10万、3.94/10万、4.84/10万、7.31/10万、10.82/10万、20.11/10万,死亡率随年龄增长呈上升趋势(χ2趋势=850.4,P<0.000 1);居住在平原、丘陵、山区居民意外跌落死亡率分别为3.54/10万、3.93/10万、8.63/10万,差异有统计学意义(χ2=223.52,P<0.000 1),3种地形居民死亡率均随年份的增加呈下降趋势(P<0.01)。结论麻城市居民1987—2008年意外跌落死亡率呈下降趋势,男性、老年人和山区居民意外跌落死亡率较高,是预防意外跌落死亡的重点人群。     

New South Wales trends in mortality differentials between small rural and urban communities over a 25-year period, 1970-1994

OBJECTIVE: To identify trends in premature mortality differences between urban and small rural communities in NSW over a 25-years period. DESIGN: A longitudinal population-based study. ABS population and death data by local government area, sex and age for the period 1970 to 1994, were used to derive mortality measures for urban and small rural communities in NSW. Setting: NSW local government areas categorised by the Rural and Remote Metropolitan Area Classification system as 'capital city' (the Sydney Statistical Division) and 'other rural area' and 'other remote area'. SUBJECTS: All persons aged 0-74 years resident in the aforementioned NSW local government areas between 1970 and 1994 inclusive. MAIN OUTCOME MEASURE: Whether premature mortality differentials have widened, narrowed or remained the same over the study period and the magnitude of any identified changes. RESULT: There was a decrease in premature mortality rates for men and women in both urban and small rural communities. However, the decline was less in small rural communities, with the differential between small rural and urban areas increasing 2-3% every 5 years. CONCLUSIONS: Differences in age structure, proportion of indigenous and migrant populations between small rural communities and urban NSW can not fully account for the increasing differential. Other possible explanatory factors include socioeconomic status and different exposures and practices in rural areas.     

Beneficial impact of the Homelands Movement on health outcomes in central Australian Aborigines

Objective: This study compares prevalence of obesity, hypertension and diabetes in two groups of Aboriginal adults: those living in homelands versus centralised communities in central Australia. It also compares weight gain, incidence of diabetes, mortality and hospitalisation rates between the groups over a seven-year period.
Methods: Baseline survey of 826 Aboriginal adults in rural central Australian communities in 1987-88 with a follow-up survey of 416 (56% response rate, excluding deaths). Each time, they had a 75 g oral glucose tolerance test (OGTT), and blood pressure and anthropometry measurement. Deaths and hospitalisations for all of the original cohort were recorded for the seven-year period.
Results: Homelands residents had a lower baseline prevalence of diabetes (risk ratio [RR]=0.77, 0.59–1.00), hypertension (RR=0.66, 0.54–0.80) and overweight/ obesity (RR=0.70, 0.59–0.83). The incidence of diabetes was lower among homelands residents (RR=0.70, 0.46–1.06). They were less likely to die than those living in centralised communities (RR=0.56, 0.37–0.85) and less likely to be hospitalised for any cause (RR=0.79, 0.71–0.87), particularly infections (RR=0.70, 0.61–0.80), injury involving alcohol (RR=0.61, 0.47–0.79) and other injury (RR=0.75, 0.60–0.93). Mean age at death was 58 and 48 years for residents of homelands and centralised communities respectively.
Conclusion: Aboriginal people who live in homelands communities appear to have more favourable health outcomes with respect to mortality, hospitalisation, hypertension, diabetes and injury, than those living in more centralised settlements in Central Australia. These effects are most marked among younger adults.     

The burden of fall-related injury among older persons in New South Wales

Objective: To develop a comprehensive estimate of the burden of fall‐related injury among older people in New South Wales. Methods: Fall injuries in 2006/07 were estimated using information from several datasets and the literature. Healthcare costs were calculated using Australia‐Refined – Diagnostic‐Related Group costs for hospital episodes of care and average costs for Emergency Department presentations, ambulance transport and residential aged care (RAC). Ratios of the cost of inpatient care relative to other health services, derived from the literature, were used to estimate the costs associated with these services. Results: In 2006/07, in NSW, there were almost 143,000 falls, among older people, resulting in injuries requiring medical treatment. The total cost of healthcare associated with these falls was estimated at $558.5 million. Although accounting for only 6% of the NSW population aged 65 years and older, persons in RAC accounted for 15% of the total cost of falls injury and 21% of hospital inpatient costs. Conclusion and implications: This study demonstrates the extremely high economic cost of falls in older persons and highlights the disproportionate impact of falls in RAC. The study underscores the urgent need for significant investment in fall‐injury prevention efforts in both the community and RAC settings.     

Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system.

OBJECTIVE: Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury. DESIGN: Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury. SETTING: Nine hospitals in a Midwestern healthcare system. PATIENTS: Inpatients who fell during 2001-2003. RESULTS: The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P<.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P<.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury. CONCLUSION: Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patient's bathroom and in patient care areas outside of the patient's room to reduce injuries.     

The impact of geographical location on trends in hospitalisation rates and outcomes for fall‐related injuries in older people

Objective : This population‐based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall‐related injury in older adults, adjusting for age, sex and comorbidities. Methods : A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall‐related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths‐of‐stay, 28‐day readmissions, and 30‐day mortalities. These were standardised for age, sex, comorbidity, and remoteness. Results : Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28‐day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30‐day mortality (5.0% vs 4.9%, p=0.0046). Conclusions : Over the study period, rural residents of NSW had lower rates of fall‐related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length‐of‐stay, but higher rates of readmission and mortality. These differences existed following standardisation. Implications : This study highlights the need for further research to characterise and explain this variability.     

Older people can stay on their feet: final results of a community-based falls prevention programme

Objective: To evaluate a multi-strategic community-based interventionto prevent older people falling. Design: A prospective cohort study comparing randomly selectedsamples from intervention and control area target populations(residents over 60 years). Repeat, cross-sectional (annual)reviews of fall-related hospitalizations were also conductedproviding an independent measure of falls incidence in the targetpopulations. Setting: North Coast of New South Wales, Australia (a large,rural region). Subjects: Cohort study (1991–1995): randomly selectedsubjects aged 60 years and over, enrolled via telephone interviewinto intervention and control area cohorts. Cross-sectionalstudy (1991/1992–1994/1995): all residents aged 60 yearsand over, from intervention and control areas hospitalized withfall-related injuries. Intervention: A 4-year (1992–1995) multi-strategic interventiontargeting fall-related knowledge, attitudes, behaviours andrisk factors. Main outcome measures: Self-reported falls and fall-relatedhospitalization incidence rates. Fall-related knowledge, attitudes,behaviours and risk factor prevalence rates. Results: At follow-up there was a 22% non-significant lowerincidence of self-reported falls in the intervention comparedto the control cohort (p = 0.17). This was supported by a 20%lower fall-related hospitalization rate in target group residentsfrom intervention compared to control areas (p < 0.01). Increasedfalls knowledge, physical activity and safe footwear were alsoobserved in the intervention cohort together with improved balanceand reduced intake of fall-related medications. Conclusions: Promotion of appropriate behaviours, environmentsand policies can improve fall-related outcomes given a commitmentto involvement of older people and sufficient lead time.     

Increased fall-related mortality rates in New Mexico, 1999-2005

Objective

In 2000, fall injuries affected 30% of U.S. residents aged ≥65 years and cost $19 billion. In 2005, New Mexico (NM) had the highest fall-related mortality rate in the United States. We described factors associated with these elevated fall-related mortality rates.

Methods

To better understand the epidemiology of fatal falls in NM, we used state and national (Web-based Injury Statistics Query and Reporting System) vital records data for 1999–2005 to identify unintentional falls that were the underlying cause of death. We calculated age-adjusted mortality rates, rate ratios (RRs), and 95% confidence intervals (CIs) by sex, ethnicity, race, and year.

Results

For 1999–2005 combined, NM''s fall-related mortality rate (11.7 per 100,000 population) was 2.1 times higher than the U.S. rate (5.6 per 100,000 population). Elevated RRs persisted when stratified by sex (male RR=2.0, female RR=2.2), ethnicity (Hispanic RR=2.5, non-Hispanic RR=2.1), race (white RR=2.0, black RR=1.7, American Indian RR=2.3, and Asian American/Pacific Islander RR=3.1), and age (≥50 years RR=2.0, <50 years RR=1.2). Fall-related mortality rates began to increase exponentially at age 50 years, which was 15 years younger than the national trend. NM non-Hispanic individuals had the highest demographic-specific fall-related mortality rate (11.8 per 100,000 population, 95% CI 11.0, 12.5). NM''s 69.5% increase in fall-related mortality rate was approximately twice the U.S. increase (31.9%); the increase among non-Hispanic people (86.2%) was twice that among Hispanic people (43.5%).

Conclusions

NM''s fall-related mortality rate was twice the U.S. rate; exhibited a greater increase than the U.S. rate; and persisted across sex, ethnicity, and race. Fall-related mortality disproportionately affects a relatively younger population in NM. Characterizing fall etiology will assist in the development of effective prevention measures.Falls are the leading cause of nonfatal injuries (2001–2007) and the third most common cause of unintentional injury-related death (with motor vehicle crashes and poisoning ranking first and second, respectively) among all ages in the United States (1999–2007).¹ Falls are also a leading cause of injury-related death in other developed countries.^2,3 Older adults are most affected by fall-related mortality. In 2000, 30% of U.S. residents aged ≥65 years sustained a fall-related injury, and these injuries cost approximately $19 billion.⁴We observed that New Mexico (NM) had the second-highest fall-related mortality rates in 1999–2005 and conducted this analysis to better characterize the epidemiology of fatal falls in this state. Some factors identified as potentially associated with this observation included racial/ethnic health disparities, age and sex structure of the population, and decreased access to care (because of distant location to a health-care facility or cost of care). Understanding the epidemiology of fatal falls is important for prioritizing public health resources. It also enhances the ability to evaluate the effectiveness of interventions that are intended to reduce fall-related deaths and injuries.     

Risk factors,incidence, consequences and prevention strategies for falls and fall‐injury within older indigenous populations: a systematic review

Objective : To examine the risk factors, incidence, consequences and existing prevention strategies for falls and fall‐related injury in older indigenous people. Methods : Relevant literature was identified through searching 14 electronic databases, a range of institutional websites, online search engines and government databases, using search terms pertaining to indigenous status, injury and ageing. Results : Thirteen studies from Australia, the United States, Central America and Canada were identified. Few studies reported on fall rates but two reported that around 30% of indigenous people aged 45 years and above experienced at least one fall during the past year. The most common hospitalised fall injuries among older indigenous people were hip fracture and head injury. Risk factors significantly associated with falls within indigenous populations included poor mobility, a history of stroke, epilepsy, head injury, poor hearing and urinary incontinence. No formally evaluated, indigenous‐specific fall prevention interventions were identified. Conclusion : Falls are a significant and growing health issue for older indigenous people worldwide that can lead to severe health consequences and even death. No fully‐evaluated, indigenous‐specific fall prevention programs were identified. Implications for Public Health : Research into fall patterns and fall‐related injury among indigenous people is necessary for the development of appropriate fall prevention interventions.     

上海市嘉定区老年人跌倒影响因素分析

目的探讨上海市嘉定区老年人跌倒发生情况及影响因素,为老年人跌倒预防提供参考依据。方法采用多阶段随机整群抽样方法,抽取上海市嘉定区4镇≥55岁老年人,以面对面询问方式入户调查,对可能跌倒相关因素分别进行单因素和多因素Logistic回归分析。结果调查的1 672名老年人中,跌倒发生率为7.12%;多因素分析结果表明,女性(OR=2.150,95%CI=1.352～3.420)、75～80岁(OR=2.032,95%CI=1.245～3.314)、服用抗高血压药(OR=2.107,95%CI=1.068～4.158)、每天参加体育锻炼(OR=1.273,95%CI=1.057～1.535)、步态不稳(OR=2.149,95%CI=1.118～4.130)、使用行走辅助工具(OR=4.373,95%CI=1.740～10.989)是跌倒的危险因素,而生活自理能力差(OR=0.246,95%CI=0.097～0.622)、手提日杂用品外出无限制(OR=0.527,95%CI=0.347～0.799)是跌倒的保护因素。结论老年人跌倒与自身生理因素和外部环境均有关,应采取针对危险因素的综合干预措施预防老年人跌倒。     

Mortality and morbidity related to injuries from falls in British Columbia

Falls are a major health problem for persons aged 65 years and over. This study examined differences in patterns of fall-related injuries and deaths between age groups, sexes, and among Health Regions of BC. For those under the age of 65 years, fall-related injuries are highest among males, whereas for those 65 and over, falls among females exceed those among males by 2:1. For persons aged 65 and over, 84% of hospital days for unintentional injuries involve falls, with transportation and "other" unintentional injuries contributing 16%. While older women are hospitalized more often for fall-related injuries, more older men die from fall-related injuries. Hospitalization rates due to injuries from falls are highest in the Northern Regions of BC. Policy implications of the findings are discussed.     

Farm injury hospitalisations in New South Wales (2010 to 2014)

Objective: To examine gender differences in the characteristics, treatment costs and health outcomes of farm injuries resulting in hospitalisation of New South Wales (NSW) residents. Method: A population‐based study of individuals injured on a farm and admitted to hospital using linked hospital admission and mortality records from 1 January 2010 to 30 June 2014 in NSW. Health outcomes, including injury severity, hospital length of stay (LOS), 28‐day readmission and 30‐day mortality were examined by gender. Results: A total of 6,270 hospitalisations were identified, with males having a higher proportion of work‐related injuries and injuries involving motorbikes compared to females. Females had a higher proportion of equestrian‐related injuries. There were no differences in injury severity, with around 20% serious injuries, in mean LOS or 28‐day hospital re‐admission. Treatment costs totalled $42.7 million, with males accounting for just under 80% of the total. Conclusions: There are some gender differences in the characteristics of farm injury‐related hospitalisations. Farm injury imposes modest, but nonetheless relatively considerable, financial costs on hospital services in NSW. Implications for public health: Continued efforts to ameliorate these injuries in a farm environment, which are mainly preventable, will have personal and societal benefits.     

Potentially avoidable hospitalisations in New Zealand, 1989-98

OBJECTIVE: To describe potentially avoidable hospitalisation in New Zealand, including recent trends and variations between groups differentiated by age, gender, ethnicity and degree of deprivation. METHOD: Hospital discharges among people aged 0-74 years for the years 1989-98 were classified as 'potentially avoidable' or 'unavoidable' based on the ICD9-CMA code of the principal diagnosis. Potentially avoidable hospitalisations (PAH) were further subcategorised according to the intervention involved--primary prevention, ambulatory care or injury prevention. RESULTS: By 1998, one in three of these hospitalisations was theoretically avoidable--two-thirds of these through more effective primary health care services. Although in practice only a proportion of these could realistically have been avoided, these estimates reveal considerable scope for further reduction in the incidence of serious disease and injury. Maori and Pacific people had age-standardised PAH rates approximately 60% higher than European and other New Zealanders. Similar discrepancies exist by socio-economic deprivation. Had all New Zealanders enjoyed the PAH rates of the most advantaged 40% of the population, 28% fewer potentially avoidable hospitalisations would have occurred in 1998, some 26,000 hospital admissions. CONCLUSION: This analysis has revealed significant scope for the health sector to contribute to population health gain and, in particular, to improvement in equity of outcomes across ethnic and socio-economic groups. Potentially avoidable hospitalisations provide a useful tool for evidence-based population health needs analysis and health policy development.     

Suicide decline in Australia: where did the cases go?

Objectives : To describe the causes of death codes assigned in Australian Bureau of Statistics (ABS) mortality data to deaths in Australia from 2000 to 2005 that were coded as intentional self-harm (suicide) in the National Coroners Information System (NCIS).
Methods : Data for deaths in the period mid-2000 to end-2005 were obtained from the National Coroners Information System database (NCIS). We selected cases recorded in the NCIS as having intent at completion = intentional self-harm. The record linkage was done by the ABS and NCIS and did not form part of this project.
Results : During the study period, 12,786 deaths recorded in NCIS were assigned intent at completion = intentional self-harm. Of these, 9,937 (77.7%) had been assigned ICD-10 underlying cause of death codes in the range normally reported as suicide (X60-X84), 1,135 had been assigned other ICD-10 codes and the remaining 1,714 (13.4%) NCIS records did not hold any ICD-10 codes.
Conclusions : These findings confirm that routine mortality data have underestimated suicide mortality in Australia in recent years probably due to incomplete coroner data being available to ABS coders. Certain types of unintentional injury deaths have been over-estimated. Incomplete linkage of NCIS and ABS data in the source data used for this project complicates calculations of adjusted estimates and trends.