Safe Waitakere Injury Prevention: re-assessing the evidence

Transcription

1 Safe Waitakere Injury Prevention: re-assessing the evidence Carolyn Coggan, PhD Mildred Lee, BTech (Hons) Pam Patterson, MA (Hons) Jacqui Fill, BA August, 2003 Injury Prevention Research Centre Te Puu Taki Aukati Whara University of Auckland New Zealand Centre Report Series No 74 ISSN

2 Table of Contents Acknowledgements Introduction Overview How to use this report Objectives Methodology Sources of information Data Analysis Waitakere City Injury Statistics Introduction Waitakere City Demographics Injury Statistics NZHIS Injury Mortality NZHIS Injury Mortality ACC Injury Statistics LTSA Road Injury Statistics Henderson Ward Demographics Injury Statistics NZHIS Injury Mortality NZHIS Injury Morbidity Massey Ward Demographics Injury Statistics NZHIS Injury Mortality NZHIS Injury Morbidity New Lynn Ward Demographics Injury Statistics NZHIS Injury Mortality NZHIS Injury Morbidity Waitakere Ward Demographics Injury Statistics NZHIS Injury Mortality NZHIS Injury Morbidity Community Consultation Findings Current position of participants Has SWIP contributed to Waitakere City Strengths of SWIP Challenges for SWIP Ethnic and geographical diversity of Waitakere City 65 2

3 8.6 How the Council has supported SWIP Future target groups for SWIP What role should Waitakere City Council have in SWIP Participants future role in SWIP Suggestions to aid the successful expansion of SWIP Evaluative Summary References 76 Appendix One 77 3

4 Acknowledgements The IPRC receives funding from the Accident Compensation Corporation, and the Ministry of Health, for research and dissemination activities associated with the provision of evidence-based research for injury prevention practitioners and policymakers. Disclaimer It is important to recognise that in relation to Section 8, comments received do not necessarily represent a consensus of opinion by the Safe Waitakere Injury Prevention Board. Comments reflect individual opinions at the time of the interviews. 4

5 1.0 Introduction 1.1 Overview The prevention of injuries is a major public health priority area in New Zealand, as injury is the leading cause of death between 1-34 years of age (Coggan, Langley & Dawe, 2000). Injuries account for more potential years of life lost than heart disease and cancer combined. Following complications of childbirth and pregnancy, injuries are also responsible for more hospitalisations than any other cause. Although injury prevention is a relatively new discipline, there is increasing recognition nationally and internationally that Community Injury Prevention Programmes (CIPPs) are an effective and acceptable way to reduce the burden of injury experienced by individuals, whanau/families and communities. Based on the World Health Organisation safe communities model, the CIPP programme has been adopted in New Zealand following successful Australian and Scandinavian initiatives (Coggan, Patterson, Brewin, Hooper, & Robinson 2000; Svanstrom 1997; Day, Ozanne-Smith, Cassell, Li, 2001). The CIPP model is a community based all ages, all injury prevention model which recognises that those most able to solve community injury prevention programmes are those people living in that particular community (Brewin & Coggan, in press). Community Injury Prevention Programmes were first established in Aotearoa/New Zealand in the early 1990s, and evaluation evidence indicates that the model is effective (Coggan, Patterson, Brewin et al, 2000). Currently in Aotearoa/New Zealand there are, in addition to Waitakere City, more than twenty other communities at various stages of implementing community action in injury prevention, including Whangarei City, Auckland City, Manukau City, Turanganui-akiwa, Ngäti Porou and Waimakariri communities. Evidence from the evaluations undertaken with most of these CIPPs to date suggests that community-based injury prevention activities are able to have an impact on the injury burden experienced by people of all ages. For example, evaluation findings from the Turanganui-a-kiwa CIPP indicate that injury death rates have steadily declined for the period

6 (Brewin & Coggan, 2002). Conversely, injury mortality rates for the comparison community (such as, no CIPP in place) increased during this period. In 1994, the New Zealand Public Health Commission awarded Waitakere City the contract for a community based injury prevention pilot based on the World Health Organisation (WHO) Safe Community model for injury prevention. The Public Health Commission also considered it important that an evaluation of the pilot project, the Waitakere Community Injury Prevention Project (WCIPP), be conducted and the contract for this was awarded to the Injury Prevention Research Centre at the University of Auckland (Coggan, Patterson, Brewin et al, 2000). In 1998, Waitakere was accredited as the first WHO Safe Community in New Zealand. In consultation with the Safe Waitakere Injury Prevention (SWIP) and the IPRC and, as part of IPRC s ongoing commitment of providing relevant injury information to communities, it was decided that a review of injuries in Waitakere City using routinely collected injury statistics from: the New Zealand Health Information Service related to injury deaths ( * ) and hospitalisations ( ) for Waitakere City; 1991, 1996 and 2001 New Zealand Census data from Statistics New Zealand; Land Transport Safety Authority data for ; and ACC data for 1994/5-2001/2 would be helpful for the further development of the project. Additionally, it was decided that key informant interviews should also be undertaken. The following document is an injury profile of Waitakere City, with particular attention given to the unintentional injury burden and opportunities for the prevention of unintentional injuries within Waitakere City. The overall aim of this document is to provide relevant data to the Waitakere City Council, and members of the SWIP management group to aid with the further development of this project. Specific objectives of the document are described in Section 1.3. * 1999 NZHIS mortality data is provisional. 6

7 1.2 How to use this report This report consists of five main sections: Section one provides a brief introduction and overview of the report objectives. Section two describes the data sources used to support this report, and the methods of data analysis used. Section three of the Community Profile describes Waitakere City injury statistics. Firstly, this section begins by providing an overview of the leading causes of mortality and morbidity for Waitakere City. Demographic data relating to Waitakere City is also provided. Injury mortality data is described, including leading causes of injury deaths, overall rates of injury deaths by age groups, and comparisons of injury deaths by wards. Injury hospitalisations for Waitakere City are also outlined, including leading causes of injury hospitalisations; overall rates of injury hospitalisations by age groups; rates of injury hospitalisations by gender; injury hospitalisations by ethnicity; and comparisons of injury hospitalisations by wards. Other sources of injury data are also described, including ACC injury statistics, and LTSA road injury statistics. Sections four to seven outline demographic and injury statistics for the four wards which comprise Waitakere City (Section four: Henderson Ward; Section five: Massey Ward; Section six: New Lynn Ward; Section seven: Waitakere Ward). Data are provided on the usual population of each ward, including information about the age and gender composition of the total population. Household and personal income information is also provided. For each ward, an analysis of overall leading causes of injury deaths is provided, and, where possible, an analysis by ethnicity is also provided. Overall causes of injury hospitalisation are provided, and a detailed analysis of injury hospitalisation is provided, including analysis by age, gender and ethnicity. Leading causes of injury hospitalisation and rates of injury hospitalisation are provided for each ward, for Mäori, New Zealand European and Pacific populations. 7

8 1.3 Objectives The objectives of this report are to: 1. present routinely collected baseline data which can be used to identify injury prevention related needs and issues in Waitakere City; 2. present routinely collected data on a ward-by-ward basis to enable comparisons by areas; 3. present routinely collected data to enable comparisons over time; 4. present the data in a meaningful and accessible manner to assist in the development of a strategic plan for injury prevention for Waitakere City; and 5. provide a discussion of points for consideration when identifying opportunities for strategic community development action related to injury prevention within Waitakere City. 8

9 2.0 Methodology 2.1 Sources of information The sources of information utilised to develop this community profile came from a wide variety of sources, including: Routinely collected injury statistics from the New Zealand Health Information Service related to injury deaths ( ) and hospitalisations ( ) for Waitakere City; 1991, 1996 and 2001 New Zealand Census data from Statistics New Zealand; Land Transport Safety Authority data for ; ACC data for 1994/5-2001/2; and Key informant interviews with people in Waitakere City. 2.2 Data Analysis Injury data were sourced from the NZHIS Minimum Dataset. Injury deaths and hospitalisations caused by medical misadventure, adverse effects, and late effects were excluded from the analysis. Injury hospitalisation records were selected for patients who were admitted overnight to hospital with a primary diagnosis of injury. Cases were only included if the patient survived the injury, and if the admission was the first hospitalisation for this injury. The category labelled Motor vehicle traffic crash on a public road include crashes involving a pedestrian, but does not included cycle crashes, which are coded as a separate category. As changes were made to the definition of ethnicity in 1995, 1996 is the beginning of a new time series for ethnicity data. Note that this data is for people resident in Waitakere City, not the location of where the injury event occurred. Analysis of trends was conducted for all age groups. Rates of injury deaths and hospitalisations were calculated for Waitakere City and compared to the rest of 9

10 Auckland and the comparison community. The trends over time for the injury death rates ranged from 1993 to 1999 whereas the rates of injury hospitalisation trends over time ranged from 1993 to Age-specific rates for each of the communities were calculated from population estimates based on the 1991, 1996 and 2001 census. Population counts for each of the communities were calculated using 1991, 1996 and 2001 census figures (for years not in a census year, population figures were estimated). Section three to six of this report discuss injury data at the ward level. Injury data for the wards were compiled by using the domicile code recorded for the injured person s place of residence. As some domicile codes fall into two ward boundaries, some records are counted in more than one ward. This means that the total number of injuries for Waitakere City will not equal the sum of the number of injuries reported for each ward. As the numbers of injury deaths for each of the wards are relatively small, separate analyses by ethnicity were not carried out for mortality data. The ACC data is taken from a summary of entitlement claims data for Waitakere City (prepared by ACC Scheme Reporting). The data excludes claims lodged with Private Insurers. An entitlement claim is one where payment is made for entitlement other than medical treatment, such as weekly compensation, independence allowance, and social rehabilitation. In addition, claims requiring dental treatment are classed as entitlement claims. Fatal claims are subject to reporting delays, so not reported for current year (2001/02). Note figures may alter upon final publication of Injury Statistics The LTSA data are taken from Motor Accidents in New Zealand 2000 (LTSA, 2001), Road Safety Atlas (LTSA, 1996), and 1997/98 Travel Survey Report (LTSA, 2000). It should be noted that not all motor vehicle crashes are reported to the Police; therefore LTSA figures underestimate the burden of injury due to motor vehicle crashes in New Zealand. A total of fourteen interviews were undertaken with key people who had been nominated by SWIP. The purpose of the key informant interviews was to enable an 10

11 exploration of what SWIP has achieved so far and to obtain a perspective from the stakeholders on what they thought SWIP should do in the future. The interviews were conducted with various members of the Safe Waitakere Injury Prevention Board, key stakeholders in organisations associated with SWIP and Waitakere City Council staff with an involvement in SWIP. A thematic analysis of data from key informant interviews was undertaken following multiple readings of the interview transcripts. Particular pieces of transcript have been selected for presentation because they illustrate broad thematic patterns observed across many interview transcripts, or because they are an example of a unique perspective offered by participants. These quotes are presented in italics. 11

12 3.0 Waitakere City Injury Statistics 3.1 Introduction: Injury in West Auckland Figure 3.1 shows that after cancer, and coronary heart disease, injury was the third leading cause of mortality in West Auckland (such as, Waitakere City and West- Rodney District Council) for the period When compared to other areas within the northern region of the Ministry of Health, West Auckland had the lowest rates of injury, stroke, suicide, and Lymph/Haem cancer. Figure 3.1: Leading Causes of Mortality for West Auckland West Auckland CORD* Stroke Injury Coronary heart disease Cancer Age-standardised mortality rate per 100,000 population *Chronic Obstructive Respiratory Disease Figure 3.2 shows that for the period , injury was the leading cause of hospital admission in West Auckland such as, Waitakere City and West-Rodney District Council), with a rate that was more than four times greater than the next leading cause of hospitalisation. It should be noted that cancer also makes a significant contribution to hospital admissions, but this information was not available at the Territorial Local Authority level. As an indication, for the whole of the North Health region, cancer was the third leading cause of hospitalisation. 12

13 Figure 3.2: Leading Causes of Hospitalisation for West Auckland West Auckland Stroke Asthma Coronary heart disease Injury Age standardised discharge rate/100,000 population 3.2 Waitakere City Demographics This section provides information relating to population, age, ethnicity and income. Table 3.1: Waitakere City- Usually resident population Population* % % Census Census Census % Maori NZ European/Other Pacific Total * In 1991 Maori ethnicity was determined by ancestry, whereas in 1996 and 2001 Maori ethnicity was by self-definition. The ethnicity total for 2001 Census shown in Table 3.1 is greater than the final count populations (168,750) for Waitakere City 2001 as people may belong to more than one ethnic group. 13

14 Table 3.2: Waitakere City - Age Composition Age Composition 2001 Census (%) 1996 Census (%) 1991 Census (%) Table 3.3: Waitakere City- Household and personal income Income 2001 Census number Households earning > $30,000 Personal incomes > $30,000 Average per capita personal income 2001 Census (%) 1996 Census number 1996 Census (%) $25,161 $21,986 Figure 3.3: Waitakere City- Age distribution by gender in 2001 Census Waitakere City Number of people Female Male 14

15 3.3 Injury Statistics NZHIS Injury Mortality * Between 1993 and 1999, 449 residents of Waitakere City died as the result of receiving an injury. This is equivalent to a crude injury rate of 41 injury deaths per 100,000 person years. Males accounted for the majority (70%) of fatalities. Figure 3.4 shows that the rates of injury deaths of all age groups for Waitakere City and the comparison community and the rest of Auckland were similar in The injury death rate in Waitakere City increased slightly in 1997 (48 injury deaths rate per 100,000 population) and it was the highest compared to the comparison community and the rest of Auckland. The injury death rate for Waitakere City decreased considerably between 1997 and Although the injury death rate for Waitakere City was slightly higher than the rest of Auckland in 1999, it was much lower compared to the comparison community. Figure 3.4: Comparison of injury mortality rates for all ages All Injury Deaths Rate per 100,000 population Start of implementation phase Comparison Community Rest of Auckland Waitakere * NZHIS 1999 mortality data is provisional. 15

16 Figure 3.5 shows that the leading cause of injury deaths was suicide (38%). One third (33%) of the injury deaths were motor vehicle crashes on a public road, 9% were caused by falls, and six percent were the result of drowning. Figure 3.5: Waitakere City- Leading Causes of Injury Mortality Waitakere City All other 14% Drowning 6% Falls 9% Suicide 38% Motor vehicle traffic crashes on public road 33% Figure 3.6 shows that the 75+ age group had the highest rate of injury death followed by young people aged years. Figure 3.6: Rates of Injury Death by Age Group, Waitakere City Rate per 100,000 person years

17 Leading causes of injury death by age group Figure 3.7 shows that for 0-4 year olds the leading cause of injury deaths was suffocation (45%). One third of the deaths were caused by drowning. Figure 3.7: Leading Causes of Injury Mortality for 0-4 year olds, years (n=18) Other 22% Suffocation 45% Drowning 33% As shown by Figure 3.8, in the 5-14 year age group nearly half of the injury deaths were caused by motor vehicle crashes on a public road (49%). Drownings accounted for 13% of the deaths. Figure 3.8: Leading Causes of Injury Mortality for 5-14 year olds, years (n=16) Other 38% Motor vehicle traffic crashes on public road 49% Drowning 13% 17

18 For year olds, motor vehicle crashes on a public road were the leading cause of injury death (46%, Figure 3.9). Suicide accounted for more than a third (40%) of the deaths, 5% were the result of drowning, and 3% of the fatalities were as a result of assault. Figure 3.9: Leading Causes of Injury Mortality for year olds, Assault 3% years (n=124) Other 6% Drowning 5% Motor vehicle traffic crashes on public road 46% Suicide 40% In the age group, suicide accounted for 45% of the deaths (Figure 3.10). Just over a third (34%) of the injury deaths were caused by motor vehicle crashes on a public road, 5% were the result of drowning, and 4% of the fatalities were as a result of assault. Figure 3.10: Leading Causes of Injury Mortality for year olds, years (n=130) Assault 4% Drowning 5% Other 12% Suicide 45% Motor vehicle traffic crashes on public road 34% 18

19 For year olds, 41% of the deaths were the result of suicide (Figure 3.11). Motor vehicle crashes on a public road were the second leading cause of injury death (26%), followed by falls (10%), and drowning (5%). Figure 3.11: Leading Causes of Injury Mortality for year olds, years (n=73) Other 18% Drowning 5% Suicide 41% Falls 10% Motor vehicle traffic crashes on public road 26% Figure 3.12 shows that for people aged between years of age, 40% of the deaths were the result of suicide. Motor vehicle crashes on a public road were the second leading cause of injury death (34%), followed by falls (15%). Figure 3.12: Leading Causes of Injury Mortality for year olds, years (n=47) Other 11% Falls 15% Suicide 40% Motor vehicle traffic crashes on public road 34% 19

20 For older people aged 75+, more than half (58%) of the deaths were the result of a fall (Figure 3.13). Suicide accounted for one fifth (20%) of the injury deaths, and motor vehicle crashes on a public road accounted for 15%. Figure 3.13: Leading Causes of Injury Mortality for 75+ year olds, years (n=41) Motor vehicle crashes on public road 15% Other 7% Suicide 20% Falls 58% Ethnic Comparison For the period *, Maori had the highest age-standardised rate of injury deaths (46 per 100,000 person years), followed by New Zealand European/Other (39 per 100,000 person years), and Pacific (36 per 100,000 person years). Of the 259 people who died from injury, New Zealand European/Other accounted for the majority (75%), Maori accounted for 16%, and Pacific accounted for 9%. Figure 3.14 gives a breakdown of injury death rates by ethnicity and age group. The Pacific and New Zealand European/Other ethnic groups had the highest injury death rates in the older age groups (75+). Maori people had the highest rate of injury death for year age group. * Due to changes in the definition of ethnicity in 1995 and 2001, ethnic comparisons can only be made from 1996 onwards to 1999 (for mortality). 20

21 Figure 3.14: Injury Death Rates by Ethnicity and Age Group for Waitakere City, Waitakere City Rate per 100,000 person years Maori NZ European/Other Pacific Table 3.4 shows that the leading causes of injury deaths were similar across all ethnic groups. However, a higher injury deaths percentage of Pacific peoples were caused by motor vehicle crashes on public road (41%) compared to the other ethnic groups. Maori and New Zealand European/Other had the same proportion of injury deaths caused by attempted suicide/ self-harm (38%). Table 3.4: Ethnic comparison of leading causes of injury deaths, Maori (n=42) NZ European/Other (n=195) Pacific (n=22) Cause % Cause % Cause % Suicide 38 Suicide 38 Motor vehicle 41 crashes on public road Motor vehicle 24 Motor vehicle 32 Drowning 14 crashes on public road crashes on public road Suffocation 12 Falls 13 Suicide 9 Drowning 7 Drowning 3 Assault Comparison by Ward The ward comparison in Figure 3.15 shows that the Massey Ward had the highest rate of injury death, while Henderson had the lowest. 21

22 Figure 3.15: Age-standardised Injury Death Rates by Ward for Waitakere City, Massey Waitakere New Lynn Henderson Age-standardised rate per 100,000 person years Figure 3.16 shows a plot of the crude injury mortality rate for each ward, graphed against the average personal income for each ward. The graph shows that there is little variation of injury mortality rate with increasing average income. Note that the trend of the plot should be interpreted with caution, as there are only four points in the graph. Figure 3.16: Relationship Between Injury Mortality Rate and Income on a Ward Basis Injury Mortality Rate vs Income by Ward Crude rate per 100,000 population $23,000 $24,000 $25,000 $26,000 $27,000 $28,000 Average personal Income 2001 Census 22

23 3.3.2 NZHIS Injury Morbidity Between 1993 and 2001, 15,308 residents of Waitakere City were hospitalised for injury. The crude injury hospitalisation rate during this period was 1,080 injury hospitalisations per 100,000 person years. Males accounted for the majority (61%) of the injury hospitalisations. Figure 3.17 shows that the injury hospitalisation rate for all age groups in Waitakere City was slightly higher than the injury hospitalisation rate for the comparison community and the rest of Auckland in The Waitakere City injury hospitalisation rate decreased in 1998 and it was lower than the comparison community and the rest of Auckland. Although the injury hospitalisation rate for Waitakere City increased from 1998 onwards, Waitakere City still had much lower injury hospitalisation rates compared to the other two communities in 2000 and Between 1999 and 2000, the overall trend of increased injury hospitalisation rate for Waitakere City was considerably lower compared to the comparison community and the rest of Auckland. Figure 3.17: Comparison of injury morbidity rates for all ages All Injury Hospitalisations Rate per 100,000 population Start of implementation phase Comparison Community Rest of Auckland Waitakere Figure 3.18 shows that the leading cause of injury hospitalisation was falls (38%). The other leading causes of injury were motor vehicle traffic crashes on a public road (11%), cutting and piercing (11%), striking an object or person (6%), attempted suicide/deliberate self-harm (5%), and assault (4%). 23

24 Figure 3.18: Waitakere City- Leading Causes of Injury Morbidity All other 25% Assault 4% Attempted suicide/self-harm 5% Striking object/person 6% Waitakere City Cutting/Piercing 11% Falls 38% Motor vehicle traffic crashes on public road 11% Since falls were the leading causes of injury hospitalisation in Waitakere City for all ages, Figure 3.19 shows the breakdowns of the falls. One fifth of the injury hospitalisation falls were caused by a fall on the same level, such as tripping or slipping. The other leading causes of falls were a fall from one level to another, not otherwise specified (14%), a fall from playground equipment (11%), a fall from collision with person e.g. in sports (8%), and a fall on or from stairs or steps (8%). Figure 3.19: Leading Causes of Injury Hospitalisation Falls for all age group, Waitakere City - Falls Fall from chair or bed Fall from 3% ladders/scaffolding 4% Fall from/out of building/structure 6% Fall into hole or opening 3% Other falls 23% Fall on/from stairs/steps 8% Fall from collision with person eg sports 8% Fall from playground equipment 11% Fall from one level to another NOS 14% Fall on same level eg tripping 20% As shown by Figure 3.20, for females, the 75+ age group had the highest rates of injury hospitalisation, followed by children aged 0-4 years. For males, the 75+ age 24

25 group had the highest rates of injury hospitalisation, followed by children aged years. Males had higher rates of injury across all age groups below the age of 60. Figure 3.20: Rates of Injury Hospitalisation by Age and Gender, Waitakere City Rate per 100,000 person years Female Male Leading Causes of injury hospitalisation by age group Figure 3.21 shows that for 0-4 year olds, falls were the leading cause of injury hospitalisation (42%). Eight percent of the hospitalisations were the result of being caught between objects, 7% were the result of cutting and piercing, 6% were the result of unintentional poisoning, 6% were the result of motor vehicle crashes on a public road, and 5% were the result of being struck by a person or object, and 5% were the result of scalding by a hot liquid or vapour. Figure 3.21: Leading Causes of Injury Hospitalisation for 0-4 year olds, Scalding from hot liquids & vapours 5% Striking an object or person 0-4 years (n=1639) Other 21% Falls 42% 5% Motor vehicle traffic crashes on public road Unintentional 6% Caught between poisoning Cutting/Piercing objects 6% 7% 8% 25

26 For 5-14 year olds, falls accounted for just over half (51%) of the injury hospitalisations (Figure 3.22). The other leading causes were cutting and piercing (9%), cycle crashes (8%), motor vehicle crashes on a public road (7%), being struck by a person or object (7%), and being caught between objects (2%). Figure 3.22: Leading Causes of Injury Hospitalisation for 5-14 year olds, years (n=3288) Caught between objects Striking an object 2% or person 7% Motor vehicle crashes on public road 7% Cycle crashes 8% Other 16% Cutting/Piercing 9% Falls 51% For year olds, motor vehicle crashes on a public road (20%) were the leading cause of injury hospitalisation (Figure 3.23). The other leading causes were falls (18%), cutting and piercing (14%), attempted suicide (9%), assault (9%), and striking a person or object (8%). Figure 3.23: Leading Causes of Injury Hospitalisation for year olds, years (n=2623) other 22% Motor vehicle traffic crashes on public road 20% Striking an object or person 8% Assault 9% Attempted suicide 9% Falls 18% Cutting/Piercing 14% 26

27 For year olds, falls (19%) were the leading cause of injury hospitalisation (Figure 3.24). The other leading causes were motor vehicle crashes on a public road (15%), cutting and piercing (14%), attempted suicide (9%), striking a person or object (7%), and assault (7%). Figure 3.24: Leading Causes of Injury Hospitalisation for year olds, Other 29% years (n=3152) Falls 19% Assault 7% Striking an object or person 7% Attempted suicide 9% Motor vehicle traffic crashes on public road 15% Cutting/Piercing 14% For year olds, falls (29%) were the leading cause of injury hospitalisation (Figure 3.25). The other leading causes were cutting and piercing (15%), motor vehicle crashes on a public road (12%), attempted suicide (9%), incidents involving machinery (5%), and overexertion and strenuous movements (4%). Figure 3.25: Leading Causes of Injury Hospitalisation for year olds, years (n=2181) Other 26% Falls 29% Overexertion/ stenuous movements 4% Incidents involving machinery 5% Attempted suicide 9% Motor vehicle crashes on public road 12% Cutting/Piercing 15% 27

28 For year olds, falls (55%) were the leading cause of injury hospitalisation (Figure 3.26). The other leading causes were motor vehicle crashes on a public road (10%), cutting and piercing (8%), striking a person or object (3%), incidents involving machinery (3%), and unintentional poisoning (3%). Figure 3.26: Leading Causes of Injury Hospitalisation for year olds, years (n=1031) Unintentional poisoning 3% Incidents involving machinery 3% Striking object/person 3% Other 18% Falls 55% Cutting/Piercing 8% Motor vehicle traffic crashes on public road 10% For 75+ year olds, falls (81%) were the leading cause of injury hospitalisation (Figure 3.27). The other leading causes were motor vehicle crashes on a public road (5%), overexertion and strenuous movement (2%), cutting and piercing (2%), striking an object or person (1%), and attempted suicide (1%). Figure 3.27: Leading Causes of Injury Hospitalisation for 75+ year olds, years (n=1394) Other Attempted suicide 8% 1% Striking object/person 1% Cutting/Piercing 2% Overexertion/ strenuous movements 2% Motor vehicle traffic crashes on public road 5% Falls 81% 28

29 Ethnic Comparison For the period *, New Zealand European/Other had the highest agestandardised rate of hospitalised injuries (1342 per 100,000 person years), followed by Pacific (1218 per 100,000 person years), and Maori (1202 per 100,000 person years). New Zealand European/Other accounted for the majority (76%) of the injury hospitalisations, Maori accounted for 13%, and Pacific accounted for 11%. Figure 3.28 gives a breakdown of injury hospitalisation rates by ethnicity and age group. The New Zealand European/Other ethnic group had the highest injury rates in the older age groups (75+). Pacific peoples had the highest rate of injury for young children aged 0-4. For Maori the younger age groups tended to have the highest rates of injury. Figure 3.28: Injury Hospitalisation Rates by Ethnicity and Age Group for Waitakere City, Waitakere City Rate per 100,000 person years Maori NZ European/Other Pacific Table 3.5 shows that the leading causes of injury hospitalisation were similar across all ethnic groups. However, a higher percentage of New Zealand European/Other were injured by falls (39%) compared to the other ethnic groups, and Pacific peoples had a higher proportion of injuries caused by striking by an object or person * Due to changes in the definition of ethnicity in 1995 and 2001, ethnic comparisons can only be made from 1996 onwards to

30 (9%). Injuries caused by attempted suicide/self-harm only featured as a leading cause of injury hospitalisation for New Zealand European/Other. Table 3.5: Ethnic comparison of leading causes of injury hospitalisation, Maori (n=1408) NZ European/Other (n=8142) Pacific (n=1139) Cause % Cause % Cause % Falls 33 Falls 39 Falls 34 Motor vehicle 13 Motor vehicle 11 Cutting/Piercing 13 crashes on public road crashes on public road Cutting/Piercing 13 Cutting/Piercing 9 Motor vehicle 9 crashes on public road Assault 6 Attempted 6 Striking an object or 9 Striking an object or person suicide/self-harm 6 Striking an object or person person 5 Assault Comparison by Ward The comparison of ward rates in Figure 3.29 shows that the New Lynn Ward had the highest rate of injury hospitalisation, while Waitakere had the lowest. Figure 3.29: Age-standardised Injury Hospitalisation Rates by Ward for Waitakere City, New Lynn Henderson Massey Waitakere Age-standardised rate per 100,000 person years Figure 2.30 shows a plot of the crude injury hospitalisation rate for each ward, graphed against the average personal income for each ward. The graph shows that the injury hospitalisation rate tends to decrease with increasing average income. 30

31 Note that the trend of the plot should be interpreted with caution, as there are only four points in the graph. Figure 3.20: Relationship Between Injury Mortality Rate and Income on a Ward Basis Injury Hospitalisation Rate vs Income by Ward Crude rate per 100,000 population $23,000 $24,000 $25,000 $26,000 $27,000 $28,000 Average Personal Income 2001 Census 3.4 ACC Injury Statistics The information in this section is taken from an ACC analysis of entitlement claims and injury deaths for residents of the Waitakere City community. It should be noted that the number of entitlement claims will be less than the total number of injury claims made to ACC, as entitlement claims only exist for cases where some form of compensation is paid directly to the injured person. As shown in Figure 3.31 the cost of new and ongoing entitlement claims in Waitakere City increased steadily from $8.6 million in 1994/95 to $11 million in 1997/98 then decreased to $5.9 million in 1999/2000. The cost of new and ongoing entitlement claims was approximately $6.8 million in 2001/02. 31

32 Figure 3.31: Costs of new and ongoing entitlement claims in Waitakere City, 1994/5-2001/2 Waitakere City $(000's) Ongoing Claims New Claims 1994/ / / / / / / /02 Figure 3.32 shows that the number of fatal claims in Waitakere City has decreased from 32 in 1994/95 to 13 in 1996/97, but increased again to 24 in 1997/98. There were only 5 fatal claims in 1999/2000 but this increased to 12 fatal claims in 2000/01. Figure 3.32: Fatal claims occurring in Waitakere City, 1994/5 2000/1 Waitakere City Number of fatal claims / / / / / / /01 Figure 3.33 shows that injuries occurring at home accounted for more than a third (35%) of entitlement claims registered with ACC in 2000/01. Injuries at work accounted for 17% of claims, sporting and recreation injuries accounted for 11%, road or street injuries accounted for 10%, and school injuries accounted for 2%. 32

33 Figure 3.33: New Entitlement claims registered with ACC in 2000/01 by scene of accident, Waitakere City Entitlement Claims, 2000/01 Not Obtainable/ Undefined 15% Other 10% School 2% Road/ Street 10% Sport/ Recreation 11% Work 17% Home 35% Figure 3.34 shows that injuries occurring at home accounted for one third (33%) of entitlement claims registered with ACC in 2001/02. Injuries at work accounted for 29% of claims, sporting and recreation injuries accounted for 15%, road or street injuries accounted for 12%, and school injuries accounted for 2%. Figure 3.34: New Entitlement claims registered with ACC in 2001/02 by scene of accident, Waitakere City Entitlement Claims, 2001/02 Not Obtainable/ Other Undefined School 7% 2% 2% Road/ Street 12% Home 33% Sport/ Recreation 15% Work 29% A breakdown of entitlement claims by diagnosis shows that soft tissue injuries accounted for 36% of all claims (Figure 3.35). Fractures and dislocations accounted for one third (33%) of claims, and lacerations/punctures accounted for 13% of the claims. 33

34 Figure 3.35: Diagnosis of entitlement claims registered with ACC in 2000/01, Waitakere City Entitlement Claims, 2000/01 burns/scalds 1% Gradual Process 2% Pain syndromes 2% Sprain/Strain 3% Infected/noninfected laceration/puncture/s ting 13% Other/ multiple injuries 10% fracture/dislocation 33% Soft tissue injury 36% As shown in Figure 3.36, a breakdown of entitlement claims by diagnosis shows that soft tissue injuries accounted for 39% of all claims. Fractures and dislocations accounted for a further 38% of claims, and lacerations/punctures accounted for 9% of the claims. Figure 3.36: Diagnosis of entitlement claims registered with ACC in 2001/02, Waitakere City Sprain/Strain burns/scalds 1% 2% Gradual Process 2% Pain syndromes 2% Infected/noninfected laceration/puncture /sting 9% Entitlement Claims, 2001/02 fracture/dislocation 38% Other/ multiple injuries 7% Soft tissue injury 39% Figure 3.37 shows that New Zealand European had the highest percentage of new entitlement claims registered with ACC in both 2000/01 and 2001/02 (72% and 69% respectively) in Waitakere City. In 2000/01, Maori accounted for 11% new entitlement claims whereas Pacific people accounted for 4% of the new claims. 34

35 Both Maori and Pacific peoples had the same percentage (9%) of new entitlement claims in 2001/02. Figure 3.37: New Entitlement claims by scene of Ethnicity registered with ACC in 2000/01 and 2001/02, Waitakere City Waitakere City Percentage of Claims 80% 60% 40% 20% 0% Pakeha/ European 2000/ /02 Maori Pacific Other Not stated 3.5 LTSA Road Injury Statistics The figures quoted in this section are taken from Motor Accidents in New Zealand 2000 (LTSA, 2001), Road Safety Atlas (LTSA, 1996), and 1997/98 Travel Survey Report (LTSA, 2000). It should be noted that not all motor vehicle crashes are reported to the Police; therefore LTSA figures underestimate the burden of injury due to motor vehicle crashes in New Zealand. In 2000, Waitakere City had a crash rate of 22.1 crashes per 10,000 population, and a casualty rate of 22.0 per 10,000 population. As shown in Table 3.6, in 2000 there were 284 road traffic crashes in Waitakere, resulting in 383 casualties. Table 3.6: Reported road traffic crashes and casualties in Waitakere City, 2000 Type of injury Number of crashes Number of injuries Fatalities 4 4 Serious injuries Minor injuries 313 Total

36 The social cost of road injury in Waitakere City is $77 million dollars/year, which is equivalent to a per capita social cost of $877 /person/year (Table 3.7). When comparing Waitakere City to the Auckland region and all of New Zealand, Waitakere City had the highest per capita social cost and the social cost per road km. Table 3.7: Measures of road safety Other road safety measures Per capita social cost ($/person/year) Social cost per road km ($000/km/yr) Waitakere City Auckland Region New Zealand As defined by the Road Safety Atlas (LTSA, 1996), risk ratios for causal factors in road crashes are calculated as the social cost per unit of traffic volume and are a useful tool for measuring and comparing the contribution of causal factors to road traffic injury. As can be seen from Table 3.8, compared to the Auckland Region, Waitakere City has higher risk-ratios for all driver factors. However the risk-ratios for speed and driver-not speed or alcohol were slightly lower in Waitakere City than for the whole of New Zealand. Table 3.8: Risk ratios for driver factors Risk Driver factors (cents/vehkm) Waitakere City Auckland Region New Zealand Alcohol Alcohol and speed combined Speed Driver -not speed or alcohol eg. Overtaking, failure to give way, tiredness Non driver factor All causes Table 3.9 shows that the risk factors for pedestrian and cyclist road injury in Waitakere City were lower than the risk-ratios for the Auckland Region. However, the risk-ratio for pedestrian involvement was slightly higher in Waitakere City than for the whole of New Zealand. 36

37 Table 3.9: Risk ratios for pedestrian and cyclist factors Risk pedestrian and cyclist factors (cents/vehkm) No pedestrian or cyclist Waitakere City Auckland Region New Zealand involved Pedestrian involvement Cyclist involvement All causes As shown in Table 3.10, the risk-ratio for road factors in Waitakere City was considerably lower than the risk-ratios for both the Auckland Region and all New Zealand. Table 3.10: Risk ratios for road factors Risk - road factors Waitakere Auckland New Zealand (cents/veh-km) City Region Non road factor Road factor involved eg slippery surface, obstructions, road works All causes As can be seen from Table 3.11, the risk-ratio for vehicle factors in Waitakere City was considerably lower than the risk-ratios for both the Auckland Region and all New Zealand. Table 3.11: Risk ratios for vehicle factors Risk vehicle factors (cents/vehkm) Waitakere City Auckland Region New Zealand Non vehicle factor Vehicle factor involved eg faulty brakes, worn tyres, punctures All causes Overall, these risk ratios indicate that driver factors contribute the greatest amount of risk for motor vehicle crashes occurring in the Waitakere City. Table 3.12 shows the results of a restraint usage survey published in Motor Accidents in New Zealand 2000 (LTSA, 2001). The figures show that the use of 37

38 restraints by adults and children, and cycle helmet were higher in Waitakere City compared to the whole of New Zealand. However, Waitakere City had a lower rate of front and rear seat belt wearing compared to the Auckland Region. Table 3.12: Restraint usage, March 2000 Restraint Usage Waitakere City (%) Auckland Region (%) New Zealand (%) Front seat adults Rear seat adults Child restraints Cycle helmet wearing The regional figures in Table 3.13 are obtained from the 1997/98 Travel Survey Report (LTSA, 2000) and show that the travel habits of Auckland Region residents were similar to all of New Zealand. Table 3.13: Travelling distances for motorists in Auckland and New Zealand 1997/98 Millions of trips per year (as a percentage of total) Auckland (%) New Zealand (%) Driver Passenger Cyclist Pedestrian Bus

39 4.0 Henderson Ward 4.1 Demographics This section provides information relating to population, age, ethnicity and income. Table 4.1: Henderson Ward- Usually resident population Population* 2001 % 1996 % 1991 % Census Census Census Maori NZ European/Other Pacific Total 42774* * In 1991 ethnicity was determined by ancestry, whereas in 1996 and 2001 ethnicity was by self-definition. * The ethnicity total for 2001 Census shown in Table 3.1 is greater than the final count populations (40,086) for Henderson Ward 2001 as people may belong to more than one ethnic group. Table 4.2: Age Composition Henderson Ward - Age Composition 2001 Census (%) 1996 Census (%) 1991 Census (%) Table 4.3: Henderson Ward- Household and personal income Income 2001 Census number Households earning> $30,000 Personal incomes > $30,000 Average per capita personal income 2001 Census (%) 1996 Census number 1996 Census (%) $23,376 $20,370 39

40 Figure 4.1: Henderson Ward- Age distribution by gender in 2001 Census Henderson Ward Number of people Female Male 4.2 Injury Statistics Henderson Ward NZHIS Injury Mortality * Between 1993 and 1999, 102 residents of the Henderson ward died as the result of receiving an injury. This is equivalent to a crude injury rate of 38 injury deaths per 100,000 person years. Males accounted for 68% of the fatalities. As can be seen in Figure 4.2, suicide was the leading cause of injury death (39%). The other leading causes of injury death were motor vehicle crashes on a public road (27%), falls (14%), and drowning (5%). Figure 4.2: Henderson Ward- Leading Causes of Injury Mortality Drowning 5% Fall 14% Henderson Ward All other 15% Suicide 39% Motor vehicle traffic crashes on public road 27% * NZHIS 1999 mortality data is provisional. 40

41 Figure 4.3 shows that the 75+ age group had the highest rate of injury death, followed by young adults aged years. Figure 4.3: Rates of Injury Death by Age Group, Henderson Ward 120 Rate per 100,000 person years Of the 65 people who died from injury between 1996 and 1999, thirteen were of Maori ethnicity, four were Pacific, and 48 were New Zealand European/Other NZHIS Injury Morbidity Between 1993 and 2001, 4044 residents of the Henderson ward were hospitalised after receiving an injury. The crude injury hospitalisation rate during this period was 1171 injury hospitalisations per 100,000 person years. Males accounted for 59% of the hospitalisations. Figure 4.4 shows that falls accounted for the greatest number of injury hospitalisations (39%). The other leading causes of injury were motor vehicle traffic crashes on a public road (11%), cutting and piercing (10%), attempted suicide/deliberate self-harm (6%), striking an object or person (6%), and assault (4%). 41

42 Figure 4.4: Henderson Ward- Leading Causes of Injury Morbidity Henderson Ward Assault 4% All other 24% Falls 39% Striking object/person 6% Attempted suicide/deliberate self-harm 6% Cutting/Piercing 10% Motor vehicle traffic crashes on public road 11% Figure 4.5 shows that for females, those aged 75+ had the highest rate of injury hospitalisation, followed by young children aged 0-4 years. For males, the 75+ age group had the highest rate of injury hospitalisation, followed by children aged years. Males had higher rates of injury hospitalisation than females across all age groups under 60. Figure 4.5: Rates of Injury Hospitalisation by Age and Gender, Henderson Ward 4500 Rate per 100,000 person years Female Male

43 Figure 4.6 shows that for the period , New Zealand European/Other had the highest rate of hospitalised injury (1,162 injury hospitalisations per 100,000 person years), followed by Pacific (1,070 injury hospitalisations per 100,000 person years) and Maori (1,055 injury hospitalisations per 100,000 person years). New Zealand European/Other accounted for the majority (76%) of the injuries. Figure 4.6: Injury Hospitalisation Rates by Ethnicity for Henderson Ward, Number/ Rate per 100,000 person years Henderson Ward Number of hospitalisations Age-standardised rate Maori NZ European/Other Pacific Table 4.4 shows that for the period of , although the leading causes of hospitalised injury were similar across ethnic groups, attempted suicide or selfharm only showed up as a leading cause of injury amongst New Zealand European/Other (7%). Falls were most common in the New Zealand European/Other ethnic group (41%), while striking an object or person was the second leading cause (14%) of injury amongst Pacific peoples. Table 4.4: Ethnic comparison of leading causes of injury hospitalisation, Maori (n=366) NZ European/Other (n=2043) Pacific (n=270) Cause % Cause % Cause % Falls 32 Falls 41 Falls 31 Motor vehicle crashes 14 Motor vehicle crashes Striking an object or 11 on public road on public road person 14 Cutting/Piercing 13 Cutting/Piercing 9 Cutting/Piercing 11 Homicide/ Assault 8 Attempted suicide/ Motor vehicle self-harm 7 crashes on public road 10 Striking an object or 7 Striking an object or Homicide/ Assault 4 person person 6 43

44 5.0 Massey Ward 5.1 Demographics This section provides information relating to population, age, ethnicity and income. Table 5.1: Massey Ward- Usually resident population Population* 2001 % 1996 % 1991 % Census Census Census Maori NZ European/Other Pacific Total * In 1991 Maori ethnicity was determined by ancestry, whereas in 1996 and 2001 Maori ethnicity was by self-definition. * The ethnicity total for 2001 Census shown in Table 4.1 is greater than the final count populations (46,785) for Massey Ward 2001 as people may belong to more than one ethnic group. Table 5.2: Age Composition Massey Ward - Age Composition 2001 Census (%) 1996 Census (%) 1991 Census (%) Table 5.3: Massey Ward- Household and personal income Income 2001 Census number Households earning> $30,000 Personal incomes > $30,000 Average per capita personal income 2001 Census (%) 1996 Census number 1996 Census (%) $24,625 $22,277 44