Bulletin 14 - Limitationss of the data that need addressing
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Limitations of the data that need addressing
Data on Aboriginal and Torres Strait Islander injury is incomplete. Queensland
has only introduced Aboriginality on death registrations for 1996 and it may
take some time for this to reach full reliability. It is evident that many
health service collections do not reliably identify Aboriginality. Accurate
identification of Aboriginal and Torres Strait Islander peoples in major health
data and the death data is essential. There is a need to explore biases in the
reporting of interpersonal violence and in particular the extent of
differential identification of both violence and Aboriginality among women
receiving hospital treatment.
At present it is not possible to analyse national hospitalisation data by
geographic region. While all states and territories collect data about place of
usual residence, the coding of geographic location varies, making it difficult
to uniformly assign cases to classifications such as the Rural and Remote Area
Classification system. Several states do not provide finely detailed geographic
classification to the national data pool due to legislation requiring the
absolute anonymity of unit record level data in the states. It is therefore not
possible to present national data for urban, rural and remote dwelling
Aboriginal and Torres Strait Islander peoples. If states were prepared to
introduce recoding to the Rural and Remote Area Classification system and
attach this to unit records, this problem would be overcome.
In addition, it is only possible to obtain population data at detailed
geographic level from the Census which, as pointed out above, is a biased
estimator of some age and sex groups of the Aboriginal and Torres Strait
Islander population.
The data presented on Aboriginal and Torres Strait Islander injury at state and
national level is an aggregation of non-homogeneous populations. It is almost
certain that the injury patterns among urban dwelling Aboriginal and Torres
Strait Islander peoples are different to those in rural areas and different
again from those living traditional lifestyles in more remote areas. Setting
priorities for prevention requires a better understanding of the injury
patterns of Aboriginal and Torres Strait Islander peoples living different
lifestyles.
National data collections have become more timely in recent years but considerable delays are still
experienced, especially with larger systems such as those dealing with hospitalisations. As
timeliness of these systems improves, the issue of having current year detailed population
estimates will become more critical, as it is difficult to make sense of the information without
adequate population denominators.
The level of detail of information available is not adequate to permit a
thorough identification of causes and the setting of specific prevention
priorities. While this should improve for deaths data if the National Coronial
Information System is put in place, it is difficult to rapidly make changes of
the kind necessary to the hospitalisations data collections. The number of
contributing hospitals and the commitment to implementing changes through the
National Health Information Agreement increases quality but does not provide a
basis for rapid changes to be made. Alternative ways of obtaining more detail
and greater reliability of information need to be considered if better
information on Aboriginal and Torres Strait Islander injury patterns are to be
produced in the short term.
Given the size of the Aboriginal and Torres Strait Islander populations and
(despite the high rate of injury) the relatively small number of injury cases,
it will be necessary to supplement existing data. This could be done in a
number of ways. The development of surveillance techniques for small
communities, that encompass both prospective and retrospective quantitative and
qualitative material, is required, and a project to develop new methods for
small communities is under way in Cairns. In addition, cause-specific studies
are needed to move beyond broad descriptive epidemiology to more detailed
understanding of injury causes and possible prevention strategies.
Data concerning injury among Aboriginal and Torres Strait Islander peoples lack
the precision and coverage that is desirable. Nevertheless, there is sufficient
evidence to show that injury rates are significantly higher among Aboriginal
and Torres Strait Islander peoples than their non-Aboriginal counterparts. In
the short term, existing data can be used to start setting prevention
priorities, but improvement in hospitalisation, death and population data is
needed to provide a more definitive picture of injury patterns.
New methods of injury surveillance that take into account the different
lifestyles of Aboriginal and Torres Strait Islander peoples are required to
better understand how to reduce the injury burden. Injury cause classifications
that are more culturally applicable are needed and attention is required to
lessen the possibility that data reported by health services contain hidden
biases.
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