Unintentional injuries Key points In 1998 451 children aged less than 15 years were admitted to hospital with burns from hot objects or substances, caustic or corrosive substances, and steam. In 1998 the burns age-specific rate for Mäori children was 72 per 1, just under the target level of 8 per 1. For all children it was 52 per 1, against the target rate of 51 per 1. Hot-water scalding is the most common type of burns injury resulting in the hospitalisation of children. While reductions in hot tap-water temperatures assist in reducing the severity and frequency of hot tap-water burns, there is currently no requirement for existing houses to comply with the water safety provisions of the Building Act 1991. New and modified buildings are required under the Building Act to adhere to maximum safe water temperatures (defined as 45 C for early childhood centres, schools and old people s homes, and 55 C for all other buildings). Drownings Preschool drownings in private swimming or spa pools In 1998 12 children aged 4 years drowned, three in private swimming or spa pools. The rate of drowning in private swimming pools or spa pools for 1998 was 1.5 per 1, the lowest rate since 1981 and close to the target set for 22. The lower rates of drowning in private swimming or spa pools observed in recent years may reflect the effects of the Fencing of Swimming Pools Act which was introduced in 1987. This suggests the need to continue with the enforcement and compliance of the Fencing of Swimming Pools Act for future improvement in the rate of preschool drownings. All unintentional drownings In 1998 there were 129 drownings (19 males and 2 females) compared to 111 drownings in 1997 (a 16 percent increase over the 1997 figure). In 1988 41 Mäori and 88 non-mäori died of drowning in 1998. Overall, the number of drownings has fluctuated during the past several years. Given the current increase in number of deaths due to drowning, the target seems unattainable by 2. Progress on Health Outcome Targets 1999 75
Targets To reduce the hospitalisation rate for burns from hot objects or substances, caustic or corrosive substances, and steam among children aged 14 years to 51 per 1 or less by 2. To reduce the hospitalisation rate for burns from hot objects or substances, caustic or corrosive substances, and steam among Mäori children aged 14 years to 8 per 1 or less by 2. Drownings To reduce the rate of drownings in private swimming or spa pools among preschool children to 1. per 1 per year or less by 22. To reduce the number of deaths due to unintentional drowning to 98 deaths or less per year by 2.* * Unintentional drownings exclude drownings due to suicide and homicide. Progress towards the targets Burns from hot objects or substances, caustic or corrosive substances, and steam cause about 1 times as many child hospitalisations as burns from fire and flames (Ministry of Health 1998). In 1998 there were 451 hospital admissions of children aged 14 years for burns from hot objects or substances, caustic or corrosive substances, and steam. Children aged 14 years accounted for 58 percent of hospitalisations of all ages for this type of burn injury and the age-specific hospitalisation rate for this age group was 52 per 1 in 1998, virtually no change from the 1997 rate. Figure 1 shows a consistent decrease in burns hospitalisation rates since 1993. 76 Progress on Health Outcome Targets 2
Figure 1: Hospitalisations for burns from hot objects or substances, caustic or corrosive substances, and steam,* ages 14 years, 1988 98 Rate per 1 8 7 6 Target 2 5 4 3 2 1 1988 1989 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 2 Source: New Zealand Health Information Service Note: Data for 1998 are provisional, and rates are age-specific to 14 years old. * ICD-9 code E924. Year During the period 1988 98, hospitalisation rates due to burns changed by nearly 3 percent annually. To achieve the target for 2, an annual decrease of less than 2percent is required. As burns hospitalisation rates decreased in most years since 1993, it is likely that the target will be achieved by 2. Two-thirds of all those hospitalised due to burns were boys (66 percent) and one-third were girls (34 percent) in 1998, as in the previous year. The age-specific rates of hospitalisation for burns for males and females were 67 and 37 per 1 respectively. The risk of burns differs not only by sex but also by age and ethnicity. The proportion of children aged less than five years was significantly higher than in any other age group (83 percent of under 14 years and 48 percent of all people hospitalised due to burns) to be injured by burns from hot objects or substances, caustic or corrosive substances, and steam. Of 451 children hospitalised in 1998, 33 percent were Mäori, an age-specific rate of 72 per 1. This was under the target of 8 per 1 set for 2. However the progress on burns among Mäori children needs to be monitored in future years as the rates are still much higher than the national rate. Sixty-one Pacific children were hospitalised for burn injuries in 1998, accounting for 14 percent of all burns less than 15 years of age in 1998. This equates to an age-specific rate of 92 per 1 (see Figure 2). Progress on Health Outcome Targets 1999 77
Figure 2: Hospitalisations for burns from hot objects or substances, caustic or corrosive substances, and steam,* ages 14 years, by ethnicity, 1996 98 12 Rate per 1 1 8 Target 2 (Mäori) 6 4 2 Mäori European and Other Pacific peoples 1996 1997 1998 Source: New Zealand Health Information Service Note: Data for 1998 are provisional, and rates are age-specific to 14 years old. * ICD-9 code E924. Fifty-three percent of all hospitalisations due to burns were between European and Others, an age-specific rate of 41 per 1, which is under the national target level of 51 per 1. As the Pacific children have higher rates of hospitalisation than Mäori and European and Other, particular attention needs to be focused on strategies to decrease the incidence of burns among Pacific children. Drowning Preschool drowning In 1998 12 children (five girls and seven boys) aged 4 years drowned which accounted for 9 percent of all unintentional drownings. The preschool drownings were lower in 1998 compared with 1997, when 15 preschoolers drowned. By ethnicity, five were Mäori and seven non-mäori. Of the total preschool drownings, three occurred in private swimming or spa pools. Drowning in a private swimming or spa pool in 1998 was considerably lower than in 1981 when 17 children drowned under similar circumstances. It is likely that this reduction in drowning is primarily attributable to the Fencing of Swimming Pools Act 1987. Recent research suggests that there is a need to focus on the compliance and enforcement of the Act. If pools were well fenced and gates closed and locked effectively most children would not have drowned (Ministry of Health 1998). It must, however, be recognised that the number of drownings is very small which means that a difference of one or two drownings may significantly affect the overall rate recorded. 78 Progress on Health Outcome Targets 2
The rate for preschool drownings in private swimming or spa pools has decreased over the past 18 years. For example, the rate declined from 5 per 1 to 1 per 1 over the period 1981 98 (see Figure 3). During the same period, drownings in private swimming or spa pools decreased by an average rate of 9 percent per year. To achieve the target level for 22, an additional 1 percent decrease in this rate is required over the period 1999 22. Given the current rate of improvement in drownings in private swimming or spa pools, it is highly likely that the target will be met. Figure 3: Drownings in private swimming or spa pools, ages 4 years, 1981 98 6 Rate per 1 5 4 Fencing of Swimming Pools Act 1987 3 2 1 Parliamentary inquiry Target 22 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 21 Year Source: Water Safety New Zealand Note: The figure for 1997 is a three-year rolling average for 1996 98, and rates are age-specific to 4 years old. All unintentional drownings The total number of deaths due to all unintentional drownings (that is, excluding suicides and homicides) was 129 in 1998 compared to 111 in 1997. Although this is an increase of 16 percent the numbers have been declining since 198 despite a peak of 195 in 1985 (Figure 4). Progress on Health Outcome Targets 1999 79
Figure 4: Deaths due to unintentional drownings, 198 98 2 Number 18 16 14 12 1 Target 2 8 6 4 2 198 1982 1984 1986 1988 199 1992 1994 1996 1998 2 Year Source: Water Safety New Zealand Note: Excludes drowning deaths from suicide and homicide. Just over one-third of the 129 unintentional drownings (37 percent) were of those aged between 15 and 29 years. As in previous years, drowning was much more common among males and non-mäori. During the period 199 98 the number of deaths due to drownings has decreased on average by 1 percent per year. An additional 7 percent annual decrease in drownings is required to meet the target level of 98 deaths per year in year 22. Given the current number of drownings, it is unlikely the target will be achieved. Indicators Burns?? Hospitalisation rate due to burns from hot objects or substances, caustic or corrosive substances and steam (code E924) for children aged 14 years. Drowning?? Age-specific mortality rate from drowning in private swimming and spa pools for children aged 4 years.?? Number of deaths due to unintentional drownings for all ages. 8 Progress on Health Outcome Targets 2
Data sources New Zealand Health Information Service National Minimum Dataset (daypatient and inpatient hospitalisations) was used. Data for 1998 are provisional. Apart from the limitations imposed by changes in coding and admission thresholds, burns hospitalisation rates are a good indicator of childhood thermal injuries. Drownings WSNZ maintains the official New Zealand drowning database, DrownBase. All drowning information is collected from the New Zealand Police and confirmed against coroners reports. The results of cross-referencing the data with coroners reports and the ICD-9 codes indicates that discrepancies sometimes occur between the data maintained by WSNZ and the statistics collected by the New Zealand Health Information Service. For instance, recent work has shown that around 21 percent more cases of drowning occur than that classified using ICD-9-CM E-codes for drownings in the National Minimum Dataset held by NZHIS (Langley and Smith 1996). The majority (65 percent) of drownings not coded as such were coded as motor vehicle traffic deaths, primarily single -vehicle crashes where the vehicle entered the water. Using WSNZ data is appropriate for monitoring targets on drowning as they seem to have a higher capture rate than the New Zealand Health Information Service. References Langley JD, Smith G. 1996. Hidden Drownings: A New Zealand case study. Paper presented at the International Collaborative Effort on Injury Statistics meeting, Melbourne, February 1996. Ministry of Health. 1998. Progress on Health Outcome Targets: Te Haere Whakamua ki ngä Whäinga Hua mö te Hauora. The state of the public health in New Zealand 1998. Wellington: Ministry of Health. Progress on Health Outcome Targets 1999 81