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Australian Statistics on Acquired Brain Injury - 2006 - Fact Sheet
 At the Brain Injury Australia National Conference 2006, Nicola Fortune from the Australian Institute of Health and Welfare (AIHW) presented national data on ABI-related disability in Australia. The data collected and analysed is high-level, painting a very broad picture of the prevalence and nature of ABI-related disability Australia-wide. A paper reporting on these findings will be written and will be available for free on www.aihw.gov.au. The following paper is based upon Nicola’s presentation.
SOURCES
There were three sources of data used:
- Prevalence data from the 2003 Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers.
- Reports from services who deliver government-funded disability services under the Commonwealth, State and Territory Disability Agreement (CSTDA).
- Data on hospital stays associated with a traumatic brain injury.
The 2003 ABS Survey of Disability, Ageing and Carers asked 17 screening questions covering a range of disability areas. ABI was identified by asking two questions regarding activity restrictions resulting from a head injury or from any other kind of brain damage. Respondents were also identified as having ABI through questions covering ABI-related conditions. Stroke as a group was not included in the ABI results. This survey could not identify individuals who were not aware that they had sustained a brain injury and did not identify those who had a brain injury but did not experience it as a disability. Unless otherwise stated, the figures presented here are from this survey.
The CSTDA covers all organisations which receive funding from state or territory governments to provide a service to any identified disability group. These organisations are required to report on the nature of the services they provide and the nature of their clients’ disabilities. This data provides a useful overview of service provision, availability and access for people with a brain injury.
The National Hospitals Database provides information on patients who access hospital services as a result of a brain injury. This data is incomplete for three reasons: It does not include non-traumatic brain injury such as tumours, stroke, degenerative diseases or anoxic/hypoxic injury; hospitals do not see those people who do not seek treatment or who are treated informally or through non-hospital medical facilities, and; a traumatic brain injury may not be registered in the database if there is a more serious presenting problem, such as a cardiac arrest or life-threatening loss of blood or injury to other parts of the body. The data does, however, provide a useful overview of traumatic brain injury in the general community.
Disability Groups and Disabling Conditions
Five distinct disability groups are used in the following data:
- ABI
- Sensory/Speech
- Psychiatric
- Intellectual and
- Physical/Diverse.
There were also ten areas of activity:
- Communication
 Cognitive/emotional - Health care
- Housework
- Meal preparation
- Mobility
- Paperwork
- Property maintenance
- Self-care
- Transport.
Services funded under the CSTDA cover the broad areas of Accommodation, Community support, Community access, Respite and Employment.
RESULTS
Total
The ABS survey indicates that 432,700 people had an ABI and some activity limitations or participation restrictions. This equates to 2.2% of the total population of Australia, or slightly more than one in every fifty people. This figure includes all those who explicitly linked a specific limitation to their brain injury, and all those who had a brain injury and also reported using activity aids or home modifications. 157,500, or 0.8% of the total population, had a ‘severe or profound core activity limitation’.
Age, gender and cause
Two thirds of all people with an ABI and an activity limitation or restriction are over the age of 45. One third are over the age of 65. The largest age group is between 40 and 49 and at all ages except 80+ rates for males are higher than for females. This reflects a higher average lifespan for females.
Hospital data indicates that two thirds of all patients with a traumatic brain injury are male, and displays two sharp peaks: Between the ages of 15 and 25, predominantly for males, and over the age of 70 for both genders. This second rise in prevalence reflects an increase in injury due to falls.
For all causes of ABI, the ABS survey revealed that nearly a third of all people with ABI sustained their injury below the age of 15, and another third between the ages of 15 and 24. One fifth sustained their injury between 25 and 44, and only one tenth above that age.
Traumatic brain injury accounted for 90% of all brain injuries identified by the survey. 64%, two thirds, reported that the injury happened on a street, road or highway. An additional 14% reported that the injury happened at home.
Geography
New South Wales, Victoria and Queensland all have a population of people with ABI of approximately 110,000. These three states together equate for approximately three quarters of the Australia-wide population of people with ABI. South Australia and Western Australia each have a population of approximately 45,000 while Tasmania has a population of between 10,000 and 15,000. The ACT and Northern Territory have populations too low for data to be reliable. Due to the differences in total population between each state, the percentage of population of people with an ABI as a percentage of total population varies much more widely. Compared to the national average of 2.2%, Queensland is the only state with a significantly higher percentage of population (3.3%) and NSW is the only state with a significantly lower percentage of population (the exact figure was not given).
Multiple Disabilities and Conditions
The ABS survey data indicates that all people with ABI also have at least one other area of disability, and only a very small percentage have only one area of activity limitation. 28,700 people with ABI reported that the ABI was their main disabling condition. By far the most common other group was physical/diverse, with close to 100% of all people with an ABI over the age of 65 and just over 80% of those under the age of 65 reporting physical disability. Sensory/speech was the second highest group, with an even greater difference between the two age groups. The age group differences for psychiatric and intellectual disability were much smaller, and both areas of disability were more common in people under the age of 65. Psychiatric disability was reported as more common than Intellectual disability. The most common response, nearly 40% of the total, was for two additional disability groups, while one tenth of all survey respondents reported belonging to all five disability groups. In comparison, among those survey respondents who did not report having an ABI, nearly half reported that they belonged to only one group.
Figures for conditions, or areas of activity limitation, were similar. Most people with an ABI reported having 2, 3 or 4 areas of limitation, with 3 the most common. A small percentage of respondents reported having only 1 area of limitation, and an equally small percentage reported having limitations in all 10 areas. Half of all respondents without an ABI were evenly split between 1 or 2 areas of limitation.
Support needs
85,500 people with ABI reported needing frequent support with core activities in the areas of self-care, mobility or communication. 58,400 needed this support more than three times a day. 46,000 people with ABI under the age of 65 needed support at least once a day. This is 47% of all people with ABI who need assistance at any time. When compared to the other disability groups, this is less than intellectual (61%) or sensory/speech (53%), the same as psychiatric but higher than physical/diverse (37%). This data, when combined with the co-morbidity data presented above, indicate that people with an ABI do not have higher support needs in general than those people in other disability groups, but do have more complex and diverse support needs.
Are those needs being met? Respondents to the ABS survey reported that for all 10 condition classifications, needs were being fully met in the majority of cases. A small percentage of respondents – under 20% for each category – reported that their needs were not being met to any degree. A variable percentage in each case reported that their needs were being partly met.
Source of assistance
The majority of respondents to the ABS survey indicated that, in all areas except health-care and cognitive/emotional, their only source of assistance was informal – friends or family. These figures varied widely across the 10 categories. A small percentage in most categories except health care (just over 30%) reported that they only received formal assistance. A noticeable percentage in each category, ranging from 10% for transport to nearly 50% for cognitive/emotional, reported receiving a mix of both formal and informal assistance. The heavy use of informal assistance, with or without additional access to formal assistance, indicates the pivotal role played by families and social networks, and the difficulties faced by people with an ABI who do not have, or do not manage to keep, these informal contacts.
Sources of assistance – CSTDA
Nationwide, 187,800 people used CSTDA services. 6% of service users, 11,500, had an ABI. 7,900 (4%) reported the ABI as their primary disability. 3,600 (2%) reported ABI as an additional disability. 38% of all service users had an intellectual disability, reflecting the historical foundation and focus of most disability services. Comparing the population of service users to the population of people with a disability presents a clear imbalance: 15% of all people with a disability have an ABI, while only 6% of all service users have an ABI.
Reflecting the greater complexity and diversity of support needs of people with ABI, as compared to those with a disability who do not have an ABI, service users with ABI had a greater need for assistance than did service users without ABI, across all areas of assistance provided. People with ABI also had greater rates of usage of multiple services, of multiple service types and of multiple service groups (the main categories of assistance).
CONCLUSIONS
There were eight conclusions from the report:
ABI disproportionately affects males
Survey data indicates that approximately two thirds of all people living with an ABI and an activity limitation or participation restriction are male.
Young men have the highest risk of sustaining a traumatic brain injury
Hospital admissions data indicate that between the ages of 15 and 24 up to three quarters of all TBI-related hospital admissions are males.
Two-thirds of people with ABI are aged 45 or over
Although two thirds of all brain injuries are acquired below the age of 25, ABI does not appreciably shorten life expectancy, and those who acquire a brain injury while young can expect to live with the effects of that injury for many decades.
Multiple disability is characteristic of the population with ABI
Injury to specific areas of the brain will have an effect upon physical, sensory, or intellectual functioning. Knowledge of the interaction between ABI and mental health is too slim to draw conclusions, but approximately 40% of all people with an ABI also have a psychiatric diagnosis. Individuals may also have been born with another disability or acquire it at the same time as the brain injury or in an unrelated incident.
Survey data indicate substantial levels of unmet need for assistance
Although only small percentages reported that their needs are not being met, the vast majority of all assistance is solely or partly informal. In addition, ABI is under-represented among users of government funded disability services.
There is a heavy reliance on informal assistance
In all areas of need apart from health care and cognitive/emotional support, only informal assistance is available to the majority of people with an ABI. In all areas of need except health care, those who receive assistance from informal as well as formal sources outnumber those who receive assistance from formal sources only.
Complex support needs are characteristic of service users with ABI
People with ABI are more likely to have multiple disabilities than people without. This can result in an increased complexity of need. Across all areas of need, service users with ABI are more likely to need assistance than are service users without ABI.
There is a high rate of multiple service use among disability service users with ABI
Complex needs are unlikely to be entirely met by only one service.
More reading:
Australian Instituate of Health and Welfare: www.aihw.gov.au
Australian Bureau of Statistics: www.abs.gov.au
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Australian statistics on acquired brain injury - 2006 
