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| Journal of the New Zealand Medical Association,
15-December-2006, Vol 119 No 1247
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Injuries to New Zealanders participating in
adventure tourism and adventure sports: an analysis of Accident
Compensation Corporation (ACC) claims
Tim Bentley, Keith Macky, Jo Edwards
The risks associated with adventure tourism and adventure
sport activity are increasingly highlighted in media reports of fatalities and
serious injuries involving overseas and domestic recreationalists in New Zealand
and elsewhere.1,2
No single organisation or body in New Zealand is responsible
for safety across this broad sector,3 thus
making it difficult to get an objective picture of risk for the various
adventure activities provided commercially and undertaken independently.
However, researchers in New Zealand have recently begun to examine the problem
of adventure tourism and adventure sports safety through epidemiological and
survey research, with the aim of establishing an injury surveillance baseline
for this sector.
Early research in this field found that certain New Zealand
adventure activities (notably whitewater rafting, scenic flights, and mountain
recreation) were responsible for a number of fatalities and serious injuries
involving overseas visitors.4–8 More
recent research, involving surveys of New Zealand adventure tourism operators
and analysis of a national hospitalisation database, has found that other
activities—including horse riding, mountain biking/cycle touring, snow
sports (i.e. skiing and snowboarding), and tramping (i.e. hiking)—are
associated with relatively large injury
counts.9–11
The present study seeks to examine the involvement of
adventure tourism and adventure sports activity in injury claims made to the
Accident Compensation Corporation (ACC).
This analysis, together with findings from the
hospitalisation study and operator survey research cited above, will provide
important injury risk information for participants, operators, and industry
bodies (amongst others) and will assist in the prioritisation of injury-control
measures as well as the identification of high-risk areas that require improved
risk management practice and other intervention.
MethodCompensation claims data for adventure tourism and
adventure sport-related injuries to adult (16 years and over) New Zealand
residents occurring during the 12-month period July 2004 to June 2005 were
extracted from ACC’s database for injuries occurring at a place for sport
or recreation.
The initial dataset of approximately 40,000 cases was
contained in a single Microsoft Excel data file. The involvement of adventure
tourism and adventure sport activity was identified by content analysis of the
one-line narrative ‘accident descriptions’ provided for each
case—with non-adventure cases removed from the dataset, and adventure
activities coded under one of 28 categories of adventure tourism/sports.
Unfortunately, many cases contained insufficient
information in the narrative to determine whether adventure tourism or adventure
sport was involved in the injury, stating only, for example, that the claimant
had ‘slipped off a rock’, was ‘walking down a steep
bank’ or ‘was riding my bike’, meaning many incidents
involving tramping, mountaineering, rock climbing, and mountain biking may have
been erroneously omitted from the analysis.
Boating activities (apart from kayaking, jet boating,
and rafting) were not included in the dataset in line with other related
studies. The final dataset of cases, therefore, is likely to underestimate the
total number of compensated adventure-related injuries during the period of the
analysis.
After data coding, the following variables were
available for analysis for each case: age and gender; region where the incident
occurred; month of incident; adventure activity; injury initiating event; body
part injured; injury diagnosis; and cost of claim.
The majority of these variables were
categorical—the exceptions being age and cost of claim, for which interval
and ordinal (age and cost groups) variables were provided.
Once coded, the data were transferred from Excel to
‘SPPS for Windows version 13’. Descriptive analyses were undertaken
for each of the variables (including cross-tabulation). Non-parametric
inferential statistics (including Chi-squared and Kruskal-Wallis tests) applied
where differences and associations between categories and variables were
examined.
Claim incidence rates were calculated for variables
where suitable denominator data were available. Denominator data were 2005
population data provided by Statistics New Zealand and New Zealand adult
participation in sport and active leisure, as derived by SPARC (Sport &
Recreation New Zealand) from sample surveys conducted during 1997, 1998, and
2000.
It is noted, therefore, that participation data are
only indicative of New Zealander participation in adventure tourism and
adventure sports activities.
ResultsDistribution and cost of claims by age and
gender—The content analysis and coding of the narrative data for
compensated injuries (occurring in a place for recreation and sport) produced a
total of 18,697 adventure tourism and adventure sports cases; 27 of these were
fatalities.
These cases were coded into some 28 activity sectors. Table
1 shows the distribution of claimants by age group as well as median and total
costs of claims (as best available proxy for injury severity) for each age
range.
Table 1. Distribution and cost of claims by
age
Note: These figures exclude the cost of
cases (n=1296) for which no cost data was provided in the dataset;
*New Zealand dollars; †First quartile; ‡Third quartile.
Age groups differed significantly in their number of claims
for adventure tourism and adventure sport injuries
(χ2(7)=10,355.6, p=.000).
Claimants in the 21–50 years age range incurred the largest proportion of
claims (approximately 70% of all claims). However, claims were most expensive,
and therefore injuries potentially most severe, in the 51–60 years age
group.
A Kruskal-Wallis test using the Monte Carlo method showed
that the cost of claims for adventure tourism and sports injuries is related to
the age of the claimant (H(6)=132.1, p=.000).
As indicated in Table 1, the median cost of claims increases
through to the 51–60 age group, and then reduces slightly for the
61–70 and >70 age groups. Jonckheere’s test supports this
observed trend in the data of claims costs increasing with claimant age
(Z=10.7, p=.000).
Males (60%) made significantly more claims than females
(40%) (χ2(1)=749.6, p=.000),
although gender of claimant distributions varied considerably across the various
activities (see below).
The injury claim incidence rate for male claimants was 533.4
per 100,000 people, compared to a rate of 356.9 for females (based on 2005
population data provided by Statistics New Zealand). However, the median cost of
claims was significantly lower for male ($111.90) than for female ($130.37)
claimants (U=33,263,846, p=.000). The proportion of claims for
each age group was very similar for male and female claimants, with the majority
of claims for both genders in the 21–50 age range.
Distribution and cost of claims by
activity—Table 2 shows the major activity categories for
adventure tourism and adventure sports injuries in New Zealand for the period of
the analysis, along with an analysis of claims costs by activity—and, for
activities where participation data is available, injury claim incidence rates.
Land-based activities comprised 61% of all cases, 38%
involved water-borne activities, and just 1% cases were aviation-based.
Approximately 60% of all adventure tourism-related injuries were incurred during
participation in just four activities: horse riding, tramping, mountain biking,
and surfing. Moreover, of these high-risk activities, horse riding had a
significantly higher rate than the other three activities.
Table 2. Distribution and cost of claims by
activity
Note: Based on SPARC Aotearoa estimates of
participation in sport and active leisure by New Zealand adults.
Specifically, the horse riding injury claim incidence rate
was almost two-times greater than the rate for mountain biking and four times
that for tramping. Moreover, horse riding was associated with three fatalities.
Only fishing (n=6; 0.6% of all fishing injury claims) and mountaineering (n=6;
2.9%) had more fatalities than horse riding. A further three fatalities involved
diving/snorkelling and two white water rafting.
Paragliding/parasailing/hang gliding participants incurred
highest median costs, with injuries costing over two-times more than the next
highest cost activity: rock climbing.
Of the high claims count activities, mountain biking had the
highest cost per claim, while horse riding was also well above the overall
median cost for all activities. Relatively low costs of claims were associated
with diving, bungy jumping, fishing, and white water rafting, although these
activities were associated with 11 fatalities combined.
Type of activity during which the injury occurred was found
to differ significantly by gender
(χ2(24)=4237.51, p=.000).
Specifically, male claimants had notably more claims for the majority of
activities, the major exceptions being horse riding (78.5% of claimants were
female), skiing (52.4% female), and tramping (54.6% female).
Indeed, women horse riders had an estimated client incidence
rate of 34.5 per 1000 annual participants, which is two-times that of male
participants (17.4), based on SPARC participation in sport data. A relatively
even distribution of claims by gender was found for bungy jumping, abseiling,
and jet boating. Male claimants dominated claims for hunting (91.6% of claims),
fishing (84.0%), surfing (81.3%), mountain biking (77.2%), snowboarding (65.8%),
and paragliding/parasailing/hang gliding (69.6%).
Geographical distribution of
claims—Adventure tourism and adventure sports injuries clustered
around the main population centres and adventure tourism regions. Thus, 16.0% of
claims were for adventure tourism-related injuries occurring in the Auckland
area, 14.3% in Canterbury, 13.0% in Waikato, and 9.4% in the Bay of Plenty. A
further 9.7% of cases were from Otago, which is the region where Queenstown, the
‘world capital for adventure tourism’, is situated.
Mountain biking injuries were most frequently incurred in
the Central North Island town of Rotorua and in Queenstown, while snow sports
injuries were predominantly based around the Southern Alps and Central North
Island regions.
Month of claim—52.4% of cases
occurred during the period, January to April, thus reflecting the seasonal
(summer) nature of New Zealand adventure tourism and adventure sports. Figure 1
shows the distribution of the top four injury claims count activities by month
of injury occurrence. The distribution of activities across the New Zealand
summer season is highlighted, while surfing injuries occur in significant
quantities during the mid-summer January holiday period.
Injury-initiating events—The vast
majority of adventure tourism and adventure sports injuries resulted from falls,
including overbalancing, slipping, and tripping (68.6%). The activities
contributing most commonly to fall counts included horse riding, mountain
biking, snowboarding, and tramping. Other event categories included lifting
and/or carrying (8%) and colliding with something (10%). Lifting and carrying
injuries most frequently occurred during kayaking, tramping, surfing, and
waterskiing.
A large number of cases involved the claimant being injured
while lifting or carrying a pack or piece of equipment such as a kayak.
Figure 1. Distribution of claims for high
claims count activities by month
 Body part injured and injury
diagnosis—The most frequently injured body parts for adventure
tourism and adventure sports claims were the lower back/spine (13.0%), shoulder
(10.2%), knee (10.5%), neck (7.8%), and ankle (7.1%). Major body part injury
areas for the four highest claims frequency activities are shown in Figure 2.
From Figure 2 it can be seen that each of the four highest
injury claims count activities have distinct injury patterns, with horse riders
commonly suffering injuries to the back/spine and head/face, while ankle and
knee injuries are most prevalent for trampers. Mountain biking injuries were
most commonly to the shoulder. Surfing injuries were most commonly to the
back/spine and head/face, presumably through being struck by surf boards.
Soft tissue (strains and sprains) injuries were most
frequent for adventure tourism and adventure sports, with nearly two-thirds
(63.0%) of all injuries having this diagnosis. Puncture/stings (12.6%) and
factures/dislocations (11.6%) were the other major diagnosis categories.
Figure 2. Distribution of claims for high
claims count activities by body part injured
 DiscussionThis study suggests a significant adventure tourism and
adventure sport injury problem, although further research is required to better
understand the extent of the problem and to identify key areas for preventive
action.
More than 18,500 domestic adventure injury cases were
compensated by ACC; this figure underestimates the true scale of the problem as
many cases will not have been captured by ACC’s database, and many that
were included on the database had insufficient information from which to code
them as involving adventure activities.
It is also noted that the study omitted injuries to overseas
visitors, although international tourists have been found to incur large numbers
of hospitalised injuries due to adventure activity in previous studies by
Bentley et al.9 Adventure sport-related claims
by New Zealand residents comprised a total financial burden of over NZ$12
million over the one-year period of the analysis.
As found previously by Bentley et
al,9 activities that are often undertaken
independently (but which are also available commercially) were associated with
the greatest number of incidents.
Adventure activities that are not currently covered by
regulatory bodies and approved codes of practice, including mountain biking and
horse riding, had highest injury counts and high claims incidence rates. These
activities also had relatively high severity as measured by cost of claims.
These findings indicate a need to explore whether some form
of regulation may be necessary to improve safety and risk management for these
sectors, and to determine the extent to which such intervention might be
effective in reducing injury to participants of these
activities.3,10 Injury prevention should also
focus on the risk to younger male participants, with the exception being horse
riding, where attention should be directed towards females of all age
groups.10
Other preventive activity should focus on risk factors for
slips, trips, and falls as these events were the most common mechanism of
injury.3,9,11 For example, tramping,
mountaineering, and hunting operators; guides; and individual recreationalists
should consider carefully the underfoot conditions on their walking tracks and
the footwear used by their clients.
Secondary safety issues such as the design of personal
protective equipment that may reduce injuries at the most vulnerable body areas
should also be considered, including the hand and wrist for mountain biking and
surfing, the head for surfing, and the lower back for horse riding. Indeed,
further research is required to identify appropriate protective equipment and
its likely effectiveness in reducing injuries to these body areas.
Limitations of the findings of the data analysis for
adventure sport-related claims include the inability to identify a large number
of cases that may have been adventure-related from the available data. Moreover,
the potential for bias in the reporting of injuries that result in claims to ACC
must be acknowledged.
A further problem was the absence of reliable participation
(denominator) data from which to determine incidence rates for many of the
activities, thus making a full comparison of risk among activities impossible.
Indeed, the participation data that was available was not up-to-date and should
be considered as indicative only of the extent of participation by New
Zealanders in these activities.
Despite these shortcomings, the current study’s
findings support those of the authors’ previous studies in providing a
useful baseline picture of the adventure tourism and adventure sports injury
situation in New Zealand.
Conflict of interest statement: There
are no potential conflicts of interest.
Author information: Tim Bentley, Senior
Lecturer; Keith Macky, Senior Lecturer; Jo Edwards, Researcher; Department of
Management and International Business, Massey University, Auckland
Acknowledgements: This study was completed
with the assistance of the Accident Compensation Corporation (ACC) who provided
the raw data. Views and conclusions in this article are those of the authors and
may not reflect those of ACC.
Correspondence: Dr Tim Bentley, Department
of Management and International Business Massey University, Auckland. Fax: (09)
441 8109; email: T.A.Bentley@massey.ac.nz
References:
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