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Hunter K, Ryder C, Coombes J, Clapham K, Mackean T, Holland AJA, Fraser S, Williams H, Griffin B, Möller H, Ivers RQ. Understanding burn injury among Aboriginal and Torres Strait Islander children - results of a two-year cohort study. Burns 2024:S0305-4179(24)00216-X. [PMID: 39043514 DOI: 10.1016/j.burns.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 05/13/2024] [Accepted: 07/13/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Despite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. METHODS The Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). RESULTS Of the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2-4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child's care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. CONCLUSION Data from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care.
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Affiliation(s)
- Kate Hunter
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Courtney Ryder
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia.
| | - Julieann Coombes
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Kathleen Clapham
- School of Medical, Indigenous and Health Sciences, University of Wollongong, NSW 2522, Australia
| | - Tamara Mackean
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia
| | - Andrew J A Holland
- Sydney Medical School, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
| | - Sarah Fraser
- College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Hayley Williams
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Bronwyn Griffin
- School of Nursing and Midwifery, Griffith University, Nathan, QLD 4111, Australia
| | - Holger Möller
- School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
| | - Rebecca Q Ivers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia; College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia; School of Population Health, UNSW, Sydney, Australia, UNSW, 2052, Australia
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MacNabb K, Smith N, Robinson A, Ilie G, Asbridge M. Self-reported injuries among Canadian adolescents: rates and key correlates. Health Promot Chronic Dis Prev Can 2022; 42:199-208. [PMID: 35544029 PMCID: PMC9306323 DOI: 10.24095/hpcdp.42.5.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Injuries sustained by adolescents in Canada represent a costly public health issue. Much of the limited research in this area uses administrative data, which underestimate injury prevalence by ignoring injuries that are not treated by the health care system. Self-reported data provide population-based estimates and include contextual information that can be used to identify injury correlates and possible targets for public health interventions aimed at decreased injury burden. METHODS The 2017 wave of the Canadian Community Health Survey was used to calculate the prevalence of self-reported total, intentional and unintentional injuries. We compared injury prevalence according to age, sex, employment status, presence of a mood disorder, presence of an anxiety disorder, smoking and binge drinking. Analyses were performed using logistic regression to identify significantly different injury prevalence estimates across key correlates. RESULTS Overall past-12-month injury prevalence among adolescents living in Canada was 31.4% (95% CI: 29.4%-33.5%). Most injuries were unintentional. All provinces had estimates within a few percentage points, except Saskatchewan, which had substantially higher prevalence for both overall and unintentional injury. Smoking and binge drinking were significantly associated with higher injury prevalence in most jurisdictions. Remaining correlates exhibited nonsignificant or inconsistent associations with injury prevalence. CONCLUSION The data suggest that injury prevention interventions aimed at reducing alcohol consumption, particularly binge drinking, may be effective in reducing adolescent injury across Canada. Future research is needed to determine how provincial context (such as mental health support for adolescents or programs and policies aimed at reducing substance use) impacts injury rates.
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Affiliation(s)
- Kathleen MacNabb
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nathan Smith
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Megyesiova S, Lieskovska V. Premature Mortality for Chronic Diseases in the EU Member States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16204021. [PMID: 31640142 PMCID: PMC6843938 DOI: 10.3390/ijerph16204021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/27/2022]
Abstract
Premature mortality, and especially premature mortality for chronic diseases, is a very important topic of public health, health care, or lifestyle of population. The main aim of countries is to reduce premature mortality, and therefore an analysis of the development and status of premature standardized death rates (SDR) is key for disclosure of successes or failures in this topic. A boxplot chart was used to detect extremes of SDR for both sexes. The gender ratio revealed the differences of mortality rates between men and women. Premature mortality declined steadily in the EU between 2000 and 2016. The men’s premature SDR decreased from 390 to 275.9 between 2000 and 2016, while the women’s rate declined from 180.1 to 138.2. On average, annual premature SDR dropped by 2.14% for men and 1.64% for women. Thus, the gender ratio (male/female) declined from 2.17 in 2000 to 2.0 in 2016, which is a positive change for gender gap closing. The highest proportion of premature mortality belonged to mortality for malignant neoplasms, where the rate was as high as 47% for women and 32% for men in 2016. Premature mortality for chronic disease is especially high in the “new” EU member states.
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Affiliation(s)
- Silvia Megyesiova
- Faculty of Business Economics with Seat in Košice, Tajovského 13, University of Economics, Bratislava, 04130 Košice, Slovakia.
| | - Vanda Lieskovska
- Faculty of Business Economics with Seat in Košice, Tajovského 13, University of Economics, Bratislava, 04130 Košice, Slovakia.
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Brussoni M, George MA, Jin A, Amram O, McCormick R, Lalonde CE. Hospitalizations due to unintentional transport injuries among Aboriginal population of British Columbia, Canada: Incidence, changes over time and ecological analysis of risk markers. PLoS One 2018; 13:e0191384. [PMID: 29373595 PMCID: PMC5786298 DOI: 10.1371/journal.pone.0191384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Worldwide, Indigenous people have disproportionately higher rates of transport injuries. We examined disparities in injury-related hospitalizations resulting from transport incidents for three population groups in British Columbia (BC): total population, Aboriginal off-reserve, and Aboriginal on-reserve populations. We also examined sociodemographic, geographic and ethnic risk markers for disparities. METHODS We identified Aboriginal people through BC's universal health care insurance plan insurance premium group and birth and death record notations. We calculated crude incidence rate and Standardized Relative Risk (SRR) of hospitalization for unintentional transport injury, standardized for age, gender and Health Service Delivery Area (HSDA), relative to the total population of BC. We tested hypothesized associations of geographic, socio-economic, and employment-related characteristics of Aboriginal communities with SRR of transport injury by multivariable linear regression. RESULTS During the period 1991-2010, the SRR for the off-reserve Aboriginal population was 1.77 (95% CI: 1.71 to 1.83); and 2.00 (95% CI: 1.93 to 2.07) among those living on-reserve. Decline in crude rate and SRRs was observed over this period among both the Aboriginal and total populations of BC, but was proportionally greater among the Aboriginal population. The best-fitting multivariable risk marker model was an excellent fit (R2 = 0.912, p<0.001), predicted SRRs very close to observed values, and retained the following terms: urban residence, population per room, proportion of the population with a high school certificate, proportion of the population employed; and multiplicative interactions of Aboriginal ethnicity with population per room and proportion of the population employed. CONCLUSIONS Disparities in risk of hospitalization due to unintentional transport injury have narrowed. Aboriginal ethnicity modifies the effects of socioeconomic risk factors. Continued improvement of socioeconomic conditions and implementation of culturally relevant injury prevention interventions are needed.
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Affiliation(s)
- Mariana Brussoni
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- British Columbia Injury Research & Prevention Unit, Vancouver, British Columbia, Canada
| | - M. Anne George
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Andrew Jin
- Epidemiology Consultant, Surrey, British Columbia, Canada
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Vancouver, British Columbia, Canada
| | - Rod McCormick
- Faculty of Human, Social and Educational Development, Thompson Rivers University, Kamloops, British Columbia, Canada
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George MA, Jin A, Brussoni M, Lalonde CE, McCormick R. Intentional injury among the indigenous and total populations in British Columbia, Canada: trends over time and ecological analyses of risk. Int J Equity Health 2017; 16:141. [PMID: 28789649 PMCID: PMC5549349 DOI: 10.1186/s12939-017-0629-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. We focus on hospitalizations, including both self-inflicted injuries and injuries inflicted by others. METHODS We used data from BC's universal health care insurance plan, 1991 to 2010, linked to Vital Statistics databases. Indigenous people were identified through the insurance premium group, and birth and death records. Place of residence was identified through postal code. We calculated crude hospitalization incidence rates and the Standardized Relative Risk (SRR) of hospitalization, standardized by gender, 5-year age group, and Health Service Delivery Area (HSDA). With HSDA populations as the units of observation, linear regression was used to test hypothesized associations of Indigenous ethnicity, geographic, and socio-economic characteristics with SRR of injury. RESULTS During the period 1991-2010, the crude rate of hospitalization for intentional injuries was 8.4 per 10,000 person-years (95% confidence interval (CI): 8.3 to 8.5) for the total BC population, compared to 45.3 per 10,000 (95% CI: 44.5 to 46.1) for the Indigenous population. For both populations, risk declined over the period for injuries self-inflicted and inflicted by others. The linear regression model predicts that the off-reserve Indigenous population will have SRR of intentional injury 3.98 greater, and the on-reserve Indigenous population 4.17, greater than the total population. The final model was an excellent fit (R2 = 0.912, F = 177.632, p < 0.001), and found that three variables - occupational risk, high school diploma, and university degree - each provide independent effects when interacting multiplicatively with Indigenous ethnicity. CONCLUSIONS The observation of substantially declining rates of intentional injury for both the Indigenous and total BC populations is off-set by the high disparity in risk between the two populations, which will likely continue until Canada reduces disparity with respect to discriminatory practices, and physical, social, and economic conditions.
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Affiliation(s)
- M. Anne George
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- BC Children’s Hospital Research Institute, Room F508, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Andrew Jin
- Epidemiology consultant, Surrey, Vancouver, BC Canada
| | - Mariana Brussoni
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- BC Children’s Hospital Research Institute, Room F508, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Christopher E. Lalonde
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC Canada
| | - Rod McCormick
- Faculty of Human, Social and Educational Development, Thompson Rivers University, Kamloops, BC Canada
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Margeson A, Gray S. Interventions Aimed at the Prevention of Childhood Injuries in the Indigenous Populations in Canada, Australia and New Zealand in the Last 20 Years: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060589. [PMID: 28574464 PMCID: PMC5486275 DOI: 10.3390/ijerph14060589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/16/2022]
Abstract
Globally, Indigenous children are found to be at a significantly higher risk of injury compared to non-Indigenous children. It has been suggested that mainstream injury prevention strategies are ineffective within Indigenous communities. The aim of this review is to identify existing interventions aimed at preventing injury in Indigenous children in the hope that it guides future strategies. To the best of the authors’ knowledge, no prior systematic reviews exist looking at interventions specifically aimed at preventing injury in Indigenous child populations in the three chosen countries. Electronic databases were systematically searched for relevant childhood interventions aimed at the prevention of injuries in Indigenous populations based in Canada, Australia and New Zealand from 1996 to 2016. A manual search of the reference lists of relevant articles and a manual search of relevant websites were also completed. After 191 records were screened, six interventions were identified meeting the criteria for inclusion. Eligible papers underwent a quality appraisal using adapted assessment checklists and key information was extracted. Findings were then synthesized using a narrative approach. The interventions mainly promoted child safety through activities focusing on education and awareness. Only three of the six studies measured changes in injury hospitalization rates, all but one evaluation reporting a significant decrease. Studies which measured awareness all demonstrated positive changes. Results suggest that interventions delivered in a culturally appropriate manner acted as a main success factor. Barriers identified as hindering intervention success included lack of cohesion within the intervention due to staff turnover and lack of experienced staff with Indigenous knowledge. This review revealed a limited amount of evaluated interventions for the prevention of Indigenous childhood injuries. Conclusive evidence of the effectiveness of existing interventions is lacking due to the predominantly small-scale evaluations of pilot interventions. Future research is needed to provide more rigorous evidence of the mechanisms driving the successful implementation, delivery and uptake of such strategies tailored to Indigenous children.
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Affiliation(s)
- Alyssa Margeson
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Selena Gray
- Department of Health and Social Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
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Wyeth EH, Samaranayaka A, Davie G, Derrett S. Prevalence and predictors of disability for Māori 24 months after injury. Aust N Z J Public Health 2017; 41:262-268. [PMID: 28370886 DOI: 10.1111/1753-6405.12657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/01/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate post-injury disability prevalence and identify pre-injury and injury-related predictors 24 months post-injury among Māori Prospective Outcomes of Injury Study participants. METHODS Participants were recruited from New Zealand's no-fault injury insurer. Pre-injury and injury-related characteristic information was obtained from participants at three and 24 months post-injury. The World Health Organization Disability Assessment Schedule was used to measure disability. Multivariable models were developed to estimate relative risks of post-injury disability. RESULTS Of 2,856 participants, 566 were Māori. Analyses were restricted to 374 Māori with pre-injury and 24-month post-injury disability data available. Pre-injury, 9% reported disability compared to 19% 24 months post-injury. Strong predictors of increased risk of disability 24 months post-injury were having ≥2 chronic conditions pre-injury and having trouble accessing healthcare services after injury. Hospitalisation for injury and having inadequate pre-injury household income were other predictors. CONCLUSIONS Māori experience considerable disability 24 months post-injury. Pre-injury socio-demographic, health and psychosocial, and injury-related characteristics independently predict post-injury disability and provide focus for future research and interventions to improve Māori post-injury outcomes. Implications for public health: Despite having had access to services, injured Māori experienced considerable long-term disability. Pre-injury and injury-related factors predict long-term disability and should be the focus to reduce the post-injury disability burden for Māori.
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Affiliation(s)
- Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand
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Amram O, Walker BB, Schuurman N, Pike I, Yanchar N. Disparities in Paediatric Injury Mortality between Aboriginal and Non-Aboriginal Populations in British Columbia, 2001-2009. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E651. [PMID: 27399748 PMCID: PMC4962192 DOI: 10.3390/ijerph13070651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/03/2016] [Accepted: 05/07/2016] [Indexed: 01/04/2023]
Abstract
Injury is the leading cause of death among children and youth in Canada. Significant disparities in injury mortality rates have been observed between Aboriginal and non-Aboriginal populations, but little is known about the age-, sex-, and mechanism-specific patterns of injury causing death. This study examines paediatric mortality in British Columbia from 2001 to 2009 using comprehensive vital statistics registry data. We highlight important disparities in Aboriginal and non-Aboriginal mortality rates, and use the Preventable Years of Life Lost (PrYLL) metric to identify differences between age groups and the mechanisms of injury causing death. A significantly greater age-adjusted mortality rate was observed among Aboriginal children (OR = 2.08, 95% CI: 1.41, 3.06), and significantly higher rates of death due to assault, suffocation, and fire were detected for specific age groups. Mapped results highlight regional disparities in PrYLL across the province, which may reflect higher Aboriginal populations in rural and remote areas. Crucially, these disparities underscore the need for community-specific injury prevention policies, particularly in regions with high PrYLL.
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Affiliation(s)
- Ofer Amram
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Blake Byron Walker
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Ian Pike
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
- BC Injury Research and Prevention Unit, Child and Family Research Institute, BC Children's Hospital, Vancouver, BC V5Z 4H4, Canada.
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada.
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Jin A, Brussoni M, George MA, Lalonde CE, McCormick R. Risk of Hospitalization Due to Unintentional Fall Injury in British Columbia, Canada, 1999-2008: Ecological Associations with Socioeconomic Status, Geographic Place, and Aboriginal Ethnicity. J Racial Ethn Health Disparities 2016; 4:558-570. [PMID: 27352116 DOI: 10.1007/s40615-016-0258-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aboriginal people in British Columbia (BC), especially those residing on Indian reserves, have higher risk of unintentional fall injury than the general population. We test the hypothesis that the disparities are attributable to a combination of socioeconomic status, geographic place, and Aboriginal ethnicity. METHODS Within each of 16 Health Service Delivery Areas in BC, we identified three population groups: total population, Aboriginal off-reserve, and Aboriginal on-reserve. We calculated age and gender-standardized relative risks (SRR) of hospitalization due to unintentional fall injury (relative to the total population of BC), during time periods 1999-2003 and 2004-2008, and we obtained custom data from the 2001 and 2006 censuses (long form), describing income, education, employment, housing, proportions of urban and rural dwellers, and prevalence of Aboriginal ethnicity. We studied association of census characteristics with SRR of fall injury, by multivariable linear regression. RESULTS The best-fitting model was an excellent fit (R 2 = 0.854, p < 0.001) and predicted SRRs very close to observed values for the total, Aboriginal off-reserve, and Aboriginal on-reserve populations of BC. After stepwise regression, the following terms remained: population per room, urban residence, labor force participation, income per capita, and multiplicative interactions of Aboriginal ethnicity with population per room and labor force participation. CONCLUSIONS The disparities are predictable by the hypothesized risk markers. Aboriginal ethnicity is not an independent risk marker: it modifies the effects of socioeconomic factors. Closing the gap in fall injury risk between the general and Aboriginal populations is likely achievable by closing the gaps in socioeconomic conditions.
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Affiliation(s)
- Andrew Jin
- , 2762-133 Street, Surrey, BC, V4P 1X9, Canada.
| | - Mariana Brussoni
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Child and Family Research Institute, Room F508, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - M Anne George
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Child and Family Research Institute, Room F508, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Rod McCormick
- Faculty of Human, Social and Educational Development, Thompson Rivers University, Kamloops, BC, Canada
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Brussoni M, George MA, Jin A, Lalonde CE, McCormick R. Injuries to Aboriginal populations living on- and off-reserve in metropolitan and non-metropolitan areas in British Columbia, Canada: Incidence and trends, 1986-2010. BMC Public Health 2016; 16:397. [PMID: 27177445 PMCID: PMC4866038 DOI: 10.1186/s12889-016-3078-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve. METHODS We used data spanning 1986 through 2010 from BC's universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. "On-reserve" residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs) were classified as "metropolitan" if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR) of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period. RESULTS Aboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0), but this was 2.3 times greater than the general British Columbia metropolitan population (0.86). For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0); 2.5 times greater than the general BC non-metropolitan population (1.2). Time trends indicated decreasing disparities, with Aboriginal non-metropolitan populations experiencing the largest declines in injury rates. CONCLUSIONS Metropolitan/non-metropolitan residence appears to be a more important predictor than on/off-reserve residence for all injuries and unintentional injuries, and the relationship was even more pronounced for intentional injuries. The persistent disparities highlight the need for culturally sensitive and geographically relevant injury prevention approaches.
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Affiliation(s)
- Mariana Brussoni
- Department of Pediatrics, School of Population & Public Health, British Columbia Injury Research & Prevention Unit, Child and Family Research Institute, University of British Columbia, F511 - 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada.
| | - M Anne George
- Department of Pediatrics, School of Population & Public Health, Child and Family Research Institute, University of British Columbia, F508 - 4480 Oak Street, Vancouver, British Columbia, V2N 3Z9, Canada
| | - Andrew Jin
- Epidemiology Consultant, 2762 - 133 Street, Surrey, British Columbia, V4P 1X9, Canada
| | - Christopher E Lalonde
- Department of Psychology, University of Victoria, PO Box 1700, Victoria, British Columbia, V8W 2Y2, Canada
| | - Rod McCormick
- Faculty of Human, Social and Educational Development, Thompson Rivers University, 900 McGill Road, Kamloops, British Columbia, V2C 0C8, Canada
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George MA, Brussoni M, Jin A, Lalonde CE, McCormick R. Ecological analyses of the associations between injury risk and socioeconomic status, geography and Aboriginal ethnicity in British Columbia, Canada. SPRINGERPLUS 2016; 5:567. [PMID: 27247864 PMCID: PMC4864732 DOI: 10.1186/s40064-016-2262-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/03/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study examines what factors contribute to higher injury risk among Aboriginal peoples, compared to the total British Columbia (BC) population. We explore socioeconomic, geographic, and cultural factors, and combinations of these factors, that contribute to increased injury risk for Aboriginal peoples. This follows from our previously reported findings of improvements in injury risk over time for both the total and Aboriginal populations. DATA AND METHODS We use provincial population-based linked health care databases of hospital discharge records. We identify three population groups: total BC population, and Aboriginal populations living off-reserve, or on-reserve. For each group we calculate age and gender-standardized relative risks (SRR) of injury-related hospitalization, relative to the total population of BC, for two 5-year time periods (1999-2003, and 2004-2008). We use custom data from the 2001 and 2006 long-form Censuses that described income, education, employment, housing conditions, proportion of urban dwellers, proportion of rural dwellers, and prevalence of Aboriginal ethnicity. We use multivariable linear regression to examine the associations between the census characteristics and SRR of injury. RESULTS The best-fitting model was an excellent fit (R(2) = 0.905, p < 0.001) among the three population groups within Health Service Delivery Areas of BC. We find indicators in all three categories (socioeconomic, geographic, and cultural) are associated with disparity in injury risk. While the socioeconomic indicators (income, education, housing, employment) were shown to be highly correlated, only living in housing that needs major repair and occupational hazardousness, along with rural residence and Aboriginal ethnicity, remained in the final model. Our data show that cultural density is not associated with injury risk for Aboriginal peoples, and that living off-reserve is associated with reduced injury by improving socioeconomic and geographic conditions (compared to living on-reserve). Finally, our analyses show that Aboriginal status itself is associated with injury risk. CONCLUSIONS Our findings confirm previous research indicating that geographical differences differentiate injury risk, including for Aboriginal populations, and that socioeconomic determinants are associated with health risks. Our analyses showing that Aboriginal status itself contributes to injury risk is new, but we can only speculate about pathway, and whether the causes are direct or indirect.
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Affiliation(s)
- M A George
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada ; Child and Family Research Institute, Room F508, 4480 Oak Street, Vancouver, BC V6H-3V4 Canada ; School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - M Brussoni
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada ; Child and Family Research Institute, Room F508, 4480 Oak Street, Vancouver, BC V6H-3V4 Canada ; School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - A Jin
- Epidemiology Consultant, Surrey, BC Canada
| | - C E Lalonde
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC Canada
| | - R McCormick
- Faculty of Human, Social and Educational Development, Thompson Rivers University, Kamloops, BC Canada
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