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 Jan 26;13(1):e0191384. doi: 10.1371/journal.pone.0191384. eCollection 2018.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • British Columbia
  • Child
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Patient Transfer*
  • Population Groups / statistics & numerical data*
  • Risk Factors
  • Rural Population / statistics & numerical data
  • Social Class
  • Time Factors
  • Urban Population / statistics & numerical data
  • Young Adult

Grants and funding

This research was funded by the Canadian Institutes of Health Research, Institute of Aboriginal People's Health (http://www.cihr-irsc.gc.ca/e/8668.html), funding reference: AHR #81043. Salary support for authors was provided by the British Columbia Children’s Hospital Research Institute (MB and MAG) and by the British Columbia Region, First Nations and Inuit Health Program, Health Canada (AJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.