Aboriginal Community-Level Predictors of Injury-Related Hospitalizations in British Columbia, Canada
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Population-level statistics indicating disparities in injury rates between Aboriginal and non-Aboriginal populations disguise considerable community-level heterogeneity. Using an ecological approach, we analyzed linked data from British Columbia’s (BC) universal health care insurance plan, worker compensation, vital statistics, and census databases to identify community-level risk markers for hospitalization due to injury among the Aboriginal population of BC, Canada. Community standardized relative risks (SRR) of injury hospitalization relative to the total population of BC ranged from 0.24 to 9.35. Variables associated with increased SRRs included the following: higher proportions of crowded housing, housing in poor condition, participating in industries with greater risk of a work injury claim, being more remote, and at higher latitude. Higher income and more high school graduates were protective. In the best-fitting multivariable model, variables independently associated with SRR were proportion of the population with a high school certificate (RR = 0.89 per unit standard deviation change, 95 % confidence interval 0.83 to 0.94), and remoteness index (RR = 1.06, 95 % confidence interval (CI) 1.01 to 1.11). Results confirm profound diversity in Aboriginal communities across BC. SRRs of injury hospitalization increased as proportion of high school graduates dropped and remoteness increased. Promoting the educational attainment of community members should be an important focus of initiatives to improve health.
KeywordsFirst Nations Accidents Population health data Social determinants of health Injury risk
This work was supported by the Canadian Institutes of Health Research [grant number AHR # 81043]. Career support for the authors was provided by the Child and Family Research Institute (MAG, MB), by a Michael Smith Foundation for Health Research scholar award (MB) and the British Columbia Region, First Nations and Inuit Health, Health Canada (AJ). The authors thank Ms. Anna Low and Ms. Sherylyn Arabsky of Population Data BC for assistance with data access and linkage and Dr. Rod McCormick for his contributions to the study design and conduct.
- British Columbia Ministry of Health (2011). Discharge Abstract Database (Hospital Separations). Population Data BC. Retrieved from http://www.popdata.bc.ca/data.
- British Columbia Ministry of Health (2012). Medical Services Plan (MSP) Payment Information File. Population Data BC. Retrieved from http://www.popdata.bc.ca/data.
- British Columbia Provincial Health Officer (2009). Pathways to health and healing—2nd report on the health and well-being of Aboriginal people in British Columbia. Provincial Health Officer’s Annual Report 2007. Victoria, BC: Ministry of Healthy Living and Sport. Retrieved from http://www.health.gov.bc.ca/pho/pdf/abohlth11-var7.pdf,
- Canadian Broadcasting Corporation (2008). A community fights gangs and guns. CBC News in Review. Retrieved September 09, 2013, from http://newsinreview.cbclearning.ca/wp-content/uploads/2008/12/nov-08-gangs.pdf.
- Corporate Information Management Directorate, & Information Management Branch (2005). Band Classification Manual. Retrieved from http://publications.gc.ca/collections/Collection/R22-1-2000E.pdf.
- DesMeules, M., Pong, R., Lagace, C., Heng, D., Manuel, D., Pitblado, R., & Koren, I. (2006). How healthy are rural Canadians? An assessment of their health status. In M. DesMeules, R. Pong, C. Lagace, D. Heng, D. Manuel, R. Pitblado, & I. Koren (Eds.), Community health (pp. 1–182). Ottawa: Canadian Institute for Health Information.Google Scholar
- Health Canada (2009). A statistical profile on the health of First Nations in Canada: Health services utilization in Western Canada, 2000. Health Canada. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/alt_formats/fnihb-dgspni/pdf/pubs/aborig-autoch/2009-stats-profil-vol2-eng.pdf.
- Kahn, H. A., & Sempos, C. T. (1989). Statistical methods in epidemiology (pp. 95–105). New York: Oxford University Press.Google Scholar
- Laflamme, L., Sethi, D., Burrows, S., Hasselberg, M., Racioppi, F., & Apfel, F. (2009). Addressing the socioeconomic safety divide: A policy briefing. Copenhagen: WHO Regional Office for Europe.Google Scholar
- Penney, C., O’Sullivan, E., & Senécal, S. (2012). The Community Well-Being Index (CWB): Examining well-being in Inuit communities, 1981–2006. Retrieved from http://www.aadnc-aandc.gc.ca/eng/1345828176385/1345828236726.
- U.S. Department of Transportation, & National Highway Traffic Safety Administration (1996). Rural and urban crashes—a comparative analysis. Washington, DC: US Dept of Transportation, NHTSA. Retrieved from http://www-nrd.nhtsa.dot.gov/Pubs/96847.pdf
- Waldram, J. B., Herring, D. A., & Young, T. K. (2006). Aboriginal health in Canada: Historical, cultural and epidemiological perspectives. Toronto: University of Toronto Press.Google Scholar
- WorkSafeBC (2010). Demand safety, Statistics 2006. Richmond, BC. Retrieved from http://www.worksafebc.com/publications/reports/statistics_reports/assets/pdf/stats2006.pdf.
- WorkSafeBC (2013). Occupational injuries by accident type and occupation in British Columbia, 2002–2011. Richmond, BC. Retrieved from http://www.worksafebc.com/publications/reports/statistics_reports/occupational_injuries/2002-2011/default.asp.