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.
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