Risk of Hospitalization Due to Unintentional Fall Injury in British Columbia, Canada, 1999–2008: Ecological Associations with Socioeconomic Status, Geographic Place, and Aboriginal Ethnicity
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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.
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.
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.
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.
KeywordsWounds and injuries (MeSH) Accidental falls (MeSH) “Indians, North American” (MeSH) Indigenous population (MeSH) “First nations” Epidemiology (MeSH)
This research was funded by the Canadian Institutes of Health Research, Institute of Aboriginal People’s Health (funding reference: AHR no. 81043). Salary support for authors was provided by the Child and Family Research Institute (AG and MB) and by the British Columbia Region, First Nations and Inuit Health Program, Health Canada (AJ). The authors thank Anna Low, Sherylyn Arabsky, and Kelly Sanderson of Population Data BC for assistance with data access and linkage and Stewart Deyell of Statistics Canada for assistance in obtaining custom tabulations of census data.
Compliance with Ethical Standards
This research was funded by the Canadian Institutes of Health Research, Institute of Aboriginal People’s Health (funding reference: AHR no. 81043). Andrew Jin, Mariana Brussoni, M. Anne George, Christopher E. Lalonde, and Rod McCormick declare that they have no conflicts of interest. The University of British Columbia Behavioural Research Ethics Board reviewed and approved our methods (BREB file H06-80585). We studied existing provincial health care databases maintained by Population Data BC. The Data Stewards representing the British Columbia Ministry of Health and the Vital Statistics Agency of British Columbia approved our requests to access the data. This article does not contain any studies with human participants or animals performed by any of the authors.
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