Skip to main content
SpringerLink
Log in

Aboriginal Community-Level Predictors of Injury-Related Hospitalizations in British Columbia, Canada

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allard, Y. E., Wilkins, R., & Berthelot, J. M. (2004). Premature mortality in health regions with high Aboriginal populations. Health Reports, 15, 51–60.

    PubMed  Google Scholar 

  • Bell, N., Schuurman, N., Hameed, S. M., & Caron, N. (2011). Are we homogenising risk factors for public health surveillance? Variability in severe injuries on First Nations reserves in British Columbia, 2001-5. Injury Prevention, 17, 394–400. doi:10.1136/ip.2010.030866.

    Article  PubMed  Google Scholar 

  • Birken, C. S., Parkin, P. C., To, T., & Macarthur, C. (2006). Trends in rates of death from unintentional injury among Canadian children in urban areas: Influence of socioeconomic status. Canadian Medical Association Journal, 175, 867–868.

    Article  PubMed Central  PubMed  Google Scholar 

  • Blatt, J., & Furman, S. M. (1998). Residence location of drivers involved in fatal crashes. Accident Analysis and Prevention, 30, 705–711.

    Article  CAS  PubMed  Google Scholar 

  • Braveman, P. A., Cubbin, C., Egerter, S., Chideya, S., Marchi, K. S., Metzler, M., & Posner, S. (2005). Socioeconomic status in health research: One size does not fit all. Journal of the American Medical Association, 294, 2879–88. doi:10.1001/jama.294.22.2879.

    Article  CAS  PubMed  Google Scholar 

  • 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.

  • Chandler, M. J., & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canada’s First Nations. Transcultural Psychiatry, 35, 191–219.

    Article  Google Scholar 

  • Coburn, D. (2004). Beyond the income inequality hypothesis: Class, neo-liberalism, and health inequalities. Social Science & Medicine, 58, 41–56.

    Article  Google Scholar 

  • Cochran, P. A. L., Marshall, C. A., Garcia-Downing, C., Kendall, E., Cook, D., McCubbin, L., & Gover, R. M. S. (2008). Indigenous ways of knowing: Implications for participatory research and community. American Journal of Public Health, 98, 22–27.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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 

  • Frohlich, K. L., Ross, N., & Richmond, C. (2006). Health disparities in Canada today: Some evidence and a theoretical framework. Health Policy, 79, 132–43. doi:10.1016/j.healthpol.2005.12.010.

    Article  PubMed  Google Scholar 

  • George, M. A., McCormick, R., Lalonde, C. E., Jin, A., & Brussoni, M. (2013). The RISC research project: Injury in First Nations communities in British Columbia, Canada. International Journal of Circumpolar Health, 72, 21182. doi:10.3402/ijch.v72i0.21182.

    Article  Google Scholar 

  • Giles, A. R., Castelden, H., & Baker, A. C. (2010). “We listen to our elders. You live longer that way”: Examining aquatic risk communication and water safety practices in Canada’s North. Health & Place, 16, 1–9.

    Article  Google Scholar 

  • Hassler, S., Johansson, R., Sjölander, P., Grönberg, H., & Damber, L. (2005). Causes of death in the Sami population of Sweden, 1961-2000. International Journal of Epidemiology, 34, 623–9. doi:10.1093/ije/dyi027.

    Article  PubMed  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.

  • Hernandez, M., Nesman, T., Mowery, D., Acevedo-Polakovich, I. D., & Callejas, L. M. (2009). Cultural competence: A literature review and conceptual model for mental health services. Psychiatric Services, 60, 1046.

    Article  PubMed  Google Scholar 

  • Hill, K., Barker, B., & Vos, T. (2007). Excess Indigenous mortality: Are Indigenous Australians more severely disadvantaged than other Indigenous populations? International Journal of Epidemiology, 36, 580–9. doi:10.1093/ije/dym011.

    Article  PubMed  Google Scholar 

  • Jacklin, K. (2009). Diversity within: Deconstructing aboriginal community health in Wikwemikong Unceded Indian Reserve. Social Science and Medicine, 68, 980–989. doi:10.1016/j.socscimed.2008.12.035.

    Article  PubMed  Google Scholar 

  • Kahn, H. A., & Sempos, C. T. (1989). Statistical methods in epidemiology (pp. 95–105). New York: Oxford University Press.

    Google Scholar 

  • Karmali, S., Laupland, K., Harrop, A. R., Findlay, C., Kirkpatrick, A. W., Winston, B., & Hameed, M. (2005). Epidemiology of severe trauma among status Aboriginal Canadians: A population-based study. Canadian Medical Association Journal, 172, 1007–1011.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kim, K., Ozegovic, D., & Voaklander, D. C. (2012). Differences in incidence of injury between rural and urban children in Canada and the USA: A systematic review. Injury Prevention, 18, 264–71. doi:10.1136/injuryprev-2011-040306.

    Article  PubMed  Google Scholar 

  • Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.

    Article  CAS  PubMed  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 

  • Marmot, M. (2002). The influence of income on health: Views of an epidemiologist. Health Affairs, 21, 31–46. doi:10.1377/hlthaff.21.2.31.

    Article  PubMed  Google Scholar 

  • Myers, S. R., Branas, C. C., French, B. C., Nance, M. L., Kallan, M. J., Wiebe, D. J., & Carr, B. G. (2013). Safety in numbers: Are major cities the safest places in the United States? Annals of Emergency Medicine. doi:10.1016/j.annemergmed.2013.05.030.

    PubMed Central  Google Scholar 

  • Peek-Asa, C., Zwerling, C., & Stallones, L. (2004). Acute traumatic injuries in rural populations. American Journal of Public Health, 94, 1689–1693.

    Article  PubMed Central  PubMed  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.

  • Soubhi, H. (2004). Neighborhood, family, and child predictors of childhood injury in Canada. American Journal of Health Behavior, 28, 13. doi:10.5993/AJHB.28.5.2.

    Article  Google Scholar 

  • 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 

  • Wilson, K., & Rosenberg, M. W. (2002). Exploring the determinants of health for First Nations peoples in Canada: Can existing frameworks accommodate traditional activities? Social Science and Medicine, 55, 2017–2031.

    Article  PubMed  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.

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Pediatrics, School of Population and Public Health, British Columbia Injury Research and Prevention Unit, Child and Family Research Institute, University of British Columbia, F511, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

    Mariana Brussoni

  2. Department of Pediatrics, School of Population and Public Health, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada

    M. Anne George

  3. Department of Psychology, University of Victoria, Victoria, BC, Canada

    Chris E. Lalonde

  4. Surrey, Canada

    Andrew Jin

Authors
  1. Mariana Brussoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Anne George
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chris E. Lalonde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariana Brussoni.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brussoni, M., Jin, A., George, M.A. et al. Aboriginal Community-Level Predictors of Injury-Related Hospitalizations in British Columbia, Canada. Prev Sci 16, 560–567 (2015). https://doi.org/10.1007/s11121-014-0503-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-014-0503-1

Keywords

Search

Navigation