Abstract
ObjectivesTo investigate ethnic differences in falls and road traffic injuries (RTIs) in Scotland. Study designA retrospective cohort of 4.62 million people, linking the Scottish Census 2001, with self-reported ethnicity, to hospitalisation and death records for 2001–2013. MethodsWe selected cases with International Classification of Diseases–10 diagnostic codes for falls and RTIs. Using Poisson regression, age-adjusted risk ratios (RRs, multiplied by 100 as percentages) and 95% confidence intervals (CIs) were calculated by sex for 10 ethnic groups with the White Scottish as reference. We further adjusted for country of birth and socio-economic status (SES). ResultsDuring about 49 million person-years, there were 275,995 hospitalisations or deaths from fall-related injuries and 43,875 from RTIs. Compared with the White Scottish, RRs for falls were higher in most White and Mixed groups, e.g., White Irish males (RR: 131; 95% CI: 122–140) and Mixed females (126; 112–143), but lower in Pakistani males (72; 64–81) and females (72; 63–82) and African females (79; 63–99). For RTIs, RRs were higher in other White British males (161; 147–176) and females (156; 138–176) and other White males (119; 104–137) and females (143; 121–169) and lower in Pakistani females (74; 57–98). The ethnic variations differed by road user type, with few cases among non-White motorcyclists and non-White female cyclists. The RRs were minimally altered by adjustment for country of birth or SES. ConclusionWe found important ethnic variations in injuries owing to falls and RTIs, with generally lower risks in non-White groups. Culturally related differences in behaviour offer the most plausible explanation, including variations in alcohol use. The findings do not point to the need for new interventions in Scotland at present. However, as the ethnic mix of each country is unique, other countries could benefit from similar data linkage-based research.
Highlights
We examine whether risks of injury or death due to falls or road traffic injuries (RTIs) vary between ethnic groups in Scotland
The proportion of people who were born in the United Kingdom (UK)/Republic of Ireland (RoI) was more than 95% for the with 30% in the general (White) Scottish, Irish, and Other British groups, 75% for the Any Mixed Background group and 30e60% for other groups
We addressed the differing age structure of the ethnic groups by adjustment for age: Table 3 Age-adjusted rates per 100,000 person-years at risk (PY) and risk ratios (RRs) for hospitalisations and deaths owing to road traffic injuries (V00eV89) by sex and ethnic group
Summary
Burden of Disease Injury and Risk Factors Study reported that in 2013 there were an estimated 56.2 million injuries requiring hospitalisation. The commonest causes were falls (36%) and road traffic injuries (RTIs) (20%).[6] Of 4.8 million deaths, about 29% were due to RTIs and 11% to falls. In Scotland in 2017, 61% of admissions to hospital for unintentional injury were owing to falls and 5% owing to RTIs.[7] Whilst the incidence of falls increases markedly in old age, many risk factors are involved including alcohol consumption, which may differ by ethnic group.8e11 RTI rates vary according to mode of transport; intoxication with alcohol or other drugs is a risk factor. In 2016, 13% of all road deaths in Great Britain involved at least one driver with an alcohol level over the drink-drive limit.[12] As these factors are socially mediated, it is reasonable to hypothesise that ethnicity could influence the risk of RTI. Several more robust studies of RTIs have been conducted in different countries, often showing clear differences between ethnic groups.15,17e19 no consistent picture emerges from these studies, probably indicating that the national context affects the patterns found
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