Injuries to Aboriginal populations living on- and off-reserve in metropolitan and non-metropolitan areas in British Columbia, Canada: Incidence and trends, 1986-2010.

Mariana Brussoni,Christopher E Lalonde,Andrew Jin,Rod Mccormick,M Anne George

doi:10.1186/s12889-016-3078-x

Abstract

BackgroundDisparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve.MethodsWe used data spanning 1986 through 2010 from BC’s universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. “On-reserve” residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs) were classified as “metropolitan” if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR) of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period.ResultsAboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0), but this was 2.3 times greater than the general British Columbia metropolitan population (0.86). For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0); 2.5 times greater than the general BC non-metropolitan population (1.2). Time trends indicated decreasing disparities, with Aboriginal non-metropolitan populations experiencing the largest declines in injury rates.ConclusionsMetropolitan/non-metropolitan residence appears to be a more important predictor than on/off-reserve residence for all injuries and unintentional injuries, and the relationship was even more pronounced for intentional injuries. The persistent disparities highlight the need for culturally sensitive and geographically relevant injury prevention approaches.

Highlights

Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established
While the off-reserve population is more likely to live in metropolitan areas than the on-reserve population, there are a greater proportion of Aboriginal populations living in non-metropolitan areas, whether on- or off-reserve
The BC population residing in metropolitan areas has the lowest total, unintentional and intentional injuries rates

Summary

Introduction

Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve. A recent Canadian study found that injury hospitalization rates were highest in geographic areas with the greatest percentage of individuals identifying as First Nations (146/10,000 person years), followed by Métis (112), and Inuit (100) [7]. Injury rates in areas with a low percentage of individuals identifying as Aboriginal were substantially lower (55/10,000 person years). Our previous research in British Columbia (BC), the Canadian province with the largest number of Aboriginal bands, indicated encouraging downward injury trends and a narrowing gap between Aboriginal and total populations [8]. Disparities persist, along with efforts to understand root causes and develop culturally and locally relevant prevention strategies

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