Abstract
BackgroundOur objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. We focus on hospitalizations, including both self-inflicted injuries and injuries inflicted by others.MethodsWe used data from BC’s universal health care insurance plan, 1991 to 2010, linked to Vital Statistics databases. Indigenous people were identified through the insurance premium group, and birth and death records. Place of residence was identified through postal code. We calculated crude hospitalization incidence rates and the Standardized Relative Risk (SRR) of hospitalization, standardized by gender, 5-year age group, and Health Service Delivery Area (HSDA). With HSDA populations as the units of observation, linear regression was used to test hypothesized associations of Indigenous ethnicity, geographic, and socio-economic characteristics with SRR of injury.ResultsDuring the period 1991–2010, the crude rate of hospitalization for intentional injuries was 8.4 per 10,000 person-years (95% confidence interval (CI): 8.3 to 8.5) for the total BC population, compared to 45.3 per 10,000 (95% CI: 44.5 to 46.1) for the Indigenous population. For both populations, risk declined over the period for injuries self-inflicted and inflicted by others. The linear regression model predicts that the off-reserve Indigenous population will have SRR of intentional injury 3.98 greater, and the on-reserve Indigenous population 4.17, greater than the total population. The final model was an excellent fit (R2 = 0.912, F = 177.632, p < 0.001), and found that three variables - occupational risk, high school diploma, and university degree – each provide independent effects when interacting multiplicatively with Indigenous ethnicity.ConclusionsThe observation of substantially declining rates of intentional injury for both the Indigenous and total BC populations is off-set by the high disparity in risk between the two populations, which will likely continue until Canada reduces disparity with respect to discriminatory practices, and physical, social, and economic conditions.
Highlights
Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada
We considered a hospitalization as “due to injury” if the level of care was “acute” or “rehabilitation,” and the Most Responsible Diagnosis on the discharge record was an International Classification of Diseases Revision 9 (“ICD-9”) numeric code in the range 800 through 999, or an International Classification of Diseases Revision 10 (“ICD-10”) code in the range S00 through T98; and “intentional” if the first occurrence of the supplemental injury diagnosis code was an ICD-9 E-code in the range E950-E958 or an ICD-10 code in the range X60-X84, or an ICD-9 E-code in the range E960-E968 or an ICD-10 code in the range X85-Y09
Compared to the total BC population, the Indigenous population had more than threefold Standardized Relative Risk (SRR) for self-inflicted injuries and more than fourfold SRR for injuries inflicted by another person
Summary
Our objective was to explore intentional injury disparity between Indigenous populations and the total population in the province of British Columbia (BC), Canada. Our previous work [1,2,3,4,5,6,7,8,9,10,11,12] has shown dramatic reduction in overall injury risk for both the total BC and Indigenous populations during the past two decades, including for children [6] It has shown decreasing, but persistent, disparity in risk between the two population groups, with more rapid rates of decreased disparity for some categories of injury (e.g., unintentional falls) [5, 10], compared to others (e.g., iatrogenic injuries) [11]. This report explores the category of intentional injury using the same populationbased dataset with both total BC and Indigenous populations, and discusses similarities with and differences from risk of other categories of injury
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