Abstract
Objectives: Injury related to violent acts is a problem in every society. Although some authors have examined the geography of violent crime, few have focused on the spatio-temporal patterns of violent injury and none have used an ambulance dataset to explore the spatial characteristics of injury. The purpose of this study was to describe the combined spatial and temporal characteristics of violent injury in a large urban centre. Methodology/Principal Findings: Using a geomatics framework and geographic information systems software, we studied 4,587 ambulance dispatches and 10,693 emergency room admissions for violent injury occurrences among adults (aged 18-64) in Toronto, Canada, during 2002-2004, using population-based datasets. We created kernel density and choropleth maps for 24-hour periods and four-hour daily time periods and compared location of ambulance dispatches and patient residences with local land use and socioeconomic characteristics. We used multivariate regressions to control for confounding factors. We found the locations of violent injury and the residence locations of those injured were both closely related to each other and clearly clustered in certain parts of the city characterised by high numbers of bars, social housing units, and homeless shelters, as well as lower household incomes. The night and early morning showed a distinctive peak in injuries and a shift in the location of injuries to a "nightlife" district. The locational pattern of patient residences remained unchanged during those times. Conclusions/Significance: Our results demonstrate that there is a distinctive spatio-temporal pattern in violent injury reflected in the ambulance data. People injured in this urban centre more commonly live in areas of social deprivation. During the day, locations of injury and locations of residences are similar. however, later at night, the injury location of highest density shifts to a "nightlife" district, whereas the residence locations of those most at risk of injury do not change.
Highlights
Descriptive epidemiology traditionally concentrates on the characteristics of person, time and place
Conclusions/Significance: Our results demonstrate that there is a distinctive spatio-temporal pattern in violent injury reflected in the ambulance data
Most injury studies in the literature use single hospital-related or health system data. These datasets usually include patient residence rather than injury location since this data is more collected in hospital or administrative databases
Summary
Descriptive epidemiology traditionally concentrates on the characteristics of person, time and place. Studies of injury have often concentrated on personal characteristics (for example age, sex, blood alcohol level) and have paid less attention to characteristics of either the time or the place of injury occurrence [1,2]. Violence has been an area of interest in regards to examining the place of injury, since violent injuries are of interest as a legal issue [6,7]. Nelson et al examined the geographic incidence of violent crime (not injury related to violence) in the central cores of two British cities using geocoded crime incidence data. Reported violent crimes were most common in areas with high concentrations of drinking establishments, in evening time periods. That study identified a pattern of afternoon and early evening violent crime associated with the poor, attributed to ‘‘vagrants and drunks [8]’’
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