The Contribution Of Geography And Risk Factors To Inequalities In Unintentional Injury Between Aboriginal And Non-Aboriginal Australian Children

Abstract

INTRODUCTION Australian Aboriginal children, like indigenous children worldwide, experience a disproportionally high burden of unintentional injuries. They are also more likely than other children to live in rural and remote and socioeconomically disadvantaged areas, which have higher underlying rates of injury. Our aim was to quantify the relative contributions of geographic clustering and other risk factors to inequalities in unintentional injuries between Aboriginal and non-Aboriginal children in Australia. METHODS Using linked hospital and mortality data for the state of New South Wales (NSW), we constructed a retrospective whole-of-population birth cohort that included 653550 children (16831 Aboriginal) born in a NSW hospital between 1 July 2000 and 31 December 2007. We estimated hazard ratios for first injury hospitalization, overall and according to major injury mechanism, using single- and multilevel Cox proportional hazards models. RESULTS Aboriginal children were 1.6 times more likely than non-Aboriginal children to be hospitalized for an unintentional injury (HR 1.62; 95% CI 1.52-1.70). Adjusting for sex, premature birth, low birth weight, area level socioeconomic status, remoteness of area and geographic clustering reduced the inequality, but it remained substantial (HR 1.40; 95% CI 1.32-1.49). After adjustment, HRs for Aboriginal compared with non-Aboriginal children were 1.76 (95% CI 1.49-2.08) for poisoning, 1.71 (95% CI 1.39-2.11) for transport injuries and 1.87 (95% CI 1.58-2.25) for injuries caused by smoke, fire, heat and hot substances. DISCUSSION Geographic clustering and available risk factors explained only in part the higher burden of unintentional injury in Australian Aboriginal children compared with non-Aboriginal children. Both geographically-focussed interventions, and those specifically targeting injury risks in Aboriginal communities, have potential to improve Aboriginal child health and reduce health inequalities.