Abstract
BackgroundIt has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and also examined community-level risk factors while controlling for individual-level factors.MethodsUsing data from the 2004 to 2013 Korea National Hospital Discharge Survey (KNHDS), trends in age-adjusted injury hospitalization rate were conducted using the Joinpoint Regression Program. Based on the 2013 KNHDS, we collected community-level factors by linking various data sources and selected dominant factors related to injury hospitalization through a stepwise method. Multilevel analysis was performed to assess the community-level factors while controlling for individual-level factors.ResultsIn 2004, the age-adjusted unintentional injury hospitalization rate was 1570.1 per 100,000 population and increased to 1887.1 per 100,000 population in 2013. The average annual percent change in rate of hospitalizations due to unintentional injury was 2.31% (95% confidence interval: 1.8–2.9). It was somewhat higher for females than for males (3.25% vs. 1.64%, respectively). Both community- and individual-level factors were found to significantly influence unintentional injury hospitalization risk. As community-level risk factors, finance utilization capacity of the local government and neighborhood socioeconomic status, were independently associated with unintentional injury hospitalization after controlling for individual-level factors, and accounted for 19.9% of community-level variation in unintentional injury hospitalization.ConclusionRegional differences must be considered when creating policies and interventions. Further studies are required to evaluate specific factors related to injury mechanism.
Highlights
It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury
The unintentional injury hospitalization rate has gradually increased since the survey began
The overall hospitalization rate was higher for males than for females, but the annual percent change (AAPC) was higher for females (3.25%, 95% Confidence interval (CI): 2.6–3.9) than for males (1.64%, 95% CI: 1.1–2.2)
Summary
It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and examined communitylevel risk factors while controlling for individual-level factors. Injuries result from traffic accidents, falls, poisonings, etc. In Korea the mortality rate due to road traffic accidents has decreased significantly from 17.1 per 100,000 in 2004 to 11.9 per 100,000 population in 2013 [3], Korea ranks second after Austria in the number of hospitalizations due to injuries, poisoning, and external causes among Organization for Economic Co-operation and Development (OECD) countries (2755.8 and 3006.8 per 100,000 population in Korea and Austria, respectively, in 2013) [4]. Since 2004, the Korea Centers for Disease Control and Prevention (KCDC) has included In-Depth Injury Surveillance as a part of the Korea National Hospital Discharge Survey (KNHDS) to collect data from hospital-based injury surveillance systems [5]
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