Examining non-fatal traffic and other injury occurrence and severity using socioeconomic and individual-level factors

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Briggs, Gemma L.
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Background. In Canada, motor vehicle collisions are the leading cause of unintentional injury deaths and second leading cause of injury hospitalization. Nationally, serious traffic injury has reduced 35% (1986-2005). Social determinants of health have not been studied with serious traffic injury in adulthood. Study Aims. To determine whether lower SES (measured by education, income, and employment), is associated with serious traffic and fall injury and injury severity and whether the pattern of association differed between traffic and fall injury. To reveal issues to be made by decision makers regarding at risk groups. Methods. Combined cycles (1.1, 2.1, and 3.1) of the cross-sectional Canadian Community Health Survey were used. Injuries in the past year ‘serious enough to limit normal activities’ were studied. Deaths and less serious injuries are not captured. “Transportation accident” was used to represent traffic injury. It does not specify victim type (e.g. driver, bicyclist) yet the category pertains to “automobiles” and published research used it as a proxy for motor vehicle collisions. Power analyses, survey weighting and bootstrapping were executed to prevent biased population estimates. Records with missing data were excluded. Logistic regression models were performed for tests with binary outcomes. Injury severity selected individuals’ highest treatment within 48 hours - admitted to hospital, Emergency Department visit, or seeing a health professional. Results. Socioeconomic variables were associated with serious traffic and fall injury and severity. For serious traffic injury, those with some post-secondary education were at higher risk (OR=1.34; 95%CI 1.08, 1.67) than post-secondary graduates. For serious fall injury, an education by gender interaction resulted. Males who did not complete high school had a higher risk (OR=1.14; 95%CI 1.03, 1.27) relative to post-secondary graduates. With the same reference group, females who completed high school had a lower risk (OR=0.86; 95%CI 0.75, 0.98). For serious fall injury, those in the lowest, versus top, personal income quintile had a higher risk (OR=1.37; 95%CI 1.23, 1.51). Females had a higher risk (OR=1.18; 95%CI 1.03, 1.35) of serious traffic injury relative to males. Youth/young adults had a higher risk of serious traffic injury (OR=1.75; 95%CI 1.50, 2.06) relative to the middle-aged group. The younger group had a higher risk of serious fall injury (OR=1.41; 95%CI 1.25, 1.60) relative to seniors. With serious traffic injury, seniors had a lower risk (OR=0.50; 95%CI 0.37, 0.68) than the middle-aged group. This did not support the literature with young and old at risk for traffic injury. In the two-level traffic severity model, employed, versus unemployed, individuals had a higher risk (OR=1.69; 95%CI 1.12, 2.55). Discussion. Associations were found between SES variables and serious traffic and fall injury for Canadians 12 years of age and over that were mostly but not always in the direction of lower SES having higher rates. Findings must be interpreted with caution due to sampling bias from missing data removal (27%). Information was not available on culpability or vehicle miles travelled. The traffic injury-SES relationship and SES-traffic severity relationship merit further inquiry in other contexts or with other datasets.
traffic, injury, socioeconomic, severity