Abstract

            Background
            Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population.
          
          
            Methods
            Linking the Canadian Community Health Survey 2005–2017 to National Ambulatory Care Reporting System 2003–2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income.
          
          
            Results
            Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07–1.25) and 1.35 (95% CI 1.24–1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29–2.53) including self-harm (aRR 1.87; 95% CI 1.03–3.40) and violence (aRR 1.79; 95% CI 1.19–2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22–1.46) including fall (aRR 1.43; 95% CI 1.24–1.65), medical complication (aRR 1.39; 95% CI 1.06–1.82), being struck by objects (aRR 1.43; 95% CI 1.07–1.91), overexertion (aRR 1.31; 95% CI 1.04–1.66), animal bite or sting (aRR 1.60; 95% CI 1.08–2.36), skin piercing (aRR 1.80; 95% CI 1.21–2.66), and poisoning (aRR 1.65; 95% CI 1.05–2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09–2.21), falls (aRR 1.22; 95% CI 1.08–1.37), being struck (aRR 1.20; 95% CI 1.01–1.43), and overexertion (aRR 1.25; 95% CI 1.04–1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries.
          
          
            Conclusions
            Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity.