title: Injuries to Aboriginal populations living on- and off-reserve in metropolitan and non-metropolitan areas in British Columbia, Canada: Incidence and trends, 1986-2010.
abstract: Disparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve.
  
  
  
  We used data spanning 1986 through 2010 from BC's universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. "On-reserve" residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs) were classified as "metropolitan" if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR) of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period.
  
  
  
  Aboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0), but this was 2.3 times greater than the general British Columbia metropolitan population (0.86). For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0); 2.5 times greater than the general BC non-metropolitan population (1.2). Time trends indicated decreasing disparities, with Aboriginal non-metropolitan populations experiencing the largest declines in injury rates.
  
  
  
  Metropolitan/non-metropolitan residence appears to be a more important predictor than on/off-reserve residence for all injuries and unintentional injuries, and the relationship was even more pronounced for intentional injuries. The persistent disparities highlight the need for culturally sensitive and geographically relevant injury prevention approaches.
authors.affiliation: Department of Pediatrics, School of Population & Public Health, British Columbia Injury Research & Prevention Unit, Child and Family Research Institute, University of British Columbia, F511 - 4480 Oak Street, Vancouver, British Columbia, V6H 3V4, Canada. mbrussoni@cw.bc.ca.
authors.forename: Mariana
authors.initials: M
authors.lastname: Brussoni
authors.affiliation: Department of Pediatrics, School of Population & Public Health, Child and Family Research Institute, University of British Columbia, F508 - 4480 Oak Street, Vancouver, British Columbia, V2N 3Z9, Canada.
authors.forename: M Anne
authors.initials: MA
authors.lastname: George
authors.affiliation: Epidemiology Consultant, 2762 - 133 Street, Surrey, British Columbia, V4P 1X9, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jin
authors.affiliation: Department of Psychology, University of Victoria, PO Box 1700, Victoria, British Columbia, V8W 2Y2, Canada.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Lalonde
authors.affiliation: Faculty of Human, Social and Educational Development, Thompson Rivers University, 900 McGill Road, Kamloops, British Columbia, V2C 0C8, Canada.
authors.forename: Rod
authors.initials: R
authors.lastname: McCormick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D004777:Environment; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000401:mortality; D055815:Young Adult
keywords: Accidents; First Nations; Indians; Indigenous population; Population surveillance; Socioeconomic factors