Unintentional injuries in children and youth from immigrant families in Ontario, Canada: a population-based cross-sectional study

Natasha Ruth Saunders; Alison Macpherson; Jun Guan; Lisa Sheng; Astrid Guttmann

doi:10.9778/cmajo.20160099

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Table 1: Characteristics of the study cohort

Characteristic	Nonimmigrants, no. (%) n = 3 171 110	Immigrants, no. (%) n = 914 372
Age group, yr
0-4	544 938 (17.2)	186 770 (20.4)
5-9	565 129 (17.8)	186 052 (20.3)
10-14	613 955 (19.4)	191 901 (21.0)
15-19	719 693 (22.7)	178 666 (19.5)
20-24	727 395 (22.9)	170 983 (18.7)
Sex
Female	1 547 106 (48.8)	445 381 (48.7)
Male	1 624 004 (51.2)	468 991 (51.3)
Neighbourhood income quintile
Q1 (lowest)	563 314 (17.8)	268 317 (29.3)
Q2	571 014 (18.0)	199 314 (21.8)
Q3	625 353 (19.7)	183 429 (20.1)
Q4	698 687 (22.0)	160 234 (17.5)
Q5 (highest)	712 742 (22.5)	103 078 (11.3)
Rurality
Urban	2 731 160 (86.1)	903 371 (98.8)
Rural	439 950 (13.9)	11 001 (1.2)

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Table 2: Unintentional injury-related emergency department visits, hospital admissions and deaths by immigrant status, 2008-2012

Characteristic	Emergency department visits				Hospital admissions				Deaths
	Immigrants		Nonimmigrants		Immigrants		Nonimmigrants		Immigrants		Nonimmigrants
	n	Rate per 100 000 population	n	Rate per 100 000 population	n	Rate per 100 000 population	n	Rate per 100 000 population	n	Rate per 100 000 population	n	Rate per 100 000 population
Age group, yr
0-4	71 791	7754.4	307 481	11 288.5	1702	183.8	6653	244.2	30	3.2	184	6.7
5-9	54 354	5827.5	273 305	9637.1	1450	155.4	5781	203.8	14	1.5	60	2.1
10-14	62 561	6542.3	450 183	14 538.9	1207	126.1	6837	220.7	16	1.7	115	3.7
15-19	61 219	6794.2	569 594	15 940.5	1879	208.8	14 664	410.4	83	9.2	738	20.6
20-24	57 815	6895.1	495 019	13 587.1	1754	209.3	12 898	354.0	165	19.7	1140	31.3
Sex
Female	117 063	5201.2	843 147	10 869	2948	133.0	17 647	225.0	88	4.2	613	7.6
Male	190 677	8210.0	1 252 435	15 311	5044	219.7	29 186	353.6	220	10.6	1624	19.1
Neighbourhood income quintile
Q1 (lowest)	87 203	6508.3	408 717	14 407.9	2550	192.4	9858	341.0	112	9.0	606	20.0
Q2	63 893	6418.4	394 427	13 693.9	1748	178.4	8768	299.4	65	7.3	411	13.3
Q3	60 562	6615.2	410 798	13 055.1	1513	167.2	8989	283.0	56	7.0	403	12.4
Q4	57 083	7129.9	444 584	12 700.7	1332	169.1	9568	272.2	53	7.7	422	12.0
Q5 (highest)	38 999	7508.3	43 7056	12 124.3	849	164.7	9650	265.7	22	4.8	395	10.6
Rurality
Urban	300 162	6650.2	1 667 436	12 146.5	7853	176.2	38 255	275.8	298	7.3	1698	11.8
Rural	7578	13 652.5	428 146	19 218.8	139	257.3	8578	383.1	10	18.7	539	23.7

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Table 3: Rate ratios of unintentional injuries for children and youth ages 0-24 years by immigration status, 2011-2012

Immigration status	Overall adjusted* model RR (95% CI)
Immigrants	0.56 (0.54-0.59)
Nonimmigrants	Reference
Age group, yr
0-4	1.23 (1.16-1.31)	0.91 (0.87-0.95)
5-9	0.92 (0.87-1.00)	0.80 (0.76-0.84)
10-14	1.05 (0.98-1.12)	1.23 (1.18-1.28)
15-19	1.02 (0.95-1.09)	1.22 (1.17-1.27)
20-24	Reference	Reference
Sex
Male	1.51 (1.45-1.58)	1.37 (1.34-1.41)
Female	Reference	Reference
Neighbourhood income quintile
Q1 (lowest)	0.88 (0.82-0.94)	1.13 (1.08-1.18)
Q2	0.86 (0.80-0.92)	1.10 (1.05-1.15)
Q3	0.89 (0.83-0.95)	1.07 (1.02-1.12)
Q4	0.95 (0.89-1.02)	1.05 (1.01-1.09)
Q5 (highest)	Reference	Reference
Rurality
Rural	1.98 (1.74-2.25)	1.58 (1.53-1.64)
Urban	Reference	Reference

Note: CI = confidence interval, RR = rate ratio.

*Adjusted for age, sex, neighbourhood income quintile and rurality.

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Table 4: Adjusted rate ratios and crude rates of cause-specific unintentional injury-related emergency department visits, hospital admissions and deaths in children and youth ages 0-24 years by immigration status, annualized 2008-2012

Cause of injury	Adjusted* RR (95% CI) (Reference = nonimmigrants)	Crude injury rate per 100 000 immigrants	Crude injury rate per 100 000 nonimmigrants
Fall	0.60 (0.58-0.62)	2108.6	3574.9
Struck by/against	0.48 (0.45-0.51)	1347.6	3069.3
Overexertion	0.59 (0.54-0.64)	568.4	1104.2
Cut/pierce	0.47 (0.44-0.50)	372.9	917.5
Natural/environmental	0.40 (0.37-0.44)	183.0	511.9
Other bicycle (Non-motor vehicle collision)	0.53 (0.48-0.58)	165.8	327.8
Poisoning	0.61 (0.57-0.65)	136.6	230.6
Motor vehicle traffic	0.73 (0.69-0.77)	308.5	468.4
Hot object/scald	0.71 (0.64-0.78)	88.5	132.0
Fire/flame	0.39 (0.32,0.46)	12.4	40.5
Other pedestrian (Non-motor vehicle collision)	0.74 (0.63-0.86)	10.3	15.9
Machinery	0.55 (0.47-0.64)	17.2	40.7
Suffocation	0.68 (0.54-0.84)	5.5	8.2
Other land transport	0.23 (0.19-0.26)	36.6	230.8
Drowning	0.69 (0.53-0.91)	2.9	4.0
Firearm	0.43 (0.33-0.56)	3.3	7.1
Other or not specified	0.64 (0.61-0.68)	1335.9	2257.2