Research Papers

Recent trends in child and youth emergency department visits because of pedestrian motor vehicle collisions by socioeconomic status in Ontario, Canada

Version 1
Date added June 18, 2019
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Category 2019 CARSP XXIX Calgary
Tags Research and Evaluation, Session 5A
Author/Auteur Rothman, Macarthur, Wilton, Howard, Macpherson
Stream/Volet Research and Evaluation
Slidedeck Presentation Only:



Background/Context: It has been well established that there are differences in unintentional injury rates among children by social class, with children in lower income households having higher injury rates. There has been more than 40 years since the socioeconomic disparity in child pedestrian motor vehicle collisions (PMVC) was first described.

Aims/Objectives: The primary objective of this paper was to examine the relationship between income status and recent child PMVC emergency department visits over time in Ontario, Canada.

Methods/Targets: ED visit data were obtained from The Institute for Clinical Evaluative Sciences for children ages 0-19 from 2008-2015. The National Ambulatory Care Reporting System (NACRS) captured the ED visits, and population information on children and youth in Ontario was obtained from the OHIP eligible Registered Population Database. Neighbourhood socioeconomic quintiles were determined using the Statistics Canada Postal Code Conversion File 2011, with quintile 1 representing the lowest income quintile and quintile 5 representing the highest income quintile. Age adjusted rates were calculated using Ontario census data. Income quintiles were determined from the Registered Persons Database. Poisson regression was used to model ED visit rates by year, age and income quintile.

Results/Activities: There were a total of 11,187 ED visits with the frequency of ED visits decreasing by 18% over the eight years, across all income quintiles. The frequency of ED visits over the study period was highest in the lowest income quintile at 3,022 ED visits, compared with only 1,592 ED visits in the highest income quintile over the same time period. Poisson regression analysis showed PMVC incidence rates were 48% lower in the highest income quintile compared to the lowest income quintile (IRR 0.52, 95% CI 0.50, 0.55) after adjusting for age, with no significant change by year.

Discussion/Deliverables: Income disparities in the rates of ED visits in Ontario for child pedestrian visits have persisted from 2008 to 2015. There were significant differences in ED visits between the highest and lowest income quantiles. Although the frequency of ED visits have decreased over time, there were no significant changes in age-adjusted rates by year. Individual level factors related to income which influence pedestrian exposure to traffic, such as car access, are difficult to modify and there may be more potential to reduce higher child pedestrian collision rates in lower income areas by focusing on ecological level built environment factors. Less safe traffic environments in lower income areas may also be strong contributors to the inequities in PMVC .

Conclusions: There appears to have been little progress in reducing income disparities in child PMVC despite a focus of Canadian health policy on reducing socioeconomic disparities in health. The most effective strategy to equalize income disparities in child pedestrian injuries may be by improving the traffic built environment in lower income areas, which has the potential to benefit pedestrians of all ages."