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Epidemiology of severe trauma among status Aboriginal Canadians: a population-based study

From the Departments of Surgery (Karmali, Harrop, Kirkpatrick, Kortbeek, Hameed), Critical Care Medicine (Laupland, Kirkpatrick, Winston, Kortbeek, Hameed), Medicine (Laupland) and Family Medicine (Crowshoe), University of Calgary, and Trauma Services, Calgary Health Region (Findlay, Kirkpatrick, Kortbeek, Hameed), Calgary, Alta.

Correspondence to: Dr. Morad Hameed, Trauma Services, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; mhameed{at}vanhosp.bc.ca

Background: Aboriginal Canadians are considered to be at increased risk of major trauma. However, population-based studies characterizing the distribution, determinants and outcomes of major trauma in this group are lacking. We sought to measure the impact of ethnicity, as reflected by Aboriginal status, on the incidence of severe trauma and to broadly define the epidemiologic characteristics of severe trauma among status Aboriginal Canadians in a large health region.

Methods: This population-based, observational study involves all adults (people 16 years) resident in the Calgary Health Region between Apr. 1, 1999, and Mar. 31, 2002. Stratification of the population into status Aboriginal Canadians and the reference population was performed by Alberta Health and Wellness using an alternate premium arrangement field within the personal health care number. Injury incidence was determined by identifying all injuries with severity scores of 12 or greater in the Alberta Trauma Registry, regional corporate data and the Office of the Medical Examiner.

Results: Aboriginal Canadians were at much higher risk than the reference population in the Calgary Health Region of sustaining severe trauma (257.2 v. 68.8 per 100 000; relative risk [RR] 3.7, 95% confidence interval [CI] 3.0–4.6). Aboriginal Canadians were found to be at significantly increased risk of injuries resulting from motor vehicle crashes (RR 4.8, 95% CI 3.5–6.5), assault (RR 11.1, 95% CI 6.2–18.6) and traumatic suicide (RR 3.1, 95% CI 1.4–6.1). A trend toward higher median injury severity scores was observed among Aboriginal Canadians (21 v. 18, p = 0.09). Although the case-fatality rate among Aboriginal Canadians was less than half that in the reference population (14/93 [15%] v. 531/1686 [31%], p < 0.0001), population mortality was almost 2 times greater (RR = 1.8, 95% CI 1.0–3.0, p = 0.046).

Interpretation: Severe trauma disproportionately affects Aboriginal Canadians.

This article has been cited by other articles:

				S. H. Chou, M. Tonelli, J. S. Bradley, S. Gourishankar, B. R. Hemmelgarn, and for the Alberta Kidney Disease Network Quality of Care among Aboriginal Hemodialysis Patients Clin. J. Am. Soc. Nephrol., January 1, 2006; 1(1): 58 - 63. [Abstract] [Full Text] [PDF]

				N. R. Caron Getting to the root of trauma in Canada's Aboriginal population Can. Med. Assoc. J., April 12, 2005; 172(8): 1023 - 1024. [Full Text] [PDF]

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