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Are we homogenising risk factors for public health surveillance? Variability in severe injuries on First Nations reserves in British Columbia, 2001–5
  1. Nathaniel Bell1,
  2. Nadine Schuurman2,
  3. S Morad Hameed3,
  4. Nadine Caron3,4
  1. 1Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, Vancouver, Canada
  2. 2Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
  3. 3Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Nathaniel Bell, Department of Surgery, University of British Columbia, Trauma Services, Vancouver General Hospital, 855W. 12th Avenue, Vancouver, BC V5Z 1M9, Canada; nathaniel.bell{at}


Background Aboriginal Canadians are considered to be at increased risk of injury. The de facto standard for measuring injury risk factors among Aboriginal Canadians is to compare hospitalisation and mortality against non-Aboriginal Canadians, but this may be too broad an approach for injury prevention and public health if it over-generalises injury risk.

Methods Data from this study are drawn from the 2001–5 British Columbia Trauma Registry and British Columbia Coroner's Service. Observed and expected hospitalisations and mortality rates on reserves were assessed against three different spatial aggregations of non-reserve reference populations. Data analysis was conducted in a geographical information system using a Poisson probability map.

Results A total of 47 (9.6%) of 487 reserves in British Columbia contained at least one person who was hospitalised or died as a result of serious injury during the study period. Of these, two reserve populations represented 20% (n=19) of all injury morbidity events and 30% (n=22) of all mortality events.

Conclusion Evidence from this study suggests that community-based rather than provincial-based injury reporting is less likely to over-generalise the burden of injury among Aboriginal communities. Community-based surveillance enables researchers to identify why severe unintentional and intentional injury continues to burden some communities but not others and avoids the potentially demoralising and stigmatising effects of current surveillance practices.

  • Aboriginal
  • Canada
  • critical public health
  • injury
  • methods
  • public health
  • risk factors
  • surveillance

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  • Funding Funding for this research was provided by the Michael Smith Foundation for Health Research (IN-RUS-0186). Funding for N Bell is provided by a fellowship awarded by the Canadian Institute for Health Research.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of British Columbia.

  • Provenance and peer review Not commissioned; externally peer reviewed.