Raghavan Malathi, Martens Patricia J, Burchill Charles
Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
Rural Remote Health. 2014;14(3):2846. Epub 2014 Aug 15.
Despite a reported socioeconomic gradient in health, little is known about relationship between socioeconomic status (SES) and frequency of dog-bite injuries. The primary objective of this study was to compare the frequency of dog-bite injuries, using data on dog-bite injury hospitalizations (DBIH), across different SES areas in Manitoba, Canada. The secondary objective of the study was to assess if frequency and pattern of DBIHs are similar to those of non-canine bite injury hospitalizations (NCBIH) and rabies post-exposure prophylaxis (PEP). SES grouping in this study was defined through rurality and area-wide income quintile groups.
Rural and urban Manitoba neighbourhoods were ranked according to average area-level incomes into five levels (quintiles) with equal numbers of people in each income level. Prevalence was defined as the number of cases of hospitalizations (whether dog-bite injury or non-canine bite injury) or PEP reported in the years 1984-2006, divided by the total population during the same time period and expressed as the number of cases per 100 000 population per SES grouping. The 95% confidence intervals (CI) were calculated using the approach for Poisson distribution.
During 1984-2006, Manitoba's prevalence (CI) of DBIH (3.19 (2.97, 3.41) per 100 000 population) was lower than prevalence of NCBIH (4.08 (3.84, 4.32)) and PEP (7.24 (6.92, 7.57)). Prevalence of DBIH was higher in rural than in urban areas (DBIH: 3.58 (3.24, 3.92) vs 2.87 (2.59, 3.15), p<0.01) and higher in the lowest income quintile areas than in the highest, whether rural (5.18 (4.24, 6.26) vs 3.29 (2.55, 4.17), p<0.0001) or urban (3.65 (2.97, 4.44) vs 2.24 (1.73, 2.87), p<0.01). The patterns of relationship between SES (rurality and income levels) and prevalence of NCBIH and PEP were similar to those between SES and DBIH.
Although only a descriptive study, the results suggest that policies for control of dog-bite injuries should be area-specific. Prevention efforts could perhaps be improved by focussing not only on families, but also on neighbourhood regions.
尽管据报道健康状况存在社会经济梯度，但对于社会经济地位（SES）与犬咬伤频率之间的关系却知之甚少。本研究的主要目的是利用加拿大曼尼托巴省不同SES地区犬咬伤住院（DBIH）数据，比较犬咬伤的频率。该研究的次要目的是评估DBIH的频率和模式是否与非犬咬伤住院（NCBIH）及狂犬病暴露后预防（PEP）的频率和模式相似。本研究中的SES分组是通过农村地区和全区域收入五分位数组来定义的。
根据平均地区收入水平，将曼尼托巴省的农村和城市社区分为五个等级（五分位数），每个收入水平的人数相等。患病率定义为1984 - 2006年期间报告的住院病例数（无论是犬咬伤还是非犬咬伤）或PEP病例数，除以同一时期的总人口，并表示为每个SES分组每10万人口中的病例数。使用泊松分布方法计算95%置信区间（CI）。
在1984 - 2006年期间，曼尼托巴省DBIH的患病率（CI）为每10万人口3.19（2.97，3.41），低于NCBIH的患病率（4.08（3.84，4.32））和PEP的患病率（7.24（6.92，7.57））。农村地区DBIH的患病率高于城市地区（DBIH：3.58（3.24，3.92）对2.87（2.59，3.15），p<0.01），最低收入五分位数地区的患病率高于最高收入五分位数地区，无论是农村地区（5.18（4.24，6.26）对3.29（2.55，4.17），p<0.0001）还是城市地区（3.65（2.97，4.44）对2.24（1.73，2.87），p<0.01）。SES（农村地区和收入水平）与NCBIH及PEP患病率之间的关系模式与SES和DBIH之间的关系模式相似。
尽管这只是一项描述性研究，但结果表明，控制犬咬伤的政策应因地制宜。预防工作可能不仅要关注家庭，还要关注邻里区域，从而得到改进。
