Saunders Natasha Ruth, Macpherson Alison, Guan Jun, Sheng Lisa, Guttmann Astrid
The Hospital for Sick Children (Saunders, Guttmann); Department of Pediatrics (Saunders, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Saunders, Macpherson, Guan, Sheng, Guttmann); York University (Macpherson); Institute of Health Policy, Management and Evaluation (Guttmann); Dalla Lana School of Public Health (Guttmann), University of Toronto; Child Health Evaluative Sciences (Guttmann), SickKids Research Institute, Toronto, Ont.
CMAJ Open. 2017 Jan 27;5(1):E90-E96. doi: 10.9778/cmajo.20160099. eCollection 2017 Jan-Mar.
Unintentional injury is the leading cause of childhood death. Injury is associated with a number of sociodemographic characteristics, but little is known about risk in immigrants. Our objective was to examine the association between family immigrant status and unintentional injury in children and youth.
We performed a population-based, cross-sectional study involving children and youth (age 0-24 yr) residing in Ontario from 2008 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by family immigrant status. Unintentional injury events (e.g., emergency department visits, admissions to hospital, deaths) were analyzed using Poisson regression models to estimate rate ratios (RRs) for injury by immigrant status.
Annualized injury rates were 11 749 emergency department visits per 100 000 population, 267 hospital admissions per 100 000 population and 12 deaths per 100 000 population. Injury rates were lower among immigrants across all causes of unintentional injury (adjusted RR 0.56, 95% confidence interval [CI] 0.54-0.59). Among nonimmigrants, lowest neighbourhood income quintile was associated with the highest rates (RR 1.13, 95% CI 1.08-1.18, quintile 5 v. 1); among immigrants, lowest income quintile was associated with the lowest rates of injury (RR 0.88, 95% CI 0.82-0.94, quintile 5 v. 1). Highest rates of injury for nonimmigrants were among adolescents (age 10-14 yr, RR 1.23, 95% CI 1.18-1.28; v. 20-24 yr), but for immigrants, was highest among young children (0-4 yr RR 1.23, 95% CI 1.16-1.31; v. 20-24 yr).
Rates of unintentional injury are lower among immigrant than among Canadian-born children, supporting a healthy immigrant effect. Socioeconomic status and age have different associations with injury risk, suggesting alternative causal pathways for injuries in immigrant children and youth.
意外伤害是儿童死亡的主要原因。伤害与一些社会人口学特征相关，但对于移民中的风险情况却知之甚少。我们的目的是研究家庭移民身份与儿童和青少年意外伤害之间的关联。
我们开展了一项基于人群的横断面研究，研究对象为2008年至2012年居住在安大略省的儿童和青少年（0至24岁）。使用多个相互关联的健康和行政数据库，按家庭移民身份描述意外伤害情况。采用泊松回归模型分析意外伤害事件（如急诊就诊、住院、死亡），以估计不同移民身份的伤害发生率比（RRs）。
年伤害发生率为每10万人中有11749次急诊就诊、每10万人中有267次住院以及每10万人中有12例死亡。在所有意外伤害原因中，移民的伤害发生率较低（调整后的RR为0.56，95%置信区间[CI]为0.54 - 0.59）。在非移民中，邻里收入最低五分位数组的发生率最高（RR为1.13，95% CI为1.08 - 1.18，五分位数5与1相比）；在移民中，收入最低五分位数组的伤害发生率最低（RR为0.88，95% CI为0.82 - 0.94，五分位数5与1相比）。非移民中伤害发生率最高的是青少年（10至14岁，RR为1.23，95% CI为1.18 - 1.28；与20至24岁相比），但在移民中，幼儿（0至4岁，RR为1.23，95% CI为1.16 - 1.31；与20至24岁相比）的伤害发生率最高。
移民儿童的意外伤害发生率低于加拿大本土出生的儿童，这支持了健康移民效应。社会经济地位和年龄与伤害风险有不同的关联，这表明移民儿童和青少年伤害的因果途径有所不同。
