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Trends in unintentional injury mortality in Canadian children 1950−2009 and association with selected population-level interventions

Sarah A. Richmond, Jennifer D'Cruz, Armend Lokku, Alison Macpherson, Andrew Howard, Colin Macarthur

Abstract


OBJECTIVES: To examine unintentional injury mortality rates in children (0−19 years) in Canada from 1950 to 2009 against national population-level injury prevention interventions.

METHODS: Injury mortality rates were age and sex adjusted. Changes in trend and level of mortality rates were assessed at pre-specified intervention periods using segmented linear regression analyses for interrupted time series. Maximum likelihood estimation was used with a second order autoregressive error process.

RESULTS: From 1950 to 2009, the overall unintentional injury mortality rate decreased by 86%. Males had consistently higher mortality rates compared to females; however, the standardized rate ratio decreased from 2.37:1 in 1950 to 1.97:1 in 2009. Substantial declines in choking/suffocation deaths were noted in children less than 1 year of age, predominantly during the period 1970−1988 when the Hazardous Products Act and Crib Regulations were implemented. For burns, significant changes in slope were noted comparing 1972–1994 to pre-1971 (introduction of the Hazardous Products Act – Flammability Regulations), where the greatest decline was noted in children ages 1–4 years (Est. = −0.03, 95% CI = −0.02, −0.04). For 15−19 year olds, there was a 408% increase in motor vehicle collision-related mortality rates between 1950 and 1971; however a significant change in slope was noted during the period 1978–1985, compared to 1972–1977 (Est. = −0.10, 95% CI = −0.20, −0.007) across all age groups.

CONCLUSION: While this study is not a cause and effect analysis, there is a strong association with implementation of safety campaigns and legislative changes related to child safety and a dramatic decline in childhood fatalities related to injury.


Keywords


Adolescent; Canada/epidemiology; cause of death; mortality/trends; wounds and injuries/mortality; wounds and injuries/prevention & control; child; preschool; infant

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DOI: http://dx.doi.org/10.17269/cjph.107.5315