A Spatial Epidemiology of Trauma: Social and Spatial Perspectives Toward Injury

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in North America and around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. In particular, recent integration of geographic information systems (GIS) is beginning to demonstrate the power of mapping and spatial analysis for better understanding these determinants. This dissertation demonstrates the utility of GIS for better understanding incidence patterns of injury using five different case studies. Each case study is an independent investigation, however all five studies converge on three research questions. First, is there a relationship between geographic scale, socio-economic status, and incidence patterns of intentional injury? Second, would information from this analysis possibly go unnoticed if spatial analysis and mapping are not used to analyze the data? Third, can GIS be used to better explain relationships between incidence patterns of injury and social and demographic data over and above non-spatial surveillance practices? To answer question one, multilevel modeling and scale and zoning restructuring analysis of iii Census boundaries were employed. Data were analyzed for the following injuries: assault, suicide, motor vehicle collisions, falls, and pedestrian. To answer question two, a spatial autocorrelation test was used and analyzed against intentional injuries. Finally, to answer question three Poisson probability mapping was applied using a dichotomized classification of intentional and unintentional injury. All data are inclusive to populations living in the province of British Columbia between 2001 and 2006. Secondary data sources included 2001 Census spatial and socio-economic records, British Columbia Trauma Registry data, and provincial Coroner records. Results indicate that severe injury morbidity and mortality in British Columbia follows a social gradient. However, this relationship is not universal and can vary according to the Census indicator, the injury, as well as the size and scope of the administrative boundaries used to assess the relationship. Further commitment by injury preventionists and Geographic Information Scientists is necessary to yield new knowledge about social and spatial determinants of injury.