NEIGHBOURHOOD-LEVEL BUILT ENVIRONMENT PREDICTORS OF CHILDHOOD INJURY RISK A DEVIANT CASE APPROACH IN CALGARY, CANADA

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1 NEIGHBOURHOOD-LEVEL BUILT ENVIRONMENT PREDICTORS OF CHILDHOOD INJURY RISK A DEVIANT CASE APPROACH IN CALGARY, CANADA Julie Kryzanowski MD, CCFP Department of Community Health Sciences University of Calgary

2 Injury as a cause of death in Alberta, Alberta Centre for Injury Control & Research. (2007). Children and Youth Injuries in Alberta. Edmonton: ACICR. Years

3 Injury mortality and obesity in Canadian children, Statistics Canada. (2005). Measured obesity: overweight Canadian children and adolescents. Catalogue no MWE n.gc.ca/pub/ m/ /pdf/ eng.pdf PHAC. Injury Surveillance On- Line. Unintentional injury mortality over time.

4 Rationale Childhood injury rates are decreasing, but: Declines in childhood injury rates parallel declines in physical activity levels (Carver et al., 2008) Socioeconomic-injury gradients persist (Roberts & Power, 1996; Birkin et al., 2006) Built and social environments are determinants of health behaviours and health outcomes Underlying mechanisms are not well understood

5 Purpose To explore the spatial distribution of child pedestrian and bicyclist injuries within an urban environment To examine the relationship between injury rates and environmental attributes associated with physical activity for neighbourhoods of differing socioeconomic status

6 Theoretical framework Determinants of health and environmental health promotion Fundamental Determinants Intermediate Determinants Proximate Determinants Health & Well-being Socioeconomic Inequalities Built Environment Safety Injury Walkability Physical Activity Adapted from Schulz A & Northrup ME. (2004) Health Education & Behaviour, 31,

7 Methodology: 3-phase approach Population-level mapping study Map injury rates by neighbourhood (ArcGIS 9.2) Alberta Health Services utilization (ICD-10) ( ) Alberta Transportation Collision Information System statistics ( ) Population-level risk analysis Stratify neighbourhoods by SES Canadian Census (2006) (linked to Calgary neighbourhoods) Index of Economic Well-Being (City of Calgary) Poverty, employment, and housing indicators Neighbourhood-level divergent case study Audit of environmental features for neighbourhoods with high and low injury rates within each strata

8 Results: Calgary neighbourhoods show variability in injury rates Calgary Neighbourhood s by Injury Rank Alberta Health Services. Emergency department visits for pedestrian and bicycle Injuries in children <15 years,

9 Results: Neighbourhood SE status varies differently across Calgary Calgary Neighbourhood ods s by by Index of Economic Well- Being Canadian Census, 2006

10 Results: Motor vehicle-related injuries cluster in low SE neighbourhoods Injury Locations in Calgary Neighbourhoods by Injury Rank and Economic Well-Being Alberta Transportation Collision Information System. Reported pedestrian and bicycle Injuries in children <15 years.,

11 Results: Motor vehicle-related injuries are related to neighbourhood SE gradient Neighbourhood SE Index High 4.4 (2.8 to 5.9)* [83] Mean Crude Motor Vehicle-Related Injury Rate per 1000 children <15 years, All (95% CI) [n] High (95% CI) [n] Low (95% CI) [n] 2.8 (0.9 to 4.6) [9] 3.2 (-1.4 to 7.8) [21] Medium 10.9 (3.1 to 18.7) [56] 4.5 (1.3 to 7.8) [7] 4.4 (1.0 to 7.8) [9] Low 8.0 (6.4 to 9.6)* [47] 8.6 (5.9 to 11.3) [7] 6.5 (1.5 to 11.5) [6]

12 Results: Significant differences in injury rates are unrelated to neighbourhood SE Neighbourhood SE Index High 29.9 (22.8 to 37.1) [83] Mean Crude Injury Rate per 1000 children <15 years, All (95% CI) [n] High (95% CI) [n] Low (95% CI) [n] 50.8 (45.8 to 55.7)* [9] 9.3 (6.6 to 11.9)* [21] Medium 39.5 (27.5 to 51.5) [56] 54.1 (45.2 to 63.1) [7] 13.8 (8.5 to 19.0) [9] Low 26.7 (23.9 to 29.4) [47] 42.1 (37.1 to 47.1) [7] 12.6 ( ) [6]

13 Conclusion and next steps BUILT ENVIRONENT MAY BE GREATER PREDICTOR OF INJURY RISK THAN SES Built Environment Safety WHAT DETERMINES RISK?: NEIGHBOURHOOD AUDITS MADGIC GIS database Irvine-Minnesota Invent y: Safety from traffic Safety from crime Accessibility Pleasurability Walkability

14 Acknowledgements Dr. Lynn McIntyre, Dr. Lindsay McLaren (Dept. Community Health Sciences, University of Calgary) Dr. David Strong, Sherry Elnitsky, Nancy Staniland, Diane Moser (Alberta Health Services, Calgary) Dr. Brent Hagel, Dr. Judy Siedel (Alberta Children s Hospital, Calgary) Peter Peller (MADGIC GIS Services Desk, University of Calgary) Alberta Transportation City of Calgary Thank you

15 References World Health Organization. (2008). World report on child injury prevention. Geneva: Author. Public Health Agency of Canada. (2007). CHIRRP. Accessed March 24, 2009 from Alberta Centre for Injury Control & Research. (2007). Children and youth injuries in Alberta. Edmonton: Author. Retrieved October 12, 2008 from Roberts I & Power C. (1996). BMJ, 313, Birkin CS, Parkin PC, To T, et al. (2006). CMAJ, 175, 867. Carver A, Timperio A, Crawford D. (2008). Health & Place, 14, Brugge D, Lai Z, Hill C, et al. (2002). J Urban Health, 79, LaScala EA, Gruenwald PJ, Johnson FW. (2004). Accid Anal Prev, 32, Roberts I, Norton R, Jackson R, et al. (1995). BMJ, 310, Ewing R. (2006). Fatal and Non-fatal Injuries. LEED-ND Core Committee. Retting RA, Ferguson SA, McCartt AT. (2003). Am J Public Health, 93, Tester JM, Rutherford GW, Wald Z, Rutherford MW. (2004). Am J Public Health, 94, Carver R, Kockelman KM. (1997). Transport Res-D, 2, Pikora T, Bull F, Jamrozik K, et al. (2002). Am J Prev Med, 23,