Individual and area socioeconomic inequalities in cause-specific unintentional injury mortality: 11-Year follow-up study of 2.7 million Canadians

This study investigated the association between individual and area socioeconomic status (SES) and leading causes of unintentional injury mortality in Canadian adults. Using the 1991–2001 Canadian Census Mortality Follow-up Study cohort (N = 2,735,152), Cox proportional hazard regression was used to calculate hazard ratios and 95% confidence intervals for all-cause unintentional injury, motor vehicle collision (MVC), fall, poisoning, suffocation, fire/burn, and drowning deaths. Results indicated that associations with SES differed by cause of injury, and were generally more pronounced for males. Low education was associated with an elevated risk of mortality from all-cause unintentional injury and MVC (males only) and poisoning and drowning (both sexes). Low income was strongly associated with most causes of injury mortality, particularly fire/burn and poisoning. Having no occupation or low occupational status was associated with higher risks of all-cause injury, fall, poisoning and suffocation (both sexes) and MVC deaths among men. Associations with area deprivation were weak, and only areas with high deprivation had elevated risk of all-cause injury, MVC (males only), poisoning and drowning (both sexes). This study reveals the importance of examining SES differentials by cause of death from a multilevel perspective. Future research is needed to clarify the mechanisms underlying these differences to implement equity-oriented approaches for reducing differential exposures, vulnerability or consequences of injury mortality.