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Traumatic brain injury in a rural indigenous population in Canada: a community-based approach to surveillance
Oliver Lasry1, Roy W Dudley1, Rebecca Fuhrer1
1Department of Epidemiology, Biostatistics and Occupational Health (Lasry, Fuhrer), McGill University, Montréal, Que.; Department of Neurosurgery (Lasry, Marcoux), McGill University Health Centre - Montréal General Hospital, Montréal, Qué.; Department of Surgery (Dudley), Division of Neurosurgery, McGill University Health Centre - Montréal Children's Hospital, Montréal, Qué.; Department of Public Health (Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Qué.; Department of Public Health (Carlin), Cree Board of Health and Social Services of James Bay, Montréal, Qué.
Background:
Indigenous populations are disproportionately affected by traumatic brain injury. These populations rely on large jurisdiction surveillance efforts to inform their prevention strategies, which may not address their needs. We examined the incidence and determinants of traumatic brain injury in an indigenous population in the Terres-Cries-de-la-Baie-James health region of the province of Quebec and compared them with the incidence and determinants in 2 neighbouring health regions and in the province overall.
Methods:
We conducted a retrospective population-based cohort study of patients in Quebec admitted to hospital with incident traumatic brain injury, stratified by health region (Terres-Cries-de-la-Baie-James, Nunavik and Nord-du-Québec), from 2000 to 2012. We used MED-ÉCHO administrative data for case-finding. A subgroup analysis of adults in the Terres-Cries-de-la-Baie-James health region was completed to assess determinants of the severity of traumatic brain injury and patient outcomes.
Results:
A total of 172 hospital admissions for incident traumatic brain injury occurred in the Terres-Cries-de-la-Baie-James region during the study period. The incidence was 92.1 per 100 000 person-years, and the adjusted incidence rate ratio was 1.84 (95% confidence interval 1.56-2.17) compared with the entire province. The incidence was higher than in the neighbouring nonindigenous population (Nord-du-Québec) but significantly lower than in the neighbouring indigenous population (Nunavik). Determinants of traumatic brain injury in the Terres-Cries-de-la-Baie-James region differed from those in the neighbouring populations and in the entire province.
Interpretation:
We found that the incidence rates and determinants of traumatic brain injury requiring hospital admission varied greatly between the three regions studied. Community-based surveillance efforts should be encouraged to inform the development of relevant prevention strategies.
