Social inequities in injury-attributable emergency department visits across Alberta: an ecological study

Injury is a leading cause of death and disability in Canada, and injury rates are disproportionately higher in Alberta. Limited evidence suggests that social inequities, including income inequality, may contribute to injury risk through differential exposure to hazards and unequal access to prevention and care. The objective of this study is to examine the ecological association between income inequality and rates of injury-attributable emergency department (ED) visits in Alberta from 2013 to 2022.

Data on social inequities were from the 2016 Census and injury-attributable ED data were from Alberta Health (2013-2022). We analysed the association between income inequality and injury mechanisms (eg, falls, poisoning) using negative binomial regression models.

Over the 10-year study period, there were 5.37 million injury-attributable ED visits in Alberta, most commonly from falls and being struck by or against objects, with moderate variation in social inequities across forward sortation areas. Higher income inequality was significantly associated with higher rates of several injury mechanisms, including burns (incidence rate ratio (IRR): 1.08, 95% CI 1.02 to 1.14), poisoning (IRR: 1.18, 95 % CI 1.10 to 1.26) and environmental injuries (IRR: 1.11, 95% CI 1.06 to 1.2). Higher income inequality was associated with a reduced risk of drownings (IRR: 0.93, 95% CI 0.90 to 0.97), falls (IRR: 0.82, 95% CI 0.79 to 0.85) and motor vehicle collisions (IRR: 0.90, 95% CI 0.87 to 0.93).

The results highlight that income inequality was associated with a variety of injury outcomes and overall the findings were mixed, with some risk of injuries increasing and some decreasing with higher levels of income inequality. These findings may lend strength to discussion on integrating equity-informed approaches to injury prevention strategies. Policies that improve neighbourhood safety and enhance equitable access to healthcare may help reduce the disproportionate injury burden experienced by populations experiencing social inequity.