P o p u l at i o n H e a lt h S e rv i c e s
2006
H AL D I M AN D - NO R F OL K
Unintentional
Injur y Repor t
Message from the Acting Medical Officer of Health
September, 2006.
According to the 2002 Chief Medical Officer of Health Report, “Injury: Predictable and Preventable” the impact of
injury is enormous in terms of mortality, morbidity, economic, and personal costs. It is fundamentally understood
that unintentional injuries are both predictable and preventable.
Injuries are categorized as being unintentional or intentional. Unintentional injuries are injuries that are not purposefully inflicted, whereas intentional injuries are injuries that are sustained from violence and suicide. To delineate the
scope of the research, unintentional injuries were examined.
The goal of the Unintentional Injury Report was to provide an overview of injuries in Haldimand and Norfolk
based on selected unintentional injury indicators. The Unintentional Injury Report is an important document for
understanding unintentional injury trends over a period of time, compared to Ontario. Besides providing new information about injuries in Haldimand-Norfolk compared with Ontario, a valuable overview of Haldimand-Norfolk
Health Units injury prevention public health initiatives are included in this report. It is intended to provide physicians, health care professionals, local politicians, the media, health units, schools, local government, and the general
public with useful information for the purpose of program planning and injury prevention.
Understanding unintentional injury trends can assist program planners in developing and implementing injury prevention programs that target the needs of Haldimand-Norfolk residents, and reduce the burden injuries place on
our community. In this report, future recommendation will be outlined.
Sincerely,
Jeff Tschirhart, M.D., C.C.F.P.
Acting Medical Officer of Health
Haldimand-Norfolk Health Unit
Unintentional Injury Report - 2006
Acknowledgements
Author
Deanna Tries, MA
Epidemiologist
Haldimand-Norfolk Health Unit
519-426-6170 Ext. 3215
[email protected]
I would like to thank the following participants for their contributions to the Unintentional Injury Report 2006:
Reviewers
Karen Boughner, RN, BScN
Manager, Public Health
Haldimand-Norfolk Health Unit
Dr. Jeff Tschirhart, MD
Acting Medical Officer of Health
Haldimand-Norfolk Health Unit
Patti Moore, RN, BScN, MPA
General Manager
Health and Social Services Dept.
Norfolk County
Jill Steen, BSc, MHSc
Program Co-ordinator, Population Health
Haldimand-Norfolk Health Unit
Layout and Design
Linda Schelstraete
Haldimand-Norfolk Health Unit
Joanne Alessi, RN, BScN
Public Health Nurse, Injury Prevention
Population Health
Haldimand-Norfolk Health Unit
Karin Marks, ECE
Health Promoter, Child Injury & Family Violence
Prevention
Population Health
Haldimand-Norfolk Health Unit
Michelle Lyne, BSc, MPH
Health Promoter, Substance Abuse Prevention
Population Health
Haldimand-Norfolk Health Unit
Executive Summary
The Unintentional Injury Report 2006 is the first focused injury report to be completed for
Haldimand and Norfolk. The Unintentional Injury Report provides an overview of unintentional
injuries in Haldimand and Norfolk based on selected unintentional injury indicators. This report is
an important document for understanding unintentional injury trends over a period of time, compared to Ontario. Besides providing new information about unintentional injuries in HaldimandNorfolk compared to Ontario, a valuable overview of Haldimand-Norfolk Health Unit injury
prevention public health initiatives are included in this report. It is intended to provide physicians,
health care professionals, local politicians, the media, health units, schools, local government and
the general public with useful information for the purpose of program planning and injury prevention. This executive summary lists some of the key highlights of the report. A glossary is provided
at the back of the report, along with 1991 Canadian Adjusted Standard Population, SRATE and
SHR/SMR formulas, and International Classification of Diseases codes ICD-9 and ICD-10 for further clarification. The reader is encouraged to review the glossary and then read the full report
in order to fully understand the analysis and interpretation. The complete report may be downloaded from the Health Unit website www.hnhu.org.
Injury Prevention Programs
The programs offered at the Health Unit include:
• Are You in Jeopardy
• Knowledge is the Best Medicine
• Stepping Out Safely
• Communities and Hospitals Against Trauma (C.H.A.T.)
• Risk Watch
• Summer Safety
• Operation Lookout
• The Last Drink Campaign
• Bike Rodeos and Bicycle Safety Campaign
• Car Seat Safety
• Home Safety Kits
• Hazard House
• Think of Me
• Booster Seat Legislation
• Resources for Parents/Caregivers
Unintentional Injury Hospitalization Separations
• The average age standardized hospitalization rates for unintentional injuries was higher in
Haldimand-Norfolk compared to the province.
• Based on selected injury indicators, the average age standardization hospitalization rate was
higher for each indicator compared to Ontario.
• Based on selected injury indictors the average age standardized hospitalization rates in
Haldimand-Norfolk were highest for injuries resulting from falls, motor vehicle traffic crashes,
poisonings, sports injuries, other off-road motor vehicles and external causes of burns.
Unintentional Injury Report - 2006
• For the years 2000-2004, significant differences were found for unintentional injuries and motor
vehicle traffic crashes for Haldimand-Norfolk compared to Ontario.
• With the exception of 2000, significant differences were found for other off-road motor vehicles for Haldimand-Norfolk compared to Ontario.
Unintentional Injuries
• Between the years 2000-2004, the age standardized hospitalization rates for unintentional injuries in Haldimand-Norfolk was consistently higher than Ontario.
• The average hospitalization rate for unintentional injuries (2000-2004) in Haldimand-Norfolk
was 657.0/100,000, compared to Ontario 498.2/100,000.
• The age standardized hospitalization rates for unintentional injuries among females and males in
Haldimand-Norfolk was consistently higher than Ontario from 2000-2004.
• Haldimand-Norfolk males average hospitalization rate (2000-2004) for unintentional injuries
was higher compared to Haldimand-Norfolk females (722.9/100,000 and 591.6/100,000 respectively).
• From 2000-2004, the age standardized hospitalization ratios for unintentional injuries was significantly higher each year than the province—on average 26%.
• There were significant differences found for unintentional injuries for Haldimand-Norfolk males
and their Ontario counterparts for each successive year (2000-2004).
• Significant differences were found for unintentional injuries between Haldimand-Norfolk
females and their Ontario counterparts for 2003 and 2004.
Motor Vehicle Traffic Crashes (MVTC)
• The age standardized hospitalization rates for MVTC for Haldimand-Norfolk was consistently
higher than Ontario (2000-2004).
• The average MVTC hospitalization rate (2000-2004) for Haldimand-Norfolk was 97.3/100,000,
compared to Ontario 55.0/100,000.
• The age standardized hospitalization rates for MVTC among females and males in HaldimandNorfolk was consistently higher than Ontario (2000-2004).
• Haldimand-Norfolk males average hospitalization rate (2000-2004) for MVTC was higher compared to Haldimand-Norfolk females (125.7/100,000 and 68.3/100,000 respectively).
• The standardized hospitalization ratios for MVTC was significantly higher in Haldimand-Norfolk
compared to Ontario for each successive year (2000-2004).
• There were significant differences for MVTC between Haldimand-Norfolk males and females
for each successive year (2000-2004) compared to their Ontario counterparts.
Falls
• The age standardized hospitalization rates for falls in Haldimand-Norfolk was consistently higher than Ontario for each successive year (2000-2004).
• Overall, the average hospitalization rate for falls was higher in Haldimand-Norfolk
(328.5/100,000) compared with Ontario (284.1/100,000).
• Falls among females and males was consistently higher for each year in Haldimand-Norfolk,
compared to Ontario.
• A higher proportion of hospitalization rates due to falls were found among older adults aged
65 years and older for both Haldimand-Norfolk and Ontario.
• Haldimand-Norfolk females average hospitalization rate (2000-2004) for falls was higher compared to Haldimand-Norfolk males (370.0/100,000 and 288.6/100,000 respectively).
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Executive Summary
• The standardized hospitalization ratios for falls were significantly higher in Haldimand-Norfolk
for 2003 and 2004, compared with Ontario.
• For the years 2003 and 2004, significant gender differences for falls were found in HaldimandNorfolk compared to the province.
External Causes of Burns
• The age standardized hospitalization rates for external causes of burns was slightly higher in
Haldimand-Norfolk than Ontario for 2000, 2001, 2003 and 2004.
• The average hospitalization rate (2000, 2001, 2003 and 2004) due to external causes of burns
was slightly higher in Haldimand-Norfolk (11.7/100,000) compared to Ontario (8.3 /100,000).
• The age standardized hospitalization rates for external causes of burns among males were
found to be predominately higher for each year in Haldimand-Norfolk compared to Ontario
for 2000, 2001, 2003 and 2004.
• The standardized hospitalization ratio for external burns for males in 2003 was twice that in
Ontario.
Poisonings
• The age standardized hospitalization rates for poisonings in Haldimand-Norfolk was slightly
higher than Ontario for each successive year (2000-2004).
• The average hospitalization rate for poisonings was slightly higher in Haldimand-Norfolk
(27.1/100,000) compared with Ontario (20.3/100,000).
• The average age standardized hospitalization rate for poisonings among females and males was
slightly higher in Haldimand-Norfolk compared to Ontario.
• Haldimand-Norfolk females average hospitalization rate (2000-2004) for poisonings was higher
compared to Haldimand-Norfolk males (32.1/100,000 and 22.3/100,000 respectively).
• The standardized hospitalization ratios for poisonings in Haldimand-Norfolk was significantly
higher than Ontario for 2003 and 2004.
Other Off-Road Motor Vehicle
• The age standardized hospitalization rates for other off-road motor vehicle crashes in
Haldimand-Norfolk was slightly higher than Ontario for each successive year (2000-2004).
• The average hospitalization rate for other off-road motor vehicle crashes was approximately
three times higher in Haldimand-Norfolk (12.4/100,000) compared with Ontario (4.5/100,000),
with the highest hospital rate reported in 2004 (16.0/100,000).
• Off-road motor vehicle crashes among males in Haldimand-Norfolk was higher for each successive year (2000-2004) compared to Ontario.
• The standardized hospitalization ratios for other off-road motor vehicles was twice that in
Ontario for 2001 and 2003 and three times of the province in 2002 and 2004.
• There were significant differences found between Haldimand-Norfolk males and their Ontario
counterparts (2001-2004) for other off-road motor vehicle crashes.
Sports Injuries
• The age standardized hospitalization rates for sports injuries was predominately higher in
Haldimand-Norfolk, with the exception of 2000 and 2002.
• The average hospitalization rate for sports related injuries was slightly higher in HaldimandNorfolk (15.1/100,000) compared with Ontario (9.7/100,000).
• Sports injuries among males in Haldimand-Norfolk were higher in 2001, 2003 and 2004, compared to Ontario.
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Unintentional Injury Report - 2006
• In 2001 and 2004, the age standardized hospitalization ratios for sports injuries was significantly
higher than the province.
Unintentional Injury Mortality
• The average age standardized mortality rates for unintentional injuries was higher in
Haldimand-Norfolk compared to the province (27.3/100,000 and 21.9/100,000 respectively).
• Based on selected injury indicators (MVTC and falls) the average age standardization hospitalization rate was higher for each indicator compared to Ontario.
• There was no statistical difference compared to the province as a whole.
• Based on selected injury indictors the average age standardized mortality rate in HaldimandNorfolk was highest for injuries resulting from MVTC, followed by falls.
Unintentional Injuries
• Compared to the province, the age standardized mortality rates for unintentional injuries in
Haldimand-Norfolk was slightly higher for each successive year (2000-2002).
• The average age standardized mortality rate in Haldimand-Norfolk for unintentional injuries
was slightly higher (27.3/100,000) compared to Ontario (21.9/100,000).
• For Haldimand-Norfolk females the average mortality rate for unintentional injuries was
20/100,000 compared to Ontario (18.0/100,000).
• The average mortality rate for unintentional injuries among Haldimand-Norfolk males was
slightly higher (34.3/100,000) compared to Ontario males (26.0/100,000).
• The standardized mortality ratios for unintentional injury deaths in Haldimand-Norfolk showed
no statistical differences compared to the province as a whole.
Motor Vehicle Traffic Crashes (MVTC)
• The age standardized mortality rates for MVTC in Haldimand-Norfolk was slightly higher for
each successive year (2000-2002).
• The average age standardized mortality rate in Haldimand-Norfolk for MVTC was slightly higher (8.1/100,000) compared to Ontario (5.1/100,000).
• The standardized mortality ratios for MVTC deaths in Haldimand-Norfolk showed no statistical
differences compared to the province as a whole.
Falls
• The age standardized mortality rates for falls was slightly higher for 2001 and comparable to
the province in 2002.
• From 2001 to 2002, the average age standardized mortality rate in Haldimand-Norfolk for falls
was slightly higher (6.9/100,000) compared to Ontario (5.5/100,000).
• Haldimand-Norfolk females were found to have a higher age standardized mortality rates for
falls for each successive year (2001 and 2002) compared to Ontario females.
• The standardized mortality ratios for deaths due to falls in Haldimand-Norfolk showed no statistical differences compared to the province as a whole.
Emergency Room (ER) Visits
• The age specific rate for unintentional injuries emergency room visits was higher in HaldimandNorfolk compared to the province.
• The age specific rate for both females and males in Haldimand-Norfolk for selected unintentional injury indicators was higher compared to the province.
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Executive Summary
• Based on selected unintentional injury indictors, the rate for emergency room visits was highest
for injuries resulting from falls (41.0/1,000), MVTC (10.5/1,000) and sports injuries (4.9/1,000).
Unintentional Injuries
• The age specific rate for unintentional injuries emergency room visits in Haldimand-Norfolk
was higher compared to Ontario (157.1/1000 and 98.4/1000 respectively).
• The age specific rate for both females and males in Haldimand-Norfolk for unintentional injuries was higher compared to the province.
• The highest rate for unintentional emergency room visits in Haldimand-Norfolk was found in
persons aged 14-20 (248.4/1000).
Motor Vehicle Traffic Crashes (MVTC)
• The age specific rate for MVTC emergency room visits in Haldimand-Norfolk was slightly higher, compared to Ontario (10.5/1000 and 6.4/1000 respectively).
• The age specific rate for both females and males in Haldimand-Norfolk for MVTC emergency
room visits was higher, compared to the province.
• The highest rate for MVTC emergency room visits in Haldimand-Norfolk was found in persons
aged 14-20 (21.6/1000).
Pedestrian (Traffic-Related)
• The age specific rate for pedestrian (traffic-related) emergency room visits in HaldimandNorfolk was the same compared to Ontario (0.3/1000).
• The age specific rate for both females and males in Haldimand-Norfolk for pedestrian emergency room visits (traffic-related) was also the same compared to the province.
• The age specific rate for pedestrian emergency room visits (traffic-related) was relatively low
for both Haldimand-Norfolk and Ontario.
Pedal Cycle
• The age specific rate for pedal cycle emergency room visits in Haldimand-Norfolk was slightly
higher compared to Ontario (2.8/1000 and 1.9/1000 respectively).
• The age specific rate for both females and males for pedal cycle for emergency room visits in
Haldimand-Norfolk was higher compared to the province.
• The highest rate for pedal cycle emergency room visits was found in the age grouping 7-13, for
both Haldimand-Norfolk and Ontario (11.1/1000 and 6.6/1000 respectively).
Other Off-Road Motor Vehicle
• The age specific rate for other off-road motor vehicle emergency room visits in HaldimandNorfolk was slightly higher compared to Ontario (1.1/1000 and 0.4/1000 respectively).
• The age specific rate for both females and males for other off-road motor vehicles emergency
room visits in Haldimand-Norfolk was higher compared to the province.
• The highest rate for other off-road motor vehicle emergency room visits in Haldimand-Norfolk
is found in persons aged 21-27 (3.4/1000).
Falls
• The age specific rate for emergency room visits attributed to falls in Haldimand-Norfolk was
higher compared to Ontario (41.0/1000 and 28.3/1000 respectively).
• The age specific rate for both females and males for emergency room visits attributed to falls in
Haldimand-Norfolk was higher compared to the province.
• The highest rate for falls emergency room visits in Haldimand-Norfolk was found in persons
aged 0-20 and in persons aged 70 and over.
Unintentional Injury Report - 2006
Poisonings
• The age specific rate for emergency room visits resulting from poisonings in HaldimandNorfolk was slightly higher compared to Ontario (2.5/1000 and 1.7/1000 respectively).
• The age specific rate for emergency room visits among females and males for poisonings in
Haldimand-Norfolk was higher compared to the province.
• The highest age specific rate for emergency room visits for poisonings was found in persons
aged 0-6 for both Haldimand-Norfolk and Ontario (7.8/1000 and 3.7/1000 respectively).
Sports Injuries
• The age specific rate for sports injuries emergency room visits in Haldimand-Norfolk was
slightly higher compared to Ontario (4.9/1000 and 3.6/1000 respectively).
• The age specific rate for both females and males for sports injuries emergency room visits in
Haldimand-Norfolk was higher compared to the province.
• The highest rate for sports injury emergency room visits in Haldimand-Norfolk was found in
persons aged 14-20 (22.6/1000), similar to Ontario (15.7/1000).
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Executive Summary
Introduction
The report provides an overview of unintentional injuries in Haldimand and Norfolk based on
selected unintentional injury indicators. Injury is a broad conceptual term that encompasses all
the ways people can get hurt or die.1 More specifically, injuries involve intentional or unintentional
injuries that can cause bodily lesions resulting from a transfer of energy (mechanical, electrical, thermal, radiant, bodily, heat and oxygen). 2 Unintentional injuries are injuries that are not
purposely inflicted. 2 Examples of unintentional injuries include injuries that result from motor
vehicle traffic crashes, poisonings, fires, drowning and suffocation to name a few. 3 Examples
of intentional injury include homicide, family violence and suicide. However, intentional injuries
were not explored in this report. 3 It is important to note that the majority of injuries are predictable and preventable. According to the Chief Medical Officer Report, “Injury: Predictable
and Preventable”, injuries in Ontario are the most pervasive health challenges.1 In Ontario
more than 2000 people are injured every day and one person is injured every minute.1 Injuries
are the fourth leading cause of deaths for Canadians of all ages and the leading cause of death
for Canadians between the ages of 1 and 44. 3 Injuries are also a contributor to potential years
lost.1 The report consists of four chapters: Injury Prevention Programs, Unintentional Injury
Hospitalization Separations, Unintentional Injury Mortality and Unintentional Injury Emergency
Room Visits. The selected unintentional injury indicators presented in this report are as follows:
• Unintentional Injuries
• Motor Vehicle Traffic Crashes (MVTC)
• Pedestrian (Traffic-Related)
• Pedal Cycle
• Other Off-Road Motor Vehicle
• Falls
• External Causes of Burns
• Poisonings
• Sports Injuries
The injuries examined in this report were in part selected in accordance with the Mandatory
Health Programs and Service Guidelines (1997, December), and others based on discussion with
injury prevention program planners. In accordance with the Mandatory Health Programs and
Service Guidelines, the goal of the Injury Prevention and Substance Abuse Prevention program
is, “To reduce disability, morbidity and mortality caused by motorized vehicles, bicycle crashes,
alcohol and other substances, falls in the elderly and to prevent drowning in specific recreational
water facilities”. Specifically the long-term objectives for this program are as follows:
1. To reduce the rates of injuries caused by cycling crashes and motorized vehicle crashes including
boats, snowmobiles and all terrain vehicles that lead to hospitalization or death by 20 per cent by
the year 2010.
2. To reduce the rate of alcohol and other substance-related injuries or deaths by 20 per cent by the
year 2010.
3. To reduce the rate of fall-related injuries in the elderly (aged 65 and over) that lead to hospitalization or death by 20 per cent by the year 2010.
4. To eliminate drowning in waters used for specific recreational purposes.
In 2002, additional funds were allocated to Health Units across Ontario to address injury prevention in preschool children (ages 0-6 years). The overall goal of the Early Childhood Development
Injury Prevention program is “to reduce the incidence of abuse, injury and morbidity of children
0-6 in Haldimand and Norfolk Counties and to decrease unintentional childhood injuries by 5%
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Unintentional Injury Report - 2006
by 2006”. In Haldimand and Norfolk, programs were developed to address local community gaps
and needs in the areas of awareness, education, training and community/system supports for children aged 0-6.
The goal of this report is to provide professionals with useful information for the purpose of
injury prevention programming in relation to the above Mandatory Health Programs and Service
Guidelines. Although this report provides new information, it does not provide data for all of
the long-term objectives as outlined in the Mandatory Health Programs and Service Guidelines.
Both time constraints and data constraints prohibited further examination of additional unintentional injury indicators. Wherever possible, selected unintentional injury indicators were
analyzed. However to ensure that this report captured a true picture of unintentional injuries in
Haldimand-Norfolk and Ontario, selected unintentional injury indicators were sometimes excluded from the analysis because of data limitations (small cell counts).
The report consists of four chapters: Injury Prevention Programs, Unintentional Injury
Hospitalization Separations, Unintentional Injury Mortality and Unintentional Injury Emergency
Room Visits. The first chapter provides a summary of injury prevention programs offered at
the health unit. In accordance with the Mandatory Health Programs and Service Guidelines, the
health unit offers a variety of injury prevention programs targeting early years, children, youth,
adults and seniors. A summary of the programs is outlined in Chapter 1. The programs offered at
the Health Unit include the following:
• Are You in Jeopardy
• Knowledge is the Best Medicine
• Stepping Out Safely
• Communities and Hospitals Against Trauma (C.H.A.T.)
• Risk Watch
• Summer Safety
• Operation Lookout
• The Last Drink Campaign
• Bike Rodeos and Bicycle Safety Campaign
• Car Seat Safety
• Home Safety Kits
• Hazard House
• Think of Me
• Booster Seat Legislation
• Resources for Parents/Caregivers
The second chapter provides an overview of unintentional injuries hospital separations in
Haldimand and Norfolk compared with Ontario over a five year period (2000-2004). Age standardized hospitalization separation rates as well as age standardized hospitalization ratios were
used. Data from 2005 was excluded because the completeness of the data was questionable.
Injury indicators that were examined included the following: unintentional injuries, MVTC, falls,
external causes of burns, poisoning, other off-road motor vehicles and sports injuries.
The third chapter of this report features mortality data resulting from unintentional injuries over
a three year period (2000-2002). Deaths as a result of unintentional injuries, MVTC and falls
were reported for Haldimand-Norfolk compared to Ontario. To date, the latest data released
was 2002. Age standardized mortality separation rate and age standardized mortality ratios were
used to capture differences in Haldimand and Norfolk compared with Ontario. Due to data
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Executive Summary
constraints, unintentional injuries, MVTC and falls were examined. Small cell counts prohibited
further examination of other selected unintentional injury indicators.
The fourth chapter provides an overview of unintentional injuries emergency room visits in
Haldimand-Norfolk and Ontario for the calendar year 2004. Data prior to 2004 was excluded
because the data was incomplete. However, it is important to note that in 2004 some institutions
reported data for a partial year as a result of hospital closure and SARS.4 Since the intent of the
report is to provide data for planning community strategies in the area of injury prevention, age
specific rates were used to mirror the age groupings used by program planners. Unintentional
injury indicators that were examined included the following: unintentional injuries, MVTC, pedestrian (traffic-related), pedal cycle, other off-road motor vehicles, falls, external causes of burns,
poisonings and sports injuries.
Data Interpretation
All the figures in this report contain either age standardized rates (SRATE), standardized hospitalization/mortality ratios (SHR, SMR) or age-specific rates. Age standardized rate is a single,
summary rate that allows a comparison of injury rates among populations or within populations
over time. 2 SRATE represents a rate if the age structure and sex distributions were the same as
that of the selected standard population. 2 The standard population used in injury surveillance is
the 1991 Adjusted Canadian population (see Appendix 1). Sex and age standardized rates are
based on sex and age specific rates in the population studied and the age distribution of the standard population. For example, if the age standardized hospitalization separation rate as a result
of burns was 3.5/100,000 this means that 3.5 cases per 100,000 were admitted to the hospital
(inpatient) with burns. Based on the analysis, some injury indicators are somewhat unstable due
to small numbers. Refer to Appendix 2 for SRATE formulas for further clarification.
The SHR or SMR allows a comparison of hospitalization or death rates among two different populations. The ratio is the number of hospitalization separations/deaths observed in HaldimandNorfolk to the number that would be expected if Haldimand-Norfolk had the same specific rate
as Ontario. 5 The Ontario population corresponding to the years of data was used as the standard population. A SHR or SMR of 1.0 infers that the rates are the same for Haldimand-Norfolk
compared to Ontario. 5 A SHR or SMR greater than 1 implies the rate is higher in HaldimandNorfolk compared to Ontario, whereas a SHR or SMR less than 1 implies the rate is lower in
Haldimand-Norfolk compared to Ontario. 5 Moreover, confidence intervals (Upper Confidence
Interval (UCI) and Lower Confidence Interval (LCI)) were examined to determine if there was
a statistically significant difference between Haldimand-Norfolk and Ontario. For example if the
SMR was 1.36 for burns, then the death rate for burns was 36% higher in Haldimand-Norfolk
compared to Ontario. Refer to Appendix 2 for SHR/SMR formulas for further clarification.
Age specific rates were also used to determine the rate for a specific age group. The numerator
and denominator refer to the same age group. For example if the rate of injury-related emergency room visits for burns in Haldimand-Norfolk was 33.3/100,000, this means that approximately
33 people per 100,000 visited the emergency room for that particular year (2000).
Data was extracted by the Health Unit from the Provincial Health Planning Database (PHPDB)
and statistical calculations were performed in Excel. Persons whose residence was out of province were excluded from the analysis. Moreover, missing data (age and gender) were excluded
from the analysis. Persons who did not have an Ontario Health Insurance Plan (OHIP) or actual
health plan number were included in the analysis.
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Unintentional Injury Report - 2006
Limitations
There are several limitations to this report, mainly which include differences between ICD-9 and
ICD-10 codes, data incompleteness and small cell counts. Although the differences between ICD9 and ICD-10 codes are universally reflective in epidemiological research, these differences should
be made apparent. Such differences include new chapters which have been added and rearranged, and ICD-10 codes are far more detailed with new and converted codes. See Appendix 3
for ICD 9 and ICD 10 Classification Tables. 6 As a result there can be differences in trending and
the reliability may be compromised. 6 Secondly, the incompleteness of the data may negatively
affect results, or prohibit analysis. To extend this position, although it is mandatory for institutions
(hospitals) to submit their data for each fiscal year, some institutions were unable to comply with
this directive, because of facility mergers, restructuring and external events (SARS).4 As a result,
collapsing of years where warranted was impossible. Thirdly, small cell counts can result in the
instability of rates and may compromise the reliability of the data. For some indicators, incompleteness of the data prohibited the collapsing of data in order to increase cell count size. To provide a more accurate picture, confidence intervals for SHR/SMR were illustrated to give a more
accurate picture of the data.
Tables and Lists
Table of Contents
Injury Prevention Programs...................................................... 1
Are You in Jeopardy .............................................................................................................................................................2
Knowledge is the Best Medicine.....................................................................................................................................2
Stepping Out Safely.................................................................................................................................................................2
Communities and Hospitals Against Trauma (C.H.A.T.).................................................................................2
Risk Watch .................................................................................................................................................................................2
Summer Safety .........................................................................................................................................................................3
Operation Lookout.................................................................................................................................................................3
The Last Drink Campaign...................................................................................................................................................3
Bike Rodeos and Bicycle Safety Campaign...............................................................................................................3
Car Seat Safety ........................................................................................................................................................................3
Home Safety Kits......................................................................................................................................................................4
Hazard House ..........................................................................................................................................................................4
Think of Me..................................................................................................................................................................................4
Booster Seat Legislation .....................................................................................................................................................4
Resources for Parents/Caregivers..................................................................................................................................4
Unintentional Injury Hospitalization Separations..................... 5
Unintentional Injuries - Overview............................................................5
Unintentional Injuries - Data and Interpretation .....................................................................6
Unintentional Injuries - Age Standardized Hospitalization Separations Rates...................................6
Unintentional Injuries - Age Standardized Hospitalization Ratios ............................................................8
Motor Vehicle Traffic Crashes - Overview ................................................9
Motor Vehicle Traffic Crashes - Data and Interpretation .....................................................9
Motor Vehicle Traffic Crashes - Age Standardized Hospitalization Separations Rates................9
Motor Vehicle Traffic Crashes - Age Standardized Hospitalization Ratios....................................... 11
Falls - Overview...................................................................................... 12
Falls - Data and Interpretation ...................................................................................................13
Falls - Age Standardized Hospitalization Separations Rates....................................................................... 13
Falls - Age Standardized Hospitalization Ratios..................................................................................................15
External Causes of Burns - Overview ..................................................... 15
External Causes of Burns - Data and Interpretation ............................................................16
External Causes of Burns - Age Standardized Hospitalization Separations Rates....................... 16
External Causes of Burns - Age Standardized Hospitalization Ratios.................................................. 17
Poisonings - Overview ........................................................................... 18
Poisonings - Data and Interpretation ........................................................................................18
Poisonings - Age Standardized Hospitalization Separations Rates.........................................................18
Poisonings - Age Standardized Hospitalization Ratios................................................................................... 21
Other Off-Road Motor Vehicles - Overview ........................................... 21
Unintentional Injury Report - 2006
Other Off-Road Motor Vehicles - Data and Interpretation................................................ 22
Other Off-Road Motor Vehicles - Age Standardized Hospitalization Separations Rates....... 22
Other Off-Road Motor Vehicles - Age Standardized Hospitalization Ratios................................. 23
Sports Injuries - Overview...................................................................... 24
Sports Injuries - Data and Interpretation................................................................................. 24
Sports Injuries - Age Standardized Hospitalization Separations Rates................................................24
Sports Injuries - Age Standardized Hospitalization Ratios..........................................................................26
Conclusion........................................................................................... 26
Unintentional Injury Mortality............................................... 29
Unintentional Injuries - Overview.......................................................... 29
Unintentional Injuries - Data and Interpretation .................................................................. 29
Motor Vehicle Traffic Crashes - Overview............................................... 33
Motor Vehicle Traffic Crashes – Data and Interpretation ................................................. 33
Falls - Overview...................................................................................... 34
Falls - Data and Interpretation.................................................................................................... 35
Conclusion........................................................................................... 36
Unintentional Injury Emergency Room Visits......................... 39
Unintentional Injuries Emergency Room Visits - Data and Interpretation .................... 39
Motor Vehicle Traffic Crashes - Data and Interpretation .................................................. 40
Pedestrian (Traffic-Related) - Data and Interpretation.........................................................41
Pedal Cycle - Data and Interpretation ..................................................................................... 42
Other Off-Road Motor Vehicles - Data and Interpretation .............................................. 42
Falls - Data and Interpretation .................................................................................................. 43
External Causes of Burns - Data and Interpretation .......................................................... 44
Poisonings - Data and Interpretation . .................................................................................... 45
Sports Injuries - Data and Interpretation ............................................................................... 46
Conclusion........................................................................................... 46
Conclusion............................................................................. 49
Recommendations............................................................................................................................................................... 50
Tables and Lists
List of Figures
Figure 1 - Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2004.......................................................................................... 6
Figure 2 - Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 by
Females in Haldimand-Norfolk and Ontario, 2000-2004................................................................. 7
Figure 3 - Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 by
Males in Haldimand-Norfolk and Ontario, 2000-2004...................................................................... 7
Figure 4 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Unintentional Injuries, Haldimand-Norfolk, 2000-2004..................................................................... 8
Figure 5 - Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 in Haldimand-Norfolk and Ontario, 2000-2004................................................................ 9
Figure 6- Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 by Females in Haldimand-Norfolk and Ontario, 2000-2004...................................10
Figure 7 - Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 by Males in Haldimand-Norfolk and Ontario, 2000-2004........................................ 11
Figure 8 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Motor Vehicle Traffic Crashes, Haldimand-Norfolk, 2000-2004...............................................12
Figure 9 - Age Standardized Hospitalization Rates for Falls per 100,000 in Haldimand-Norfolk
and Ontario, 2000-2004......................................................................................................................................13
Figure 10 - Age Standardized Hospitalization Rates for Falls per 100,000 by Females in
Haldimand-Norfolk and Ontario, 2000-2004........................................................................................14
Figure 11 - Age Standardized Hospitalization Rates for Falls per 100,000 by Males in
Haldimand-Norfolk and Ontario, 2000-2004........................................................................................14
Figure 12 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Falls, Haldimand-Norfolk, 2000-2004........................................................................................................15
Figure 13 - Age Standardized Hospitalization Rates for External Causes of Burns per 100,000
in Haldimand-Norfolk and Ontario, 2000-2004...................................................................................16
Figure 14 - Age Standardized Hospitalization Rates for External Causes of Burns per 100,000
by Males in Haldimand-Norfolk and Ontario, 2000-2004...........................................................17
Figure 15 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
External Causes of Burns, Haldimand-Norfolk, 2000-2004.........................................................17
Figure 16 - Age Standardized Hospitalization Rates for Poisonings per 100,000 in HaldimandNorfolk and Ontario, 2000-2004...................................................................................................................19
Figure 17 - Age Standardized Hospitalization Rates for Poisonings per 100,000 for Females
in Haldimand-Norfolk and Ontario, 2000-2004...................................................................................20
Figure 18 - Age Standardized Hospitalization Rates for Poisonings per 100,000 for Males in
Haldimand-Norfolk and Ontario, 2000-2004........................................................................................20
Figure 19 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Poisonings, Haldimand-Norfolk, 2000-2004............................................................................................21
Unintentional Injury Report - 2006
Figure 20 - Age Standardized Hospitalization Rates for Other Off-Road Motor Vehicles
per 100,000 in Haldimand-Norfolk and Ontario, 2000-2004.................................................... 22
Figure 21 - Age Standardized Hospitalization Rates for Other Off-Road Motor Vehicles per
100,000 by Male in Haldimand-Norfolk and Ontario, 2000-2004.......................................... 23
Figure 22 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Other Off-Road Motor Vehicles, by Gender, Haldimand-Norfolk, 2000-2004.............. 23
Figure 23 - Age Standardized Hospitalization Rates for Sports Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2004....................................................................................... 25
Figure 24 - Age Standardized Hospitalization Rates of Sports Injuries per 100,000 by Males
in Haldimand-Norfolk and Ontario, 2000-2004.................................................................................. 25
Figure 25 - Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Sports Injury, Haldimand-Norfolk, 2000-2004......................................................................................26
Figure 26 - Age Standardized Mortality Rates for Unintentional Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2002....................................................................................... 30
Figure 27 - Age Standardized Mortality Female Rates for Unintentional Injuries per 100,000
in Haldimand-Norfolk and Ontario, 2000-2002.................................................................................31
Figure 28 - Age Standardized Mortality Rates for Unintentional Injuries for Males per 100,000
in Haldimand-Norfolk and Ontario, 2000-2002...................................................................................32
Figure 29 - Age Standardized Mortality Ratios and Confidence Intervals for Unintentional
Injuries, Haldimand-Norfolk, 2000-2002...................................................................................................32
Figure 30 - Age Standardized Mortality Rates for Motor Vehicle Traffic Crashes, per 100,000
in Haldimand-Norfolk and Ontario, 2000-2002.................................................................................. 34
Figure 31 - Age Standardized Mortality Ratios and Confidence Intervals for Motor Vehicle
Traffic Crashes, Haldimand-Norfolk, 2000-2004................................................................................ 34
Figure 32 - Age Standardized Mortality Rates for Falls, per 100,000 in Haldimand-Norfolk
and Ontario, 2001-2002.......................................................................................................................................35
Figure 33 - Age Standardized Female Mortality Rates for Falls, per 100,000 in HaldimandNorfolk and Ontario, 2001-2002....................................................................................................................36
Figure 34 - Age Standardized Mortality Ratios and Confidence Intervals for Falls, HaldimandNorfolk, 2000-2004................................................................................................................................................36
List of Tables
Table 1 - Summary of Average Age Standardized Hospitalization Rates per 100,000 for
Selected Unintentional Injuries (2000-2004), Haldimand-Norfolk and Ontario................27
Table 2 - Summary of Average Age Standardized Mortality Rates for Unintentional Injuries,
Motor Vehicle Traffic Crashes, (2000-2002) and Falls (2001, 2002), HaldimandNorfolk and Ontario..................................................................................................................................................37
Table 3 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for
Unintentional Injuries, Haldimand-Norfolk and Ontario, 2004.................................................... 40
Table 4 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Motor
Vehicle Traffic Crashes, Haldimand-Norfolk and Ontario, 2004..................................................41
Tables and Lists
Table 5 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Pedestrian
(Traffic-Related), Haldimand-Norfolk and Ontario, 2004.................................................................41
Table 6 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Pedal
Cycle Haldimand-Norfolk and Ontario, 2004...........................................................................................42
Table 7 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Other
Off-Road Motor Vehicles, Haldimand-Norfolk and Ontario, 2004............................................43
Table 8 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Falls,
Haldimand-Norfolk and Ontario, 2004........................................................................................................ 44
Table 9 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for External
Causes of Burns, Haldimand-Norfolk and Ontario, 2004.................................................................45
Table 10 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for
Poisonings, Haldimand-Norfolk and Ontario, 2004..............................................................................45
Table 11 - Age Specific Rates (per 1,000 population) of Emergency Room Visits for Sports
Injuries, Haldimand-Norfolk and Ontario, 2004..................................................................................... 46
Table 12 - Summary of Age Specific Rates (per 1,000 population) of Emergency Room Visits
for Selected Unintentional Injuries, Haldimand-Norfolk and Ontario, 2004........................47
Unintentional Injury Report - 2006
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Chapter
1
Injury
Prevention
Programs
The first chapter provides a summary of the injury prevention programs offered at the Health
Unit. The Health Unit offers a variety of public health education initiatives and programs with a
primary emphasis on injury prevention that includes:
• Are You in Jeopardy
• Knowledge is the Best Medicine
• Stepping Out Safely
• Communities and Hospitals Against Trauma (C.H.A.T.)
• Risk Watch
• Summer Safety
• Operation Lookout
• The Last Drink Campaign
• Bike Rodeos and Bicycle Safety Campaign
“An effective injury
prevention strategy
is based on a multifaceted approach
which addresses the
3 E’s: Education,
Engineering and
Enforcement. Our
Health Unit strives to
provide comprehensive
programming in these
three areas.”
Jill Steen
Program Coordinator
Haldimand-Norfolk
Health Unit
• Car Seat Safety
• Home Safety Kits
• Hazard House
• Think of Me
• Booster Seat Legislation
• Resources for Parents/Caregivers
The injury prevention programs offered at the Health Unit depend on the time of year and the
availability of staff and community resources. The following section is a summary of the Health
Unit.
Unintentional Injury Report - 2006
Are You in Jeopardy
The objective of this program is to promote home safety, particularly among seniors who are at
risk for falling. This program provides a comprehensive safety checklist in the form of a flyer and
a video that identifies safety hazards in the home. Presentations, workshops and resources are
available to community groups upon request. The safety checklist includes the following modules:
• Safety Throughout the House
• Kitchen Safety
• Bathroom Safety
• Bedroom Safety
• Garage/Basement Safety
Knowledge is the Best Medicine
This program was developed by the Ontario Pharmacy Association to raise awareness particularly among seniors about the importance of the appropriate use of medications (brand name,
prescription, non-prescription, generic, or herbal) and to promote individual responsibility in their
own overall health care. Workshops, educational brochures and personal medication journals are
valuable resources provided to the community.
Stepping Out Safely
The purpose of this program is to prevent pedestrian injuries among seniors. This program
teaches seniors how to use crossing signals, pedestrian crossovers and how to walk safely where
there is an increase traffic volume and turning cars. This program also teaches seniors how to
walk safely in rural neighbourhoods where there are no sidewalks. An important component of
the program is a community audit. Seniors assess the safety of the community in order to prevent falls (i.e., contrast strips on curbs, timed traffic lights, sidewalk design, etc.). Trained senior
volunteers use a checklist to determine how safe it is for seniors to access their place of business
(stores, banks and public buildings). Presentations, displays and volunteer training are an integral
part of the program.
Communities and Hospitals Against Trauma (C.H.A.T.)
The Communities and Hospitals Against Trauma (C.H.A.T) program provides an opportunity for
youth aged 15-19 to learn about trauma from a community perspective. The goal of the program
is to introduce youth to the consequences of risk-taking behaviours that may result in injury or
even death, like drinking and driving. The program begins with a school assembly to introduce
injury prevention issues to secondary school students. Thirty students are then chosen to spend
a day at Norfolk General Hospital. At the beginning of the day, the students follow the path of a
crash survivor from the scene of injury to the Emergency Room (ER). Throughout the remaining day, students experience what it is like to be a patient undergoing rehabilitation and have the
opportunity to speak with trauma survivors living in the community. Video presentations as well
as other resources (handouts) support the program.
Risk Watch
The Risk Watch Program is a comprehensive injury prevention curriculum that links teachers
with community safety educators, parents, or other teachers. The curriculum is divided into five
appropriate teaching modules (Pre-K/Kindergarten, Grades 1-2, Grades 3-4, Grades 5-6 and
Grades 7-8) and addresses eight key areas of childhood injuries:
• Motor Vehicle Safety
• Fire and Burn Prevention
Injury Prevention Programs
• Choking, Suffocation and Strangulation Prevention
• Poisoning Prevention
• Falls Prevention
• Firearms Injury Prevention
• Bike and Pedestrian Safety
• Water Safety
The Health Unit supports this program by training teachers and acting as a community resource.
Summer Safety
The Summer Safety Program provides an opportunity for a College or University Student to promote injury prevention programs such as water, farm, sun and bicycle safety for both Haldimand
and Norfolk Counties. This program is offered at day camps, recreation programs, conservation
areas and early childhood programs.
Operation Lookout
Operation Lookout is a Canada-wide, year round aggressive marketing campaign that encourages the public and businesses to call police if they see an impaired driver. This program is offered
locally through the efforts of the Drinking and Driving Prevention Task Force. Posters, displays
and person-to-person contact with motorists are some marketing strategies used to enhance
public awareness.
The Last Drink Campaign
In collaboration with the Drinking and Driving Prevention Task Force, the Last Drink Program is
a program which involves tracking the location of the “last drink” of an impaired motorist. This
allows police to identify establishments which continually pose a problem and take corrective
actions. Such corrective measures include the following: informing the establishment of the problem, initiating surveillance and taking disciplinary action where deemed necessary.
Bike Rodeos and Bicycle Safety Campaign
In partnership with the O.P.P and community groups, bike rodeos are implemented at schools
and community events. The purpose of a bike rodeo is to promote proper use of bike safety
equipment, enhance cycling skill development, to review the rules of the road, and bike safety in
general. Particularly, bike safety inspections and helmet fittings are offered. In addition, free coupons are given to children who wear their bicycle helmet while riding their bike.
Car Seat Safety
The Health Unit provides car seat training, donor programs and car seat clinics. Car seat training
is offered to various community organizations who promote child safety. Having completed the
training, a certificate of completion is awarded. The donor program allows community members
who are in financial need to obtain a car seat from the Health Unit through a third party referral.
A Child Car Seat Restraint Technician from the Health Unit will also show the client how to correctly install and use the car seat. Car Seat Clinics are offered twice a month in cooperation with
the Please Be Seated Committee to ensure correct installation of child restraints with a qualified
Child Car Seat Restraint Technician.
Unintentional Injury Report - 2006
Home Safety Kits
The purpose of the Home Safety Kit is to provide parents with resources to improve childhood
safety in the home. The Home Safety Kit includes drawer latches, blind cleats, doorknob covers, oven locks, smoke detectors, water temperature cards, plug covers, booklets and checklists.
Approximately 200 Home Safety Kits are distributed each year to families in need. The kits are
distributed by intermediaries including: Family Home Visitors, Women Services, Community
Action Program for Children (C.A.P.C.) and the Children’s Aid Society (C.A.S.).
Hazard House
The Hazard House is a three dimensional, educational, animated, interactive teaching aid. More
specifically, the Hazard House is a scale model of a house which allows children to see and hear
the dangers of injury and fire. The Hazard House is used in partnership with Haldimand Fire
Services and Norfolk Fire Services to educate children about injury prevention and fire safety.
Presentations are made to elementary schools, Ontario Early Years Centres and child care programs throughout Haldimand and Norfolk Counties. In addition, the Hazard House has been
used in open houses, festivals and community events.
Think of Me
The Think of Me program involves grade 4 to 6 students in participating schools. The students
are asked to write a message and draw a picture on the back of an envelope provided by the
O.P.P. The decorated envelopes are then used by police officers to hand out traffic violation
tickets during R.I.D.E. programs. The people receiving the tickets are asked to ponder how their
behaviour might have affected the child whose name (first only) is on the cover of the envelope.
Booster Seat Legislation
The Haldimand-Norfolk Please Be Seated Car Seat Safety Committee began advocating for legislative changes to the Highway Traffic Act in 1998. The committee wanted to change the child
restraint section to include booster seats for children aged 4 to 9 years to ensure that they were
being transported safely in motor vehicles. After six years of advocacy and working collaboratively
with provincial partners, Booster Bill # 73 was unanimously passed as legislation in December
2004. The new legislation was implemented September 1, 2005. In June 2006, the committee
received an award from Safe Kids Canada for Successful Community Advocacy.
Resources for Parents/Caregivers
The Health Unit provides a variety of puppet shows to Ontario Early Years Centres, day cares,
schools and youth groups to promote child safety. Topics include bike, farm, sun and water safety.
The Health Unit provides 911 Teaching Telephones to day cares, moms and tot groups and kindergarten classes to teach children how to call for help during an emergency. The 911 Teaching
Telephones are available for loan upon request.
Chapter
2
Unintentional
Injury
Hospitalization
Separations
The second chapter provides an overview of hospitalization separations in Haldimand and
Norfolk compared with Ontario over a five year period (2000-2004). It is important to note that
hospitalizations are measured by ‘separations’. 6 A hospitalization separation refers to a death,
discharge, transfer or sign out. 6 Therefore, it is important to understand that a patient can be discharged several times. 6 Data extracted for the report includes inpatient discharge only. Hospital
separations are used instead of admissions because information for day procedures and inpatient
is gathered at the time of discharge. 6 Age standardized hospitalization rates as well as age standardized hospitalization ratios were used. Data from 2005 was excluded because the completeness of the data was questionable. Injury indicators examined included the following: unintentional injuries, MVTC, falls, external causes of burns, poisoning, other off-road motor vehicles and
sports injuries. The following section provides an overview of selected unintentional injury indicators followed by data and interpretation.
Unintentional Injuries - Overview
Unintentional injuries are injuries that are caused by falls, scalds, motor vehicle collisions, poisoning and suffocation to name a few.1 According to the Chief Medical Officer Report, “Injury:
Predictable and Preventable”, in 1996, 43,000 people were hospitalized for unintentional injuries, (all causes) and of that proportion two-thirds resulted from falls.1 However, the number
of unintentional injuries treated in hospital decreased by 10% in the last five years.1 This can be
attributed to health promotion efforts in the area of injury prevention.1 In 1999-2000 there were
64,925 acute care hospital admissions, and of those the highest proportion hospitalized were persons aged 65 and older (43%).1 For females a higher proportion of acute care hospital admissions
were in their 80s, while the peak in injuries for males were in their late teens, late 30s, and the
late 70s.1 According to the, “Economic Burden of Unintentional Injury in Ontario Report (1999)”,
in 1996 preventable injuries cost $260 for every citizen and costs Ontarians $2.9 billion dollars.7
“Hospitalizations
due to injuries in
Haldimand-Norfolk
are consistently higher
than the provincial
average. What we
need to determine is
whether the cause is
rooted in the social
determinants of
health or whether
the higher rates are
a ref lection of the
unique environmental
and access challenges
posed by rural life.”
Joanne Alessi
Injury Prevention
Coordinator
Haldimand-Norfolk
Health Unit
Unintentional Injury Report - 2006
Unintentional Injuries - Data and Interpretation
Unintentional Injuries - Age Standardized Hospitalization Separation Rates
As shown in Figure 1, between the years 2000-2004, the age standardized incident hospitalization rate for unintentional injuries in Haldimand-Norfolk was consistently higher than Ontario.
The average hospitalization rate for unintentional injuries (2000-2004) in Haldimand-Norfolk
was 657.0/100,000 compared to Ontario 498.2/100,000. For the years 2002, 2003 and 2004, a
higher proportion of unintentional injuries in Haldimand-Norfolk were attributed to falling on the
same level from slip, trip and stumble, an unspecified fall and other fall on the same level. The
hospitalization rate for unintentional injuries in Haldimand-Norfolk decreased from 2001 to 2002
and then increased in 2003 and 2004. Although this pattern cannot be explained here, given the
geographic makeup of Haldimand-Norfolk, the higher rate of unintentional injuries compared
to the province may be attributed to the disparities associated with living in a rural community.
According to the Commission on the “Future of the Health Care in Canada—Final Report,” the
rate of unintentional injuries, is higher in smaller rural communities. 8
Figure 1 – Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2004
800
600
400
200
0
2000
2001
2002
2003
2004
H-N
706.5
710.2
484.6
677.5
706.4
ON
568.7
572.1
385.3
483.6
481.2
H-N
Cases
841
848
578
847
875
ON
Cases
70785
73139
50157
64585
65560
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 2, the age standardized hospitalization rate for unintentional injuries among
females in Haldimand-Norfolk was consistently higher than Ontario from 2000-2004. The average hospitalization rate for unintentional injuries among females (2000-2004) in HaldimandNorfolk was 591.6/100,000 compared to the Ontario rate (491.3/100,000). The hospitalization
rate for unintentional injuries among females in Haldimand-Norfolk decreased between 2000 and
2002 and increased thereafter. Similar to Haldimand-Norfolk females, the hospitalization rate for
unintentional injuries among males in Haldimand-Norfolk was consistently higher than Ontario
(2000-2004) (see Figure 3). The average age rate among males (2000-2004) in HaldimandNorfolk was 722.9/100,000 compared to the Ontario rate (509.0/100,000). Particularly interesting, among males, the highest peak for unintentional injury hospitalization rate was found in 2004
(798.6/100,000) (see Figure 3).
Unintentional Injury Hospitalization Separations
Figure 2 – Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 by
Females in Haldimand-Norfolk and Ontario, 2000-2004
700
600
500
400
300
200
100
0
2000
2001
2002
2003
2004
H-N Females
651.2
644.6
445.4
603.1
613.9
ON Females
H-N Cases
ON Cases
562.7
573.9
374.1
474.9
470.9
402
36151
414
37870
277
25183
406
32802
416
33256
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Figure 3 – Age Standardized Hospitalization Rates for Unintentional Injuries per 100,000 by
Males in Haldimand-Norfolk and Ontario, 2000-2004
1000
800
600
400
200
0
H-N Males
ON Males
H-N Cases
ON Cases
2000
2001
2002
2003
2004
761
779.7
524.5
750.9
798.6
578.4
574.6
399.4
496.4
496.3
439
34634
434
35269
301
24974
441
31783
459
32304
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: I ncludes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Unintentional Injury Report - 2006
Unintentional Injuries - Age Standardized Hospitalization Ratios
A similar trend was seen in the age standardized hospitalization ratio for unintentional injuries
(see Figure 1). Overall, from 2000-2004, the age standardized hospitalization ratio for unintentional injuries was significantly higher each year than the province—on average 26% (see Figure
4). The standardized hospitalization ratio for injuries increased from 2002-2004. Of particular
interest, the standardized ratio of hospital separations for this category was 40% higher than the
province in 2004.
There were also significant differences found between Haldimand-Norfolk males and their
Ontario counterparts (see Figure 4). Of particular interest, the standardized hospitalization ratio
for this category among males was at its highest peak in 2004 (52% higher than the province).
There were also significant differences found between Haldimand-Norfolk females and their
Ontario counterparts for years 2003 and 2004 (see Figure 4). Consistent with males, the standardized hospitalization ratio for this category among females was also at its highest peak in 2004
(27% higher than the province).
Figure 4 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Unintentional Injuries, Haldimand-Norfolk, 2000-2004
1.60
1.40
1.20
1.00
Total
0.80
Males
0.60
Females
0.40
0.20
0.00
2000
Year
2000
2001
2002
2003
2004
SMR
**1.20
**1.18
**1.18
**1.36
**1.40
2001
Total
LCI
1.12
1.10
1.09
1.27
1.30
2002
UCI
1.28
1.26
1.28
1.45
1.49
SMR
**1.29
**1.27
**1.26
**1.47
**1.52
2003
Males
LCI
1.17
1.15
1.12
1.33
1.38
2004
UCI
1.42
1.39
1.41
1.60
1.66
Females
SMR
LCI
1.10
0.99
1.09
0.99
1.10
0.97
**1.25
1.13
**1.27
1.15
UCI
1.21
1.20
1.23
1.37
1.40
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents.
Unintentional Injury Hospitalization Separations
Motor Vehicle Traffic Crashes - Overview
According to the Chief Medical Officer Report,“Injury: Predictable and Preventable”, MVTC were
the second leading cause of hospital admissions (83,409 or 13%) in 1999-2000 in Ontario.1 Males
attributed to 61% of hospital admissions.1 A higher proportion of males aged 16 and 20 were
admitted to hospital as a result of a MVTC.1 The average age of hospitalized drivers was 45.9 In
Ontario, the most responsible diagnoses for hospitalization for driving injuries were injuries to the
abdomen, chest, pelvis and back followed by injuries to the neck and head.9 However, hospitalizations due to MVTC have decreased in Canada.10 Injury prevention programs and government
mandates such as laws mandating child restraints, seat belt use, safer vehicles, road infrastructure,
stringent drinking and driving sanctions and injury prevention public health initiatives have attributed to the increased safety of Canadian road users.10 However, MVTC still remain unacceptably
high.
Motor Vehicle Traffic Crashes - Data and Interpretation
Motor Vehicle Traffic Crashes - Age Standardized Hospitalization Separations
Rates
As shown in Figure 5, the age standardized hospitalization rate for Haldimand-Norfolk was consistently higher than Ontario (2000-2004). The average hospitalization rate (2000-2004) for
Haldimand-Norfolk was 97.3/100,000 compared to Ontario 55.0/100,000. In Haldimand-Norfolk
this current trend may be attributed to several factors including unsafe vehicles, poor driving and
unsafe roads, which are more predominant in rural areas.11 Typically, rural roads are not well
designed.11 They are sometimes unlighted, poorly signed and shoulders may be missing or poor.11
In addition, drivers in rural areas may be less compliant with road safety behaviours and feel that
they are more likely to get away with infractions such as speeding.11 Moreover, other factors such
as age, gender, alcohol and drug use, presence of passengers, health status, time of day and seat
belt use are also related to motor vehicle crashes.9 Although, these assumptions are not conclusive in this report, further examination is warranted. On the other hand, in conjunction with the
literature, the current trend in Haldimand-Norfolk has been declining since 2002, and this may
likely be explained by injury prevention programming.
Figure 5 – Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 in Haldimand-Norfolk and Ontario, 2000-2004
140
120
100
80
60
40
20
0
2000
2001
2002
2003
2004
H-N
116.6
86
99.4
94.9
89.7
ON
63.6
60.4
48.1
52.1
51
H-N
Cases
125
91
108
103
99
ON
Cases
7447
7239
5845
6485
6465
Unintentional Injury Report - 2006
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 6, the age standardized hospitalization rate among females in HaldimandNorfolk was consistently higher than Ontario (2000-2004). The average hospitalization rate
among females (2000-2004) in Haldimand-Norfolk was 68.3/100,000 compared to the Ontario
rate (43.3/100,000).
Similar to females, the hospitalization rate of MVTC among males (2000-2004) in HaldimandNorfolk was consistently higher for Ontario for each successive year (see Figure 7). The average
hospitalization rate (2000-2004) among males in Haldimand-Norfolk was approximately double
125.7/100,000 compared to the Ontario rate of 67.2/100,000. Similar to Ontario demographic
trends, males have a higher hospitalization rate resulting from MVTC compared to females.
According to the literature, males account for about 61% of the injury hospitalizations attributed
to driving, particularly males aged 18 to 20.10
Figure 6 – Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 by Females in Haldimand-Norfolk and Ontario, 2000-2004
100
80
60
40
20
0
2000
2001
2002
2003
2004
H-N Females
90.1
63.9
73.1
63
51.2
ON Females
52.1
50.3
35.7
39.7
38.6
49
3108
38
3077
38
2217
35
2523
29
2506
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
10
Unintentional Injury Hospitalization Separations
Figure 7 – Age Standardized Hospitalization Rates for Motor Vehicle Traffic Crashes per
100,000 by Males in Haldimand-Norfolk and Ontario, 2000-2004
200
150
100
50
0
2000
2001
2002
2003
2004
H-N Males
143.1
107.4
125.2
125.3
127.4
ON Males
75.4
70.9
60.9
64.9
63.8
76
4339
53
4162
70
3628
68
3962
70
3959
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Motor Vehicle Traffic Crashes - Age Standardized Hospitalization Ratios
A similar trend occurred in the age standardized hospitalization ratio for MVTC. As shown in
Figure 8, the standardized hospitalization ratio for MVTC was significantly higher in HaldimandNorfolk compared with Ontario. Of particular interest, the standardized hospitalization ratio for
MVTC in Haldimand-Norfolk was twice that in Ontario in 2002. Overall, there was a lot of variation from year-to-year.
There were significant differences between Haldimand-Norfolk males and females for each successive year (2000-2004) and their Ontario counterparts (see Figure 8). Moreover, as seen with
hospital separations overall for this category, both Haldimand-Norfolk male and female hospitalization ratios for MVTC were higher than the province. Interestingly, the standardized hospitalization ratio for MVTC in Haldimand-Norfolk for males was twice that in Ontario in 2002. Likewise,
for the year 2002 the standardized hospitalization ratio for females in Haldimand-Norfolk was
87% higher than Ontario.
11
Unintentional Injury Report - 2006
Figure 8 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Motor Vehicle Traffic Crashes, Haldimand-Norfolk, 2000-2004
2.5
2
Total
1.5
Males
1
Females
0.5
0
2000
Year
2000
2001
2002
2003
2004
SMR
**1.81
**1.37
**2.03
**1.75
**1.70
2001
Total
LCI
1.49
1.09
1.65
1.41
1.37
2002
UCI
2.12
1.65
2.41
2.09
2.03
SMR
**1.86
**1.37
**2.11
**1.88
**1.95
2003
Males
LCI
1.44
1.00
1.62
1.43
1.50
2004
UCI
2.28
1.75
2.60
2.32
2.41
SMR
**1.71
**1.35
**1.87
**1.53
**1.28
Females
LCI
1.23
0.92
1.28
1.02
0.81
UCI
2.19
1.77
2.47
2.03
1.75
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents.
Falls - Overview
According to the Chief Medical Officer Report, “Injury: Predictable and Preventable”, unintentional falls were the leading cause of injury admission, resulting in 73 percent of all days spent
in hospital due to injuries.12 Falls are a serious public health issue, particularly among older
adults.12 In 1999/2000 nearly two-thirds of hospitalizations due to unintentional injury were as a
result of falls (38,513 or 59%).1 Of those who were admitted for falls, two-thirds were aged 65
and over.1 According to the Canadian Centre for Health Information, hospital separation rates
for falls increases with age.13 The most common injuries for women as a result of a fall that
requires hospitalization are fractures of the hip, radius, humerus, ulna, ankle and pelvis. Whereas
the most common injuries for men are fractures of the ribs, hips, vertebral column, pelvis and
humerus.13 Beyond physical injury, falls among older adults are also associated with a decrease
in confidence and self-efficacy.14 According to the, “Economic Burden of Unintentional Injury in
Ontario Report”, in 1996, $390 million dollars were spent on treating falls among the elderly.7
Furthermore, because of the increase in the aging population, the Ministry of Finance predicts
that by 2031, persons age 65 years and older will nearly double to 22.3% in Ontario.14 As a result
there may be an increase in the number of fall-related injuries.14
12
Unintentional Injury Hospitalization Separations
Falls - Data and Interpretation
Falls - Age Standardized Hospitalization Separations Rates
As shown in Figure 9, the age standardized hospitalization rate for falls in Haldimand-Norfolk
was consistently higher than Ontario for each successive year (2000-2004). Overall, the average
hospitalization rate was higher in Haldimand-Norfolk (328.5/100,000) compared with Ontario
(284.1/100,000). In 2001, falls were at an all time high (357.9/100,000). For the years 2002, 2003
and 2004, a higher proportion of falls in Haldimand-Norfolk were attributed to falling on the
same level from slip, trip and stumble, other fall on same level and unspecified fall. Consistent
with Ontario, slips and trips on the same level were frequent in both older adults and seniors.14
Possible explanations of falls, particularly among seniors can be attributed to depression, muscle
weakness, cognitive and visual impairment, drug use, floor obstacles, poor lighting and dizziness.12
Moreover, another plausible explanation may be attributed to the disparities in access to health
care services and programs in rural and remote communities. 8 Specifically, persons living in rural
and remote communities may have difficulty accessing health care services and health promotion
programs. 8 Lack of transportation is one barrier that may prevent people, especially seniors from
utilizing health care services and programs. 8 As a result, persons living in rural and remote areas
have poorer health status and are more susceptible to injuries. 8 However, these plausible explanations were not explored in this report.
Figure 9 – Age Standardized Hospitalization Rates for Falls per 100,000 in Haldimand-Norfolk
and Ontario, 2000-2004
400
300
200
100
0
2000
2001
2002
2003
2004
H-N
353.8
357.9
231.5
355
344.4
ON
328
336.9
211.3
275.7
268.4
H-N
Cases
456
469
297
489
473
ON
Cases
42376
44767
28733
38618
38541
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 10, falls among females were consistently higher for each year in HaldimandNorfolk compared to Ontario. Overall, the average hospitalization rate for females was higher in
Haldimand-Norfolk (370.0/100,000) compared to Ontario (337.2/100,000). As shown in Figure
11, falls among males was consistently higher for each year in Haldimand-Norfolk compared to
the province. Overall, the average hospitalization rate for males was higher in Haldimand-Norfolk
(288.6/100,000) compared to Ontario (233.2/100,000). In conjunction with the literature, the
13
Unintentional Injury Report - 2006
hospitalization rate for falls was found to be consistently higher for females compared with males
for both Haldimand-Norfolk and Ontario. Predominately, a higher proportion of hospitalization
rates due to falls was found among older adults aged 65 and older for both Haldimand-Norfolk
and Ontario, although it is not illustrated here.
Figure 10 – Age Standardized Hospitalization Rates for Falls per 100,000 by Females in
Haldimand-Norfolk and Ontario, 2000-2004
500
400
300
200
100
0
2000
2001
2002
2003
2004
H-N Females
405.6
409.5
274.3
377.8
384.3
ON Females
H-N Cases
ON Cases
391
265
25767
403.8
278
27321
248.4
182
17224
324.4
275
23129
318.5
277
23258
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Figure 11 – Age Standardized Hospitalization Rates for Falls per 100,000 by Males in
Haldimand-Norfolk and Ontario, 2000-2004
400
300
200
100
0
14
2000
2001
2002
2003
2004
H-N Males
301.9
310.6
190.9
333.6
305.8
ON Males
H-N Cases
ON Cases
266.8
191
16609
272.6
191
17446
175.8
115
11509
229.6
214
15489
221.4
196
15238
Unintentional Injury Hospitalization Separations
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Falls - Age Standardized Hospitalization Ratios
As shown in Figure 12, the standardized hospital ratios for falls were significantly higher in
Haldimand-Norfolk for 2003 and 2004 compared with Ontario. Specifically, hospital separations
caused by falls in Haldimand-Norfolk were found to be 26% higher in 2003 and 24% higher in
2004 compared to Ontario. For the years 2003 and 2004 significant gender differences were also
found (see Figure 12). In 2003 and 2004 the standardized hospitalization ratio was significantly
higher for Haldimand-Norfolk females and males compared to Ontario. There were no other significant differences found between Ontario and Haldimand-Norfolk for this category.
Figure 12 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Falls, Haldimand-Norfolk, 2000-2004
1.6
1.4
1.2
1
Total
0.8
Males
0.6
Females
0.4
0.2
0
2000
Year
2000
2001
2002
2003
2004
SMR
1.04
1.03
1.02
**1.26
**1.24
2001
Total
LCI
0.95
0.93
0.91
1.15
1.13
2002
UCI
1.14
1.12
1.14
1.38
1.35
SMR
1.13
1.09
1.10
1.41**
1.33**
2003
Males
LCI
0.97
0.93
0.82
1.22
1.14
2004
UCI
1.29
1.24
1.19
1.60
1.51
Females
SMR
LCI
0.99
0.87
0.99
0.87
1.03
0.88
**1.17
1.03
**1.18
1.04
UCI
1.11
1.11
1.18
1.31
1.32
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents.
External Causes of Burns - Overview
According to CIHI and Statistics Canada, in 1998, 3493 Canadians were hospitalized due to
burn and fire related injuries.15 Children are found to be at highest risk for burns.15 According
to “Canadian Hospitals Injury Reporting and Prevention Program” for 1999, the most common
15
Unintentional Injury Report - 2006
type of burns reported were scalds, burns caused by steam or hot liquid, hot objects, open fires,
flashes or flames, electrical sources, chemicals, explosions and other sources.15 Contact burns and
scalds are more common in children less than 2 years of age and chemical burns associated with
flame and flash are most common among young adults.15 Higher frequency of hospital admissions occur among patients burned by open flames (i.e. camp fire), explosions (container holding
flammable fireworks or liquids), while a smaller proportion admitted to hospital are from contact
burns and electrical burns.15
External Causes of Burns - Data and Interpretation
External Causes of Burns - Age Standardized Hospitalization Separations Rates
As shown in Figure 13, the age standardized hospitalization rate for external causes of burns was
slightly higher in Haldimand-Norfolk than Ontario for each successive year (2000-2004). Overall,
the average hospitalization rate due to external causes of burns was slightly higher in HaldimandNorfolk (11.7/100,000) compared to Ontario (8.3 /100,000). For the year 2002, a higher proportion of hospitalizations in Haldimand-Norfolk for this category were attributed to contact with
hot drink, food, or fat cooking oil. In 2003, a higher proportion of hospitalization were attributed
to exposure to ignition highly flammable material and exposure to uncontrolled building fire. In
2004, a higher proportion of hospitalizations were attributed to contact other/unspecified heat
and hot substance exposure to controlled fire not in a building, exposure to unspecified electric
current, and exposure to ignition melt other clothing apparel. Consistent with Ontario, hot liquids
or vapours (including steam) were reported as the primary type of hot substance attributing to
injury in all age groups.16
Figure 13 – Age Standardized Hospitalization Rates for External Causes of Burns per 100,000
in Haldimand-Norfolk and Ontario, 2000-2004
15
10
5
0
2000
2001
2002
2003
2004
H-N
11.3
13.5
7.4
12.7
13.5
ON
9.9
9.1
7
8.1
7.6
H-N
Cases
13
12
7
15
12
ON
Cases
1157
1074
839
986
924
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 14, external causes of burns among males were found to be predominately
higher for each year in Haldimand-Norfolk compared to Ontario (2000, 2001, 2003, 2004).
Overall the average age standardized hospitalization rate for males over a four-year period (2000,
16
Unintentional Injury Hospitalization Separations
2001, 2003 and 2004) was nearly doubled in Haldimand-Norfolk (21.1/100,000) compared to
Ontario (11.0/100,000). The year 2002 was excluded because the cell counts were less than five
for Haldimand-Norfolk, therefore the number was not releasable. Moreover, females were also
excluded resulting from data constraints (small cell counts).
Figure 14 – Age Standardized Hospitalization Rates for External Causes of Burns per 100,000
25
20
15
10
5
0
2000
2001
H-N Males
18.9
21.8
ON Males
13.3
12.2
11
763
10
709
H-N Cases
ON Cases
2002
2003
2004
23.4
20.1
9
10.4
10
-535
14
623
9
606
by Males in Haldimand-Norfolk and Ontario, 2000-2004
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents. Cell left
blank, or -- -- if cell counts are less than five incidents in a given year.
External Causes of Burns - Age Standardized Hospitalization Ratios
As shown in Figure 15 the standardized hospitalization ratio for external burns for males in 2003
was twice that in Ontario. However, there are no other significant differences found between
Haldimand-Norfolk and Ontario for this category.
Figure 15 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
External Causes of Burns, Haldimand-Norfolk, 2000-2004
3.00
2.50
2.00
Total
1.50
Males
1.00
0.50
0.00
2000
2001
2002
2003
2004
17
Unintentional Injury Report - 2006
Year
2000
2001
2002
2003
2004
SMR
1.20
1.23
-- -1.69
1.45
Total
LCI
0.55
0.53
-- -0.83
0.63
UCI
1.86
1.92
-- -2.54
2.27
SMR
1.54
1.54
-- -**2.49
1.65
Males
LCI
0.63
0.59
-- -1.18
0.57
UCI
2.45
2.50
-- -3.79
2.73
SMR
-- --- --- --- --- --
Females
LCI
-- --- --- --- --- --
UCI
-- --- --- --- --- --
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents. -- -- if cell counts less than five incidents in a given year.
Poisonings - Overview
Hospitalizations due to unintentional poisonings or exposure to a noxious substances exclude
administration with harm or intent or an adverse drug reaction. According to Sick Kids Canada,
“Preventing Poisoning”, medication is the leading cause of poisoning in children.17 Every year
1,700 children age 7 to 14 are hospitalized for serious injuries as a result of poisonings.17 Although
not reported in the following section, it is interesting to note that the Ontario Regional Poison
Information Centre in Toronto received 43,818 calls for unintentional poisonings in fiscal year
2002/2003.18 Leading exposures included analgesics such as acetaminophen and ibuprofen and
cleaning products such as laundry detergent and bleach.18
Poisonings - Data and Interpretation
Poisonings - Age Standardized Hospitalization Separations Rates
As shown in Figure 16, the age standardized hospitalization rate for poisonings in HaldimandNorfolk was slightly higher than Ontario for each successive year (2000-2004). Overall, the average hospitalization rate was slightly higher in Haldimand-Norfolk (27.1/100,000) compared with
Ontario (20.3/100,000). Poisonings in Haldimand-Norfolk have been increasing since 2002. The
highest hospital rate was reported in 2004 (38.3/100,000). For the years 2002, 2003 and 2004
a higher proportion of persons were hospitalized as a result of ingesting prescription medication (antiepileptic, sedative-hypnotic, psychotropic and antiparkinsonism drugs). Consistent with
Ontario, the most common type of hospitalization for unintentional poisoning was poisoning from
a medicine (antiepileptic, sedative-hypnotic, psychotropic and antiparkinsonism drugs). Factors
that may attribute to unintentional poisonings include improper storage, labelling, handling of
medicines and other substances and inadequate child supervision.18 It is also important to understand that predominately rural areas have an increased rate of poisonings. 8
18
Unintentional Injury Hospitalization Separations
Figure 16 - Age Standardized Hospitalization Rates for Poisonings per 100,000 in HaldimandNorfolk and Ontario, 2000-2004
50
40
30
20
10
0
2000
2001
2002
2003
2004
H-N
21.3
22.9
17.5
35.5
38.3
ON
20.9
19.1
16.5
21.1
23.9
H-N
Cases
23
28
22
41
49
ON
Cases
2465
2327
2054
2668
3037
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 17, poisonings among females in Haldimand-Norfolk was higher for each
successive year compared to Ontario. Overall, the average age standardized hospitalization
rate for females was slightly higher in Haldimand-Norfolk (32.1/100,000) compared to Ontario
(20.3/100,000). The age standardized hospitalization rate for females in Haldimand-Norfolk was
highest in 2003 (46.9/100,000).
Compared to Ontario, poisonings among males in Haldimand-Norfolk were lower for the years
2000, 2001 and 2002 and slightly higher thereafter (see Figure 18). Overall, the average age standardized hospitalization rate for males was slightly higher in Haldimand-Norfolk (22.3./100,000)
compared to Ontario (20.4/100,000). The age standardized hospitalization rate for poisonings
among males for both Haldimand-Norfolk and Ontario has been increasing since 2002. Overall,
the age standardized rate for poisonings is higher among females (32.1/100,000), than males in
Haldimand-Norfolk (22.3/100,000).
19
Unintentional Injury Report - 2006
Figure 17 – Age Standardized Hospitalization Rates for Poisonings per 100,000 for Females in
Haldimand-Norfolk and Ontario, 2000-2004
50
40
30
20
10
0
2000
2001
2002
2003
2004
H-N Females
27.7
29.2
18.9
46.9
37.8
ON Females
21.7
18.9
16
20.9
24.1
14
1299
18
1180
11
1014
26
1340
26
1573
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Figure 18 – Age Standardized Hospitalization Rates for Poisonings per 100,000 for Males in
Haldimand-Norfolk and Ontario, 2000-2004
50
40
30
20
10
0
2000
2001
2002
2003
2004
H-N Males
15.6
17
16
24.1
38.8
ON Males
20.2
19.4
17.1
21.5
23.8
9
1166
10
1147
11
1040
15
1328
23
1464
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
20
Unintentional Injury Hospitalization Separations
Poisonings - Age Standardized Hospitalization Ratios
A similar trend occurred in the age standardized hospitalization ratio for poisonings in 2003 and
2004. As shown in Figure 19, the standardized hospitalization ratio for poisonings in HaldimandNorfolk was significantly higher for 2003 and 2004, as seen with hospital separations for this
category. Of particular interest, the standardized hospitalization ratio for 2004 was 78% higher in
Haldimand-Norfolk compared to Ontario. In 2004, the standardized hospitalization ratio for poisonings among females was 83% higher than the province and for males the ratio was 74% higher
compared to the province (see Figure 19).
Figure 19 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Poisonings, Haldimand-Norfolk, 2000-2004
2.5
2
Total
1.5
Males
1
Females
0.5
0
2000
Year
2000
2001
2002
2003
2004
SMR
0.99
1.28
1.14
**1.66
**1.78
2001
Total
LCI
0.59
0.80
0.67
1.15
1.28
2002
UCI
1.39
1.75
1.62
2.17
2.28
SMR
0.82
0.92
1.13
1.21
**1.74
2003
Males
LCI
0.28
0.35
0.46
0.60
1.03
2004
UCI
1.35
1.50
1.80
1.83
2.45
Females
SMR
LCI
1.15
0.55
1.63
0.87
1.16
0.47
**2.11
1.30
**1.83
1.12
UCI
1.75
2.38
1.84
2.92
2.53
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents.
Other Off-Road Motor Vehicles - Overview
Other off-road motor vehicles include vehicles like snowmobiles, all-terrain vehicles (ATVs),
tractors, golf-carts, and mini-bikes to name a few. Next to cycling and snowmobiling, ATVrelated activities are the third most common cause of severe injuries in Canada.19 According to
the Canadian Institute for Health Information (CIHI), over the last 5 years there has been an
increase in hospitalizations due to ATVs.19 ATVs are widely used in rural areas for transportation, occupation and recreation and are commonly used by children. 20 However these vehicles
are dangerous among children and young adolescents. 20 Inexperience, speed, non-use of helmets,
improper apparel, location and alcohol are risk factors that increase the exposure to injuries.19, 21
In Ontario, the most responsible diagnosis attributed to other off-road motor vehicle injuries was
21
Unintentional Injury Report - 2006
injury to the lower limb followed by injury of the back, chest, abdomen, pelvis and injury to the
upper limb. 20 The most common type of injury sustained was a bone fracture. 21
Other Off-Road Motor Vehicles - Data and Interpretation
Other Off-Road Motor Vehicles - Age Standardized Hospitalization Separations
Rates
As shown in Figure 20, the age standardized hospitalization rate for other off-road motor vehicle
crashes in Haldimand-Norfolk was higher than Ontario for each successive year (2000-2004).
Overall, the average hospitalization rate was approximately three times higher in HaldimandNorfolk (12.4/100,000) compared with Ontario (4.5/100,000), with the highest hospital rate
reported in 2004 (16.0/100,000). For the years 2002, 2003 and 2004 other off-road motor
vehicle crashes predominately involved an ATV. This may be attributed to an increase in the sale
of ATVs.19 Moreover, in conjunction with the literature, ATVs are widely used in rural areas compared to urban areas. 20
Figure 20 – Age Standardized Hospitalization Rates for Other Off-Road Motor Vehicles per
100,000 in Haldimand-Norfolk and Ontario, 2000-2004
18
16
14
12
10
8
6
4
2
0
2000
2001
2002
2003
2004
H-N
8
12.8
14.1
10.9
16
ON
4.6
5.2
3.7
4.2
4.7
H-N
Cases
8
15
14
13
17
ON
Cases
520
590
429
503
565
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 21, other off-road motor vehicle crashes among males in Haldimand-Norfolk
were higher for each successive year compared to Ontario. Overall, the average age standardized hospitalization rate for males was approximately three times higher in Haldimand-Norfolk
(22.3./100,000) compared to Ontario (7.7/100,000). Females were not reported here due to data
constraints for Haldimand-Norfolk. Consistent with the literature, Ontario males account for a
higher proportion of injury hospitalizations for both snowmobile incidents and ATVs. 21
22
Unintentional Injury Hospitalization Separations
Figure 21 – Age Standardized Hospitalization Rates for Other Off-Road Motor Vehicles per
100,000 by Male in Haldimand-Norfolk and Ontario, 2000-2004
30
25
20
15
10
5
0
2000
2001
2002
2003
2004
H-N Males
15.9
25.8
25.6
17.4
26.6
ON Males
8.3
8.9
6.2
7.1
8.1
8
461
15
506
13
359
10
414
14
484
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Other Off-Road Motor Vehicles - Age Standardized Hospitalization Ratios
Overall, from 2001-2004, the age standardized hospitalization ratio for off-road vehicles was
significantly higher each year than the province (see Figure 22 ). The standardized hospitalization
ratio for other off-road motor vehicles was twice that in Ontario for 2001 and 2003 and three
times that of the province in 2002 and 2004.
There were also significant differences found between Haldimand-Norfolk males and their
Ontario counterparts (2001-2004) (see Figure 22). For Haldimand-Norfolk males the standardized hospitalization ratio for other off-road motor vehicles was four times that of the province in
2002.
Figure 22 – Age Standardized Hospitalization Separations Ratios and Confidence Intervals for
Other Off-Road Motor Vehicles, Haldimand-Norfolk, 2000-2004
4.5
4
3.5
3
2.5
Total
2
Males
1.5
1
0.5
0
2000
2001
2002
2003
2004
23
Unintentional Injury Report - 2006
Year
2000
2001
2002
2003
2004
SMR
1.66
**2.82
**3.67
**2.93
**3.41
Total
LCI
0.51
1.39
1.75
1.34
1.79
UCI
2.80
4.25
5.59
4.53
5.03
SMR
1.85
**3.26
**4.03
**2.72
**3.26
Males
LCI
0.57
1.61
1.84
1.03
1.55
UCI
3.13
4.90
6.23
4.41
4.97
SMR
-- --- --- --- --- --
Females
LCI
-- --- --- --- --- --
UCI
-- --- --- --- ---
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents, -- -- if cell counts less than five incidents in a given year.
Sports Injuries - Overview
According to the Canadian Institute for Health Information, in the fiscal year 2002-2003, 9% of
the province’s injury hospitalizations were sports and recreation related. 22 A higher proportion
of males were hospitalized with sports and recreation related injury hospitalizations compared to
females. 22 The average age of both genders was 26.8 years. 22 The leading causes of sports and
recreational injury hospitalizations were bicycle, playground and hockey injuries. 22 A higher proportion of sports injuries occur in the summer months (June July, August). 22 Seventy-six percent
of all sports and recreational injuries were related to orthopaedic, head and superficial injuries. 22
Sports Injuries - Data and Interpretation
Sports Injuries - Age Standardized Hospitalization Separations Rates
As shown in Figure 23, the age standardized hospitalization rate for sports injuries is predominately higher in Haldimand-Norfolk, with the exception of 2000 and 2002. For the years 2002,
2003 and 2004 a higher proportion of persons sustained injuries from playing hockey (striking
against or struck by in hockey). Consistent with Ontario, a higher proportion of hockey injury
hospitalizations were attributed to striking against or being struck by an object. 23 This may
be attributed to the fact that not all hockey players are registered with the Ontario Hockey
Federation, and therefore may be more likely to sustain injuries because they are not playing in a
regulated setting. 23
Overall, the average hospitalization rate was slightly higher in Haldimand-Norfolk (15.1/100,000)
compared with Ontario (9.7/100,000). The highest hospitalization rates in Haldimand-Norfolk
were reported in 2001(25.3/100,000) and 2004 (21.8/100,000). Similar to Ontario, the hospitalization rate for sports injuries has been successively increasing since 2002. This may be explained
by factors associated with rural disparities to include: increase risk of sports injuries due to fewer
available volunteers to organize and deliver organized sports; lack of coaching personnel and lack
of health professionals in rural settings. 24 However, this rationale warrants further investigation.
24
Unintentional Injury Hospitalization Separations
Figure 23 – Age Standardized Hospitalization Rates for Sports Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2004
30
25
20
15
10
5
0
2000
2001
2002
2003
2004
H-N
11.4
25.3
4.7
12.5
21.8
ON
11.8
10.9
6.3
9.2
10.1
H-N
Cases
12
25
5
13
23
ON
Cases
1321
1243
725
1073
1194
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 24, sports injuries among males in Haldimand-Norfolk was higher in 2001,
2003 and 2004 as compared to Ontario. From 2002, the hospitalization rate for sports injuries
among males in Haldimand-Norfolk had increased with each successive year. Overall, the average
age standardized hospitalization rate for males was higher in Haldimand-Norfolk (25.1./100,000)
compared to the province (16.3/100,000). Females were not reported here due to data constraints.
Figure 24 – Age Standardized Hospitalization Rates of Sports Injuries per 100,000 by Males in
Haldimand-Norfolk and Ontario, 2000-2004
50
40
30
20
10
0
2000
2001
2002
2003
2004
H-N Males
17.7
40.1
9.4
19.8
38.4
ON Males
19.9
18.7
10.8
15.2
17
10
1108
20
1058
5
614
10
880
20
998
H-N Cases
ON Cases
25
Unintentional Injury Report - 2006
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Sports Injuries - Age Standardized Hospitalization Ratios
In 2001 and 2004, the age standardized hospitalization ratio for sports injuries was significantly
higher than the province (see Figure 25). The standardized hospitalization ratio for sports injuries
in Haldimand-Norfolk was twice that in Ontario for 2001 and 2004. Females were not reported
here due to data constraints. There was no statistical difference between Haldimand-Norfolk and
Ontario for sports injuries for 2000, 2002 and 2003.
Figure 25 – Age Standardized Hospitalization Separation Ratios and Confidence Intervals for
Sports Injuries, Haldimand-Norfolk, 2000-2004
2.5
2
1.5
Total
Males
1
0.5
0
2000
Year
2000
2001
2002
2003
2004
SMR
0.97
**2.20
0.76
1.33
**2.14
2001
Total
LCI
0.42
1.34
0.09
0.61
1.27
2002
UCI
1.52
3.06
1.42
2.06
3.02
SMR
0.95
**2.04
0.89
1.25
**2.23
2003
Males
LCI
0.36
1.15
0.11
0.48
1.25
2004
UCI
1.55
2.94
1.67
2.03
3.21
SMR
-- --- --- --- --- --
Females
LCI
-- --- --- --- --- --
UCI
-- --- --- --- --- --
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, includes patient ID Source Code
“H” and “D” and excludes out of province Ontario residents, -- -- if cell counts less than five incidents in a given year.
Conclusion
In summary, the average age standardized hospitalization rate in Haldimand-Norfolk for unintentional injuries was higher than Ontario (657/100,000 and 498.2/100,000 respectively) (see Table
1). A similar trend was seen in the age standardized hospitalization ratio for unintentional injuries
(see Figure 4). There were also significant differences found between Haldimand-Norfolk males
and their Ontario counterparts (see Figure 4).
26
Unintentional Injury Hospitalization Separations
Overall, average age standardized hospitalization rates for selected injuries were higher compared to the province. Based on selected unintentional injury indictors the average age standardized hospitalization rates in Haldimand-Norfolk were highest for unintentional injuries resulting
from falls (328.5/100,000), MVTC (97.3/100,000) and poisonings (27.1/100,000) (see Table 1).
Compared to provincial data, this pattern is consistent with Ontario.
Both Haldimand-Norfolk and Ontario males have a higher rate of unintentional injury hospitalization separations. Moreover, both Haldimand-Norfolk and Ontario females had a higher hospitalization separation rate for falls and poisonings, while Haldimand-Norfolk and Ontario males had a
higher separation rate for MVTC. For the years 2000-2004, significant differences were found for
unintentional injuries and MVTC (see Figure 4, see Figure 8). With the exception of 2000, significant differences were found for other off-road motor vehicles (see Figure 22).
Table 1 – Summary of Average Age Standardized Hospitalization Rates per 100,000 for
Selected Unintentional Injuries (2000-2004), Haldimand-Norfolk and Ontario
Average Age - Age Standardized Rates (per 100,000 population)
Unintentional Injury
Total
Females
H-N
ON
H-N
ON
Total
Total
Total
Total
All Unintentional Injuries
657.0
498.2
591.6
491.3
Falls
328.5
284.1
370.0
337.2
Motor Vehicle Traffic
97.3
55.0
68.3
43.3
Crashes
Poisonings
27.1
20.3
32.1
20.3
Sports Injuries
15.1
9.7
-- --- -Other Off-Road Motor
12.4
4.5
-- --- -Vehicles
External Causes of
11.7
8.3
-- --- -Burns
Males
H-N
ON
Total
Total
722.9
509.0
288.6
233.2
125.7
67.2
22.3
25.1
22.3
20.4
16.3
7.7
21.1
(4 years)
11.0
Data Source: Ontario and Haldimand-Norfolk Population Estimates Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Inpatient Hospitalizations, Provincial Health Planning Database (PHPDB), (Extracted
March 14, 2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents, -- -- if cell
counts less than five incidents in a given year.
27
Unintentional Injury Report - 2006
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28
Chapter
3
Unintentional
Injury
Mortality
The third chapter of this report features mortality data resulting from injuries over a three year
period (2000-2002). Since data conversions from ICD 9 to ICD 10 codes are not recommended,
ICD 9 codes were excluded. Deaths as a result of unintentional injuries, MVTC and falls were
reported for Haldimand-Norfolk compared to Ontario. To date, the latest data released was
2002. Age standardized mortality separation rate and age standardized mortality ratio was used
to capture differences in Haldimand and Norfolk compared with Ontario. Due to data constraints, only unintentional injuries, MVTC and falls were examined.
Unintentional Injuries - Overview
“The majority of
deaths attributed to
unintentional injuries
are preventable”
Deanna Tries
Epidemiologist
Haldimand-Norfolk
Health Unit
According to the “Chief Medical Officer Report Injury: Predictable and Preventable”, in 1996,
2,844 people died of unintentional injuries in Ontario. Of these deaths, a higher proportion were
a result of MVTC, followed by falls, poisonings, drowning, suffocation and fire.1
Unintentional Injuries - Data and Interpretation
When comparing Haldimand-Norfolk to the province, the age standardized mortality rate was
slightly higher for each successive year (2000-2002) (see Figure 26). The age standardized mortality rate for Ontario has remained relatively stable from 2000-2002, whereas the mortality rate
for Haldimand-Norfolk has been slightly increasing. The average age standardized mortality rate
in Haldimand-Norfolk for unintentional injuries was slightly higher (27.3/100,000) compared to
Ontario (21.9/100,000). A higher proportion of deaths for unintentional injuries were attributed
to exposure to an unspecified factor (2000 and 2002) and unspecified falls (2001). Health indicators have shown that the health status of people living in rural areas is poorer than people
living in urban communities. 8 According to the “Commission on the Future of Health Care in
Canada-Final Report”, in 1996 the age standardized mortality rate for unintentional injury was
higher in predominately rural areas (45.4/100,000) compared with predominately urban areas
(25.9/100,000). 8 However, this warrants further investigation and was not conclusive in this
report.
29
Unintentional Injury Report - 2006
Figure 26 – Age Standardized Mortality Rates for Unintentional Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2002
35
30
25
20
15
10
5
0
2000
2001
2002
H-N
25.5
26.6
29.9
ON
22
21.4
22.3
H-N
Cases
31
33
36
ON
Cases
2786
2787
2991
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 27, the age standardized mortality rate for unintentional injuries among
females in Haldimand-Norfolk was the same as Ontario in 2000 and slightly lower in 2001.
However, in 2002 the age standardized mortality rate among females (25.1/100,000) was slightly
higher in Haldimand-Norfolk compared to Ontario (18.4/100,000). For Haldimand-Norfolk
females the average mortality rate was 20/100,000 compared to Ontario (18.0/100,000). The
highest mortality rate for Haldimand-Norfolk females was found in 2002 (25.1/100,000).
30
Unintentional Injury Mortality
Figure 27 – Age Standardized Mortality Female Rates for Unintentional Injuries per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2002
30
25
20
15
10
5
0
2000
2001
2002
H-N Females
18.2
16.7
25.1
ON Females
18.2
17.3
18.4
13
1212
12
1178
17
1281
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
As shown in Figure 28, the age standardized mortality rate for unintentional injuries among males
in Haldimand-Norfolk was successively higher for each year (2000-2002) compared to Ontario.
The average mortality rate for Haldimand-Norfolk males was slightly higher (34.3/100,000)
compared to the province (26.0/100,000). Overall, the age standardized mortality rate for unintentional injuries was higher among Haldimand-Norfolk males compared to Haldimand-Norfolk
females for each successive year (2000-2002). The standardized mortality ratios for unintentional
injury deaths in Haldimand-Norfolk showed no statistical differences compared to the province
as a whole (see Figure 29).
31
Unintentional Injury Report - 2006
Figure 28 – Age Standardized Mortality Rates for Unintentional Injuries for Males per 100,000
in Haldimand-Norfolk and Ontario, 2000-2002
40
30
20
10
0
2000
2001
2002
H-N Males
32.5
35.8
34.7
ON Males
25.9
25.6
26.3
18
1574
21
1609
19
1710
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Figure 29 – Age Standardized Mortality Ratios and Confidence Intervals for Unintentional
Injuries, Haldimand-Norfolk, 2000-2002
1.4
1.2
1
Total
0.8
Males
0.6
Females
0.4
0.2
0
2000
Year
2000
2001
2002
32
SMR
1.10
1.19
1.21
2001
Total
LCI
0.71
0.78
0.82
UCI
1.48
1.59
1.61
SMR
1.15
1.33
1.14
2002
Males
LCI
0.62
0.76
0.63
UCI
1.68
1.89
1.65
SMR
1.02
0.99
1.29
Females
LCI
0.47
0.43
0.68
UCI
1.57
1.55
1.91
Unintentional Injury Mortality
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, -- -- if cell counts less than five
incidents in a given year.
Motor Vehicle Traffic Crashes - Overview
According to the “Road Safety in Canada–An Overview”, there were 2,778 deaths as a result
of MVTC in Canada in the year 2001. Despite the increasing number of vehicles and licensed
drivers, there has been a decline in road traffic deaths by almost 50% since 1982.10 This may be
explained by government interventions such as laws mandating the use of child restraints and seat
belt use. Moreover, public education, enforcement campaigns, safer vehicles, drinking and driving
sanctions and road infrastructure enhancements also improved safety of Canadian road users.10
Factors that contribute to fatalities are drinking and driving, non-use of seat belts and singlevehicle crashes on individual roads.10 Although alcohol use among Canadian drivers has decreased
over the years, in 2001, 38% of fatally injured drivers who were tested had been drinking alcohol
and of that proportion 85% had blood alcohol levels above the legal limit.10 Older adults aged 75
and older, as well as young drivers aged 16-19 have the highest risk of being killed in a traffic collision.10
Motor Vehicle Traffic Crashes – Data and Interpretation
When comparing Haldimand-Norfolk to the province, the age standardized mortality rate for
MVTC was slightly higher for each successive year (2000-2002) (see Figure 30). The age standardized mortality rate for Ontario and Haldimand-Norfolk has remained relatively stable from
2000-2002. The average age standardized mortality rate in Haldimand-Norfolk for MVTC was
slightly higher (8.1/100,000) compared to Ontario (5.1/100,000). A higher proportion of deaths
for MVTC were attributed to a person injured in a collision between other specified motor
vehicles for each year (2000, 2001 and 2002). Given that Haldimand-Norfolk is a rural community, it is important to understand that the number of fatal collisions is higher in rural areas compared to urban areas. 25 Certain risk factors that are unique to rural roads (physical environment)
as well as personal risk factors like fatigue and distractions may contribute to fatal collisions.1
However, this warrants further investigation and was not conclusive in this report. The age standardized mortality rates for Haldimand-Norfolk females and males was suppressed, due to data
constraints (trend analysis was not plausible). The standardized mortality ratio for MVTC deaths
in Haldimand-Norfolk showed no statistical differences compared to the province as a whole. A
graph was not warranted here (see Figure 31).
33
Unintentional Injury Report - 2006
Figure 30– Age Standardized Mortality Rates for Motor Vehicle Traffic Crashes, per 100,000 in
Haldimand-Norfolk and Ontario, 2000-2002
10
8
6
4
2
0
2000
2001
2002
H-N
7.5
8.4
8.3
ON
5.1
5.1
5
H-N
Cases
10
9
8
ON
Cases
597
617
622
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province.
Figure 31 - Age Standardized Mortality Ratios and Confidence Intervals for Motor Vehicle
Traffic Crashes, Haldimand-Norfolk, 2000-2004
Year
2000
2001
2002
SMR
1.79
1.58
1.39
Total
LCI
0.68
0.55
0.43
UCI
2.90
2.61
2.35
SMR
-- -1.56
-- --
Males
LCI
-- -0.31
-- --
UCI
-- -2.80
-- --
SMR
3.43
-- -2.48
Females
LCI
0.68
-- -0.31
UCI
6.17
-- -4.65
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, -- -- if cell counts less than five incidents in a given year. Includes patient ID Source Code “H” and “D” and excludes out of province.
Falls - Overview
According to the “Technical Report: Deaths Due to Falls Among Canadians Age 65 and Over”,
in 1999/2000 in Canada, 3.4% died as a result of their injuries and 75% of in hospital deaths were
due to injuries from a fall. 26 Of particular interest, over a six year period (1997-2002) approximately 7,000 Canadians aged 65 and older died as a direct result of a fall. 26
34
Unintentional Injury Mortality
Falls - Data and Interpretation
When comparing Haldimand-Norfolk to the province, the age standardized mortality rate for falls
was slightly higher for 2001 and comparable to the province in 2002 (see Figure 32). The average
age standardized mortality rate in Haldimand-Norfolk for falls was slightly higher (6.9/100,000)
from 2001 to 2002 compared to Ontario (5.5/100,000). A higher proportion of deaths for falls
in Haldimand-Norfolk was attributed to an unspecified fall for both years. Haldimand-Norfolk
females were found to have a higher age standardized mortality rate for falls for each successive
year (2001 and 2002) compared to the province (see Figure 33). The age standardized mortality
rates for Haldimand-Norfolk males were suppressed, for the most part due to data constraints
(small cell counts). The standardized mortality ratio for falls deaths in Haldimand-Norfolk showed
no statistical differences compared to the province as a whole. A graph was not warranted here
(see Figure 34).
9
8
7
6
5
4
3
2
1
0
2001
2002
H-N
8.3
5.5
ON
5.3
5.6
H-N
Cases
12
8
ON
Cases
734
803
Figure 32 – Age Standardized Mortality Rates for Falls, per 100,000 in Haldimand-Norfolk and
Ontario, 2001-2002
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
35
Unintentional Injury Report - 2006
Figure 33 – Age Standardized Female Mortality Rates for Falls, per 100,000 in HaldimandNorfolk and Ontario, 2001-2002
10
8
6
4
2
0
2001
2002
H-N Females
6.7
7.8
ON Females
5.4
5.7
5
382
6
415
H-N Cases
ON Cases
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province. Ontario residents.
Figure 34 – Age Standardized Mortality Ratios and Confidence Intervals for Falls, HaldimandNorfolk, 2000-2004
Year
2001
2002
SMR
1.53
0.94
Total
LCI
0.67
0.29
UCI
2.40
1.59
SMR
1.87
-- --
Males
LCI
0.48
-- --
UCI
3.25
-- --
SMR
1.22
1.34
Females
LCI
0.15
0.27
UCI
2.29
2.42
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 14, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: ** significantly higher than Ontario; * significantly lower than Ontario, -- -- if cell counts less than five
incidents in a given year.
Conclusion
In summary, the average age standardized mortality rate for unintentional injuries was higher in
Haldimand-Norfolk compared to Ontario (27.3/100,000 and 21.9/100,000 respectively) (see
Table 2). For Haldimand-Norfolk males (34.3/100,000), the average standardized mortality rate
for unintentional injuries was higher compared to Haldimand-Norfolk females (20.0/100,000) (see
Figure 27 and 28). Overall, the average age standardized mortality rates for selected unintentional
injuries were higher compared to the province (see Table 2). Based on selected unintentional
injury indictors the average age standardized mortality rates in Haldimand-Norfolk were highest
for injuries resulting from MVTC (8.1/100,000) and falls (6.9/100,000) (see Table 2). Overall, there
were no statistically significant differences compared to the province as a whole.
36
Unintentional Injury Mortality
Table 2 – Summary of Average Age Standardized Mortality Rates for Unintentional Injuries,
Motor Vehicle Traffic Crashes (2000-2002) and Falls (2001, 2002), Haldimand-Norfolk and
Ontario
Average Age - Age Standardized Rates (per 100,000 population)
Injury
H-N Total
All Unintentional Injuries
27.3
Motor Vehicle Traffic Crashes
8.1
Falls
6.9
ON Total
21.9
5.1
5.5
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted March 13, 2006) and Vital Statistics, Provincial Health Planning Database (PHPDB), (Extracted March 14,
2006).
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
37
Unintentional Injury Report - 2006
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38
Chapter
4
Unintentional
Injury Emergency
Room Visits
The fourth chapter provides an overview of emergency room visits due to unintentional injuries
in Haldimand-Norfolk and Ontario for the calendar year 2004. Data prior to 2004 was excluded
because the data was incomplete. In 2004 some institutions reported data for a partial year as a
result of hospital closure and SARS.4 Since the intent of the report is to provide data for planning
community strategies in the area of injury prevention, age specific rates were used to mirror the
age groupings used by program planners. Tables were used instead of graphs to give a complete
picture of emergency room visits from unintentional injuries. Moreover, since emergency room
data is relatively new and does not reflect the mandatory guidelines, a brief overview is provided
for the purpose of injury prevention planning. Injury indicators that were examined included the
following: unintentional injuries, MVTC, pedestrian (traffic-related), pedal cycle, other off-road
motor vehicles, falls, external causes of burns, poisonings and sports injuries.
Unintentional Injury Emergency Room Visits - Data and
Interpretation
As shown in Table 3, the age specific rate for unintentional injury emergency room visits in
Haldimand-Norfolk was higher compared to Ontario (157.1/1000 and 98.4/1000 respectively).
From a demographic perspective, the age specific rate for both females and males in HaldimandNorfolk was higher compared to the province (125.2/1000 and 80.5/1000 respectively;
189.1/1000 and 116.7/1000 respectively). Similar to Ontario, the rate for unintentional injuries in
Haldimand-Norfolk predominately decreased from age 14 to 69 and then increased thereafter.
The highest rate for unintentional injury emergency room visits in Haldimand-Norfolk was found
in persons aged 14-20 (248.4/1000). Whereas, in Ontario, the highest rate for unintentional injury
emergency room visits was found in persons aged 84 and over (160.6/1000), followed by persons
aged 14-20 (146.9/1000). In 2004, a higher proportion of unintentional injury emergency room
visits in Haldimand-Norfolk were attributed to overexertion, strenuous repetitive movement,
exposure to unspecified fall and eye injuries.
“Most childhood
injuries are preventable and almost all
of them occur at
home. You can play
an important role in
reducing child injuries! Prevention and
supervision are two
of the greatest safety
devices to keep your
child safe and sound.”
Karin Marks
Health Promoter
Haldimand-Norfolk
Health Unit
39
Unintentional Injury Report - 2006
Table 3 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for
Unintentional Injuries, Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0-6
150.2
101.9
200.5
130.4
175.5
116.4
7-13
161.0
100.3
232.3
143.2
197.1
122.2
14-20
170.4
104.1
324.9
187.6
248.4
146.9
21-27
130.9
79.6
278.3
150.4
210.0
115.4
28-34
113.0
66.7
222.0
119.9
168.0
93.3
35-41
111.2
65.7
182.3
109.5
147.4
87.7
42-48
117.0
64.8
162.8
99.5
140.3
82.1
49-55
93.5
65.1
121.9
82.7
108.0
73.8
56-62
89.1
64.8
109.5
74.0
99.5
69.3
63-69
87.4
63.0
103.1
66.5
95.3
64.7
70-76
101.8
76.6
91.1
68.8
96.7
73.0
77-83
139.8
108.4
123.5
88.8
133.2
100.0
84+
190.8
171.5
170.6
137.3
184.9
160.6
Total
125.2
80.5
189.1
116.7
157.1
98.4
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Motor Vehicle Traffic Crashes - Data and Interpretation
As shown in Table 4, the age specific rate for MVTC emergency room visits in HaldimandNorfolk is slightly higher compared to Ontario (10.5/1000 and 6.4/1000 respectively). From a
demographic perspective the age specific rate for both females and males in Haldimand-Norfolk
was higher compared to the province (females, 9.2/1000 and 6.2/1000 respectively; males,
11.7/1000 and 6.5/1000 respectively). The age specific rate for MVTC emergency room visits in
Haldimand-Norfolk has remained relatively unstable in all age groupings. In Ontario, the rate
decreased steadily from age grouping 21-27 onward, with the exception of persons aged 77-83.
The highest rate for MVTC emergency room visits in Haldimand-Norfolk was found in persons
aged 14-20 (21.6/1000), while Ontario’s highest rate was found in persons aged 21-27 (11.0/1000).
In 2004, a higher proportion of MVTC emergency room visits in Haldimand-Norfolk was attributed to car occupant versus car truck driver traffic accident.
40
Unintentional Injury Emergency Room Visits
Table 4 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Motor
Vehicle Traffic Crashes, Haldimand-Norfolk and Ontario, 2004
Age Group
0-6
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
2.0
2.0
3.2
2.1
2.6
2.1
7-13
5.1
2.8
10.2
3.6
7.7
3.2
14-20
18.0
11.0
25.1
10.9
21.6
10.9
21-27
19.4
10.9
17.6
11.1
18.5
11.0
28-34
11.8
7.5
15.0
8.5
13.4
8.0
35-41
9.4
6.7
11.6
7.2
10.5
7.0
42-48
11.1
6.3
11.4
6.5
11.3
6.4
49-55
7.3
5.7
9.4
5.6
8.4
5.7
56-62
4.7
5.2
8.1
5.0
6.4
5.1
63-69
5.4
4.6
3.6
4.1
4.5
4.4
70-76
6.2
4.4
8.6
4.3
7.3
4.3
77-83
7.8
4.6
7.6
4.6
7.7
4.6
84+
4.5
2.8
6.3
4.7
5.0
3.4
Total
9.2
6.2
11.7
6.5
10.5
6.4
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Pedestrian (Traffic-Related) - Data and Interpretation
As shown in Table 5, the age specific rate for pedestrian (traffic-related) emergency room visits in Haldimand-Norfolk was the same compared to Ontario (0.3/1000). From a demographic
perspective the age specific rate for both females and males in Haldimand-Norfolk was also the
same compared to the province (0.3/1000). The age specific rate for pedestrian (traffic-related)
was relatively low for both Haldimand-Norfolk and Ontario. In 2004, a higher proportion of
pedestrian (traffic-related) emergency room visits in Haldimand-Norfolk was attributed to pedestrian versus car truck pedestrian traffic accident
Table 5 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Pedestrian
(Traffic-Related), Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0.0
0.1
0.5
0.2
0.2
0.1
7-13
0.4
0.2
0.6
0.4
0.5
0.3
14-20
0.2
0.6
0.0
0.6
0.1
0.6
21-27
0.8
0.4
0.7
0.4
0.7
0.4
28-34
0.7
0.2
0.2
0.2
0.5
0.2
35-41
0.4
0.2
0.3
0.3
0.4
0.2
42-48
0.2
0.2
0.0
0.2
0.1
0.2
49-55
0.5
0.2
0.7
0.2
0.6
0.2
56-62
0.0
0.2
0.0
0.2
0.0
0.2
63-69
0.0
0.3
0.0
0.2
0.0
0.3
70-76
0.0
0.3
0.4
0.3
0.2
0.3
77-83
0.4
0.5
0.0
0.3
0.3
0.4
84+
0.6
0.3
0.0
0.3
0.5
0.3
Total
0.3
0.3
0.3
0.3
0.3
0.3
0-6
41
Unintentional Injury Report - 2006
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Pedal Cycle - Data and Interpretation
As shown in Table 6, the age specific rate for pedal cycle emergency room visits in HaldimandNorfolk is slightly higher compared to Ontario (2.8/1000 and 1.9/1000 respectively). From a
demographic perspective the age specific rate for both females and males in Haldimand-Norfolk
was slightly higher compared to the province (females, 1.2/1000 and 0.9/1000 respectively; males,
4.4/1000 and 2.8/1000 respectively). The age specific rate for pedal cycle emergency room visits
in Haldimand-Norfolk predominately decreased in persons aged 7-13 onward. This pattern is
comparable to the province. The highest rate for pedal cycle emergency room visits is found in
the age grouping 7-13, for both Haldimand-Norfolk and Ontario (11.1/1000 and 6.6/1000 respectively). In 2004, a higher proportion of pedal cycle emergency room visits in Haldimand-Norfolk
were attributed to cycle non collision transport driver non traffic.
Table 6 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Pedal Cycle
Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0-6
1.2
1.3
3.4
2.7
2.3
2.0
7-13
5.9
3.8
16.1
8.8
11.1
6.6
14-20
1.9
1.3
12.2
7.1
7.1
4.3
21-27
0.5
0.7
3.7
2.5
2.2
1.6
28-34
1.0
0.6
2.2
1.8
1.6
1.2
35-41
0.4
0.6
2.3
1.7
1.3
1.2
42-48
0.2
0.5
1.4
1.6
0.8
1.0
49-55
0.9
0.5
2.4
1.3
1.7
0.9
56-62
0.7
0.4
1.1
0.9
0.9
0.6
63-69
0.0
0.4
0.3
0.7
0.1
0.5
70-76
0.0
0.2
0.4
0.6
0.2
0.4
77-83
0.0
0.1
0.0
0.5
0.0
0.2
84+
0.0
0.0
0.0
0.5
0.0
0.2
Total
1.2
0.9
4.4
2.8
2.8
1.9
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Other Off-Road Motor Vehicles - Data and Interpretation
As shown in Table 7, the age specific rate for other off-road motor vehicle emergency room visits
in Haldimand-Norfolk was slightly higher compared to Ontario (1.1/1000 and 0.4/1000 respectively). From a demographic perspective the age specific rate for both females in Haldimand-Norfolk
was slightly higher compared to the province (females, 0.6/1000 and 0.1/1000 respectively; males,
1.7/1000 and 0.6/1000 respectively). The age specific rate for other off-road motor vehicles was
relatively low for both Haldimand-Norfolk and Ontario. The highest rate for other off-road
motor vehicles emergency room visits in Haldimand-Norfolk was found in persons aged 21-27
(3.4/1000), while the highest rate for Ontario was found in persons aged 14-20 (1.2/1000). In
2004, other off-road motor vehicles emergency room visits were attributed to ATVs.
42
Unintentional Injury Emergency Room Visits
Table 7 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Other OffRoad Motor Vehicles, Haldimand-Norfolk and Ontario, 2004
Age Group
0-6
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0.2
0.1
0.0
0.1
0.1
0.1
7-13
1.1
0.3
2.4
0.9
1.8
0.6
14-20
1.5
0.5
4.5
1.9
3.0
1.2
21-27
1.3
0.2
5.2
1.2
3.4
0.7
28-34
0.5
0.1
1.5
0.7
1.0
0.4
35-41
0.7
0.1
1.2
0.5
1.0
0.3
42-48
0.3
0.1
2.3
0.4
1.3
0.2
49-55
0.4
0.0
0.2
0.2
0.3
0.1
56-62
0.0
0.1
0.2
0.2
0.1
0.1
63-69
0.0
0.0
0.3
0.2
0.1
0.1
70-76
0..0
0.0
0.4
0.1
0.2
0.1
77-83
0.0
0.0
0.0
0.1
0.0
0.0
84+
0.0
0.0
0.0
0.1
0.0
0.1
Total
0.6
0.1
1.7
0.6
1.1
0.4
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Falls - Data and Interpretation
As shown in Table 8, the age specific rate for emergency room visits due to falls in HaldimandNorfolk was higher compared to Ontario (41.0/1000 and 28.3/1000 respectively). The rate for
Haldimand-Norfolk females and males was higher compared to Ontario (females, 43.3/1000 and
28.7/1000 respectively; males, 38.6/1000 and 27.9/1000 respectively). The highest rate for fall
emergency room visits in Haldimand-Norfolk was found in persons aged 0-20 and in persons 70
years and older. This pattern is consistent with the province. Similar to Ontario, the highest rate
for emergency room visits attributed to falls in Haldimand-Norfolk was found in persons aged 84
and over (131.2/1000). In 2004, a higher proportion of unintentional injury emergency room visits
in Haldimand-Norfolk was attributed to an unspecified fall, followed by fall from same level, slip,
trip and stumble and fall on and from stairs to steps.
43
Unintentional Injury Report - 2006
Table 8 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Falls,
Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
58.2
43.2
75.9
54.2
67.1
48.8
7-13
59.2
36.5
65.5
45.0
62.4
40.8
14-20
34.4
22.7
51.3
34.5
42.9
28.8
21-27
27.5
16.2
31.6
20.9
29.7
18.6
28-34
22.2
14.8
29.3
17.0
25.8
15.9
35-41
27.3
15.6
24.8
17.5
26.0
16.6
42-48
29.9
17.8
23.5
18.9
26.6
18.4
49-55
32.8
22.0
25.7
18.5
29.2
20.3
56-62
34.7
26.0
25.6
19.3
30.1
22.7
63-69
43.3
30.2
25.7
22.0
34.5
26.2
70-76
59.3
44.6
29.1
30.1
44.9
37.9
77-83
96.1
74.2
65.2
51.1
83.5
64.8
84+
146.0
135.5
95.5
97.7
131.2
123.5
Total
43.3
28.7
38.6
27.9
41.0
28.3
0-6
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
External Causes of Burns - Data and Interpretation
As shown in Table 9, the age specific rate due to external causes of burns emergency room visits
in Haldimand-Norfolk was slightly higher compared to Ontario (2.4/1000 and 1.5 /1000 respectively). The rate for Haldimand-Norfolk females and males was higher compared to Ontario
(2.0/1000 and 1.3/1000 respectively; 2.7/1000 and 1.7/1000 respectively). Similar to Ontario, the
highest rate for external causes of burns emergency room visits in Haldimand-Norfolk was found
in persons aged 0-6 (5.4/1000). For the most part, the rate for external causes of burns emergency room visits in Haldimand-Norfolk decreased from age grouping 14-20 onward. This pattern
was consistent with Ontario. In 2004, a higher proportion of external causes of burns emergency
room visits in Haldimand-Norfolk was attributed to contact with hot drink or food cooking oil,
followed by contact with other hot fluids and contact with hot heat appliance radiator pipe.
44
Unintentional Injury Emergency Room Visits
Table 9 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for External
Causes of Burns, Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
5.9
2.4
4.8
3.5
5.4
3.0
7-13
1.1
0.8
2.0
1.0
1.6
0.9
14-20
3.6
2.1
3.0
2.4
3.3
2.3
21-27
1.8
1.7
3.7
2.4
2.8
2.1
28-34
1.7
1.4
3.4
2.0
2.6
1.7
35-41
2.3
1.3
2.8
1.8
2.6
1.6
42-48
2.2
1.4
2.8
1.6
2.5
1.5
49-55
2.5
1.1
2.4
1.3
2.4
1.2
0-6
56-62
0.9
1.0
1.3
1.1
1.1
1.0
63-69
0.0
0.8
3.3
0.9
1.6
0.8
70-76
0.7
0.8
1.5
0.6
1.1
0.7
77-83
0.0
0.7
0.6
0.7
0.3
0.7
84+
0.0
0.6
1.6
0.7
0.5
0.7
Total
2.0
1.3
2.7
1.7
2.4
1.5
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Poisonings - Data and Interpretation
As shown in Table 10, the age specific rate for poisonings emergency room visits in HaldimandNorfolk is slightly higher compared to Ontario (2.5/1000 and 1.7 /1000 respectively). The rate for
Haldimand-Norfolk females and males was higher compared to Ontario (2.2/1000 and 1.7/1000
respectively; 2.8/1000 and 1.8/1000 respectively). Similar to Ontario, the highest rate for poisoning emergency room visits in Haldimand-Norfolk was found in persons aged 0-6 (7.8/1000).
In 2004, a higher proportion of poisonings emergency room visits in Haldimand-Norfolk was
attributed to other/unspecified chemical toxic substance, followed by poison by other gases and
vapours.
Table 10 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Poisonings,
Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0-6
6.6
3.4
9.0
4.0
7.8
3.7
7-13
0.6
0.7
0.9
0.8
0.8
0.7
14-20
1.7
2.5
3.8
2.2
2.8
2.3
21-27
2.8
2.0
2.8
2.5
2.8
2.3
28-34
2.0
1.7
4.8
2.0
3.4
1.8
35-41
2.7
1.6
3.3
1.7
3.0
1.7
42-48
2.2
1.5
2.0
1.6
2.1
1.6
49-55
1.4
1.4
1.2
1.3
1.3
1.4
56-62
1.8
1.2
0.6
1.0
1.2
1.1
63-69
1.5
1.1
0.9
1.0
1.2
1.0
70-76
1.4
1.2
3.0
1.1
2.1
1.1
77-83
1.3
1.4
0.6
1.2
1.0
1.3
84+
1.9
1.3
3.1
1.5
2.3
1.4
Total
2.2
1.7
2.8
1.8
2.5
1.7
45
Unintentional Injury Report - 2006
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Sports Injuries - Data and Interpretation
As shown in Table 11, the age specific rate for sports injury emergency room visits in HaldimandNorfolk is slightly higher compared to Ontario (4.9/1000 and 3.6 /1000 respectively). The rate for
Haldimand-Norfolk females and males was higher compared to Ontario (2.0/1000 and 1.5/1000
respectively; 7.8/1000 and 5.7/1000 respectively). Similar to Ontario, the highest rate for sports
injury emergency visits in Haldimand-Norfolk was found in persons aged 14-20 (22.6/1000). In
2004, a higher proportion of sports injury emergency room visits in Haldimand-Norfolk was
attributed to playing hockey.
Table 11 – Age Specific Rates (per 1,000 population) of Emergency Room Visits for Sports
Injuries, Haldimand-Norfolk and Ontario, 2004
Age Group
Females
Males
Total
H-N
ON
H-N
ON
H-N
ON
0-6
0.2
0.7
2.2
1.3
1.2
1.0
7-13
5.3
5.3
20.8
14.5
13.2
10.0
14-20
9.7
6.8
35.2
24.2
22.6
15.7
21-27
2.3
1.3
8.5
6.5
5.6
4.0
28-34
1.7
0.1
4.8
4.5
3.3
2.8
35-41
1.4
0.7
2.4
3.0
1.9
1.9
42-48
0.0
0.4
2.8
2.0
1.4
1.2
49-55
0.0
0.2
0.5
0.9
0.3
0.6
56-62
0.0
0.1
0.6
0.5
0.3
0.3
63-69
0.3
0.1
0.3
0.2
0.3
0.2
70-76
0.0
0.1
0.0
0.1
0.0
0.1
77-83
0.0
0.0
0.0
0.1
0.0
0.1
84+
0.0
0.0
0.0
0.1
0.0
0.0
Total
2.0
1.5
7.8
5.7
4.9
3.6
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
Conclusion
In summary, the age specific rate for unintentional injuries emergency room visits was higher
in Haldimand-Norfolk compared to Ontario. For Haldimand-Norfolk males and females, the
rate was higher compared to Ontario (see Table 12). Based on selected injury indictors the
rate for emergency room visits in Haldimand-Norfolk was highest for injuries resulting from
falls (41.0/1,000), MVTC (10.5/1,000) and sports unintentional injuries (4.9/1,000) (see Table 12).
Compared to provincial data, this pattern is consistent with Ontario. For the most part, the
Haldimand-Norfolk rate for emergency room visits for selected injuries is higher than the province, with the exception of pedestrian (traffic-related).
46
Unintentional Injury Emergency Room Visits
Table 12 - Summary of Age Specific Rates (per 1,000 population) of Emergency Room Visits
for Selected Unintentional Injuries, Haldimand-Norfolk and Ontario, 2004
Age Specific Rate (per 1,000 population)
Injury
Total
H-N
ON
Total
Total
All Unintentional
157.1
98.4
Injuries
Falls
41.0
28.3
Motor Vehicle Traffic
10.5
6.4
Crashes
Sports Injuries
4.9
3.6
Pedal Cycle
2.8
1.9
Poisonings
2.5
1.7
External Causes of
2.4
1.5
Burns
Other Off-Road Motor
1.1
0.4
Vehicles
Pedestrian
0.3
0.3
(Traffic-related)
Females
H-N
ON
Total
Total
125.2
80.5
H-N
Total
189.1
Males
ON
Total
116.7
43.3
9.2
28.7
6.2
38.6
11.7
27.9
6.5
2.0
1.2
2.2
2.0
1.5
0.9
1.7
1.3
7.8
4.4
2.8
2.7
5.7
2.8
1.8
1.7
0.6
0.1
1.7
0.6
0.3
0.3
0.3
0.3
Data Source: Ontario and Haldimand-Norfolk Population Estimates, Provincial Health Planning Database (PHPDB),
(Extracted July 10, 2006) and Emergency Room Visits, Provincial Health Planning Database (PHPDB), (Extracted July 10,
2006). If the counts are less than 5 incidents in a given year, the number is not releasable.
Data Notes: Includes patient ID Source Code “H” and “D” and excludes out of province Ontario residents.
47
Unintentional Injury Report - 2006
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48
Conclusion
The goal of the Unintentional Injury Report was to provide an overview of unintentional injuries
in Haldimand and Norfolk based on selected injury indicators. This report was an important document for understanding unintentional injury trends over a period of time compared to Ontario.
Also a valuable overview of the Haldimand-Norfolk Health Unit’s injury prevention public health
initiatives were included in this report. It was intended to provide physicians, health care professionals, local politicians, media, health units, schools, local government and the general public with
useful information for the purpose of program planning and injury prevention.
Based on the analysis, this report provided new information and illuminated several aspects of
unintentional injuries in Haldimand-Norfolk for injury hospitalization separations, injury mortality and injury emergency room visits. Most notable for unintentional injury hospitalization is that
the average age standardized hospitalization separation rate was higher for each selected injury
indicator compared to Ontario. Based on selected injury indictors the average age standardized
hospitalization rates in Haldimand-Norfolk was highest for injuries resulting from falls, MVTC,
poisonings, sports injuries, other off-road motor vehicles and external causes of burns. Significant
differences for the years 2000-2004 were found for unintentional injuries and MVTC.
For injury mortality data, it was found that the average age standardized mortality rate for unintentional injuries was higher in Haldimand-Norfolk compared to the province. Moreover, based
on selected injury indicators (MVTC and falls) the average age standardization mortality rate was
higher for each indicator compared to Ontario. However, there were no statistical differences
compared to the province as a whole.
For emergency room visits data, it was found that the age specific rate for unintentional injuries
emergency room visits was higher in Haldimand-Norfolk compared to the province. In addition,
the age specific rate for both females and males in Haldimand-Norfolk for selected unintentional
injury indicators was higher compared to the province. Based on selected injury indictors the rate
for emergency room visits were highest for injuries resulting from falls, MVTC and sports injuries.
49
Unintentional Injury Report - 2006
Continued efforts in injury prevention programming are essential to reduce injuries. At the same
time, further examination of both selected injury indicators and additional injury indicators would
provide meaningful data and further explanation. The following section are recommendations as
a result of the report.
Recommendations
1.
To examine differences between injuries in rural areas compared to urban areas and identify
best practices in rural health for injury prevention programming.
2.
To conduct further analysis comparing Haldimand-Norfolk to rural surrounding health units.
3.
To develop a subsequent report on intentional injuries for Haldimand-Norfolk compared to
Ontario.
4.
To develop a subsequent report on alcohol and other substance-related injuries or deaths.
5.
To examine age and gender grouping data for unintentional injuries in Haldimand-Norfolk
compared to Ontario.
6.
To identify program needs from the data and to modify existing injury prevention programs to
address those needs.
7.
To provide residents, physicians, health care professionals, local politicians and the media,
health units, schools, local government and the general public with useful information for the
purpose of program planning and injury prevention.
8.
To conduct further investigations into the factors influencing the high MVTC rates in
Haldimand-Norfolk.
9.
To conduct further investigations into the factors influencing the high fall rates in HaldimandNorfolk.
10. To conduct further investigations into the factors influencing injuries to children age 0-6
(burns, falls, poisonings).
50
Appendices
Appendix 1
1991 Canadian Adjusted Standard Population
Age Group
0-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90 and over
Total
Females
955983
942483
924828
936776
1025803
1237171
1283628
1173175
1060889
829574
667664
618932
612026
588125
470852
367465
240600
130485
69913
14136372
Males
1002469
991363
973036
991216
1062179
1269802
1298896
1172240
1068117
843971
674865
616524
580049
498715
364884
255989
142435
62274
25468
13894492
Total
1953346
1953045
1913115
1926090
2109452
2529239
2598289
2344872
2138891
1674153
1339902
1238441
1190217
1084588
834024
622221
382303
192410
95467
28120065
*Adopted from the Public Health Agency of Canada
51
Unintentional Injury Report - 2006
Appendix 2
Age Standardized Rate (SRATE) and
Age Standardized Hospitalization Rate/Age Standardized Mortality Rate (SHR/
SMR) Formulas
SRATE Formula:
SRATE = summation (r*P)/summation P
Variance = summation [(r* (1-r)/q * (P*P)]/[(summation P)*(summation P)]
Lower Interval = (SRATE-(1.96*(square root of Variance)) *1000
Upper Interval = (SRATE + (1.96 * (square root of the Variance)) *1000
“r” is the age specific death rate in the local area (e.g., public health unit)
“r” = d/q
“d” is the number of deaths in age group i of the local public area population (e.g., public
health unit)
“q” is the number of persons in age group i of the local area population (e.g., public health unit)
“P” is the number of persons in age group i in the standard population (1991 Canadian
adjusted population)
For hospital data, replace death rate with hospitalization rate.
SMR/SHR Formula:
SMR = (summation o)/ (summation M*q) observed/expected
Variance = summation [(q * m (1-m)] / [(summation q * M) * (summation q * M]
Variance = SMR/ [summation q * M]
Lower Interval = (SMR – (1.96 * (square root of Variance)
Upper Interval = (SMR + (1.96 * (square root of Variance)
“o” is the observed number of deaths in a local area (e.g., public health unit)
“q” is the number of persons in age group i of the local population (e.g., public health unit)
“M” is the age specific death rate in the standard population (i.e., Ontario) for persons in
age group i
“m” is the age specific death rate in the local area (e.g., public health unit) for persons in age
group in the Standard Population.
For hospital data, replace death rate with hospitalization rate.
52
Appendices
Appendix 3
ICD 9 and ICD 10 Classification Tables
Types of Injuries
Unintentional Injuries
Motor Vehicle Traffic Crashes
Pedestrian (Traffic-Related)
Pedal Cycle
Motor Driven Snow Vehicle
Other Off-Road Motor
Vehicles
Recreational Boating
Accidents
Drowning
Falls
External Causes of Burns
Suffocation, including choking
Poisonings
Sports Injury
ICD 9 Codes
E800-E929 excluding E870E879
E810-E819
Codes ending in .7 for E810E819
E826 and codes ending in .6
for E810-E825
E820
ICD 10 Codes
V01-X59, Y85-Y86
V02-V04, V09.0, V09.2, V12V14, V19.0-V19.2, V19.4-V19.6,
V20-V79, V80.3-V80.5,
V81.0-V81.1, V82.0-V82.1,
V83-V86, V87.0-V87.8, V88.0V88.8,V89.0,V89.2
V02.1,V03.1, V04.1,V09.2,V09.3
V10-V14, V16-V19
V86.00,V86.10,V86.30, V86.50,
V86.51, V86.60, V86.61,
V86.90,V86.91
E821
V86.08,V86.18,V86.2,V86.38,
V86.4,V86.58,V86.68,V86.7,V
86.98
Codes ending in .0,.4, or .5 for V90.2-V90.8, V91.2E830-E838
V91.8, V92.2-V92.8,V93.2V93.8,V94.2-V94.8
E830, E832, E910
V90,V92,W65-W74
E880-E888
W00-W19
E890-E899, E924-E926
W85-91, X00-X19
E911-E913
W75-W84
E850-E869
X40-X49
E917.0
W02,W21,W22.00W22.07,W51.00-W51.07
53
Unintentional Injury Report - 2006
Appendix 4
Glossary of Statistical and Analytical Terms
Terms
Age Specific Rate
Age Standardization
Confidence Interval (CI)
Confidence Limits (LCI, UCI)
Hospital Separations
Standardized Mortality/
Hospitalization Ratio
Statistically Significant Difference
Definition
A rate for a specified age group. The numerator and
denominator refer to the same age group. The multiplier
(i.e., 1,000 or 100,000) is chosen to produce a rate that
can be expressed as a convenient number.
A procedure for adjusting rates, e.g., death rates, designed
to minimize the effects of differences in age composition
when comparing rates for different populations.
The computed interval with a given probability, e.g., 95%,
that the true value of the variable such as a mean, proportion, rate, or ratio is contained within the interval. The
computed interval with a given probability, e.g., 95%, that
the true value of the variable such as a mean, proportion,
rate, or ratio is contained within the interval.
The computed interval with a given probability, e.g., 95%,
that the true value of the variable such as a mean, proportion, rate, or ratio is contained within the interval. LCI and
UCI—the lower boundary/limit and upper boundary limit
of the confidence interval.
A hospital separation is a discharge or transfer from a hospital, or a death that occurs in a hospital. Separations are a
data source used to provide an indicator of the extent of
the disease and illness in a community.
The ratio of the number of hospital separations observed
in Haldimand-Norfolk to the number that would have
been expected if Haldimand and Norfolk had the same
specific rates as Ontario. If the confidence interval around
the ratio includes the value of 1.0 then the two rates do
not differ. Otherwise the differences are statistically
different.
Tests of statistical significances are used to determine
whether differences in point estimates, proportions or
rates exist between populations.
*Adopted in its entirety from Haldimand-Norfolk Health Status Report 2002.
54
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