Multilevel analysis of associations between socioeconomic status and injury among Canadian adolescents

Study objective: To determine the contribution of individual and area level measures of socioeconomic status (SES) to the occurrence of various injury types among Canadian adolescents. Design and setting: Cross sectional Canadian data were used from two sources: (1) the 2001/02 health behaviour in school aged children survey (individual level SES measures, injury measures), and (2) the 2001 Canada census of population (area level SES measures). Injury outcomes included: medically treated injury, injury hospitalisation, sport/recreational injury, and fighting injury. Multilevel logistic regression models were used to examine individual and area level SES measures as potential determinants of adolescent injury. Participants: 7235 students in grades 6-10 from 170 schools across Canada. Main results: Associations between SES and injury were identified for each injury outcome examined, although a clear direction of association was not present for the overall measure of medically treated injury. In general, lower SES was associated with increased risk for hospitalised and fighting injury. Higher SES was associated with increased risks for sport/recreational injury. Independent contributions of individual and area level measures of SES were seen for hospitalised and fighting injury. Conclusions: Associations between SES and adolescent injury exist; however, the direction of these relations becomes more apparent with particular indicators of SES and when homogenous injury outcomes are evaluated.