Abstract
OBJECTIVES: To examine unintentional injury mortality rates in children (0–19 years) in Canada from 1950 to 2009 against national population-level injury prevention interventions.
METHODS: Injury mortality rates were age and sex adjusted. Changes in trend and level of mortality rates were assessed at pre-specified intervention periods using segmented linear regression analyses for interrupted time series. Maximum likelihood estimation was used with a second order autoregressive error process.
RESULTS: From 1950 to 2009, the overall unintentional injury mortality rate decreased by 86%. Males had consistently higher mortality rates compared to females; however, the standardized rate ratio decreased from 2.37:1 in 1950 to 1.97:1 in 2009. Substantial declines in choking/ suffocation deaths were noted in children less than 1 year of age, predominantly during the period 1970–1988 when the Hazardous Products Act and Crib Regulations were implemented. For burns, significant changes in slope were noted comparing 1972–1994 to pre-1971 (introduction of the Hazardous Products Act - Flammability Regulations), where the greatest decline was noted in children ages 1–4 years (Est. = −0.03, 95% CI = −0.02, −0.04). For 15–19 year olds, there was a 408% increase in motor vehicle collision-related mortality rates between 1950 and 1971; however a significant change in slope was noted during the period 1978–1985, compared to 1972–1977 (Est. = −0.10, 95% CI = −0.20, −0.007) across all age groups.
CONCLUSION: While this study is not a cause and effect analysis, there is a strong association with implementation of safety campaigns and legislative changes related to child safety and a dramatic decline in childhood fatalities related to injury.
Key words: Adolescent, Canada/epidemiology, cause of death, mortality/trends, wounds and injuries/mortality, wounds and injuries/prevention & control, child, preschool, infant
Résumé
OBJECTIFS: Examiner les taux de mortalité liés aux blessures non intentionnelles chez les enfants (0–19 ans) au Canada de 1950 à 2009 par rapport aux interventions nationales de prévention des blessures à l’échelle de la population.
MÉTHODE: Les taux de mortalité liés aux blessures ont été rajustés selon l’âge et le sexe. Nous avons estimé les changements dans les tendances et le niveau des taux de mortalité durant des périodes d’intervention préétablies à l’aide d’analyses en régression linéaire segmentée pour des séries chronologiques interrompues. Nous avons procédé par estimation du maximum de vraisemblance avec un processus d’erreur autorégressif d’ordre 2.
RÉSULTATS: De 1950 à 2009, le taux global de mortalité lié aux blessures non intentionnelles a diminué de 86 %. Les taux de mortalité des garçons étaient systématiquement plus élevés que ceux des filles, mais le rapport de taux standardisés a baissé, passant de 2,37:1 en 1950 à 1,97:1 en 2009. Nous avons remarqué des baisses importantes des décès par étouffement ou suffocation chez les enfants de moins d’1 an, principalement pour la période de 1970 à 1988, quand la Loi sur les produits dangereux et le Règlement sur les lits d’enfant ont été mis en œuvre. Pour les brûlures, nous avons remarqué des changements importants dans la pente de la courbe entre la période de 1972 à 1994 et celle d’avant 1971 (introduction du Règlement sur l’inflammabilité de la Loi sur les produits dangereux); la plus forte baisse a été remarquée chez les enfants de 1 à 4 ans (est. = −0,03, IC de 95 % = −0,02, −0,04). Chez les 15 à 19 ans, il y a eu une hausse de 408 % des taux de mortalité liés aux collisions entre véhicules automobiles entre 1950 et 1971; cependant, nous avons remarqué un changement significatif dans la pente de la courbe pour la période de 1978 à 1985 comparativement à celle de 1972 à 1977 (est. = −0,10, IC de 95 % = −0,20, −0,007) dans tous les groupes d’âge.
CONCLUSION: Notre étude n’est pas une analyse causale, mais il existe une forte association entre la mise en œuvre des campagnes de sécurité et des modifications législatives liées à la sécurité des enfants et la baisse spectaculaire des blessures mortelles durant l’enfance.
Motsclés: adolescent, Canada/épidémiologie, cause de décès, mortalité/tendances, plaies et lésions traumatiques/mortalité, plaies et lésions traumatiques/prévention et contrôle, enfant d’âge préscolaire, nourrisson
Footnotes
Conflict of Interest: None to declare
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