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A population-based comparison of injuries among farm children to non-farm children in Alberta, 1999-2010 Open Access


Other title
Type of item
Degree grantor
University of Alberta
Author or creator
Kim, Kyungsu
Supervisor and department
Voaklander, Don (School of Public Health)
Examining committee member and department
Beach, Jeremy (School of Public Health)
MacPherson, Alison (School of Kinesiology & Health Science)
Dryden Donna (School of Public Health)
Senthilselvan, Sentil (School of Public Health)
Department of Public Health Sciences
Date accepted
Graduation date
Doctor of Philosophy
Degree level
Objectives - To systematically review literature on rural-urban differences in pediatric injury incidence and to examine incidence of all-cause injury, agricultural injury, and injury-related health care utilization for farm children compared to several groups of non-farm children under 18 years of age in Alberta, Canada. Methods – A systematic review examined population-based observational studies published from 1970 to August 2013, that compared rates or health care outcomes of injury between rural and urban children (<18) living in Canada or the United States. Three of population-based retrospective cohort studies followed farm, rural, First Nations (FN), urban children from 1999 to 2010 to examine incidence of injury and related health services using the linkage of four administrative health databases (data from physician visits to deaths). Person-time incidence rates and adjusted hazard ratios were calculated based on injury episode. Results – Systematic review demonstrated that rural children sustained a higher rate of overall injury, particularly from MVC and suicide than urban children. Primary studies showed farm and rural children, especially rural FN children, had higher rates and greater utilizations of overall injury, especially for severe injuries, than urban children. This trend was consistent for most injury mechanisms but more notably for other land transport (e.g., ATVs, animal riding, agricultural vehicle-related injuries), natural/environmental (e.g., bees, insects, animals-related), and unintentional firearm-related injuries. Farm and rural non-FN children were at a greater risk of agricultural injuries, more outstandingly for farm-animal and machinery-related injuries, than rural FN and urban children. Agricultural injuries appeared to be more unintentional and lethal. Rural FN children, followed by rural non-FN and farm children, experienced greater utilization of higher levels of medical facilities, thinner shapes of injury pyramid, and greater proportions of pre-hospital deaths. Conclusions – Greater burden of injury for farm and rural children and specific patterns per group indicate a need for targeted and specialized injury prevention strategies for higher-risk mechanisms in each group, attention for agricultural injury controls to extended populations, comprehensive intervention strategies for underlying inter-related causes of injury in rural areas, and an advanced pediatric trauma care for serious injuries the ED for efficient and timely care in rural areas.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Kyungsu Kim, Dejan Ozegovic, Donald C Voaklander. Differences in incidence of injury between rural and urban children in Canada and the U.S.: a systematic review. Inj Prev 2012;18:264-271.

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