The epidemiology of traumatic brain injury in the Cree Communities of Eeyou Istchee

Fri, 11/06/2015 - 10:42 -- Iain Cook
TitleThe epidemiology of traumatic brain injury in the Cree Communities of Eeyou Istchee
Publication TypeResearch
Year of Publication2015
AuthorsLasry OJ
Tertiary AuthorsCarlin D.Robert, Torrie J
Keywordshospitalization, injury prevention, TBI, traumatic brain injuries

Background: The effect of traumatic brain injury on populations around the globe is heterogeneous. The literature has described that the incidence rates and risk factors for TBI vary greatly between different rural populations. More specifically, indigenous populations around the globe seem to be disproportionately affected. Given this great variation, experts have recommended that epidemiological studies be conducted on a community-by-community basis to provide insights on prevention that are specific to a given population. In Canada, no such epidemiological analysis of TBI in indigenous populations has been completed.

Methods: A descriptive, retrospective, population-based study of all incident TBI hos- pitalizations of Quebec Health Region 18 (Eeyou Istchee) beneficiaries between 2000-2012 was completed. For the primary analysis, the administrative MED-E ́CHO database was used for case finding. A chart-review of TBI cases in Region 18 was completed for the sub-analysis of risk factors in adults. Statistical analyses were conducted using multiple regression models, multiple imputations for missing data and sensitivity analyses to assess for relevant biases.

Results: There were a total of 172 incident TBI hospitalizations during the study period. The rate of TBI for Eeyou Istchee beneficiaries was 1.86 times (95% CI 1.56 - 2.17) the rate of the rest of Québec. Incidence rates in Eeyou Istchee were higher than in a neighbouring non-indigenous population but lower than in another neighbouring indigenous population. Assaults and off-road vehicle collisions were the leading cause of TBI in the region and their distribution differed significantly from other regions in the province. Protective equipment use predicted higher initial Glasgow Coma Score (GCS) and a better functional outcome. Use of rehabilitation services tended to be systematically more frequent amongst patients involved in motor vehicle collisions in comparison to other mechanisms of injury.

Conclusion: This analysis demonstrates that the occurrence and determinants of TBI are quite different for Eeyou Istchee compared to neighbouring and distant populations within Qu ́ebec. This type of epidemiologic description is a critical tool for indigenous rural populations that wish to develop relevant TBI prevention strategies.

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