281 - Urban-rural differences in pediatric ATV-related trauma in Canada from 2002-2019: A population-based descriptive study

Publication Number: 2271.281

Mattea Heck, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Shamsia Sobhan, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; Robert Balshaw, University of Manitoba, Winnipeg, MB, Canada; Jonathan McGavock, University of Manitoba, Winnipeg, MB, Canada

Background: Tens of thousands of children and adolescents are hospitalized for all-terrain vehicle (ATV) related injuries in Canada and the US every year. The Canadian Pediatric Society (CPS) and the American Academy of Pediatrics (AAP) have recommendations to reduce these injuries with specific suggestions for youth living in rural areas. A few studies suggest there are differences in injury patterns and severity differences between rural- and urban-dwelling patients but these are restricted to single-centre medical records and are at risk of selection bias, misrepresenting the difference in ATV-related injuries among rural-dwelling youth.

Objective: The aim of this study was to describe population estimates and trends in ATV-related hospitalizations for urban and rural-dwelling youth in Canada.

Design/Methods: We conducted a cross-sectional study using administrative hospital abstract data of all patients admitted for an ATV-related injury across 9 provinces of Canada between 2002 and 2019. The primary exposure was rural residence, defined by postal code. Rural-urban comparisons were stratified by age group: children ( < 16 years), adolescents (16-20 years), and adults (≥21 years). The primary outcome was the incidence of hospitalization for any ATV-related injury per 100,000 people, secondary outcomes were head injury, fractures, crush injury, and spinal cord injury.

Results: Among 34,390 patients with complete data, 17% were children and 14% were adolescents; 78% of children and 85% of adolescents were male, and 47% lived rurally. The rate ratio (RR) for being hospitalized for an ATV related injury in children was 5.6-fold higher (95% CI: 5.33-5.92) in rural groups compared to urban (Table 1). Rural-dwelling adolescents had a 5.22-fold higher (95% CI: 4.93-5.53) rate of injury than urban-dwelling peers. When injury rates were separated by injury type (Table 1) rural-dwelling children displayed higher relative rate of head injury (RR: 6.61; 95% CI: 5.81-7.52), while adolescents had a 10.54-fold higher (95% CI: 5.8-19.15) relative rate of crush injury compared to urban-dwelling peers. Hospitalization rates in adolescents were higher than those in children and adults.

Conclusion(s): While differences in estimated annual rates of hospitalizations per 100,000 people are not adjusted for exposure time (eg. hours of ATV use), they clearly indicate that rural children and adolescents are more commonly being hospitalized for ATV-related injuries than urban-dwelling peers. This strengthens the recommendation from the CPS and AAP that targeted public health interventions directed towards rural settings are still needed.

Table 1. Hospitalization rates, rate difference (RD) and rate ratio (RR) of youth and adults hospitalized for ATV-related injuries
Table 1.pdfHospitalization rate per 100,000, rate difference (RD) and rate ratio (RR) with 95% confidence interval (CI) of rural children, adolescents and adults hospitalized for ATV-related injuries.