Claire Benny

Background: Unintentional injuries are a major cause of morbidity and mortality in Canada, and socioeconomic position (SEP) is an important but understudied upstream determinant of injury risk. This study examined the sex-stratified association between educational attainment and unintentional injury risk using population-based administrative data.Methods: Data were from the 2016 Canadian Census, linked to Alberta National Ambulatory Care Reporting System (NACRS) records until 2023. The primary exposure was educational attainment (less than high school, high school/some postsecondary, bachelor's degree or higher). Outcomes were time-to-first emergency department (ED) visit for overall unintentional injury and specific mechanisms (falls, burns, poisonings, drowning, motor-vehicle collisions), identified via ICD-10-CA codes. Sex-stratified Cox proportional hazards models estimated hazard ratios (HRs).Results: Our sample represented approximately 1.3 million working-aged Albertans. Estimates highlighted that higher education was associated with reduced overall unintentional injury risk for both females (HR=0.73, p<0.05) and males (HR=0.74, p<0.05), with a clear dose-response gradient corresponding to the level of education. There was a protective association between education and falls in both sexes (females: HR=0.70, p<0.05; males: HR=0.83, p<0.05), burns among females (HR=0.50, p<0.05), and with motor vehicle collisions among males (HR=0.51, p<0.05). There were no statistically significant associations between educational attainment and poisonings or drowning among either sex.Discussion: Educational attainment demonstrates a strong, consistent, dose-dependent inverse association with unintentional injury risk, with mechanism- and sex-specific variation suggesting distinct mechanisms. These findings support education as an upstream target for injury prevention.

Background: Injury is a leading cause of death and disability in Canada, and injury rates are disproportionately higher in Alberta. Limited evidence suggests that social inequities, including income inequality, may contribute to injury risk through differential exposure to hazards and unequal access to prevention and care. The objective of this study is to examine the ecological association between income inequality and rates of injury-attributable emergency department (ED) visits in Alberta from 2013 to 2022. Methods: Data on social inequities were from the 2016 Census and injury-attributable ED data were from Alberta Health (2013–2022). We analysed the association between income inequality and injury mechanisms (eg, falls, poisoning) using negative binomial regression models. Results: Over the 10-year study period, there were 5.37 million injury-attributable ED visits in Alberta, most commonly from falls and being struck by or against objects, with moderate variation in social inequities across forward sortation areas. Higher income inequality was significantly associated with higher rates of several injury mechanisms, including burns (incidence rate ratio (IRR): 1.08, 95% CI 1.02 to 1.14), poisoning (IRR: 1.18, 95 % CI 1.10 to 1.26) and environmental injuries (IRR: 1.11, 95% CI 1.06 to 1.2). Higher income inequality was associated with a reduced risk of drownings (IRR: 0.93, 95% CI 0.90 to 0.97), falls (IRR: 0.82, 95% CI 0.79 to 0.85) and motor vehicle collisions (IRR: 0.90, 95% CI 0.87 to 0.93). Conclusions: The results highlight that income inequality was associated with a variety of injury outcomes and overall the findings were mixed, with some risk of injuries increasing and some decreasing with higher levels of income inequality. These findings may lend strength to discussion on integrating equity-informed approaches to injury prevention strategies. Policies that improve neighbourhood safety and enhance equitable access to healthcare may help reduce the disproportionate injury burden experienced by populations experiencing social inequity.

Purpose: Intentional injuries are among leading causes of death in Canadians and socioeconomic position (SEP) may be an important risk factor that can inform targetted prevention programming. The association between SEP and intentional injury risk has been seldom studied in Canada, and education is a key indicator of SEP that is a potential modifiable risk factor for injury risk. The objective of this study was to understand the association between educational attainment and emergency department (ED) visits due to intentional injuries in Alberta between 2016 and 2023. Principal Results: Higher educational attainment was associated with lower hazards of ED visits for intentional injury, assault, and self-harm. Compared with individuals who did not complete high school, those with a high school diploma or equivalent had a reduced hazard of intentional injury (HR = 0.69, 95% CI: 0.59–0.80), assault (HR = 0.73, 95% CI: 0.62–0.85), and self-harm (HR = 0.60, 95% CI: 0.42–0.85). The protective association was even stronger among individuals with a Bachelor’s degree or higher, who had substantially lower hazards of intentional injury (HR = 0.37, 95% CI: 0.30–0.46), assault (HR = 0.44, 95% CI: 0.35–0.56), and self-harm (HR = 0.23, 95% CI: 0.15–0.34) relative to those who did not complete high school. The results highlighted that both men and women experience educational inequalities in intentional injury-attributable ED visits. Major conclusions: Higher education was associated with lower hazards of intentional injury, particularly for assault. Gender-specific analyses further suggest that the influence of education on intentional injury risk is not uniform. These differences point to potentially distinct mechanisms through which education shapes injury risk for women and men and emphasize the need for sex-specific prevention strategies.

Background: Public health unit (PHU) engagement in schools is important for promoting wellness in students. We aimed to investigate if PHU engagement with schools may have provided protection against the risk of depression and anxiety in students during the COVID-19 pandemic. Methods: We used longitudinal data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour survey between the 2018/19 and 2020/21 academic years. Multilevel models were used to assess the association between PHU engagement with school mental health programs prior to the COVID-19 pandemic and depressive (Center for Epidemiologic Studies Depression scale Revised) and anxiety symptoms (Generalized Anxiety Disorder scale) during the COVID-19 pandemic. Results: The sample included 23 894 students across 104 secondary schools in British Columbia, Alberta, Ontario and Quebec. In confounder-adjusted models, PHU engagement before the pandemic was not associated with student depressive symptoms (B = −0.01, 95% CI = −0.04, 0.02), but was protective against anxiety symptoms (B = −0.03, −0.06, 0.001) during the COVID-19 pandemic. Discussion: The results highlight that PHU engagement with mental health programming in schools was protective against anxiety for students during the COVID-19 pandemic. The findings support the importance of PHU engagement for improving student mental health and pandemic recovery.

Introduction: Individuals with low socio‐economic position (SEP) experience disproportionate alcohol‐attributable harm. Limited research has investigated whether these inequities are driven by alcohol‐attributable conditions that are acute or chronic. The study aimed to estimate the sex‐specific associations between SEP and incident wholly alcohol‐attributable emergency department (ED) visits for acute and chronic harms, respectively.Methods: A cohort study was conducted using the Canadian Community Health Survey (2003–2008) linked to the National Ambulatory Care Reporting System (2002–2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow‐up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol‐attributable ED visits.Results: The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07–2.87; men HR 3.47, 95% CI 2.29–5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04–4.80; men HR 5.02, 95% CI 2.88–8.75). Acute and chronic wholly alcohol‐attributable ED visit rates were higher in men than women.Discussion and Conclusions: The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol‐attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol‐attributable ED visits.

Introduction: Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19. Material and methods: Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19. Results: The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (β = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19. Discussion: The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health.

Background Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time. Methods Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007–2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables. Results The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant. Conclusion Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm.