Transportation injury inequities among Canadian children in a linked, population-based cohort

Transportation injury is a leading cause of morbidity and mortality for children. Risk is inequitable, but transportation injury studies often rely on ecological-level indicators of sociodemographics. This study examines individual and household-level social inequities in Canadian children which increase their risk of bicycling, pedestrian and motor vehicle occupant/driver injuries based on a unique linked data set. We analyzed three cohorts linking Canadian census data to health records: an emergency department (ED) cohort (n = ∼1,731,200), a hospitalization cohort (n = ∼3,615,500) and a mortality cohort (N = ∼4,664,000). We used Poisson regression to estimate the incidence rate ratio (IRR) of pedestrian, bicycling and motor vehicle occupant/driver injuries separately in each cohort. We found positive associations across most outcomes for male children and rural residence. For pedestrian and motor vehicle injuries, older age of the child at onset increased risk, while higher parental education level was protective. A single adult household was a predictor for traffic injury ED visits and hospitalizations for all modes of transportation studied. Commute mode of the child or adults in their household was associated with increased risk of both motor vehicle and bicycling injuries, suggesting it may have indicator value for household mode usage. Children experience varying risks of traffic injury based on household and individual characteristics, underscoring the need for systemic and targeted prevention efforts to reduce injuries and address health disparities. Future work could examine how preventive initiatives interact with social and area-level risk factors for children's traffic injury. • Individual sociodemographic factors influence risk of child transportation injuries. • Low income, low parental education, and rurality increased risk. • Indigenous status was one of the main risk factors for any type of child transportation-related hospitalizations. • Visible minority status, female sex, and urban residence decreased risk.