Distribution and Neighbourhood Deprivation Patterns of Unintentional Home Injuries in British Columbia, Canada

Abstract

Unintentional injuries occurring in the home represent a substantial and persistent public health burden in Canada, accounting for a large proportion of injury-related hospitalizations, particularly among older adults, children, and equity-owed populations. While prior research has documented socioeconomic gradients in injury risk, limited scholarship has examined unintentional home injuries through population-level analyses of neighbourhood deprivation, spatial epidemiology, and community-engaged qualitative inquiry to understand how structural inequities and lived experiences intersect to shape vulnerability to home injury risks. Recent immigrants and refugees, particularly those navigating resettlement within constrained housing and settlement structures, remain underrepresented in this body of work.

In this manuscript-based thesis, I explored unintentional home injuries in British Columbia (BC) through three stand-alone papers that collectively link structural and spatial patterns of home injury risks and how these risks are experienced by members of Afghan newcomer communities. In the first paper, I examined neighbourhood-level disparities in unintentional home injury hospitalizations across BC between 2015 and 2019 using administrative health data linked with the Canadian Index of Multiple Deprivation (CIMD). I calculated neighbourhood-level unintentional home injury hospitalization rates across CIMD dimensions and observed that injury rates were disproportionately higher in areas characterized by greater situational vulnerability, economic dependency, and residential instability, while lower rates were observed in neighbourhoods with higher ethnocultural diversity.

Building on the findings of the first paper, in the second paper, I applied spatial epidemiological methods to identify geographic hotspots of age-standardized unintentional home injury hospitalization rates across BC. Using hotspot analysis and geographically weighted regression, I identified significant spatial clustering of home injury risk, with high-risk areas concentrated in the Lower Mainland. Key predictors of elevated unintentional home injury rates included lower educational attainment, lower annual household income, and higher concentrations of low-rise apartment dwellings, with relationships varying across geographic space. These patterns often characterize neighbourhoods where newcomer populations are more likely to reside.

Building on the spatial identification of structurally patterned home injury risk, in the third paper, I examined how these conditions are experienced and navigated by Afghan newcomers in the Greater Vancouver area. Guided by an intersectional framework and community-based participatory research approach, I conducted nine qualitative interviews and a focus group (n=8). Using reflexive thematic analysis, I produced four themes illustrating home safety as a socially negotiated process shaped by vulnerability to unintentional injury risks within structurally constrained and resettlement contexts, and by resilience expressed through collective problem-solving, embodied learning, and community support.

Across the three papers, I demonstrated that unintentional home injury risk in BC is patterned across neighbourhood deprivation and geographic space, and that these place-based risks are experienced and navigated within everyday home environments shaped by resettlement conditions. By integrating spatial epidemiology with community-engaged qualitative research, this work advances injury prevention scholarship and calls for equity-driven, place-based, and culturally responsive interventions that address social and structural determinants of home injury risks.