Access to medical care and its association with physical injury in adolescents : a cross-national analysis
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Background Strong variations in injury rates have been documented cross-nationally. Historically, these have been attributed to contextual determinants, both social and physical. We explored an alternative, yet understudied, explanation for variations in adolescent injury reporting-that varying access to medical care is, in part, responsible for cross-national differences. Methods Age-specific and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/2014 Health Behaviour in School-aged Children study (n=209 223). Available indicators of access to medical care included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries) and (3) hospitals per 100 000 (30 countries) then physicians per 100 000 (36 countries). Ecological analyses were used to relate injury rates and indicators of access to medical care, and the proportion of between-country variation in reported injuries attributable to each indicator. Results Adolescent injury risks were substantial and varied by country and sociodemographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations between serious injury and physicians and hospitals per 100 000. Individual indicators explained up to 9.1% of the total intercountry variation in medically treated injuries and 24.6% of the variation in serious injuries. Conclusions Cross-national variations in reported adolescent serious injury may, in part, be attributable to national differences in access to healthcare services. Interpretation of cross-national patterns of injury and their potential aetiology should therefore consider access to medical care as a plausible explanation.
Pagnotta , V F , King , N , Donnelly , P D , Thompson , W , Walsh , S D , Molcho , M , Ng , K , Malinowska-Cieslik , M & Pickett , W 2022 , ' Access to medical care and its association with physical injury in adolescents : a cross-national analysis ' , Injury Prevention , vol. Online First . https://doi.org/10.1136/ip-2022-044701
Copyright © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.. This work has been made available online in accordance with publisher policies or with permission. Permission for further reuse of this content should be sought from the publisher or the rights holder. This is the author created accepted manuscript following peer review and may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1136/ip-2022-044701.
DescriptionFunding information: Grant funding for this analysis was provided by the: (1) Centre for Surveillance and Research, Public Health Agency of Canada (6D016-123071/001/SS); 2) Canadian Institutes of Health Research (Project Grant PJT 162237); 3) Polish National Science Centre (2013/09/B/HS6/03438). Corresponding author, Valerie F. Pagnotta, is supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship.
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