Leading Causes of Unintentional Injury and Suicide Mortality in Canadian Adults across the Urban-Rural Continuum

Abstract

Objective. We examined the leading causes of unintentional injury and suicide mortality in adults across the urban-rural continuum. Methods. Injury mortality data were drawn from a representative cohort of 2,735,152 Canadians aged ≥25 years at baseline, who were followed for mortality from 1991 to 2001. We estimated hazard ratios and 95% confidence intervals for urban-rural continuum and cause-specific unintentional injury (i.e., motor vehicle, falls, poisoning, drowning, suffocation, and fire/burn) and suicide (i.e., hanging, poisoning, firearm, and jumping) mortality, adjusting for socioeconomic and demographic characteristics. Results. Rates of unintentional injury mortality were elevated in less urbanized areas for both males and females We found an urban-rural gradient for motor vehicle, drowning, and fire/burn deaths, but not for fall, poisoning, or suffocation deaths. Urban-rural differences in suicide risk were observed for males but not females. Declining urbanization was associated with higher risks of firearm suicides and lower risks of jumping suicides, but there was no apparent trend in hanging and poisoning suicides. Conclusion. Urban-rural gradients in adults were more pronounced for unintentional motor vehicle, drowning, and fire/burn deaths, as well as for firearm and jumping suicide deaths than for other causes of injury mortality These results suggest that the degree of urbanization may be an important consideration in guiding prevention efforts for many causes of injury fatality.