Socioeconomic status and the occurrence of injuries in Vietnam: A multilevel analysis to examine the association between injury and both individual and contextual determinants
Description
Statement of problem. Socioeconomic status (SES) is considered to be a major determinant of injury and this relationship has been examined in developed countries for a number of years. The relationship between SES and the occurrence of injury is often discussed at either the individual or contextual level. However, few studies have examined the relationship between SES and injuries at both levels at the same time. Injury is an emerging public health problem in low and middle income countries, but little attention has been paid to injury research, and there are very few studies that examine the relationship between socioeconomic status and injury in the developing world. This study aims to examine the association between individual and contextual-level socioeconomic status and the occurrence of injury mortality and morbidity in Vietnam. In this study, individual and contextual-level socioeconomic status were studied together; with special emphasis on evaluating the influence of contextual effects on the occurrence of injury after adjusting for individual factors Methods. The Vietnam Multi-Center Injury Survey was used as the main source of injury and individual SES information. Data on nonfatal and fatal injuries obtained from the Vietnam Multi-Center Injury were used as the outcome variables. Contextual socioeconomic characteristics extracted from the 1999 Vietnam Census of Population were merged with the injury surveillance file The Census file contained information on 128,627 individual records grouped into 72 districts throughout the country of Vietnam. Multilevel logistic regressions were performed to model the relationship of individual and contextual level SES measures to the injury outcomes. The multilevel regression technique allowed examination of both single-level and dual-level relationships between individual and contextual level socioeconomic status and the occurrence of injury in the source population Results. The findings from this study show that there is an emerging injury problem in Vietnam. Both nonfatal and fatal injury rates are very high in comparison with other developed countries. The patterns of injury vary by different socioeconomic status characteristics. Nonfatal and fatal injuries are gender unbalanced with the rates in males always higher than those in females. Injury rates varied by different age groups, living standards of the family, geographical region, and other characteristics. Individual socioeconomic status characteristics were found to have a strong independent relationship with the occurrence of various injury causes, age group, gender and family standard of living. Contextual socioeconomic status measured by a composite index was also associated with the occurrence of nonfatal and fatal injury in Vietnam independently of individual socioeconomic status Conclusions. The findings from this study showed an emerging public health problem of injury in Vietnam with a high rate of nonfatal and fatal injury, specific patterns of injury related to different demographic and socioeconomic variables among the population. The individual and contextual level socioeconomic status measures were related to the injury outcomes with the contextual effect maintained after controlling for the individual level factors. The findings of this study help to improve our understanding about the association between individual and contextual level socioeconomic status and the occurrence of injury in a developing country. The findings also support the theory that contextual socioeconomic status has an independent effect on the health outcomes of population. Understanding this issue could contribute more for the success of injury control program and more general the health programs in Vietnam