Motor Vehicle Crash-Related Injuries and Deaths Among Indigenous People in Canada: Meta-Analysis of Geo-Structural Factors

Background and purpose: Indigenous people are much more likely than non-Indigenous people to be seriously injured and die in motor vehicle crashes (MVCs). Such premature deaths of Indigenous children to elders represents many person-years of life and wisdom lost to Indigenous communities and the world. To effectively reduce these tragic losses we need to better understand the magnitude and causes of the problem. This study updated and extended a previous non-meta-analytic review that suggested future research ought to incorporate social-environmental factors (Short et al., 2013). This synthetic study aimed to pool all such new evidence related to social-environmental factors or the structures of Canadian society.

Methods: A systematic review and meta-analysis of the published and grey literature on MVCs involving Indigenous people in Canada between 2010 and 2020 was conducted. Eleven retrospective cohorts that observed 23 independent, age-standardized, mortal or morbid outcomes were included. The focus was personal (driving an old vehicle) and community-level social-environmental-economic factors (prevalent low socioeconomic statuses) associated with places where more Indigenous people tended to live (on-reserves in rural remote places). Heterogeneous random main effects were sample-weighted, and moderators were tested with meta-regressions. Hypotheses were: Compared to non-Indigenous Canadians after MVCs, Indigenous people have significantly greater mortality, more prevalent and serious injuries, and any such mortal or morbid disadvantages are greater in geo-structurally vulnerable places.

Results: We found that Indigenous people were more than twice as likely as non-Indigenous people to be seriously injured (relative risk [RR_pooled] = 2.61) and more than three times as likely to die (RR_pooled = 3.40) in MVCs. Moreover, such large Indigenous relative risks did not seem to have diminished over the past generation. Furthermore, Indigenous risks were significantly greater on-reserves and in similar rural and remote places. Substantial proportions (33% to 90%) of the Indigenous injury and mortality relative risks could be explained by profound lacks of community-level resources.

Conclusions and implications: Geo-structurally vulnerable places probably suffer relative lacks of such community resources as transportation and health care infrastructural investments, resulting in poorer road condition in Indigenous communities and longer delays to trauma care. Consistent with longstanding evidence of Indigenous oppression across numerous other structures of Canadian society, ranging from child welfare and criminal justice to education, banking, housing and the labor market (Alberton, 2020), this study’s findings seem further evidence of structural violence. In this instance, geo-structural violence seemed to have been perpetrated against Indigenous people in yet more structures of Canadian society: Canada’s system of highways and roadways, and its remote health care system. These represent legitimate policy targets to help solve this probably largely structural, public health problem.

References:

Alberton, A. M. (2020). Predictive effects of (neo)colonialism and other forms of structural violence on involuntary contacts with the criminal justice system in Canada: Statistical analysis with an autoethnographic perspective (Doctoral dissertation). ProQuest Dissertations & Theses Global, 28259900.

Short, M. M., Mushquash, C. J., & Bédard, M. (2013). Motor vehicle crashes among Canadian Aboriginal people: Review of the literature. Canadian Journal of Rural Medicine, 18(3), 86-98.