Geographic variation in work injuries: a multilevel analysis of individual-level data and area-level factors within Canada

Purpose: This study sought to examine provincial variation in work injuries and to assess whether contextual factors are associated with geographic variation in work injuries. Methods: Individual-level data from the 2003 and 2005 Canadian Community Health Survey was obtained for a representative sample of 89,541 Canadians aged 15 to 75 years old who reported working in the past 12 months. A multilevel regression model was conducted to identify geographic variation and contextual factors associated with the likelihood of reporting a medically attended work injury, while adjusting for demographic and work variables. Results: Provincial differences in work injuries were observed, even after controlling for other risk factors. Workers in western provinces such as Saskatchewan (adjusted odds ratio [AOR], 1.30; 95 confidence interval [CI], 1.09-1.55), Alberta (AOR, 1.31; 95 CI, 1.13-1.51), and British Columbia (AOR, 1.46; 95 CI, 1.26-1.71) had a higher risk of work injuries compared with Ontario workers. Indicators of area-level material and social deprivation were not associated with work injury risk. Conclusions: Provincial differences in work injuries suggest that broader factors acting as determinants of work injuries are operating across workplaces at a provincial level. Future research needs to identify the provincial determinants and whether similar large area-level factors are driving work injuries in other countries.