Unintentional Injury among the Indigenous People of the U.S. and Canada: A Review of the Literature

We performed a literature search focused on 4 interrelated questions: What are the most common types of unintentional injury among indigenous North Americans? How do rates of unintentional injury in this group compare with those in other racial and ethnic groups in North America? Do rates of injury vary between urban and rural settings? Which factors are reproducibly associated with increased rates of unintentional injuries among indigenous North Americans?

We applied the broad search terms injur* and trauma*, along with additional qualifying terms as needed, to a database specific to Native health and to the PubMed and World of Science databases. After applying exclusion criteria, we retained 82 articles published 1966-2008 on rates of unintentional injury among adults of North American indigenous communities. We abstracted information on participants, methodology, and major findings.

North American indigenous populations experience a substantially greater burden of unintentional injury than do Whites and members of other races. Studies documented higher rates of unintentional injury across all trauma types, geographic regions, and rural/urban sites. Elevated rates were often associated with alcohol use, male gender, and motor vehicle crashes.

A substantial body of research indicates excessive unintentional injury among the indigenous peoples of North America, often associated with alcohol use. Future needs include further elucidation of the individual and community effects of unintentional trauma, studies that do not solely rely on mortality and discharge data, development of effective interventions to alleviate this burden of injury, and evaluation of existing interventions.