Associations between social determinants of health and interpersonal violence-related injury in Cameroon: a cross-sectional study

Abstract

Introduction: Risk factors for interpersonal violence-related injury (IPVRI) in low-income and middle-income countries (LMICs) remain poorly defined. We describe associations between IPVRI and select social determinants of health (SDH) in Cameroon.

Methods: We conducted a cross-sectional analysis of prospective trauma registry data collected from injured patients >15 years old between October 2017 and January 2020 at four Cameroonian hospitals. Our primary outcome was IPVRI, compared with unintentional injury. Explanatory SDH variables included education level, employment status, household socioeconomic status (SES) and alcohol use. The EconomicClusters model grouped patients into household SES clusters: rural, urban poor, urban middle-class (MC) homeowners, urban MC tenants and urban wealthy. Results were stratified by sex. Categorical variables were compared via Pearson's χ² statistic. Associations with IPVRI were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).

Results: Among 7605 patients, 5488 (72.2%) were men. Unemployment was associated with increased odds of IPVRI for men (aOR 2.44 (95% CI 1.95 to 3.06), p<0.001) and women (aOR 2.53 (95% CI 1.35 to 4.72), p=0.004), as was alcohol use (men: aOR 2.33 (95% CI 1.91 to 2.83), p<0.001; women: aOR 3.71 (95% CI 2.41 to 5.72), p<0.001). Male patients from rural (aOR 1.45 (95% CI 1.04 to 2.03), p=0.028) or urban poor (aOR 2.08 (95% CI 1.27 to 3.41), p=0.004) compared with urban wealthy households had increased odds of IPVRI, as did female patients with primary-level/no formal (aOR 1.78 (95% CI 1.10 to 2.87), p=0.019) or secondary-level (aOR 1.54 (95% CI 1.03 to 2.32), p=0.037) compared with tertiary-level education.

Conclusion: Lower educational attainment, unemployment, lower household SES and alcohol use are risk factors for IPVRI in Cameroon. Future research should explore LMIC-appropriate interventions to address SDH risk factors for IPVRI.

Keywords: cross-sectional survey; hospital-based study; injury; prevention strategies; public health.

Figure 1

Flow diagram of injured patients who sought hospital-level care in Cameroon between October 2017 and January 2020 and were included in the present analysis. ^*Injured patients presenting to one of the four Cameroon trauma registry hospitals. ^†A similar percentage of men (3.8%) and women (3.7%) were missing consent. ^‡Of the children excluded from this analysis, n=647 (57.7%) were male, n=472 (42.1%) were female and n=3 (0.3%) were missing sex data. There were 51 (4.5%) with IPVRI, with a slightly higher percentage of IPVRI among women (5.6%) than men (4.3%). ^§Includes 36 who were missing age, sex and/or hospital, 127 who were either uninjured or missing injury data, and 10 with internal data inconsistencies. ^¶See online supplemental table S1 for demographic and injury characteristics of patients excluded due to missing intention of injury (n=232) or for missing education, employment and household SES cluster data (n=44). ^**Most self-inflicted injuries were among women (n=31, 68.9%). IPVRI, interpersonal violence-related injury; SDH, social determinants of health; SES, socioeconomic status.

Figure 2

Age group distribution of men (A) and women (B) who sought hospital-level care for interpersonal violence-related injuries or unintentional injuries in Cameroon between 2017 and 2020. IPVRI, interpersonal violence-related injury.