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Original research
Factors associated with experiencing reassault in Ontario, Canada: a population-based analysis
  1. Rachel Strauss1,2,
  2. Rinku Sutradhar1,2,3,
  3. David Gomez2,4,5,
  4. Jin Luo2,
  5. Carolyn Snider5,6,
  6. Natasha Ruth Saunders2,3,7,8
  1. 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2ICES, Toronto, Ontario, Canada
  3. 3Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  5. 5St Michael's Hospital, Toronto, Ontario, Canada
  6. 6Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  7. 7Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
  8. 8Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Natasha Ruth Saunders, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; natasha.saunders{at}sickkids.ca

Abstract

Background Individuals who experience a violence-related injury are at high risk for subsequent assault. The extent to which characteristics of initial assault are associated with the risk and intensity of reassaults is not well described yet essential for planning preventive interventions. We sought to describe the incidence of reassault and associated risk factors in Ontario, Canada.

Methods In this population-based retrospective cohort study using linked health and demographic administrative databases, we included all individuals discharged from an emergency department or hospitalised with a physical assault between 1 April 2005 and 30 November 2016 and followed them until 31 December 2016 for reassault. A sex-stratified Andersen-Gill recurrent events analysis modelled associations between sociodemographic and clinical risk factors and reassault.

Results 271 522 individuals experienced assault (mean follow-up=6.4 years), 24 568 (9.0%) of whom were reassaulted within 1 year, 45 834 (16.9%) within 5 years and 52 623 (19.4%) within 10 years. 40 322 (21%) males and 12 662 (17%) females experienced reassault over the study period. Groups with increased rates of reassault included: those aged 13–17 years versus older adults (age 65+) (males: relative rate (RR) 2.16; 95% CI 1.96 to 2.38; females: RR 2.79; 95% CI 2.39 to 3.26)), those living in rural areas versus urban (males: RR 1.22; 95% CI 1.19 to 1.24; females: RR 1.32; 95% CI 1.27 to 1.37) and individuals with a history of incarceration versus without (males: RR 2.38; 95% CI 2.33 to 2.42; females: RR 2.57; 95% CI 2.48 to 2.67).

Conclusion One in five who are assaulted experience reassault. Those at greatest risk include youth, those living in rural areas, and those who have been incarcerated, with strongest associations among females. Timely interventions to reduce the risk of experiencing reassault must consider both sexes in these groups.

  • injury
  • violence
  • prevention
  • public health

Data availability statement

Data may be obtained from a third party and are not publicly available. The dataset from this study is held securely in coded form at ICES. Data-sharing agreements prohibit ICES from making the data set publicly available, but access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.

https://doi.org/10.1136/jech-2021-216964

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The dataset from this study is held securely in coded form at ICES. Data-sharing agreements prohibit ICES from making the data set publicly available, but access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.

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    Footnotes

    • Contributors RSt conceptualised and designed the study, analysed and interpreted the results, drafted the initial manuscript, revised the manuscript and approved the final manuscript as submitted. RSu designed the study, interpreted the results, revised the manuscript and approved the final manuscript as submitted. NRS and DG conceptualised and designed the study, interpreted the results, revised the manuscript, and approved the final manuscript as submitted. JL had access to and analysed the data, interpreted the results, revised the manuscript and approved the final manuscript as submitted. CS interpreted the results, revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH). This study was also supported by a St. Michael’s Hospital Association AFP Innovation Fund Award (SMHA Project #SMH-20-013) and the Department of Pediatrics at The Hospital for Sick Children. No endorsement by ICES, St. Michael’s Hospital Association, The Hospital for Sick Children or the Ontario MOH is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and Immigration, Refugees Citizenship Canada (IRCC). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors, and not necessarily those of CIHI or IRCC. Parts of this report are based on Ontario Registrar General information on deaths, the original source of which is Service Ontario. NRS was supported by Canadian Institute for Health Research and Sickkids Foundation New Investigator Award during this study.

    • Disclaimer The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. The views expressed herein are those of the authors and do not necessarily reflect those of the Ontario Registrar General or Ministry of Government Services.

    • Competing interests DG is a member of national and international medical associations that advocate for the reduction of violent injuries: the American College of Surgeons, the Trauma Association of Canada and the Panamerican Trauma Society. In addition, DG is a member of the Canadian Doctors for Protection from Guns, which is an advocacy group. The Research article does not represent any of these societies or advocacy groups.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.