Serious injuries in children: variations by area deprivation and settlement type

Phil Edwards ^1*, Judith Green ¹, Kate Lachowycz ¹, Chris Grundy ¹ and Ian Roberts ¹

¹ London School of Hygiene & Tropical Medicine, United Kingdom

^* To whom correspondence should be addressed. E-mail: phil.edwards{at}lshtm.ac.uk.

Accepted 30 January 2008

Abstract

Objective: To examine variations in serious injuries in children by level of area deprivation and settlement type.

Design: Analysis of hospital admission rates in census lower super output areas.

Setting: England during the five-year period 1 April 1999 to 31 March 2004.

Patients: Children aged 0-15 years.

Main outcome measures: Admission rates for serious injury.

Results: Rates of serious injury in children were higher in the most deprived areas than in the least deprived for pedestrians (rate ratio (RR) 4.1; 95% CI 2.8 to 6.0) and cyclists (RR 3.0; 95% CI 1.9 to 4.7). Rates of serious pedestrian injury were lower in town & fringe (RR 0.67; 95% CI 0.53 to 0.86) and in village (RR 0.64; 95% CI 0.50 to 0.83) areas than in urban areas. The rate of serious injury to cyclists was lower in London than other urban areas (RR 0.78; 95% CI 0.62 to 0.98). The rate of serious injury to car occupants was higher in village than urban areas (RR 1.51; 95% CI 1.05 to 2.17). Rates of serious injury due to falls were higher in London (RR 1.60; 95% CI 1.47 to 1.75), and lower in village (RR 0.76; 95% CI 0.66 to 0.88) than in urban areas. Steeper socio-economic gradients in serious injury rates were identified for cyclists, and due to falls, among children living in rural areas.

Conclusions: Socio-economic inequalities in serious injury exist across the whole of England, particularly for child pedestrians. Rates of serious injury vary by settlement type and inequalities vary by cause of injury between rural and urban settings.