BMJ 2002;324:1132 ( 11 May )

Primary care

Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992-7

Julia Hippisley-Cox, senior lecturer in general practice,  Lindsay Groom, research unit coordinator,  Denise Kendrick, senior lecturer in general practice,  Carol Coupland, senior lecturer in medical statistics,  Elizabeth Webber, researcher in general practice,  Boki Savelyich, researcher in general practice. 

Division of General Practice, Tower Building University Park, Nottingham NG7 2RD

Correspondence to: J Hippisley-Cox julia.hippisley-cox{at}nottingham.ac.uk

Objective: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years.
Design: Cross sectional survey of routinely collected hospital admission data for injury 1992-7.
Setting: 862 electoral wards in Trent Region.
Subjects: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14.
Main outcome measures: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward.
Results: Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was >= 3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)).
Conclusion: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources.

What is already known on this topic?
There is a steep socioeconomic gradient for injury related mortality

There is conflicting evidence regarding the socioeconomic gradient for injury morbidity, particularly with respect to different injury severity and injury mechanisms

What this study adds
A socioeconomic gradient for injury morbidity exists in children aged <15 years, particularly in those aged <5, which persist for different measures of injury severity

The socioeconomic gradient for injury mechanisms is steepest for pedestrian injuries, burns and scalds, and poisoning, which has implications for targeting injury prevention strategies




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