Socioeconomic differences in Swedish children and adolescents injured in road traffic incidents: cross sectional study
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7334.396 (Published 16 February 2002) Cite this as: BMJ 2002;324:396
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Sir,
It might be said, and with some justification, that any proposal that
a complex social phenomenon like teenage deaths in road traffic accidents
[1] is due to the "effects of testosterone," [2] i.e. the action of a
single molecule, is just about as absurdly simplistic and reductionistic
as to try and balance the entire Great Pyramid of Cheops [3] upside down
on the point of a needle. Surely this very approach seems just about as
foolish as futile, or what MacDonagh called " a lean road flung over
profitless bog Where only a snipe could nest," [4]
Sources
[1] PAPERS, Socioeconomic differences in Swedish children and adolescents
injured in road traffic incidents: cross sectional study, Lucie Laflamme
and Karin Engström, BMJ 2002; 324: 396-397
http://bmj.com/cgi/content/full/324/7334/396
[2] BMJ e-letter, Testosterone May be Involved in Increased Injuries
in Lower Socioeconomic Areas James M. Howard, bmj.com, 18 Feb 2002
http://bmj.com/cgi/eletters/324/7334/396#19848
[3] http://touregypt.net/cheops.htm
[4] Dublin Made Me, poem by Donagh MacDonagh
http://members.tripod.com/IrishBornMan/poetry.txt
Competing interests: No competing interests
It is my hypothesis that increased testosterone levels increase
impulsivity and aggression, and negatively affect the ability to learn. A
modern, industrialized society will positively award individuals who
exhibit reduced impulsivity and aggression and increased ability to learn.
Therefore, this eventually will concentrate people of high testosterone
within specific areas because of economic limitations.
The findings of Laflamme and Engström may be shown to fit this
explanation of “socioeconomic differences” in “adolescents injured in road
traffic incidents.” That is, the “relative risks of being injured in a
traffic related incident” are coinciden with the beginnings of
testosterone production, especially the onset of testosterone levels of
adolescence. These effects of testosterone on traffic injuries may be
interpreted as increased impulsivity and aggression in traffic and reduced
ability to learn from authorities and/or experience. I suggest these
behaviors occur with greater frequency in populations of individuals of
high testosterone.
Competing interests: No competing interests
The Editor BMJ
..
The paper by Laflamme and Engstrom (in BMJ 324 396-8) on Socio-economic
differences in Swedish children and adolescents injured in road traffic
accidents provides some useful information. However, neither your
commentary nor the authors’ comment have really picked out the key
messages from this study.
Your commentary (This week in the BMJ) shows a histogram (which is
not in the original text) that merely shows the rates of injury as
pedestrians per 100000 person years by age group and not the relative
risks as described in the text and in your commentary.
More importantly the authors have chosen to explain that the risks
of being injured in road traffic accidents are higher for children
belonging to a lower social class which is nothing new even in
egalitarian Sweden. They have failed to emphasise a number of other very
important issues which can be raised from the data provided.
The important points to make from this study are that in the age
group 0-19 the greatest risk of injury on the road is to 15 – 19 year old
drivers at 169.13 injuries per 100000 person years. The next greatest risk
is to 10 – 14 year old cyclists at 130.64. In both groups males have
higher risks than girls. The rate of injury to 0 – 4 year old
pedestrians, although not unimportant, was only 5.61 injuries per 100000
person years. It is the higher rates in 10 - 14 year old cyclists and the
15 –19 year old drivers and the sex differences that need to be addressed
rather than the social inequalities.
The study also raises some very important questions
· What are 0 - 4s (and indeed the 5 –9s) doing being injured as a
pedestrian? Shouldn’t they all be properly supervised by parent or
guardian?
· What are 0-4s doing being injured as cyclists ? This is well
before the age when it is safe for a child to ride a bike. Or were they
all passengers on bikes ?
· How important were these injuries in relation to exposure? eg was
the relative risk at 2 : 1 for the poorer 15 – 19 year old child
passengers due to more miles travelled (unlikely) or due to not wearing
seat belts (possible) or were they being taken in older less road worthy-
cars (more likely)?
· What were 10 – 14 year old children doing driving motor vehicles
or mopeds even if the numbers were probably very small?
It may be that Sweden – which along with Britain has the lowest child
injury death rates in the world – has gone about as far as it can in
reducing children road traffic accidents. In essence any injury on the
road is unacceptable and the data show that there is still much that needs
to be done to reduce them.
Competing interests: No competing interests
I am surprised that Authors do not discuss their scientific findings.
The reader is left with uncertainty and speculations about results
provided in the brief paper. What are the findings suggesting? What do
they mean and what are the policy implications for the future? Authors are
pointing to a serious problem and call for attention. What kind of
attention should be given and by whom? They focus a problem without
considering that the decision to not include any competing or more
deepening interpretations than socio-economic factors as cause to excess
mortality among young people is reductive. Is it likely that the injuries
among the 15–19 years old depend on their place of residence,
alternatively the access to motor vehicles? Are these two factors
interrelated? How about the distribution of motor vehicles among the
socio–economic groups in the Swedish society? What about distribution of
ways designed for bicyclists or about people’s priorities on how to
distribute their investments in cars or charter travels to other
countries? Is it possible that as Anthony Giddens (1993) describes if
individuals are not able to learn to think logically and in abstracts
terms at approximately 15 years old – it is not likely that they will
learn it later? It is risky to drive. However, the Authors are not
answering and discussing any alternative causal explanations. They simply
provide some results and only a single and crude explanation to a complex
problem.
1. Giddens A. Sociology, Polity Press, Cambridge, England 1993.
Competing interests: No competing interests
Re: Great Pyramids
"...one should not make more assumptions than the minimum needed."
Competing interests: No competing interests