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Primary Care

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

BMJ 2002; 324 doi: (Published 11 May 2002) Cite this as: BMJ 2002;324:1132
  1. Julia Hippisley-Cox, senior lecturer in general practice (julia.hippisley-cox{at},
  2. Lindsay Groom, research unit coordinator,
  3. Denise Kendrick, senior lecturer in general practice,
  4. Carol Coupland, senior lecturer in medical statistics,
  5. Elizabeth Webber, researcher in general practice,
  6. Boki Savelyich, researcher in general practice
  1. Division of General Practice, Tower Building University Park, Nottingham NG7 2RD
  1. Correspondence to: J Hippisley-Cox
  • Accepted 15 April 2002


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?

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

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


  • Contributors JHC initiated the study, obtained ethical approval, undertook the literature review, designed the study, contributed to the data collection and manipulation, undertook the data analysis and interpretation, and drafted the paper. LG contributed to the study design, project management, data manipulation, and interpretation of findings, advised on data analysis, and commented on the paper. DK contributed to the study design, analysis plan, and drafting of the paper. EW contributed to the literature search and review, data collection, data entry and manipulation, administration of project meetings, and obtaining ethical approval. CC contributed to the study design, analysis plan, and interpretation of results, checked the analyses, and commented on the paper. BS helped with data manipulation, administration of project meetings, and the interpretation of the findings. JHC is guarantor for the study.

  • Funding Grant from Trent NHS Executive Trent.

  • Competing interests None declared.

  • Accepted 15 April 2002
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