Intended for healthcare professionals


Deaths from injury in children and employment status in family: analysis of trends in class specific death rates

BMJ 2006; 333 doi: (Published 13 July 2006) Cite this as: BMJ 2006;333:119
  1. Phil Edwards (phil.edwards{at}, lecturer in statistics1,
  2. Ian Roberts, professor of epidemiology1,
  3. Judith Green, senior lecturer in sociology2,
  4. Suzanne Lutchmun, injury prevention specialist3
  1. 1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT,
  2. 2 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine,
  3. 3 Camden Primary Care Trust, St Pancras Hospital, London NW1 0PE
  1. Correspondence to: P Edwards
  • Accepted 24 March 2006


Objective To examine socioeconomic inequalities in rates of death from injury in children in England and Wales.

Design Analysis of rates of death from injury in children by the eight class version of the National Statistics Socio-Economic Classification (NS-SEC) and by the registrar general's social classification.

Setting England and Wales during periods of four years around the 1981, 1991, and 2001 censuses.

Subjects Children aged 0-15 years.

Main outcome measures Death rates from injury and poisoning.

Results Rates of death from injury in children fell from 11.1 deaths (95% confidence interval 10.8 to 11.5 deaths) per 100 000 children per year around the 1981 census to 4.0 deaths (3.8 to 4.2 deaths) per 100 000 children per year around the 2001 census. Socioeconomic inequalities remain: the death rate from all external causes for children of parents classified as never having worked or as long term unemployed (NS-SEC 8) was 13.1 (10.3 to 16.5) times that for children in NS-SEC 1(higher managerial/professional occupations). For deaths as pedestrians the rate in NS-SEC 8 was 20.6 (10.6 to 39.9) times higher than in NS-SEC 1; for deaths as cyclists it was 27.5 (6.4 to 118.2) times higher; for deaths due to fires it was 37.7 (11.6 to 121.9) times higher; and for deaths of undetermined intent it was 32.6 (15.8 to 67.2) times higher.

Conclusions Overall rates of death from injury and poisoning in children have fallen in England and Wales over the past 20 years, except for rates in children in families in which no adult is in paid employment. Serious inequalities in injury death rates remain, particularly for pedestrians, cyclists, house fires, and deaths of undetermined intent.


  • Embedded ImageA table of the results stratified by age group can be found on

  • We thank the Office for National Statistics, in particular Mr Folkert van Galen, for providing the mortality and census data. We also thank Colin Cryer, whose comments helped to improve this paper.

  • Contributors PE and IR designed the study, obtained the data, and conducted all analyses. All authors interpreted the data and wrote the paper. PE is guarantor.

  • Funding This work was undertaken by the London School of Hygiene and Tropical Medicine, who received funding from the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health. Conflict of interest statement: None declared.

  • Ethical approval Not required.

View Full Text