Abstract
BackgroundUnintentional injury is a leading cause of death/disability, with more disadvantaged children at greater risk. Understanding how inequalities vary by injury type, age, severity, and place of injury, can inform prevention.MethodsFor all Scotland-born children 2009-2013 (n=195,184), hospital admissions for unintentional injury (HAUI) were linked to socioeconomic circumstances (SECs) at birth: area deprivation via the Scottish Index of Multiple Deprivation (SIMD), mother's occupational social class, parents’ relationship status. HAUI was examined from birth-five, and during infancy. We examined HAUI frequency, severity, injury type, and injury location (home vs. elsewhere). We estimated relative inequalities using the relative indices of inequality (RII, 95% CIs), before and after adjusting for demographics and other non-mediating SECs.FindingsMore disadvantaged children were at greater risk of any HAUI from birth-five, RII: 1•59(1•49-1•70), 1•74(1•62-1•86), 1•97(1•84-2•12) for area deprivation, maternal occupational social class, and relationship status respectively. These attenuated after adjustment (1•15 [1•06-1•24], 1.22 [1•12-1•33], 1.32 [1•21-1•44]). Inequalities were greater for severe (vs. non-severe), multiple (vs. one-off) and home (vs. other location) injuries. Similar patterns were seen in infancy, excluding SIMD-inequalities in falls, where infants living in more disadvantaged neighbourhoods were at lower risk (0•79 [0•62-1•00]). After adjustment, reverse SIMD-gradients were also observed for all injuries and poisonings.InterpretationChildren living in more disadvantaged households are more likely to be injured across multiple dimensions of HAUI in Scotland. Upstream interventions which tackle family-level disadvantage may be most effective at reducing childhood HAUI.FundingWellcome Trust, Medical Research Council, Scottish Government Chief Scientist Office.
Highlights
The World Health Organisation (WHO) recognises unintentional injury (UI) as a major public health issue [1]
Of the 195,184 children analysed, just under 5% (n=9,666) were hospitalised for at least one UI before age five years; children who were excluded from the complete case analysis were slightly less likely than the complete-case sample to have experienced an hospital admissions for unintentional injury (HAUI) (Table 1) (NB characteristics for the full sample are shown in Appendix A8)
Adjustment for age of mother at first live birth was principally responsible for this change in direction, adjustment for individual socioeconomic circumstances (SECs) variables attenuated the associations to the null (Appendix A9). Reversal of effects such as this can be caused by multi-collinearity, we examined the Condition Index and VIFs, finding no evidence of strong multicollinearity [29]; we found a Condition Index of 18.76 and VIFs of 1.25, 1.53, 1.41 and 1.67 for Scottish Index of Multiple Deprivation (SIMD), National Statistics Socio-economic Classification (NS-SEC), relationship status and age of the mother respectively
Summary
The World Health Organisation (WHO) recognises unintentional injury (UI) as a major public health issue [1]. Methods: For all Scotland-born children 2009-2013 (n=195,184), hospital admissions for unintentional injury (HAUI) were linked to socioeconomic circumstances (SECs) at birth: area deprivation via the Scottish Index of Multiple Deprivation (SIMD), mother's occupational social class, parents’ relationship status. We estimated relative inequalities using the relative indices of inequality (RII, 95% CIs), before and after adjusting for demographics and other non-mediating SECs. Findings: More disadvantaged children were at greater risk of any HAUI from birth-five, RII: 159(149-170), 174(162-186), 197(184-212) for area deprivation, maternal occupational social class, and relationship status respectively. Findings: More disadvantaged children were at greater risk of any HAUI from birth-five, RII: 159(149-170), 174(162-186), 197(184-212) for area deprivation, maternal occupational social class, and relationship status respectively These attenuated after adjustment (115 [106-124], 1.22 [112-133], 1.32 [121144]).
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