Social inequality and injuries: Do morbidity patterns differ from mortality?

doi:10.1016/S0277-9536(96)00095-0

Social Science & Medicine

Volume 44, Issue 1, January 1997, Pages 63-70

https://doi.org/10.1016/S0277-9536(96)00095-0 Get rights and content

Abstract

Using the 1988 and 1989 National Health Interview Surveys, we explore the hypothesis that injury-related morbidity in general follows the same patterns of association with social/economic circumstances as has been found for injury-related mortality. We find the relationship to sociodemographic factors is similar to injury mortality. Also, being married appears to offer some protection against the risk of injury morbidity. Socioeconomic factors indicate that, controlling for poverty, whites of all ages are more likely to report a nonfatal injury. Finally, the net effects of other living circumstances and level of education have no significant effect on the risk of nonfatal injury. We discuss several explanations: problems of defining reportable morbidity; differential access to medical care; and the need to understand injury cause and severity to better explore the structural correlates of injury morbidity.

References (28)

L.M. Verbrugge
From sneezes to adieux: stages of health for American men and women
Soc. Sci. Med.
(1986)
National Committee for Injury Prevention and Control
National Center for Health Statistics
D.P. Rice
M. Haan et al.
Poverty and health: prospective evidence from the Alameda county study
Am. J. Epidemiol.
(1987)
D.B. Dutton et al.
Socioeconomic status and health: overview, methodological critique, and reformulation
S.P. Baker et al.
The Injury Fact Book
(1992)
R.T. Gill et al.
Our Changing Population
(1992)
J.F. Kraus et al.
The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, San Diego County, California
Am. J. Public Hlth
(1986)
G. Lapidus et al.
Child pedestrian injury: a population-based collision and injury severity profile
J. Trauma
(1991)

F.P. Rivara et al.

Demographic analysis of childhood pedestrian injuries

Pediatrics

(1985)

J.C. Riley

From a high mortality regime to a high morbidity regime: is culture everything in sickness?

Hlth Trans. Rev.

(1992)

S.R. Johansson

Measuring the cultural inflation of morbidity during the decline in mortality

Hlth Trans. Rev.

(1992)

L.I. Pearlin

The sociological study of stress

J. Hlth Soc. Behav.

(1989)

Cited by (31)

Injury severity and increased socioeconomic differences: A population-based cohort study
2022, Injury
Citation Excerpt :
Several studies have reported an inverse gradient between SES and injury mortality rates [19–22], where individuals with low SES are at greater risk of fatal injuries. However, the evidence is less consistent for injury morbidity rates [8,23–27], with some studies even observing increased injury incidence for the highest SES groups [28]. Moreover, there is evidence to suggest that the association between injury morbidity and SES may vary according to injury severity.
Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort.
We conducted a registry-based cohort study of all individuals aged 25–64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation.
We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07).
We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.
The association between improved standard of living and paediatric burns
2022, Burns
Citation Excerpt :
When one examines the paediatric population of the Central part of Croatia (our catchment area for outpatient burns) there was the decrease by 7.5% (Table 1) [3]. Apart from Edelman, socioeconomic status was emphasized by a myriad of authors as a factor with a significant influence on the incidence of burn injuries in adults and in paediatric patients [5–22]. Large scale analyses on the world population by Peck [23] and on the European continent by Brusselaers et al. [24] showed that the incidences of paediatric burns were declining.
In the “Children’s Hospital Zagreb Referral Centre for Paediatric Trauma of the Ministry of Health Republic of Croatia (MHC)” we observed a significant decline in the number of both hospitalised and ambulatory treated paediatric patients with burn injuries in the period from 2011 to 2018. Our hypothesis is that this decline could be either due to the decline of the paediatric population of Croatia or due to the economic growth and the improvement in the standard of living that Croatians have enjoyed in the past decade.
In this observational study, we analysed data on the numbers of patients treated due to burn injuries from January 2011 to December 2018 in the Children’s Hospital Zagreb Hospital. Indicators of standard of living and population size estimates were obtained from Eurostat and the Croatian Bureau of Statistics. Associations between the proportion of people with poor standard of living and the number of treated patients were analysed with logistic regression models.
Percentage of the population with low housing standards, percentage of Croatians with low level of education, percentage of children that live in jobless households, and percentage of children at risk of poverty and social exclusion were predictors of the rate of hospital admissions, ambulatory treated patients and total number of treatments. The slight decrease in the rate of treated patients was interrupted with notable decline in 2014 followed by the slight increase in 2015. Over following years, the rate did not change remarkably.
Apart from the decline of the paediatric population of Croatia, it is reasonable to assume that the improvement in the standard of housing, level of education and employment rate as well as the reduction in the risk of poverty and social exclusion in children had a notable contribution to the decline in the rate of paediatric burns in the observed period.
The social side of accidental death
2014, Social Science Research
Mortality from unintentional injuries, or accidents, represents major and understudied causes of death in the United States. Epidemiological studies show social factors, such as socioeconomic and marital status, relate with accidental death. But social theories posit a central role for social statuses on mortality risk, stipulating greater relevance for causes of death that have been medically determined to be more preventable than others. These bodies of work are merged to examine deaths from unintentional injuries using 20 years of nationally representative survey data, linked to prospective mortality. Results indicate that socially disadvantaged persons were significantly more likely to die from the most preventable and equally likely to die from the least preventable accidental deaths over the follow-up, compared to their more advantaged counterparts. This study extends our knowledge of the social contributors to a leading cause of death that may have substantial implications on overall disparities in length of life.
Low-income mothers' social support and children's injuries
2009, Social Science and Medicine
Citation Excerpt :
One difficulty with it is that accident prevalence among sample children as well as mothers' propensity to seek care for their children influence responses. Maternal care-seeking behavior may be a function of a variety of factors, including having access to medical care, risk tolerance, and perceived need for medical care (Kelly & Miles-Doan, 1997). We acknowledge this potential bias and address its implications for our results in the Discussion.
This study examined the association between low-income mothers' perceived social support and the prevalence of their children's medically treated accidents and injuries. Data were drawn from the National Evaluation of Welfare-to-Work Strategies (NEWWS), an experimental evaluation of 11 welfare-to-work programs in seven U.S. cities. In regression models, maternal social support was significantly associated with the likelihood that children experienced an accident or injury between the ages of 8 and 10 such that children of mothers with very limited support were at the highest risk. This association was robust to the inclusion of a wide range of controls, including a prior measure of accident and injury occurrence. A primary finding was that only children whose mothers had the lowest levels of social support, characterized here as socially isolated, suffered significantly higher rates of injury. This suggests that social isolation presents a meaningful threat to child safety and may play an important role in the etiology of child injury among low-income families.
Burn prevention mechanisms and outcomes: Pitfalls, failures and successes
2009, Burns
Burns are responsible for significant mortality and morbidity worldwide and are among the most devastating of all injuries, with outcomes spanning the spectrum from physical impairments and disabilities to emotional and mental consequences. Management of burns and their sequelae even in well-equipped, modern burn units of advanced affluent societies remains demanding and extremely costly. Undoubtedly, in most low and middle income countries (LMICs) with limited resources and inaccessibility to sophisticated skills and technologies, the same standard of care is obviously not possible. Unfortunately, over 90% of fatal fire-related burns occur in developing or LMICs with South-East Asia alone accounting for over half of these fire-related deaths. If burn prevention is an essential part of any integrated burn management protocol anywhere, focusing on burn prevention in LMICs rather than treatment cannot be over-emphasized where it remains the major and probably the only available way of reducing the current state of morbidity and mortality.
Like other injury mechanisms, the prevention of burns requires adequate knowledge of the epidemiological characteristics and associated risk factors, it is hence important to define clearly, the social, cultural and economic factors, which contribute to burn causation. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs) such as the United States due to sustained research on the epidemiology and risk factors, the same cannot be said for many LMICs. Many health authorities, agencies, corporations and even medical personnel in LMICs consider injury prevention to have a much lower priority than disease prevention for understandable reasons. Consequently, burns prevention programmes fail to receive the government funding that they deserve.
Prevention programmes need to be executed with patience, persistence, and precision, targeting high-risk groups. Depending on the population of the country, burns prevention could be a national programme. This can ensure sufficient funds are available and lead to proper coordination of district, regional, and tertiary care centres. It could also provide for compulsory reporting of all burn admissions to a central registry, and these data could be used to evaluate strategies and prevention programmes that should be directed at behavioural and environmental changes which can be easily adopted into lifestyle. Particularly in LMICs, the emphasis in burn prevention should be by advocating change from harmful cultural practices. This needs to be done with care and sensitivity.
The present review is a summary of what has already been accomplished in terms of burn prevention highlighting some of the successes but above all the numerous pitfalls and failures. Recognizing these failures is the first step towards development of more effective burn prevention strategies particularly in LMICs in which burn injury remains endemic and associated with a high mortality rate. Burn prevention is not easy, but easy or not, we have no options; burns must be prevented.
Occupational disparities in accidents and roles of lifestyle factors and disabilities: a population-based study in north-eastern France
2008, Public Health
Citation Excerpt :
Third, education determines knowledge and awareness of potentially dangerous activities and the subsequent implementation of preventive behaviours (seatbelt use, bicycle helmet use, alcohol consumption, etc.). Furthermore, the influence of these characteristics is likely to vary according to severity of the accident, as social class was found to have a strong inverse association with the risk of fatal accidents, while the findings for non-fatal accidents are less consistent across studies and vary depending on the type of accident.6,13,14 Certain indices, such as income, educational level or place of residence, may not provide an accurate reflection of the living and occupational activities and their risks.6
To assess occupational disparities with regard to the occurrence of occupational, traffic, domestic and sports accidents, and the role of factors such as smoking, excessive alcohol consumption, obesity, psychotropic drug intake and disability in mediating these disparities.
The sample included 3368 economically active subjects aged 18–64 years, selected at random in north-eastern France. Subjects completed a postal questionnaire about sociodemographic and lifestyle information, and recorded the occurrence of accidents by type during the previous 2 years. Data were analysed using a logistic regression model with different sets of independent variables and covariates in order to describe the disparities and investigate the role of personal factors.
During the 2 years preceding the survey, 11.8% of men and 5.4% of women had an occupational accident, 3.7% of men and 4.5% of women had a traffic accident, 4.1% of men and 1.5% of women had a domestic accident, and 6.1% of men and 1.9% of women had a sports accident. Personal factors were strongly related to the occurrence of accidents, with different patterns in men compared with women, and according to the type of accident. Men in intermediary occupations, clerks, craftsmen and tradesmen and, to an even greater extent, manual workers and farmers had a much higher occurrence of occupational accidents than men in the upper occupations, while craftsmen and tradesmen had a much higher occurrence of traffic accidents. Manual workers had a lower occurrence of sports accidents. After adjustment for lifestyle factors and disability, estimated odds ratios were reduced slightly but remained significant. Occupational disparities in accidents were virtually non-existent among women.
Occupational disparities in accidents mainly concern men and are predominantly observed in occupational and traffic accidents. Lifestyle factors do play a role in explaining these disparities, but are fairly limited. Improved work conditions, equipment, health behaviours, safe driving practices and accommodation of people with disabilities are needed to reduce the risk of accidents.

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Social inequality and injuries: Do morbidity patterns differ from mortality?

Abstract

Soc. Sci. Med.

Poverty and health: prospective evidence from the Alameda county study

Am. J. Epidemiol.

Socioeconomic status and health: overview, methodological critique, and reformulation

The Injury Fact Book

Our Changing Population

The relationship of family income to the incidence, external causes, and outcomes of serious brain injury, San Diego County, California

Am. J. Public Hlth

Child pedestrian injury: a population-based collision and injury severity profile

J. Trauma

Demographic analysis of childhood pedestrian injuries

Pediatrics

From a high mortality regime to a high morbidity regime: is culture everything in sickness?

Hlth Trans. Rev.

Measuring the cultural inflation of morbidity during the decline in mortality

Hlth Trans. Rev.

The sociological study of stress

J. Hlth Soc. Behav.