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Socioeconomic inequalities in childhood road traffic injuries (RTIs) have been well documented.1 However, in is not clear if, and how, these inequalities have changed over recent years.2–4 We investigated time trends in socioeconomic inequalities in childhood RTIs between 1988 and 2003 using police data from the North East of England.
The British police record a variety of information on each collision involving a vehicle they are aware of, including: the circumstances of the collision, and the drivers, vehicles, and casualties involved. This information is collated as STATS19 returns. Between July 1988 and June 2003 Northumbria Police also recorded the home postcode of all casualties.
Using data from the 1991 census, we calculated Townsend Deprivation Scores (TDS)5 for all enumeration districts in the area covered by Northumbria Police (Northumberland and Tyne and Wear). After linking postcodes to enumeration districts, RTI counts in children under 16, and population denominator data from the 1991 census, were then added to this dataset. Logistic regression was used to calculate the odds of childhood RTIs in each quintile of TDS, compared with the most affluent, in three five year time periods. Separate analyses were performed by sex and for children injured as pedestrians or vehicle passengers. Tests for interaction were used to investigate any changes in TDS variations in childhood RTIs over time.
Of 14 146 recorded RTIs to children, 11 194 (79.1%) children were pedestrians (not cyclists) or vehicle passengers at the time of the injury. Full data were available for 10 542 injuries (94.2%), including 6840 (64.9%) pedestrian injuries and 6035 (57.2%) boys. Overall rates of RTIs decreased progressively over time in all groups (see http://www.injuryprevention.com/supplemental for table 1). Rates of pedestrian, but not passenger, RTIs were consistently greater in boys than girls. Trends in the odds of boys and girls being injured as pedestrians were present in each time period according to quintiles of TDS with children from more deprived areas having a greater chance of being injured than those from more affluent areas. The opposite trend was seen in girls injured as vehicle passengers in the earliest time period with no trend in the later two time periods.
Although the gradient in pedestrian RTIs according to TDS showed a decrease over time in both boys and girls, this only reached conventional levels of statistical significance in girls (p<0.001 in girls, p = 0.069 in boys). In contrast, there was an increase in the gradient of passenger RTIs according to TDS quintiles over time in girls (p<0.001 in girls, p = 0.247 in boys). However, this represents a reduction in an originally negative gradient rather than an increasing positive gradient (see fig 1).
We have found strong socioeconomic inequalities in pedestrian RTIs in children living in the Northeast of England but also evidence that these gradients have decreased over the last 15 years. There was no evidence of persistent socioeconomic inequalities in childhood RTI in vehicle passengers.
Although not all accidents occurring on public roads will be reported to the police,6 it is likely that STATS19 information is available for most RTI involving vehicles. These data also allowed us to investigate the full range of childhood RTI and not just those brought to medical attention—a process that may, itself, be socioeconomically patterned. The use of 1991 census data for denominator counts and to calculate TDS throughout may have led to inaccuracies in the later two time periods but provided consistency in our measure of socioeconomic position.
Our finding of decreasing inequalities in childhood pedestrian RTIs is at odds with other recent work,2–4 perhaps due to variations in study populations or defining injuries, but does suggest recent success in this area. Further work is needed to confirm the patterns we have found elsewhere in the UK.
Many thanks to Steve Jarvis and Philip Lowe who coordinated the collection of the data used in this analysis, Northumbria Police Statistics Department for collection of casualty postcodes throughout the study period, the Transport and Accident Data Unit based at Gateshead Borough Council for provision of STATS19 data, Ruth Wood for helping with data transformation, and Vicky Ryan for providing statistical advice. No specific funding was provided for this analysis.
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- [view PDF] - Table 1. Trends in child RTI in Northumbria by quintiles of Townsend Deprivation Score, 1988-2003
This study used anonymous data and did not require ethical permission.
All authors conceived the idea for this analysis. JA performed the analysis and drafted the manuscript. All authors contributed to interpretation of the data and results. All authors have read and approved the final version.
No special funding was received for the analysis or preparation of this paper.
None of the authors is aware of any competing interests in relation to this manuscript.