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Childhood injuries: extent of the problem, epidemiological trends, and costs
  1. Ian Roberts1,
  2. Carolyn DiGuiseppi1,
  3. Heather Ward2
  1. 1Child Health Monitoring Unit, Institute of Child Health, University of London, 30 Guilford Street, LondonWC1N 1EH
  2. 2Centre for Transport Studies, University College London
  1. Correspondence to:
 Dr Roberts (e-mail:

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Our Healthier Nation, a consultation paper from the Department of Health, identifies accidents as one of four key areas for improving the health of the population.1 It sets a target to reduce accidental injuries requiring a hospital visit or consultation with a family doctor by at least a fifth (20%) by the year 2010. The paper notes that accidents are the greatest single threat to life for children and young people. Treating injuries costs the NHS about £1.2 billion each year. Mental health is also identified as a key area for improving health. Although suicide rates are declining, the strategy sets a target to reduce the death rate from suicide and undetermined injury by at least a further sixth (17%) by 2010. Thus two of four key government targets for improving the health of the nation involve injuries. In this section, we will review the extent of the child injury problem in this country and compare it with other countries, describe trends in child injury deaths and some of the determinants, and discuss the scale of the injury problem in terms of costs.

Extent of the problem in children


In England and Wales in 1995, 590 children aged 1 month to 15 years died as a result of injury or poisoning (table 1).2 Injury and poisoning deaths, both unintentional and intentional, accounted for nearly one in five deaths among children in this age group (18.5% of the total), and were the leading cause of death among children aged 28 days to 15 years.2 (Published national data are not available for older teenagers, for example 15–19 years, as their deaths are combined with those of adults in the age groupings.)

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Table 1

Leading causes of death among children aged 28 days to 15 years*; values are number (%)


Injuries* account for a greater proportion …

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  • * In the remainder of this document, “injury and poisoning” is referred to as “injuries”, except when otherwise specified.

  • A data file containing the anonymised records of all injury and poisoning deaths for people aged 0–19 years inclusive, resident in England and Wales, was obtained from the Office for National Statistics. Each record included the external cause of injury code (E code), age, sex, year of death, and parents' occupational class. Population denominator data were obtained from published sources.11 Trends in overall and cause specific injury death rates were examined using Poisson regression modelling.12 Class specific death rates were estimated using the Registrar General's Standard Occupational Classification.13 For deceased children aged less than 15 years, social class is based on the father's social class, unless this is missing, in which case it is based on the mother's. Teenagers aged 15–19 are assigned their own social class but because many people in this age group are in full time education, assigning social class on the basis of the Standard Occupational Classification is problematic. For this reason we restricted our analyses of social class gradients in injury death rates to children under 15 years. To increase the precision of class specific injury mortality rates, an eight year period (1985–92) was used. Class specific denominator data were obtained by linear interpolation using data from the 1981 and 1991 censuses.

  • The Stats 19 figures published by DETR give casualty figures for children aged 0–15 years while those published by the Office for National Statistics in the Mortality Statistics series give 0–14 years.