We were interested to read the careful and detailed analysis of
injury mortality data by Borrell et al.[1] We have also examined individual
and neighbourhood effects on injury incidence in younger age groups and
would like to draw these results to readers’ attention, as they extend and
support the findings by Borrell et al. and were not referenced in their
paper. In a study in Norwich, UK...
We were interested to read the careful and detailed analysis of
injury mortality data by Borrell et al.[1] We have also examined individual
and neighbourhood effects on injury incidence in younger age groups and
would like to draw these results to readers’ attention, as they extend and
support the findings by Borrell et al. and were not referenced in their
paper. In a study in Norwich, UK, we have shown that injury risk among
preschool children is determined in part by individual and family factors
such as sex, number of siblings, maternal age and lone parenthood, but in
addition there were independent contextual neighbourhood effects which
were partly accounted for by neighbourhood deprivation.[2] In a follow up
study on injury risk to school-age children we have shown strikingly
similar findings, both at the individual and neighbourhood level.[3] The
neighbourhood effects again were only partly explained by deprivation, but
the rest of the variation was not random because there was a high
correlation between the neighbourhood risks in the preschool and school
age groups. The type and mechanisms of injury are very different in these
two age groups, with home based injuries predominating in the younger
children and incidents at school, during sports activities or while
unsupervised occurring in the older children. What this implies to us is
that there are contextual (or collective[4]) neighbourhood factors
influencing injury risk which operate at a deeper level than the immediate
antecedents of an injury and probably reflect community based attitudes
and behaviour around risk, safety, exposure and protection.
Like Borrell et al, we feel European studies are important as studies
of this type are not necessarily generalisable across the Atlantic. The
pattern of risk factors and meanings of neighbourhoods are different
between countries, but probably there is a greater similarity within
Europe. Also, as Borrell et al. imply, we are surprised there are not more
studies of neighbourhood influences on injury risk, as the potential
mechanisms are inherently more plausible than those which, presumably
indirectly, influence cardiovascular health and all cause mortality.
References
(1) Borrell C, Rodriguez M, Ferrando J, Brugal MT, Pasarin MI,
Martinez V,Plasencia A. Role of individual and contextual effects in
injury mortality: new evidence from small area analysis. Injury Prev
2002;8:297-302
(2) Reading R, Langford IH, Haynes R, Lovett A. Accidents to
preschool children: comparing family and neighbourhood risk factors.
Social Science and Medicine 1999; 48:321-330.
(3) Haynes R, Reading R, Gale S. Household and neighbourhood
risks for injury to 5-14 year old children. Social Science and Medicine 2003; in
press.
(4) Macintyre, S., Ellaway, A. & Cummins, S. Place effects
on health: how can we conceptualise, operationalise and measure them?
Social Science and Medicine 2002;55: 125-139.
Dear Editor
We were interested to read the careful and detailed analysis of injury mortality data by Borrell et al.[1] We have also examined individual and neighbourhood effects on injury incidence in younger age groups and would like to draw these results to readers’ attention, as they extend and support the findings by Borrell et al. and were not referenced in their paper. In a study in Norwich, UK...
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