Research article
Injuries in Homes with Certain Built Forms

https://doi.org/10.1016/j.amepre.2006.02.007Get rights and content

Background

Rates of injuries may occur more frequently in different types of homes.

Methods

Retrospective population-based cohort study utilizing three linked databases: a population register, an architectural assessment of homes in the area, and an emergency department-based injury surveillance system.

Results

Over 58,000 homes were classified into 94 different types according to age, size, and built form. Among the 112,248 inhabitants, there were 18,044 emergency department attendances for treatment of an injury suffered in the home. Adjusted odds ratio of injuries for residents of purpose-built apartments was substantially elevated for all injuries (2.07; 95% confidence interval [CI]=1.87–2.30) and poisoning episodes (5.6; 95% CI=3.8–8.3).

Conclusions

Residents of apartment buildings have substantially higher injury rates. Additional research is required to investigate the contribution of environmental hazards and behavioral factors underlying these high rates.

Introduction

The influence of the built environment on health is receiving renewed attention, particularly in relation to urban-renewal programs and development of sustainable communities.1 One major theme is the relationship between the built environment and injuries, although research has focused mainly on traffic-related injuries rather than injuries occurring in the home. In the United States, unintentional injuries in the home account for some 18,000 deaths per annum, and 12 million injuries require medical attention.2, 3 The societal cost of unintentional home injuries occurring in the United States in 1998 has been estimated at $217 billion.4 Children are particularly vulnerable to home injuries. Approximately 55% of unintentional injury-related deaths and 39% of emergency department (ED) visits in children and young people in the United States result from injuries that occur in the home.5, 6 In the United Kingdom, the British Medical Association’s Board of Science and Education report that more unintentional injury deaths occur in the home than on the road, and that every year more than 1 million UK children are injured at home.7 Despite this, there has been very little work looking at whether particular types of homes are more hazardous. In the United Kingdom, the newly adopted Housing Health and Safety Rating System (HHSRS) suggests that pre-1919 dwellings are substantially more hazardous than post-1980 dwellings,8, 9 but how this conclusion was reached and the extent to which adjustment was made for potential confounders is not clear. A multilevel study in the United States reported that pediatric injuries are more common in housing units built before 1950.10

The objective of this population-based study was to determine whether injuries occur more commonly in different types of homes. The magnitude of differential injury rates would be useful in assessing the feasibility and desirability of targeted or universal approaches to injury prevention in the home.

Section snippets

Methods

This study was carried out within a long-term partnership between academia and local government to understand the relationship between the social and built environments and health in order to develop interventions to improve health.11 The research was carried out in the Neath-Port Talbot County area in South Wales in the United Kingdom, in which injury-event data from an injury surveillance system were linked with a register of property types and with a population register.

Research exploited a

Results

A total of 62,943 properties were identified from a database held by the local authority, of which 60,171 (95.6%) could be mapped on to a GIS using Ordnance Survey software (Southhampton, UK). In this group, 58,041 properties were classified as domestic properties and 55,148 (87.6% of total) were visible from the road, surveyed, and assigned built-form codes. Nursing and care homes were subsequently removed by cross-checking with local registers, leaving 54,913 individual homes (of which 54,081

Discussion

Given the enormous scale of mortality, morbidity, health service utilization, and societal costs associated with injuries in the home, prevention of such injuries should be a key public health and societal goal.15 In order to target injury prevention initiatives, it is important to know which types of homes contain the most dangerous hazards. Residential injury is likely a result of complex interactions between the housing type and individual motor skills behavior and susceptibility.

A high

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