Household and neighbourhood risks for injury to 5-14 year old children

Injuries in childhood are strongly related to poverty at the household level and to living in a deprived neighbourhood, but it is not clear whether these effects are independent. In this prospective population study, all injuries to 5-14 year old children living in the city of Norwich, UK, and presented at the hospital Accident and Emergency Department over a 13 month period were recorded (N=3526). Information on the population of resident children and household composition was assembled from the health authority population register. Neighbourhood information was extracted from the census and local surveys. Unadjusted risks were calculated for individual and neighbourhood factors, followed by multilevel modelling in which predictors were included at three levels: individual, enumeration district and social area (neighbourhood). The overall injury rate was 16.44 per 100 children per year. Injury rates between neighbourhoods varied two-fold and were highest in more deprived areas. In the final multilevel model injury risk was related to gender (boys vs. girls OR=1.35), age of child (OR=1.07 per year), number of adults in the household (OR=0.91 per adult), and age gap between child and eldest female (15-24 years vs. 25-34 years, OR=1.15). Injury rates were also related to social area deprivation, although variations in injury rates between neighbourhoods were not wholly explained by deprivation. The adjusted odds ratio between the most and least deprived social areas was 1.35. Excluding less serious injuries did not substantially change the results. The risks were very similar to those found in a previous study of pre-school children, with the same neighbourhoods identified as high and low risk as before. This evidence that neighbourhood factors independently influence injury risk over and above individual and household factors supports the use of area-based policies to reduce injuries in children.