20 Years of Research on Socioeconomic Inequality and Children's—Unintentional Injuries Understanding the Cause-Specific Evidence at Hand
Table 2
Individual-level studies for childhood road traffic injuries: summary of methodological features and results ().
Author & year country (city/region)
Outcomes
Age group data source
SES measure
Analysis covariates
Results: the level of 95% is used for all confidence intervals (CI)
Cho et al. 2007 South Korea (whole country)
Death due to transport accident (all types) stratified by sex and age group
10–14 and 15–19 years R: death register, health insurance beneficiary dataset
Parental income (based on insurance contribution – 3 levels)
Cox proportional hazards model None
Boys with parents in the third income tertile have significantly higher mortality in transport accidents than those in the first tertile. Boys 10–14 (RR=2.66; CI 1.8–3.9), 15–19 (RR=2.15; CI 1.6–2.8). There were no significant differences for girls
Donroe et al. 2009 Peru (Lima)
RTI as pedestrian, severe enough to require medical consultation
0–18 years I: household survey with guardian or with child if aged 12 years and over
Poverty (2 levels, parental education (2 levels)
Logistic regression Sex, age, other SES, overcrowding, number of children in the home
Children in poor households have increased odds for pedestrian injury (OR=1.59; CI 1.2–2.2) compared to those in more affluent households. Children with parents with low level of education have increased odds for pedestrian injuries compared to children with parents with high education (RR=1.91; CI 1.4–2.7)
Edwards et al. 2006 United Kingdom (England and Wales)
Deaths as pedestrian, car occupant, cyclist
0–15 years R: Population based death register
Family occupational status (8 levels)
Death rates (95% CI) None
Children from family with the least favourable occupational status had 20.6 (CI 10.6–39.9) times higher deaths as pedestrians, 5.5 (CI 3.1–9.6) times higher deaths as car occupants and 27.5 (CI 6.4–118.2) times higher for deaths as cyclists than children in the most advantaged families
Engström et al. 2002 Sweden (whole country)
Hospitalisations and deaths combined, RTI (all types) stratified by age
0–4, 5–9, 10–14, 15–19 years R: population and housing censuses, hospital discharge register, death register
Parental social class (4 levels)
Logistic regression, slope index of inequality, relative index of inequality Parents’ country of birth, single parent home, receipt of welfare benefits
Children of unskilled workers have higher odds for traffic injuries than children with parents that are intermediate and high level employees: 5–9 years (adjusted RR=1.36; CI 1.2–1.5), 10–14 years (adjusted RR=1.23; CI 1.1–1.3), 15–19 years (adjusted RR=1.52; CI 1.4–1.6)
Hasselberg & Laflamme 2005 Sweden (whole country)
Hospitalisations, RTI as car driver
16–23 years R: population and housing censuses, hospital discharge register
Household social class (4 levels) Parental education (3 levels)
Logistic regression None
Car drivers who were injured several times show a similar social distribution to that of drivers sustaining just one. However, drivers from self-employed households show greater odds of injury repletion compared to drivers with parents that are intermediate and high level salaried employees (OR=1.65; CI 1.0–2.7)
Hasselberg & Laflamme 2004 Sweden (whole country)
Hospitalisations, RTI as pedestrian, bicyclist and car passenger
1–14 years R: population and housing censuses, hospital discharge register
Household social class (7 levels) Household disposable income (quartiles) Parental education (3 levels)
Poisson regression, population attributable risk Child’s age, mother’s age at delivery
Low socioeconomic position of the household increases the risk of being injured in traffic as pedestrian (RR=1.39; CI 1.2–1.7), bicyclist (RR=1.34; CI 1.3–1.4) and car passenger (RR=1.31; CI 1.1–1.6). This association is also shown for other measures of SEP such as low disposable income and low level of education. The highest population-attributable risks were related to family disposable income and were indicated for pedestrians and car passengers (19%–20%)
Hasselberg & Laflamme 2003 Sweden (whole country)
Hospitalisations, RTI as car driver
16–23 years R: population and housing censuses, hospital discharge register
Household social class (7 levels) Household disposable income (quartiles) Parental education (3 levels)
Poisson regression, population attributable risk Child’s age, mother’s age at delivery
The long-term effects of low parental social class (OR=1.62; CI 1.4–1.9) and low education (OR=1.76; CI 1.52–2.03) on RTIs are evident in the case of young drivers. Level of family disposable income is not related to RTI among young car drivers
Hasselberg et al. 2001 Sweden (whole country)
Hospitalisations, RTI as pedestrian, bicyclist, moped user, mc-user, car driver
2–24 years R: population and housing censuses, hospital discharge register
Household social class (7 levels)
Logistic regression, population attributable risk Child’s age, mother’s age at delivery
Children of unskilled workers have higher odds for injuries as pedestrians (OR=1.30; CI 1.1–1.5), bicyclists (OR=1.34; CI 1.3–1.4), moped users (OR=1.80; CI 1.6–2.0), motorcyclists (OR=1.80; CI 1.6–2.0) and car drivers (OR=1.75; CI 1.6–2.0)
Laflamme et al. 2004 Sweden Stockholm County
Hospitalisations and deaths combined, RTI as protected and unprotected road user
0–19 years R: population housing censuses, hospital discharge register
Household socioeconomic status
Relative index of inequality, Chi-squared test
Equalisation for older boys as bicycle users (13–15 years RII=1.64;0.9–3.0, 16–18 years RII=1.16; CI 0.5–2.7)
Laflamme & Engström 2002 Sweden (whole country)
Hospitalisations, RTI as pedestrian, bicyclist, motor vehicle passenger, motor vehicle driver
0–4, 5–9, 10–14, 15–19 years R: population housing censuses, hospital discharge register
Household socioeconomic status (4 levels)
Regression analysis Sex
Significantly higher odds for children (aged 5–9 and 15–19 years) of unskilled workers for pedestrian injuries than for those in higher socioeconomic groups (5–9 years RR=2.33; CI 1.7–3.1, 15–19 years RR1.55; CI 1.2–2.0
Murray 1998 Sweden (whole country)
Police reported traffic accidents among young motor vehicle drivers
16–22 years R: national road administration database, population and housing census
Social class (8 levels), school achievement (based on school marks in the school-leaving certificate)
-test, difference of proportions None
The school achievement and school attainment were lower among young people involved in injuries compared to a sample of young people not involved in RTIs ()
Roberts 1997 United Kingdom (England and Wales)
Death rates RTI (all types), cyclist and pedestrian in a collision with motor vehicle
0–15 years R: death register
Social class of father (6 levels)
Poisson regression None
Children in social class V are more likely to suffer traffic accidents compared to those in social class I (motor vehicle accidents, OR=1.11; CI 1.1–1.2, cyclists, OR=1.30; CI 1.2–1.4, pedestrian, OR=1.47; CI 1.4–1.5)
Roberts & Power 1996 United Kingdom (England and Wales)
Death rates for motor vehicle accidents and pedestrian accidents.
0–15 years R: population censuses, death register
Social class of the father (6 levels)
Poisson regression None
Children in disadvantaged families have more RTI in both periods (1979–83 and 1989–92) compared to children in more advantaged households (). The decline in mortality due to motor vehicle injuries and pedestrian injuries was smaller in the manual working class (23% decline; CI 16–28) than in the nonmanual working class (34% decline; CI 24–43)
Zambon & Hasselberg 2006 Sweden (whole country)
Police reported road traffic crash as a motorcycle driver
16–23 years R: population and housing census, hospital discharge register, national road administration database
Household social class (5 levels)
Logistic regression, population attributable risk
Low socioeconomic position increases the motorcycle injury risk of both minor (OR=1.66; CI 1.5–1.9) and severe (OR=1.64; CI 1.3–2.1) outcomes to an equal extent, without giving rise to a higher risk of severe outcomes
