20 Years of Research on Socioeconomic Inequality and Children's—Unintentional Injuries Understanding the Cause-Specific Evidence at Hand
Table 3
Area-level studies for childhood road traffic injuries: summary of methodological features and results ().
Author and 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)
Adams et al. 2005 United Kingdom (Tyne, Northumberland, Wear)
Police reported RTI as pedestrian, cyclist, car occupantStratified by sex
0–16 years R: regional police register
Townsend deprivation index of enumeration districts (quintiles)
Logistic regression None
Deprivation increases the odds of RTIs as pedestrian 1998–2003 (boys RR=2.7; CI 2.2–3.3 and girls RR=2.6; CI 2.0–3.2), vehicle passengers 1998-2003 (boys RR=1.2; CI 1.0–1.6 and girls RR=1.1; CI 1.0–1.4). Decreasing differences between 1988 and 2003
Birken et al. 2006 Canada (urban areas
Deaths pedestrian collisions with a motor vehicle
0–14 years R: death register
Household income for census tracts (quintiles)
Poisson regression Age, sex
For each unit change in income quintile, from highest to lowest, the risk of death as pedestrian increased by 13% (CI 5%–22%)
Coupland et al. 2003 United Kingdom (Trent)
Hospitalisations, RTI as bicyclist, pedestrian or other transport injury
0–14 years R: hospital records
Townsend deprivation index for electoral wards (quintiles)
Poisson regression Rurality, percentage males, ethnicity, distance to nearest hospital
Children in deprived areas have increased risk for RTI compared to those in more affluent area in the years 1996 to 1997, but no significant change between 1992–1997 (pedestrian injuries RR=4.0; CI 1.9–8.2 and bicycle injuries RR=1.8; CI 1.2–2.6)
Dougherty et al. 1990 Canada (urban areas and Montréal)
RTI mortality and morbidity as pedestrian and bicyclist
0–14 years R: hospital records, police reported accidents
Median household income, rate of poverty among children under 18 years for census tracts (quintiles)
Relative rates with 95% CI None
The rate of RTI was four times higher for children living in deprived neighbourhoods compared to those in affluent areas (injury rate 168; CI 138–204 and 686; CI 622–756). Inequalities more pronounced for pedestrians than bicyclists. Socioeconomic inequalities in fatal injuries greater in girls than in boys.
Durkin et al. 1994 United States (Northern Manhattan)
RTI mortality and morbidity asmotor vehicle user, pedestrian
0–16 years R: injury surveillance system
Household income (3 levels), education (2 levels), unemployment (2 levels) for census tracts (quartiles)
Regression analysis, rate ratios with 95% CI None
The injury rate ratio for children in low-income neighbourhoods is higher than for children living in neighbourhoods with few low-income households (motor vehicle injuries RR=2.5; CI 2.0–3.2 and pedestrian injuries RR=3.1; CI 2.3–4.2)
Edwards et al. 2008 United Kingdo (England)
Hospitalisations, RTI as pedestrian, bicyclist, car occupant
0–15 yearsR: centralised inpatient register, population censuses
Index of Multiple Deprivation (deciles)
Negative binomial regressionEthnicity, % households with no car, % lone-parent families
Rates of serious injury were higher in the most deprived areas than in the least deprived for pedestrians (RR=4.1; CI 2.8–6.0), bicyclists (RR=2.6; CI 1.7–4.0) and car occupants (RR=2.0; 95% 1.4–3.3)
Elmén & Sundh 1994 Sweden (Gothenburg)
RTI mortality (all types)
1–14 and 15–24 years R: cause of death register
Mean income for parishes (3 levels)
Mantel-Haenszel tests Calendar year
Successively increasing RTI mortality with lower socioeconomic status of the area for both men and women ()
Faelker et al. 2000 Canada (Ontario)
Traffic injuries seen in emergency departments
0–19 years R: Emergency department-based surveillance system
The percentage of individuals living below the poverty line (5 levels)
Poisson regression Age, sex, education, unemployment, single parenthood, dwelling value, dwellings in need of repair
No statistically significant relationship between SES and traffic injuries (RR 1.5; CI 1.1–2.1)
Gagné & Hamel 2009 Canada (Québec province)
Hospitalisations, RTI as motor vehicle occupant, bicyclist & pedestrian
0–14 years R: hospital administrative data system
Area material deprivation for census dissemination areas (quintiles)
Poisson regression Age, sex, residence location, area social deprivation
Children from the least privileged areas have significantly higher RRs than their peers from privileged areas (motor vehicle occupants RR=1.7; CI 1.3–2.2, pedestrians RR=3.6; CI 2.7–5.0, bicyclists RR=1.3; CI 1.1–1.5).
Graham et al. 2005 United Kingdom (England)
Police reported pedestrian casualties
0–16 years R: regional register data
Deprivation index for wards
Negative binomial regression Number of children, volume of traffic flows, physical environment, local road infrastructure
An association between increased deprivation and higher number of pedestrian causalities. For adults (t-statistics 16.0) but stronger association for children (t-statistics 26.4)
Hippsley-Cox et al. 2002 United Kingdom (Trent)
Hospitalisations, RTI as pedestrian, bicyclist and other transport injuries
0–14 years R: regional admissions data
Townsend deprivation index of electoral wards (quintiles)
Poisson regression Rurality, percentage males, ethnicity, distance to nearest hospital
Socioeconomic gradient for RTI among children up to 15 years, especially in those under 5 years that persisted with severity level. The gradient was steepest for pedestrian injuries (adjusted RR=3.7; CI 2.9–4.5)
Kendrick 1993 United Kingdom (Greater Nottingham)
Police reported pedestrian accidents
0–10 years R: regional register data
Deprivation zones based on aggregated enumeration districts (4 levels)
-test, Spearman rank correlation coefficients
A significantly higher rate of pedestrian accidents in deprived areas for children 0–4 years (; CI 0.5–0.7) and children 5–11 years (; CI 0.6–0.8)
Lyons et al. 2003 United Kingdom (Wales)
Hospitalisations, pedestrian RTI and nonpedestrian RTI
0–14 years R: routine centralised inpatient register
Townsend deprivation index of electoral tracts (quintiles)
Admission rates for pedestrian injuries are substantially higher in more deprived areas (63.2; CI 57.1–69.2) than in the most affluent areas (28.3; CI 23.2–33.3).
Moustaki et al. 2001 Greece (Greater Athens)
Hospitalisations, pedestrian injuries
0–14 years R: emergency department injury surveillance system
% adult household head with higher education degree% of residences with less than one person per room
Chi square, Mantel Haenzel, -test, analysis of variance
Less wealthy towns had an almost twofold excess of pedestrian injuries compared with wealthier ones. The social gradient was steeper outside the residential town ()
Oliver & Kohen 2009 Canada (whole country)
Hospitalisations, RTI as motor vehicle passenger and pedestrian/bicyclist
0–19 years R: hospital morbidity database
Neighbourhood income level based on Dissemination Areas (DA)
Poisson regression, linear trend test Age, sex
In rural areas, children from lower income neighbourhoods have higher hospitalisation rate for injuries as vehicle occupants (hospitalisation rates 5.52; CI 5.1–5.9) than those from the richest neighbourhoods (4.3; CI 3.9–4.7)
Poulos et al. 2007 Australia (New South Wales)
Hospitalisations, RTI as pedestrian, bicyclist, motorcycle rider, motor vehicle occupant
0–14 years R: inpatient register
Index of Relative Socioeconomic Disadvantage of statistical local areas (quintiles)
Negative binomial regression Age, sex
Children in the most disadvantaged quintile are more likely to be hospitalised than children in the least disadvantaged quintile for RTI as pedestrians (IRR=2.54; CI 1.9–3.4), bicyclists (IRR=1.30; CI 1.2–1.4), motor vehicle occupants (IRR=1.84; CI 1.6–2.2), motorcycle rider (IRR=2.95; CI 2.5–3.5)
Reimers et al. 2008 Sweden (Stockholm county)
Hospitalisations stratified by sex, age and time period (1993–95; 2003–05) motor vehicle rider
10–14 and 15–19 years R: regional inpatient register
Socioeconomic deprivation index of parishes (quintiles)
Poisson regression None
Boys living in areas with the highest level of economic deprivation have lower rates of RTI as motor vehicle rider (10–14 years, RR= 0.26; CI 0.1–0.7, 15–19 years, RR=0.3; CI 0.2–0.5)
Reimers & Laflamme 2005 Sweden (Stockholm county)
Hospitalisations, RTI as pedestrian, bicyclist, moped rider, car passenger motor vehicle rider
0–15 years R: regional inpatient register
Deprivation index, SES index of parishes (3 levels of each)
Rate ratios None
Higher levels of deprivation negatively influence pedestrian injuries (RR=1.92; CI 1.2–2.3) and a protective effect on other traffic-related injuries, bicyclists (RR=0.59; CI 0.5–0.7), moped riders (RR=0.30; CI 0.2–0.4), car passengers (RR=0.67; CI 0.3–0.6)
Reimers & Laflamme 2004 Sweden (Stockholm county)
Hospitalisations, RTI as bicyclist, moped rider
10–19 years R: routine centralised inpatient register
Material deprivation, SES, and multi-ethnicity indices for parishes (3 levels of each)
Logistic regression None
Boys in areas with relatively higher concentration of socioeconomic precariousness and immigrant concentration have reduced risk for RTIs as bicyclists (OR=0.4; CI 0.3–0.5) and moped riders (OR=0.6; CI 0.5–0.8)
Silversides et al. 2005 Ireland (North and West Belfast
Injuries seen in emergency department RTI as pedestrian, bicyclist, car passenger
0–12 years R: emergency department register
The Noble economic deprivation index of enumeration districts (2 levels – most versus least deprived areas)
Student’s -test None
Children living within the most deprived areas were more likely to be involved in road traffic injuries, pedestrian (RR=1.32; ), bicycle (RR=2.43; ), vehicle (RR=2.88; )
Turrell & Mathers 2001 Australia (whole country)
Mortality due to motor vehicle traffic accident
0–14, 15–24 years R: Death register
Index of relative socioeconomic disadvantage for statistical local areas, Gini coefficient
Rate ratio with 95% CI
Children in disadvantaged areas have increased mortality due to motor vehicle accidents for males in both age groups (0–14 years, RR=2.49; , 15–24 years, RR=2.26; ) and for females (0–14 years, RR=1.4; , 15–24 years, RR=1.83; )
