Social inequalities and hospital admission for unintentional injury in young children in Scotland: a nationwide linked cohort study

Henery, P. M., Dundas, R. , Katikireddi, S. V. , Leyland, A. , Wood, R. and Pearce, A. (2021) Social inequalities and hospital admission for unintentional injury in young children in Scotland: a nationwide linked cohort study. Lancet Regional Health - Europe, 6, 100117. (doi: 10.1016/j.lanepe.2021.100117) (PMID:34291228) (PMCID:PMC8278494)

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Background: Unintentional injury is a leading cause of death/disability, with more disadvantaged children at greater risk. Understanding how inequalities vary by injury type, age, severity, and place of injury, can inform prevention. Methods: For all Scotland-born children 2009-2013 (n=195,184), hospital admissions for unintentional injury (HAUI) were linked to socioeconomic circumstances (SECs) at birth: area deprivation via the Scottish Index of Multiple Deprivation (SIMD), mother's occupational social class, parents’ relationship status. HAUI was examined from birth-five, and during infancy. We examined HAUI frequency, severity, injury type, and injury location (home vs. elsewhere). We estimated relative inequalities using the relative indices of inequality (RII, 95% CIs), before and after adjusting for demographics and other non-mediating SECs. Findings: More disadvantaged children were at greater risk of any HAUI from birth-five, RII: 1•59(1•49-1•70), 1•74(1•62-1•86), 1•97(1•84-2•12) for area deprivation, maternal occupational social class, and relationship status respectively. These attenuated after adjustment (1•15 [1•06-1•24], 1.22 [1•12-1•33], 1.32 [1•21-1•44]). Inequalities were greater for severe (vs. non-severe), multiple (vs. one-off) and home (vs. other location) injuries. Similar patterns were seen in infancy, excluding SIMD-inequalities in falls, where infants living in more disadvantaged neighbourhoods were at lower risk (0•79 [0•62-1•00]). After adjustment, reverse SIMD-gradients were also observed for all injuries and poisonings. Interpretation: Children living in more disadvantaged households are more likely to be injured across multiple dimensions of HAUI in Scotland. Upstream interventions which tackle family-level disadvantage may be most effective at reducing childhood HAUI.

Item Type:Articles
Additional Information:PMH and AP are supported by funds from the Wellcome Trust [205412/Z/16/Z]. PMH, RD, SVK, AL, and AP are supported by funds from the Medical Research Council [ MC_UU_00022/2 ] and the Scottish Government Chief Scientist Office [SPHSU17]. SVK is funded by a NRS Senior Clinical Fellowship ( SCAF/15/02 ).
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Leyland, Professor Alastair and Pearce, Dr Anna and Henery, Mr Paul and Dundas, Professor Ruth
Authors: Henery, P. M., Dundas, R., Katikireddi, S. V., Leyland, A., Wood, R., and Pearce, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Lancet Regional Health - Europe
Publisher:Lancet Publishing Group
ISSN (Online):2666-7762
Published Online:09 May 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published Lancet Regional Health - Europe 6:100117
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174091Improving life chances & reducing child health inequalities: harnessing the untapped potential of existing dataAnna PearceWellcome Trust (WELLCOTR)205412/Z/16/ZSHW - MRC/CSO Social & Public Health Sciences Unit
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02SHW - Public Health