London School of Hygiene & Tropical Medicine

Children in the UK whose parents are long-term unemployed or who have never worked are thirteen times more likely than children at the top end of the socio-economic scale to die from an injury or poisoning incident, according to a shocking new study published in today's British Medical Journal.

The paper, published by experts from the London School of Hygiene & Tropical Medicine and Camden Primary Care Trust, reveals how children in families where no adult is in paid employment have failed to benefit from the fall in child injury death rates, which dropped from 11.1 deaths per 100,000 a year in 1981 to 4 deaths per 100,000 in 2001.

The death rates from all external causes for children of parents classified as 'never having worked or long-term unemployed' were 13 times that for children of parents in managerial and professional occupations. For pedestrian deaths the rate was 20 times greater, for pedal cyclist deaths 27 times higher, and for deaths due to fires 37 times higher. For deaths of undetermined intent the rate was 32 times greater.

The seven leading causes of child injury deaths - being a pedestrian injured in a transport accident, being the victim of events of undetermined intent, experiencing other accidental threats to breathing, being a passenger in a car involved in an accident, being exposed to smoke, fire and flames, suffering accidental drowning or being a cyclist involved in a transport accident - accounted for over 80% of deaths due to injury and poisoning.

Phil Edwards, Lecturer in Statistics at the London School of Hygiene & Tropical Medicine and lead author of the study, comments: 'Given the decline in death rates over the last twenty years, and the relatively low number of deaths, it is surprising that these inequalities, which were identified a decade ago, are persisting into the 21st Century. Children in families where no adult is in paid employment have failed to experience the same decline in injury mortality as children from more advantaged backgrounds, and are disproportionately represented in the mortality figures.

'We can only speculate as to why this might be. But families where no adult is in paid employment may be less likely to have a car, and more likely to be exposed to road injury risk. The higher risks of dying in house fires may reflect the quality and type of housing, with the greatest fire risks for those in temporary or poor quality housing'.

The authors calculate that about 600 of the deaths from injury and poisoning which occurred between 2001 and 2003 could have been prevented if every child in England and Wales had experienced the same low mortality rates seen among children from the most advantaged families. They conclude that 'economic exclusion of the poorest families' is still very much with us in 21st Century Britain.

Reductions in child injury mortality in England & Wales: have the children of unemployed parents been excluded? Phil Edwards PhD, Lecturer in Statistics; Judith Green PhD, Senior Lecturer in Sociology; Ian Roberts PhD, Professor of Epidemiology: London School of Hygiene & Tropical Medicine. Suzanne Slater, Injury Prevention Specialist, Camden Primary Care Trust, St Pancras Hospital, London.