London School of Hygiene & Tropical Medicine

Rates of serious injury in child pedestrians are four times higher in the most deprived areas of England than in the least deprived, and three times higher for child cyclists, according to a study published today in the Online First edition of Archives of Disease in Childhood journal.

Child injury mortality has declined over the last twenty years, from about 11 deaths per 100,000 children aged 0-15 in 1981 to 4 deaths per 100,000 children in 2001. However, socio-economic inequalities remain. This study, from a team led by Dr Phil Edwards of the London School of Hygiene & Tropical Medicine (LSHTM), demonstrates that a child's risk of non-fatal injury may be determined by how socially deprived their neighbourhood is.

The LSHTM team analysed Hospital Episode Statistics from the Department of Health containing records of all child admissions (aged 0-15 years) during a five-year period around the 2001 census. They found evidence to suggest that socio-economic inequalities in serious injury exist across the whole of England, particularly for child pedestrians. They also discovered significant variations in rates of serious injury between urban and rural settings.

Although there is strong evidence to suggest that socio-economic inequalities in child injury mortality persist, and some evidence to suggest that these inequalities are also reflected in morbidity, gaps remain in both our knowledge about other sources of variation in injury rates, and in how socio-economic status may affect injury risk. Recent analysis of mortality data found that death rates for children with parents in routine occupations were twice those of children with parents in higher managerial and professional occupations, while death rates among children in families with no adult in paid employment were thirteen times higher.

The LSHTM team analysed hospital admissions for injuries that are so severe that the probability of death is about 1 in 15. They identified a positive relationship between serious injury admission rates and increasing areas of deprivation, for the leading causes of unintentional injury. These included falls, by far the most common cause, transport injuries involving pedestrians, cyclists and cars, exposure to smoke, fire and flames, and accidental poisoning.

Serious injury rates were found to be lower for pedestrians in rural areas, and lower for cyclists in London. But they were found to be higher for children travelling in cars in rural areas. The researchers also found evidence that inequalities in cycling injury were greater in rural than in urban areas. The rate of serious injury from children falling was found to be highest in London, which could be related to factors such as unsafe housing stock and hazards in both the built environment and in leisure facilities in more deprived parts of the capital.

Dr Edwards comments: 'For transport-related injury, our findings indicate that the most pressing policy need is to make our roads safer for young pedestrians and cyclists. There is evidence that reducing both the speed and the volume of car traffic would achieve this, particularly in more deprived areas where pedestrians are more exposed.

He continues: 'In the UK, cycling and walking appear less safe as modes of transport. However, given evidence for a 'critical mass' effect, whereby walking and cycling become progressively safer as more people walk and cycle, it may be that by encouraging walking and cycling they will, in the longer term, become less risky, thereby mitigating the added exposure risk for those in the most deprived areas'.