Incidence of childhood fractures in affluent and deprived areas Ronan A Lyons

Background Childhood injury mortality rates vary more between social groups than any other cause of death Many people assume that non-fatal injuries show the same pattern There is limited data on the distribution of non - fatal injuries

Injuries: Data Availability Death Registeries Hospital Admissions Emergency Room Attendances Primary Care Visits Not brought to Medical Care: surveys

Socioeconomic Measures Individual or Ecological Level Education Level Income: individual or household Job Status: social class Neighbourhood Wealth Deprivation Scores

Townsend Index of Deprivation Based on 4 questions in census every 10 years Averaged area scores for : Households with access to a car Ovecrowding (>1 person per room) Households owner occupied (not rented) Unemployment Rate Variables are Z scored and averaged

Study Design All children with fractures attend 3 hospitals Fracture rates do not decline with distance Address used to define geographical area Area divided into quartile of deprivation Fracture rate calculated for each area Crude and age standardised rates similar Sub-analyses by cause of fracture

Results 1 Townsend Scores in quartiles of population 6.3 0.7 -1.6 -4.4 6.3 0.7 -1.6 -4.4 Population: 0-14 years 12150 14018 19924 22049 Number of fractures 752 740 521 386

Fracture rates by Deprivation Quartile by Activity

Fracture rates by Deprivation Quartile by Sports Activity (1)

Fracture rates by Deprivation Quartile by Sports Activity (2)

Ecological Study Deprivation measured at area level Comparison between areas not individuals Results based on individuals may differ Difficult to target deprived individuals Easier to target deprived areas or schools Prevention easier to focus on areas Study based on non-fatal injuries

Fatal vs non fatal injuries Motor vehicle accidents (MVAs) cause 35% childhood injury deaths in England + Wales Only 1.4% of fractures due to MVAs Therefore, epidemiology of fatal injuries differs to that of non-fatal injuries

Conclusions Unlike fatal injuries, childhood fractures rates are similar in affluent and deprived areas There is a tendancy for higher fracture rates from sports in more affluent areas Fractures from assaults are more common in deprived areas