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

2. 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

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

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

5. 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

6. 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

7. Results 1 Townsend Scores in quartiles of population 6.3 0.7 -1.6 -4.4
Population: 0-14 years
Number of fractures

8. Fracture rates by Deprivation Quartile by Activity

9. Fracture rates by Deprivation Quartile by Sports Activity (1)

10. Fracture rates by Deprivation Quartile by Sports Activity (2)

11. 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

12. 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

13. 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