Reading R, Langford I H, Haynes R, Lovett A
School of Health Policy and Practice, UK.
Soc Sci Med. 1999 Feb;48(3):321-30. doi: 10.1016/s0277-9536(98)00311-6.
Accidental injury in young children is more common among poorer families and in deprived areas but little is known about how these factors interact. This paper describes a study to measure the contribution of individual family factors and area characteristics in determining risk of accidental injury among preschool children. We conducted a population based study of preschool accident and emergency attendances over two years in and around the city of Norwich, UK. Information on individual families was extracted from the district child health information system while "social areas" were constructed from adjacent census enumeration districts with homogeneous social and demographic characteristics. Statistical analysis was by multilevel modelling. Accidental injury rates were much higher in deprived urban neighbourhoods than in affluent areas but the multilevel analysis showed that, for all accidents, much of the variation in rates was accounted for by factors at the individual level i.e. male sex, young maternal age, number of elder siblings and distance from hospital, with a smaller, but independent, influence of living in a deprived neighbourhood. The model for more severe injuries was similar except single parenthood was now significant at the level of individuals and the effect of area deprivation was stronger. We conclude that preschool accidental injuries are influenced by factors operating at both the level of individual families and between areas. This evidence suggests that both social policy changes to improve child care among unsupported young families and targeting accident prevention measures at a local level towards deprived neighbourhoods would reduce accidents.
幼儿意外伤害在贫困家庭和贫困地区更为常见，但对于这些因素如何相互作用却知之甚少。本文描述了一项研究，旨在衡量个体家庭因素和地区特征在确定学龄前儿童意外伤害风险方面的作用。我们在英国诺里奇市及其周边地区进行了一项为期两年的基于人群的学龄前儿童事故和急诊就诊情况研究。个体家庭信息从地区儿童健康信息系统中提取，而“社会区域”则由具有相同社会和人口特征的相邻人口普查枚举区构建。统计分析采用多水平模型。贫困城市社区的意外伤害发生率远高于富裕地区，但多水平分析表明，对于所有事故，发生率的大部分差异是由个体层面的因素造成的，即男性、母亲年龄较小、年长兄弟姐妹的数量以及与医院的距离，而生活在贫困社区的影响较小但独立。更严重伤害的模型类似，只是单亲家庭在个体层面现在具有显著性，并且地区贫困的影响更强。我们得出结论，学龄前意外伤害受到个体家庭层面和地区层面因素的影响。这一证据表明，改善无支持年轻家庭儿童照料的社会政策变化以及在地方层面针对贫困社区采取事故预防措施都将减少事故。
