Accidents to preschool children: comparing family and neighbourhood risk factors.

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.