Orton Elizabeth, Kendrick Denise, West Joe, Tata Laila J
Lecturer and Specialty Registrar in Public Health, Division of Primary Care, University Park, University of Nottingham, Nottingham United Kingdom.
Professor of Primary Care Research, Division of Primary Care, University Park, University of Nottingham, Nottingham United Kingdom.
PLoS One. 2014 Oct 27;9(10):e111631. doi: 10.1371/journal.pone.0111631. eCollection 2014.
Injury is a significant cause of childhood death and can result in substantial long-term disability. Injuries are more common in children from socio-economically deprived families, contributing to health inequalities between the most and least affluent. However, little is known about how the relationship between injuries and deprivation has changed over time in the UK.
We conducted a cohort study of all children under 5 registered in one of 495 UK general practices that contributed medical data to The Health Improvement Network database between 1990-2009. We estimated the incidence of fractures, burns and poisonings by age, sex, socio-economic group and calendar period and adjusted incidence rate ratios (IRR) comparing the least and most socio-economically deprived areas over time. Estimates of the UK annual burden of injuries and the excess burden attributable to deprivation were derived from incidence rates.
The cohort of 979,383 children experienced 20,804 fractures, 15,880 burns and 10,155 poisonings, equating to an incidence of 75.8/10,000 person-years (95% confidence interval 74.8-76.9) for fractures, 57.9 (57.0-58.9) for burns and 37.3 (35.6-38.0) for poisonings. Incidence rates decreased over time for burns and poisonings and increased for fractures (p<0.001 test for trend for each injury). They were significantly higher in more deprived households (IRR test for trend p<0.001 for each injury type) and these gradients persisted over time. We estimate that 865 fractures, 3,763 burns and 3,043 poisonings could be prevented each year in the UK if incidence rates could be reduced to those of the most affluent areas.
The incidence of burns and poisonings declined between 1990 and 2009 but increased for fractures. Despite these changes, strong socio-economic inequalities persisted resulting in an estimated 9,000 additional medically-attended injuries per year in under-5s.
伤害是儿童死亡的一个重要原因，并且可能导致严重的长期残疾。伤害在社会经济贫困家庭的儿童中更为常见，这加剧了最富裕和最贫困人群之间的健康不平等。然而，在英国，伤害与贫困之间的关系如何随时间变化却鲜为人知。
我们对在495家英国全科诊所之一登记的所有5岁以下儿童进行了一项队列研究，这些诊所于1990年至2009年间向健康改善网络数据库提供了医疗数据。我们按年龄、性别、社会经济群体和日历时间段估计了骨折、烧伤和中毒的发病率，并比较了随着时间推移社会经济最贫困和最富裕地区之间的调整发病率比（IRR）。英国每年伤害负担的估计值以及归因于贫困的额外负担是根据发病率得出的。
这一包含979,383名儿童的队列经历了20,804例骨折、15,880例烧伤和10,155例中毒事件，骨折的发病率为每10,000人年75.8例（95%置信区间74.8 - 76.9），烧伤为57.9例（57.0 - 58.9），中毒为37.3例（35.6 - 38.0）。烧伤和中毒的发病率随时间下降，而骨折的发病率上升（每种伤害的趋势检验p<0.001）。在更贫困的家庭中，发病率显著更高（每种伤害类型的趋势IRR检验p<0.001），并且这些梯度随时间持续存在。我们估计，如果发病率能够降至最富裕地区的水平，英国每年可预防865例骨折、3,763例烧伤和3,043例中毒事件。
1990年至2009年间，烧伤和中毒的发病率下降，但骨折的发病率上升。尽管有这些变化，强烈的社会经济不平等仍然存在，导致5岁以下儿童每年估计有9,000例额外的需就医伤害事件。
