[Accident-related hospital admission of children and adolescents in relation to their social status--findings with data from North Rhine-Westphalia federal health insurance].

This paper review examines whether there are health inequalities in terms of hospital admissions due to accidents in children and adolescents in Germany, and whether the social gradient varies according to age and gender. Analyses are based on information from a statutory health insurance North-Rhine Westphalia. The social structure of these insured persons does not correspond to the German population. Lower social positions are predominant while persons holding higher positions are under-represented and professionals are virtually absent. Data were compiled from hospitals, routinely transmitted from employers and from data collections by the insurance for accounting purposes. 47,427 records of children and adolescents below the age of 17 were included; altogether 4246 accidents were recorded. Hospital admissions following accidents showed a clear social gradient. The odds-ratio (OR) of children with an unskilled/semi-skilled background as compared to the highest occupational position considered was OR = 1.4. Social gradients differed by gender and age. The respective odds-ratio for the group below 6 years was OR = 0.9, for ages 6 to 10 OR = 2.2, and OR = 1.4 for ages 11 to 16. The interpretation of age-specific odds-ratios is impaired by low numbers of events in the highest status group. Girls had a lower rate than boys. With regard to accidents, children and adolescents who could not be classified according to their socioeconomic status were similar to the two lower status groups. These findings are comparable to results of the few international studies in this research area. They suggest the necessity of preventive efforts to reduce social inequalities in the lower status groups.