Measuring socio-economic inequalities in the presentation of injuries to a paediatric A&E department: the importance of an epidemiological approach.
OBJECTIVE
To contrast the socio-economic pattern of childhood injuries presenting to a paediatric accident and emergency (A&E) department revealed by using both a numerator-based and a denominator-based approach to the analysis of injury surveillance data.


METHODS
Injury surveillance data collected during 1997-1998 at a Glasgow children's hospital A&E department were analysed. Socio-economic status was measured using Carstairs' deprivation index. Data from West Glasgow postcode sectors only were analysed in order to optimize epidemiological validity. Socio-economic patterning of injury was investigated in two ways-numerator-based and denominator-based.


RESULTS
A total of 12,762 children (0-14 years) living in West Glasgow attended the A&E department of the Royal Hospital for Sick Children over the study period. Both analytical approaches showed a clear and statistically significant excess of injury presentations in children from more deprived postcode sectors, but the variation appeared much greater in the numerator-based rather than the denominator-based approach. In regression analysis, however, only the denominator-derived rates showed a statistically significant linear trend across deprivation categories.


CONCLUSIONS
The most appropriate and accurate means of measuring the extent of socio-economic (and other) inequalities in injury risk is to adopt a population-based rather than numerator-based perspective on the data collected by injury surveillance systems.
Brown
C E
CE
Department of Child Health, Paediatric Epidemiology and Community Health (PEACH) Unit, University of Glasgow, Yorkhill Hospital, Glasgow G3 8SJ, UK.
Chishti
P
P
Stone
D H
DH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D011159:Population Surveillance; D012606:Scotland / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000453:epidemiology*