title: Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study.
abstract: There has been little research into the role of neighbourhood effects in childhood injury. We report results from a cohort study, comprising 1717 families (2357 children aged 0-7 years) registered at 47 general practices in Nottingham, UK. Multi-level Poisson regression examined relationships between electoral ward (neighbourhood), family and child characteristics and medically attended injury rates. Primary care attendance rates were higher for children in rented accommodation and those aged 2-3 years. An n-shaped relationship was found between geographical access to services and the primary care attendance rate. Accident and Emergency (A&E) department attendance rates were higher amongst boys, children in rented accommodation, with a teenage mother, aged 2-5 years and living in wards with a higher number of parks and play areas. They were lower for children whose families had a smoke alarm. Hospital admission rates were higher amongst children living in more deprived wards and wards with higher violent crime rates. They were lower in children whose families had smoke alarms, stair gates and stored sharp objects safely. Primary care and A&E attendance rates varied significantly between families. Variation between wards in the A&E attendance rate was explained by family characteristics. We conclude that characteristics of wards, families and children are associated with medically attended childhood injury rates. This study did not find a neighbourhood effect for A&E attendances that could not be explained by family level characteristics. Studies with greater power and a measure of injury severity independent of health service utilisation are needed to explore the relationship between neighbourhood effects and more severe injuries. The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary.
authors.affiliation: Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham NG7 2RD, UK. denise.kendrick@nottingham.ac.uk
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
authors.forename: Caroline
authors.initials: C
authors.lastname: Mulvaney
authors.forename: Paul
authors.initials: P
authors.lastname: Burton
authors.forename: Michael
authors.initials: M
authors.lastname: Watson
mesh_terms: D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000145:classification*; D012449:Safety; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control