title: Is ethnic density associated with risk of child pedestrian injury? A comparison of inter-census changes in ethnic populations and injury rates.
abstract: OBJECTIVE
  Research on inequalities in child pedestrian injury risk has identified some puzzling trends: although, in general, living in more affluent areas protects children from injury, this is not true for those in some minority ethnic groups. This study aimed to identify whether 'group density' effects are associated with injury risk, and whether taking these into account alters the relationship between area deprivation and injury risk. 'Group density' effects exist when ethnic minorities living in an area with a higher proportion of people from a similar ethnic group enjoy better health than those who live in areas with a lower proportion, even though areas with dense minority ethnic populations can be relatively more materially disadvantaged.
  
  
  METHODS
  This study utilised variation in minority ethnic densities in London between two census periods to identify any associations between group density and injury risk. Using police data on road traffic injury and population census data from 2001 to 2011, the numbers of 'White,' 'Asian' and 'Black' child pedestrian injuries in an area were modelled as a function of the percentage of the population in that area that are 'White,' 'Asian' and 'Black,' controlling for socio-economic disadvantage and characteristics of the road environment.
  
  
  RESULTS
  There was strong evidence (p < 0.001) of a negative association between 'Black' population density and 'Black' child pedestrian injury risk [incidence (of injury) rate ratios (IRR) 0.575, 95% CI 0.515-0.642]. There was weak evidence (p = 0.083) of a negative association between 'Asian' density and 'Asian' child pedestrian injury risk (IRR 0.901, 95% CI 0.801-1.014) and no evidence (p = 0.412) of an association between 'White' density and 'White' child pedestrian injury risk (IRR 1.075, 95% CI 0.904-1.279). When group density effects are taken into account, area deprivation is associated with injury risk of all ethnic groups.
  
  
  CONCLUSIONS
  Group density appears to protect 'Black' children living in London against pedestrian injury risk. These findings suggest that future research should focus on structural properties of societies to explain the relationships between minority ethnicity and risk.
authors.affiliation: a Department of Social and Environmental Health Research , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Steinbach
authors.affiliation: b Department of Health Services and Policy , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Green
authors.affiliation: c Department of Medical Statistics , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Kenward
authors.affiliation: d Department of Population Health , London School of Hygiene and Tropical Medicine , London , UK.
authors.forename: Phil
authors.initials: P
authors.lastname: Edwards
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D044466:Asian People; D044383:Black People; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D000069636:Pedestrians; D011156:Population Density; D012307:Risk Factors; D012959:Socioeconomic Factors; D016138:Walking; D014947:Wounds and Injuries / Q000208:ethnology*
keywords: children; ethnic density; injury