Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991

Abstract

Abstract Objective : To examine whether the decline in child injury death rates between 1981 and 1991 varied by social class. Design : Comparison of class specific child injury death rates for 1979, 1980, 1982, and 1983, with those for the four years 1989-92. Setting : England and Wales. Subjects : Children aged 0-15 years. Main outcome measures : Death rates from injury and poisoning. Results : Death rates from injury and poisoning have fallen for children in all social classes. The decline for children in social classes IV and V (21% and 2% respectively), however, is smaller than that for children in social classes I and II (32% and 37%). As a result of the differential decline in injury death rates, socioeconomic mortality differentials have increased. In the four years 1979-80 and 1982-83 the injury death rate for children in social class V was 3.5 times that of children in social class I. For the four years 1989-92 the injury death rate for children in social class V was 5.0 times that of children in social class I. Poisson regression modelling showed that the trend in the decline in death rates across the social classes was unlikely to have arisen by chance alone. Conclusions : Socioeconomic inequalities in child injury death rates have increased. If these gradients persist, the Health of the Nation's target is likely to be met for children in the non-manual social classes but not for those in the manual social classes. Key messages Mortality from childhood injury is falling, but there are steep social class gradients in death rates A comparison of class specific child injury death rates in 1981 and 1991 shows that the decline in injury death rates in social classes IV and V (21% and 2% respectively) was much smaller than for those in classes I and II (32% and 37%) Because of the differential decline in child injury death rates, socioeconomic mortality differentials increased during this period Unless government rhetoric on social class gradients in health is matched with appropriate action, the Health of the Nation's target for accidents will be met for children in the non-manual social classes but not for those in the manual classes