Lucie Laflamme

Social differences in traffic injury risks in childhood and youth—a literature review and a research agenda

Objectives—The paper reviews the scientific literature concerning social differences in traffic injuries in childhood in order to highlight the current state of knowledge and to draw the main lines of a research agenda. Method—A conceptual framework is used that identifies the mechanisms through which social context, social position, and various exposures may interact in the determination of health inequalities. It is used as a frame for presenting the evidence accumulated so far concerning social differences in traffic injury in childhood, including pedestrian, cyclist, and vehicle passenger injuries. Results—For most types of traffic injuries, mortality and morbidity are often higher among children from lower social positions and in more deprived socioeconomic areas. Whether the greater occurrence of injuries in deprived areas is a phenomenon attributable to the areas themselves, or merely a reflection of a wider pattern of injuries affecting lower socioeconomic groups, is unclear. There is evidence of an interaction effect between age and gender, and also between socioeconomic status and gender. Conclusions—The mechanisms leading to social inequalities in traffic injuries in childhood deserve greater scrutiny in future research. Further theoretical developments and empirical investigation will help define intervention needs and enable more effective targeted, long term prevention.

Aging and occupational accidents a review of the literature of the last three decades

Abstract This paper deals with age-related accident risks (largely in industrial settings), and offers a synthesis of the scientific literature of the last three decades. It is concerned with large-scale and intra-occupational studies that have investigated age-related accident frequency severity or characteristics. It is maintained that the findings so far shed little light on the expected direction and magnitude of the relation between aging and occupational accidents. A framework is outlined for the purpose of identifying jobs in which aging has either a preventive or an aggravating effect on accident occurrence. This framework is proposed tentatively as a means for understanding the confusing findings of the literature review. It is concluded that the safety problems of older workers may well be restricted to activities that are specifically “age-impaired”. Age-related accident problems can also be specific in terms of injury type. Finally, it is emphasized that further research would benefit greatly from longitudinal designs, proper exposure measurements, intra-occupational investigations, consideration of the positive effect of relevant experience on occupational safety, and greater precision with regard to the type of accident in focus.

Socioeconomic differences in road traffic injuries during childhood and youth: a closer look at different kinds of road user

STUDY OBJECTIVE To investigate if there are socioeconomic differences in road traffic injuries among Swedish children and adolescents, and if this applies to the same extent to all categories of road users. To assess the modification effect of gender of child. DESIGN A closed population-based cohort study based on the Swedish Population and Housing Census of 1985. Individual census records are linked to Swedens National Hospital Discharge Register (1987–1994). SETTING AND SUBJECTS All children aged 0–15 years in 1985 (approximately 1.5 million subjects) were monitored for five categories of road traffic injuries over eight years, and divided into seven socioeconomic groups on the basis of parental socioeconomic status. Odds ratios and population attributable risks were computed using the children of intermediate and high level salaried employees as reference group. MAIN RESULTS The injury risks of pedestrians and bicyclists are 20% to 30% higher among the children of manual workers than those of intermediate and high level salaried employees. Socioeconomic differences are greatest for injuries involving motorised vehicles—that is, moped, motorcycle and car. If all children had the same rate as children in the reference group, the rate for all groups would be 25% lower for moped riders and 37% lower for car drivers. CONCLUSIONS Socioeconomic differences in road traffic injuries are substantial for both boys and girls. Socioeconomic injury-risk differentials increase when young people use motorised vehicles.

Falls and fall-related injuries among the elderly: a survey of residential-care facilities in a Swedish municipality

Injurious falls among the elderly are an increasing public-health problem in Sweden. One group particularly vulnerable to falls consists of elderly people living in residential-care facilities. The purpose of this study was to investigate the extent to which falls lead to injury within a defined population of elderly people in institutionalized care. All the elderly persons living in residential-care facilities in an urban Swedish municipality during the year 1997 (n = 469 institutional places). Falls and fall-related injuries were registered over a one-year period. Data were gathered by personnel at the time of the falls, using a form specifically designed for surveillance purposes. Of the 865 falls reported during the study period, 375 were among men, with an average age of 82 years, and 490 among women, with an average age of 85 years. Men were subject to falling to a greater extent than women. The most common location was the individuals own bedroom. Injuries were incurred in approximately one in four falls, and the head was the body part most frequently injured. Only 24 falls (2.8%) resulted in a fracture, of which 18 were hip fractures. Although elderly people living in residential-care facilities fall fairly often, serious injuries, in the form of fractures, are incurred to a relatively limited extent.

Socioeconomic differences in injury risks in childhood and adolescence: a nation-wide study of intentional and unintentional injuries in Sweden

Study objective: To measure socioeconomic differences in injuries among different age groups of children and adolescents. Subjects: Children under 20 living in Sweden between 1990 and 1994 (about 2.6 million). Method: A cross sectional study based on record linkage between 15 Swedish national registers. Children were divided into four age groups and allocated to four household socioeconomic status groups. Absolute and relative risks were compiled using children of high/intermediate level salaried employees as the comparison group. Four diagnostic groups were considered: fall, traffic, interpersonal violence, and self inflicted injuries. Results: Injury incidences were relatively low and socioeconomic differences negligible in the 0–4 year olds. Thereafter, significant socioeconomic differences were observed in all diagnostic groups except falls. The highest absolute differences were in traffic injuries, especially among 15–19 year olds, and in self inflicted injuries among 15–19 year old girls. Relative differences were highest in both categories of intentional injuries for the age group 10–14. Social circumstances in the household other than family socioeconomic status affected the social pattern of intentional but not that of unintentional injuries. Conclusions: Socioeconomic differences in injury risks are not necessarily constant over age. Inequalities are particularly high in absolute terms among adolescents 15–19 years old for traffic injuries and in relative terms among 10–14 year olds for intentional injuries.

Injuries among children in Karachi, Pakistan--what, where and how.

OBJECTIVES To describe the epidemiology of injuries among children in Karachi, Pakistan. STUDY DESIGN Retrospective case series. METHODS Data on children aged < or =15 years who were injured between October 1993 and January 1996 were extracted from the logs of the main provider of emergency medical transportation, and were classified according to the World Health Organizations basic data set for information on injuries. RESULTS We identified 1320 cases of injuries in children < or =15 years old. The major causes were: motor vehicle crashes (MVC) (80%), falls other than from vehicles (5%), burns (5%) and drowning (3%). One in six of these children (15%) died either at the scene of the accident or during transportation to the hospital. The majority of deaths were either due to MVCs (67%) or drowning (18%) Large vehicles (buses, minibuses and trucks) were involved in 54% of all childhood road traffic injuries. Almost one-third (33%) of burns took place in the kitchen at home, and half (51%) of all drowning cases occurred in the sea. CONCLUSIONS The majority of children transported by the ambulance service were male and were victims of MVCs. Prevention efforts aimed at stricter enforcement of driving laws and family/child education geared towards pedestrian safety could potentially reduce morbidity and mortality. This study also highlights the role of the prehospital transport system in injury surveillance.

Cohort Profile: The Stockholm Public Health Cohort

The Stockholm Public Health Cohort was set up within the Stockholm County Council public health surveys to inform on determinants and consequences of significant contributors to the current burden of disease. Participants are 89 268 randomly selected individuals from the adult population of Stockholm County. Baseline surveys took place in 2002, 2006 and 2010 via self-administered questionnaires. So far, participants recruited in 2002 were re-surveyed twice, in 2007 and 2010, and those enrolled in 2006 were re-surveyed once, in 2010. Self-reported data are regularly supplemented by information from national and regional health data and administrative registers, for study participants and their relatives (including their offspring). Available data are extensive and include a wide array of health, lifestyle, perinatal, demographic, socio-economic and familial factors. The cohort is an international resource for epidemiological research, and the data available to the research community for specific studies obtained approval from the Stockholm Public Health Cohort Steering Committee and the Stockholm Regional Ethical Review Board.

20 Years of Research on Socioeconomic Inequality and Children's—Unintentional Injuries Understanding the Cause-Specific Evidence at Hand

Injuries are one of the major causes of both death and social inequalities in health in children. This paper reviews and reflects on two decades of empirical studies (1990 to 2009) published in the peer-reviewed medical and public health literature on socioeconomic disparities as regards the five main causes of childhood unintentional injuries (i.e., traffic, drowning, poisoning, burns, falls). Studies have been conducted at both area and individual levels, the bulk of which deal with road traffic, burn, and fall injuries. As a whole and for each injury cause separately, their results support the notion that low socioeconomic status is greatly detrimental to child safety but not in all instances and settings. In light of variations between causes and, within causes, between settings and countries, it is emphasized that the prevention of inequities in child safety requires not only that proximal risk factors of injuries be tackled but also remote and fundamental ones inherent to poverty.

Socioeconomic differences in Swedish children and adolescents injured in road traffic incidents: cross sectional study

Traffic related injuries are among the most common causes of death in childhood and in youth.1 Young people belonging to a low social class and living in deprived socioeconomic areas are consistently at greater risk than others. 2 3 The extent to which socioeconomic differences in risks from traffic injury vary during childhood and adolescence deserves consideration. 4 5 We examined socioeconomic patterning in Swedish children and adolescents injured in road traffic incidents, considering four categories of road users. We created a dataset of about 2.2 million children and adolescents (aged 0-19 years) living in Sweden at some time during 1990-4 by linking records from 13 Swedish national registers. We established their sex and year of birth by linking the Swedish population register to the national censuses of 1985 or 1990 or to the medical register …

Interference between work and outside-work demands relative to health: unwinding possibilities among full-time and part-time employees

Background: Demands from work and home may interfere with one another and the stress engendered by that can be detrimental to health. Purpose: To study the relationship between experienced interference and subjective health, and address the impact of unwinding on these associations. Method: Questionnaire data from a representative sample of the Swedish population are used considering full-time and part-time employed women and men aged 25–64. The associations between negative interference (either work-home or home-work) and sleep quality, self-rated health, and the use of sleeping pills/tranquillizers are analyzed by means of logistic regressions, compiling odds ratios (ORs) with 95% confidence intervals (CIs). The impact of adjustment for lack of unwinding on these associations is assessed. Results: Work-home interference is associated with suboptimal sleep quality and self-rated health for both women and men. The significance of this disappears among women after adjustment for lack of unwinding, regardless of work schedule. Among both sexes, home-work interference is associated with suboptimal sleep quality and self-rated health. When adjusting for lack of unwinding, the relationship to sleep quality disappears, but not the one to self-rated health, equally for women and men. Conclusion: Only among women, unwinding seems to buffer the association between work-home interference and health.