Marie Hasselberg

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.

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.

Factors Affecting the Severity of Injuries Among Young Motorcyclists—A Swedish Nationwide Cohort Study

Objectives. To determine factors affecting the severity of motorcycle injuries, considering variables related to the individual, the environment, the vehicle, and the crash. Methods. This is a register-based retrospective cohort study. All individuals born in 1970–1972 (n = 334,070) were extracted from the Swedish Population and Housing Census of 1985 and followed up from 1988 to 2000, when aged 16–30. All subjects whose records indicated an injury as a motorcycle driver in the Swedish National Road Administration Accident Database were selected, and constituted the study population (n = 1,748). Factors related to the individual, the environment, the vehicle, and the crash were considered as exposure measures, whereas the outcome measure was the level of injury severity, based on assessments made on-site by police officers, in two categories: fatal/severe and minor. Associations between individual, environmental, vehicle and crash factors and injury severity were measured, using Chi-square, and through univariate and multivariate stepwise logistic regression. Results. Factors such as alcohol consumption, traffic environment, speed limit, and type of crash were significantly associated (p < 0.0001) with injury severity. More specifically, a positive suspicion of alcohol consumption, driving in a rural area, and a posted speed limit over 50 km/hour were all factors positively associated (OR > 1.0) with the likelihood of being severely injured. On modeling all the variables together through stepwise logistic regression, positive suspicion of alcohol emerged as the strongest determinant (adjusted OR = 2.7) of a severe outcome. Conclusions. Motorcycle crashes still place a heavy burden on young drivers. Increased efforts are needed to prevent alcohol-related crashes—through law enforcement and a multiplicity of policies at local and national levels.

How do car crashes happen among young drivers aged 18-20 years? Typical circumstances in relation to license status, alcohol impairment and injury consequences

AIM The study aims to clarify the most typical circumstances in which car crashes involving young drivers and leading to the occurrence of injuries and to consider the various licensing statuses of the drivers in such crashes. METHOD Young Swedish drivers born between 1984 and 1986 were followed up in the Police register (2003-2004) for their involvement in car crashes as drivers (n=2448). A set of five variables (25 categories) descriptive of those crashes was analyzed simultaneously by means of cluster analysis. Associations between crash clusters and licensing status (including none), licensing duration and alcohol involvement were also measured. RESULTS Five clusters were identified, typical of one or some specific crash type(s): single-vehicle in sparsely populated areas, front-on collisions, crashes at dawn or at dusk, turning, cars of later model, crashes in urban areas and speed limits below 50 km/h. Clusters differ in consequences and in the proportions of alcohol impaired drivers involved but not regarding proportions of novice drivers. Unlicensed drivers were found in excess in some clusters (especially single and night time crashes). CONCLUSION Young drivers are involved in crashes leading to injuries in rather specific circumstances. For some of them, novice drivers or even unlicensed drivers are over-represented, which points to the need for targeted counter-measures, alongside those general ones already in place.

Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden.

The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 ( n = 727,995), and followed up by a search for cases of injury to car drivers in Swedens National Hospital Discharge Register over the years 1991-96 ( n = 1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.

Social determinants of child and adolescent traffic-related and intentional injuries: A multilevel study in Stockholm County

Several significant developmental and socialisation processes in the life of children and adolescents take place in the area where they live. The extent to which they can feel and be safe in this environment is an important component of the success of those processes. This study highlights the independent contribution of neighbourhood and individual-level demographic and socioeconomic attributes to child and adolescent injuries. All individuals between the ages of 7 and 16 years living in Stockholm County in January 1998 (n=184 545) were followed up for their injuries during a five-year period considering injuries sustained as a pedestrian/cyclist/motor-vehicle rider and intentional injuries (violence-related and self-inflicted). A series of two-level logistic regressions were conducted to examine the association between the occurrence of injuries and individual (compositional) characteristics nested into parish of residence as well as contextual characteristics. For children and adolescents living in Stockholm County, contextual socioeconomic and social attributes of their place of residence were significant for injuries sustained as motor-vehicle riders but not for those sustained as pedestrians/cyclists or those inflicted intentionally. In the latter case, only the highest concentration of social benefit recipients was associated with significantly higher odds ratios. This emphasises that each injury mechanism has its own socioeconomic and social pathway, where contextual and compositional factors come into play to varying degrees.

Child home injury mortality in Europe: a 16-country analysis.

BACKGROUND Child injury mortality and morbidity are a public health concern in European countries and data are scarce. Cross-national efforts are needed to identify high-risk groups, follow trends and assist in establishing European-wide safety legislation. This study investigates fatal child injuries in the home, as compared to those in transport in European countries. METHODS Injury mortality was extracted from the World Health Organization Mortality Database for the years 2002-04. The mortality rate per 100 000 population was calculated by age group for 16 contributing countries, grouped by their economic level of development. RESULTS Fatal home injuries were highest in children under 5 years of age and then sharply decreased, as opposed to road traffic injuries, which increased with age. The majority of the upper-middle-economy countries tended to have higher home injury incidence rates compared to the high-income countries. The top five injury causes all countries aggregated were drowning/submersion, thermal injuries, poisoning, falls and homicide, all of which account for almost 90% of home injury deaths. CONCLUSION Home injuries were the leading cause of injury death in children under 5 years of age in the countries under study and the inequalities found among the countries indicate potential for improvement. Evidence-based interventions exist to prevent these injuries and the barriers to their implementation ought to be determined and addressed.

Road traffic crash circumstances and consequences among young unlicensed drivers: A Swedish cohort study on socioeconomic disparities

BackgroundYoung car drivers run a higher risk of road traffic crash and injury not only because of their lack of experience but also because of their young age and their greater propensity for adopting unsafe driving practices. Also, low family socioeconomic position increases the risk of crash and of severe crash in particular. Whether this holds true for young unlicensed drivers as well is not known. Increasing attention is being drawn to the prevalence and practice of unlicensed driving among young people as an important contributor to road traffic fatalities.MethodsThis is a population-based cohort study linking Swedish national register data for a cohort of 1 616 621 individuals born between 1977 and 1991. Crash circumstances for first-time road traffic crash (RTC) were compared considering licensed and unlicensed drivers. The socioeconomic distribution of injury was assessed considering household socioeconomic position, social welfare benefits, and level of urbanicity of the living area. The main outcome measure is relative risk of RTC.ResultsRTCs involving unlicensed drivers were over-represented among male drivers, suspected impaired drivers, severe injuries, crashes occurring in higher speed limit areas, and in fair road conditions. Unlicensed drivers from families in a lower socioeconomic position showed increased relative risks for RTC in the range of 1.75 to 3.25. Those living in rural areas had an increased relative risk for a severe RTC of 3.29 (95% CI 2.47 - 4.39) compared to those living in metropolitan areas.ConclusionsAt the time of the crash, young unlicensed drivers display more risky driving practices than their licensed counterparts. Just as licensed drivers, unlicensed young people from low socioeconomic positions are over-represented in the most severe injury crashes. Whether the mechanisms lying behind those similarities compare between these groups remains to be determined.

Road traffic injuries among young car drivers by country of origin and socioeconomic position

SummaryObjectives:The study examines the relationship between country of birth, socioeconomic position, and the risk of being injured as a young car driver.Methods:The study consists of a nationwide follow-up of young people in Sweden in which individual census records on country of birth and household socioeconomic position were linked to the Hospital Discharge Register so as to identify subjects’ road traffic injuries (RTIs) as car drivers. Multivariate analyses were conducted using Cox regression, with hospital admission due to RTI as car driver as the dependent variable.Results:There are no significant differences in injury risks between foreign-born and Swedish-born drivers, but clear socioeconomic differences were found. Young drivers from manual worker families have 80% higher risk for RTIs compared to drivers in families with salaried employee parents (RR 1.83, CI 1.63-2.05).Conclusions:The results do not support the idea that type of country of origin constitutes a significant marker of risk level for RTI as novice car driver. On the other hand, the results reconfirm that, in Sweden, the risk of RTI among young drivers from different socioeconomic backgrounds varies.

Pre-hospital trauma care resources for road traffic injuries in a middle-income country--a province based study on need and access in Iran.

BACKGROUND Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.