Introduction Unintentional injuries represent a substantial public health burden among children and adolescents, and previous evidence suggests that there are disparities in injury by socioeconomic status (SES). This paper reports on a systematic review of literature on injury rates among children and adolescents by measures of SES. Methods A systematic literature search was conducted using six electronic databases: MEDLINE, PsycINFO, CINAHL, HealthSTAR, EMBASE, and SportsDiscus. This review considered children ages 19 years and under and publications between 1997 and 2017—representing an update since the last systematic review examined this specific question. Fifty-four articles were summarized based on study and participant descriptions, outcome and exposure, statistical tests used, effect estimates, and overall significance. Results Most articles addressed risk factors across all injury mechanisms; however, some focused particularly on burns/scalds, road traffic injuries, falls/drowning cases, and playground/sports injuries. Other studies reported on specific injury types including traumatic dental injuries, traumatic brain injuries, and fractures. The studies were of moderate quality, with a median of 15.5 (95% confidence interval [CI]: 15.34 to 15.66) out of 19. Thirty-two studies found an inverse association between SES and childhood unintentional injury, three found a positive association while twenty were not significant or failed to report effect measures. Conclusion Given the variability in definition of the exposure (SES) and outcome (injury), the results of this review were mixed; however, the majority of studies supported a relationship between low SES and increased injury risk. Public health practice must consider SES, and other measures of health equity, in childhood injury prevention programming, and policy.
Concussion has been a topic of interest recently, new research and guidelines are emerging around the world. In Ontario, the number of Emergency Department (ED) visits for concussion is rising, but little is known about the association between concussion and socio-economic status. The objective of this study was to examine the association between socio-economic status and ED visits for concussions in Ontario, Canada.This is a longitudinal population-based study using routinely-collected administrative data from the Institute for Clinical Evaluative Sciences. Data from all Emergency Department visits and hospitalizations are included. For the purposes of this study, all injuries coded using the ICD-10 CA code associated with concussion (S060) were included. The denominator used for this study was the number of children residing in Ontario in each age group. The rate per 1 00 000 children was calculated from 2008 to 2015.There were 5889 concussions reported at an emergency department in 2008, and 14 906 in 2015. The rate among the lowest socioeconomic class quintile was 5.23 per 1 00 000 person years in 2008, and 7.12 for the highest socioeconomic class quintile. By comparison, the lowest and highest quintiles recorded 8.64 and 11.07 respectively in 2015. The rates of concussions among all socioeconomic quintiles were either stable or increasing.The results of this study suggest that rates of concussions are increasing among children. However, children in a higher income quintile consistently visited EDs for concussion more than children from lower income quintiles. This may be due to the increased opportunity wealthier children have to engage in organized sports. These results suggest that further policies related to awareness and identification of concussion need to be considered for all children.
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