Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study

Abstract

Objectives: To simultaneously examine the effects of area-level and individual-level socioeconomic position on fatal injuries in children ,5 years of age. Methods: A retrospective cohort study based on the national birth and death registers of Korea. 2 667 060 children born during 1995-8 were followed up from birth to the 5th birthday. Cumulative incidences of fatal injuries were calculated, and through multilevel Poisson regression models, relative risks (RRs) of incidence rate were estimated according to children's sex, father's occupation and mother's education at individual level, and deprivation and degree of urbanity at area level. Results: Girls had lower risk for fatal injuries than boys (RR 0.81; 95% confidence interval (CI) 0.75 to 0.87). Compared with children with fathers in non-manual occupations, those with fathers in manual (RR 1.45; 95% CI 1.34 to 1.58) or other occupations (RR 1.35; 95% CI 1.13 to 1.62) had higher risk. Children with mothers who were high school graduates (RR 1.23; 95% CI 1.12 to 1.36) or junior school graduates (RR 1.91; 95% CI 1.66 to 2.19) had higher risk than those whose mothers were college graduates. After controlling for individual-level variables, residence in more deprived districts (RR 1.13; 95% CI 1.05 to 1.21) or nonmetropolitan regions (urban RR 1.34; 95% CI 1.22 to 1.47 and rural RR 1.61; 95% CI 1.40 to 1.86) was significantly associated with increased risk. Conclusions: Both individual-level and area-level socioeconomic position influenced the risk for childhood fatal injuries. To reduce the socioeconomic inequalities and the absolute burden in Korea, universal strategies should receive priority, and special efforts in implementation should be directed towards both disadvantaged households and areas.

Childhood cancer mortality and socioeconomic position in South Korea: a national population-based birth cohort study

“…Marital status of parents has similarly been used as an important indicator of socioeconomic status for children [17]. The level of urbanization in the location of birth may reflect individuals' SEP [18] as well and has been reported to be predictive of childhood injuries [19] and adult mortality in South Korea [20]. Education levels were grouped into college or higher, high school, and middle school or below according to highest educational level completed.…”

Neighborhood and Community

“…Because poor neighborhoods are often located in congested innercity areas, the risk of pedestrian injury to children in this setting is likely to be elevated. The importance of the street as a play area and the lack of engineered barriers that separate children from motor vehicle thoroughfares contribute to the functional prox imity of young children and moving vehicles, an associa tion that guarantees high rates of pedestrian injury and death (Kim et al, 2007).…”

Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients: using National Health Insurance Cohort in Korea: poverty and endoscopic resection

“…A positive, higher score on the index denotes greater deprivation. This modified index displays a significant association with health and has been shown to be robust for consistency over time and over outcome variables in many previous studies in Korea [9,[13][14][15]. Thus, the use of this verified area deprivation index provides more reliable results and could help in developing an area-deprived index suitable for health-related studies in South Korea.…”