Children from the poorest families in England and Wales face greater risks of dying from injury than children in all other social groups, finds a study published on bmj.com today.

This suggests that serious inequalities in injury death rates still exist, despite a government strategy to target ‘particular areas of health inequality’ say the researchers.

A decade ago, the death rate from injury and poisoning for children in the lowest social class was five times greater than that for children in the highest social class. Inequalities were greatest for house fire and pedestrian deaths.

Ten years on, researchers examined child injury death rates by social class to test whether these inequalities persist. They analysed all child (0-15 years) deaths due to injury and poisoning in England and Wales using population data from the 1981, 1991 and 2001 censuses. Each record included the year of death, the underlying cause of death, and the parents’ socio-economic class.

They found that injury death rates for children have declined from 11 deaths per 100,000 children per year around the 1981 census to 4 deaths per 100,000 children per year around the 2001 census.

But socio-economic inequalities remain: the death rate for children of parents classified as never worked or long-term unemployed (social class 8) was 13 times that for children of parents in higher managerial and professional occupations (social class 1).

And inequalities were again greatest for house fire and pedestrian deaths. Compared to children of parents in social class 1, the death rate in children of parents in social class 8 was 20 times higher for pedestrian deaths and nearly 40 times higher for deaths due to fires. Serious inequalities also existed for cyclists and deaths of undetermined intent.

Child death rates from injury and poisoning have fallen in England and Wales over the last 20 years, say the authors. However, children in families where no adult is in paid employment are a notable exception.

Children in these families face greater risks of dying in road traffic accidents, in fires and from undetermined causes than children in all other social groups. In short, these children have been excluded from the reductions in injury mortality made over this period.

Explanations are speculative, but probably lie in different exposure to risk, they add. For example, the higher risk of dying in house fires may reflect the quality and type of housing, with the greatest fire risks for those in temporary and poor housing.

At the beginning of the 21st century, there is evidence that the economic exclusion of the poorest families is reflected in significantly increased death rates from injury in childhood, they conclude.

An editorial, published in this week’s print BMJ, argues that approaches to reduce these inequalities must tackle economic and transport policy as well as interventions affecting the environment, vehicles, and road users, rather than relying solely on changing the behaviour of victims.

British Medical Journal