Open Policy Forum on Child Injury Prevention

Mortality, hospital admissions and

self/carer reports of child unitentional

injury in the RoI: 2006-2015

Open Policy Forum on Child Injury Prevention

Dublin Castle, November 18, 2016

Prof Kevin Balanda & Dr Jude Cosgrove

Institute of Public Health in Ireland

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Overview

Unintentional injuries among 0-19 year olds

Statistical context for the development of the Child

Injury Action Plan:

• Injury fatalities: 2008–2015

• Hospital-treated child injuries: 2006–2015

• Self/carer-reported child injury: GUI and HBSC

Injuries grouped with TACTICS framework

(www.eurosafe.eu.com) (mostly)

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http://www.eurosafe.eu.com

Data sources

CSO Statbank (2015 not final)

HIPE microdata extract

GUI Longitudinal Study:

• Infant cohort (9 months 2008/09, years 2010/11, 5 years

2013)

• Child cohort (9 years 2007/08,13 years 20111/12)

• Mainly carer-reported lifetime prevalence, context

HBSC cross-sectional surveys:

• 11-18 year-olds (2010 & 2014)

• Self-reported 12-month prevalence, context

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Child injury fatalities: 2008 - 2015

672 injury deaths

55% unintentional injuries, 36% intentional self-harm, 3%

assault, and 6% other causes

Unintentional child injury fatalities were due:

• Road traffic accidents: 59%

• Accidental drownings: 12%

• Accidental poisonings: 10.5%

• Being struck by an object: 6%

• Choking or strangulations – Falls - Fires, burns or

scalds: each less than 5%

Unintentional injury deaths more common among boys &

adolescents

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Trends in child injury fatalities (%): 2008-2015

Unintentional child injury fatalities (ICD-10 codes V01-X49) expressed as percentages of all child

deaths, overall and by sex and age, RoI, 2008-2015

Source: CSO Statbank, www.cso.ie

0

5

10

15

20

25

30

35

All Males Females Age 0-4 Age 5-9 Age 10-14 Age 15-19

2008-2009 2010-2011 2012-2013 2014-2015

Trends in child injury fatalities (rates): 2008-2015

Unintentional child injury fatalities (ICD-10 codes V01-X49) expressed as rates per 100,000

population, by TACTICS categories, RoI, 2008-2015

Source: CSO Statbank, www.cso.ie

0

0.5

1

1.5

2

2.5

2008-2009 2010-2011 2012-2013 2014-2015

Child injury hospitalisation: 2006-2016

62%-65% of hospital admissions were of males.

One-third 0-4 years, about 40% 5-14 years & a quarter 15-19 years

As a percentage of all unintentional child injury admissions:

• Accidental falls: 42% - 48% (highest rates among males & 0-

4 year olds)

• Accidentally struck by an object or person: one in four

• Accidental submersion in water: 1% or less (rates higher

among males & 0-4 year olds)

• Transport accident: (consistently higher among males &15-19

year olds

• Accidental burns and scalds & accidental poisoning: each

between 2-4% (rates higher among 0-4 year olds)

Trends in unintentional child injury

hospitalisation (rates): 2006-2015

All child unintentional injury hospital admission rates per 100,000 population by age and sex,

2006-2015

Source: HIPE microdata extract, www.hpo.ie

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

1800

Year:2006

Year:2007

Year:2008

Year:2009

Year:2010

Year:2011

Year:2012

Year:2013

Year:2014

Year:2015

Males Females Age 0-4 Age 5-9 Age 10-14 Age 15-19 All

Serious injury hospitalisations (%): 2006-2015 Percentages of all unintentional injuries, and percentage of these admitted to hospital as serious

injuries, 2006-2015 totals, RoI

Source: HIPE microdata extract, www.hpo.ie

0.0

10.0

20.0

30.0

40.0

50.0

All land transport Submersion Fall Burn Poison Struck by object/person

Other/undetermined

% of all injuries % of these admitted as severe injuries

Carer-reported injuries among young children

Prevalence of injury among children from GUI, overall and by sex

Cohort/Wave Age Sample

size Measure All Males Females

Infant W1 2008/2009 9 months 11134 Ever … requiring hospital treatment/admission

4.2 4.3 4.2

Infant W2 2010/2011 3 years 9793 Ever ... requiring hospital treatment/admission

16.1 17.7 14.4

Infant W3 2013 5 years 9001 Ever ... taken to doctor, health centre or hospital

28.3 31.2 25.2

Child W1 2007/2008 9 years 8568 Ever... requiring hospital treatment/admission

34.3 36.6 32.1

Child W2 2011/2012 13 years 7525 Past 12 months … requiring hospital treatment/admission

13.8 16.8 10.6

Source: GUI anonymised microdata file, ISSDA, https://www.ucd.ie/issda/

Bold indicates a statistically significant difference (p < .001).

Location of carer-reported injuries (5 year

olds): 2012/13

Location of self-reported injuries

among 11-18 year olds: 2014

Type of carer-reported injury (5 year olds): 2012/13

Risk of carer-reported injuries (5 year olds): 2012/13

Characteristic (Reference group)

Comparison group

Not brought to hospital vs. Brought to ED

Not brought to hospital vs. Admitted as inpatient

p Odds Ratio

95% Confidence Interval for OR Odds

Ratio

95% Confidence Interval for OR

Lower Upper Lower Upper

Gender (Female) Male 1.225 1.100 1.364 1.679 1.296 2.175 <.001

Family structure (Two parents, two or more children)

Two parents, one child 0.875 0.709 1.079 0.744 0.426 1.299

<.001 One parent, two or more children

1.321 1.064 1.641 1.105 0.683 1.788

One parent, one child 1.198 0.938 1.529 1.822 1.146 2.896

Household occupation class (Managerial, professional or technical)

Not in paid work 0.826 0.654 1.043 1.781 1.125 2.819

<.001

Non-manual 0.984 0.847 1.144 1.052 0.726 1.523

Skilled manual 0.909 0.772 1.069 1.135 0.774 1.663

Semi-skilled and unskilled manual

1.005 0.836 1.208 1.131 0.731 1.748

Community type (Rural) Urban 1.350 1.211 1.506 1.045 0.807 1.354 <.001

Accommodation (Suitable for family's needs)

Unsuitable for family's needs

1.164 0.985 1.377 1.746 1.244 2.449 .003

Source: GUI anonymised microdata file, ISSDA, https://www.ucd.ie/issda/


Self-reported injuries among older children :

2010-2014 Prevalence of injury among children from HBSC, overall and by sex

Cohort/Wave Age Sample

size Measure All Males Females

HBSC 2010 10-11 years

1613 Past 12 months ... requiring treatment from doctor or nurse

34.5 42.7 25.9



37.5 43.6 31.1



37.8 45.5 29.6



36.2 40.8 31.9



41.2 47.0 35.2



43.4 51.8 34.6

Source: HBSC 2010 and 2014 data compiled by the HBSC Ireland Team, NUI, Galway, with thanks to Catherine Perry, Eimear Keane, and Michal Molcho. The HBSC Ireland homepage is http://www.nuigalway.ie/hbsc/


Activities during self-reported injuries (11-18 year olds): 2014

Risk factors for self-reported injuries

among 11-18 year olds: 2014

Characteristic (Reference group)

Comparison group

No days missed vs. 1-2 days missed

No days missed vs. 3+ days missed

p Odds Ratio

95% Confidence Interval for OR Odds

Ratio

95% Confidence Interval for OR

Lower Upper Lower Upper

Age 10-11


Age 12-14


Age 15-18


Source: HBSC 2010 compiled by the HBSC Ireland Team, NUI, Galway, with thanks to Catherine Perry, Eimear Keane, and Michal Molcho. The HBSC Ireland homepage is http://www.nuigalway.ie/hbsc/

Patterning (preliminary conclusions)

• Mortality rates: highest among boys & older children &

adolescents

• Hospital admission: risk highest among boys & 0-4 years olds

• Hospital admission for severe injuries: more likely among boys

Sex-age patterning depends on the type of injury:

• Land transport accidents rates highest among adolescents

• Accidental poisoning - Burns and scalds rates are higher

among children aged 0-4 years.

Location of injury also depends on age:

• Younger children: more likely in home

• Adolescents: more likely during sports & recreation

Trends (preliminary conclusions)

Overall decline in unintentional child injury mortality &

hospitalisation rates is positive

However, these mortality rates and hospitalisation rates

appear have plateaued in the past 2-3 years

Trends in mortality rates does not appear to depend on

TACTICS category of injury

However, trends in hospitalisation rates do appear to

depend on TACTICS category of injury

Child injury prevention (preliminary conclusions)

Different age groups require different focii

Different contextual factors play different roles in different

injuries (particularly amongst younger children)

Some possible focii:

• Home safety among younger children (particularly

“bangs” and falls)

• Safety during sports and recreation (particularly

among older children & adolescents)

• Cycling safety (particularly among younger children)

• Promotion of a culture of safety and ‘safe play’ among

boys (at all ages but particularly in older age groups

and adolescents)

Research & data gaps (preliminary conclusions)

Data gaps:

• Data quality in existing data sources

• ED treated injury

• GP treated injury

• Survey questions that map to TACTICS framework

• Harmonised content & wording across study

waves and across surveys

Research gaps:

• Wider range of contextual factors (location,

activity, severity, etc) for particular injury types

• Explorie other data sources such as ED data

Thank you

Any questions?

Email : [email protected]

Web: www.publichealth.ie

www.thehealthwell.info

www.twitter.com/publichealthie

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http://www.publichealth.ie

http://www.thehealthwell.info

http://www.twitter.com/publichealthie

Trends in child injury hospitalisation rates:

2006-2015 (%)

As percentage of all admissions for unintentional injuries:

• Land transport accidents: steadily decreased from 15% in

2006 to 10% in 2015

• Motor vehicle driver/passenger injuries: decreased

steadily

• Bicycle accidents: not changed substantially

• Struck by an object or person: not changed substantially

Open Policy Forum on Child Injury Prevention

Healthcare

Transcript of Open Policy Forum on Child Injury Prevention