The use of linked health and mortality data to inform injury prevention strategies

The problem

Guidance from the National Institute for Health and Care Excellence on preventing injuries in children and young people recommends that primary care professionals identify and target preventative interventions to those at greatest risk. Despite this, understanding patterns of injury remains a challenge due to a lack of national injury surveillance data. Through recent linkage of a large primary care research database to secondary care and mortality data, we describe the epidemiology of three common childhood injury types, poisonings, fractures and burns. This information in turn can inform the planning of preventative interventions and the safety advice given to families.

The approach

We conducted an open cohort study of 2,147,853 0-24 year olds living in England who had linked primary care, secondary care and mortality data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics, respectively, during the period 1997-2012. Incidence rates, per 10,000 person-years (PY) with 95% confidence intervals (95%CI) were estimated by age, sex and socioeconomic status. Mechanisms of injury (e.g. falls) were identified for injuries leading to hospitalisation or death.

Findings

Among the cohort we identified 42,985 poisoning, 185,517 fracture, and 36,719 burn events, giving overall incidence rates of 41.9/10,000PY (95%CI 41.4, 42.4), 180.8 (95%CI 179.8, 181.7) and 35.8 (95%CI 35.4, 36.1), respectively.Different patterns of injury incidence were seen according to age and injury type, with incidence peaking at 2 (75.2/10,000 PY) and again at 18 years old (74.7/10,000 PY) for poisonings; compared to 13 years old for fractures (306.5/10,000 PY) and 2 years old for burns (117.8/10,000 PY). Large differences in rates were seen by sex for poisonings and fractures (p<0.0001). For each injury type, those from more deprived socioeconomic groups had higher injury rates; although the strength of gradient varied by injury type and age. The strongest association was seen for poisonings, with those in the most deprived areas having a two-fold higher incidence than those in the least deprived areas (incidence rate ratio 2.24, 95%CI 2.17, 2.31). Mechanisms of injury also varied by age; for example, proportions of fractures due to transport incidents and animate mechanical forces increased with age, as did the proportion of poisonings due to intentional self-harm.

Consequences

Linkage of primary care data to other data sources allows detailed description of injury epidemiology. Differing injury patterns according to age and injury type reflect differences in underlying mechanism and intent, highlighting the importance of developing tailored preventative interventions across the life course, and providing tailored safety advice according to child age. Inequalities in injury occurrences support the targeting of preventative interventions to households in the most deprived areas.

Credits

• Ruth Baker
• Laila Tata
• Elizabeth Orton
• Denise Kendrick