Social inequalities in fatal childhood accidents and assaults: England and Wales, 2001-03.

BACKGROUND This article presents age-specific mortality rates of children for selected causes of accidents and assault using the National Statistics Socio-economic Classification (NS-SEC). The study is an analysis of the social inequalities in fatal childhood accidents and assault at the start of the 21st century. It aims to identify the causes and age groups for which these inequalities are the widest. METHODS In order to classify children by NS-SEC, the most advantaged class of the biological or adoptive parents was used. Death registrations provided the number of deaths from accidents and assault for children aged from 28 days to 15 years, in England and Wales, between 2001 and 2003. The population of children by NS-SEC and age group was obtained from the 2001 Census. Age-specific mortality rates were estimated. Inequalities were measured using socio-economic gradients in mortality. RESULTS There were wide social inequalities in fatal accidents and assaults for children aged between 28 days and 15 years. The overall mortality rate in the routine class was 64 per million children aged up to 15, 4.5 times the rate of children with parents in the higher managerial and professional class. The greatest inequalities in accidental mortality for children in that age group were observed for fire and pedestrian accidents, followed by accidental suffocation. Infants at least 28 days but less than one year were subject to the widest inequalities of all age groups in fatal accidents and assault. The highest mortality rate in this study resulted from assault on babies whose parents could not be classified by occupation. Pedestrian and other transport accidents were the greatest causes of death for children between 5 and 15 years old. Inequalities were much larger for pedestrian than for other transport accidents for children aged 14 years and under. The leading cause of death for children aged less than five years was suffocation, followed by drowning and exposure to fire/hot substances. In that age group, the risk of death from exposure to fire was significantly higher for children whose parents could not be classified by occupation. CONCLUSIONS Substantial social inequalities in childhood mortality from accidents and assault existed in 2001-03. Reducing the large inequalities between the most advantaged class and the most disadvantaged group in the non-occupied category, would make a substantial impact on childhood deaths from accidents and assaults. If the mortality rates in the latter group were the same as in the most advantaged managerial and professional class, deaths of infants of at least 28 days but less than one year, from assault would be reduced by 62 per cent. Deaths from fire, accidental suffocation and pedestrian accidents in the under fives would be reduced by 50 per cent, 25 per cent and 28 per cent respectively. Deaths in pedestrian and transport accidents for children aged 5-15 would be reduced by 25 per cent and 16 per cent respectively.