Association between childhood community safety interventions and hospital injury records: a multilevel study.

STUDY OBJECTIVE To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome. DESIGN A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression. SETTING Twenty five municipalities in Stockholm County in Sweden were studied. PARTICIPANTS Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years. MAIN RESULTS Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children. CONCLUSIONS This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.