Parental educational level and injury incidence and mortality among foreign-born children: a cohort study with 46 years follow-up

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Abstract:

Background:

Injury risk during childhood and adolescence vary depending on socio-economic factors. The aim of this study was to study if the risk of fatal and non-fatal unintentional injuries among foreign-born children was similar across parental educational level or not.

Methods:

In this retrospective cohort study we followed 907,335 children between 1961 and 2007 in Sweden. We established the cohort by linkage between Swedish national registers including cause of death register and in-patient register, through unique Personal Identification Numbers. The main exposure variable was parental (maternal and paternal) educational level. The cohorts was followed from start date of follow-up period, or date of birth whichever occurred last, until exit date from the cohort, which was date of hospitalization or death due to unintentional injury, first emigration, death due to other causes than injury or end of follow-up, whichever came first. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) by Cox proportional hazards regression models.

Results:

Overall, we found 705 and 78,182 cases of death and hospitalization due to unintentional injuries, respectively. Risk of death and hospitalization due to unintentional injuries was statistically significantly 1.48 (95% CI: 1.24-1.78) and 1.10 (95% CI: 1.08-1.12) times higher among children with lowest parental educational level (9 years and shorter years of study) compared to children with highest parental educational level (+13 years of study). We found similar results when stratified our study group by sex of children, by maternal and paternal educational level separately, and injury type (traffic-related, fall, poisoning, burn and drowning).

Conclusions:

It seems injury prevention work against unintentional injuries is less effective among children with low parental education compared with those with higher parental education. We recommend designing specific preventive interventions aiming at children with low parental education.

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Most cited references 14

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How physically active are South Asians in the United Kingdom? A literature review.

C Fischbacher, Duncan Alexander, Sarah Hunt (2004)

Moderate physical activity is protective against coronary heart disease (CHD) and diabetes, both important public health problems among UK South Asian (Indian, Pakistani and Bangladeshi) ethnic groups. We assessed the evidence that physical activity is lower in South Asian groups than in the general population. We carried out a systematic literature review of studies describing levels of physical activity and fitness in UK South Asians using MEDLINE, EMBASE, the Cochrane databases, hand searching of relevant journals and review of reference lists. We identified 12 studies in adults and five in children. Various methods were used to assess physical activity and fitness, but all the studies reported lower levels among South Asian groups. The differences were substantial, particularly among women and older people. For example, the Health Survey for England found that Indian, Pakistani and Bangladeshi men were 14, 30 and 45 per cent less likely than the general population to meet current guidelines for physical activity. Limited information was provided about translation and adaptation of questionnaires. Levels of physical activity were lower in all South Asian groups than the general population and patterns of activity differed. No studies used validated measures. Insufficient attention has been paid to issues of cross-cultural equivalence. With these caveats, low levels of physical activity among UK South Asian ethnic groups may contribute to their increased risk of diabetes and CHD. Closer attention to validity, translation and adaptation is necessary to monitor changes and assess the effectiveness of interventions to increase physical activity.

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Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases.

Mohammad Siahpush, G. Singh (2002)

This study examines the extent to which various ethnic-immigrant and US-born groups differ in their risks of all-cause and cause-specific mortality, morbidity, and health behaviors. Using data from the National Longitudinal Mortality Study, 1979-1989, we estimated, for major US racial and ethnic groups, mortality risks of immigrants relative to those of the US-born. The Cox regression model was used to adjust mortality differentials by age, sex, marital status, rural/urban residence, education, and family income. Logistic regression was fitted to the National Health Interview Survey data to determine whether health status and behaviors vary among ethnic-immigrant groups and by length of US residence. Compared with US-born whites of equivalent socioeconomic and demographic background, foreign-born blacks, Hispanics, and Asians/Pacific Islanders (APIs), US-born APIs, US-born Hispanics, and foreign-born whites had, respectively, 48%, 45%, 43%, 32%, 26%, and 16% lower mortality risks. While American Indians did not differ significantly from US-born whites, US-born blacks had an 8% higher mortality risk. Black and Hispanic immigrants experienced, respectively, 52% and 26% lower mortality risks than their US-born counterparts. Considerable differentials were also found in mortality for cancer, cardiovascular, respiratory, infectious disease, and injury, and in morbidity and health behaviors, with API and Hispanic immigrants generally experiencing the lowest risks. Consistent with the acculturation hypothesis, immigrants' risks of smoking, obesity, hypertension, and chronic condition, although substantially lower than those for the US-born, increased with increasing length of US residence. Given the substantial nativity differences in health status and mortality, future waves of immigrants of diverse ethnic and cultural backgrounds will likely have a sizeable impact on the overall health, disease, and mortality patterns in the United States.

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Socio-economic status and types of childhood injury in Alberta: a population based study

Susan Gilbride, T Cameron Wild, Douglas R. Wilson … (2006)

Background Childhood injury is the leading cause of mortality, morbidity and permanent disability in children in the developed world. This research examines relationships between socio-economic status (SES), demographics, and types of childhood injury in the province of Alberta, Canada. Methods Secondary analysis was performed using administrative health care data provided by Alberta Health and Wellness on all children, aged 0 to 17 years, who had injuries treated by a physician, either in a physician's office, outpatient department, emergency room and/or as a hospital inpatient, between April 1st. 1995 to March 31st. 1996. Thirteen types of childhood injury were assessed with respect to age, gender and urban/rural location using ICD9 codes, and were related to SES as determined by an individual level SES indicator, the payment status of the Alberta provincial health insurance plan. The relationships between gender, SES, rural/urban status and injury type were determined using logistic regression. Results Twenty-four percent of Alberta children had an injury treated by physician during the one year period. Peak injury rates occurred about ages 2 and 13–17 years. All injury types except poisoning were more common in males. Injuries were more frequent in urban Alberta and in urban children with lower SES (receiving health care premium assistance). Among the four most common types of injury (78.6% of the total), superficial wounds and open wounds were more common among children with lower SES, while fractures and dislocations/sprains/strains were more common among children receiving no premium assistance. Conclusion These results show that childhood injury in Alberta is a major health concern especially among males, children living in urban centres, and those living on welfare or have Treaty status. Most types of injury were more frequent in children of lower SES. Analysis of the three types of the healthcare premium subsidy allowed a more comprehensive picture of childhood injury with children whose families are on welfare and those of Treaty status presenting more frequently for an injury-related physician's consultation than other children. This report also demonstrates that administrative health care data can be usefully employed to describe injury patterns in children.

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Author and article information

Journal

Journal ID (nlm-ta): J Inj Violence Res

Journal ID (iso-abbrev): J Inj Violence Res

Journal ID (pmc): kums

Title: Journal of Injury and Violence Research

Publisher: Kermanshah University of Medical Sciences

ISSN (Print): 2008-2053

ISSN (Electronic): 2008-4072

Publication date (Print): January 2014

Volume: 6

Issue: 1

Pages: 37-43

Affiliations

^aResearch Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.

^bUnit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

^cDepartment of Public Health, Karolinska Institutet, Stockholm, Sweden.

Author notes

[* ] Corresponding Author at: Najmeh Karimi: Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran, Tel/ Fax: +988318262005, Email: kariminajmeh@ 123456yahoo.com (Karimi N.).

Article

DOI: 10.5249/jivr.v6i1.525

PMC ID: 3865454

PubMed ID: 24042970

SO-VID: 44e99d49-10a3-49da-8d52-15bf4e713c5d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Parental educational level and injury incidence and mortality among foreign-born children: a cohort study with 46 years follow-up

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Most cited references 14

How physically active are South Asians in the United Kingdom? A literature review.

Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases.

Socio-economic status and types of childhood injury in Alberta: a population based study

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