How useful are sociodemographic characteristics in identifying children atrisk of unintentional injury?

The social class gradient in childhood injury mortality is steep and increa sing, so there is emphasis on targeting injury prevention on the basis of s ocioeconomic deprivation, to reduce inequalities in health. This paper exam ines the relationship between medically attended unintentional injury, soci odemographic characteristics and previous injury. This was a cohort study using the control group from a cluster randomised c ontrolled trial of injury prevention in primary care. The cohort comprised children aged 3-12, months registered with participating practices, whose p arents completed the baseline questionnaire (n = 771). 94% were followed fo r 25 months. Medically attended unintentional injury was ascertained from t he primary and secondary care records. Logistic regression analysis examine d the relationship between sociodemographic factors, previous injury and th e occurrence of future medically attended injuries. Poisson regression exam ined the relationship between sociodemographic factors, previous injury and the number of future medically attended injuries. The response rate to the questionnaire was 75%. Residence in a deprived war d, lack of access to a car and male sex were associated with at least one m edically attended injury. Residence in a deprived ward and young maternal a ge were associated with hospital admission. Residence in a deprived ward, m ale sex and non-ownership of a car were independently associated with numbe r of unintentional injuries. Specificity exceeded sensitivity for all facto rs for medically attended injury and hospital admission. The positive predi ctive value was low for all factors, especially for hospital admissions. In conclusion, residence in a deprived ward was independently associated wi th any medically attended injury, with hospital admission and with number o f injuries received. However, more than half of those children residing in a deprived ward did not have a medically attended injury and more than 90% did not have a hospital admission. 60% of children who had a medically atte nded injury and 40% who had a hospital admission do not live in a deprived ward. A combination of a population approach and targeted interventions wil l achieve the greatest health gain, and is unlikely to widen inequalities i n health.