Non-accidental head injury: a consequence of deprivation?

• Published in: Journal of epidemiology and community health (1979) Vol. 64; no. 12; pp. 1049 - 1055
• Main Authors: Mok, J Y Q, Jones, P A, Myerscough, E, Shah, A R F, Minns, R A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.12.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Age; Alcohol; Babies; Biological and medical sciences; Brain research; Child abuse; Child abuse & neglect; Child health services; Child, Preschool; childhood injury; Children & youth; Craniocerebral trauma; Craniocerebral Trauma - epidemiology; Craniocerebral Trauma - etiology; Criminal statistics; Data collection; deprivation indices; Employment; Female; Funding; General aspects; Head injuries; Health Status Indicators; Housing; Humans; Infant; Infant, Newborn; Infants; inflicted brain injury; Injuries of the nervous system and the skull. Diseases due to physical agents; Intensive care; Male; Maternal age; Medical sciences; Miscellaneous; Non-accidental head injury; Parents & parenting; Population; Population mean; Poverty; Predisposing factors; Prospective Studies; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research reports; Risk Factors; risk prediction; Scotland - epidemiology; Social Class; social paediatrics; Socioeconomic Factors; Socioeconomics; Studies; Traumas. Diseases due to physical agents; Traumatic brain injury; violence RB; Scotland; United Kingdom > UK; British Isles, Scotland; Medicine; Nervous system diseases; Poverty; Craniocerebral; Head trauma; Public health; Inequality
• ISSN: 0143-005X; 1470-2738; 1470-2738
• DOI: 10.1136/jech.2009.090217

BackgroundNon-accidental head injury (NAHI) is a significant personal and public health problem, with considerable mortality and morbidity. The evidence base for risk factors specific for NAHI is limited due to difficulties with case definition and study design. The risk factors associated with NAHI in infants was evaluated in this study, and the extent to which indices of deprivation influence this health problem was addressed.MethodsA 10-year prospective study was conducted in Scotland involving all paediatric hospitals and other general hospital departments admitting children. Subjects were children ≤2 years of age, with a diagnosis of “suspected NAHI”. Socioeconomic characteristics of the index cases were compared to the general population, using the Scottish Index of Multiple Deprivation (SIMD) 2006.ResultsThere were highly significant differences (p<0.001) between the SIMD rank scores of the NAHI cases and scores for the whole Scottish population. For the cohort, SIMD ranks ranged from 34 to 6253 (median 1210; mean 1577) compared to the population range of 1–6505 (median and mean=3253). Similar differences were found for each of the component domains of income, employment, health, education, crime and housing (p<0.001). In contrast, the scores for “geographic access” (to essential service) were higher than for the whole population (p<0.001), indicating that the deprivation was not due to lack of local services.ConclusionIn Scotland, children who present with suspected NAHI originate predominantly from the most deprived areas of the community. Public health and intervention strategies should be focused in these areas.