RESEARCH REPORT

Association between childhood fatal injuries and socioeconomic position at individual and area levels: a multilevel study

Myoung-Hee Kim¹, S V Subramanian², Ichiro Kawachi², Chang-Yup Kim³

¹ Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
² Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
³ Seoul National University School of Public Health, Seoul, South Korea

Correspondence to:
Correspondence to:
Dr C-Y Kim
Seoul National University School of Public Health, 28 Yongon-dong, Chongno-gu, Seoul 110–799, South Korea;cykim{at}snu.ac.kr

Objectives: To simultaneously examine the effects of area-level and individual-level socioeconomic position on fatal injuries in children <5 years of age.

Methods: A retrospective cohort study based on the national birth and death registers of Korea. 2 667 060 children born during 1995–8 were followed up from birth to the 5th birthday. Cumulative incidences of fatal injuries were calculated, and through multilevel Poisson regression models, relative risks (RRs) of incidence rate were estimated according to children’s sex, father’s occupation and mother’s education at individual level, and deprivation and degree of urbanity at area level.

Results: Girls had lower risk for fatal injuries than boys (RR 0.81; 95% confidence interval (CI) 0.75 to 0.87). Compared with children with fathers in non-manual occupations, those with fathers in manual (RR 1.45; 95% CI 1.34 to 1.58) or other occupations (RR 1.35; 95% CI 1.13 to 1.62) had higher risk. Children with mothers who were high school graduates (RR 1.23; 95% CI 1.12 to 1.36) or junior school graduates (RR 1.91; 95% CI 1.66 to 2.19) had higher risk than those whose mothers were college graduates. After controlling for individual-level variables, residence in more deprived districts (RR 1.13; 95% CI 1.05 to 1.21) or non-metropolitan regions (urban RR 1.34; 95% CI 1.22 to 1.47 and rural RR 1.61; 95% CI 1.40 to 1.86) was significantly associated with increased risk.

Conclusions: Both individual-level and area-level socioeconomic position influenced the risk for childhood fatal injuries. To reduce the socioeconomic inequalities and the absolute burden in Korea, universal strategies should receive priority, and special efforts in implementation should be directed towards both disadvantaged households and areas.

Abbreviations: NBR, National Birth Registration database; NDR, National Death Registration database; PINs, personal identification numbers; SEP, socioeconomic position

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