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Contribution of violence to health inequalities in England: demographics and trends in emergency hospital admissions for assault
  1. M A Bellis1,
  2. K Hughes1,
  3. Z Anderson1,
  4. K Tocque2,
  5. S Hughes1
  1. 1
    Centre for Public Health, WHO Collaborating Centre for Violence Prevention, Liverpool John Moores University, Liverpool, UK
  2. 2
    North West Public Health Observatory, Liverpool John Moores University, Liverpool, UK
  1. Professor M A Bellis, Centre for Public Health, Liverpool John Moores University, Castle House, North Street, Liverpool L3 2AY, UK; m.a.bellis{at}


Introduction: Violence is increasingly recognised as a major public health issue yet health data are underutilised for describing the problem or developing responses. We use English emergency hospital admissions for assault over four years to examine assault demography and contribution to health inequalities.

Methods: Geodemographic cross-sectional analyses utilising records of all individuals in England (n = 120 643) admitted between 1 April 2002 and 31 March 2006.

Results: Over 4 years, rates of admission increased by 29.56% across England. Admissions peaked on Saturdays (22.34%) and Sundays (20.38%). Higher rates were associated with deprivation across all ages, including those <15 years, with a sixfold increase in admission rates between the poorest and wealthiest quintiles of residence. Logistic regression analyses indicate males are 5.59 times more likely to be admitted to hospital for assault and such admissions peak in those aged 15–29 years. Modelling based on national assault admissions and limited Accident and Emergency (A&E) data suggest that while more serious assaults requiring hospital admission have increased, assault attendances at A&Es have fallen.

Discussion: Hospital admission and A&E data identify a direct contribution made by violence to health inequalities. Levels of violence inhibit other interventions to improve people’s health through, for instance, outdoor exercise or delivery of health-related services in affected areas. With disproportionate exposure to violence in poorer areas even in those under 15, early life primary prevention initiatives are required in disadvantaged communities to reduce childhood harm and the development of adult perpetrators and victims of violence.

Statistics from


  • Competing interests: None.

  • Contributors: MAB designed the study, analysed and interpreted the data, and wrote the manuscript. KH conducted background literature reviews and edited the paper. ZA and SH assisted with literature reviews and edited the paper. KT extracted the data, assisted with data analyses and edited the paper.

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