Contribution of violence to health inequalities in England: demographics and trends in emergency hospital admissions for assault

Abstract

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. 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.Despite being considered primarily a judicial issue, violence, or the threat of violence, has major repercussions for the health of individuals and communities.

The social patterning of deaths due to assault in Scotland, 1980-2005: population-based study

“…The equivalent rate ratios for all-cause mortality were 3.5 (3.3 to 3.6) and 2.6 (2.5 to 2.8) for men and women, respectively. Not only do these inequalities for assault exceed those for other causes of death in Scotland, but also they far exceed the ratio reported for homicide in Great Britain15 (5.7 comparing the top and bottom deciles, 1996–2000) and that for emergency hospital admissions for assault in England33 (6.3 comparing the top and bottom quintiles in 2005–2006). The reasons for the different findings are unclear; the measures reported in these studies have some differences (eg, both refer to men and women combined and to all ages), but these could not account for the stark inequalities observed in Scotland.…”

National five-year examination of inequalities and trends in emergency hospital admission for violence across England

“…Of course, hospital admissions account for only a small proportion of violent events; often the more severe. There are an estimated 10 emergency department attendances for every hospital admission for violence,9 and many more people again who are treated in primary care, who self-medicate, or whose injuries are treated or hidden by parents and guardians. However, our data identify the prepubescent period as significantly more violent in poorer areas, with the ratio of admissions for violence in the most deprived to most affluent quintiles being consistently above 8 in both sexes (figure 2A,B).…”

“…In order to assign individuals with a measure of deprivation, their postcode of residence was mapped to lower super output areas (LSOA; geographical areas (population mean=1500) designed to standardise reporting of small area statistics in England and Wales) 9. This allowed linkage with the Index of Multiple Deprivation 2007, a composite measure of deprivation combining economic, social, and housing data,25 also available at LSOA level.…”

“…For instance, a study in England found strong associations between indicators of deprivation and both investigation of parents for child maltreatment and registration of children (aged under 6) with child protection services 7. In Canada, individuals requiring emergency medical treatment for violent injuries have been found to reside most commonly in areas of social deprivation (eg, higher social housing, lower household incomes),8 while in the UK, individuals living in deprived areas (particularly young males) have shown significantly increased risks of both hospitalisation for violent injury (England)9 and violent death (Scotland) 10. In fact, international reviews consistently identify links between deprivation and increased risks of being both a perpetrator and a victim of many forms of violence 11 12.…”

Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales

“…Individuals living in deprived areas (particularly young men) have significantly higher risks of hospitalisation for violent injury (England)10 and violent death (Scotland) 11. In Canada, persons requiring emergency medical care for injuries resulting from violence resided most commonly in areas of social deprivation 12.…”