Socioeconomic Inequalities in Injury: Critical Issues in Design and Analysis

Abstract

s Abstract Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.

The social side of accidental death

“…Associations between SES and accidental death have been documented in the epidemiological literature (Cubbin and Smith 2002) and investigations of SES as a fundamental cause of mortality have harnessed growing support Phelan and Link 2005;Phelan et al 2004) for the theory. Social support is also leveraged toward better health and social scientists have long connected the benefits of social relationships, particularly those relating to the family, to health (Durkheim [1897] 1951).…”

“…Injury prevention literature has established SES as an important element of injuries incidence and accident mortality (Barss et al 1998;Cubbin and Smith 2002;Hosking et al 2011;Kposowa and Breault 2009). Accidental deaths disproportionately burden persons of lower SES because they experience greater exposure to hazardous environments, lack high-quality and safe equipment to protect themselves, and suffer greater consequences resulting from injury (Burrows et al 2012).…”

“…Accidental deaths disproportionately burden persons of lower SES because they experience greater exposure to hazardous environments, lack high-quality and safe equipment to protect themselves, and suffer greater consequences resulting from injury (Burrows et al 2012). Additionally, lower SES prevents individuals from accessing important safety information and adopting preventative behaviors (Cubbin and Smith 2002).…”

“…While more recent accident mortality analyses have begun focusing on SES as a primary contributor to risk (Burrows et al 2012;Cubbin, LeClere and Smith 2000b;Cubbin and Smith 2002), marital status, with few exceptions in the epidemiological literature (see, for example Whitlock et al 2004), has been included in analyses of accidental death mainly as a confounding factor. Important exceptions include Ben-Shlomo et al (1993), who use the Whitehall study to find elevated risks of death from accidents and violence (a category that combines all accidents and deaths from violence including homicide for example) among unmarried men.…”

Road crash involvement and professional status: A prospective study using the French Gazel cohort

“…Among adults who use a motorized vehicle, socially disadvantaged subjects are the most exposed to "fragility": they have the least protective (Choo and L. 2003), poorly maintained vehicles (Cubbin and Smith 2002) and wear seat belts less often than other groups of road users (Lerner et al 2001).…”