6: Accidents

Contacts

Preface

Contents

List of Tables
List of Figures

Abbreviations

Main Body

1: Boundaries and Populations
2: Inequalities and Deprivation
3: Ethnicity and Health
4: Environmental Hazards
5: Health related behaviour
    of young people
6: Accidents
7: Cancer
8: Teeth and fluoridation
9: Coronary Heart Disease
10: Communicable diseases

Appendices

The public health White Paper, Our Healthier Nation identifies accidents as a key area for action, proposing the following target:

"Target: to reduce the death rates from accidents by at least one fifth and to reduce the rate of serious injury from accidents by at least one tenth by 2010 - saving up to 12,000 lives in total "
(DOH, 1999a)

This section describes accidents, whom they affect and how. Data from a number of sources have been drawn together.

6.1 Accidents in the General population - Health Survey of England
6.2 Accidents and school absence - West Midlands Young Persons Lifestyle Survey
6.3 Road traffic accidents - County Councils and Unitary Authorities
6.4 Hospital admission for non-intentional injuries - West Midlands Hospital Episode Statistics
6.5 Mortality from non-intentional injuries - Public Health Mortality Files

6.1    Health Survey of England

The Health Survey of England (DOH, 1999b) asked informants to recall how many 'Major' accidents requiring a visit to a doctor or to hospital they had had in the previous six months. The data are believed to underestimate the true non-fatal rate, especially for older people.

Figure 6.1 Major accidents by Health Authority as self reported in the Health Survey of England, 1996. Age sex standardized rates per 100 population with 95% confidence intervals.

6.2    Accidents and school absence – West Midlands Young Persons Lifestyle

'Accidental injury puts more children in hospital than any other cause' (DOH, 1999a)

For a variety of different types of accident (riding a bicycle, playing a sport, crossing the road, at home, travelling by car, at school, other) the West Midlands Young Persons Lifestyle Survey asked school children whether, in the last year, had take time off school as a result of such an accident. The results below show the proportion that had taken time off school in the last year for any accident. A greater proportion of boys (56.6%) than girls (43.1%) had taken time off school as a result of an accident but there was not much variation across the Year groups (Year 7 (aged 11-12) = 48.8%, Year 9 (age 13- 14)= 52.6%, Year 11 (aged 11-16) = 48.3%)(see Figure 6.2). When compared by ethnicity the Chinese group have the highest total rate (55.3%) and the Bangladeshi group have the lowest total rate (43.5%) (see Figure 6.3).

Figure 6.2 Percentage of young people having time off school due to accidental injury in a one year period by age and sex.

Figure 6.3 Percentage young people having time off school due to accidental injury in a one year period by ethnic group.

6.3    Road Traffic Accidents

Transport is a vital part of a modern society's infrastructure. The movement of material and people underpins economic, cultural and social well-being at personal and societal levels. The West Midlands region is at the centre of the national road and rail networks and the level of traffic and congestion is a major problem for business, local people and visitors. These costs are continuing to grow as the number of cars on the road increases. Even the low estimate of the number of cars in the West Midlands in 20 years time shows an increase of 30% (West Midlands Joint Committee, 1999). As the nature of work has changed, people have had to become more flexible and mobile. Access to even basic facilities has become increasingly dependent upon access to transport.

For many people, using a car is now no longer a choice but a necessity. Increased traffic, and speed have made the streets more threatening for pedestrians and cyclists. Children's freedom to play and to walk or cycle to school unaccompanied has been severely curtailed. Twenty years ago, nearly one in three 5-10 year olds made their own way to school (Department of the Environment, 1999). Now only one child in nine does. People walk less than they used to and cycling, other than for leisure, is mostly left to a few enthusiasts.

The death rate from road accidents in this country is lower than in most other European countries but rates of death in childhood from pedestrian accidents in this country are amongst the highest in Europe. In 1998 there were over 28,000 accidents in the West Midlands including 307 fatal and over 4,000 serious accidents. Quite apart from the personal tragedy each road traffic fatality is estimated to cost the community £1m (Regional Road Safety Liaison Group, 1998).

As children grow up, deaths from accidental injury account for a greater proportion of all childhood deaths. Road accidents and serious injuries are more severe on rural roads than in other areas. County Councils collate data on road traffic accidents and can provide it at a local authority level. These cover the number and type of casualties and data on particularly vulnerable groups such as children and pedestrians.

Figures 6.4 to 6.7 show details of road traffic accidents for 1998 in the West Midlands region.

Road accident severity rate = (fatal + serious accidents) / total accidents

Figure 6.4 The percentage of casualties by road user for the region.

Figure 6.5 Total number and severity (fatal and serious)/total accidents by local authority (County and Unitary Authority for Shropshire) 1998

Figure 6.6 Road Traffic Accident Rate per 10,000 population by local authority (County and Unitary Authority for Shropshire) 1998

Figure 6.7 Road traffic severity rate by local authority (County and Unitary Authority for Shropshire) 1998.

6.4    Admissions to Hospital for non-intentional injury

Information on the number of people presenting to health services as a result of an accident relies on two sources of information collected on a regular basis across the region : hospital episode statistics (HES) and deaths from accidents. There are plans to start routine region-wide collection of the Accident and Emergency Minimum Data Set which will help fill the gaps in knowledge regarding those patients who are not admitted.

The following graphs present the annual age-sex standardised admission rates by health authority (standardised to the European Standard Population). A map of crude rates has also been produced by PCG (see figure 6.9).

The causes of accidents have been grouped into following accident types:

Examples of 'inanimate' physical accidents are; being struck by a falling object; crushed between two objects; or accidents involving machinery. 'Animate' accidents involve injuries caused by animals excluding poisoning by venomous animals and striking against an object.

ICD9 to ICD10 conversion

The NHS updated ICD9 with ICD10 in April 1995. Guidance issued by the NHS Centre for Coding and Classification warns that the degree of direct equivalence between ICD9 and ICD10 is small. This means that absolute continuity is not always possible. Therefore, any change in trend at that time should not be regarded as a real change without further investigation. In addition, it is not unusual to see dramatic declines in trends caused by local confusion in the application of the new classification.

Figure 6.8 Age sex standardised rates of admission for non-intentional injury, by Health Authority, 1992/3 to 1997/8
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Figure 6.9 Crude Admission rates per 100,000 populations for accidents by PCG, 1996/7

6.5    Reported mortality from Accidents

The data presented here are complied from the ONS Public Health Death Files. Due to changes in the coding of unintentional accidents in 1993 it is not possible to show mortality by cause, by health authority.

The following graphs present the annual age-sex standardised mortality rate by health authority in three age groups, 0-4, 65+ and all ages. The rates have been standardised to the European Standard Population.

Figure 6.10 Mortality from non-intentional injury, 1987-1997. Age sex standardised rates per 100,000 population

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Figure 6.11 Crude annual mortality rates per 100,000 population for accidents by PCG

REFERENCES

Department of Health (1999) Our Healthier Nation: Saving Lives. Stationary Office,1999

Department of Health (1999) The Health Survey for England can be found online at
http://www.doh.gov.uk/public/hthsurep.htm

Department of the Environment, Transport and Regions. A New Deal for Transport.
http://www.detr.gov.uk/itwp/paper/index.1/4.htm

16th November 1999. Regional Road Safety Liaison Group (1998) Safer Roads in the West Midlands.

West Midlands Joint Committee (1999) Provisional West Midlands Local Transport Plan.

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