Understanding pathways to social inequalities in childhood unintentional injuries: findings from the UK millennium cohort study.

BACKGROUND: Childhood unintentional injuries (UI) are common but continue to happen more often to children living in less advantaged socioeconomic circumstances (SEC). Our aim was to explore how early life factors mediate the association between SEC and UIs, using the UK Millennium Cohort Study. METHODS: We calculated risk ratios (RR) and 95% confidence intervals (95%CI) for parental report of UI occurring between age 3 and 5 years, using Poisson regression according to family income as a measure of SEC. We explored potentially mediating pathways by controlling associations between SEC and UI for groups of early life risks in three domains: factors that may influence environmental safety, supervision and the MCS child's abilities and behaviours. RESULTS: Twenty eight percent of children had a UI from 3 to 5 years old. Children from the lowest income quintile were more likely to be injured compared to those from the highest (RR 1.20 95%CI 1.05, 1.37). Sequentially controlling for early life factors that may influence environmental safety (RR 1.19 95%CI 1.02, 1.38), then supervision (RR 1.18, 95%CI 1.02, 1.36), and finally adding child's behaviour and abilities (RR 1.15, 95%CI 1.00, 1.34) into the model reduced the RR by 5, 10 and 25% respectively. CONCLUSIONS: Addressing factors that may influence environmental safety and supervision, and the child's abilities and behaviours only partly explains the increased UI risk between the highest and lowest income quintiles. Further research is required to explore factors mediating associations between SEC and specific mechanisms and types of injuries.

How Much Money Is Enough? Poverty and Health in Older People.

OBJECTIVES: We examined the relationship between absolute income, adequacy of disposable income, and self-rated health among participants aged 60 years and over. DESIGN: Cross sectional study. SETTING: Community living older people in Hong Kong. PARTICIPANTS: Older people aged 60 years and over in five districts in Hong Kong. MEASUREMENTS: Data from a cross sectional survey of age friendly characteristics across five districts of Hong Kong carried out using stratified random sampling across a broad range of socioeconomic attributes. RESULTS: Self-rated health showed a gradient for both absolute and adequacy of disposable income. The OR for the association between having just enough, or insufficient disposable income and poor health was higher: 2.0 and 3.6 respectively, and higher than that for absolute income (OR 1.8), and remained significant after adjustment for absolute income. No association between absolute income and self-rated health was observed among women. These findings suggest that adequacy of disposable income provide a stronger association with self-rated health compared with absolute income among older people aged 60 years and over, particularly for women. The absolute income corresponding to what is considered adequate disposable income lies between HK$4000-10000. CONCLUSION: Adequacy of disposable income may be a better indicator than absolute income for older people in examining the relationship with health outcomes, particularly for older women.