Housing Characteristics and Hospital Admissions due to Falls on Stairs: A National Birth Cohort Study.

ABSTRACT

OBJECTIVE: To assess associations between housing characteristics and risk of hospital admissions related to falls on/from stairs in children, to help inform prevention measures. STUDY DESIGN: An existing dataset of birth records linked to hospital admissions up to age 5 for a cohort of 3,925,737 children born in England between 2008 and 2014, was linked to postcode-level housing data from Energy Performance Certificates. Association between housing construction age, tenure (eg, owner occupied), and built form and risk of stair-fall-related hospital admissions was estimated using Poisson regression. We stratified by age (<1 and 1-4 years), and adjusted for geographic region, Index of Multiple Deprivation, and maternal age. RESULTS: Incidence was higher in both age strata for children in neighborhoods with homes built before 1900 compared with homes built in 2003 or later (incidence rate ratio [IRR] 1.40, 95% confidence interval [CI] 1.10-1.77 [age <1 year], 1.20, 95% CI 1.05-1.36 [age 1-4 years]). For ages 1-4 years, incidence was higher for those in neighborhoods with housing built 1900-1929, compared with 2003 or later (IRR 1.26, 95% CI 1.13-1.41), or with predominantly social-rented homes compared with owner occupied (IRR 1.21, 95% CI 1.13-1.29). Neighborhoods with predominantly houses compared with flats had higher incidence (IRR 1.24, 95% CI 1.08-1.42 [<1 year] and IRR 1.16, 95% CI 1.08-1.25 [1-4 years]). CONCLUSION: Changes in building regulations may explain reduced fall incidence in newer homes compared with older homes. Fall prevention campaigns should consider targeting neighborhoods with older or social-rented housing. Future analyses would benefit from data linkage to individual homes, as opposed to local area level.