Socio-economic inequalities in injury incidence in the Netherlands

Abstract

Background: Interventions to reduce socio-economic inequalities in injury incidence should be tailored to
specific priority areas that may be identified by descriptive studies. We aimed to provide an overview of
existing socio-economic inequalities in injury incidence in the Netherlands and to assess the potential
influence of methodological choices on the relationships found.
Methods: Self-reported medically treated injuries (all injuries versus fractures) were derived from a survey
among a random sample of 59 063 persons. Injuries resulting in hospital admissions (all injuries versus
fractures) were derived from a prospective cohort study of 18 810 participants, linked to the National
Hospital Discharge Register for a follow-up period of 7 years. Logistic regression was used to calculate the
odds ratios of self-reported medically treated injuries and fractures by level of education, occupation and
income, and of hospital-admitted injuries by level of education and occupation.
Results: Socio-economic inequalities in injury incidence in the Netherlands were dependent on the indicator of
non-fatal injury incidence, indicator of socio-economic status (SES) and studied cause of injury. In the majority
of specific relations analyzed, injury risks were not or only moderately elevated in lower SES-classes. Analyses
focusing on injury with higher severity levels (admitted injuries and/or admitted fractures) revealed the
steepest SES gradient with odds ratios of injury of 1.5 or more of the lowest socio-economic (educational)
groups compared to persons with higher SES (education). In hospital admitted traffic injuries, we found the
most striking difference with a threefold higher risk in the lowest educational groups.
Conclusion: Future descriptive research into socio-economic differences in injury incidence should include
all three core indicators of SES and separate analyses on the more severe injuries should be conducted.