Pediatric injury inequalities: Socio-economic position and social capital

Background and purpose: The relationship between poverty and injury may be influenced by a variety of psychosocial factors including social support networks and social integration. We posit that the inverse association between socio-economic position (SEP) and morbidity and mortality, in general, and injury, in particular, may be mediated by factors related to social capital. In this study we examine whether the SEP gradient in injury-related hospitalization rates remains stable regardless of increased social capital offered in a religiously affiliated community with strong social networks and integration. Methods: An ecological retrospective study using the national Israel Trauma Registry (ITR) was performed. We identified three cities in Israel with exclusive coverage by the ITR, ethnic homogeneity, low, medium or high area-level SEP, varied religious affiliation and similar geographic location (central Israel). City-specific injury rates were calculated for children 0-17 years. Results: Rates of intentional and unintentional injuries were lower among children living in the low SEP/religiously affiliated (injury rate per 100,000 person-years = 295.9, 95% CI 281.3-311.0) compared with those living in medium or high SEP/non-religiously affiliated cities (injury rate per 100,000 person-years = 646.8, 95% CI 609.1-686.3 and 469.8, 95% CI 441.3-499.7, respectively). Conclusions: We showed that the inverse association between SEP and injury was modified by religious affiliation. Notwithstanding, lower injury rates in the low-SEP/religious community were offset by a greater absolute number of children injured. Targeted prevention programs should consider the influence of social support networks and social integration on health.