TITLE: Taking the Long View: As Systematic Review of Long Term Trends in Childhood Injury

A systematic review was undertaken to explore published studies of long and medium term (>20 years) time trends in childhood injury. Thirty studies met inclusion and quality criteria, twenty four from high income countries and six from middle income countries.  No studies were identified from low income countries. Time trends were reported from 20 year- up to 98 year-periods.

 All but two studies reported falling rates in overall child injury mortality over time. Six reported rising or variable road traffic injury mortality. Suicide and homicide was either failing to fall or rising. Analysis of injury rates by age and gender were generally well reported. Boys were reported to have a greater incidence of injury mortality than girls at all ages, though two studies showed significant reductions in gender differences with time, with reducing rates for boys for falls or drowning whilst rates in girls were broadly stable.

Only two studies reported trends by ethnic group and only four by measures of socioeconomic status. Both of the two studies reporting injury mortality by ethnic group identified widening ethnic disparities with time across injury types. The four studies examining injury morality rates by socioeconomic status were from high income countries; all found widening social disparities, within the context of overall falling injury rates, with the rate of decrease amongst the most disadvantaged groups slower than that in those groups who were more advantaged.

Conclusion

The challenge is now to translate the substantial declines seen in childhood injury mortality rates seen in high income countries to the 95% of all child injury deaths that currently occur in low and medium income countries. High income countries need to monitor and dealing effectively with widening disparities and addressing the relative- and in some case absolute increase- in intentional injury deaths.

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