Scottish Health Survey 2015 - volume 1: main report

10 Injuries / Accidents

Diarmid Campbell-Jack

Summary

• Just over a tenth (11%) of adults aged 16 and over in 2013/2015 had an accident in the previous twelve months, a comparable prevalence to that in 2009/2011 (11%) and 2003 (12%).
• Prevalence of accidents was similar for men (12%) and women (11%), with higher prevalence for those aged 16-24 (16%) than those aged 25 and over (9-12%).
• The proportion of children aged 0-15 having had an accident in the previous twelve months was similar in 2003 (16%), 2009/2011 (14%) and 2013/2015 (15%).
• The proportion of boys (17%) having had an accident in the last twelve months in 2013/2015 was significantly higher than the proportion of girls (12%).
• For children, prevalence of accidents tended to increase with age, from 9% among those aged 0-1 to 20-22% among those aged 12-15.

• The main cause of accidents for all respondents (aged 0 and above) was a fall, slip or trip (57% of adults and 53% of children who had had an accident in the last 12 months), followed by sports or recreational accidents (12% of adults and 21% of children).
• Falls, slips or trips were more frequently cited by women than men (68% compared with 46%), while women were less likely than men to cite sports or recreational activities (6% compared with 18%) and accidents using a tool, implement or equipment (2% compared with 12%).

10.1 Introduction

After cardiovascular disease, cancer and respiratory disease, injury is the fourth most common cause of death in the European Union and the most common in young ages ^[1] .

The risk of death and severe injury is particularly high in such diverse areas as the home, leisure activities and sports, road transportation, the workplace and in connection with consumer products and services ^[2] .

Accidents accounted for just over 3% of all deaths in Scotland in 2014. However, among those aged between 10 and 34, they were the cause of around one third of deaths, making them the most common cause of death in this age group ^[3] .

Figures for hospital admissions and deaths caused by unintentional injuries are reported by ISD Scotland for both children and adults ^[4] . In 2014/15, there were 7,763 emergency hospital admissions among children in Scotland as a result of unintentional injuries, accounting for approximately one in eight of all emergency admissions for those aged under 15 years. Administrative statistics suggest hospital admissions for children caused by unintentional injuries reduced from 2006 until 2013 but have increased slightly in the last two years.

Figures for adult hospital admissions and death caused by unintentional injuries showed 1,727 deaths in 2014 and 46,947 emergency admissions in adults aged 15 and over ^[5] . The rate for men has been gradually decreasing since a peak in 2009 while the rate for women has shown a slight increase over the last ten years but has been more consistent over recent years.

In addition to this, there were 52 deaths in 2014 and 2,532 emergency admissions to hospital in 2014/15 for assault.

10.1.1 Policy background

The National Falls Programme supports Community Falls Leads across Scotland to develop and implement local integrated falls prevention and management and fracture prevention pathways in Health and Social Care Partnership areas. Health and Social Care Partnerships have been established under the Public Bodies (Joint Working) (Scotland) Act 2014 to develop more preventative, anticipatory and person-centred approaches to care. These approaches are core elements of the National Falls Programme.

The Programme's focus is currently on partnership working to deliver the Prevention and Management of Falls in the Community Framework for Action, published in 2014. The Framework aims to support a more consistent approach to falls prevention and management, enabling people to access the information, advice, support and care they need regardless of where they are on the falls pathway.

The Scottish Action Plan on Health and Safety was published in 2007 in order to promote good health and safety practice in Scotland, including challenging those failing to meet standards and promoting the benefits of good health and safety management to Scottish businesses and Scotland's economy.

The 2008 report of the Ministerial Taskforce on Health Inequalities Equally Well ^[7] included a recommendation to target children from disadvantaged areas who are at greater risk of road traffic related unintentional injuries. Go Safe: Scotland's Road Safety Framework to 2020 ^[8] was published in 2009, outlining the vision of a steady reduction in the numbers of those killed and seriously injured, leading eventually to a future where no-one is killed on Scotland's roads and there is a much reduced injury rate. This was reviewed in 2016 in the Road Safety Framework: Mid-term Review ^[9] and three key priority focus areas were identified around speed, age, and vulnerable road users.

Other key areas of focus have been fire safety ^[10] , school trips and occupational health and safety, including for major employers such as the NHS ^[11] . Initiatives to reduce the incidence and severity of unintentional injuries in childhood focus on multiple settings, including roads and pavements ^[12] . The Scottish Government works with a number of partner agencies to reduce unintentional injuries (the Royal Society for the Prevention of Accidents, the Child Accident Prevention Trust, Scottish Accident Prevention Council), and supports an annual child safety week to disseminate messages about unintentional injury prevention.

The Building Safer Communities ( BSC) initiative is part of the justice change programme that contributes to the Justice Strategy. BSC works collaboratively with local and national partners to help communities make best use of their existing strengths.

BSC sets out a vision of a flourishing, optimistic Scotland in which resilient individuals, families and communities live safe from crime, disorder, danger and harm. Phase 2 aims to reduce the number of victims of unintentional harm. The Scottish Health Survey will provide useful information to monitor progress against this aim.

10.1.2 Definition of injury and accidents

The term 'injury' is generally preferred to 'accidents' as the latter implies events are inevitable and unavoidable whereas a high proportion of these incidents are now regarded as being preventable ^[13] .

In order to maintain continuity with earlier data in the Scottish Health Survey and for ease of understanding among participants, the 2015 Scottish Health Survey continued to refer to 'accidents' in all questionnaires, with this covering a very broad range of events from the extremely serious through to the relatively trivial. As a result, when referring to data from the Scottish Health Survey the term 'accident' is used whereas 'injury' is used solely to refer to data from other sources specifically collected as injuries.

10.1.3 Reporting on accidents in the Scottish Health Survey ( SHeS)

This chapter presents trends over time in accident rates since 1998 for both adults and children by age and sex. It then looks at the causes of accidents among both adults and children by age and sex using combined 2013/2015 data.

10.2 Methods And Definitions Of Measurement

10.2.1 Accident classification and recall period

In order to concentrate on events which are most salient to those monitoring health in Scotland, the definition of 'accident' used in the Scottish Health Survey ( SHeS) is any which resulted in injury or physical harm where advice was sought from a doctor, nurse or other health professional, or which caused time to be taken off work or school.

Participants were asked to recall any accidents they had had in the 12 months prior to the interview which fitted this definition. Figures shown within the report, however, are based only on those accidents about which advice was sought from a doctor or which required a visit to hospital.

All those who reported having at least one accident of this kind were then asked detailed questions about the nature and cause of the most recent accident. The reference period of 12 months before the interview was chosen so as to be sufficiently long to generate details of enough accidents for analysis, yet short enough for participants to be able to remember accurate details about their most recent unintentional injury.

10.2.2 Coverage of accidents

The survey covers most, but not all, accidents to adults and children. Since SHeS collects data directly from participants, fatal accidents are excluded. In addition, there will be under-representation of accidents that lead to long-term hospitalisation. For these reasons, the accident data presented in this chapter can best be described as non-fatal accident prevalence for the household population. Reported prevalence will most likely slightly under-estimate true accident prevalence because of the exclusions. However, since the great majority of accidents do not lead to long-term stays in hospitals, any downward bias should be small.

10.2.3 Causes of accidents

Participants who had at least one accident in the twelve months prior to interview were asked to describe the cause of the most recent accident and interviewers coded responses using the following options:

• hit by a falling object
• fall, slip or trip
• road traffic accident
• sports or recreational accident
• use of tool of implement, or piece of electrical or mechanical
• equipment
• burn or scald
• animal or insect bite or sting
• caused by another person (e.g. attacked)
• lifting
• other

10.2.4 Data collection years

Some caution is needed in the interpretation of the data on cause of accident derived from this interviewer coding. What is coded in individual cases will depend firstly upon how the participant describes the accident and secondly on how the interviewer interprets that description. For example, an accident in which a child sprains their ankle when playing football may be described as a fall by one participant ("I fell and sprained my ankle") or as a sporting accident by another ("I sprained my ankle when I was out playing football"). If the participant describes the accident to the interviewer as "I fell and sprained my ankle" then some interviewers may code this as a fall or slip automatically whereas others may probe further, establish that the participant was playing football at the time of the fall, and code it as a sports accident. Interviewers were briefed to code more than one cause per accident if appropriate, the intention being to collect as full a description of the accident as possible in order to avoid misclassification. One implication of the ambiguity in coding is that prevalence of accidents cannot be readily derived for different types of accident.

The same information about accidents was collected in the 1998 and 2003 surveys and biennially from 2009 onwards. It is next due to be asked in 2017. As many of the figures are based only on those who had an accident, to increase the sample size available for analysis data from the 2013 and 2015 surveys have been combined to enable more robust estimates to be presented.

10.3 Trends In Accident Prevalence

10.3.1 Adult accident prevalence, 1998 to 2013/2015 (combined), by age and sex

The prevalence of accidents for adults aged 16 and over in 1998, 2003, 2009/2011 and 2013/2015 by age and sex are shown in table 10.1 In 1998, data were obtained for adults aged 16-74, whereas for the other survey years they were collected for all adults aged 16 years or older. As a result of these changes, this section focuses on data from 2003 onwards.

The prevalence of accidents for all adults aged 16 and over was 12% in 2003 and stayed at similar levels (11%) in both 2009/2011 and 2013/2015. There was no significant difference in accident prevalence in 2013/2015 between men (12%) and women (11%), with those aged 16-24 (16%) having a higher prevalence of accidents than those aged 25 and over (9-12%). Patterns for men and women by age were largely comparable, with the highest prevalence for both groups being among those aged 16-24 (16% for both men and women). There was, however, a significantly higher proportion of men aged 25-34 (15%) compared to women in the same age group (8%) who had experienced an accident in the last twelve months.

Figure 10A, Table 10.1

10.3.2 Child accident prevalence, 1998, to 2013/2015 (combined), by age and sex

Accident prevalence for 1998, 2003, 2009/2011 and 2013/2015, by age and sex are shown in table 10.2 for children. As infants aged 0-1 were not included in the 1998 survey, comparisons focus on data from 2003 onwards.

In 2013/2015, 15% of all children aged 0-15 had at least one accident in the previous twelve months, a comparable figure to that seen in both 2003 (16%) and 2009/2011 (14%). As in previous survey periods, there was a higher prevalence of accidents in 2013/2015 for boys (17%) than girls (12%). Again, as in 2003 and 2009/2011, the lowest prevalence was among those aged 0-1 (9%), and the highest among those aged 12-15 (20-22%).

Those aged 0-1 had the lowest prevalence of accidents for both boys (10%) and girls (7%). Prevalence generally increased with age for boys from 10% of those aged 0-1 to 24-31% of those aged 12-15. For girls prevalence was highest among those aged 12-13 (21%).

Figure 10B, Table 10.2

10.3.3 Causes of accidents, 2013/2015 (combined), by age and sex

Table 10.3 shows the causes of accidents for all respondents who had had an accident (age 0 and over) by age and sex for 2013/2015. The most common cause of accidents for adults was a fall, slip or trip; 57% of those who had had an accident in the last 12 months mentioned this as the cause, or one of the causes, of their most recent accident. Sports or recreational accidents (12%) and road traffic accidents (9%) were both mentioned by around a tenth of those who had had an accident in the last twelve months. Women who had had an accident were more likely than men to have had a fall, slip or trip (68% compared with 46%) while men were more likely to have had a sports or recreational accident (18% compared with 6% for women) or an accident due to using a tool, implement or equipment (12% compared with 2%).

As with adults, the most common cause of accidents for children was also falls, slips or trips, with this being reported as a cause for 53% of those who had had an accident in the last 12 months. Sports or recreational accidents were reported as the cause for 21% of children who had had an accident, and another person was cited as the cause for 9%.

In 2013/2015, accidents due to a fall, slip or trip were most common for the youngest age group (63% for those aged 0-7) and those aged 45 and over (65-79%). Both sports or recreational accidents and accidents involving another person were most common for those aged 8-15 (28% and 11% respectively).

Table 10.3