Elsevier

Public Health

Volume 120, Issue 8, August 2006, Pages 732-741
Public Health

Original Research
Gender differences in adolescent injury characteristics: A population-based study of hospital A&E data

https://doi.org/10.1016/j.puhe.2006.02.011Get rights and content

Summary

Objectives

To investigate patterns of adolescent home/leisure injury serious enough to require hospital attendance.

Study design

Population-based analysis of data collected by the Home and Leisure Accident Surveillance System (HASS/LASS).

Methods

Study subjects were 0–17 year old residents of Airdrie and Coatbridge, Lanarkshire, Scotland, who attended Monklands Hospital Accident and Emergency (A&E) Department with a home/leisure injury during calendar years 1996–1999. Male to female relative risk ratios (M:F RRRs) for A&E attendance, fracture and hospital admission, stratified into sports and non-sports injuries, were calculated. Sports injuries were further analysed by specific sports and by whether the sports activity was organized or informal. Data were analysed in age groups corresponding to children's stage of schooling.

Results

The M:F RRR for non-sports A&E attendances remained constant throughout childhood (1.35, 95% CI 1.30–1.39 in 0–17 year olds), whilst that for sports attendances increased sharply with age (2.50, 95% CI 0.89–7.02 in 0–4 year olds, increasing to 8.11, 95% CI 6.27–10.51 in 16–17 year olds). Of sports injury attendances, 50.3% were football-related. Football was overwhelmingly the main cause of boys’ sports injury in both the organized and informal sports injury categories. When football injuries were excluded from the analysis, the widening teenage gender gap in injury risk disappeared. There was no significant gender difference in teenagers’ rates of A&E attendance for injuries sustained during compulsory school physical education (PE), suggesting a dose–response relationship between sports participation and injury risk.

Conclusions

This study found significant gender inequalities in adolescent injury risk, which were largely attributable to boys’ football injuries. Focusing prevention efforts on making football safer would, then, be a sensible strategy for reducing the overall burden of adolescent injury and for reducing sex inequalities in injury risk; however further research is needed to understand how the risks differ between organized and informal football. These findings are also interesting because of what they suggest about teenage girls’ lack of participation in sport and habitual physical activity. This is clearly of public health concern because of the links between physical inactivity and a range of health problems.

Introduction

It is well documented that from the age of 1–2 onwards, reported injury rates are higher for boys than girls1, 2, 3, 4, 5, 6, 7 and that this continues through adulthood and into old age.8 There is also clear evidence that adolescence is a period of heightened vulnerability to injury1, 5, 9, 10, 11, 12, 13, 14, 15 and that the gap between boys’ and girls’ injury risk widens during this period of life.7, 11, 12, 16 However, despite the clear evidence for a male excess in injury risk, the reasons for this are less well understood. Various theories have been suggested.

There is evidence that boys are more active than girls17, 18 and it has been suggested that the male excess in injury rates is, at least in part, attributable to this.19

An alternative theory is that boys are at greater risk of injury because they perceive risk differently and are more likely to engage in risk-taking behaviour than girls.19 There is evidence for a biological basis for male risk-taking behaviour from both human and primate studies.20 There is also evidence that boys and girls are differently socialized20, 21 which could result in gender differences in risk perception and behaviour.20, 22 It may be that socialization processes shape gender differences in injury–risk perception and behaviour but that this takes place on a foundation of biological differences.20

The overall objective of this research project was to use an existing data set to investigate patterns of adolescent home/leisure injury serious enough to require hospital attendance. Specifically, the project sought to answer the following questions:

  • Does the gender gap in injury risk widen during the teenage years in this population?

  • If so, can this data set be used to quantify and describe the male excess in injury risk in order to inform prevention strategies?

Section snippets

Methods

The Home and Leisure Accident Surveillance System (HASS/LASS) was set up by the Department of Trade and Industry (DTI) to collect data on home and leisure accidents throughout the UK. Road traffic accidents, occupational accidents and intentional injuries were excluded. Data were coded into more than 50 fields, describing the accident, the injured person, the outcome, the injury and any article involved.23 Until it was discontinued in 2003, data collection took place in a nationally

Injury rates by age and sex

Table 1 shows A&E attendance, fracture and hospital admission rates and M:F RRRs for all injuries, sports injuries and non-sports injuries by age band.

The distribution of A&E attendance rates by year of age was bimodal, with the major peak at age 1 year and a second peak at age 12 years (see Fig. 1). Although A&E attendance rates for boys and girls followed a similar pattern, boys had higher rates of attendance at every age and the M:F RRR increased significantly with age (see Table 1).

Male and

Discussion

These data were collected as part of a large, well-established national system, which ensured a high degree of data quality. Although HASS/LASS was not designed for local, population-based analysis, this project demonstrates that with careful attention to identifying a target population, the data can be used successfully for this purpose. The system dictated that data collection was restricted to a single hospital but because this is not a large urban conglomeration with a choice of easily

Acknowledgments

The authors would like to acknowledge the contributions of the following: Dr Neil Hamlet; Professor David Stone, University of Glasgow; Hazel Towers and Derek Roseburgh of NHS Lanarkshire; Paul Clark from Monklands Hospital; Alistair Stewart from Lanarkshire Acute Hospitals NHS Trust and Lesley Mann from North Lanarkshire Council.

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