Key Facts

  • Mortality from accidents in B&NES has remained relatively stationary over time (1993 96 per 100,000, 2010 92 per 100,000) and is generally lower than regionally or nationally
  • Overall rates of admissions for unintentional injuries in under 18s in B&NES have decreased from 7.6 per 1,000 of 0-17 year olds (2003-2006) to 7.3 (2009-2012)
  • In B&NES in 2013/14 there were 129.5 hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years), per 10,000  of 0-14 population, significantly higher than the South West as a whole (110.6) and England (112.2).
  • In the financial year 2012/13 there were 1,513 emergency hospital admissions caused by unintentional injuries to older people (65 years +). This is a rate of 472 admissions per 10,000 of the 65 years and older resident B&NES population.
  • Falls comprise the single largest cause of injury in B&NES 

The term "unintentional injury" refers to injuries that are nonvolitional but preventable. Injury prevention is an effort to prevent or reduce the severity of bodily injuries caused by external mechanisms, such as accidents, before they occur. Injury prevention is acomponent of safety and public health, and its goal is to improve the health of the population bypreventing injuries and hence improving quality of life.

Mortality from accidents

Mortality from accidents has remained relatively stationary over time (1993 96 per 100,000, 2010 92 per 100,000, nationally 100 per 100,000) and generally lower than regionally or nationally, although variation at a B&NES level is greater than regionally and nationally1

A high proportion of all deaths from accidents are premature (72% for men and 31% for women)2

Mortality from accidents (ages 65+) has seen an increase with time (nationally equivalent increase but currently decreasing which is not seen regionally or at a B&NES level) In B&NES 1993 35 per 100,000, 2010 63 per 100,000.

Rates are currently higher than regionally and nationally (63 per 100,000, nationally 56 per 100,000, regionally 54 per 100,000 (2010)3

Mortality from accidental falls in line regionally and nationally has remained relatively stationary with time whereas regional and national rates have risen slightly. (1993 5 per 100,000, 2010 3 per 100,000, nationally 3.5 per 100,000)4

Under 18 emergency hospital admissions for unintentional injuries 5

Overall rates of admissions for unintentional injuries in under 18s in B&NES have decreased from 2003 to 2012. Using a 3 year rolling time series, the rate per thousand under 18s has decreased from 7.6 (2003-2006) to 7.3 (2009-2012). This is an overall decrease of -4% over the last 9 years.

Falls still comprise the single largest cause of injury with an average of 152 per year, though this has decreased by -14% over the timeseries.

18% of falls are from playground equipment (22, 2011-12)

Of the remaining main causes of injury, accidental poisoning and foreign body injuries have seen notable increases over the last 9 years, by 58% and 28% respectively. It should be noted however that compared to falls, the numbers of these incidents are low.

Figure 1 below shows the top 10 causes of accidental injuries in under 18s excluding falls. 3 year rolling figures are used to smooth out the impact of large variations in data due to small numbers of incidents.

Unintentional Injuries_figure 1

Figure 1: Numbers of emergency admissions for unintentional injuries to under 18s, by 3 year bands

Regional comparisons for under 18 injuries (including intentional)

Unintentional Injuries_ figure 2

Figure 2: VSC 29 indicator over time for under 18 emergency hospital admissions for injuries

Note: In order to compare B&NES PCT with our neighbouring authorities we must include intentional injuries (including assault, self-poisoning and road traffic collisions) with the unintentional injuries data.

Since 2006/07 and 2007/08 the rates of emergency admissions due to injuries among under 18s have been decreasing in all PCTs in Avon except BANES PCT (increase by 2.6%). The year 2011/12 saw a decrease in rates: for NHS South Gloucestershire - 2%, NHS Bristol - 3.5% and NHS North Somerset -14.1%, comparing to previous year. Rates in NHS Bristol have been significantly above the Avon average, however, the gap seems to be narrowing.

Wards with the highest rate of under 18 emergency admissions for injuries (08/09-10/11) are: Southdown (highest), Keynsham North, Chew Valley South, Publow and Whitchurch, Clutton and Twerton

Table 1: Number and rate of hospital admissions for injuries by age range in 2011/12

age

number admissions for injuries

rate per 1000 population

age under 5

130

11.9

age 5-10

86

6.6

age 11-15

122

10.6

age 16-17

53

10.1

Emergency hospital admissions for unintentional injuries of under 5s (2006-11)6

Overall there has been a slight increase over time of emergency hospital admissions for injuries of under 5s from 2003-2011. Using a 3 year rolling time series, the rate per thousand accidents has increased from 10 (2003-2006) to 10.7 (2009-2012).

Odd Down (highest), Walcot, Radstock, Lambridge and Clutton have significantly high rates of emergency hospital admissions for injuries of under 5s 2006-11 (>14 per 1000 population) (standard deviation) (95% confidence intervals do not indicate any significance)

There is no significance between deprivation quintile although the lowest deprivation quintile does have the highest rate of hospital admissions for injuries of under 5s (lowest quintile 10 per 1,000; highest quintile 14 per 1000) (2006/07- 2010/11)

Falls were still the largest recorded cause of injury with 128 over the time period of 2009-2012. This has however fallen by 12% over this time period.

The next largest cause of injury in accidental poisoning/exposure to harmful substances, with 44 over the last 3 years. Although still small numbers, this has increased by 11% from 2003-2012.

Emergency hospital admissions caused by unintentional injuries to 0-14 year olds 7

In B&NES in 2013/14 there were 129.5 hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years), per 10,000  of 0-14 population (364 admissions), significantly higher than the South West as a whole (110.6) and England (112.2). The B&NES rate has been increasing since 2010/11 when it was 102.8.

Figure 3: B&NES and England hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years), per 10,000  of 0-14 population (2010/11-2013/14) The red circles indicate when the B&NES rate became significantly higher than England 8

Emergency hospital admissions caused by unintentional injuries to 15-24 year olds 9

In B&NES in 2013/14 there were 127.6 hospital admissions caused by unintentional and deliberate injuries in young people (aged 15 to 24 years), per 10,000  of 15-24 population (403 admissions), lower than the South West as a whole (147.0) and England (136.2). The B&NES rate has been fairly stable since 2010/11.

Figure 4: B&NES and England hospital admissions caused by unintentional and deliberate injuries in young people (aged 15 to 24 years), per 10,000  of 15-24 population (2010/11-2013/14) The green circle indicates when the B&NES rate was significantly lower than England, and yellow indicates when it was similar. 10

Emergency hospital admissions caused by unintentional injuries to older people (65 years +) (FY 2008/09 - FY 2012/13) 11

In the financial year 2012/13 there were 1,513 emergency hospital admissions caused by unintentional injuries to older people (65 years +). This is a rate of 472 admissions per 10,000 of the 65 years and older resident B&NES population.

There was a peak in the number and rate of emergency hospital admissions caused by unintentional injuries to older people (65 years +) in the financial year 2009/10, with 1,762 admissions, a rate of 565 per 10,000 of the 65 years and older resident B&NES population. However, apart from this peak the numbers and rates of admissions remained relatively stable between financial years 2008/09 and 2012/13.

Emergency hospital admissions caused by unintentional injuries has made up about 5% of all emergency hospital admissions for the 65 years and older resident B&NES population each financial year between 2008/09 and 2012/13.

The majority of emergency hospital admissions caused by unintentional injuries to older people (65 years +) were a result of falls, making up 61% (933 admissions) of these admissions in the finical year 2012/13.

After falls, incidents with medical devices and/or procedures, making up 13% (202 admissions), and the effects of drugs, meds & biolog substances in therapeutic use, making up 10% (156 admissions) were the chief causes of emergency hospital admissions caused by unintentional injuries to older people (65 years +) in the finical year 2012/13.

Unintentional injuries hospital admissions of older people by type pie chart

 

Figure 5: Emergency hospital admissions caused by unintentional injuries to older people (65 years +) in B&NES in the financial year 2012/13 – By type of accident 12

The makeup of the causes of emergency hospital admissions caused by unintentional injuries to older people (65 years +) between the financial years 2008/09 and 2012/13, has on the whole remained very similar.

However, admissions caused by supplementary factors (norm. healthcare associated infections) have decreased by 43% from 82 admissions (making up 5%) in 2008/09 to 47 admissions (making up 3%) in 2012/13.

In contrast admissions caused by accidental exposure to other and unspecified factors have increased by 109% from 33 admissions in 2008/09 (making up 2%) to 69 admissions (making up 5%) in 2012/13

Unintentional injuries hospital admissions of older people caused by falls pie chart

Figure 6: Emergency hospital admissions caused by falls experienced by older people (65 years +) in B&NES in the financial year 2012/13 – By type of falls 13

 

The makeup of the types of falls causing emergency admissions to older people (65 years +) between the financial years 2008/09 and 2012/13, has on the whole remained very similar.

 

However, the number of admissions caused by other falls on the same level have increased by 145% from 62 admissions (making up 7%) in 2008/09 to 152 admissions (making up 17%) in 2012/13.

Emergency hospital admissions for hip fractures (2006-09) 14

There were 393 emergency hospital admissions for hip fractures 2008-09

Wards with significantly high rates of emergency hospital admissions for hip fractures 2008-09 are:Timsbury (highest rate; 14 admissions), Publow and Whitchurch, Abbey, Paulton, High Littleton and Chew Valley South

There are a higher numbers of emergency hospital admissions for hip fractures in 2008-09 than 2006-07 but lower numbers than 2007-08

B&NES is in line or better than Bristol, South Gloucester and England for emergency hospital admission for hip fractures of 65+ , but higher than North Somerset (198 admissions, 466 age standardised rate per 100,000 population, North Somerset 394 age standardised rate financial year 09/10)15

There has been an increase in the age standardised rate per 100,000 population of emergency admissions for hip fractures for patients 65+ between 2007-10 but not higher than 2006/7

47% of emergency hospital admissions for hip fractures (2006-09) are aged over 85, 20% 80-84 year olds, 32% less than 80 years old of which 8% are under 65

356 were for 65+ population, given current trends in population change, this number may rise to 637 by 2025 and 2026

Mortality from hip fractures lower than nationally and regionally (0.5 per 100,000 compared with above 2.5 per 100,000 nationally and 2 per 100,000 regionally (2008-10)). This may be due to good prevention measures or a difference in coding of primary cause of death16

Crude rate of hospital admissions where the primary diagnosis is fracture of femur by pharmacy needs assessment zones 2007-2009 – Bath North West highest rate (7.9 per 1000 population) – significantly higher than B&NES overall rate (6.6 per 1000 population). Chew also significantly higher than B&NES overall rate (7.6 per 1000 population)17

Unintentional injuries and socio-economic deprivation

Unintentional injury continues to be a major cause of death, ill health and long-term disability in childhood18. Current evidence suggests that children in the most deprived households are more likely to be injured or die from an accidental injury19

In B&NES There is no significance between deprivation quintile although the lowest deprivation quintile does have the highest rate of hospital admissions for injuries of under 5s (lowest quintile 10 per 1,000; highest quintile 14 per 1000)

There are around 100 emergency admissions for injuries of children under 5 every year

The highest year since 2006 was during financial year 2009/10 where there was a spike in injuries during April/May 2009

Public protection provided 207 households (222 children, 7% BME) with child safety equipment during financial year 2010/11 – 286 safety gates, 21 fire guards and 32 smoke alarms.

Reasons for giving child safety equipment to these households include:

  • They have already experienced a near miss
  • On state benefit
  • No access to transport
  • No partner, less than 2 adults
  • Mother under 19 years
  • Mother no qualifications
  • Housing association
  • Moved more than once in last year
  • Special needs/support requirement

Most households were in receipt of state benefits and in council/housing association

41% have no live in partner 20

What does the community say?

The Child Health-Related Behaviour Survey21 22

The Health-Related Behaviour Survey developed by the Schools Health Education Unit (SHEU) is designed for young people of primary and secondary school age. The surveys have been developed by health and education professionals, and cover a wide range of topics. Data arising from the survey can be used to help inform planning and policy decisions as well being used in the classroom as the stimulus for discussion with young people. These surveys are carried out every two years.

When considering the results of the Child Health-Related Behaviour Survey in B&NES it is worth bearing in mind the level of participation in the survey, and thus how representative the responses are likely to be of children in B&NES as a whole. For more information see the Child Health-Related Behaviour Survey section in Children and Young People

As well as the local B&NES results, comparisons are made with national/aggregate figures from all the surveys conducted by the Schools Health Education Unit (SHEU) in the previous year from their publication “Young People into 2013”. The national sample used for the 2013 comparison consists of 43,014 young people aged 10 to 15.

When the Child Health-Related Behaviour Survey in B&NES in 2013 asked primary school children in B&NES in year 4 and 6 whether they had been treated for an accident by a doctor or at a hospital in the 12 months before the survey:

  • 23% of pupils responded that they have been, this is lower than the national SHEU rate of 33%, and is a decrease since 2011, when it was 35%.

Socio-economic Inequality - In order to acquire some idea if there were any differences in terms of children that were likely to be from a more deprived background, the primary school children were asked if they had ever had free school meals or vouchers for free school meals.

10% (116) of year 4 and 6 respondents in 2013 stated that they were receiving or eligible to receive free school meals.

A significantly higher proportion of the primary school pupils eligible for free school meals (FSM) responded that they had been treated for an accident by a doctor or at a hospital in the 12 months before the survey, 36% compared to the 21% of children that stated that they were not eligible for them. 23

When the Child Health-Related Behaviour Survey in B&NES in 2013 asked secondary school children in B&NES in year 8 and 10 how many accidents they had had when they were treated by a doctor or at a hospital in the past 12 months:

  • 44% of pupils responded that they were treated for an accident by doctor or at a hospital within the last year, higher than the national SHEU rate of 38%, but a decrease since 2011 when it was 51%.
  • 14% of pupils responded that they had 3 or more accidents requiring medical attention, slightly lower than in 2011 when it was 17%.

Are we meeting the needs?

Public Protection for B&NES runs the Child Safety Equipment Scheme which provides child safety equipment to vulnerable families in B&NES. It is expected that in the next year around 250 households will be supplied with child safety equipment in order to help reduce unintentional injury.

Public Protection aims to develop and pilot and evaluate a home safety project for older people with a target of 50 older people in pilot year to be referred and receive a home safety check. This pilot is now completed and being picked up by the Home Improvement Service.

All 'year 6' children within B&NES have the opportunity to visit Lifeskills (a safety education and training centre) and undertake realistic safety education in a safe environment. There are a minimum of 4 sessions organised for older people a year and there is also a programme for young people and adults with learning difficulties who live independently or are working towards living independently.

Priorities: Children and young people, older people and vulnerable adults

  • 1. NHS Information Centre Indicator Portal (1993-2010) Mortality from accidents (ICD9 E800-E928 exc E870-E879, ICD10 V01-X59), all ages, directly age-standardised rates (downloaded 23/3/2012) https://indicators.ic.nhs.uk/webview/
  • 2. Exeter mortality file (2002-10) Broad Cause of deaths in B&NES, in-house analysis]
  • 3. NHS Information Centre Indicator Portal (1993-2010) Mortality from accidents (ICD9 E800-E928 exc E870-E879, ICD10 V01-X59), ages 65+, directly age-standardised rates (downloaded 23/3/2012) https://indicators.ic.nhs.uk/webview/
  • 4. NHS Information Centre Indicator Portal (1993-2010) Mortalityfrom accidental falls (ICD9 E880-E888 adjusted, ICD10 W00-W19), all ages, directly age standardised rates (downloaded 23/3/2012) https://indicators.ic.nhs.uk/webview/
  • 5. Emergency admissions to under 18s 2003-2012, in-house analysis
  • 6. Emergency admissions to under 5s 2003-2012, in-house analysis]
  • 7. Public Health England (2015) Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-14 years), 2013/14, http://fingertips.phe.org.uk/search/injuries#page/4/gid/1/pat/6/par/E12000009/ati/102/are/E06000022/iid/90284/age/26/sex/4 
  • 8. Public Health England (2015) Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-14 years), 2013/14, http://fingertips.phe.org.uk/search/injuries#page/4/gid/1/pat/6/par/E12000009/ati/102/are/E06000022/iid/90284/age/26/sex/4 
  • 9. Public Health England (2015) Hospital admissions caused by unintentional and deliberate injuries in children (aged 15-24 years), 2013/14, http://fingertips.phe.org.uk/search/injuries#page/4/gid/1/pat/6/par/E12000009/ati/102/are/E06000022/iid/90284/age/26/sex/4 
  • 10. Public Health England (2015) Hospital admissions caused by unintentional and deliberate injuries in children (aged 15-24 years), 2013/14, http://fingertips.phe.org.uk/search/injuries#page/4/gid/1/pat/6/par/E12000009/ati/102/are/E06000022/iid/90285/age/156/sex/4 
  • 11. Bath and North East Somerset Council (2013) In house analysis of SUS data for Finished emergency hospital admissions caused by unintentional or deliberate injuries to older (65+) people with an external cause of morbidity or mortality in ICD-10 range V01 to Y98 (excluding X33-X39 and X52) for Banes PCT resident population between 1st April 2001 - 31st March 2013
  • 12. Bath and North East Somerset Council (2013) In house analysis of SUS data for Finished emergency hospital admissions caused by unintentional or deliberate injuries to older (65+) people with an external cause of morbidity or mortality in ICD-10 range V01 to Y98 (excluding X33-X39 and X52) for Banes PCT resident population between 1st April 2001 - 31st March 2013
  • 13. Bath and North East Somerset Council (2013) In house analysis of SUS data for Finished emergency hospital admissions caused by unintentional or deliberate injuries to older (65+) people with an external cause of morbidity or mortality in ICD-10 range V01 to Y98 (excluding X33-X39 and X52) for Banes PCT resident population between 1st April 2001 - 31st March 2013
  • 14. SUS data (2006-2009) Emergency Hospital Admissions for Hip Fractures, In house analysis
  • 15. NHSIndicators (2010) Emergency hospital admissions for fractured proximal femur, age standardised rate https://indicators.ic.nhs.uk/webview/
  • 16. NHS Information Centre Indicator Portal (2008-10) Mortality from fracture of femur (neck and other than neck) (ICD10 S72): Directly age-standardised rates (DSR), 3 year average, all ages (downloaded 12/3/2011) https://indicators.ic.nhs.uk/webview/
  • 17. SUS data (2007-09) Crude rate of hospital admissions where the primary diagnosis is Fracture of Femur by Pharmacy Needs Assessment Zones, in-house analysis
  • 18. Errington, G. et al. (September 2011) Evaluation of the National Safe At Home Scheme, Final Report
  • 19. Fauth, R. Childhood Unintentional Injuries, National Children’s Bureau Research Centre (downloaded 23/03/2012) http://www.ncb.org.uk/media/434674/summary_4-_unintentional_injuries.pdf
  • 20. Bath and North East Somerset Council (2010-2011) Child Safety Equipment Scheme, in-house data
  • 21. Schools Health Education Unit (2013) The Health-Related Behaviour Survey 2013, A report for BANES Primary, Bath and North East Somerset Council
  • 22. Schools Health Education Unit (2013) The Health-Related Behaviour Survey 2013, A report for BANES Secondary, Bath and North East Somerset Council
  • 23. Schools Health Education Unit (2013) The Health-Related Behaviour Survey 2013, B&NES  Primary  Pupil Premium Headline Results, Bath and North East Somerset Council