Children at risk in traffic: improvement potentials in the Swedish context

Aim: To investigate the social risk distribution and improvement potentials for road traffic injuries among Swedish children by considering three categories of road users. Methods: A population-based cohort study of children aged 1-14 y was carried out. Subjects were taken from the Swedish Population and Housing Census of 1990 (n=1406405), and followed-up in the National Hospital Discharge Register for the years 1991-1999 focusing on injuries incurred as pedestrians, bicyclists or car passengers (n=16084). Household socio-economic position was measured using social class, education and disposable income. Relative risks were calculated using Poisson regression for each measure of socio-economic position and by combining them, adjusting for sex, age of child and age of mother at delivery. Population-attributable risks were compiled for each category of road user and each measure of socio-economic position. Results: Children of farmers and the self-employed are at greater risk for injuries as car passengers (RR 2.40, CI 1.79-3.20 and RR 1.44, CI 1.16-1.79, respectively), but not for pedestrian- and bicycle-related injuries. Children of unskilled workers are at greater risk for pedestrian injuries (RR 1.39, CI 1.15-1.67). Controlling for education and disposable income did not affect the relative risks to the same extent according to the social class and category of road user. The highest population-attributable risks were related to family disposable income and were indicated for pedestrians and car passengers (19-20%). Conclusion: By taking children's limited ability to deal with different types of traffic situations into consideration, considerable improvements in children's risk levels have been observed. Now there is a need to add equity in the road traffic safety equation.