Influence of changing travel patterns on child death rates from injury: Trend analysis

Objectives: To examine trends in child mortality from unintentional injury between 1985 and 1992 and to find how changes in modes of travel contributed to these trends. Design: Poisson regression modelling using data from death certificates, censuses, and national travel surveys. Setting: England and Wales. Subjects: Resident children aged 0-14. Main outcome measures: Deaths from unintentional injury and poisoning. Results: Child deaths from injury declined by 34% (95% confidence interval 28% to 40%) per 100 000 population between 1985 and 1992. Substantial decreases in each of the leading causes of death from injury contributed to this overall decline. On average, children walked and cycled less distance and travelled substantially more miles by car in 1992 compared with 1985. Deaths from road traffic accidents declined for pedestrians by 24% per mile walked and for cyclists by 20% per mile cycled, substantially less than the declines per 100 000 population of 37% and 38% respectively. In contrast, deaths of occupants of motor vehicles declined by 42% per mile travelled by car compared with a 21% decline per 100 000 population. Conclusions: if trends in child mortality from injury continue the government's target to reduce the rate by 33% by the year 2005 will be achieved. A substantial proportion of the decline in pedestrian traffic and pedal cycling deaths, however, seems to have been achieved at the expense of children's walking and cycling activities. Changes in travel patterns may exact a considerable price in terms of future health problems.