An Investigation of Inequalities in Paediatric Thermal Injuries in England And Wales

Abstract

This research aimed to investigate inequalities in burns to children and young people in the UK. A review of published research on paediatric burns epidemiology in some high-income countries over 23 years revealed gaps in current knowledge on the subject. Evidence was weak or moderate in some areas, driving the need for better quality research to examine contributions of deprivation levels, ethnicity, geographical variations, supervision levels, additional or complex needs of the child and vulnerable families’ characteristics.
The investigation of inequalities involved secondary data analyses of two datasets: The Hospital Episodes Statistics (HES) and Burns and Scalds Assessment Template (BaSAT) datasets. HES collects data on severe burns cases in England admitted to the hospital, while BaSAT collects data of children attending emergency departments (ED) in England and Wales for minor burns.
Analyses used descriptive and inferential methods via multivariable logistic regressions run in STATA 14. Odds ratios and 95% confidence intervals are presented describing the likelihood of admission or attendance at the hospital from a range of individual, family and environmental factors that acted as exposures, mediators, moderators and confounders on the burn outcomes.
HES analyses revealed associations between burn admissions in under 16s and greater deprivation (largest adjusted odds ratios (AOR) in 5th quintile: 1.55 [95% C.I: 1.48-1.63]); minority ethnic groups (largest AOR for Black/Black British: 1.50 [95% C.I: 1.42-1.59]) and living in urban areas (AOR: 1.11 [95% C.I: 1.06-1.15]). BaSAT analyses showed no increase in attendance in children with additional needs. However, there were associations between the application of cool running water first aid in under 16s and having sub-optimal supervision (AOR: 0.56 [95% C.I: 0.34-0.90]) and being from most deprived backgrounds (AOR: 0.43 [95% C.I: 0.22-0.81]). The complex relationship between ethnicity, social deprivation and paediatric burns was explored in further depth.
Both the aetiology and the initial treatment of paediatric burns show socio-demographic inequalities: these findings should inform preventative strategies to reduce the burden of thermal injuries to children.
Keywords: Inequality, deprivation, ethnic minorities, supervision levels, additional needs, urban/rural divide, epidemiology, children, burns, scalds.

Date of Award	5 Oct 2020
Original language	English
Awarding Institution	University of Bristol
Sponsors	The Scar Free Foundation
Supervisor	Alan M Emond (Supervisor), Julie Mytton (Supervisor) & Linda I Hollen (Supervisor)