Elsevier

Injury

Volume 40, Issue 8, August 2009, Pages 820-825
Injury

Trends in violence in England and Wales 2000–2004: An accident and emergency perspective

https://doi.org/10.1016/j.injury.2008.08.017Get rights and content

Abstract

Purpose

To evaluate overall, gender and age-specific trends in violence in England and Wales from an accident and emergency (A&E) perspective.

Methods

Violence data were collected from a sample of 32 major A&E departments in the ten Government Office Regions of England and Wales over 5 years, 1st January 2000–31st December 2004. Attendance date, age, and gender of patients who reported injury in assault were studied. Time series statistical methods were used to detect national trends in overall violence and violence in which males and females were injured. Separate time series analyses were carried out for the five age groups (0–10, 11–17, 18–30, 31–50, and 50+ years).

Results

203,819 (150,050 males: 74%) violence-related attendances were identified. Overall estimated annual injury rate was 6.4 per 1000 resident population (9.5 and 3.5 for males and females, respectively). There was a significant decrease in overall violence-related A&E attendance in England and Wales over the five-year period (p < 0.05; 20% in Wales and 13% in England). There were significant decreases in A&E attendance for both males and females and all age groups (p < 0.05). There were regional differences in violence-related A&E attendances with decreases in Wales, East Midland, London, North West and West Midland and increases in North East, Yorkshire and Humberside and South West regions. Violence-related A&E attendances were highest during the months of May to September and during December (p < 0.05).

Conclusions

This national study from the perspective of health services suggest that overall levels of violence decreased over the period 2000–2004 in England and Wales. Increases were not detected for any age group or gender. The reason for regional difference in trends in violence deserves further study.

Introduction

Trends in community violence have become a prominent health issue.26 Police records and the British Crime Survey (BCS) are the traditional national sources of information on violent crime in England and Wales but neither is a measure of harm and trends derived from these have often been contradictory.12, 22 National injury surveillance based in hospital A&E departments in England and Wales provides a new, objective measure of violence using injury data and have been developed to bring clarity to confusing messages from other sources.27 Information about violence is recorded in A&E shortly after injury when the event is fresh in the minds of the injured and those who accompany them. In the UK all current A&E computer software packages categorise cause of injury as accident or assault on registration. The advantages of A&E-derived violence data are reliable electronic recording, an existing infrastructure for data collection, and the potential for using local, regional and national data for violence measurement and community violence prevention.

Surveillance systems have been developed in Canada, Australia and the United States to measure morbidity associated with violence but these systems are not yet used to inform prevention or used in conjunction with criminal justice systems.6, 19, 20 In 2002, the WHO published its “World Report on Violence and Health” with nine recommendations aimed to mobilise action against community violence, including enhancing the capacity for data collection.17 Increasingly, A&E injury records are being utilised to inform the public and policy makers about community violence and violence trends.

Most recently in the UK, government have moved to a harm based approach to reducing violent crime.15 A study of trends in violence in England and Wales 1995–2000 found that, apart from a significant increase in assault injury in females aged 11–17, levels of violence did not change.31 Slowing of city-specific increases in violence and acceleration in decreases in violence were interpreted as evidence that violence had come under control in that period. However, a further study in England showed that the number of people admitted to hospital reportedly following an assault involving a sharp object rose by 30%, from 3770 in 1997/1998 to 4891 in 2004/2005.21

We studied trends in violence according to A&E data in England and Wales, over the five-year period, 1st January 2000 to 31st December 2004. The purposes of the study were to determine age, gender and region-specific rates of violence and violence trends and seasonality.

Section snippets

A&E departments

Data were collected from a stratified sample of 32 Type 1 (open 24 h with medical and nursing support) A&E departments in the ten Government Office Regions (Eastern, East Midlands, London, North East, North West, South East, South West, Wales, West Midlands, Yorkshire and Humberside) of England and Wales over 5 years, January 1st 2000–31st December 2004 (Fig. 1). A&E departments were recruited on the basis that they were able to share prospective electronic data on violence-related attendance

Violence-related injury rates

Altogether, 203,819 people injured in violence were treated in the 32 A&E departments in the 5 years, 2000–2004. Table 1 shows the distribution of patients by age and gender. Almost three-quarters of these were males (150,050 assaults). This ratio of almost three males to one female was seen in all age groups. Almost half were aged 18–30 years and one-quarter were aged 31–50 years, followed by those aged 11–17 years, 51 years and over, and those aged 10 years and under. Table 2 shows injury

Discussion

To be an ideal indicator of violent crime locally, A&E-derived violence data must satisfy a number of criteria; first, that those injured in violence who seek treatment attend an A&E department in the same region; and, secondly, that those attending A&E with violence-related injury declare to A&E staff that they have been injured in violence. It is important to recognise at the outset that A&E injury data represent only a proportion of overall violence. According to the BCS the proportion of

Conclusion

From an A&E perspective, overall violence in England and Wales decreased over this five-year period. An increase in violence was not detected for any age group or gender. Notwithstanding this, evidence from hospital admissions data indicates that the severity of injury, reflecting greater knife carrying and use, increased. Variations in regional trend in violence deserve further study – especially of the violence prevention strategies and practice implemented by Regional Crime Reduction

Conflict of interest

This paper has not been published previously and is not under consideration elsewhere. The authors have no financial or personal relationships with other people, or organisations, that could inappropriately influence (bias) their work.

Acknowledgements

We would like to thank the clinical leads of all A&E departments that took part in this study: Bassetlaw District General (Worksop), Birmingham Heartlands, Broomfield (Chelmsford), Burnley General, Cheltenham General, Chesterfield and North Derbyshire Royal (Chesterfield), Darlington Memorial, Eastbourne District General, Friarage (Northallerton), General Hospital (Hereford), Glan Clwyd (Rhyl), Good Hope (Sutton Coldfield), Hinchingbrooke (Huntingdon), Huddersfield Royal Infirmary, Ipswich,

References (33)

  • V. Sivarajasingam et al.

    Association of assault-related injury, ambient conditions and calendar events

    Injury

    (2004)
  • V. Sivarajasingam et al.

    Shepherd JP Price of beer and violence-related injury in England and Wales

    Injury

    (2006)
  • Cameron AC, Trivedi PK. Regression analysis of count data. Econometric Society Monographs, No. 30. Cambridge University...
  • Clegg M, Finney A, Thorpe K. Crime in England and Wales: quarterly update to December 2004. London: HMSO,...
  • Dodd T, Nicholas S, Povey D, et al., Crime in England and Wales 2003/2004. Home office statistical bulletin. London:...
  • Eviews 6 User's Guide1994–2007, Quantitative Micro Software...
  • Goddard E, Green H. Smoking and drinking among adults, 2004. General household survey 2004. London: Office for National...
  • J. Harrison et al.

    Injury surveillance in Australia

    Acta Paediatr Jpn

    (1993)
  • Home Office. Violence against the person—long term national recorded crime trends, London. Research Development and...
  • C.C. Hsieh et al.

    Poverty, income inequality and violent crime: a meta-analysis of recent aggregate data studies

    Criminal Just Rev

    (1993)
  • Cited by (0)

    View full text