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