Original Article
The association between disability and unintentional injuries among adolescents in a general education setting: Evidence from a Swedish population-based school survey

https://doi.org/10.1016/j.dhjo.2019.100841Get rights and content

Abstract

Background

Unintentional injuries are the leading cause of death among adolescents. Adolescents with disabilities may be particularly vulnerable with an increased risk of unintentional injuries.

Objective

To study the association between a set of disabilities and unintentional injury risks among adolescents, accounting for comorbidity, subjective disability severity and sex.

Method

Cross-sectional data from a Swedish national school survey including 4,741 students (15 and 17-year olds) conducted in 2016 was analyzed using log-binomial generalized linear models.

Results

We found a 33% increased risk of injury the last 12 months and a 53% increased risk of injury leading to hospitalization for adolescents with any disability compared to their peers with no disability. The differences in injury risk were greater for girls than boys. There was a dose-response relationship between disability severity and injury risk. In analyses adjusted for sociodemographic factors and comorbidity, attention-deficit/hyperactivity disorder (ADHD) and epilepsy were associated with an increased risk of injury the last 12 months, risk ratios [RR] were 1.41 (95% Confidence Interval [CI] 1.08–2.97) and 1.79 (95% CI 1.10–1.81) respectively. Autism spectrum disorder was associated with a decreased injury risk the last 12 months (RR = 0.43, CI 0.2–0.92). ADHD, mobility impairment and visual impairment were associated with hospitalization due to injury during lifetime.

Conclusions

There was an increased risk of unintentional injuries for adolescents with disabilities compared to their non-disabled peers, specifically for individuals with ADHD, epilepsy, visual impairment and mobility impairment. Injury prevention strategies may include adapting the physical environment and medical treatment.

Section snippets

Methods

Our study is based on cross-sectional data from a Swedish national survey on 4,741 children's experiences of maltreatment, including questions about health, injuries and background.23 The data was collected in schools, in primary schools grade 9 (15-year olds) and sophomore year in high school (17-year olds), in autumn 2016.

Results

Among the total sample, 14.8% of the students reported having at least one of the six disabilities we have included in this study (see Table 3). The most common disability was ADHD (5.8%), followed by visual impairment (4.8%). Epilepsy and mobility impairment were the least common disabilities (0.7% and 1.2% respectively).

Table 2 shows that adolescents with disabilities report living with single parent or shared living to a higher degree than adolescents with no disabilities (50% vs. 31%).

Discussion

This is the first comprehensive investigation into the relationship between disability and unintentional injury risks among adolescents in Sweden. Consistent with previous research, our results imply that adolescents with disabilities are more likely to sustain unintentional injuries compared to their non-disabled peers.3 Our findings also support previous research suggesting an increased risk of unintentional injury for individuals with ADHD,5 sensory disabilities,13,16 mobility impairment3,17

Conclusion

There is an increased risk of unintentional injuries for adolescents with disabilities compared to their non-disabled peers, but longitudinal studies focusing on mediating factors are needed to better understand the mechanisms behind this relationship. Meanwhile, prevention efforts could be focused on environments where children with disability are more likely to be injured, but further research is required to assess the efficacy of such interventions for this population.

Conflicts of interest

The authors have no conflict of interest to declare.

Funding

The study was funded by a research grant (grant number 2013-4176) from Swedish Civil Contingencies Agency (Myndigheten för Samhällsskydd och Beredskap, MSB), and data was provided by Children's Welfare Foundation (Stiftelsen Allmänna Barnhuset), Stockholm, Sweden.

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