National five-year examination of inequalities and trends in emergency hospital admission for violence across England

Objectives To examine relationships between violence, age (0e74 years), and deprivation, and to explore in which communities, age groups, and gender the potential for transmission of violent tendencies between individuals is greatest. Methods Five year (2004/2005 to 2008/2009) ecological study of emergency admissions resulting from violence (n=170 074) into all English hospitals using trend and logistic regression analyses. Results Hospital admissions for violence peak as individuals achieve legal adulthood (18 years). Risks of admission increase exponentially with increasing quintile of deprivation of residence, with odds overall being 5.5 times higher in the poorest quintile compared with the richest. The greatest absolute difference in violence admissions by deprivation quintile is seen in males aged 18 (218/100 000, richest; 698/100 000, poorest). However, the highest deprivation rate ratios (quintile 5:1) are seen at ages 0-10 years in both sexes and at all ages after 40 years in males (40-58 years, females). In males aged 17-19 years, violence accounts for 20% of the entire gap between wealthiest and poorest quintiles in all cause emergency hospital admissions. Conclusions Analyses identify four lifetime periods for violence: up to 10 years (prepubescent), 11-20 years (adolescence), 21-45 years (younger adults), and over 45 years (older adults). While violence is most common in adolescence, its concentration in poorer areas during prepubescence and in younger adulthood (parenting age) suggests that poorer children are exposed to much more aggressive communities. This is likely to contribute to the disproportionate escalation in violence they experience during adolescence. Effective interventions to prevent such escalations are available and need to be implemented particularly in poor communities.