Injury Surveillance in the North West of England Merseyside & Cheshire Local Authority Profile St Helens Road Traffic Collisions April 2012 to March 2015 February 2016 Jennifer Germain, Simon Russell and Mark Whitfield Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2ET cph.org.uk 0151 231 4500 tiig@ljmu.ac.uk tiig.info twitter.com/tiig_cph ISBN: 978-1-910725-49-8 (web)
Key findings In Great Britain during 2014, there were 194,477 people injured or killed in a road traffic collision (RTC). Young males (aged 25 years or under) are almost three times more likely to be killed in a car crash than young females. Between April 2012 and March 2015 there were 37,295 Emergency Department (ED) attendances for RTCs across Merseyside and Cheshire. 3,132 attendances were made by residents of St Helens Local Authority (LA). Over this three year period, attendances by St Helens residents for RTCs fell by 50%. The majority of St Helens residents attended Whiston Hospital ED (83%), followed by Warrington Hospital ED (11%) and Aintree Hospital ED (3%). People aged 19 to 31 years accounted for the highest number of attendances, and, unlike other areas, females accounted for more attendances than males in this group. The rate of RTC attendance for people aged 15 to 29 years was 3.1 per 100 population compared to 1.5 for all other groups combined. Across the three years the highest rate of attendances was in July with an average of 10.2 attendances per day; Wednesday had the most RTC attendances overall with 16%; and, attendances peaked between 16:00 and 17:59 (14%). The highest proportion of attendances arrived by private transport (47%) followed by 41% who arrived by ambulance; the majority of attendees self-referred (67%); and, 56% of RTC attendees were discharged with no further treatment required. Road traffic injuries have been neglected from the global health agenda for many years despite being predictable and preventable. Rich and timely data from EDs, analysed by TIIG and applied by community partners may be invaluable in monitoring the prevalence and trends, and identifying those at the highest risk of suffering injuries as a consequence of RTCs. Road traffic collisions in St Helens Road traffic collisions (RTCs) are responsible for causing thousands of injuries and deaths every year. The World Health Organization (WHO, 2015) estimate that globally 1.25 million people die every year as a result of a RTC. Throughout Great Britain during 2014, there were 194,477 people injured or killed in a RTC (Department for Transport, 2015). The majority of individuals were slightly injured (169,895), while 49,164 were either seriously injured or killed. Public Health England s (PHE) Public Health Outcomes Framework (PHOF) indicator reported a rate of 39.7 per 100,000 resident population killed or seriously injured on England s roads across St Helens in 2012-2014 (n=210; PHE, 2015). This figure represents a similar rate to the England (39.3) and North West (39.6) averages. WHO (2015) identify age as a potential risk factor for RTCs with road traffic injuries being the leading cause of death amongst those aged between 15 and 29 years. The road safety charity Brake estimate that drivers aged between 17 and 19 years only make up 1.5% of UK licence holders however they are involved in 12% of fatal and serious RTCs (Brake, 2014). WHO (2015) also identify males as more likely to be involved in RTCs than females with 73% of all road traffic deaths occurring amongst men. It is estimated that young males are more likely to be involved in RTCs with men aged under 25 years being almost three times more likely to be killed in a car crash than young females. Research has also been carried out looking at the link between RTCs and levels of deprivation which found that both area and person deprivation was linked to an increased risk of being involved in a serious injury collision (Hurst, 2011). St Helens is a town and metropolitan borough in Merseyside, in the North West of England. According to mid-2014 population estimates, St Helens has a population of 177,188 (ONS, 2015), of which 90,207 (51%) are female and 86,981 (49%) are male. Young men have been identified as being potentially at risk for being involved in RTCs and across St Helens 16,070 people are males aged between 15 and 29 years of age (9% of the whole population). Local Authority Profile St Helens Page 1
This Trauma and Injury Intelligence Group (TIIG) Local Authority Profile presents RTC injuries sustained by people in St Helens using ED recorded data between April 2012 and March 2015. This profile will contextualise ED data by providing an overview of the population, highlighting who is at increased risk of RTCs and describing the specific level of need in St Helens. This profile also provides recommendations for local government and commissioners in terms of the efficient use of resources, and to health and social care Figure 1 shows the majority of RTC attendances were made to Whiston Hospital (2,613; 83%), 11% attended Warrington Hospital (342), 3% University Hospital Aintree (99) and 1% Southport and Formby District General Hospital (32). There was 1% combined attendances from Leighton Hospital (13), Alder Hey Children s Hospital (10), Countess of Chester Hospital (10), Arrowe Park Hospital (9) and Royal Liverpool University Hospital (<5). providers in terms of delivering improved outcomes. Injuries across St Helens, April 2012 to March 2015 Figure 1. RTC attendances by St Helens residents by Emergency Department. For all age groups, between April 2012 and March 2015 there were 51,255 injury attendances made by St Helens residents to Emergency Departments (EDs) across Merseyside and Cheshire. During this period there were 3,132 RTC attendances by St Helens residents to Emergency Departments (EDs) across Merseyside and Cheshire. This figure represents 8% of the total number of attendances for RTCs across all Merseyside and Cheshire EDs (table 1). Between April 2012 and March 2015, attendances for RTCs by St Helens residents fell by 50%. Table 1. RTC attendances by Local Authority, April 2012 to March 2015. LA 2012/13 2013/14 2014/15 Total Halton 1402 1172 886 3460 Warrington 1293 1233 827 3353 Cheshire East 1335 1378 1212 3925 Cheshire West and Chester 1887 1671 1492 5050 Knowsley 1641 1194 1083 3918 Liverpool 1743 1547 1476 4766 St Helens 1468 925 739 3132 Sefton 1432 1303 1264 3999 Wirral 1975 1966 1751 5692 Total 14176 12389 10730 37295 There were slightly more male (1,603; 51%) than female (1,529; 49%) RTC attendances. In terms of age, 38% were aged between 30 and 59 years (1,202), 31% between 15 and 29 years (984), 16% were 60 and over (513), 8% aged 5 to 14 years (236) and 6% aged between 0 and 4 years (197). Table 2 shows that 31% of attendances were aged between 15 and 29 years (984) despite only making up 18% of the population of St Helens. Local Authority Profile St Helens Page 2
Number of attendances Table 2. St Helens residents RTC attendances by age and gender, April 2012 to March 2015. Age group/gender Female Male Total Population Rate per 100 population 0-4 94 103 197 10,522 1.9 5-14 105 131 236 19,316 1.2 15-29 499 485 984 31,691 3.1 30-59 568 634 1202 69,746 1.7 60+ 263 250 513 44,946 1.1 Total 1529 1603 3132 176,221 1.9 Figure 2 shows the age breakdown by gender for RTC attendances. For both males and females there is a spike in attendances for those aged between 19 to 23 years. The number of RTC attendances then generally declines. Figure 2. St Helens residents RTC attendances by age and gender, April 2012 to March 2015. 60 50 Female Male 40 30 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 Age Local Authority Profile St Helens Page 3
Figure 3. Rate of RTC attendance per 100 population for people aged 15 to 29 years and all other groups combined. attendances (359; 11%). Figure 6 displays RTC attendances by time group. Where times were recorded (1,850), attendances peaked between 16:00 and 17:59 (256; 14%) and between 12:00 and 13:59 (257; 14%). Attendances were lowest between 04:00 and 05:59 (30; 2%). Figure 4 shows RTC attendance numbers for St Helens residents. The map displays patient LSOA of residence, not the location of the incident. Figure 4. RTC attendance numbers for St Helens residents, April 2012 to March 2015. Where ethnicity was recorded, the majority of RTC attendees from St Helens were White (1,990; 75%), 22% (592) were unknown and 1% were Black (38). There were 30 combined attendances by patients of Chinese, Indian, Pakistani and other ethnic origin. Time, day and month of attendance Figure 5 shows that attendances were highest during 2012/13 (1,468). Across the three years the highest rate of attendances was in July with an average of 10.2 attendances per day, followed by May (10.1). Attendances were lowest in September (7.1). Wednesday (516) had the most RTC attendances overall (516; 16%); Sunday had the fewest Local Authority Profile St Helens Page 4
Attendance time Number of attendances Rate per month Figure 5. St Helens residents RTC attendances by financial year and month, April 2012 to March 2015. 180 12.0 160 140 120 100 80 9.3 10.1 8.7 10.2 7.8 7.1 9.0 9.3 8.4 7.3 7.5 7.9 10.0 8.0 6.0 60 4.0 40 20 2.0 0 April May June July August September October November December January February March 2012/13 2013/14 2014/15 Rate per month 0.0 Figure 6. St Helens residents RTC attendances by time group, April 2012 to March 2015. 0-01:59 2-03:59 4-05:59 6-07:59 8-09:59 10-11:59 12-13:59 14-15:59 16-17:59 18-19:59 20-21:59 22-23:59 30 37 49 51 100 175 191 229 236 239 257 256 0 50 100 150 200 250 300 Number of attendances Local Authority Profile St Helens Page 5
Arrival, referral and disposal Table 3 displays the arrival mode to EDs for RTC attendances. The highest proportion of attendances arrived by private transport (1,460; 47%) followed by 41% who arrived by ambulance (1,272). Table 3. St Helens residents RTC attendances by arrival mode, April 2012 to March 2015. Arrival mode N % Private transport 1460 47 Ambulance 1272 41 Other 279 9 Public transport 70 2 Foot 26 1 Police 21 1 Taxi *** 0 Unknown *** 0 Total 3132 100 Table 4 displays the referral source to EDs for RTC attendances. The majority of attendees self-referred (2,088; 67%) and 13% were referred by the emergency services (420). Table 4. St Helens residents RTC attendances by referral source, April 2012 to March 2015. Source of referral N % Self-referral 2088 67 Emergency services 420 13 Friend/relative 239 8 Other 127 4 Health care professional 126 4 GP 68 2 Police 35 1 Work 9 0 Educational establishment 8 0 Carer 7 0 Unknown 5 0 Total 3132 100 The majority of RTC attendees were discharged from hospital following their attendances (1,750; 56%), 21% (644) were referred to another health care provider or for follow up treatment and 20% (634) were admitted into hospital. Generally the older the attendee the greater the likelihood of them being admitted into hospital. Forty-seven per cent of attendees aged 60 years and over were admitted into hospital compared to only 14% of those aged between 15 and 29 years of age. Similarly the likelihood of being discharged from hospital decreased as attendees got older with 71% of people aged between 0 and 4 ED attendances for RTCs peak among people between the ages of 15 and 29 years. In St Helens, Females accounted for more RTC attendances than males among this group. years (140) being discharged compared to only 38% of those aged 60 years and over (195; Table 5). Local Authority Profile St Helens Page 6
Table 5. St Helens residents RTC attendances by disposal method and age group, April 2012 to March 2015. Disposal 0-4 5-14 15-29 30-59 60+ Total n % n % n % n % n % n % Admitted 30 15 30 13 141 14 191 16 242 47 634 20 Discharged 140 71 159 67 576 59 680 57 195 38 1750 56 Other *** 1 *** 1 64 7 33 3 *** 1 104 3 Referred <30 13 <50 19 203 21 298 25 <75 14 644 21 Total 197 100 236 100 984 100 1202 100 513 100 3132 100 Figure 7 shows RTC rates for St Helens residents per 100 population. The map displays patient LSOA of residence, not the location of the incident. Figure 7. RTC attendance rates for St Helens residents per 100 population, April 2012 to March 2015. Location of injury Table 6 displays incident location for RTC attendances. The majority of incidents took place in an other location (190; 37%) or a public place (160; 31%). Table 6. St Helens residents RTC attendances by location of incident, April 2012 to March 2015. Location N % Other 190 37 Public place 160 31 Unknown 159 31 Home <10 2 Work *** 0 Total 519 100 Young males (aged 25 years or under) are almost three times more likely to be killed in a car crash than young females. Throughout Great Britain during 2014, there were 194,477 people injured or killed in a road traffic collision. Local Authority Profile St Helens Page 7
Deprivation score Rate of RTC attendance LSOA breakdown Table 7 displays the number and rate of RTC attendances for the top ten Lower Super Output Areas (LSOAs) for St Helens residents. Table 7. Top ten LSOAs for all RTC attendances per 100 population for St Helens residents, April 2012 to March 2015. LSOA name LSOA code Population Total attendances Rate of attendances per 100 population St. Helens 022B E01006900 2762 63 2.3 St. Helens 018C E01006828 2110 57 2.7 St. Helens 019F E01006907 1543 54 3.5 St. Helens 021C E01006893 1375 50 3.6 St. Helens 021A E01006890 1438 50 3.5 St. Helens 007F E01006919 1577 48 3.0 St. Helens 019H E01006913 1310 47 3.6 St. Helens 021B E01006892 1335 47 3.5 St. Helens 023C E01006891 1375 44 3.2 St. Helens 022C E01006908 1315 43 3.3 Figure 8 displays the rate of RTC attendances per 100 population by LSOA for St Helens residents, with a linear trend line, plotted against deprivation scores where higher scores represent higher levels of deprivation, for each LSOA. As shown, RTC rates declined with decreasing levels of deprivation. Figure 8. RTC attendance rates per 100 population for St Helens residents for each LSOA by deprivation score, April 2012 to March 2015. 90 80 IMD score Rate 4 3.5 70 60 50 40 30 20 3 2.5 2 1.5 1 10 0 St Helens LSOAs 0.5 0 Local Authority Profile St Helens Page 8
Summary and Recommendations St Helens had the lowest number of RTCs in Merseyside and Cheshire, but an average overall rate of 1.9 per 100 population. Accidents were found to be clustered around St Helens town and the south of the LA. There was a substantial drop in RTCs between April 2012 and March 2015 (50%); this decrease was the largest of all LAs in Merseyside and Cheshire. Unlike other LAs, females accounted for more ED attendances than males for people aged 15 to 29 years but the difference was not substantial. Educational messages and road safety awareness campaigns should be particularly tailored to young adults (aged 15 to 29 years) since the RTC rate for this group was more than double other age and gender groups combined. There was an association between deprivation and RTC rate, which may require further exploration. St Helens LA may also consider further exploration of specific LSOAs identified as having high rates of RTCs. Consider mechanisms to enable the EDs in Cheshire and Merseyside to categorise further data items relating to RTCs. For example, whether the attendee was in a vehicle or was a pedestrian and, if in a vehicle, whether the attendee was the driver or the passenger, and whether the attendee was wearing a seatbelt or not. This can be achieved through multi-agency meetings and dialogue, primarily between the TIIG team and EDs. A potential barrier may be the IT systems used by EDs (and the costs involved in potentially changing them), which may be overcome with cooperative action and by highlighting the importance of such data in informing prevention strategies and road safety campaigns. Similarly consider improving the location details to include specific roads or streets in order to identify accident hotspot areas. Analysis of this data would be valuable in predicting where accidents are likely to occur and initiating safety measures and precautions. Road traffic injuries have been neglected from the global health agenda for many years (WHO, 2015), despite being predictable and largely preventable. Evidence from many countries shows that dramatic successes in preventing road traffic crashes can be achieved through concerted efforts that involve, but are not limited to, the health sector. Rich and timely data from EDs, analysed by TIIG and applied by community partners may be invaluable in monitoring the prevalence and trends, and identifying those at the highest risk of suffering injuries as a consequence of RTCs. This information can then be used to inform the targeting and planning of appropriate interventions across a range of behavioural risk factors including speed, drink driving, mobile phone use, seat belt and helmet use and child restraints (WHO, 2015). These recommendations are unlikely to be achieved without sustained working between cooperating agencies. However their implementation would be likely to reduce the number of RTCs in St Helens and the burden on EDs in Merseyside and Cheshire. Local Authority Profile St Helens Page 9
References Brake. (2014). Young drivers [online]. Available at http://www.brake.org.uk/safedrivingreports/15-facts-a-resources/facts/488-young-drivers-the-hard-facts [Accessed 8th January 2016] Department for Transport.(2015). Reported Road Casualties in Great Britain: Main Results 2014 [online]. Available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/463045/rrcgb2014-01.pdf [Accessed 8th January 2016]. Hurst, L.M. (2011). Deprivation. A review and exploratory analysis of fatalities and serious injury collisions in relation to deprivation: implications for practice [online] Available at https://www.cornwall.gov.uk/media/3625473/deprivation-reportfinal-3-.pdf [Accessed 14 th January 2016]. Office for National Statistics. (2015). Population Estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2014 [online]. Available at http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3a77-368259 [Accessed 8 th January 2016]. Public Health England. (2015). Public Health Outcomes Framework [online]. Available at http://www.phoutcomes.info/public-health-outcomesframework#page/3/gid/1000041/pat/6/par/e12000002/ati/102/are/e08000011/iid/11001/age/1/sex/4 [Accessed 8th January 2016]. World Health Organization. (2015). Road traffic injuries [online]. Available at http://www.who.int/mediacentre/factsheets/fs358/en/ [Accessed 14 th January 2016]. This work was commissioned by the Cheshire and Merseyside Public Health Intelligence Network. Local Authority Profile St Helens Page 10