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Table 5 Statistically significant (p < 0.05) neighborhood-level effects in final multilevel models for included studies

From: Neighborhood risk factors for sports and recreational injuries: a systematic review of studies applying multilevel modeling techniques

Study ID

Authors and year of publication

Estimated effects of significant neighborhood-level variables on SRI or total injuries including SRI in final multilevel model(s)

Summary of study's main findings

1

Haynes, Reading, Gale. 2003

Social area material deprivation was positively correlated with the risk of all injuries and serious injuries. The risk of all injuries and serious injuries increased by 4% for each unit increase in Townsend material deprivation score (ORall = 1.04, 95%CI = 1.02–1.06; ORserious = 1.04, 95%CI = 1.02–1.07)

Neighborhood material deprivation increased the risk of all injuries and serious injuries

2

Sellström, Guldbrandsson, Bremberg, Hjern & Arnoldsson. 2003

Few and average level of safety measures (lower safety index) were positively associated with higher hospital admissions rate for injuries in preschool-aged children. The odds of being admitted for injuries were greater by 20% (RRaverage = 1.20, 95%CI = 1.05–1.36) and 33% (RRfew = 1.33, 95%CI = 1.15–1.49) in municipalities with average and few safety measures, respectively, compared with those with many safety measures. In school-aged children, positive association was also observed between lower safety index and hospital admissions rate; however, the relationships were not statistically significant

Lower level of safety measures increased the risk of injuries for preschool-aged children

3

Kendrick, Mulvaney, Burton, & Watson. 2005

(1) Primary care attendance rates for injuries were 2.4 (RR = 2.41, 95%CI = 1.34–4.34) and 1.9 (RR = 1.92, 95%CI = 1.04–3.52) times greater in children living in the 3rd and 4th deprived quintile of wards per geographical access to services, respectively, than those living in the least deprived quintile of wards. However, the attendance rates for injuries were not significantly greater in children living in the 2nd (RR = 1.22, 95%CI = 0.65–2.29) and most deprived (5th) quintile (RR = 1.65, 95%CI = 0.90–3.03) of wards

(1) The relationship between neighborhood access to health care services and primary care attendance rates for injuries in children was n-shaped

(2) Accident and Emergency Department attendance rate for injuries (in model that included rented accommodation) increased by 2% for each additional increase in the parks and play areas per 1000 children < age 5 (RR = 1.02, 95%CI = 1.00–1.04)

(2) The rates of visiting Accident and Emergency Departments for injuries increased with higher number of parks and play areas in wards

(3) Hospital admission rates for injuries in model that included fitted stairgate were 5.2 (RR = 5.21, 95%CI = 1.52–17.90) and 4.5 (RR = 4.50, 95%CI = 1.32–15.40) times greater in children living in the 2nd and most deprived quarter of wards per child poverty index, respectively, than those living in the least deprived quarter of wards. Also, hospital admission rates for injuries in model that included smoke alarm were 7.0 (RR = 7.04, 95%CI = 2.07–23.94), 4.2 (OR = 4.23, 95%CI = 1.16–15.40) and 4.1 (RR = 4.13, 95%CI = 1.17–14.64) times greater in children living in the 2nd, 3rd, and most deprived quarter of wards per child poverty index, respectively, than those living in the least deprived quarter of wards. In addition, hospital admission rates for injuries in the fitted stairgate model increased by 14% (RR = 1.14, 95%CI = 1.03–1.27) for every percent increase in population experiencing violent crimes

(3) Hospital admission rates for injuries were higher in wards with higher child poverty index than those with lower index. Also, admission rates were higher in wards where a greater proportion of the population were experiencing violent crimes

4

Simpson, Janssen, Craig, & Pickett. 2005

(1) The odds of being hospitalized for injuries was 64% greater in schools' neighborhood with high (OR = 1.64, 95%CI = 1.04–2.61) and very high (OR = 1.64, 95%CI = 1.05–2.56) percentages of lone parent families compared with those with low percentage. Also, the odds of hospitalization for injuries was more than 2 times greater in schools' neighborhood with a very high percentage of population with less than a high school education compared with those with low percentage (OR = 2.11, 95%CI = 1.36–3.28)

Lower socioeconomic status increased the risk of injury hospitalization

(2) The odds of having sports/recreational injury were 20% (OR = 0.80, 95%CI = 0.67–0.96) and 19% (OR = 0.81, 95%CI = 0.68–0.97) lower in schools' neighborhood with medium and high average employment income, respectively, than those with very high average employment income

Higher socioeconomic status was associated with increased risk of sports/recreational injury among adolescents

5

Pattussi, Hardy, & Sheiham. 2006

The odds of having dental injuries in boys decreased by 45% (OR = 0.55, 95%CI = 0.32–0.81) per unit increase in neighborhood social capital index. The relationship was not significant in girls

Higher social capital index was protective against dental injuries in boys but not girls

6

Mecredy, Janssen, & Pickett. 2012

(1) The relative odds of being injured while playing in the street was not significantly greater in children living in neighborhoods with the highest, second to highest, and third to the highest quintile of parks/recreational facilities versus those living in neighborhoods with the lowest quintile. However, the relative odds of street injury was 69% greater in children living in neighborhoods with second to the lowest quintile of parks/recreational facilities (OR = 1.69, 95%CI = 1.05–2.71) versus those living in neighborhoods with the lowest quintile

Increased number of parks and recreational facilities was not associated with increased risk of street injury while playing

(2) The relative odds of being injured while biking/cycling in the street was more than two times greater in neighborhoods with low street connectivity (OR = 2.33, 95%CI = 1.28–4.25) versus those with high street connectivity

Lower street connectivity was associated with increased risk of biking/cycling injuries

7

Mutto, Lawoko, Ovuga, & Svanstrom. 2012

The odds of being injured was about 4 times (OR = 4.08, 95%CI = 1.12–18.67) and 7 times (OR = 6.85, 95%CI = 1.42–33.15) greater for students attending school in urban and peri-urban locations, respectively, than those attending school in rural location

Schools situated in urban and peri-urban locations increased risk of childhood and adolescent injuries when compared with those situated in rural locations

8

Gropp, Janssen & Pickett. 2012

Urban community status resulted in 1.64-fold increase in the relative odds of active transportation injury for students compared to rural community status (OR = 1.64, 95%CI = 1.14–2.36). Results of the association between neighborhood-level factors and walking/running and bicycling injuries were not reported

Living or attending schools in urban communities increased the risk of active transportation injuries for students

9

Byrnes, King, Hawe, Peters, Pickett & Davison. 2015

Lack of permanent road access lowered the risk of injury by 11% (RR = 0.89, 95%CI = 0.80–0.98)

Lack of access to road was protective against injury