Childhood deaths from injuries: trends and inequalities in Europe.

BACKGROUND: In 1998, a UNICEF report quantified the large East-West gap in Europe in child mortality from external causes (injuries and violence). In the past decade, much has changed in central and eastern Europe, economically, politically and socially. This study updates the earlier analysis, tracking changes in deaths from external causes in the different parts of Europe. METHODS: The WHO mortality database was used to examine mortality from external causes for children aged 1-14 years between 1993 and 2008, by country, European subregion and cause. RESULTS: Deaths from external causes have fallen in all of Europe since 1993. However, a clear east-west divide persists, with higher death rates in the former Soviet countries, especially the Commonwealth of Independent States (CIS). Trends in specific causes also vary geographically; the greatest overall declines have been in transport-related deaths, drowning, poisoning and 'other' external causes. Transport, drowning and 'other' remain the commonest external causes of death in childhood. CONCLUSION: Child injury mortality rates have fallen across Europe. In the former Soviet countries, this is likely to reflect improvements in living conditions since transition. Yet, large geographical inequalities remain, highlighting the need for enhanced measures to prevent injuries, particularly in the CIS countries and the Baltic states. However, except in a few countries, there is still little research on the nature of the problem or the effectiveness of potential interventions. Child deaths from injuries are avoidable and measures to reduce them would have a significant impact upon the overall burden of child mortality in Europe.