epidemiology

Statistical information regarding the extent of injury can be obtained from various sources. This section will outline available data for injury, homicide and self-inflicted wounds.

British Crime Survey

The British Crime Survey (2005) is an annual survey based on interviews with a randomly selected population in England and Wales, and the most recent study estimates that there were 2,412,000 violent incidents experienced by adults in 2004/5. 

There were 1,184,702 incidents of violent crime recorded by the police during the same period.  Of these, 19,425 were 'serious wounding' (including 'threat or conspiracy to murder' and 'wounding or other act endangering life' as well as grevious bodily harm (GBH)). 'Less serious wounding' incidents include 'common assaults' recorded by the police, and account for 62% of BCS violence. In accordance with guidance on charging individuals, assaults resulting in abrasions, minor bruising, swellings, reddening of the skin, superficial cuts or black eyes are classified as 'common assaults'. In 46% of the 'violent incidents', there was no injury, and incidents of wounding have been decreasing over the last decade.

Types of injuries sustained during violent incidents

The Home Office Homicide Index is currently being prepared, but the BCS indicates that there were 1,048 homicides recorded for 2002/2003, which includes those crimes attributed to Dr Harold Shipman (172 homicides). This represents an 18% increase on 2001/2002, or 157 cases, and thus the overall number of homicides excluding those attributed to Dr Shipman has actually fallen. 859 homicides were recorded during 2004/2005.

deaths from injury and poisoning 2001 (DH4 Series)

The National Statistics agency produces annual data on deaths from injury and poisoning for England and Wales, and the latest publication in their DH4 series relates to 2001 data (2003 National Statistics).

The total number of deaths from injury or poisoning recorded in England and Wales for 2001 was 16,569.

Trend in deaths from homicide and suicide from 1993-2000

Suicide was found to be the most common violent cause of death for men (34%), and the preferred method was hanging, strangulation or suffocation (44%).

homicide trends in England and Wales

The Office for National Statistics (as they were then known) produced an analysis of homicide data for England and Wales in 2000, which drew on data from a variety of sources. It noted that the number of homicides had steadily increased in these countries between 1950 and 1980, and had then begun to level off.

Homicide in England and Wales remains a relatively rare event – about 1 in 800 deaths and approximately 4.5% of all death due to injury or poisoning.

The highest rates of homicide are found in infants of both sexes, with the most frequent cause of death being skull fractures or intracranial injury (including haemorrhage), followed by suffocation/ strangulation.

A subsequent homicide peak is seen in young adults, particularly men in their 20’s, where those aged 20-24 represented 5.2% of homicide victims (1991-1995).

The number of suicides had increased by 30% in men aged 25-34 between the years 1983 and 1995.

The average number of homicides by sharp instrument, blunt instrument, hitting or kicking and shooting had all increased during the period 1993-1997, compared with 1979-1983, whilst the numbers of homicidal strangulation and burning had decreased. The largest absolute rise in homicides was attributed to sharp instrument use – 175 p.a. between 1979 and 1983, to 211 p.a. between 1993 and 1997.

Homicide by firearm had also increased dramatically – by 66% over the same period, but the absolute numbers per year are still relatively low (61 deaths p.a. between 1993 and 1997).

An interesting finding is that of the effect of social class on homicide data. Deaths from homicide, accidents, suicide and ‘undetermined injury’ are all inversely related to social class, and men of social class V (unskilled) between the ages of 20-64 are more than 12 times as likely to be killed than their counterparts in social class I.

The ONS also looked at the data produced by other countries, and found that the homicide rates are lower in Denmark, Netherlands, Norway and France, whilst the rates in England and Wales compare more favourably with those of the USA, Scotland, New Zealand, Israel, Australia and Canada.

The homicide rate in the USA is 6.5 times that of England and Wales, and the use of firearms accounts for 75% of the difference. This clearly reflects the ease of availability of firearms in that country.

homicides in Scotland

The Scottish Executive Justice Department has recently produced homicide data for 2001 (2002 Scottish Executive National Statistics), and they have identified 104 homicides – the same number as in 2000.

77% of victims were men (the majority being in the 16-29 and 30-39 years age groups).

Just under half of all homicides involved the use of a sharp instrument (46%).

75% of victims knew their assailant (23% killed by a relative, 56% killed by an acquaintance), and 89% of assailants were male.

56% of assailants were reported to have been either drunk or under the influence of drugs at the time of the assault, whilst 10% of victims were similarly ‘under the influence’.

knife crime and London

The Daily Telegraph, a broadsheet newspaper recently carried the story, ‘It’s official: Hackney is more dangerous than Soweto’, indicating that residents of the east-London borough of Hackney were more likely to be shot or stabbed than their counterparts in the troubled South African township (Flanagan 2002).

Homerton Hospital in Hackney was said to be treating 55 knife or gunshot wounds each month, and the trauma team was seeking guidance and teaching from accident and emergency specialists in Soweto.

Across London, the use of guns has increased as drug gangs vie for control of the lucrative ‘crack cocaine’ market. 30 people were killed during the period 2000-2001, compared to 16 the year before, and guns had been used in 7,362 crimes nationally in the same period.

The increased use of sharp instruments seen in the statistics above is reflected in the ‘knife culture’ of London and the country nationally. This was dramatically illustrated following the death of Damilola Taylor, a 10-year-old boy stabbed or slashed in the leg on a Peckham estate in South East London. The trend for younger and younger children to carry knives as protection or for ‘fun’ was highlighted by the media (McVeigh and Harris 2000).

Hocking had investigated assaults in Lewisham, South London in the late 1980’s, where he found that 77% of victims of violence attending the accident and emergency department were males and over half were between the ages of 16 and 26. However, the bulk of the injuries sustained were due to punching and kicking, with only 15% being injured by knives. Broken bottles accounted for an additional 9% of sharp force related injuries. 40% of all stabbings took place on the street, and 23% in pubs and clubs.

Iron bars and baseball bats were used in 21% of street assaults, whilst knives were used in 18%. Weapons used in pubs and clubs included knives (28%) and broken drinking glasses (25%).

The types of injury sustained included open wounds, most commonly, with the targets being the head, neck and face primarily, followed by the upper limbs. These sites of injury have been confirmed as being favoured targets in assaults by other researchers (Brink et al 1998 and Shephard et al 1990).

wounds presentation to Accident and Emergency departments

Wardrope and Smith (1992 p.5) highlighted the types of wounds presenting to accident and emergency departments in the UK, and they explain that 25-30% of the total emergency workload is injury related, accounting for an approximate of 3 million wounds and injuries in total, across the UK. The commonest wounds encountered are lacerations, followed by sharp force trauma and abrasions.

Approximate percentages of wounds presenting to accident and emergency departments in the UK (Wardrope and Smith 1992 p.5)

references

• Brink O., Vesterby A., Jensen J. (1998), ‘Pattern of injuries due to interpersonal violence’, Injury Vol. 29(9) pp.705-709
• Home Office Research Development Statistics (2006) British Crime Survey 2004/2005 (http://www.homeoffice.gov.uk/rds/crimeew0405.html)
• Flanagan J. (2002), ‘It’s official: Hackney is more dangerous than Soweto’, www.telegraph.co.uk/news/main.jhtml?xml=/news/2002/04/14/nhack14.xml
• Hocking M.A. (1989), ‘Assaults in south east London’, Journal of the Royal Society of Medicine Vol. 82 May 1989 pp.281-284
• McVeigh T., Harris P. (2000), ‘Damilola: a victim of Britain’s knife culture’, http://society.guardian.co.uk/socialcare/news/0,8372,409795,00.html
• National Statistics (2003), ‘Mortality Statistics – Deaths from injury and poisoning 2001’, National Statistics Series DH4 No. 26, July 2003
• Office for National Statistics (1999), ‘Recent trends in deaths from homicide in England and Wales’, Health Statistics Quarterly 03, Autumn 1999, Office for National Statistics
• Scottish Executive National Statistics (2002), ‘Homicides in Scotland in 2001 – Statistics published’, Scottish Executive Justice Department (Criminal Justice Division) November 2002
• Shephard J.P, Shapland M., Pearce N.X., Scully C. (1990), ‘Pattern, severity and aetiology in victims of assault’, Journal of the Royal Society of Medicine Vol 83 Feb 1990 pp.75-78
• Wardrope J., Smith J.A.R. (1992), ‘The Management of Wounds and Burns’, Oxford University Press