Associations Between Socioeconomic Position and Unintentional Injury: A Prospective Cohort Study of 70,226 15–24-Year-Old Danish Students

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PURPOSE: Injuries are a major cause of morbidity and mortality during adolescence. We examined how parental socioeconomic position in mid- and late adolescence is associated with risk of unintentional injury. METHODS: We followed 70,226 Danish adolescents aged 15-24 years from the Danish National Youth Cohort 2014 for 8 years using national registers. Injuries were identified via International Classification of Diseases, 10th Revision codes, and parental socioeconomic position was measured by education, income, and occupation. Poisson regression estimated absolute and relative injury risks, and the Pareto Principle was applied to identify a high-risk subgroup, assessing its association with parental socioeconomic position. RESULTS: Between 2014 and 2022, 28,233 adolescents sustained at least one unintentional injury (47,776 injuries in total), including 1,425 severe cases dominantly head trauma (62.4%). Upper/lower extremities and the head accounted for nearly 90% of all injuries. Injury rates were 15%-34% higher among the least advantaged adolescents compared to the most advantaged, and the risk curve reflected a dose-dependent gradient across income, education, and occupational status groups. Severe injuries showed a similar pattern, though not statistically significant. Notably, 11% of adolescents accounted for 50% of injury incidences, and those at the lower end of the social gradient were more likely to belong to this high-risk group experiencing repeated injury exposures. DISCUSSION: Socioeconomic inequalities in unintentional injury permeate the entire social gradient, suggesting structural inequities that ultimately result in a high-risk subgroup, accounting for 50% of all injuries. Evidence regarding causal explanations driving these inequalities as well as cost-effective measures to reduce inequalities is warranted.