Knife crime, defined by British law, is a crime involving a knife or a sharp instrument to harm, threaten or hurt others. In the United Kingdom (UK), knife-enabled crimes encompass various forms including aggravated assault, threats, robbery, and homicide. Knife crime victims are individuals who are subjected to such violent exposure and are often associated with young males in deprived areas. Since 2014, the UK has seen a clear and consistent rise in violent crimes and offences caused by sharp instruments. Therefore, knife crime is a public health issue.
Exposure to knife crime is associated with health problems and mortality, manifesting through mental, physical, and social health outcomes. Current literature exposes the mental health determinants of knife crime victims such as anxiety, depression, Post-Traumatic Stress Disorder (PTSD) and other mental health disorders. Physical health outcomes include mobility loss, organ damage, infections and pain. Previous studies that used ‘Trauma Audit Research Network’ captured the overall and reported the correlation between knife crime exposure and physical outcomes.
However, the lack of research on health outcomes including physical, mental and social of knife crime victims portrays a critical gap in understanding the nature and ramifications of knife crime in the UK population. Therefore, we aim to explore Hospital Episode Statistics (HES) and GP-linked datasets on a wider scale and provide a truer depiction of the health burden of knife crime in the UK. Understanding this better will be able to inform policymakers on more effective prevention strategies, resource allocation and public awareness.
Aims: 1) Explore the prevalence and incidence of knife crime and 2) to describe the burden of health in patients who are deemed to be a victim of knife crime
Population and data sources: All patients who contribute to CPRD GOLD, AURUM and linked HES admitted patient data between 1st January 2001 to 1st January 2022
Exposure: Victim of knife-enabled crime including use of any other sharp object.
Outcomes (relevant to aim 2): The risk of developing a variety of health outcome including physical, social and mental.
Study Design: 1) Annual incidence rates will be calculated by dividing the number of eligible patients, who for the first time meet the knife crime victim exposure criteria (numerator) by the total number of person-years at risk (denominator) for the given year. 2) Annual point prevalence will be the proportion of knife crime victims on 1 January each year of the study. 3) We propose to undertake a series of population-based retrospective open cohort studies to explore the risk of such negative consequences following exposure to knife-enabled crime. We will calculate the incidence rate of each outcome of interest and where suitable use a Cox proportional Hazard model to describe risk.
Intended benefits: 1) Improve estimation of the health burden of knife crime victims to support commissioners and policy makers and 2) to highlight the estimated associated health burden and identify particular condition which could aid targeted preventative approaches to support knife crime victims.
Objective 1: Epidemiology of knife crime victim
• Annual incidence rate per million person years will be calculated
• Annual prevalence per million population will be calculated
To avoid any risk of reidentification we will not undertake sub-group analyses by demography or otherwise. Additionally, we will only present aggregate level details about the cohorts across the full time period.
Objective 2: Outcomes of knife crime victims
We aim to explore the risk of all health outcomes including physical, mental and social, in accordance to the WHO definitions and the Global Burden of Health (1,2). We aim to explore the risk of mental health outcomes and cardiometabolic diseases, in accordance to the WHO definitions and the Global Burden of Health (1,2). Our study will prioritise mental health outcomes as primary outcomes and cardiometabolic disease as secondary outcomes. Mental health outcomes include the following conditions below:
· Depression disorders
· Anxiety disorders
· Mood disorders
· Psychotic disorders
· Eating disorders
· Post-Traumatic Stress Disorders (PTSD)
· Obsessive-Compulsive Disorders (OCD)
· Attention-Deficit/Hyperactivity Disorders (ADHD)
· Personality disorders
· Substance use disorders
· Suicide
· fibromyalgia
Chronic fatigue syndrome
Cardiometabolic disease includes the following conditions below:
· Coronary heart disease
· Stroke
· Hypertension (high blood pressure)
· Diabetes mellitus (type 2)
· Obesity
· Dyslipidaemia
· Metabolic syndrome
· Heart failure
· Peripheral artery disease (PAD)
· Atrial fibrillation
Joht Singh Chandan - Chief Investigator - University of Birmingham
Joht Singh Chandan - Corresponding Applicant - University of Birmingham
Illin Gani - Collaborator - University of Birmingham
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation