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Deaths attributable to injuries in infants, United States, 1983-1991
R A Brenner1, M D Overpeck, A C Trumble
1National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
Insights
Infant injury deaths are linked to sociodemographic factors, with risks varying by cause. Identifying high-risk groups is crucial for targeted interventions to prevent infant mortality.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- Infant injury death is a significant public health concern in the United States.
- Understanding specific risk factors associated with various external causes of death is essential for developing targeted prevention strategies.
Purpose of the Study:
- To identify and describe sociodemographic risk factors for infant injury death.
- To analyze these risk factors in relation to specific external causes of infant death.
Main Methods:
- Analysis of US-linked birth/infant death files from 1983-1991.
- Case-control study design utilizing birth certificate data for maternal and infant factors.
- Multivariate analyses to assess the independent effect of potential risk factors.
Main Results:
- Leading causes of infant injury death include homicide, suffocation, motor vehicle crashes, and choking.
- Increased rates of homicide and mechanical suffocation were observed, while fire and choking deaths decreased.
- Maternal factors such as lack of prenatal care, low maternal education, and young maternal age were associated with increased injury death risk.
Conclusions:
- Sociodemographic characteristics significantly influence infant injury-related mortality.
- The association between risk factors and infant death varies by the specific cause of death.
- Identifying high-risk infant subgroups is critical for implementing effective, cause-specific interventions.
Objective:
To describe risk factors for injury death among infants in the United States by the specific external cause of death.
Methods:
Data were analyzed from the US-linked birth/infant death files for the years 1983-1991. Potential risk factors for injury death were identified from birth certificate data and included both maternal and infant factors. Injury rates were calculated by external cause of death. Characteristics of infants who died from an injury were compared with those of the entire birth cohort. The independent effect of potential risk factors was assessed in multivariate analyses using a case-control study design.
Results:
A total of 10 370 injury deaths were identified over the 9-year study period (29. 72/100 000 live births). The leading causes of death were homicide, suffocation, motor vehicle crashes, and choking (inhalation of food or objects). There was no significant temporal trend in the overall rate of injury death; however, this was because significant increases in the rates of death from homicide (6.4%/year) and mechanical suffocation (3.7%/year) were offset by decreases in rates of death from fires (-4.7%/year) and choking (-4.6%/year). In adjusted analyses, infants born to mothers with no prenatal care, <12 years of education, two or more previous live births, Native American race, or <20 years of age were at twice the risk of injury death compared with the lowest risk groups (initiation of prenatal care in the first trimester, >/=16 years of education, no previous live births, white, or >/=25 years of age). When analyzed by the specific cause of death, the factors that were associated most strongly with death varied. For example, Native Americans were at greatest risk of a motor vehicle related death (compared with whites: OR: 3.6; 95% CI: 1.8-7.1), and infants with birth weights of <1500 g were at greatest risk of death attributable to inhalation of food (compared with >/=2500 g: OR: 9.6; 95% CI: 3.3-28.0) or objects (OR: 11.8; 95% CI: 4.5-30.5).
Conclusion:
A number of sociodemographic characteristics are associated with an increased risk of injury-related death in infants. The strength of associations between specific risk factors and death varies with the external cause of death, thus identifying high-risk subgroups for targeting of cause-specific interventions and simultaneously increasing our understanding of the individual and societal mechanisms underlying these tragedies.