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Risk factors for long-bone fractures in children up to 5 years of age: a nested case-control study
Ruth Baker1, Elizabeth Orton2, Laila J Tata1
1Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK.
Insights
Younger maternal age, higher birth order, and maternal alcohol misuse are key risk factors for long-bone fractures in children under five. These findings help target injury prevention interventions to at-risk families.
Area of Science:
- Pediatric injury prevention
- Epidemiology of childhood fractures
- Public health interventions
Background:
- Long-bone fractures are a common childhood injury.
- Identifying risk factors is crucial for effective prevention strategies.
- Previous research has not fully elucidated risk factors in very young children.
Purpose of the Study:
- To identify specific risk factors for first long-bone fractures in children up to 5 years old.
- To provide evidence for prioritizing families for injury prevention programs.
- To inform targeted public health interventions for childhood injuries.
Main Methods:
- Population-based matched nested case-control study.
- Utilized The Health Improvement Network (THIN) UK primary care database (1988-2004).
- Assessed maternal, household, and child risk factors in 2456 cases and 23,661 matched controls.
Main Results:
- Increased odds of fracture associated with younger maternal age and higher birth order (4th+ born: OR 3.12).
- Children over 1 year old had significantly higher fracture odds (13-24 months: OR 4.09; 37+ months: OR 4.88).
- Maternal alcohol misuse history linked to increased fracture odds (OR 2.33).
Conclusions:
- Key risk factors for pediatric long-bone fractures include child's age (>1 year), birth order, younger maternal age, and maternal alcohol misuse.
- These identified factors can guide the prioritization of families and communities for injury prevention efforts.
- Evidence supports targeted interventions for high-risk populations to reduce childhood fractures.
Aim:
To investigate risk factors for first long-bone fractures in children up to 5 years old in order to provide evidence about which families could benefit from injury prevention interventions.
Methods:
Population-based matched nested case-control study using The Health Improvement Network, a UK primary care research database, 1988-2004. Maternal, household and child risk factors for injury were assessed among 2456 children with long-bone fractures (cases). 23,661 controls were matched to cases on general practice. Adjusted ORs and 95% CIs were estimated using conditional logistic regression.
Results:
Fractures of long-bones were independently associated with younger maternal age and higher birth order, with children who were the fourth-born in the family, or later, having a threefold greater odds of fracture compared to first-born children (adjusted OR 3.12, 95% CI 2.08 to 4.68). Children over the age of 1 year had a fourfold (13-24 months, adjusted OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, adjusted OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0-12 months. Children in families with a history of maternal alcohol misuse had a raised odds of long-bone fracture (adjusted OR 2.33, 95% CI 1.13 to 4.82) compared to those with no documented history.
Conclusions:
Risk factors for long-bone fractures in children less than 5 years old included age above 1 year, increasing birth order, younger maternal age and maternal alcohol misuse. These risk factors should be used to prioritise families and communities for injury prevention interventions.
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