Social Determinants of Health and Injury Among Children

Pediatric physical injuries have lasting effects on child mental and physical health and social outcomes. Little is known about social determinants that increase the odds of injury in children.

To examine the association between 14 social determinants of child health (SDoCH) and odds of pediatric injury.

Population-based retrospective case-control study in Winnipeg, Canada. Cases (children aged ≤17 years admitted to the hospital from 2002 to 2019 with physical injuries) were linked to their mothers using a unique identifier and matched 1:5 on age, sex, and geographic region with uninjured controls from the general population. Data were analyzed from May 2023 to July 2024.

Fourteen SDoCH measured as present or absent from birth to date of injury: low-income neighborhood; rural status; receipt of income assistance; justice system involvement; parent with less than a high school education; social housing; having an immigrant parent; high residential mobility; being born to a teen mother; having a child in protective care; child mental health diagnosis; maternal axis I or axis II mental disorder; and maternal physical disorder.

Pediatric injury that required hospitalization. Analyses were conducted using conditional multivariate logistic regression modeling.

The final groups included 9853 cases and 49 442 controls for a total sample of 59 295. For cases at time of injury, the mean (SD) age was 9.8 (5.2) years, 6358 (64.5%) were male, 4688 (47.6%) lived in a rural area, and 3639 (36.9%) were low income. There were no significant differences between cases and controls for demographics; however, there was a greater proportion than expected of both groups in the lowest quintile. In the final multivariable model, rural area (adjusted odds ratio [aOR], 6.62; 95% CI, 4.62-9.47), having a child in protective care (aOR, 1.43; 95% CI, 1.31-1.55), being born to a teen mother (aOR, 1.34; 95% CI, 1.26-1.41), parent criminal justice system involvement (aOR, 1.27; 95% CI, 1.21-1.33), and receipt of income assistance (aOR, 1.13; 95% CI, 1.06-1.21) increased odds of pediatric traumatic injury.

In this retrospective case-control study, several adverse SDoCH were associated with increased odds of pediatric injury. These findings can inform targeted injury risk reduction programs.