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Social Determinants of Health and Injury Among Children
Hunter Goodon1, Justin P Gawaziuk1, Brenda Comaskey1
1Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Adverse social determinants of child health, including rural living and parental involvement with the justice system, significantly increase the risk of pediatric injuries. Understanding these factors is crucial for developing targeted prevention programs.
Area of Science:
- Public Health
- Pediatric Medicine
- Social Epidemiology
Background:
- Pediatric physical injuries have profound, long-term impacts on child well-being.
- Social determinants of child health (SDoCH) are increasingly recognized as critical factors influencing health outcomes.
- Limited research exists on the specific SDoCH that elevate the risk of injury in children.
Purpose of the Study:
- To investigate the association between 14 identified SDoCH and the likelihood of pediatric injury.
- To quantify the increased odds of injury linked to specific adverse social determinants.
Main Methods:
- A population-based retrospective case-control study was conducted in Winnipeg, Canada.
- Hospitalized pediatric injury cases (≤17 years) were matched with uninjured controls.
- Conditional multivariate logistic regression analysis was employed to assess the impact of SDoCH.
Main Results:
- Rural area residence (aOR, 6.62), child protective care involvement (aOR, 1.43), being born to a teen mother (aOR, 1.34), parent criminal justice involvement (aOR, 1.27), and income assistance receipt (aOR, 1.13) were significantly associated with increased pediatric injury odds.
- The study included 9,853 injury cases and 49,442 controls.
- Demographics showed no significant differences, but both groups had a higher proportion in the lowest income quintile.
Conclusions:
- Several adverse social determinants of child health are linked to a higher risk of pediatric injury.
- Findings highlight the need for targeted interventions and injury prevention strategies addressing these social factors.
- This research provides valuable insights for public health policy and clinical practice aimed at protecting children.
Importance:
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.
Objective:
To examine the association between 14 social determinants of child health (SDoCH) and odds of pediatric injury.
Design, Setting, And Participants:
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.
Exposures:
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.
Main Outcomes And Measures:
Pediatric injury that required hospitalization. Analyses were conducted using conditional multivariate logistic regression modeling.
Results:
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.
Conclusions And Relevance:
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.
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