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Temporal trend of pediatric fracture epidemiology in Thailand: a nationwide study 2018-2024
Nattakarn Numsriskulrat1, Chatchai Suesirisawad2, Ratikorn Chaisiwamongkol3
1Division of Academic Affairs and Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
Pediatric fracture epidemiology in Asian countries is limited. Using a nationwide claims database (2018-2024), we demonstrated lower fracture incidence in Thai vs. Western children. Incidence was higher in males and adolescents. Incidence fell during COVID-19 then rebounded, resulting in non-significant overall change. Forearm fractures and traffic injuries were prominent.
Purpose:
Data on pediatric fracture epidemiology in Thailand remain limited. We aimed to examine 7-year trends in fracture incidence among Thai children and adolescents.
Methods:
Fractures recorded in the National Health Security Office (NHSO) claims database from 2018 to 2024 were identified using ICD-10 codes. Fracture incidence in individuals aged < 20 years was calculated per 10,000 person-years among NHSO-insured population. Temporal trends were summarized using annual percent change (APC).
Results:
We identified 787,866 fractures among 569,819 individuals. The median annual age-standardized incidence rate (ASIR) was 88.1 per 10,000 person-years (range, 76.5-90.6), with a median (Q1-Q3) male-to-female incidence rate ratio (IRR) of 2.6 (2.5-2.6). Forearm fractures were the most common (31%). Incidence increased gradually with age in females but rose sharply in males, with the greatest sex difference during adolescence (IRR, 3.35 [95% CI: 3.32-3.38]). Transportation injuries (37%) and falls (35%) were the leading causes of fractures. ASIR declined during 2018-2022 (APC -4.2%/year, 95% CI: -6.5% to -2.0%) and increased during 2022-2024 (APC 9.6%/year, 95% CI: 4.5%-14.9%), resulting in an overall stable trend (average APC 0.15%/year, 95% CI: -1.27%-1.59%).
Conclusions:
Fracture incidence among the Thai pediatric population was lower than that reported from Western countries and remained relatively constant during 2018-2024. Incidence was highest in male adolescents, with traffic accident being the major contributor. Strengthening targeted prevention, particularly traffic-safety interventions, should be a national priority to reduce pediatric fracture burden in Thailand.
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