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Persistently increased injury mortality rates in high-risk young children
S J Scholer1, G B Hickson, E F Mitchel
1Department of Pediatrics, Vanderbilt University, Nashville, Tenn., USA.
Insights
Injury mortality rates for high-risk young children in Tennessee have not significantly decreased over 18 years. The disparity in injury deaths between high-risk and low-risk children has widened.
Area of Science:
- Pediatric Injury Prevention
- Public Health Surveillance
- Childhood Mortality Trends
Background:
- Injury remains a leading cause of death in young children.
- Identifying risk factors for injury mortality is crucial for targeted interventions.
- Previous studies have highlighted disparities in child injury outcomes.
Purpose of the Study:
- To analyze trends in injury mortality among young children (0-4 years) in Tennessee.
- To compare injury mortality rates between low-risk and high-risk children.
- To assess the impact of maternal risk factors on child injury mortality over time.
Main Methods:
- Utilized birth and death certificates for Tennessee children aged 0-4 years (1978-1995).
- Classified children into low- and high-risk groups based on maternal education, age, and parity.
- Calculated injury mortality rates for six 3-year periods for both groups.
Main Results:
- High-risk children, representing 28% of child-years, experienced significantly higher injury mortality rates (48.9/100,000) compared to low-risk children (16.8/100,000).
- While low-risk children saw a slight decrease in injury mortality, high-risk children experienced a sharp increase in the 1993-1995 period.
- The disparity in excess injury deaths per 100,000 widened considerably, particularly in the later study years.
Conclusions:
- Maternal factors (education, age, parity) reliably identify children at elevated risk of injury mortality.
- No substantial reduction in injury mortality has been observed for high-risk young children in Tennessee over the study period.
- The widening disparity underscores the need for focused injury prevention strategies for high-risk populations.
Objective:
To study trends in injury mortality for low- and high-risk young children.
Design And Methods:
For Tennessee children 0 to 4 years of age, we used birth certificates to obtain data on maternal education, age, and parity; these risk factors were used to classify children into low- and high-risk groups. The outcome was death from injury, as determined from linked death certificates. Between 1978 and 1995, injury mortality rates were calculated for six 3-year periods for low- and high-risk children.
Results:
There were 1.5 million children 0 to 4 years of age who contributed 4.9 million child-years. The high-risk group contributed 28% of all child-years. There were 673 injury deaths in the high-risk group, 48.9 deaths per 100,000 child-years, and 586 deaths in the low-risk group, 16.8 deaths per 100,000 child-years. The injury mortality rate for low-risk children decreased from 20.7 to 15.7 per 100,000 child-years between the 1978-1980 and 1981-1983 periods; thereafter it remained relatively stable. For high-risk children, the injury mortality rate decreased from 50.9 to 43.5 per 100,000 between the 1978-1980 and 1981-1983 periods, remained mostly unchanged through 1992, and then increased sharply in the 1993-1995 period to 64.1 per 100,000 child-years. The disparity between high- and low-risk children widened from 29.3 (95% confidence interval, 25.1-33.5) excess deaths per 100,000 for 1978 through 1991 to 46.9 (95% confidence interval, 35.9-57.9) in 1993 through 1995.
Conclusions:
In Tennessee, maternal education, age, and parity consistently identified a population of children at increased risk of injury mortality. For these high-risk children, there has been no substantial reduction in injury mortality in high-risk young children during the last 18 years.