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Changing epidemiology of injury-related pediatric mortality in a rural state: implications for injury control
T K Rausch1, N D Sanddal, T L Sanddal
1University of Washington, Seattle, USA.
Insights
Pediatric injury deaths in rural Montana have shifted, with significant increases in suicide and firearm-related fatalities. These trends highlight the urgent need for targeted public health and injury prevention strategies in rural communities.
Area of Science:
- Public Health
- Epidemiology
- Injury Prevention
Background:
- Pediatric injury-related deaths pose a significant public health challenge, particularly in rural settings.
- Understanding temporal trends in injury mortality is crucial for effective intervention development.
Purpose of the Study:
- To document the current epidemiology of pediatric injury-related deaths in a rural state.
- To evaluate changes in pediatric injury mortality patterns over time.
Main Methods:
- Retrospective review of pediatric injury deaths (age < 15) in Montana (1989-1992).
- Data sources included death certificates, coroner, autopsy, prehospital, and hospital records.
- Analysis of injury mechanisms, demographics, toxicology, and safety device use, compared with earlier data (1980-1985).
Main Results:
- Motor vehicle crashes were the leading cause of injury death, followed by drowning and firearm-related injuries.
- A notable increase in suicide deaths (3.2 vs 0.8 per 100,000) and unintentional firearm injury deaths (2.3 vs 0.6 per 100,000) was observed.
- Firearm-related injuries, both intentional and unintentional, represented a substantial proportion of pediatric deaths.
Conclusions:
- The epidemiology of rural pediatric injury deaths has evolved, with a concerning rise in suicide and firearm-related fatalities.
- Firearm-related violent deaths are approaching the magnitude of all other causes combined.
- Findings underscore the need for enhanced public health education and tailored injury control strategies for rural populations.
Study Objective:
To document the current epidemiology of pediatric injury-related deaths in a rural state and evaluate changes over time.
Design:
Retrospective review of injury-related deaths in children less than 15 years of age. Data were obtained from death certificates and coroner, autopsy, prehospital, and hospital records. Analysis was done of the mechanism of injury, age, sex, race, location of incident, toxicology, and safety device use. Comparisons with analogous data collected from an earlier time period were made.
Setting:
The state of Montana, from October 1989 to September 1992.
Measurements:
Deaths per 100,000 population, intentionality of injury, mechanism of injury, use of protective devices, and comparisons with previous data (1980-1985) collected by Baker and Waller (Childhood injury: State by state mortality facts. Baltimore: Johns Hopkins Injury Prevention Center, 1989;148-152).
Results:
Of 121 patients reviewed, 56% were male and 44% were female. Mean age was 7.0 years (median, 8.0). Eighty-one percent of patients were Caucasian, and 16% were Native American. The leading cause of injury was motor vehicle crashes, which was followed by drowning, unintentional firearm injuries, deaths related to house fires, homicides, and suicides. Overall, 87% of injuries were unintentional and 13% were intentional, with 62% of these suicides and 38% homicides. When considered independently of intent, firearm-related injuries ranked second. Earlier data showed motor vehicle crashes ranking second, unintentional firearm injuries seventh, and homicide fourth. Comparison of death rates per 100,000 people for the two time periods showed increases in suicide deaths (3.2 vs 0.8) and unintentional firearm injury deaths (2.3 vs 0.6).
Conclusion:
The epidemiology of rural pediatric injury-related deaths has changed. Deaths related to suicide and firearms have increased. Violent deaths related to injuries caused by firearms are at a magnitude approaching all other causes. These findings have implications for public health education and injury control strategies in rural areas.