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Persistently Increased Injury Mortality Rates in High-Risk Young Children

Seth J. Scholer, MD, MPH; Gerald B. Hickson, MD; Edward F. Mitchel Jr, MS; Wayne A. Ray, PhD
Arch Pediatr Adolesc Med. 1997;151(12):1216-1219. doi:10.1001/archpedi.1997.02170490042007.
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Objective:  To study trends in injury mortality for low-and high-risk young children.

Design and Methods:  For Tennessee children o 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 100000 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 100000 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.Arch Pediatr Adolesc Med. 1997;151:1216-1219


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