December 1997

Persistently Increased Injury Mortality Rates in High-Risk Young Children

Author Affiliations

From the Division of General Pediatrics, Department of Pediatrics (Drs Scholer and Hickson), and the Department of Preventive Medicine (Mr Mitchel and Dr Ray), Vanderbilt University, Nashville, Tenn.

Arch Pediatr Adolesc Med. 1997;151(12):1216-1219. doi:10.1001/archpedi.1997.02170490042007

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