Determinants of pediatric injuries
S. M. Horwitz, H. Morgenstern, L. DiPietro and C. L. Morrison
Department of Epidemiology, Yale University School of Medicine, New Haven, CT 06510.
Injuries are an important health issue for children. Previous research,
however, has presented confusing and conflicting results on the
determinants of childhood injuries, particularly psychosocial predictors,
largely due to methodologic problems. The purpose of this analysis, based
on a prospective follow-up study of 532 children, was to identify factors
related to injuries encountered in a prepaid group practice during a
12-month period. Using logistic regression, we found four factors
independently associated with the risk of at least one treated injury: high
activity level, high rate of pediatric utilization for non-injury-related
visits during the follow-up period, occurrence of a treated injury during
the year preceding the follow-up period, and negative attitude toward
medical care providers by the child's mother. In addition, four factors
were found to be independent predictors of injuries judged severe enough to
always warrant medical care: occurrence of a treated injury in the
preceding year, high rate of pediatric utilization for non-injury-related
visits during the follow-up period, working more than 15 hours a week
outside the home by the child's mother, and more life events reported by
the mother for the year preceding the follow-up period. Since family
stressors are related specifically to the risk of more severe injuries,
which are unlikely to escape medical attention, we conclude that these
factors probably are related to the occurrence of common injuries of early
childhood and not exclusively to utilization behavior. We therefore suggest
that children from families with these characteristics be targeted for
injury prevention strategies.
