Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992
C. D. Siegel, P. Graves, K. Maloney, J. M. Norris, B. N. Calonge and D. Lezotte
Community Health Services, Denver Department of Health and Hospitals, USA.
OBJECTIVES: To investigate the association between maternal age and other
risk factors and infant injury deaths in the state of Colorado from 1986 to
1992. DESIGN: A retrospective cohort design was used to compare rates of
unintentional and intentional infant injury mortality by maternal age
group. A case-control design explored the importance of various risk
factors, particularly maternal age, using multivariate logistic regression.
PARTICIPANTS: The 2 case groups comprised all unintentional and intentional
injury deaths in the first year of life. The control group was a random
sample of both survivors and noninjury deaths selected from the entire
birth cohort. RESULTS: The infant injury mortality rate for the 322766 live
births in Colorado from 1986 to 1992 was 3.1 per 10000. Intentional injury
death rates were highest for infants of teenaged mothers, peaking at 10.5
per 10000 live births for mothers aged 16 years. Unintentional injury death
rates were highest for infants of mothers aged 20 to 24 years, peaking at
3.7 per 10000 live births for 22-year-old mothers. For intentional injury
death, maternal marital status had a significant impact on maternal age;
compared with the baseline group of married mothers older than 24 years,
significantly higher risks were observed for infants of teenagers who were
married (odds ratio [OR] = 32.0; 95% confidence interval[CI], 9.9-104.0)
but also in infants of older mothers who were unmarried (OR = 3.6; 95% CI,
1.0-13.0 for unmarried mothers aged 20-24 years and (OR = 7.7; 95% CI,
2.4-25.0 for those > 24 years). Black race (OR = 3.5; 95% CI, 1.4-9.4)
was also associated with intentional injury death. For unintentional injury
death, the highest risk was for infants of mothers aged 20 to 24 years and
unmarried (OR = 3.9; 95% CI, 1.7-9.3). Risk was also elevated for infants
of married teenaged mothers (OR = 3.5; 95% CI, 0.7-17.8) but was not
significantly different from the baseline group for unmarried teenagers,
married 20- to 24-year-old mothers, or unmarried mothers aged 25 years or
older. Risk was increased by the presence of older siblings (OR = 1.5 per
sibling; 95% CI, 1.2-2.0). CONCLUSIONS: Maternal age and marital status
significantly affect the rate of both unintentional and intentional infant
injury mortality. These results suggest that child abuse prevention
strategies should be targeted to teenaged mothers, and that strategies
designed to prevent unintentional injuries should focus particularly on
parents or caretakers of infants born to unmarried mothers in their early
20s as well as married teenagers.
The relation between child death and child maltreatment.
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Arch. Dis. Child. 2006;91:265-269.
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Crume et al.
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Deaths Attributable to Injuries in Infants, United States, 1983-1991
Brenner et al.
Pediatrics 1999;103:968-974.
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Risk Factors for Infant Homicide in the United States
Overpeck et al.
NEJM 1998;339:1211-1216.
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