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Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data

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  • Elizabeth Orton
  • Denise Kendrick
  • Joe West
  • Laila J Tata

Abstract

Background: Injuries in childhood are largely preventable yet an estimated 2,400 children die every day because of injury and violence. Despite this, the factors that contribute to injury occurrence have not been quantified at the population scale using primary care data. We used The Health Improvement Network (THIN) database to identify risk factors for thermal injury, fractures and poisoning in pre-school children in order to inform the optimal delivery of preventative strategies. Methods: We used a matched, nested case-control study design. Cases were children under 5 with a first medically recorded injury, comprising 3,649 thermal injury cases, 4,050 fracture cases and 2,193 poisoning cases, matched on general practice to 94,620 control children. Results: Younger maternal age and higher birth order increased the odds of all injuries. Children’s age of highest injury risk varied by injury type; compared with children under 1 year, thermal injuries were highest in those age 1-2 (OR = 2.43, 95%CI 2.23–2.65), poisonings in those age 2-3 (OR = 7.32, 95%CI 6.26–8.58) and fractures in those age 3-5 (OR = 3.80, 95%CI 3.42–4.23). Increasing deprivation was an important modifiable risk factor for poisonings and thermal injuries (tests for trend p≤0.001) as were hazardous/harmful alcohol consumption by a household adult (OR = 1.73, 95%CI 1.26–2.38 and OR = 1.39, 95%CI 1.07–1.81 respectively) and maternal diagnosis of depression (OR = 1.45, 95%CI 1.24–1.70 and OR = 1.16, 95%CI 1.02–1.32 respectively). Fracture was not associated with these factors, however, not living in single-adult household reduced the odds of fracture (OR = 0.88, 95%CI 0.82–0.95). Conclusions: Maternal depression, hazardous/harmful adult alcohol consumption and socioeconomic deprivation represent important modifiable risk factors for thermal injury and poisoning but not fractures in preschool children. Since these risk factors can be ascertained from routine primary care records, pre-school children’s frequent visits to primary care present an opportunity to reduce injury risk by implementing effective preventative interventions from existing national guidelines.

Suggested Citation

  • Elizabeth Orton & Denise Kendrick & Joe West & Laila J Tata, 2012. "Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-8, April.
  • Handle: RePEc:plo:pone00:0035193
    DOI: 10.1371/journal.pone.0035193
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    References listed on IDEAS

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    1. Reading, Richard & Langford, Ian H. & Haynes, Robin & Lovett, Andrew, 1999. "Accidents to preschool children: comparing family and neighbourhood risk factors," Social Science & Medicine, Elsevier, vol. 48(3), pages 321-329, February.
    2. Shenassa, E.D. & Stubbendick, A. & Brown, M.J., 2004. "Social Disparities in Housing and Related Pediatric Injury: A Multilevel Study," American Journal of Public Health, American Public Health Association, vol. 94(4), pages 633-639.
    3. Reading, Richard & Jones, Andrew & Haynes, Robin & Daras, Konstantinos & Emond, Alan, 2008. "Individual factors explain neighbourhood variations in accidents to children under 5 years of age," Social Science & Medicine, Elsevier, vol. 67(6), pages 915-927, September.
    4. Haynes, Robin & Reading, Richard & Gale, Susan, 2003. "Household and neighbourhood risks for injury to 5-14 year old children," Social Science & Medicine, Elsevier, vol. 57(4), pages 625-636, August.
    5. Kendrick, Denise & Mulvaney, Caroline & Burton, Paul & Watson, Michael, 2005. "Relationships between child, family and neighbourhood characteristics and childhood injury: A cohort study," Social Science & Medicine, Elsevier, vol. 61(9), pages 1905-1915, November.
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    1. Elizabeth Orton & Denise Kendrick & Joe West & Laila J Tata, 2014. "Persistence of Health Inequalities in Childhood Injury in the UK; A Population-Based Cohort Study of Children under 5," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.

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