May 9, 1997

Study links childhood risk of death by injury with parental education

Study links childhood risk of death by injury with parental education

A child's risk of death from injury is greatly increased if his or her mother has less than a high school education, is younger than 20, and has more than two other children, a new study shows.

The analysis by a Children's Hospital pediatrician and collaborators from Vanderbilt's Department of Preventive Medicine may help guide the development of injury prevention efforts targeting children considered to be at high risk.

Dr. Seth J. Scholer, assistant professor of Pediatrics, recently presented the findings at the joint annual meeting of the Ambulatory Pediatric Association, the Society of Pediatric Researchers and the American Pediatric Society in Washington, D.C.

"When you consider the causes of mortality among children, injuries are certainly right at the top," Scholer said. "From a public health standpoint, it's a very important issue."

The researchers obtained data from state death certificates of all children ages 4 and under who died from injuries between Jan. 1, 1985 and Dec. 31, 1994. There were 803 deaths from injury during that 10-year period.

They then matched that data with sociodemographic information included in those children's birth certificates and U.S. Census data.

Factors analyzed included mother's age, education, address, race, income and amount of prenatal care, as well as the child's gender and whether he or she had been born prematurely.

Their analysis found that a mother's level of education, age, and number of children were most strongly associated with an increased risk of death from injury, Scholer said.

"Neither race nor income was significantly associated with injury mortality after we controlled for other factors," he said.

The researchers then classified the 803 deaths according to maternal education, maternal age and number of other children. They found that the children in the highest risk category had a mortality rate 15 times that of children in the lowest risk group.

The lowest risk group represented 18 percent of the total population of children studied. The researchers calculated that if the injury mortality rate for all children were equal to that of the lowest risk group, 614 of the deaths — 75 percent — would not have occurred.

"We now have evidence that there are rather large disparities between high- and low-risk children and that high-risk children can

be relatively easily identified based on three easily obtainable sociodemographic factors," Scholer said.

The paper does not speculate as to why maternal age, education and number of children are associated with an increased risk, but Scholer said he suspected that attention to detail — or lack of it — is a factor.

"Many injuries occur because of lack of attention to details," he said. "Education likely increases a mother's attention to details related to her child's environment. A mother caring for four or five children generally cannot pay as close attention to her children as a mother of one or two children."

The researchers next plan to examine risk of mortality for various types of injury, such as fires. They also believe it would be worthwhile to analyze non-fatal injuries; however, that data is not as accessible and would have to come from numerous sources, including hospitals, emergency rooms and clinics.

"Our long-term goal would be to develop an injury prevention program that targets high-risk children and can be shown to reduce the number of injuries in those groups," Scholer said.

Scholer's collaborators were Wayne A. Ray, Ph.D., professor of Preventive Medicine, and Edward F. Mitchel, a programmer in the department of Preventive Medicine. Their findings will be published in the September issue of the journal Pediatrics.