Socioeconomic and racial/ethnic factors affecting non-fatal medically attended injury rates in US children.

OBJECTIVE: Using a representative survey of US children, the purpose was to evaluate separate effects of socioeconomic and racial/ethnic factors, including access to care, on medically attended non-fatal injury rates. METHODS: Multivariate linear regression models were used to determine associations between injuries and health care coverage (insurance or Medicaid), having a place to go for care, race/ethnicity, maternal education, number of adults and children in the household, poverty, and urbanicity. The 1988 Child Health Supplement to the National Health Interview Survey included questions on medically attended injuries, and their cause, location, and effects on the child. Injury categories included total, consequential, occurrence at home or school, falls, and being struck or cut. RESULTS: Lack of health care coverage was consistently associated with lower medically attended injury rates in non-Hispanic blacks or whites and Mexican-Americans, but affected total rates for each group differently due to unequal distribution of health care coverage. Injuries occurred about 40% more frequently to children and adolescents living in single adult households compared with two adult homes for all injury categories except for injuries occurring at school. CONCLUSIONS: Preventive interventions targeted to specific populations based on assumptions that poverty, lack of education, or minority status result in greater risks for injuries require a closer look. Efficient targeting should address underlying factors such as differences in exposures and environments associated with single adult homes or recreational activities. Data sources used to target high risk populations for interventions need to address bias due to access to care.

[1]  T. Beattie,et al.  Socioeconomic status and adolescent injuries. , 1997, Social science & medicine.

[2]  P. F. Adams,et al.  Current estimates from the National Health Interview Survey, 1994. , 1995, Vital and health statistics. Series 10, Data from the National Health Survey.

[3]  M. Kogan,et al.  The effect of gaps in health insurance on continuity of a regular source of care among preschool-aged children in the United States. , 1995, JAMA.

[4]  P. Scheidt,et al.  Sports and recreation injuries in US children and adolescents. , 1995, Archives of pediatrics & adolescent medicine.

[5]  M. Overpeck,et al.  Medically attended nonfatal injuries among preschool-age children: national estimates. , 1995, American journal of preventive medicine.

[6]  M. Overpeck,et al.  The effect of US children's access to care on medical attention for injuries. , 1995, American journal of public health.

[7]  S. James.  John Henryism and the health of African-Americans , 1994, Culture, medicine and psychiatry.

[8]  L. McCaig,et al.  Epidemiology of injury-related visits to officebased physicians in the United States, 1991 , 1994 .

[9]  M. Durkin,et al.  Low-income neighborhoods and the risk of severe pediatric injury: a small-area analysis in northern Manhattan. , 1994, American journal of public health.

[10]  T. Laveist.  Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. , 1994, Health services research.

[11]  P. Scheidt,et al.  The effects of recall on estimating annual nonfatal injury rates for children and adolescents. , 1994, American journal of public health.

[12]  A. Kriska,et al.  The role of socioeconomic status and injury morbidity risk in adolescents. , 1994, Archives of pediatrics & adolescent medicine.

[13]  C. Henderson,et al.  Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? , 1994, Pediatrics.

[14]  L. Cornelius.  Barriers to medical care for white, black, and Hispanic American children. , 1993, Journal of the National Medical Association.

[15]  M. D. Nelson,et al.  Socioeconomic status and childhood mortality in North Carolina. , 1992, American journal of public health.

[16]  P. Scheidt,et al.  Parental alcohol use, problem drinking, and children's injuries. , 1992, JAMA.

[17]  S M Teutsch,et al.  Inconsistencies in coding of race and ethnicity between birth and death in US infants. A new look at infant mortality, 1983 through 1985. , 1992, JAMA.

[18]  D. Wagener,et al.  Injuries in working populations: black-white differences. , 1991, American journal of public health.

[19]  R. Hopkins,et al.  Risk factors for childhood homicides in Ohio: a birth certificate-based case-control study. , 1991, American journal of public health.

[20]  E. Menaghan,et al.  Determining Children's Home Environments: The Impact of Maternal Characteristics and Current Occupational and Family Conditions. , 1991 .

[21]  Martin Raw.  Racial and Ethnic Differences in Disease , 1990 .

[22]  F. Rivara,et al.  Environmental factors and the risk for childhood pedestrian-motor vehicle collision occurrence. , 1990, American journal of epidemiology.

[23]  D. Kalmuss,et al.  Barriers to prenatal care among low-income women in New York City. , 1990, Family planning perspectives.

[24]  E. Mcloughlin,et al.  The causes, cost, and prevention of childhood burn injuries. , 1990, American journal of diseases of children.

[25]  W. Manning,et al.  Prepaid group practice effects on the utilization of medical services and health outcomes for children: results from a controlled trial. , 1989, Pediatrics.

[26]  C. Schoenborn,et al.  Current estimates from the National Health Interview Survey. , 1988, Vital and health statistics. Series 10, Data from the National Health Survey.

[27]  J. Singer,et al.  Health Care Access and Use Among Handicapped Students in Five Public School Systems , 1986, Medical care.

[28]  M. R. Petit,et al.  Childhood death and poverty: a study of all childhood deaths in Maine, 1976 to 1980. , 1985, Pediatrics.

[29]  Phil A. Silva,et al.  Socio‐economic status and childhood injuries , 1983, Australian paediatric journal.

[30]  S P Azen,et al.  OBTAINING CONFIDENCE INTERVALS FOR THE RISK RATIO IN COHORT STUDIES , 1978 .

[31]  J. Dewey,et al.  50,000 child-years of accidental injuries. , 1966, Public health reports.

[32]  P. Newacheck,et al.  Children's access to primary care: differences by race, income, and insurance status. , 1996, Pediatrics.

[33]  Y. Harel,et al.  The health of youth. A cross-national survey. , 1996, WHO regional publications. European series.

[34]  M. Lillie-Blanton.  In the Nation's Interest: Equity in Access to Health Care: Project on the Health Care Needs of Hispanics and African Americans: Summary Report , 1995 .

[35]  K. Lui.  Confidence intervals for the risk ratio in cohort studies under inverse sampling , 1995 .

[36]  D F Stroup,et al.  Race and ethnicity in public health surveillance: criteria for the scientific use of social categories. , 1994, Public health reports.

[37]  R. Cooper,et al.  A case study in the use of race and ethnicity in public health surveillance. , 1994, Public health reports.

[38]  R. A. Wright,et al.  Current estimates from the National Health Interview Survey, 1993. , 1994, Vital and health statistics. Series 10, Data from the National Health Survey.

[39]  Overpeck,et al.  Effects of maternal education and access to medical care on analysis of injury risk according to patterns of child care. , 1993 .

[40]  George Comstock,et al.  Television and the American child , 1991 .

[41]  P. Ries.  Health of black and white Americans, 1985-87. , 1990, Vital and health statistics. Series 10, Data from the National Health Survey.

[42]  D. Reboussin,et al.  Use of medical care in the Rand Health Insurance Experiment. Diagnosis- and service-specific analyses in a randomized controlled trial. , 1986, Medical care.

[43]  D. Webster,et al.  The Injury Fact Book , 1984 .

[44]  C Rouquette,et al.  [Epidemiologic research]. , 1970, Bulletin de l'Institut national de la sante et de la recherche medicale.