Searching for preventable causes of child mortality in Texas: trends in the major causes from 1987 through 1996.

We ranked the underlying causes of child deaths in Texas from 1989 through 1991 for the groups aged 1 through 4, 5 through 9, 10 through 14, and 15 through 19 years. External causes (injuries) accounted for 66% of child deaths, and 5 accounted for at least 100 deaths each: motor vehicle accidents, homicide, suicide, drowning, and burns. Of the deaths that had potential for primary prevention, more than 95% involved accidents, suicide, and homicide. Of the smaller number of deaths that had potential for secondary prevention, treatment of infectious conditions had the greatest potential. From 1987 through 1996, child deaths from all causes averaged 2498 per year. Natural causes averaged 871 per year; external causes averaged 1627 per year. Among the external causes, annual averages for accidents were 1089 deaths; for motor vehicle accidents, 703; for homicide, 334; and for suicide, 187. We used linear regression analyses to estimate trends in deaths and mortality rates. The only categories that experienced an increased number of deaths, despite a 12% increase in the population, were deaths from all causes in the adolescent age groups; from natural causes in all but the group aged 1 through 4 years; from external causes in the adolescent age groups; from suicide in all but the group aged 1 through 4 years; and from homicide in all age groups. The increased number of deaths was often lower than the increase in the population, resulting in lower mortality rates. The only mortality rates that increased were those from all causes in the group aged 15 through 19 years; from natural causes, in both adolescent age groups; from suicide, in the group aged 10 through 14 years; and from homicide, in all but the group aged 5 through 9 years. These trends suggest that primary prevention of child deaths in Texas should focus on external causes, particularly motor vehicle accidents, homicides, and suicides.