Tomashek Kay Marie, Hsia Jason, Iyasu Solomon
Maternal and Infant Health Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Pediatrics. 2003 May;111(5 Pt 2):1219-25.
Half of all postneonatal mortality (PNM; deaths among infants aged 28-364 days) in the United States is caused by potentially preventable causes such as sudden infant death syndrome, infections, and injuries. A detailed analysis of PNM attributable to injury has not been conducted and may provide useful data in prioritizing prevention strategies and targeting high-risk populations.
The authors used US infant death certificate data to analyze trends in PNM caused by injury during 1988-1998. Attending physicians, medical examiners, or coroners report cause of death on death certificates using a format specified by the World Health Organization and endorsed by the Centers for Disease Control and Prevention. The major causes of PNM by type of injury were evaluated, and trends were compared over time. Injury-related deaths per 100 000 live births were examined by race and region of residence. Rate ratios between black and white infants also were calculated.
Among major causes of PNM during the study period, injury mortality declined the least (13.0% decline; from 29.6 to 25.7 per 100 000 live births). All types of unintentional injury deaths declined except for mechanical suffocation rates, which increased from 4.8 to 7.1. Homicide rates increased slightly (8.5%) from an 11-year low in 1988 and accounted for a greater proportion of all PNM caused by injury by 1998 (27.5% in 1998, 22.1% in 1988). Overall, PNM rates attributable to injury declined less among blacks (8.7%) than whites (13.6%) during the study period, and rates were on average 2.6 times higher among black infants (range: 2.4-3.0). Unintentional injury declined less among blacks (15.4%) than among whites (24.9%), in part because of an increase in motor vehicle crash-related mortality rates among black infants. Although black infants were more than 3 times as likely to be a victim of homicide than white infants (range: 3.0-4.4), increases in homicide rates were similar among black infants (9.9%) and white infants (10.6%) from 1988 through 1998. Racial disparities in PNM attributable to injury varied by region. PNM rates attributable to injury increased only among black infants residing in the Midwest (10.2%) and West (27.7%) as a result of increases in unintentional injury (ie, motor vehicle crash-related deaths in the West and mechanical suffocation in the Midwest) and homicide rates in these regions. Homicide rates increased among all infants regardless of race, except for infants residing in the Northeast.
Overall PNM rates attributable to injury declined, yet rates of mechanical suffocation increased and large regional and racial disparities persisted. Death certificates have limited information to help explain the observed differences. Because injuries are frequently preventable, prevention strategies should encourage formation of infant and child death review teams to help identify community and system factors that may contribute to injury deaths. Health care providers can assist parents in providing a safe environment for infants by counseling on age-appropriate injury prevention as part of their anticipatory guidance and serving as child advocates. Additional studies should examine regional differences in death investigation practices, case ascertainment, and reporting of deaths attributed to intentional injuries.
在美国，所有出生28天至364天婴儿的新生儿后期死亡率（PNM）中有一半是由诸如婴儿猝死综合征、感染和伤害等潜在可预防原因导致的。尚未对归因于伤害的PNM进行详细分析，而这可能为确定预防策略的优先顺序和针对高危人群提供有用数据。
作者利用美国婴儿死亡证明数据来分析1988 - 1998年间由伤害导致的PNM趋势。主治医生、法医或验尸官使用世界卫生组织规定并经疾病控制与预防中心认可的格式在死亡证明上报告死因。按伤害类型评估了PNM的主要原因，并比较了随时间的趋势。按种族和居住地区检查了每10万例活产中与伤害相关的死亡数。还计算了黑人与白人婴儿之间的比率。
在研究期间PNM的主要原因中，伤害死亡率下降最少（下降13.0%；从每10万例活产29.6例降至25.7例）。除机械窒息率从4.8升至7.1外，所有类型的意外伤害死亡均下降。杀人率从1988年的11年低点略有上升（8.5%），到1998年在所有因伤害导致的PNM中所占比例更大（1998年为27.5%，1988年为22.1%）。总体而言，在研究期间，归因于伤害的PNM率在黑人中（8.7%）的下降幅度小于白人（13.6%），并且黑人婴儿的比率平均高出2.6倍（范围：2.4 - 3.0）。黑人中意外伤害的下降幅度（15.4%）小于白人（24.9%），部分原因是黑人婴儿中与机动车碰撞相关的死亡率上升。尽管黑人婴儿成为杀人受害者的可能性是白人婴儿的3倍多（范围：3.0 - 4.4），但从1988年到1998年，黑人婴儿（9.9%）和白人婴儿（10.6%）的杀人率上升幅度相似。归因于伤害的PNM中的种族差异因地区而异。由于意外伤害（即西部与机动车碰撞相关的死亡以及中西部的机械窒息）和这些地区杀人率的上升，仅居住在中西部（10.2%）和西部（27.7%）的黑人婴儿中归因于伤害的PNM率有所上升。除居住在东北部的婴儿外，所有种族的婴儿杀人率均上升。
总体而言，归因于伤害的PNM率下降了，但机械窒息率上升，并且存在较大的地区和种族差异。死亡证明提供有限信息以帮助解释观察到的差异。由于伤害通常是可预防的，预防策略应鼓励组建婴儿和儿童死亡审查小组，以帮助识别可能导致伤害死亡的社区和系统因素。医疗保健提供者可以通过在其预期指导中就适合年龄的伤害预防提供咨询并充当儿童权益倡导者，协助父母为婴儿提供安全环境。更多研究应检查死亡调查实践、病例确定以及故意伤害导致死亡的报告方面的地区差异。
