Keenan Heather T, Marshall Stephen W, Nocera Mary Alice, Runyan Desmond K
Department of Social Medicine, University of North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7240, USA.
Am J Prev Med. 2004 Apr;26(3):189-93. doi: 10.1016/j.amepre.2003.10.023.
The incidence of child abuse following natural disasters has not been studied thoroughly. However, parental stress and decreased social support have been linked to increased reports of child maltreatment. We hypothesized that a large-scale natural disaster (North Carolina's Hurricane Floyd) would increase the incidence of inflicted traumatic brain injury (TBI) in young children.
An ecologic study design was used to compare regions affected to those regions unaffected by the disaster. Cases of inflicted TBI resulting in admission to an intensive care unit or death from September 1998 through December 2001 in North Carolina were ascertained. Poisson regression modeling was employed to calculate rate ratios of injury for each geographic area by time period.
Inflicted TBI in the most affected counties increased in the 6 months post-disaster in comparison to the same region pre-disaster (rate ratio 5.1, 95% confidence interval [CI]=1.3-20.4), as did non-inflicted TBI (rate ratio 10.7, 95% CI=2.0-59.4). No corresponding increased incidence was observed in counties less affected or unaffected by the disaster. The rate of inflicted injuries returned to baseline in the severely affected counties 6 months post-hurricane; however, the rate of non-inflicted injuries appeared to remain elevated for the entire post-hurricane study period.
Families are vulnerable to an elevated risk of inflicted and non-inflicted child TBI following a disaster. This information may be useful in future disaster planning.
自然灾害后虐待儿童的发生率尚未得到充分研究。然而，父母压力和社会支持的减少与虐待儿童报告的增加有关。我们假设一场大规模自然灾害（北卡罗来纳州的弗洛伊德飓风）会增加幼儿遭受创伤性脑损伤（TBI）的发生率。
采用生态学研究设计，比较受灾地区和未受灾地区。确定了1998年9月至2001年12月在北卡罗来纳州因遭受创伤性脑损伤而入住重症监护病房或死亡的病例。采用泊松回归模型计算每个地理区域在不同时间段的损伤率比。
与受灾前同一地区相比，受灾最严重的县在灾后6个月内遭受创伤性脑损伤的发生率有所增加（率比为5.1，95%置信区间[CI]=1.3 - 20.4），非遭受创伤性脑损伤的发生率也有所增加（率比为10.7，95%CI=2.0 - 59.4）。在受灾较轻或未受灾的县未观察到相应的发病率增加。飓风过后6个月，受灾严重的县遭受创伤的发生率恢复到基线水平；然而，在整个飓风后研究期间，非遭受创伤的发生率似乎仍然居高不下。
灾难后，家庭中儿童遭受创伤性脑损伤和非创伤性脑损伤的风险易升高。这些信息可能对未来的灾难规划有用。
