Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London WC1N 1EH, UK.
J Epidemiol Community Health. 2010 Feb;64(2):161-6. doi: 10.1136/jech.2009.092643. Epub 2009 Nov 24.
In recent decades the proportion of infants and young children being cared for in childcare has increased. Little is known about the impact that non-parental care has on childhood unintentional injury and whether this varies by socioeconomic group.
Using data from a contemporary UK cohort of children at age 9 months (N = 18 114) and 3 years (N = 13 718), Poisson regression was used to explore the association between childcare type (parental, informal, formal) and the risk of unintentional injury, overall and by socioeconomic group.
At age 9 months there was no overall association between childcare and injury. However, when stratifying the analyses, infants from higher socioeconomic groups were less likely to be injured if they were cared for in formal childcare (compared with being cared for only by a parent), whereas those from lower social groups were more likely to be injured. At age 3 years informal childcare was associated with an increased risk of injury overall; in the stratified analyses this increased risk occurred only in less affluent groups. Formal childcare was no longer associated with injury at age 3 in any strata.
Previous findings have shown that childcare can have a positive influence on childhood injury; however, a recent Unicef report highlighted that a lack of access to high-quality childcare could lead to a widening of inequalities. Our analyses indicate that childcare does have the potential to widen inequalities in injury; further research is required to understand why childcare has a differential impact on unintentional injury and how this might be prevented.
近几十年来，在儿童保育机构中照顾的婴幼儿和幼儿比例有所增加。人们对非父母照顾对儿童意外伤害的影响知之甚少，也不知道这种影响是否因社会经济群体而异。
利用来自英国当代儿童队列的 9 个月（n=18114）和 3 岁（n=13718）儿童的数据，采用泊松回归分析了儿童保育类型（父母、非正式、正式）与意外伤害风险之间的关系，包括总体风险和按社会经济群体分层的风险。
9 个月时，儿童保育与伤害之间没有总体关联。然而，在分层分析中，来自较高社会经济群体的婴儿如果在正规儿童保育机构（与仅由父母照顾相比）中受到照顾，受伤的可能性较小，而来自较低社会群体的婴儿受伤的可能性较大。3 岁时，非正式儿童保育与总体伤害风险增加有关；在分层分析中，这种风险增加仅发生在不太富裕的群体中。在任何分层中，3 岁时正规儿童保育不再与伤害相关。
先前的研究结果表明，儿童保育可以对儿童伤害产生积极影响；然而，最近联合国儿童基金会的一份报告强调，缺乏获得高质量儿童保育的机会可能导致不平等加剧。我们的分析表明，儿童保育确实有可能扩大伤害方面的不平等；需要进一步研究以了解为什么儿童保育对意外伤害有不同的影响，以及如何预防这种情况。
