Division of Emergency Medicine, Children's National Medical Center, Children's National Medical Center, Washington, DC 20010, USA.
J Investig Med. 2013 Mar;61(3):558-63. doi: 10.2310/JIM.0b013e318280a835.
Effects of neighborhood contextual features have been found for many diseases, including bone fractures in adults. Our study objective was to evaluate the association between neighborhood characteristics and pediatric bone fracture rates. We hypothesized that neighborhood indices of deprivation would be associated with higher fracture rates.
Pediatric bone fracture cases treated at a tertiary, academic, urban pediatric emergency department between 2003 and 2006 were mapped to census block groups using geographical information systems software. Fracture rates were calculated as fractures per 1000 children in each census block. Exploratory factor analysis of socioeconomic indicators was performed using 2000 census block data. Factor scores were used to predict odds of bone fracture at the individual level while adjusting for mean age, sex composition, and race/ethnicity composition at census block level using our sample data.
We analyzed 3764 fracture visits in 3557 patients representing 349 distinct census blocks groups. Fracture rates among census blocks ranged from 0 to 207 per 1000 children/study period. Logistic regression modeling identified 2 factors (race/education and large families) associated with increased fracture risk. Census variables reflecting African American race, laborer/service industry employment, long-term block group residence, and lower education levels strongly loaded on the race/education factor. The large families factor indicated the children-to-families ratio within the block group. The poverty factor was not independently associated with fracture risk.
Thus, neighborhood characteristics are associated with risk for fractures in children. These results can help inform translational efforts to develop targeted strategies for bone fracture prevention in children.
已经发现邻里环境特征对许多疾病都有影响，包括成年人的骨折。我们的研究目的是评估邻里特征与儿童骨折率之间的关系。我们假设，贫困邻里指数与更高的骨折率有关。
使用地理信息系统软件，将 2003 年至 2006 年间在一家三级学术性城市儿科急诊室治疗的儿童骨折病例与普查块组进行了映射。骨折率按每千名儿童中骨折人数计算。利用 2000 年普查块数据对社会经济指标进行了探索性因子分析。使用因子得分，在个体水平上预测骨折的几率，同时根据普查块级别的平均年龄、性别构成和种族/族裔构成进行调整，利用我们的样本数据。
我们分析了 3557 名患者的 3764 次骨折就诊，代表了 349 个不同的普查块组。普查块中的骨折率从 0 到每 1000 名儿童/研究期 207 不等。逻辑回归模型确定了与骨折风险增加相关的 2 个因素（种族/教育和大家庭）。反映非裔美国人种族、体力劳动者/服务业就业、长期块组居住和较低教育水平的普查变量强烈加载在种族/教育因素上。大家庭因素表明块组内的儿童与家庭的比例。贫困因素与骨折风险无关。
因此，邻里特征与儿童骨折风险相关。这些结果可以帮助为儿童骨折预防制定有针对性的策略提供信息。
