Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; and.
Pediatrics. 2020 Nov;146(5). doi: 10.1542/peds.2019-3009. Epub 2020 Oct 20.
Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States.
We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality.
We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]).
There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.
道路交通伤害是导致美国儿童死亡的主要原因。尽管这在国家和州层面已经得到了研究，但在县一级获取信息以指导地方政策更有价值。我们旨在估计美国县际道路交通伤害导致的儿童死亡率。
我们查询了 2010-2017 年的伤亡分析报告系统数据库，以获取在车祸后 30 天内死亡的道路交通伤害事故。我们纳入了所有<15 岁的因汽车事故受伤致死的儿童。我们估计了县际年龄和性别标准化死亡率。我们评估了创伤中心的可用性和县城的城乡分类对死亡率的影响。
我们纳入了 9271 例儿童死亡。其中，45%的儿童在事故现场死亡。中位年龄为 7 岁。总体死亡率为每 10 万儿童 1.87 例。县际死亡率范围为每 10 万儿童 0.25 至 21.91 例。县内有创伤中心与死亡率降低相关（成人创伤中心[比值比（OR）：0.59；95%可信区间（CI）：0.52-0.66]；儿科创伤中心[OR：0.56；95%CI：0.46-0.67]）。与大城市中心都会县相比，欠发达县城的死亡率更高（非核心县[OR：2.33；95%CI：1.85-2.91]）。
美国各县的道路交通伤害导致的儿童死亡率存在显著差异。我们的研究结果可以指导在儿童死亡率过高且创伤救治机会有限的高风险县城采取有针对性的公共卫生干预措施。
