Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
BMJ Open. 2021 Oct 11;11(10):e053179. doi: 10.1136/bmjopen-2021-053179.
Previous studies have investigated the association between socioeconomic characteristics and fractures among children, producing different results. In a population-based study, we previously found an increased risk of fractures among children living in an urban municipality compared with rural municipalities. This study aimed to evaluate the importance of socioeconomic variables for the incidence of fractures among 0-17 year olds.
SETTING, DESIGN AND OUTCOME MEASURE: We present a longitudinal, observational study of a population 0-17 years of age. Data from an injury database were linked with additional socioeconomic data for the population at risk. These were 55 758 individuals residing within the primary catchment area of a regional hospital in northern Sweden. Using the number of fractures as the outcome, we fitted a generalised linear mixed model for a Poisson response with socioeconomic variables at the family level as independent variables while controlling for age, sex and place of residence.
We found a significant association between higher levels of family income and the risk of fracture, rate ratio 1.40 (1.28-1.52) p<0.001 when comparing the highest income quintile to the lowest as well as the number of siblings and the risk of fracture. Children with one or two siblings had a rate ratio of 1.28 (1.19-1.38) p<0.001 when compared with children with no siblings. Parents' educational level and having a single parent showed no significant association with fractures. The previously observed association between municipalities and fracture risk was less pronounced when taking family-level socioeconomic variables into account.
Our results indicate that children from families with higher income and with siblings are at greater risk of sustaining fractures.
先前的研究已经调查了社会经济特征与儿童骨折之间的关系，得出了不同的结果。在一项基于人群的研究中，我们之前发现与农村相比，居住在城市自治市的儿童骨折风险增加。本研究旨在评估社会经济变量对 0-17 岁儿童骨折发病率的重要性。
背景、设计和结果测量：我们呈现了一项 0-17 岁人群的纵向观察性研究。从伤害数据库中获取的数据与风险人群的其他社会经济数据相关联。这些数据来自瑞典北部一家地区医院的主要集水区内的 55758 名个体。使用骨折数量作为结果，我们拟合了一个广义线性混合泊松响应模型，以家庭层面的社会经济变量为自变量，同时控制年龄、性别和居住地。
我们发现家庭收入水平与骨折风险之间存在显著关联，在比较最高收入五分位数与最低收入五分位数时，收入比为 1.40（1.28-1.52），p<0.001，当比较有一个或两个兄弟姐妹的儿童与没有兄弟姐妹的儿童时，其收入比为 1.28（1.19-1.38），p<0.001。父母的教育水平和单亲家庭与骨折风险无显著关联。当考虑家庭层面的社会经济变量时，先前观察到的自治市与骨折风险之间的关联变得不那么明显。
我们的结果表明，来自高收入家庭和有兄弟姐妹的儿童骨折风险更大。
