National Programme for Prevention and Control of Non-Communicable Diseases, Ministry of Health, Colombo, Sri Lanka.
Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
BMC Public Health. 2022 Sep 26;22(1):1825. doi: 10.1186/s12889-022-14154-0.
Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb fractures are common in adolescents due to various risk factors. Many injuries are predictable and can be prevented by identifying the risk factors. The aim of the study was to determine the risk factors for upper limb fractures among adolescents in Sri Lanka.
A case control study was undertaken with 450 cases and 450 controls. Cases were recruited consecutively from all major hospitals among the adolescent victims who had admitted with newly diagnosed upper limb fractures in the district of Colombo. Controls were apparently healthy adolescents from the same district and excluded who had previous upper limb fractures. The age and gender were not matched in selecting controls since these two factors were potential risk factors for adolescent fractures according to previous literature. Risk factors for upper limb fractures were assessed by odds ratio (OR) with 95% confidence interval (CI) and adjusted for possible confounding by performing logistic regression analysis.
The mean age of the cases was 13.62 years with a Standard Deviation (SD) of 2.8 and controls was 12.75 years (SD = 2.7) respectively. Having a high standard of living index (OR = 3.52; 95%CI: 2.3-5.2, p < 0.001), being in a high social class category (social class I & II) (OR = 2.58, 95%CI: 1.7-3.92, p < 0.001), engage in physical or sports activity (OR = 9.36; 95%CI: 3.31-26.47, p < 0.001), watching television (OR = 1.95; 95%CI: 1.18 -3.22, p = 0.009), playing video or computer games (OR = 2.35; 95%CI: 1.7-3.24, p < 0.001), and attending extra classes (OR = 1.82; 95%CI: 1.2-2.7, p = 0.007) were risk factors for having a upper limb fracture. Risk factors for upper limb fractures following adjusted for confounders were siblings in the family (aOR = 11.62, 95% CI: 6.95-41.29, p = 0.03) and attend extra classes after school hours (aOR = 2.51, 95%CI: 0.68-0.93, p = 0.04). Two significant effect modifications between being a Buddhist and low standard of living index (p < 0.001) and having one sibling in the family and attend extra classes after school hours (p = 0.01) were observed.
Modifiable risk factors in relation to lifestyle factors and socioeconomic position were important determinants of upper limb fracture risk in adolescents. Many fractures can be prevented by strengthening awareness programmes in the community.
在青少年中，伤害是发病率和死亡率的首要原因。青少年骨折是斯里兰卡一个隐藏的公共卫生问题。由于各种风险因素，上肢骨折在青少年中很常见。许多伤害是可以预测的，可以通过识别风险因素来预防。本研究的目的是确定斯里兰卡青少年上肢骨折的危险因素。
采用病例对照研究，病例为科伦坡地区所有主要医院新诊断为上肢骨折的青少年患者，连续招募；对照组为同一地区无既往上肢骨折的健康青少年，排除病例。由于年龄和性别是青少年骨折的潜在危险因素，因此在选择对照组时未对其进行匹配。通过比值比（OR）及其 95%置信区间（CI）评估上肢骨折的危险因素，并通过进行逻辑回归分析调整可能的混杂因素。
病例组的平均年龄为 13.62 岁，标准差（SD）为 2.8，对照组为 12.75 岁（SD=2.7）。生活水平指数高（OR=3.52；95%CI：2.3-5.2，p<0.001）、社会阶层高（社会阶层 I 和 II）（OR=2.58，95%CI：1.7-3.92，p<0.001）、参加体育活动（OR=9.36；95%CI：3.31-26.47，p<0.001）、看电视（OR=1.95；95%CI：1.18-3.22，p=0.009）、玩视频或电脑游戏（OR=2.35；95%CI：1.7-3.24，p<0.001）和参加课外辅导班（OR=1.82；95%CI：1.2-2.7，p=0.007）是上肢骨折的危险因素。在校外参加额外课程（aOR=2.51，95%CI：0.68-0.93，p=0.04）和有兄弟姐妹（aOR=11.62，95%CI：6.95-41.29，p=0.03）是上肢骨折的危险因素。
与生活方式因素和社会经济地位相关的可改变危险因素是青少年上肢骨折风险的重要决定因素。通过加强社区宣传活动，可以预防许多骨折。
