Goodon Hunter, Gawaziuk Justin P, Comaskey Brenda, Afifi Tracie O, Château Dan, Brownell Marni, Sareen Jitender, Morgan Cora, Logsetty Sarvesh, Spiwak Rae
Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
JAMA Netw Open. 2025 Jun 2;8(6):e2513584. doi: 10.1001/jamanetworkopen.2025.13584.
Pediatric physical injuries have lasting effects on child mental and physical health and social outcomes. Little is known about social determinants that increase the odds of injury in children.
To examine the association between 14 social determinants of child health (SDoCH) and odds of pediatric injury.
DESIGN, SETTING, AND PARTICIPANTS: Population-based retrospective case-control study in Winnipeg, Canada. Cases (children aged ≤17 years admitted to the hospital from 2002 to 2019 with physical injuries) were linked to their mothers using a unique identifier and matched 1:5 on age, sex, and geographic region with uninjured controls from the general population. Data were analyzed from May 2023 to July 2024.
Fourteen SDoCH measured as present or absent from birth to date of injury: low-income neighborhood; rural status; receipt of income assistance; justice system involvement; parent with less than a high school education; social housing; having an immigrant parent; high residential mobility; being born to a teen mother; having a child in protective care; child mental health diagnosis; maternal axis I or axis II mental disorder; and maternal physical disorder.
Pediatric injury that required hospitalization. Analyses were conducted using conditional multivariate logistic regression modeling.
The final groups included 9853 cases and 49 442 controls for a total sample of 59 295. For cases at time of injury, the mean (SD) age was 9.8 (5.2) years, 6358 (64.5%) were male, 4688 (47.6%) lived in a rural area, and 3639 (36.9%) were low income. There were no significant differences between cases and controls for demographics; however, there was a greater proportion than expected of both groups in the lowest quintile. In the final multivariable model, rural area (adjusted odds ratio [aOR], 6.62; 95% CI, 4.62-9.47), having a child in protective care (aOR, 1.43; 95% CI, 1.31-1.55), being born to a teen mother (aOR, 1.34; 95% CI, 1.26-1.41), parent criminal justice system involvement (aOR, 1.27; 95% CI, 1.21-1.33), and receipt of income assistance (aOR, 1.13; 95% CI, 1.06-1.21) increased odds of pediatric traumatic injury.
In this retrospective case-control study, several adverse SDoCH were associated with increased odds of pediatric injury. These findings can inform targeted injury risk reduction programs.
儿童身体损伤对儿童的身心健康及社会发展有着持久影响。对于增加儿童受伤几率的社会决定因素，人们了解甚少。
探讨14种儿童健康社会决定因素（SDoCH）与儿童受伤几率之间的关联。
设计、背景和参与者：基于人群的回顾性病例对照研究，在加拿大温尼伯市开展。病例（2002年至2019年因身体损伤入院的17岁及以下儿童）通过唯一标识符与他们的母亲建立联系，并在年龄、性别和地理区域方面与来自普通人群的未受伤对照按1:5进行匹配。数据于2023年5月至2024年7月进行分析。
从出生到受伤日期测量的14种SDoCH，包括：低收入社区；农村地区；接受收入援助；司法系统介入；父母教育程度低于高中；社会住房；有移民父母；高居住流动性；青少年母亲生育；有儿童处于保护性监护；儿童心理健康诊断；母亲患有轴I或轴II精神障碍；以及母亲身体疾病。
需要住院治疗的儿童损伤。分析采用条件多变量逻辑回归模型。
最终样本包括9,853例病例和49,442例对照，共计59,295例。受伤时病例的平均（标准差）年龄为9.8（5.2）岁，6,358例（64.5%）为男性，4,688例（47.6%）居住在农村地区，3,639例（36.9%）为低收入人群。病例组和对照组在人口统计学方面无显著差异；然而，两组中处于最低五分位数的比例均高于预期。在最终的多变量模型中，农村地区（调整优势比[aOR]，6.62；95%置信区间[CI]，4.62 - 9.47）、有儿童处于保护性监护（aOR，1.43；95% CI，1.31 - 1.55）、青少年母亲生育（aOR，1.34；95% CI，1.26 - 1.41）、父母司法系统介入（aOR，1.27；95% CI，1.21 - 1.33）以及接受收入援助（aOR，1.13；95% CI，1.06 - 1.21）均增加了儿童创伤性损伤的几率。
在这项回顾性病例对照研究中，几种不良的SDoCH与儿童受伤几率增加相关。这些发现可为针对性的伤害风险降低项目提供参考。
