Injury mortality in American Indian, Hispanic, and non-Hispanic white children in New Mexico, 1958-1982

Factors Associated with Increased Risk for Acute Unintentional Childhood Poisoning among Children Living on the U.S.-Mexico Border

This study evaluated prevalence of unsafe storage of toxic products and evaluated the association of demographic-socio-cultural variables with risk of young-child exposure to household poisons. Interviews were conducted with 698 low-income caregivers living on the U.S./Mexico border. Multiple-ordinal regression was used to analyze associations between very unsafe storage of toxic products and household factors. At least one toxic product was accessible to children in 49.4% of households and 18.5% of these households' stored substances very unsafely in that products were accessible and stored either in non-original containers or without childproof caps. At-risk households were associated with U.S.-born caregivers who were single, employed, and live in more U.S. acculturated communities. These homes stored an increased number of toxins and were more likely to house a smoker. U.S./Mexico border childhood poisoning prevention programs should focus on potentially acculturated families with personal and household characteristics akin to the U.S. mores and customs.

Injury mortality rates in Native and non-Native children: a population-based study

OBJECTIVES

To examine injury mortality rates in Native and non-Native children in the province of Alberta, Canada, over a 10-year period, temporal trends in injury mortality rates (Native vs. non-Native), as well as relative risks of injury mortality (Native vs. non-Native) by injury mechanism and intent, were calculated.

METHODS

An observational, population-based study design was used. Mortality data were obtained from provincial vital statistics, with injury deaths identified using external injury codes (E-codes). The relative risk (RR) of injury mortality (Native vs. non-Native) along with 95% confidence intervals (CIs) were calculated. Stratified analyses and Poisson regression modeling were used to calculate adjusted relative risk.

RESULTS

Injury mortality rates declined over the study period, with no difference in the rate of decline between Native and non-Native children. The adjusted relative risk for all-cause injury death (Native vs. non-Native) was 4.6 (95% CI 4.1 to 5.2). The adjusted relative risks (Native vs. non-Native) by injury intent categories were: unintentional injuries, 4.0 (95% CI 3.5 to 4.6); suicide, 6.6 (95% CI 5.2 to 8.5); and homicide, 5.1 (95% CI 3.0 to 8.5). Injury mortality rates were consistently higher for Native children across all injury mechanism categories. The largest relative risks (Native vs. non-Native) were pedestrian injury (RR = 17.0), accidental poisoning (RR = 15.4), homicide by piercing objects (RR = 15.4), and suicide by hanging (RR = 13.5).

CONCLUSION

The burden of injury mortality is significantly greater in Native children compared with non-Native children. Therefore, injury prevention strategies that target both intentional and unintentional injuries are needed.

Childhood trauma fatality and resource allocation in injury control programs in a developing country

Background

Only a few studies have addressed the trimodal distribution of childhood trauma fatalities in lesser developed countries. We conducted this study to evaluate pre-hospital, Emergency Department (ED) and in-hospital distribution of childhood injury-related death for each mechanism of injury in Tehran, Iran. This information will be used for the efficient allocation of the limited injury control resources in the city.

Methods

We used Tehran's Legal Medicine Organization (LMO) database. This is the largest and the most complete database that receives information about trauma fatalities from more than 100 small and large hospitals in Tehran. We reviewed all the medical records and legal documents of the deceased registered in LMO from September 1999 to September 2000. Demographic and injury related characteristics of the children 15 years old or younger were extracted from the records.

Results

Ten percent of the 4,233 trauma deaths registered in LMO occurred among children 15 years old or younger. Motor vehicle crashes (MVCs) (50%), burns (18%), falls (6%) and poisonings (6%) were the most common mechanisms of unintentional fatal injuries. Prehospital, emergency department and hospital deaths comprised 42%, 20% and 37% of the trauma fatalities, respectively. While, more than 80% of fatal injuries due to poisoning and drowning occurred in prehospital setting, 92% of burn-related fatalities happened after hospital admission.

Conclusion

Injury prevention is the single most important solution for controlling trauma fatalities due to poisoning and drowning. Improvements in the quality of care in hospitals and intensive care units might substantially alleviate the magnitude of the problem due to burns. Improvements in prehospital and ED care might significantly decrease MVC and falls-related fatalities.

Child and adolescent suicide deaths in New Mexico, 1990-1994

The suicide death rate in New Mexico is consistently higher than the national rate. Among adolescents, suicide is the third leading cause of death nationally, but in New Mexico it is the second leading cause of death. This study describes the pattern of adolescent suicide deaths in New Mexico. We conducted a retrospective review of all medical examiner autopsies for adolescent suicides (ages 20 years and younger) in New Mexico from 1990-1994. Records were reviewed for demographics and possible contributing factors such as depression, previous attempts, and alcohol and drug use. We identified 184 suicide deaths among children and adolescents ages 9-20 years for an overall rate of 12.9 per 100,000. Our rates for ages 5-9 years (0.2), 10-14 years (3.8), and 15-19 years (22.3) are over twice the U. S. rates. Suicide deaths resulted primarily from firearms (67%), hanging (16%), poisoning (6%), inhalation (4%), and other methods (7%). Method varied by ethnicity (p = .01) and gender (p = .03); males and non-Hispanic Whites were overrepresented among firearm deaths. Firearm ownership was known in 60 (48%) of the firearm deaths. Of these, 53% of the firearms belonged to a family member, 25% to the decedent, and 22% to a friend. Over one-third of decedents (41%) experienced mental disorders, primarily depressed mood and clinical depression. Previous suicide attempts were noted for 15% of the decedents. Some 50% of the decedents had alcohol or drugs present at the time of death; among American Indians/Alaska Natives, 74% had drugs or alcohol present (p = .003). Targeted interventions are needed to reduce adolescent suicide in New Mexico. We suggest raising awareness about acute and chronic contributing factors to suicide; training physicians to look for behavioral manifestations of depression; and involving physicians, teachers, and youth activity leaders in efforts to limit firearm accessibility, such as advising parents to remove firearms from their households.

Hospitalization for motor vehicle injuries among American Indians and Alaska Natives in Washington

OBJECTIVE

Little is known about the epidemiology of hospitalization for motor vehicle injury among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest. Current secondary data sources are inadequate to track this significant health problem. The purpose of this study was to determine the rate of hospitalization for motor vehicle injury in this population through linkage of Indian Health Service (IHS) patient registration data to a statewide hospital discharge database.

METHODS

To create the numerator, IHS patient registration data were linked to Washington State hospital discharge abstracts from 1990 to 1994 for motor vehicle injury (ICD-9 E-codes 810-819). The denominator for this population was derived from the total number of IHS enrollees in 1992. Comparative numerator and denominator data for all residents were derived from the discharge database and Washington State intercensal population estimates, respectively.

RESULTS

AI/ANs experienced a nearly two-fold higher rate of motor vehicle injury hospitalization (N = 588) compared to all residents [Incidence Ratio (I.R.): 1.82; 95% C.I. 1.52-2.19]. The greatest disparity in incidence rates occurred among 25-34 year olds (I.R. 2.18; 95% C.I. 1.53-3.10) and 35-44 year olds (I.R. 2.18; 95% C.I. 1.36-3.47). In-hospital mortality, severity of injury and length of stay were not different between the 2 groups. Median charges for American Indian hospitalizations were $6188 and the IHS was payer in, at most, 24% of hospitalizations.

CONCLUSIONS

AI/ANs are at higher risk of hospitalization for motor vehicle injuries but, compared to all residents of Washington, appear to have similar severity of injuries and outcomes. Motor vehicle injury hospitalization among AI/ANs incurs substantial health care costs.

Demographic risk factors for injury among Hispanic and non-Hispanic white children: an ecologic analysis

OBJECTIVES

To determine the effects of neighborhood levels of poverty, household crowding, and acculturation on the rate of injury to Hispanic and non-Hispanic white children.

SETTING

Orange County, California.

METHODS

An ecologic study design was used with census block groups as the unit of analysis. Measures of neighborhood poverty, household crowding, and acculturation were specific to each ethnic group. Poisson regression was used to calculate mutually adjusted incidence rate ratios (IRRs) corresponding to a 20% difference in census variables.

RESULTS

Among non-Hispanic white children, injury rates were more closely associated with neighborhood levels of household crowding (adjusted IRR 2.36, 95% confidence interval (CI) 1.22 to 4.57) than with neighborhood poverty (adjusted IRR 1.06, 95% CI 0.89 to 1.26). For Hispanic children, the strongest risk factors were the proportion of Hispanic adults who spoke only some English (compared with the proportion who spoke little or no English, adjusted IRR 1.26, 95% CI 1.04 to 1.53) and the proportion who were US residents for < 5 years (adjusted IRR 1.20, 95% CI 1.001 to 1.43). Neighborhood levels of household crowding were not related to injury among Hispanic children (adjusted IRR 0.98, 95% CI 0.89 to 1.08), but surprisingly, neighborhood poverty was associated with lower injury rates (adjusted IRR 0.89, 95% CI 0.81 to 0.97).

CONCLUSIONS

Cultural and geographic transitions, as well as socioeconomic differences, appear to contribute to differences in childhood injury rates between ethnic groups.

Farm-related injury mortality in New Mexico, 1980-91

To compare the epidemiology of farm with non-farm occupational injury deaths, we reviewed state medical examiner data for all occupational injury deaths in New Mexico from 1980 to 1991. We identified 53 farm-related injury deaths for a rate of 21.3 per 100,000 worker-years. Farm workers were four times more likely than non-farm workers to die from occupational injury. American Indians had the highest farm injury death rate. Farm decedents were older than non-farm decedents (t498 = 6.29, p < 0.0001). Half of the farm decedents were 50 years of age or older; one-third were 60 years of age or older. Crush injuries accounted for half of all farm injury deaths including 18 of 23 motor vehicle deaths, half of these involving a tractor rollover. One in six farm injury deaths were from electrocution: one in five involved alcohol. Our study indicates that New Mexico has high farm-related injury mortality related to tractor use, alcohol intoxication, farm animals, and exposure to electricity. American Indians and older males are especially susceptible to these factors.

Motor-vehicle crash fatalities among American Indians and non-Indians in Arizona, 1979 through 1988

OBJECTIVES

This study evaluated the contributions of rural residence, alcohol use, and pedestrian fatalities to the high American Indian motor-vehicle crash mortality rate in Arizona.

METHODS

Records from the Fatal Accident Reporting System were used to examine mortality rates between 1979 and 1988.

RESULTS

American Indians had increased relative risks in all motor-vehicle crash categories in all residence-gender groups. The percentage of excess mortality associated with alcohol varied from 36.8% to 66.7%, and the percentage associated with pedestrian deaths ranged from 27.2% to 55.4%.

CONCLUSIONS

Efforts to reduce excess motor-vehicle crash mortality among American Indians should concentrate on preventing pedestrian and alcohol-related fatalities.

Safe at home? Domestic violence and other homicides among women in New Mexico

STUDY OBJECTIVE

To define the contribution of domestic violence (DV) to homicides in women in New Mexico and to examine differences in ethnicity, mechanism, previous documented injuries, incidence of sexual assault, and use of alcohol or illicit drugs between DV- and non-DV-related homicides.

METHODS

We carried out a retrospective analysis of reports of the state office of the medical investigator (OMI) reports from all female homicides from 1990 to 1993 in New Mexico. A homicide was defined as being related to DV if the perpetrator was a current or former male intimate partner. The chi-squared and Mann-Whitney tests were used to analyze data.

RESULTS

The OMI investigated 134 homicides in women for an overall fatality rate of 4.3 per 100,000. A male intimate partner was the perpetrator in 62 cases (46%). The rate of DV homicide among American Indians (4.9 per 100,000) was significantly higher than that among Hispanics (1.7) and non-Hispanic whites (1.8)(RR=2.8; 95% confidence interval (CI), 1.5 to 5.1). Firearms were almost two times as likely to be used in DV homicides as in non-DV homicides (RR=1.8; 95% CI, 1.2 to 2.6). Evidence of old injuries was found more often in DV homicide cases (35.5%) than in non-DV cases (83%) (RR=4.3; 95% CI, 1.8 to 9.8). The presence of alcohol or other drugs was higher among non-DV homicide victims (69%) than DV homicide victims (54.3%) (P=.03).

CONCLUSION

American Indian women are at particularly high risk of homicide, including DV homicide. Firearms were overrepresented in DV homicides, suggesting that removing firearms from the homes of previous DV perpetrators would be a useful public health strategy. Alcohol or illicit drugs were found in approximately two thirds of New Mexico women who were victims of homicide. The high prevalence of history of previous injuries among DV homicide victims indicates that early identification of DV victims in the emergency department and other health care settings is an important point of intervention.

Occupational injury mortality in New Mexico

STUDY OBJECTIVE

To examine specific risks for occupational injury deaths in New Mexico.

DESIGN

Retrospective review of state medical investigator reports from 1980 through 1991 with regard to industry, agent of death, gender, ethnicity, location, and alcohol and other drug involvement.

PARTICIPANTS

New Mexico residents who were fatally injured while on the job.

RESULTS

We identified 613 deaths: 87.1% unintentional, 10.6% homicides, and 2.3% suicides. Industries with the most fatalities were construction (11.8%), oil/gas (10.6%), and farming (8.6%). The primary agents of death were motor vehicles (41.7%), firearms (10.1%), and falling objects (10.0%). Almost all (95.6%) of the decedents were male. However, females were overrepresented among homicide deaths (P < .0001). Most unintentional injuries occurred in rural areas (69.1%), whereas most homicides (73.4%) and suicides (71.4%) occurred in urban areas. Drug or alcohol use was evident in 19.4% of cases.

CONCLUSION

New Mexico has a high rate of occupational injury death, which appears to be associated with rural location and use of motor vehicles and alcohol.

Trauma among Hispanic children: a population-based study in a regionalized system of trauma care

We studied 1164 injured Hispanic and 2560 injured non-Hispanic White children newborn through 14 years triaged to the San Diego County Regionalized Trauma System from 1985 through 1990. Incidence rates did not differ by ethnic group. Hispanic children were more likely to be struck as pedestrians (odds ratio [OR] = 1.5) and less likely to be injured in falls (OR = 0.7) than non-Hispanic White children. For motor vehicle and pedal cycle injuries, Hispanic children were more likely not to have been restrained by seatbelts (OR = 4.0) or car seats (OR = 3.7).

Analysis of childhood pedestrian deaths in New Mexico, 1986-1990

STUDY OBJECTIVE

To determine if the mechanism of fatal childhood pedestrian injuries correlated with location, injury pattern, and age of the pedestrian and to determine ethnic differences in fatality rates.

DESIGN

Retrospective review of state medical investigator reports and autopsies from 1986 to 1990. Logistic regression and chi 2 were used to test for statistically significant differences between the groups in our data set.

TYPE OF PARTICIPANTS

New Mexican children, 0 to 14 years old fatally injured by moving vehicles.

RESULTS

Sixty-four children died for an overall fatality rate of 3.8 (per 100,000). Native American children and children younger than 5 years experienced the highest fatality rates. Children younger than 5 years were more likely to be crushed under the wheels of a slow-moving vehicle in both a nontraffic and a traffic location, whereas older children were found more often to have died from injuries from a high-speed impact event in a traffic location (P < .001). Leg fractures (P = .001) and spinal fractures (P = .02) occurred more frequently in impact than crush injuries.

CONCLUSION

Young children are at risk for a crush injury in both the traffic and nontraffic environment.

Fire fatalities among New Mexico children

STUDY OBJECTIVE

To explore the relationship between social conditions and fire mortality rates among children.

DESIGN

Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico.

SETTING

State Office of the Medical Investigator.

TYPE OF PARTICIPANTS

All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991.

INTERVENTIONS

Medical investigator and autopsy records were reviewed and abstracted. Demographic and housing figures were obtained from US Census reports. Data were analyzed by chi 2 or by Fisher's exact test, with Bonferroni correction for multiple comparisons.

RESULTS

Two thirds of decedents were male (P = .0014), and three fourths were less than 5 years old (P < .0001). Children living in mobile homes had triple the mortality rate of those in houses or apartments, and children in homes without plumbing (substandard) had more than ten times the mortality rate of those in houses or apartments (P < .0001). Two thirds of the victims in substandard homes were Native American (P < .0001). Errors or negligence of adults occurred in more than half of the deaths. Eighty-two percent of decedents died at the scene; only 11% reached a burn center.

CONCLUSION

Substandard homes are associated with an increased fire mortality rate among children. Strategies to prevent childhood fire fatalities should address housing conditions and adult safety practices. Enhanced prehospital or burn unit care is unlikely to greatly affect childhood fire mortality rates.