Injury and Health Among Children in Vulnerable Families

Abstract

Injury is the leading cause of death for children older than 1 year. The incidence of childhood injury varies greatly depending on social factors, including income, family violence, and other social stressors. This study reports the incidence of injury among children aged 5 years in a cohort of vulnerable families. The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5,000 at-risk families across the United States. Data from interviews with mothers conducted shortly after giving birth and follow-up surveys at 1 year, 3 years, and 5 years were used. Multivariate regression analysis was used to identify independent risk factors for injury in year 5. Five-year follow-up data on injury was complete for 2,397 families. Two hundred ninety-six children were injured at the age of 5 years (12.3%). Multivariate regression found that the strongest predictors of injury in year 5 were male gender (OR, 2.62; 95% CI, 1.02-6.75; p = 0.04) and being in the lowest income stratum (OR, 1.23; 95% CI, 1.01-1.49; p = 0.03). Children in vulnerable families are at higher risk for injury. The incidence of 12.3% found in this cohort is substantially higher than CDC risk for 5-year-old children, that is, overall 9.3%. This longitudinal cohort has demonstrated a persistently elevated risk of childhood injury, but risk factors for injury have changed with age. As these children reached school age, low household income and male gender were risk factors for injury. This suggests that recognition of gender differences and targeted interventions for caregivers and play environments may be useful.