PERSISTENTLY INCREASED INJURY MORTALITY-RATES IN HIGH-RISK YOUNG-CHILDREN

Objective: To study trends in injury mortality for low- and high-risk young children. Design and Methods: For Tennessee children 0 to 4 year s of age, we used birth certificates to obtain data on maternal educat ion, age, and parity; these risk factors were used to classify childre n into low-and high-risk groups. The outcome was death from injury, as determined from linked death certificates. Between 1978 and 1995, inj ury mortality rates were calculated for six 3-year periods for low-and high-risk children. Results: There were 1.5 million children 0 to 4 y ears of age who contributed 4.9 million child-years. The highrisk grou p contributed 28% of all child-years. There were 673 injury deaths in the high-risk group, 48.9 deaths per 100000 child-years, and 586 death s in the low-risk group, 16.8 deaths per 100000 child-years. The injur y mortality rate for low-risk children decreased from 20.7 to 15.7 per 100000 child-years between the 1978-1980 and 1981-1983 periods; there after it remained relatively stable. For high-risk children, the injur y mortality rate decreased from 50.9 to 43.5 per 100000 between the 19 78-1980 and 1981-1983 periods, remained mostly unchanged through 1992, and then increased sharply in the 1993-1995 period to 64.1 per 100000 child-years. The disparity between high-and low-risk children widened from 29.3 (95% confidence interval, 25.1-33.5) excess deaths per 1000 00 for 1978 through 1991 to 46.9 (95% confidence interval, 35.9-57.9) in 1993 through 1995. Conclusions: In Tennessee, maternal education, a ge, and parity consistently identified a population of children at inc reased risk of injury mortality. For these high-risk children, there h as been no substantial reduction in injury mortality in high-risk youn g children during the last 18 years.