PREDICTORS OF MORTALITY FROM FIRES IN YOUNG-CHILDREN

Background. In the United States in 1994, fires claimed 3.75 lives per 100 000 child years and accounted for 17.3% of all injury deaths in c hildren <5 years of age. Objectives. To conduct a historical cohort st udy that uses maternal demographic characteristics to identify young c hildren at high risk of fire-related deaths, thus defining appropriate targets for prevention programs. Methods. The cohort consisted of chi ldren born to mothers who resided in the state of Tennessee between 19 80 and 1995. Information was obtained by linking birth certificates, 1 990 census data, and death certificates. Children were eligible for th e study if they were less than or equal to 5 years of age at any time within the study period and if key study variables were present (99.2% of births). Birth certificates provided information on maternal chara cteristics including age, race, education, previous live births, use o f prenatal care, and residence tin standard metropolitan statistical a rea). Child characteristics included gender, gestational age, and birt h type (singleton/multiple gestation). Neighborhood income was estimat ed by linking the mother's address at the time of birth to the 1990 ce nsus (block group mean per capita income). The study outcome was a fir e resulting in at least one fatality (fatal fire event) during the stu dy period, identified from death certificates (coded E880 through E889 in the International Classification of Diseases, 9th rev). We calcula ted the fatal fire event rate corresponding to each stratum of materna l/child characteristics. We assessed the independent association betwe en each characteristic and the risk of a fatal fire event from a Poiss on regression multivariate analysis. Results. During the study period, 1 428 694 children contributed 5 415 213 child years to the cohort: t here were 270 deaths from fire (4.99 deaths per 100 000 child years) a nd 231 fatal fire events. In the multivariate analysis, factors associ ated with greater than a threefold increase in fatal fire events inclu ded maternal education, age, and number of other children. Compared wi th children whose mothers had a college education, children whose moth ers had less than a high school education had 19.4 times (95% confiden ce interval [CI], 2.6-142.4) an increased risk of a fatal fire event. Children whose mothers had more than two other children had 6.1 times (95% CT, 3.8-9.8) an increased risk of a fatal fire event compared wit h children whose mothers had no other children. Children of mothers <2 0 years of age had 3.9 times (95% CI, 2.2-7.1) increased risk of a fat al fire event compared with children whose mothers were greater than o r equal to 30 years old. Although both maternal neighborhood income an d race were associated strongly with increased rates of fatal fire eve nts in the univariate analysis, this association did not persist in th e multivariate analysis. Other factors that were associated with incre ased risk of fatal fire events in the multivariate analysis were male gender and having a mother who was unmarried or who had delayed prenat al care. The three factors associated most strongly with fire mortalit y were combined to create a risk score based on maternal education (gr eater than or equal to 16 years, 0 points; 13 to 15 years, 1 point; 12 years, 2 points; <12 years, 3 points); age (greater than or equal to 30 years, 0 points; 25 to 29 years, 1 point; 20 to 24 years, 2 points; <20 years, 3 points); and number of other children (none, 0 points; o ne, 1 point; two, 2 points; three or more, 3 points). The lowest-risk group (score <3) included 19% of the population and had 0.19 fatal fir e events per 100 000 child years. In contrast, highest-risk children ( score >7) comprised 1.5% of the population and had 28.6 fatal fire eve nts per 100 000 child years, 150 times higher than low-risk children. Children with risk scores >5 contributed 26% of child years but experi enced 68% of all fatal fire events. If the fatal fire event rate for a ll children had been equal to that of the low-risk group (risk score < 3), then 95% of deaths from fires would not have occurred. Discussion. Maternal education, age, and number of other children had strong and independent associations with fire-related deaths among young children . Taken together, these factors defined a steep risk gradient, where c hildren in the highest-risk group had a fire-related mortality rate th at was 150 times that of the lowest-risk group. From a public health p erspective, maternal factors clearly define children who would be good candidates for prevention programs. There is an urgent need to develo p prevention programs that fan be shown to reduce fire-related injury in high-risk children.