Objectives. Injuries pose a threat to health and well-being and are a major
source of medical spending in the United States for children and youth 0 t
o 21 years of age. This study provides national estimates of the incidence
of fatal and nonfatal childhood injuries and comprehensive cost estimates b
y age, gender, race, family income, metropolitan residence, and place of in
cident.
Methods. Eight years of National Health Interview Survey data (1987 to 1994
) were used to estimate nonfatal injury incidence rates among children and
youth 21 years of age and younger. The survey documents all medically atten
ded or temporarily disabling injuries within the 2 weeks before the intervi
ew. Injuries were defined as diagnoses 800-995 in the International Classif
ication of Diseases, Ninth Revision, excluding late effects cases. Fatality
counts came from 1994 Vital Statistics.
Estimates of the costs of injuries (1994 US dollars) included medical spend
ing, lost future work, and lost quality of life. Medical payments included
spending on hospital and professional services, rehabilitation, prescriptio
ns, home health care, and medical equipment. Lost future work and lost qual
ity of life consisted of the present value of work that children will be un
able to do as adults if they are killed or permanently disabled combined wi
th the pain and suffering that children and their families experience becau
se of the injury. Cost estimates excluded parental income losses from work
missed, property damage, legal costs, and insurance claims-adjustment costs
related to permanent disability and death.
Results. Incidence. A total of 3073 injury episodes for 3058 children were
obtained from 8 years of National Health Interview Survey data. This repres
ents 20.6 million children in the United States who were injured each year,
or similar to 25 per 100 children. This translates to 56 000 nonfatal inju
ry episodes each day that require medical attention or limit children's act
ivity. For fatal injuries, the rate was 38 children per 100 000. The nonfat
al injury rate for males (mean: 30; 95% confidence interval [CI]: 29,31) wa
s higher than the rate for females (mean: 20; 95% CI: 19,21); the fatal inj
ury rate for males was more than twice that of females.
Injury rates increased with age. Children 0 to 9 years of age had the lowes
t rate of nonfatal injury. Rates for nonfatal injury among children 0 to 4
years of age were lower (mean: 20; 95% CI: 18,21) than those for the 5 to 9
age group (mean: 22; 95% CI: 20,23). However, the rate for fatal injuries
(21 per 100 000) among the 0 to 4 age group was higher than the 5 to 9 age
group (9 per 100 000). Nonfatal injury rates for children 10 years of age a
nd older were higher, with the highest estimated injury rates in late adole
scence (15-19 years; mean: 31; 95% CI: 29,33).
Nonfatal injuries occurred at higher rates among white children (mean: 27;
95% CI: 26,28) than black children (mean: 19; 95% CI: 17,21) or children fr
om other racial backgrounds (mean: 13; 95% CI: 10,16). The reverse was true
for fatal injuries, with higher fatality rates among black children (59 pe
r 100 000). Children in families with incomes under $5000 had the highest r
ate of nonfatal injury (mean: 31; 95% CI: 27,35), followed by those in the
$35 000 to $49 999 income range (mean: 25; 95% CI: 23,27). The rate of nonf
atal injuries in the other income brackets were fairly similar, with those
in the highest income bracket having the lowest rate (mean: 14; 95% CI: 13,
15). Fatality rates by family income were not available. The nonfatal injur
y rate in nonmetropolitan areas (mean: 10; 95% CI: 9,11) was higher than in
metropolitan areas (mean: 8; 95% CI: 7,8); the same was true for fatal inj
ury rates (33 per 100 000 in nonmetropolitan areas vs 25 in metropolitan ar
eas).
Males consistently had higher injury rates than females across all places o
f injury. Youth 15 years of age and older had higher rates for injuries tha
t occur on the public roads, in recreation centers, and in industrial place
s. With increasing age for both boys and girls, injuries at home declined,
whereas injuries at school tended to climb. These trends reflect the develo
pmental changes in time spent in these environments. Injury rates in indust
rial places by age and gender were initially very low for children 0 to 14
years of age, then predictably increased for the 15 to 19 and 20 to 21 age
groups, again caused by the increasing time spent in these places as childr
en grow. Injury on farms had the lowest occurrence, rendering a breakdown b
y age and gender unreliable.
Costs. The estimated cost of unintentional childhood injuries was a stagger
ing $347 billion each year. This estimate included $17 billion in medical c
osts, $72 billion in future work lost, and $257 billion in lost quality of
life. Injury accounts for approximately 15% of total medical spending from
1 to 21 years of age. The estimated cost per child injured was approximatel
y $17 000. This included approximately $800 in medical payments alone; the
estimated cost of lost future work and quality of life costs amounted to $3
500 and $12 400, respectively. The estimated cost per resident child was an
estimated $4200. The annual costs of injuries per male child were $1500 hi
gher than those per female, although the costs per injured male and per inj
ured female were roughly similar.
The total cost of injuries to white children ($283 billion) and higher inco
me children ($48 billion) were the highest compared with those for minority
and lower and middle income children. When looking at the cost per child i
njury survivor, those in higher income families also have the highest costs
. Children with non-white racial backgrounds had higher costs per injured c
hild than did white children. Injuries to children in metropolitan areas co
st $149 billion more than injuries to those in nonmetropolitan areas. Howev
er, the costs per injured child in nonmetropolitan and metropolitan areas w
ere relatively similar. Injuries that occurred on farms and industrial plac
es had the lowest costs.
Conclusions. Approximately 1 in 4 children in the United States are injured
each year, with huge corresponding costs. This article demonstrates the po
tential economic benefits of prevention programs targeted toward reducing c
hildhood injuries.