Risk factors for long-bone fractures in children up to 5 years of age: a nested case-control study
Risk factors for long-bone fractures in children up to 5 years of age: a nested case-control study
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DOI：
10.1136/archdischild-2013-305715
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发表时间：
2015-05-01
影响因子：
5.2
通讯作者：
Kendrick, Denise
中科院分区：
文献类型：
--
作者：
Baker, Ruth;Orton, Elizabeth;Kendrick, Denise
目的 调查 5 岁以下儿童首次长骨骨折的危险因素，以便为哪些家庭可以从伤害预防干预措施中受益提供证据。 方法 使用英国初级保健研究数据库健康改善网络 (The Health Improvement Network)，1988-2004 年进行基于人群的匹配巢式病例对照研究。对 2456 名长骨骨折儿童（例）进行了母亲、家庭和儿童伤害危险因素评估。 23 661 个对照与一般实践中的病例相匹配。使用条件逻辑回归估计调整后的 OR 和 95% CI。 结果 长骨骨折与母亲年龄较小和出生顺序较高独立相关，家庭中第四个或更晚出生的孩子的骨折几率是第一个孩子的三倍（调整后 OR 3.12，95% CI 2.08 至 4.68）。与 12 个月大的儿童相比，1 岁以上儿童发生长骨骨折的几率增加了四倍（13-24 个月，调整后 OR 4.09 95% CI 3.51 至 4.76）至五倍（37 个月以上，调整后 OR 4.88 95% CI 4.21 至 5.66）。与没有记录的病史的家庭相比，有母亲酗酒史的家庭中的儿童发生长骨骨折的几率较高（调整后 OR 2.33，95% CI 1.13 至 4.82）。结论 5 岁以下儿童发生长骨骨折的危险因素包括年龄超过 1 岁、出生顺序增加、母亲年龄较小和母亲酗酒。应利用这些风险因素来优先考虑家庭和社区的伤害预防干预措施。
Aim To investigate risk factors for first long-bone fractures in children up to 5 years old in order to provide evidence about which families could benefit from injury prevention interventions.Methods Population-based matched nested case-control study using The Health Improvement Network, a UK primary care research database, 1988-2004. Maternal, household and child risk factors for injury were assessed among 2456 children with long-bone fractures (cases). 23 661 controls were matched to cases on general practice. Adjusted ORs and 95% CIs were estimated using conditional logistic regression.Results Fractures of long-bones were independently associated with younger maternal age and higher birth order, with children who were the fourth-born in the family, or later, having a threefold greater odds of fracture compared to first-born children (adjusted OR 3.12, 95% CI 2.08 to 4.68). Children over the age of 1 year had a fourfold (13-24 months, adjusted OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, adjusted OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 012 months. Children in families with a history of maternal alcohol misuse had a raised odds of long-bone fracture (adjusted OR 2.33, 95% CI 1.13 to 4.82) compared to those with no documented history.Conclusions Risk factors for long-bone fractures in children less than 5 years old included age above 1 year, increasing birth order, younger maternal age and maternal alcohol misuse. These risk factors should be used to prioritise families and communities for injury prevention interventions.