Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis.
Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis.
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DOI：
10.1016/j.jpeds.2017.04.044
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发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Qureshi FG
中科院分区：
文献类型：
--
作者：
Wolf LL;Chowdhury R;Tweed J;Vinson L;Losina E;Haider AH;Qureshi FG
目的：研究与汽车碰撞(MVC)相关的儿童死亡率的地理变异，并确定国家层面的死亡率预测因素。使用2010年至2014年的死亡分析报告系统，我们确定了涉及致命≥的乘客和15岁，MVC的定义是在美国公共道路上发生撞车事故，MVC 1死亡(成人或儿童)在30天内。我们评估了乘客、司机、车辆、撞车和国家政策特征作为潜在的与MVC相关的儿科死亡率相关的因素。我们的结果是年龄调整后的每100,000名儿童中与MVC相关的死亡率(AAMR)和死于致命MVC的儿童的百分比。分析单位是美国国务院。我们使用多变量线性回归来定义与每个结果的较高水平相关的状态特征。在18,116名死于MVC的儿童中，15.9%的儿童死亡。AAMR从马萨诸塞州的0.25到密西西比州的3.23(全国平均比率=0.94)不等。更大的AAMR的预测因素包括更大比例的无约束/不适当约束的儿童(p<；0.001)和在农村道路上更大比例的撞车(p=0.016)。此外，在没有红灯摄像机立法的州，儿童死亡率更高(p<；0.001)。我们的风险调整模型预测，在全国范围内适当使用儿童约束装置的情况下，10%的绝对改善将使1,100名儿童死亡避免5年以上。与MVC相关的儿童死亡率因州而异，并与限制不使用/滥用、乡村道路、车辆类型和闯红灯相机政策有关。修改州法规并围绕这些因素加强执法可能会防止大量儿科死亡。
To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality. Using the 2010–2014 Fatality Analysis Reporting System, we identified passengers <15y involved in fatal MVCs, defined as crashes on U.S. public roads with ≥1 death (adult or pediatric) within 30d. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100,000 children (AAMR) and percentage of children that died of those in fatal MVCs. Unit of analysis was U.S. state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome. Of 18,116 children in fatal MVCs, 15.9% died. AAMR varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate=0.94). Predictors of greater AAMR included greater percentage of children unrestrained/inappropriately restrained (p<0.001) and greater percentage of crashes on rural roads (p=0.016). Additionally, greater percentages of children died in states without red light camera legislation (p<0.001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1,100 pediatric deaths averted over 5y. MVC-related pediatric mortality varied by state and was associated with restraint nonuse/misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.
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