Infant injury deaths with unknown intent: what else do we know?
Infant injury deaths with unknown intent: what else do we know?
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意图不明的婴儿受伤死亡：我们还知道什么？
DOI：
10.1136/ip.5.4.272
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Berendes,HW
中科院分区：
文献类型：
--
作者：
Overpeck,MD;Brenner,RA;Trumble,AC;Smith,GS;MacDorman,MF;Berendes,HW
目标--基于案例记录审查的有力证据表明，死亡证明报告的儿童杀人案的发生率尚未确定。比较了未确定但可疑意图的婴儿伤害死亡的特征，以确定他们应被认为是他杀的概率。方法-使用1983-91年美国所有出生队列的相关出生和死亡证明，2345例故意伤害死亡，7594例意外伤害死亡，431例不明意图伤害死亡。基于增加的双变量相关性，选择了可能预测伤害死亡的母婴变量。结果：在所有意向类别中，母亲受教育程度最低、没有产前护理、母亲年龄较小和单身婚姻状况的婴儿，以及第二个或更晚出生的婴儿、早产、黑人或美国印第安人的婴儿，相对风险始终较高。与故意或无意伤害相比，意图不明的死亡在最高风险类别中的相对风险更大。与非故意死亡相比，意图不明死亡的风险特征更接近故意死亡的特征。结论--如果将意图不明的死亡包括在内，伤害凶杀率将比官方分类高出近20%。在对婴儿杀人案的分析中，排除意图不明的死亡可能会导致低估婴儿故意伤害这一公共卫生问题的严重性。基于多个来源的记录审查的其他研究表明，对杀人案的错误分类和确定不足的情况可能更大。
Objectives—Strong evidence based on case record reviews indicates that the incidence of child homicide reported from death certificates is under ascertained. The characteristics of infant injury fatalities with undetermined, but suspicious, intent were compared for the probability that they should be considered homicides.Methods—Using linked birth and death certificates for all birth cohorts in the US from 1983–91, 2345 injury fatalities reported as intentional, 7594 as unintentional, and 431 as undetermined intent were identified. Maternal and infant variables potentially predictive of injury fatalities were selected based on increased bivariate associations. Relative risks of injury death by intentional, unintentional, and undetermined intent were assessed for maternal and infant characteristics.Results—Relative risks were consistently higher across all intent categories for infants of mothers with the least education, no prenatal care, young maternal age, and single marital status, as well as for infants who are second or later born, preterm, black, or American Indian. Fatalities with undetermined intent have larger relative risks in the highest risk categories than either intentional or unintentional injuries. Deaths with undetermined intent have risk profiles that more closely resemble profiles for intentional deaths than unintentional.Conclusions—Injury homicide rates would be almost 20% greater than official classifications indicate if deaths with undetermined intent were included. In analyses of infant homicide, excluding deaths of undetermined intent may lead to an underestimation of the magnitude of the public health problem of intentional injuries among infants. Other studies based on record reviews from multiple sources indicate that misclassification and under ascertainment of homicides may be even greater.