title: Persistently increased injury mortality rates in high-risk young children.
abstract: OBJECTIVE
  To study trends in injury mortality for low- and high-risk young children.
  
  
  METHODS
  For Tennessee children 0 to 4 years of age, we used birth certificates to obtain data on maternal education, age, and parity; these risk factors were used to classify children into low- and high-risk groups. The outcome was death from injury, as determined from linked death certificates. Between 1978 and 1995, injury mortality rates were calculated for six 3-year periods for low- and high-risk children.
  
  
  RESULTS
  There were 1.5 million children 0 to 4 years of age who contributed 4.9 million child-years. The high-risk group contributed 28% of all child-years. There were 673 injury deaths in the high-risk group, 48.9 deaths per 100,000 child-years, and 586 deaths in the low-risk group, 16.8 deaths per 100,000 child-years. The injury mortality rate for low-risk children decreased from 20.7 to 15.7 per 100,000 child-years between the 1978-1980 and 1981-1983 periods; thereafter it remained relatively stable. For high-risk children, the injury mortality rate decreased from 50.9 to 43.5 per 100,000 between the 1978-1980 and 1981-1983 periods, remained mostly unchanged through 1992, and then increased sharply in the 1993-1995 period to 64.1 per 100,000 child-years. The disparity between high- and low-risk children widened from 29.3 (95% confidence interval, 25.1-33.5) excess deaths per 100,000 for 1978 through 1991 to 46.9 (95% confidence interval, 35.9-57.9) in 1993 through 1995.
  
  
  CONCLUSIONS
  In Tennessee, maternal education, age, and parity consistently identified a population of children at increased risk of injury mortality. For these high-risk children, there has been no substantial reduction in injury mortality in high-risk young children during the last 18 years.
authors.affiliation: Department of Pediatrics, Vanderbilt University, Nashville, Tenn., USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Scholer
authors.forename: G B
authors.initials: GB
authors.lastname: Hickson
authors.forename: E F
authors.initials: EF
authors.lastname: Mitchel
authors.forename: W A
authors.initials: WA
authors.lastname: Ray
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*