The association between fracture rates and neighborhood characteristics in Washington, DC, children.
BACKGROUND
Effects of neighborhood contextual features have been found for many diseases, including bone fractures in adults. Our study objective was to evaluate the association between neighborhood characteristics and pediatric bone fracture rates. We hypothesized that neighborhood indices of deprivation would be associated with higher fracture rates.


METHODS
Pediatric bone fracture cases treated at a tertiary, academic, urban pediatric emergency department between 2003 and 2006 were mapped to census block groups using geographical information systems software. Fracture rates were calculated as fractures per 1000 children in each census block. Exploratory factor analysis of socioeconomic indicators was performed using 2000 census block data. Factor scores were used to predict odds of bone fracture at the individual level while adjusting for mean age, sex composition, and race/ethnicity composition at census block level using our sample data.


RESULTS
We analyzed 3764 fracture visits in 3557 patients representing 349 distinct census blocks groups. Fracture rates among census blocks ranged from 0 to 207 per 1000 children/study period. Logistic regression modeling identified 2 factors (race/education and large families) associated with increased fracture risk. Census variables reflecting African American race, laborer/service industry employment, long-term block group residence, and lower education levels strongly loaded on the race/education factor. The large families factor indicated the children-to-families ratio within the block group. The poverty factor was not independently associated with fracture risk.


CONCLUSIONS
Thus, neighborhood characteristics are associated with risk for fractures in children. These results can help inform translational efforts to develop targeted strategies for bone fracture prevention in children.
Division of Emergency Medicine, Children's National Medical Center, Children's National Medical Center, Washington, DC 20010, USA. lryan@childrensnational.org
Leticia Manning
LM
Ryan
Mark
M
Guagliardo
Stephen J
SJ
Teach
Jichuan
J
Wang
Jennifer E
JE
Marsh
Steven A
SA
Singer
Joseph L
JL
Wright
James M
JM
Chamberlain
D019352:Censuses; D002648:Child; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D005843:Geography; D006801:Humans; D008297:Male; D012111:Residence Characteristics / Q000706:statistics & numerical data*