Risk factors for long-bone fractures in children up to 5 years of age: a nested case-control study.
OBJECTIVE
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 0-12 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.
Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK.
Ruth
R
Baker
Division of Primary Care, University Park, University of Nottingham, Nottingham, UK.
Elizabeth
E
Orton
Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, UK.
Laila J
LJ
Tata
Division of Primary Care, University Park, University of Nottingham, Nottingham, UK.
Denise
D
Kendrick
D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
child; epidemiology; fractures; preschool; risk factors