title: Change in child mortality patterns after injuries in Sweden: a nationwide 14-year study.
abstract: BACKGROUND
  Sweden has one of the world's lowest child injury mortality rates, but injuries are still the leading cause of death among children. Child injury mortality in the country has been declining, but this decline seems to decrease recently. Our objective was therefore to further examine changes in the mortality of children's death from injury over time and to assess the contribution of various effects on mortality. The underlying hypothesis for this investigation is that the incidence of lethal injuries in children, still is decreasing and that this may be sex specific.
  
  
  METHODS
  We studied all deaths from injury in Sweden under-18-year-olds during the 14 years 1999-2012. We identified those aged under 18 whose underlying cause of death was recorded as International Classification of Diseases, 10th Revision (ICD-10) diagnosis from V01 to X39 in the Swedish cause of death, where all dead citizens are registered.
  
  
  RESULTS
  From the 1 January 1999 to 31 December 2012, 1213 children under the age of 18 died of injuries in Sweden. The incidence declined during this period (r = -0.606, p = 0.02) to 3.3 deaths/100,000 children-years (95 % CI 2.6-4.2). Death from unintentional injury was more common than that after intentional injury (p < 0.0001). There was a reduction in the incidence of unintentional injuries during the study period (r = -0.757, p = 0.03). The most common causes of death were injury to the brain (n = 337, 41 %), followed by drowning (n = 109, 13 %). The number of deaths after intentional injury increased (r = 0.585, p = 0.03) and at the end of the period was 1.5 deaths/100,000 children-years. The most common causes of death after intentional injuries were asphyxia (n = 177, 45 %), followed by injury to the brain (n = 76, 19 %).
  
  
  CONCLUSIONS
  Mortality patterns in injured children in Sweden have changed from being dominated by unintentional injuries to a more equal distribution between unintentional and intentional injuries as well as between sexes and the overall rate has declined further. These findings are important as they might contribute to the preventive work that is being done to further reduce mortality in injured children.
authors.affiliation: Department of Anesthesia and Intensive care, Vrinnevi Hospital, S-601 82, Norrköping, Sweden. denise.backstrom@regionostergotland.se.
authors.forename: D
authors.initials: D
authors.lastname: Bäckström
authors.affiliation: Department of Hand and Plastic Surgery, Linköping University, 581 85, Linköping, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Steinvall
authors.affiliation: Department of Anesthesia, The Burn Center, Linköping University, 581 85, Linköping, Sweden.|Department of Intensive Care, The Burn Center, Linköping University, 581 85, Linköping, Sweden.|Department of Hand and Plastic Surgery, Linköping University, 581 85, Linköping, Sweden.|Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Sjöberg
mesh_terms: D000058:Accidental Falls / Q000401:mortality*; D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002662:Child Health Services; D046688:Child Mortality / Q000639:trends; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D013548:Sweden; D014947:Wounds and Injuries / Q000401:mortality*
keywords: Children; Injury; Mortality; Scandinavia; Trauma