title: Incidence of fractures among children and adolescents in rural and urban communities - analysis based on 9,965 fracture events.
abstract: BACKGROUND
  Previous work has explored the significance of residence on injuries. A number of articles reported higher rates of injury in rural as compared to urban settings. This study aimed to evaluate the importance of residency on the occurrence of fractures among children and adolescents within a region in northern Sweden.
  
  
  METHODS
  In a population based study with data from an injury surveillance registry at a regional hospital, we have investigated the importance of sex, age and place of residency for the incidence of fractures among children and adolescents 0-19 years of age using a Poisson logistic regression analysis. Data was collected between 1998 and 2011.
  
  
  RESULTS
  The dataset included 9,965 cases. Children and adolescents growing up in the most rural communities appeared to sustain fewer fractures than their peers in an urban municipality, risk ratio 0.81 (0.76-0.86). Further comparisons of fracture rates in the urban and rural municipalities revealed that differences were most pronounced for sports related fractures and activities in school in the second decade of life.
  
  
  CONCLUSIONS
  Results indicate that fracture incidence among children and adolescents is affected by place of residency. Differences were associated with activity at injury and therefore we have discussed the possibility that this effect was due to the influence of place on activity patterns. The results suggest it is of interest to explore how geographic and demographic variables affect the injury pattern further.
authors.affiliation: Division of Surgery and Perioperative Sciences, Umeå University, 901 87, Umeå, Sweden. erik.hedstrom@orthop.umu.se.
authors.forename: Erik M
authors.initials: EM
authors.lastname: Hedström
authors.affiliation: Department of Statistics, Umeå University, 901 87, Umeå, Sweden.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Waernbaum
keywords: Child; Ecological; Epidemiology; Fracture; Paediatric