The Association between Fracture Rates and Neighborhood Characteristics in Washington, DC, Children

Abstract

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. Pediatric bone fracture cases treated at a tertiary, academic, urban pediatric emergency department between 2003 -2006 were mapped to census block groups using geographical information systems software. Fracture rates were calculated as fractures per 1,000 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, gender composition, and race/ethnicity composition at census block level using our sample data. 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 1,000 children/study period. Logistic regression modeling identified two 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. Thus,

Is Household Composition Associated With Repeat Fight Injuries in Adolescents Living in Urban Neighborhoods?

“…Our data demonstrate an association between presence of a grandparent in the household and increased risk for medically attended repeat fight injury in adolescents living in urban neighborhoods without a corresponding association with adult:child ratio or total household size. These findings differ from the protective associations shown for these factors with unintentional injury risk (Bishai et al, 2008; Celis et al, 2003; Ryan et al, 2013) and may reflect limitation in family resources, other risk factors for violence within these households, and/or differences in caregiver styles for which grandparent residence may be a risk factor. This is supported by studies of African American families that show that the most common reasons for grandparent co-residence were financial challenges experienced by the parents of the grandchild, and the inability of the grandchild’s parents to independently manage a home, that is, due to parental maturity and cognitive abilities, parental employment, or school enrollment (Baker, Silverstein, & Putney, 2008; Minkler & Fuller-Thomson, 2015).…”

“…Contrary to our hypothesis, we did not find a statistically significant association between adult:child ratio or household size and repeat medically attended fight injury. Prior studies show associations for these household factors with unintentional injury risk in children as well as other noninjury outcomes (Black et al, 2005, 2010; Celis et al, 2003; Ryan et al, 2013). Thus, our study also provides further evidence that, despite some commonalities, the epidemiology of urban violence-related injury is distinct from that of unintentional injury risk.…”

“…Components of household composition, including the number of residents in a household, the ages of residents, and their relationships to each other, have also been shown to relate to risk for unintentional injury (Bishai et al, 2008; Celis, Gomez, Martinez-Sotomayo, Arcila, & Villasenor, 2003; Ryan et al, 2013). For instance, prior studies show that higher adult:child ratio, lower household size, and the presence of a grandparent are protective for unintentional injury risk in children, independent of socioeconomic status (Bishai et al, 2008; Celis et al, 2003; Ryan et al, 2013). It is thought that this protective association may reflect increased supervision (Morrongiello, Corbett, & Brison, 2009; Schnitzer, Dowd, Kruse, & Morrongiello, 2015).…”

“…It is thought that this protective association may reflect increased supervision (Morrongiello, Corbett, & Brison, 2009; Schnitzer, Dowd, Kruse, & Morrongiello, 2015). For instance, Ryan et al found that census blocks in Washington, D.C., with higher adult:child ratios had significantly lower rates of bone fractures (Ryan et al, 2013). Similarly, Celis et al found that lower household size significantly decreased risk for pedestrian injury in Mexican children 1 to 14 years of age (Celis et al, 2003).…”

Fractures in children and adolescents living with perinatally acquired HIV

“…It could also be a consequence of growth delays and poorer weight gain in young PHIV children thereby negatively impacting early bone acquisition [32]. There may be differences in socioeconomic or neighborhood characteristics between these two populations [33]. Finally, the large 95% CI for children <6 yr suggests considerable uncertainty around the estimate and indicates the need to replicate the study in a prospective manner in another cohort of PHIV children.…”