Social Determinants of Health and Injury among Children

Abstract

Importance: Pediatric physical injuries have lasting effects on child mental and physical health and social outcomes. Little is known about social determinants that increase the odds of injury in children. Objective: To examine the association between 14 social determinants of child health (SDoCH) and odds of pediatric injury. Design, Setting, and Participants: Population-based retrospective case-control study in Winnipeg, Canada. Cases (children aged ≤17 years admitted to the hospital from 2002 to 2019 with physical injuries) were linked to their mothers using a unique identifier and matched 1:5 on age, sex, and geographic region with uninjured controls from the general population. Data were analyzed from May 2023 to July 2024. Exposures: Fourteen SDoCH measured as present or absent from birth to date of injury: low-income neighborhood; rural status; receipt of income assistance; justice system involvement; parent with less than a high school education; social housing; having an immigrant parent; high residential mobility; being born to a teen mother; having a child in protective care; child mental health diagnosis; maternal axis I or axis II mental disorder; and maternal physical disorder. Main Outcomes and Measures: Pediatric injury that required hospitalization. Analyses were conducted using conditional multivariate logistic regression modeling. Results: The final groups included 9853 cases and 49442 controls for a total sample of 59295. For cases at time of injury, the mean (SD) age was 9.8 (5.2) years, 6358 (64.5%) were male, 4688 (47.6%) lived in a rural area, and 3639 (36.9%) were low income. There were no significant differences between cases and controls for demographics; however, there was a greater proportion than expected of both groups in the lowest quintile. In the final multivariable model, rural area (adjusted odds ratio [aOR], 6.62; 95% CI, 4.62-9.47), having a child in protective care (aOR, 1.43; 95% CI, 1.31-1.55), being born to a teen mother (aOR, 1.34; 95% CI, 1.26-1.41), parent criminal justice system involvement (aOR, 1.27; 95% CI, 1.21-1.33), and receipt of income assistance (aOR, 1.13; 95% CI, 1.06-1.21) increased odds of pediatric traumatic injury. Conclusions and Relevance: In this retrospective case-control study, several adverse SDoCH were associated with increased odds of pediatric injury. These findings can inform targeted injury risk reduction programs.