Explanatory capacity of measures of community context for paediatric injury hospitalisations in the USA.

Abstract

Objective: Community context influences children's risk for injury. We aimed to measure the explanatory capacity of two ZIP code-level measures-the Child Opportunity Index V.3.0 (COI) and median household income (MHHI)-for rates of paediatric injury hospitalisations.

Methods: This was a retrospective cross-sectional population-based study of children living in 19 US states in 2017. We examined injury hospitalisation rates for three categories: physical abuse among children <5 years, injuries suspicious for abuse among infants <12 months and unintentional injuries among children <18 years. Hospitalisation counts were obtained from the Healthcare Cost and Utilization Project and population data from the US Census. The COI is a multidimensional measure of communities' education, health and environment and social and economic characteristics. We used pseudo R² values from Poisson regression models to describe the per cent of variance in rates of each injury category explained by the COI and MHHI.

Results: The COI explained 75.4% of the variability in rates of physical abuse, representing a 13.5% improvement over MHHI. The COI explained 58.5% of the variability in injuries suspicious for abuse, a 20.7% improvement over MHHI. The COI and MHHI explained 85.7% and 85.8% of the variability in unintentional injuries, respectively; results differed when unintentional injuries were stratified by mechanism and age.

Implications: The COI had superior explanatory capacity for physical abuse and injuries suspicious for abuse compared with MHHI and was similar for unintentional injury hospitalisations. COI represents a means of accounting for community advantage in paediatric injury data, research and prevention.