Severe unintentional injuries sustained by Ohio children: Is there urban/rural variation?

BACKGROUND: Determining at risk populations is essential to developing interventions that prevent injuries. This study examined the rates of severe unintentional injuries among urban versus rural Ohio children.

METHODS: Demographic and injury data for children 0 to 14 years old who had unintentional injuries from January 1, 2003, to December 31, 2012, were extracted retrospectively from the Ohio Trauma Acute Care Registry. Cases with no designated county were excluded. Injury rates per 100,000 children 14 years or younger were calculated annually using county of residence and US census data. Each county was assigned an urbanization level based on population density (A = most urban, D = most rural).

RESULTS: There were 40,625 patients from 88 Ohio counties who met the inclusion criteria; the overall annual injury rate was 231.9. The mean age was 6.7 (SD, 4.5) years; 26,035 (64.1%) were male, and 31,468 (77.5%) were white. There were 593 deaths (1.5%). Injury rates by urbanization level were as follows: A: 120.4, B: 196.8, C: 249.1, and D: 247.4 (p = 0.04). Nearly 50% of all deaths occurred in the most urban counties. Those in the most urban areas were more likely to suffer injury from burns, drownings, and suffocations and less likely to be injured by animal bites or motorized vehicle collisions (p < 0.001). Length of stay and injury severity score were highest in the most urban children (p < 0.001).

CONCLUSION: While rural counties experienced higher injury rates, urban areas suffered more severe injuries. Specific mechanisms of injury differed by demographics and urbanization in Ohio, suggesting areas for targeted injury prevention.

LEVEL OF EVIDENCE: Epidemiologic study, level III.