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

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.