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Fractures in children: a population-based study from northern Sweden
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. (Arcum)ORCID iD: 0000-0002-1700-8223
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Fractures and other injuries are notoriously common in childhood and adolescence and a major cause of morbidity. They place a heavy burden on individuals, families, health systems and society. In a population-based study using data from the Injury Database at Umeå University Hospital we analysed injuries, and especially fractures, in Umeå and it´s five surrounding municipalities to increase knowledge on the epidemiology of injuries in children. 

We found an injury rate requiring visits to the hospital’s emergency department of 110/1000 person-years among those 0-19 years of age. For the same age group, the incidence of injuries resulting in admittance to hospital was 132/104 person-years. The incidence of fractures was 201/104 person-years. The accumulated risk of sustaining a fracture before 17 years of age was 34%, and the peak sex-specific incidence of fractures coincided with the pubertal growth spurt in both sexes. Fractures were more common from May-September when temperatures were warmer and days longer. The most common activity at injury in toddlers and preschool children was play, whereas teenagers were more often injured in sports and traffic-related activities. 

In an analysis of fracture incidence between municipalities we noted that children and adolescents growing up in rural communities appeared to sustain fewer fractures than their peers in an urban municipality, risk ratio 0.81 (95 % confidence interval 0.76-0.86). We speculated that this observation might be due to differences in behaviour and activities among teenagers in rural and urban communities. 

In a further analysis we combined data from the Injury Database with socioeconomic microdata. By linking data between individual children and their parents/families we could analyse the relevance of socioeconomic variables and the number of siblings on fracture rate. We observed that children in households with higher incomes sustained significantly more fractures. Comparing the highest and lowest quintiles for income, the rate ratio was 1.40 (1.28-1.54). We also found that having siblings correlated with an increased risk of fractures, rate ratio 1.28 (1.19-1.38). Parents’ education level and family type did not influence the prevalence of fractures significantly. It appeared that the association between variables at the individual level and fractures was stronger than the association between municipality and fractures.  

Conclusions: Our results show that the incidence of fractures varies with sex, age, developmental stages, skeletal growth, activities of daily life, and seasons. However, it is also influenced by place of residence, family’s socioeconomic status and having siblings. Refined methods and data allowing an analysis of subsets of fractures and other injuries on the individual/family- and area-level simultaneously should lead to further insights into the possible causal mechanisms underlying observed correlations. 

Place, publisher, year, edition, pages
Umeå: Umeå University , 2021. , p. 35
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2129
Keywords [en]
Epidemiology, fracture, child, pediatric, injury
National Category
Public Health, Global Health and Social Medicine Orthopaedics Pediatrics
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-182513ISBN: 978-91-7855-507-9 (print)ISBN: 978-91-7855-508-6 (electronic)OAI: oai:DiVA.org:umu-182513DiVA, id: diva2:1547001
Public defence
2021-05-21, Trippel Helix / Zoom, meeting id: 683 6691 5969, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-04-30 Created: 2021-04-23 Last updated: 2025-02-20Bibliographically approved
List of papers
1. Epidemiology of fractures in children and adolescents
Open this publication in new window or tab >>Epidemiology of fractures in children and adolescents
2010 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 81, no 1, p. 148-153Article in journal (Refereed) Published
Abstract [en]

Background and purpose Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths 19 years of age, who were seen at Umeå University Hospital, Sweden.

Material and methods All injuries seen at the hospital have been recorded in a database since 1993. The data include variables such as age, sex, date, type of injury, mechanism of injury, and treatment. For the period 1993–2007, there were 10,203 injury events that had resulted in at least 1 fracture.

Results The incidence for the whole period was 201/104 person years. The incidence increased by 13% during the period 1998–2007, when we were able to control for registration errors. The most common fracture site was the distal forearm. The most common type of injury mechanism was falling. The peak incidence occurred at 11–12 years in girls and at 13–14 years in boys, with a male-to-female incidence ratio of 1.5. We found variations in mechanisms and activities at injury with age, and over time.

Interpretation Fractures are caused by a combination of intrinsic and extrinsic factors that vary with age. We believe the increase in incidence is partly explained by changes in children's activity patterns over time. Further research may help to identify preventive measures to reduce the number of fractures, in particular those involving hospital care, surgical treatment, and—most importantly—long-term impairment.

Read More: http://informahealthcare.com/doi/abs/10.3109/17453671003628780

National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-40555 (URN)10.3109/17453671003628780 (DOI)
Available from: 2011-02-28 Created: 2011-02-28 Last updated: 2022-03-15Bibliographically approved
2. Injuries in children and adolescents: analysis of 41,330 injury related visits to an emergency department in northern Sweden
Open this publication in new window or tab >>Injuries in children and adolescents: analysis of 41,330 injury related visits to an emergency department in northern Sweden
2012 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 43, no 9, p. 1403-1408Article in journal (Refereed) Published
Abstract [en]

Objectives: We present an overview of the injuries seen at the emergency department of a regional hospital in northern Sweden and the variations in the injury pattern with age, sex and time. Methods: Data consisting of all injuries sustained by those 0–19 years of age seen at the emergency department of Umeå University Hospital between 1998 and 2008 (41,330 injury events) were analysed with respect to injury type, mechanism, activity, age and sex. Rates were calculated using population data from Statistics Sweden. Results: The rate of injury related visits to the emergency department was 110/1000 person years. The most common causes of visits to the emergency department were minor injuries such as contusions, abrasions and open wounds. 12% of the injuries resulted in admission to a ward. Variations in type of injury, mechanism and activity at injury were noted, in particular with age, but also with sex. We noted a 31% rate increase of visits to the hospital's emergency department between 1998 and 2008, rate ratio 1.31 (1.27–1.38). There was no significant increase in the rate of injuries resulting in hospitalisation. Conclusions: Our results give an estimate of the rate of all injuries and subsets of injuries resulting in visits to the only hospital emergency department within a well defined catchment area. It was not possible to determine whether the increased rate of visits to the ED was due to an increase in the actual rate of injuries within the catchment area. The variations seen in different age groups reflect the hazards associated with different periods in growth and the ability to cope with these. The results point to areas where improved preventive measures may be implemented or where further research may be of value

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
child, trauma, injury, pediatric, epidemiology
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-48193 (URN)10.1016/j.injury.2011.01.027 (DOI)000306666100012 ()
Note

Accepted 24 January 2011.

Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2021-11-03Bibliographically approved
3. Incidence of fractures among children and adolescents in rural and urban communities: analysis based on 9,965 fracture events
Open this publication in new window or tab >>Incidence of fractures among children and adolescents in rural and urban communities: analysis based on 9,965 fracture events
2014 (English)In: Injury Epidemiology, E-ISSN 2197-1714, Vol. 1, no 14Article in journal (Refereed) Published
Abstract [en]

Background: Previous work has explored the significance of residence on injuries. A number of articles reported higher rates of injury in rural as compared to urban settings. This study aimed to evaluate the importance of residency on the occurrence of fractures among children and adolescents within a region in northern Sweden.

Methods: In a population based study with data from an injury surveillance registry at a regional hospital, we have investigated the importance of sex, age and place of residency for the incidence of fractures among children and adolescents 0-19 years of age using a Poisson logistic regression analysis. Data was collected between 1998 and 2011.

Results: The dataset included 9,965 cases. Children and adolescents growing up in the most rural communities appeared to sustain fewer fractures than their peers in an urban municipality, risk ratio 0.81 (0.76-0.86). Further comparisons of fracture rates in the urban and rural municipalities revealed that differences were most pronounced for sports related fractures and activities in school in the second decade of life.

Conclusion: Results indicate that fracture incidence among children and adolescents is affected by place of residency. Differences were associated with activity at injury and therefore we have discussed the possibility that this effect was due to the influence of place on activity patterns.

The results suggest it is of interest to explore how geographic and demographic variables affect the injury pattern further.

Place, publisher, year, edition, pages
Springer, 2014
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-89922 (URN)10.1186/2197-1714-1-14 (DOI)2-s2.0-85007229882 (Scopus ID)
Available from: 2014-06-15 Created: 2014-06-15 Last updated: 2024-01-16Bibliographically approved
4. Socioeconomic impact on the incidence of fractures in children and adolescents: a population-based study fron northern Sweden
Open this publication in new window or tab >>Socioeconomic impact on the incidence of fractures in children and adolescents: a population-based study fron northern Sweden
(English)Manuscript (preprint) (Other academic)
National Category
Orthopaedics Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-182507 (URN)
Available from: 2021-04-23 Created: 2021-04-23 Last updated: 2025-02-20

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