Socioeconomic variables and fracture risk in children and adolescents: a population-based study from northern Sweden.
OBJECTIVES
Previous studies have investigated the association between socioeconomic characteristics and fractures among children, producing different results. In a population-based study, we previously found an increased risk of fractures among children living in an urban municipality compared with rural municipalities. This study aimed to evaluate the importance of socioeconomic variables for the incidence of fractures among 0-17 year olds.


SETTING, DESIGN AND OUTCOME MEASURE
We present a longitudinal, observational study of a population 0-17 years of age. Data from an injury database were linked with additional socioeconomic data for the population at risk. These were 55 758 individuals residing within the primary catchment area of a regional hospital in northern Sweden. Using the number of fractures as the outcome, we fitted a generalised linear mixed model for a Poisson response with socioeconomic variables at the family level as independent variables while controlling for age, sex and place of residence.


RESULTS
We found a significant association between higher levels of family income and the risk of fracture, rate ratio 1.40 (1.28-1.52) p<0.001 when comparing the highest income quintile to the lowest as well as the number of siblings and the risk of fracture. Children with one or two siblings had a rate ratio of 1.28 (1.19-1.38) p<0.001 when compared with children with no siblings. Parents' educational level and having a single parent showed no significant association with fractures. The previously observed association between municipalities and fracture risk was less pronounced when taking family-level socioeconomic variables into account.


CONCLUSION
Our results indicate that children from families with higher income and with siblings are at greater risk of sustaining fractures.
['Hedström|Erik|E|0000-0002-1700-8223', 'Crnalic|Sead|S|', 'Kullström|Antonia|A|', 'Waernbaum|Ingeborg|I|']
D000293:Adolescent D002648:Child D006801:Humans D015994:Incidence D007182:Income D012307:Risk Factors D012959:Socioeconomic Factors D013548:Sweden
community child health epidemiology paediatric orthopaedics