Risk Factors for Long-bone Fractures in Young Children
Risk Factors for Long-bone Fractures in Young Children
Table 2 shows the characteristics of the 2456 long-bone fracture cases and 23 661 controls, unadjusted ORs and risk factors identified as significant in the adjusted multivariable model. Of the cases, 1260 (51%) were male and 1196 (49%) were female, with similar proportions of males and females among the controls. Cases were generally older than controls; 38% of cases were 37 months or older, compared to 28% of controls.
In multivariable analysis, child sex was not associated with risk of long-bone fracture (OR 0.99, 95% CI 0.91 to 1.08). Children over the age of 1 year had a fourfold (13–24 months, OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0–12 months. Children of mothers aged less than 20 had a raised odds of long-bone fracture compared to those with mothers aged 30 and over (OR 1.31, 95% CI 1.07 to 1.59). The odds of fracture increased with increasing birth order (test for trend p<0.0001), with fourth or more born children having a threefold greater odds of long-bone fracture than first-born children (OR 3.12, 95% CI 2.08 to 4.68). Children whose mother had a history of alcohol misuse recorded on the medical record had a twofold higher odds of long-bone fracture (OR 2.33, 95% CI 1.13 to 4.82) compared to those without a record of alcohol misuse.
Table 3 presents the sensitivity analysis used to assess the impact of varying the definition of long-bone fractures. Findings were robust to excluding greenstick fractures, and restricting the definition to the most specific Read codes. No statistically significant interactions were found between risk factors, and no evidence of multicollinearity was identified in the final regression model.
Results
Table 2 shows the characteristics of the 2456 long-bone fracture cases and 23 661 controls, unadjusted ORs and risk factors identified as significant in the adjusted multivariable model. Of the cases, 1260 (51%) were male and 1196 (49%) were female, with similar proportions of males and females among the controls. Cases were generally older than controls; 38% of cases were 37 months or older, compared to 28% of controls.
In multivariable analysis, child sex was not associated with risk of long-bone fracture (OR 0.99, 95% CI 0.91 to 1.08). Children over the age of 1 year had a fourfold (13–24 months, OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0–12 months. Children of mothers aged less than 20 had a raised odds of long-bone fracture compared to those with mothers aged 30 and over (OR 1.31, 95% CI 1.07 to 1.59). The odds of fracture increased with increasing birth order (test for trend p<0.0001), with fourth or more born children having a threefold greater odds of long-bone fracture than first-born children (OR 3.12, 95% CI 2.08 to 4.68). Children whose mother had a history of alcohol misuse recorded on the medical record had a twofold higher odds of long-bone fracture (OR 2.33, 95% CI 1.13 to 4.82) compared to those without a record of alcohol misuse.
Table 3 presents the sensitivity analysis used to assess the impact of varying the definition of long-bone fractures. Findings were robust to excluding greenstick fractures, and restricting the definition to the most specific Read codes. No statistically significant interactions were found between risk factors, and no evidence of multicollinearity was identified in the final regression model.