Injury Prevalence, Causes, and Medical Care Among Children of Immigrants: The Implications for the National Action Plan for Child Injury Prevention Strategies

Background and Purpose:

Unintentional injuries are the leading cause of child mortality in the U.S. with the main causes including vehicle crashes, suffocation, falls, and drownings. Approximately 9.2 million children receive initial treatments at the emergency department, and 225,000 children require hospitalization or a transfer to another hospital for more intensive care, costing $87 billion dollars annually. Although the National Action Plan for Child Injury Prevention (NAP) was launched in 2009 to guide essential actions needed to reduce the burden of childhood injuries in the U.S., there is limited information on injuries among children of immigrants. In order to inform injury prevention efforts by the NAP, this study a) examines epidemiological patterns of injuries, b) systematically compares the likelihood of the most common causes of injury, and c) compares the likelihood of receiving different types of medical care in response to an injury, among first- and second-generation children compared to children of U.S.-born parents.

Methods:

This study uses data from the National Health Interview Survey (NHIS) including the injury section, which provides information on nonfatal injury occurrences that required medical attention as well as detailed circumstances surrounding each injury occurrence, including causes and types of medical care received or sought. We merge person- and injury-level data using the unique person identifiers of 126,508 children aged 0-17 between 2010 and 2014 in the period following the implementation of the Affordable Care Act. This study employs multivariate regression models and conducts post-hoc analysis to test for differences in the outcomes by immigrant generation as well.

Results:

This study finds that both first-generation children (OR=0.67; CI=0.66, 0.72) and second-generation children (OR=0.71; CI=0.68, 0.74) were less likely to report injuries compared to children of U.S.-born parents. First-generation children were less likely to get injured by being struck than second-generation children while significantly more prone to injuries caused by a cut or piercing. Importantly, this study finds that after an injury, first-generation children were significantly less likely to visit a doctor’s office or clinic (OR=0.58; CI=0.50, 0.67), to call a physician (OR=0.89; CI=0.87, 0.91), or to receive any other type of care (OR=0.41; CI=0.33, 0.51) compared to children of U.S.-born parents. However, an emergency care was more involved with injury treatment (OR=1.15; CI=1.00, 1.33) among first-generation children than their counterpart children groups.

Conclusions and Implications:

We find that children of immigrants, both first- and second-generation children, are less prone to injuries compared to children of U.S.-born parents. Our findings inform that the NAP should focus on promoting the use of regular sources of health care rather than costly emergency care for timely-proper treatments to protect foreign-born families’ health and well-being. The findings also offer the NAP strategies that interventions which could capture less risky behaviors of immigrant children and immigrant parents’ close supervision may strengthen the roadmap of the NAP in preventing injury occurrence among all American children.