(WITHDRAWN) What Accounts for the Gender Gap in Child Injury Deaths in the United States?

Background/Purpose:

For decades, scholars in demography, public health, and medicine have documented a gender gap in early childhood mortality rates, primarily attributing this gap to male biological fragility (susceptibility to disease and perinatal conditions and disorders). However, unintended and intended injuries are leading causes of death for males in early childhood (0-4 years of age). In this body of research, early childhood (ages 0-5 years) is subsumed either under the theories for infancy (biological fragility) and/or under the theories of adolescence and beyond (gender identities driving health behaviors). In this paper we aim to clarify the extent of the mortality differential, examining possible changes over time. Extending the understanding that early childhood development is relational, we ask how might gendered caretaking and supervision on the part of adults account for some of the gender differences in fatalities in early childhood?

Methods:

Our primary mortality data are the 1999-2017 All County Detailed Mortality Vital Statistics records for children under five years of age (N = 583,519). These restricted vital statistics records are collected and maintained by the National Center for Health Statistics (NCHS) for 57 jurisdictions in the United States. To obtain population mortality rates by age, we use Bridged-Race Population Estimates for children under five for 1999-2017 produced by the U.S. Census Bureau in collaboration with the NCHS. Our binary outcomes are a series of dichotomous variables indicating death by cause (mechanism) or death by manner (intent). We calculate age and gender stratified crude mortality rates by cause and manner of death. Mortality rates are influenced by a number of biological and contextual factors that may be related to sex, of which we attempt to control for in our multivariate models. In these models, we assess three binary dependent variables: (1) unintended injury death versus “natural” death, (2) homicide versus “natural” death, and (3) undetermined cause of death versus “natural” death.

Results:

We find that gender gaps in unintentional injury deaths are persistent over time and unexplained by prior theory or empirical work. In line with theory, across all years, boys were significantly more likely to die of “natural” causes of death in infancy than girls. However, boys were also more likely than girls to die of injuries after age 1. We demonstrate that males suffer excess mortality where social interactions (i.e. adult supervision) are likely to play important roles, such as drowning.

Conclusions:

We argue that gendered fatalities in early childhood may be caused in part by a process of gendered socialization. Decades of study have shown that parents engage in gendered supervision of children, spending more time supervising girls and requiring boys to play more independently. The mortality gaps we observe are for causes of death that typically involve some level of adult supervision. Our results raise questions regarding interventions targeting parents of boys, as well as the prior work which has asserted that interventions aimed at reducing excess male deaths in early childhood are inappropriate due to their cost (Overpeck et al., 1998).