tennessee birth certificates - DOC

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					Andy Yang
Data Summary
Ms. Hardin

1. Article Citation:
        Seth J. Scholar, MD, Mph; Gerald B. Hickson, MD; Edward F, Mithel, Jr, MS;
Wayne A. Bay. PhD (1997). “Persistently Increased Injury Mortality Rates in High-Risk
Young Children” Arch Pediatr Adolesc Med/Vol. 151.DEC 1997

2. Goals of the Study:
       The goal of this observational study is to study trends in injury mortality for low-
risk and high-risk young children. During the past two decades, considerable attention
has been focused on reduction of childhood injuries. National data suggest that there has
been a corresponding reduction in injury death rate. In Tennessee, material education,
age, and parity consistently identified a population of children at increased risk of injury
mortality. The findings show that during the past eighteen years there has been limited
progress in reducing injury mortality among high-risk young children in Tennessee.

3. Treatment Arms:
        This study is an observational study, a nested-control study; no treatments are
imposed to the population. The treatment groups are the high-risk children and the other
is the low-risk children group. In each of the group when they are comparing the
difference causes of the death, it was stratified into two groups: Motor Vehicle Accident
and all other causes. Motor Vehicle Accident was listed because it had a significant
influence in causing death among both high and low risk children. The explanatory
variables are strong independent predictors of injury mortality (maternal education,
prenatal care, married parents, etc…). The response variable is the mortality rate.

4. Experimental Design:
         The sample of the study selected is from linked birth and death certificate of all
children in the state of Tennessee and included children who mother resided in Tennessee
at the time of birth, who were between 0 and 4 years of age at anytime between January
1, 1978, and December 31, 1995. This resulted we have a population (larger group of any
child ever born past or future in Tennessee) of 15 million children. 28% of high-risk
children and 72% were low-risk children. Birth certificates were used to obtain data on
maternal education, age, and parity; these risks factors were used to classify children into
low-risk and high-risk by using a developed scoring system based on maternal
characteristics reliably recorded on the birth certificates. The system assign more points
(associated with increased risk) for children who had mothers who had less education
(13-15 years, 1 point; 12 years, 2 points; and <12 years, 3 points), were younger (26-30
years, 1 point; 20-25, 2 points; <20 years, 3 points), and had other children ( 1 children, 1
point; 2 children, 2 points; 3 children, 3 points). Then separate the children into two
groups, low-risk (risk score < =5) and high-risk group (risk score>=6) for this study.
5. Who was removed:
       Children who had missing data for study variables were excluded from the study.
Approximately 6801 children which is about 0.5% of the whole population were

6. Variables
    byyear: year of birth ,from year 1986-1995
    injflag: fate of children when injured, injflag = 1 is if subject died of injuries;
      injflag = 0 is not died.
    pnclate: whether the children have receive prenatal care in the first four months of
      pregnancy. pnclare = 1, no prenatal care received; pnclate = 0, care was given or
      NA(missing information)
    illegit: whether the children is born with or without marriage. Illegit = 1, children
      born without wedlock; illegit = 0, children born with wedlock.

7. Further Concern
         This article was very exciting to read and the method in collecting data and the
    data analysis were very good. Especially they used the stratified sample in each
    causes and determined the major factor of causing injure among both high and low
    risk children. The conclusion is given in a broad view which it provided many
    alternatives explanations of the results. One really important question was answer in
    the article which is: does this increase in mortality rates represent a true increase in
    serious injuries in high-risk children? If possible, I would like to see the data and
    analysis after this study passed 1995; to see if their prediction was right.

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