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Maternal social characteristics and mortality from injuries among infants and toddlers in Estonia
  1. S Tiikkaja1,2,
  2. K Rahu3,4,
  3. I Koupil2,
  4. M Rahu3,4
  1. 1
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  2. 2
    Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
  3. 3
    Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
  4. 4
    Estonian Centre of Behavioural and Health Sciences, Tallinn/Tartu, Estonia
  1. Ms S Tiikkaja, Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, SE-171 77 Stockholm, Sweden; Sanna.Tiikkaja{at}


Background: Injuries are a major cause of ill health among children, with a social gradient in child injuries documented in many countries. The effects of maternal sociodemographic characteristics on injury mortality in Estonian infants and toddlers were investigated.

Methods: A population-based study using linkage of data from the Estonian Medical Birth Registry with Mortality Database. A total of 148 521 children born 1992–2002 were followed for injury mortality (ICD-9 E800-E999) from birth to third birthday. Associations of maternal age, education, marital status, nationality, place of residence and child’s birth order and multiplicity with risk of injury death were studied using logistic regression.

Results: Maternal age (<20 years compared with ⩾30 years: OR 2.12; 95% CI 1.00 to 4.51), education (basic compared with secondary or higher: OR 3.22; 95% CI 2.12 to 4.87), marital status (single, divorced or widowed compared with married: OR 2.74; 95% CI 1.53 to 4.91), nationality (other compared with Estonian: OR 2.00; 95% CI 1.32 to 3.02), birth order (fourth or higher compared with first: OR 6.66; 95% CI 3.42 to 12.99), and multiple birth (twin or triplet compared with singleton: OR 3.12; 95% CI 1.44 to 6.73) affected the risk of injury death among infants (<1 year). Among toddlers (1–2 years), boys were at higher risk than girls (OR 1.75; 95% CI 1.15 to 2.66) and low mother’s education (basic compared with secondary or higher OR 2.08; 95% CI 1.28 to 3.37) and high birth order (fourth or higher compared with first: OR 7.88; 95% CI 3.90 to 15.90) increased the risk of injury death.

Conclusions: Maternal sociodemographic characteristics are associated with injury mortality among infants and toddlers. Substantial variation in injury mortality rates within Estonia suggests potential for prevention.

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  • Funding: The research of KR and MR at the institute was financed by the Estonian Ministry of Education and Science target funding (SF0940026s07).

  • Competing interests: None declared.

  • Ethics approval: The study was approved by Tallinn Medical Ethics Committee.