Predictors of Mortality From Fires in Young Children
Authors: Scholer Seth J. , Hickson Gerald B. , Mitchel Edward F. , Ray Wayne A. 
Published: August 2004

Background. In the United States in 1994, fires claimed 3.75 lives per 100 000 child years and accounted for 17.3% of all injury deaths in children &lt;5 years of age.

Objectives. To conduct a historical cohort study that uses maternal demographic characteristics to identify young children at high risk of fire-related deaths, thus defining appropriate targets for prevention programs.

Methods. The cohort consisted of children born to mothers who resided in the state of Tennessee between 1980 and 1995. Information was obtained by linking birth certificates, 1990 census data, and death certificates. Children were eligible for the study if they were &lt;5 years of age at any time within the study period and if key study variables were present (99.2% of births).

Birth certificates provided information on maternal characteristics including age, race, education, previous live births, use of prenatal care, and residence (in standard metropolitan statistical area). Child characteristics included gender, gestational age, and birth type (singleton/multiple gestation). Neighborhood income was estimated by linking the mother's address at the time of birth to the 1990 census (block group mean per capita income).

The study outcome was a fire resulting in at least one fatality (fatal fire event) during the study period, identified from death certificates (coded E880 through E889 in the International Classification of Diseases, 9th rev). We calculated the fatal fire event rate corresponding to each stratum of maternal/child characteristics. We assessed the independent association between each characteristic and the risk of a fatal fire event from a Poisson regression multivariate analysis.

Results. During the study period, 1 428 694 children contributed 5 415 213 child years to the cohort: there were 270 deaths from fire (4.99 deaths per 100 000 child years) and 231 fatal fire events. In the multivariate analysis, factors associated with greater than a threefold increase in fatal fire events included maternal education, age, and number of other children. Compared with children whose mothers had a college education, children whose mothers had less than a high school education had 19.4 times (95% confidence interval [CI], 2.6–142.4) an increased risk of a fatal fire event. Children whose mothers had more than two other children had 6.1 times (95% CI, 3.8–9.8) an increased risk of a fatal fire event compared with children whose mothers had no other children. Children of mothers &lt;20 years of age had 3.9 times (95% CI, 2.2–7.1) increased risk of a fatal fire event compared with children whose mothers were ≥30 years old. Although both maternal neighborhood income and race were associated strongly with increased rates of fatal fire events in the univariate analysis, this association did not persist in the multivariate analysis. Other factors that were associated with increased risk of fatal fire events in the multivariate analysis were male gender and having a mother who was unmarried or who had delayed prenatal care.

The three factors associated most strongly with fire mortality were combined to create a risk score based on maternal education (≥16 years, 0 points; 13 to 15 years, 1 point; 12 years, 2 points; &lt;12 years, 3 points); age (≥30 years, 0 points; 25 to 29 years, 1 point; 20 to 24 years, 2 points; &lt;20 years, 3 points); and number of other children (none, 0 points; one, 1 point; two, 2 points; three or more, 3 points). The lowest-risk group (score &lt;3) included 19% of the population and had 0.19 fatal fire events per 100 000 child years. In contrast, highest-risk children (score &gt;7) comprised 1.5% of the population and had 28.6 fatal fire events per 100 000 child years, 150 times higher than low-risk children. Children with risk scores &gt;5 contributed 26% of child years but experienced 68% of all fatal fire events. If the fatal fire event rate for all children had been equal to that of the low-risk group (risk score &lt;3), then 95% of deaths from fires would not have occurred.Table 1.Risk Factors Associated With Fatal Fire Events for Children &lt;5 Years of Age in Tennessee From 1980 Through 1995Child YearsN*Rate†Relative RiskAdjusted Relative Risk‡95% CITotal5 415 2132314.27Maternal characteristics Education  &lt;12 Years1 516 6871479.6974.519.362.63 –142.39  12 Years2 253 674733.2424.910.201.40 –74.61 13–15 Years 897 389101.118.535.040.64 –39.62  ≥16 Years 747 46410.131.001.00Number of other children  Three or more 405 8924511.094.146.093.79 –9.79 Two 765 720415.352.002.941.91 –4.55  One1 820 804804.391.642.301.63 –3.27 None2 422 798652.681.001.00Age &lt;20 Years 985 999808.114.433.912.17 –7.05 20–24 Years1 801 530975.382.942.701.62 –4.51  25–29 Years1 537 671342.211.211.350.77 –2.36 ≥30 Years1 090 013201.831.001.00Neighborhood income§ Lowest quintile (&lt;$8159)1 071 374797.374.691.440.82 –2.51 Second quintile ($8159–$9790)1 081 587534.903.121.370.78 –2.43  Third quintile ($9791–$11 514)1 081 903484.442.831.460.83 –2.59  Fourth quintile ($11 515–$14 007)1 095 098343.101.971.180.66 –2.12  Highest quintile (&gt;$14 007)1 085 252171.571.001.00Race African-American1 223 873887.192.101.130.79 –1.62 White/other4 191 3411433.421.001.00Married No1 339 8241128.362.861.491.08 –2.06 Yes4 075 3891192.921.001.00First prenatal care visit  &gt;4 Months' gestation 892 344808.972.691.511.14 –1.99  ≤4 Months' gestation4 522 8701513.341.001.00Residence Rural (non-SMSA)‖1 626 876845.161.331.180.88 –1.60  Urban (SMSA)3 788 3371473.881.001.00Child Characteristics Gestational age  &lt;37 Weeks 505 649275.341.290.870.58 –1.31 ≥37 Weeks4 909 5642044.151.001.00Sex Male2 776 7891354.861.341.341.03 –1.75 Female2 638 425963.641.001.00* N indicates number of fatal fire events.† Rate indicates rate of death from injury per 100 000 person years.‡ Adjusted relative risk indicates relative risk adjusted for other factors in Poisson regression.‖ SMSA indicates standard metropolitan statistical area.§ Neighborhood income: block group mean annual per capita income obtained from 1990 US census.

Discussion. Maternal education, age, and number of other children had strong and independent associations with fire-related deaths among young children. Taken together, these factors defined a steep risk gradient, where children in the highest-risk group had a fire-related mortality rate that was 150 times that of the lowest-risk group. From a public health perspective, maternal factors clearly define children who would be good candidates for prevention programs. There is an urgent need to develop prevention programs that can be shown to reduce fire-related injury in high-risk children.