650 Developing SKIRI, a national risk index for unintentional child injury

<h3>Background</h3> Unintentional injury is the leading cause of death among children ages 1–19 years in the U.S. Risk is unequally distributed by social, demographic, and geographic factors. Although existing indices explore geographic disparities in child health and wellbeing, none specifically address the risk of unintentional injury among children. <h3>Objective</h3> To develop an index identifying ZIP Code Tabulation Areas (ZCTAs) at increased risk of fatal unintentional child injury by linking fatality data with U.S. Census Bureau socio-economic and demographic data. <h3>Methods</h3> Multivariate regression modeling was conducted using county-level rates of unintentional injury death among children ages 0–19 for the years 2010–2019 as the dependent variable. Twenty-one population characteristics representing factors associated with increased risk of child unintentional injury identified through a literature review were explored as independent variables. Coefficients from the final model were applied to population characteristics at the ZCTA level to produce risk scores. Scores were grouped into quintiles ranging from very low risk to very high risk, weighted by US child population. <h3>Results</h3> The final regression model included 15 variables and explained 60% of the variance in child unintentional injury deaths. Of 32,821 ZCTAs, 36% were at low or very low risk, 21% at moderate risk, 20% at high risk, and 23% at very high risk. Proportions of ZCTAs at high or very high risk by state ranged from 6% to 82%. Very high and high risk ZCTAs were most concentrated in the Southern and Western U.S. regions. More than half of children living in poverty, Black, Native Americans, and Hispanic Americans in the U.S. in 2019 resided in ZCTAs at very high or high risk (63%, 59%, 63%, and 57%, respectively), as did 49% of adults with a high school or less education. <h3>Conclusions</h3> Fifty-two percent of U.S. ZCTAs were at high or very high risk of child unintentional injury death, with large proportions of historically marginalized and underserved groups residing in these locations. The Safe Kids Injury Risk Index (SKIRI) provides a unique tool for injury prevention targeting to these groups at the local level.