A study of injury-related mortality attempted to identify socioeconomic factors linked to racial differences in injury rates (Hussey, 1997). When compared to white children, black children were twice as likely to live with a head of household who had not completed high school, more than four times as likely to live in a household in the lowest income bracket, almost four times as likely to live in a female-headed household, and almost three times as likely to live in an inner city. Of these socioeconomic factors, however, the educational attainment of the head of household was the single independent factor related to mortality of children related to injuries. When the head of household had less than a high school diploma, the injury-related death rate of children in the family was 3.5 times greater than for children living with a college-educated head of household. Income and other disparities interact to account statistically for almost two-thirds of the overall difference in injury-related death rates.

Older black children have higher death rates than whites for both injury-related and other causes of death (Table 2.9). For other causes of death, in 1999, HIV/AIDS was not among the top 10 among white children, but it ranked tenth among causes of death for black children 1 to 4 years old, seventh for those aged 5 to 14, and sixth for ages 15 to 24 (NCHS, 2001e).

The greatest disparity in death rates between races is seen in the adolescent homicide rate. Black adolescents between the ages of 15 and 19 years are killed at six times the rate for white adolescents (37.5 per 100,000 versus 5.7 per 100,000). In contrast, suicide and motor vehicle death rates are almost half again as high among white adolescents, ages 15 to 19, compared to black adolescents in this age group (8.6 per 100,000 versus 5.9 per 100,000 for suicide and 28.4 versus 18.2 per 100,000 for motor vehicle deaths) (NCHS, 2001e).

A number of factors appear to underlie racial differences in homicide rates including socioeconomic disparities and age structure of racial subgroups. For example, in a study of domestic homicides in black and white neighborhoods in New Orleans and Atlanta, Centerwall (1995) reported that differences in relative risk of homicide essentially disappeared when controlled for socioeconomic variables such as household crowding. As noted earlier, the United States has substantially higher homicide mortality for children than other developed countries, and explanations for this difference (and similar differences across all age groups) generally focus on handgun availability (CDC, 1997).

WHERE CHILDREN DIE

Based on analysis of 1997 national mortality data, more than 56 percent of child deaths (under age 19) occurred in inpatient hospital settings



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