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Primary Caregiver Employment Status Is Associated With Traumatic Brain Injury In Children
Emma Tian, Stephanie Chen, Shadassa Ourshalimian, *Pradip P Chaudhari, *Ryan G Spurrier
Children's Hospital Los Angeles, Los Angeles, CA

Background:
Traumatic brain injury (TBI) is a common injury in children. Previous literature has demonstrated that incidence of injury may be associated with level of supervision. We hypothesized that caregiver employment would be associated with current child TBI.
Methods:
A retrospective cross-sectional study was performed for children ages 0-17 years using the National Survey of Children’s Health (NSCH) 2018-2019 database. The NSCH contains survey data on children’s health completed by adult caregivers from randomly selected households in the United States. Current TBI prevalence was compared between children from households of different employment statuses. Current TBI was defined by a survey response indicating that a healthcare provider diagnosed TBI/concussion for the child and that the condition was present at time of survey completion. Household employment status was categorized as two caregivers employed, two caregivers unemployed, one of two caregivers unemployed, single caregiver employed, and single caregiver unemployed. Multivariable logistic regression identified factors associated with current TBI, controlling for sociodemographic factors.
Results:
Of 56,438 children, the median age was 10 years (IQR: 5-14) and 0.59% (n=334) had a current TBI. Children with TBI were older than children without TBI (median 12 years vs. 10 years, p<0.001). On multivariable regression, children with one of two caregivers unemployed (OR1.56, 95%CI:1.16-2.11) or both caregivers unemployed (OR2.27, 95%CI:1.22-4.23) had increased odds of current TBI compared to children with both caregivers employed.
Conclusions:
Contrary to the hypothesized association, children from households with one of two caregivers unemployed or both caregivers unemployed had increased odds of TBI compared to children from households with both caregivers employed. These findings highlight a population of families that may benefit from targeted injury prevention education and intervention.

Univariate and multivariable model of household factors associated with current TBI
Household Employment StatusUnadjusted OR(95% CI)Adjusted OR*(95% CI)
Both Caregivers EmployedRefRef
One Caregiver Employed and One Caregiver Unemployed1.69 (1.32-2.17)1.56 (1.16-2.11)
Single Caregiver Employed1.67 (1.16-2.41)0.74 (0.09-6.36)
Single Caregiver Unemployed3.77 (2.47-5.75)0.53 (0.06-4.73)
Both Caregivers Unemployed2.58 (1.56-4.25)2.27 (1.22-4.23)
*Controlling for child sex, child race/ethnicity, child age, household income level, primary caregiver age, grandparent as primary caregiver, and presence of additional adults in the household


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