Racial, Gender, and Neighborhood-Level Disparities in Pediatric Trauma Care.
Disparity
Gender
Injury
Pediatric
Race
Social determinants
Trauma care
Journal
Journal of racial and ethnic health disparities
ISSN: 2196-8837
Titre abrégé: J Racial Ethn Health Disparities
Pays: Switzerland
ID NLM: 101628476
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
26
01
2022
accepted:
17
03
2022
revised:
14
03
2022
pmc-release:
01
06
2024
medline:
8
5
2023
pubmed:
30
3
2022
entrez:
29
3
2022
Statut:
ppublish
Résumé
Disparities in trauma outcomes and care are well established for adults, but the extent to which similar disparities are observed in pediatric trauma patients requires further investigation. The objective of this study was to evaluate the unique contributions of social determinants (race, gender, insurance status, community distress, rurality/urbanicity) on trauma outcomes after controlling for specific injury-related risk factors. All pediatric (age < 18) trauma patients admitted to a single level 1 trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed (n = 14,398). Primary outcomes were receipt of opioids in the emergency department, post-discharge rehabilitation referrals, and mortality. Multivariate logistic regressions evaluated demographic, socioeconomic, and injury characteristics. Multilevel logistic regressions evaluated area-level indicators, which were derived from abstracted home addresses. Analyses adjusting for demographic and injury characteristics revealed that Black children (n = 6255) had significantly lower odds (OR = 0.87) of being prescribed opioid medications in the emergency department compared to White children (n = 5883). Children living in more distressed and rural communities had greater odds of receiving opioid medications. Girls had significantly lower odds (OR = 0.61) of being referred for rehabilitation services than boys. Post hoc analyses revealed that Black girls had the lowest odds of receiving rehabilitation referrals compared to Black boys and White children. Results highlight the need to examine both main and interactive effects of social determinants on trauma care and outcomes. Findings reinforce and expand into the pediatric population the growing notion that traumatic injury care is not immune to disparities.
Sections du résumé
BACKGROUND
Disparities in trauma outcomes and care are well established for adults, but the extent to which similar disparities are observed in pediatric trauma patients requires further investigation. The objective of this study was to evaluate the unique contributions of social determinants (race, gender, insurance status, community distress, rurality/urbanicity) on trauma outcomes after controlling for specific injury-related risk factors.
STUDY DESIGN
All pediatric (age < 18) trauma patients admitted to a single level 1 trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed (n = 14,398). Primary outcomes were receipt of opioids in the emergency department, post-discharge rehabilitation referrals, and mortality. Multivariate logistic regressions evaluated demographic, socioeconomic, and injury characteristics. Multilevel logistic regressions evaluated area-level indicators, which were derived from abstracted home addresses.
RESULTS
Analyses adjusting for demographic and injury characteristics revealed that Black children (n = 6255) had significantly lower odds (OR = 0.87) of being prescribed opioid medications in the emergency department compared to White children (n = 5883). Children living in more distressed and rural communities had greater odds of receiving opioid medications. Girls had significantly lower odds (OR = 0.61) of being referred for rehabilitation services than boys. Post hoc analyses revealed that Black girls had the lowest odds of receiving rehabilitation referrals compared to Black boys and White children.
CONCLUSION
Results highlight the need to examine both main and interactive effects of social determinants on trauma care and outcomes. Findings reinforce and expand into the pediatric population the growing notion that traumatic injury care is not immune to disparities.
Identifiants
pubmed: 35347650
doi: 10.1007/s40615-022-01288-5
pii: 10.1007/s40615-022-01288-5
pmc: PMC9515239
mid: NIHMS1790575
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1006-1017Subventions
Organisme : NIMHD NIH HHS
ID : U54 MD007586
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH108155
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL105324
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD010757
Pays : United States
Organisme : NIGMS NIH HHS
ID : U54 GM115428
Pays : United States
Organisme : NIGMS NIH HHS
ID : K08 GM138812
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA040966
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD007593
Pays : United States
Informations de copyright
© 2022. W. Montague Cobb-NMA Health Institute.
Références
Am J Public Health. 2016 Dec;106(12):2219-2226
pubmed: 27736207
J Trauma Acute Care Surg. 2013 May;74(5):1195-205
pubmed: 23609267
World J Surg. 2020 Sep;44(9):3010-3021
pubmed: 32430743
J Emerg Nurs. 2012 May;38(3):211-7
pubmed: 21435705
Med Care. 2019 Dec;57(12):924-929
pubmed: 31730566
J Trauma. 2008 Mar;64(3):819-23
pubmed: 18332830
Am J Public Health. 2013 Jun;103(6):1103-9
pubmed: 23597339
J Trauma. 2007 May;62(5):1259-62; discussion 1262-3
pubmed: 17495733
J Am Coll Surg. 2012 May;214(5):756-68
pubmed: 22321521
J Pediatr Surg. 2009 Oct;44(10):1952-7
pubmed: 19853754
Ann Surg. 2020 Oct;272(4):556-561
pubmed: 32932306
Am J Emerg Med. 2019 Sep;37(9):1770-1777
pubmed: 31186154
J Surg Res. 2013 Sep;184(1):383-7
pubmed: 23582228
J Trauma Acute Care Surg. 2017 Jul;83(1):111-118
pubmed: 28422905
J Surg Res. 2016 Oct;205(2):261-271
pubmed: 27664871
Health Aff (Millwood). 2019 Dec;38(12):2069-2076
pubmed: 31747321
J Trauma Nurs. 2018 Sep/Oct;25(5):266-281
pubmed: 30216255
J Trauma Acute Care Surg. 2022 May 1;92(5):897-905
pubmed: 34936591
Am J Public Health. 2003 Mar;93(3):461-6
pubmed: 12604496
J Trauma Acute Care Surg. 2014 Apr;76(4):1061-9
pubmed: 24662872
Brain Sci. 2020 Feb 28;10(3):
pubmed: 32121176
Am Surg. 2012 Apr;78(4):426-31
pubmed: 22472399
J Trauma. 1987 Apr;27(4):370-8
pubmed: 3106646
J Trauma Acute Care Surg. 2019 Mar;86(3):540-550
pubmed: 30531328
Pediatrics. 1997 May;99(5):711-4
pubmed: 9113948
J Pediatr Surg. 2019 Nov;54(11):2369-2374
pubmed: 31255326
Medicine (Baltimore). 2018 Sep;97(39):e12606
pubmed: 30278575
Anesthesiol Clin. 2019 Mar;37(1):107-117
pubmed: 30711224
Am J Emerg Med. 2002 May;20(3):139-43
pubmed: 11992329
Injury. 2018 Jan;49(1):75-81
pubmed: 28965684
Ann Emerg Med. 1994 Feb;23(2):203-7
pubmed: 8304599
Curr Opin Psychiatry. 2017 Jul;30(4):238-246
pubmed: 28426545
J Neurosurg Pediatr. 2015 Oct;16(4):463-71
pubmed: 26114993
J Trauma. 2011 Jun;70(6):1532-8
pubmed: 21427613
Pediatrics. 2005 Dec;116(6):e810-7
pubmed: 16322139
J Trauma Acute Care Surg. 2018 Sep;85(3):649-650
pubmed: 30036263
J Pediatr Surg. 2007 Jan;42(1):172-6; discussion 176-7
pubmed: 17208560
J Pain. 2020 Jan - Feb;21(1-2):170-181
pubmed: 31255798
Ann Emerg Med. 2003 Jul;42(1):41-7
pubmed: 12827122
Pediatrics. 1996 Nov;98(5):890-7
pubmed: 8909482
Front Pediatr. 2019 Dec 19;7:525
pubmed: 31956644
Arch Surg. 2008 Oct;143(10):945-9
pubmed: 18936372