Epidemiology of injury and the impact of health disparities.

PURPOSE OF REVIEW

The purpose of this review is to highlight recent advances in understanding the epidemiology of pediatric trauma and the impact of health disparities on care of the injured child.

RECENT FINDINGS

Recent studies examining outcomes for injury in children consistently demonstrate worse clinical and functional outcomes for minority children compared with white children, with African-American race being an independent predictor of mortality. Despite controlling for injury severity and insurance status (as a surrogate of socioeconomic status), these disparities persist. Significant racial differences in mortality were also identified when national data were compared with local institutional data for children with traumatic brain injury. Studies examining the effect of insurance status on care of the injured child have similarly uncovered unsettling inequities. Disparities in delivery of pediatric trauma care have been identified based on access to pediatric trauma centers. Other studies have sought to reduce disparities by use of guidelines. Finally, prevention studies have demonstrated racial disparities in the use of motor vehicle restraints, with improved restraint use in minority populations after implementation of culturally tailored prevention programs.

SUMMARY

The cause of disparities in childhood trauma appears to be multifactorial and may include race, socioeconomic factors, insurance status, access, and healthcare provider biases. Multiple studies have confirmed that disparities exist, but it is difficult to tease out the reasons why they exist. Further work is necessary to identify causes of such disparities and formulate strategies to eliminate them.