Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston University School of Medicine, Boston, Massachusetts; Department of Surgery, Boston Medical Center, Boston, Massachusetts.
Boston University School of Medicine, Boston, Massachusetts.
J Surg Res. 2022 Aug;276:100-109. doi: 10.1016/j.jss.2022.01.033. Epub 2022 Feb 22.
Following the declaration of the COVID-19 pandemic, there were reports of decreased trauma hospitalizations, although violent crime persisted. COVID-19 has had the greatest impact on minoritized and vulnerable communities. Decreases in traumatic events may not extend to these communities, given pandemic-related socioeconomic and psychological burdens that increase the risk of exposure to trauma and violence.
This was a retrospective cohort study (n = 1634) of all trauma activations presenting to our institution January 1, 2020 to May 31, 2020, and same time periods in 2018 and 2019. Census tracts and associated Social Vulnerability Index quartiles were determined from patient addresses. Changes in trauma activations pre and post Massachusetts' state-of-emergency declaration compared to a historical control were analyzed using a difference-in-differences methodology.
Weekly all-cause trauma activations fell from 26.44 to 8.25 (rate ratio = 0.36 [0.26, 0.50]) postdeclaration, with significant difference-in-differences compared to a historical control (P < 0.0001). Nonviolent trauma activations significantly decreased from 21.11 to 5.17 after the declaration (rate ratio = 0.27 [0.37, 0.91]; P < 0.0001), whereas there was no significant decrease in violent injury (5.33 to 3.08 rate ratio = 0.69 [0.39, 1.22]; P = 0.20). Stratified by vulnerability, the most vulnerable quartile had an increased proportion of all-cause trauma postdeclaration and had no decrease in violent trauma activations following the declaration compared to the historical control (rate ratio = 0.84 [0.38-1.86]; P = 0.67).
The state-of-emergency declaration was associated with significant decreases in overall trauma, to a greater extent in nonviolent injuries. Among those living in the most socially vulnerable communities, there was no decrease in violent trauma. These findings highlight the need for violence and injury prevention programs in vulnerable communities, particularly in times of crisis.
自 COVID-19 大流行宣布以来，尽管暴力犯罪仍在持续，但创伤医院的入院人数有所减少。COVID-19 对少数族裔和弱势群体社区的影响最大。由于与大流行相关的社会经济和心理负担增加了接触创伤和暴力的风险，创伤事件的减少可能不会扩展到这些社区。
这是一项回顾性队列研究（n=1634），纳入了 2020 年 1 月 1 日至 5 月 31 日期间以及 2018 年和 2019 年同期在我院就诊的所有创伤激活患者。从患者地址确定了普查区和相关社会脆弱性指数四分位数。使用差异中的差异方法分析马萨诸塞州宣布紧急状态前后与历史对照相比创伤激活的变化。
自宣布以来，所有原因创伤激活的每周频率从 26.44 降至 8.25（率比为 0.36 [0.26, 0.50]），与历史对照相比差异有统计学意义（P<0.0001）。宣布后，非暴力创伤激活从 21.11 降至 5.17（率比为 0.27 [0.37, 0.91]；P<0.0001），而暴力损伤无明显下降（率比为 0.69 [0.39, 1.22]；P=0.20）。按脆弱性分层，最脆弱的四分位数在宣布后创伤的所有原因比例增加，与历史对照相比，宣布后暴力创伤激活没有减少（率比为 0.84 [0.38-1.86]；P=0.67）。
紧急状态宣言与整体创伤的显著减少相关，而非暴力伤害的减少程度更大。在生活在最弱势社区的人群中，暴力创伤没有减少。这些发现强调了在弱势群体社区中需要开展暴力和伤害预防计划，尤其是在危机时期。
