Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
Department of Psychiatry and Human Behavior and Center for the Neurobiology of Learning and Memory, University of California - Irvine, CA, Irvine, USA.
J Racial Ethn Health Disparities. 2023 Jun;10(3):1006-1017. doi: 10.1007/s40615-022-01288-5. Epub 2022 Mar 28.
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.
成人创伤结局和护理方面的差异已经得到充分证实，但在儿科创伤患者中是否存在类似的差异仍需要进一步研究。本研究的目的是评估社会决定因素（种族、性别、保险状况、社区困境、城乡差异）在控制特定与损伤相关的风险因素后对创伤结局的独特贡献。
回顾性分析了 2010 年 1 月至 2020 年 12 月期间，一家位于全州范围内、以农村为主的一级创伤中心收治的所有年龄<18 岁的儿科（儿童）创伤患者（n=14398）。主要结局是在急诊科接受阿片类药物治疗、出院后康复转介和死亡率。多变量逻辑回归评估了人口统计学、社会经济和损伤特征。多层次逻辑回归评估了从抽象的家庭地址中提取的区域水平指标。
调整人口统计学和损伤特征的分析显示，与白人儿童（n=5883）相比，黑人儿童（n=6255）在急诊科接受阿片类药物治疗的可能性显著降低（OR=0.87）。生活在更为困难和农村社区的儿童接受阿片类药物治疗的可能性更高。女孩接受康复服务转介的可能性明显低于男孩（OR=0.61）。事后分析显示，与黑人男孩和白人儿童相比，黑人女孩接受康复转介的可能性最低。
结果强调需要检查社会决定因素对创伤护理和结局的主要和交互影响。这些发现强化并扩展了创伤性损伤护理不受差异影响的观点，使其适用于儿科人群。
