邻里层面的社会经济剥夺与儿童 firearm 相关伤害之间的关系。
Relationships between socioeconomic deprivation and pediatric firearm-related injury at the neighborhood level.
机构信息
From the Division of Pediatric General and Thoracic Surgery (S.T., S.M., D.G., R.A.F.J., M.K.), Cincinnati Children's Hospital Medical Center; Department of Surgery (R.A.F.J., M.K.), University of Cincinnati College of Medicine; Division of Biostatistics and Epidemiology (A.V.), Division of General & Community Pediatrics (C.B., A.F.B.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (C.B., C.R., A.F.B.), University of Cincinnati College of Medicine; Division of Critical Care (A.A.P., C.R.), Division of Biostatistics and Epidemiology (R.S.), James M. Anderson Center for Health System Excellence (N.S.), and Division of Hospital Medicine (A.F.B.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
出版信息
J Trauma Acute Care Surg. 2022 Sep 1;93(3):283-290. doi: 10.1097/TA.0000000000003679. Epub 2022 May 12.
BACKGROUND
Disparities in pediatric injury are widely documented and partly driven by differential exposures to social determinants of health (SDH). Here, we examine associations between neighborhood-level SDH and pediatric firearm-related injury admissions as a step to defining specific targets for interventions to prevent injury.
METHODS
We conducted a retrospective review of patients 16 years or younger admitted to our Level I pediatric trauma center (2010-2019) after a firearm-related injury. We extracted patients' demographic characteristics and intent of injury. We geocoded home addresses to enable quantification of injury-related admissions at the neighborhood (census tract) level. Our population-level exposure variable was a socioeconomic deprivation index for each census tract.
RESULTS
Of 15,686 injury-related admissions, 140 were for firearm-related injuries (median age, 14 years; interquartile range, 11-15 years). Patients with firearm-related injuries were 75% male and 64% Black; 66% had public insurance. Nearly half (47%) of firearm-related injuries were a result of assault, 32% were unintentional, and 6% were self-inflicted; 9% died. At the neighborhood level, the distribution of firearm-related injuries significantly differed by deprivation quintile ( p < 0.05). Children from the highest deprivation quintile experienced 25% of injuries of all types, 57% of firearm-related injuries, and 70% of all firearm-related injuries from assault. They had an overall risk of firearm-related injury 30 times that of children from the lowest deprivation quintile.
CONCLUSION
Increased neighborhood socioeconomic deprivation is associated with more firearm-related injuries requiring hospitalization, at rates far higher than injury-related admissions overall. Addressing neighborhood-level SDH may help prevent pediatric firearm-related injury.
LEVEL OF EVIDENCE
Prognostic and epidemiological, Level III.
背景
儿科伤害的差异广泛记录在案，部分原因是对健康社会决定因素（SDH）的差异暴露。在这里，我们研究了邻里 SDH 与儿科枪支伤害入院之间的关联，作为确定预防伤害干预具体目标的一个步骤。
方法
我们对我院一级儿科创伤中心（2010-2019 年）收治的 16 岁以下因枪支相关伤害而入院的患者进行了回顾性审查。我们提取了患者的人口统计学特征和伤害意图。我们将家庭住址进行地理编码，以量化邻里（普查区）层面与伤害相关的入院情况。我们的人群水平暴露变量是每个普查区的社会经济剥夺指数。
结果
在 15686 例与伤害相关的入院中，有 140 例是与枪支相关的伤害（中位数年龄为 14 岁；四分位距为 11-15 岁）。枪支相关伤害患者中，75%为男性，64%为黑人；66%有公共保险。近一半（47%）的枪支相关伤害是由攻击造成的，32%是意外的，6%是自残的；9%死亡。在邻里层面，枪支相关伤害的分布与贫困五分位数显著不同（p<0.05）。来自贫困程度最高五分位数的儿童经历了所有类型伤害的 25%、枪支相关伤害的 57%以及所有由攻击造成的枪支相关伤害的 70%。他们因枪支相关伤害而住院的总体风险是来自贫困程度最低五分位数的儿童的 30 倍。
结论
邻里社会经济剥夺程度的增加与需要住院治疗的枪支相关伤害有关，其发生率远远高于整体伤害相关入院率。解决邻里层面的 SDH 可能有助于预防儿科枪支相关伤害。
证据水平
预后和流行病学，III 级。
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