From the Center for Surgery and Public Health (Orlas, Rentas, Hau, Ortega, Herrera-Escobar), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA (Sanchez).
J Am Coll Surg. 2023 Jan 1;236(1):47-56. doi: 10.1097/XCS.0000000000000428. Epub 2022 Dec 15.
The impact of disparities at the intersection of multiple marginalized social identities is poorly understood in trauma. We sought to evaluate the joint effect of race, ethnicity, and sex on new functional limitations 6 to 12 months postinjury.
Moderately to severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing functional outcomes 6 to 12 months postinjury. Multivariate adjusted regression analyses were used to compare functional limitations by race and ethnicity alone, sex alone, and the interaction between both race and ethnicity and sex. The joint disparity and its composition were calculated across race and sex strata.
Included were 4,020 patients: 1,621 (40.3%) non-Hispanic White male patients, 1,566 (39%) non-Hispanic White female patients, 570 (14.2%) Black or Hispanic/Latinx male patients, and 263 (6.5%) Black or Hispanic/Latinx female patients (BHF). The risk-adjusted incidence of functional limitations was highest among BHF (50.6%) vs non-Hispanic White female patients (39.2%), non-Hispanic White male patients (35.8%), and Black or Hispanic male patients (34.6%; p < 0.001). In adjusted analysis, women (odds ratio 1.35 [95% CI 1.16 to 1.57]; p < 0.001) and Blacks or Hispanic patients (odds ratio 1.28 [95% CI 1.03 to 1.58]; p = 0.02) were more likely to have new functional limitations 6 to 12 months postinjury. When sex and race were analyzed together, BHF were more likely to have new functional limitations compared with non-Hispanic White male patients (odds ratio 2.12 [1.55 to 2.90]; p < 0.001), with 63.5% of this joint disparity being explained by the intersection of race and ethnicity and sex.
More than half of the race and sex disparity in functional limitations experienced by BHF is explained by the unique experience of being both minority and a woman. Intermediate modifiable factors contributing to this intersectional disparity must be identified.
在创伤领域，多种边缘化社会身份交叉带来的差异影响仍知之甚少。我们旨在评估种族、族裔和性别对受伤后 6 至 12 个月新功能障碍的联合影响。
将收入三家一级创伤中心的中度至重度创伤患者邀请参加电话调查，以评估受伤后 6 至 12 个月的功能结果。采用多变量调整回归分析，单独比较种族和族裔、性别以及两者相互作用对功能障碍的影响。在种族和性别分层的基础上，计算联合差异及其构成。
共纳入 4020 名患者：1621 名（40.3%）非西班牙裔白人男性患者、1566 名（39%）非西班牙裔白人女性患者、570 名（14.2%）黑人和西班牙裔/拉丁裔男性患者和 263 名（6.5%）黑人和西班牙裔/拉丁裔女性患者（BHF）。功能障碍发生率风险调整后，BHF 最高（50.6%），而非西班牙裔白人女性患者（39.2%）、非西班牙裔白人男性患者（35.8%）和黑人或西班牙裔男性患者（34.6%）；p < 0.001）。调整分析表明，女性（优势比 1.35[95%CI 1.16 至 1.57]；p < 0.001）和黑人或西班牙裔患者（优势比 1.28[95%CI 1.03 至 1.58]；p = 0.02）受伤后 6 至 12 个月发生新功能障碍的可能性更高。当同时分析性别和种族时，BHF 比非西班牙裔白人男性患者更有可能发生新的功能障碍（优势比 2.12[1.55 至 2.90]；p < 0.001），其中 63.5%的联合差异由种族和族裔以及性别的交叉解释。
BHF 在功能障碍方面的种族和性别差异超过一半是由他们作为少数族裔和女性的独特经历所解释的。必须确定导致这种交叉差异的中间可调节因素。
