Trinidad Stephen, Kotagal Meera
Division of Pediatric General and Thoracic Surgery, Cincinnati Children...s Hospital Medical Center, Cincinnati, Ohio.
Assistant Professor, Division of General and Thoracic Surgery, Director, Trauma Services, Director, Pediatric Surgery Global Health Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States.
Semin Pediatr Surg. 2022 Oct;31(5):151221. doi: 10.1016/j.sempedsurg.2022.151221. Epub 2022 Oct 27.
A child's social determinants of health (SDH), including their neighborhood environment, insurance status, race and ethnicity, English language proficiency and geographic location, all significantly impact their risk of injury and outcomes after injury. Children from socioeconomically disadvantaged neighborhoods experience overall higher rates of injury and different types of injuries, including higher rates of motor vehicle-, firearm-, and violence-related injuries. Similarly, children with public insurance or no insurance, as a proxy for lower socioeconomic status, experience higher rates of injuries including firearm-related injuries and non-accidental trauma, with overall worse outcomes. Race and associated racism also impact a child's risk of injury and care received after injury. Black children, Hispanic children, and those from other minority groups disproportionately experience socioeconomic disadvantage with sequelae of injury risk as described above. Even after controlling for socioeconomic status, there are still notable disparities with further evidence of racial inequities and bias in pediatric trauma care after injury. Finally, where a child lives geographically also significantly impacts their risk of injury and available care after injury, with differences based on whether a child lives in a rural or urban area and the degree of state laws regarding injury prevention. There are clear inequities based on a child's SDH, most predominantly in a child's risk of injury and the types of injuries they experience. These injuries are preventable and the SDH provide potential upstream targets in injury prevention efforts.
儿童的健康社会决定因素（SDH），包括其邻里环境、保险状况、种族和族裔、英语语言能力及地理位置，均会对其受伤风险及受伤后的结果产生重大影响。来自社会经济条件不利社区的儿童总体受伤率更高，且受伤类型各异，包括机动车、枪支和暴力相关伤害的发生率更高。同样，以公共保险或无保险作为社会经济地位较低的指标，这类儿童受伤率更高，包括与枪支相关的伤害和非意外创伤，总体预后更差。种族及相关的种族主义也会影响儿童的受伤风险及受伤后接受的治疗。黑人儿童、西班牙裔儿童以及其他少数群体儿童不成比例地经历社会经济劣势，伴随上述受伤风险的后果。即使在控制了社会经济地位之后，在儿童创伤治疗中仍存在明显差异，进一步证明了受伤后存在种族不平等和偏见。最后，儿童居住的地理位置也会显著影响其受伤风险及受伤后可获得的治疗，这取决于儿童是生活在农村还是城市地区，以及各州关于伤害预防的法律程度。基于儿童的健康社会决定因素存在明显的不平等，最主要体现在儿童的受伤风险及其经历的伤害类型上。这些伤害是可预防的，而健康社会决定因素为伤害预防工作提供了潜在的上游目标。
