邻里剥夺程度和儿童机会指数与洛杉矶县儿童暴力伤害有关。

Neighborhood deprivation and childhood opportunity indices are associated with violent injury among children in Los Angeles County.

机构信息

From the Fielding School of Public Health (S.S.), University of California, Los Angeles; Department of Medical Education (E.E.R.), Keck School of Medicine, University of Southern California; Division of Pediatric Surgery, Department of Surgery (S.O., R.G.S.) and Division of Emergency and Transport Medicine (P.P.C.), Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.

出版信息

J Trauma Acute Care Surg. 2023 Sep 1;95(3):397-402. doi: 10.1097/TA.0000000000003860. Epub 2023 Jan 11.

DOI:10.1097/TA.0000000000003860

PMID:36728330

Abstract

BACKGROUND

Previous research has demonstrated mixed relationships between individual neighborhood socioeconomic factors and incidences of violence, such as poverty level, population density, and income inequality. We used the Childhood Opportunity Index and Area Disadvantage Index to evaluate the relationship between neighborhood characteristics and the number of incidents of violence among children across the zip codes of Los Angeles (LA) County.

METHODS

We performed a retrospective cross-sectional study of children younger than 18 years from 2017 to 2019 who were entered in the LA County Trauma and Emergency Medicine Information System registry with violent mechanisms of injury, including gunshot, stabbing, or assault. Mechanisms classified as self-inflicted injuries were excluded from the study. The number of incidences of violent mechanism per 100,000 persons younger than 18 years for each zip code was calculated using population data from the US Census American Community Survey 5-Year estimates from 2019. The incidences of violence per capita younger than 18 years for each zip code was compared with the zip code Area Deprivation Index and Childhood Opportunity Index using logistic regression models.

RESULTS

There were 6,791 trauma activations in LA County over the study period, 12.8% (n = 866) of which were due to violence. The mean prevalence of pediatric violent mechanism of injury per zip code was 4 cases per 100,000 persons younger than 18 years. Most injuries were the result of firearms (n = 345 [60.4%]) and occurred among Hispanic/Latino children (n = 362 [57.1%]). There were significantly greater rates of violent injury among children from highest disadvantage (odds ratio, 8.84) and lowest opportunity (odds ratio, 42.48) zip codes.

CONCLUSION

Children living in high disadvantage or low opportunity zip codes had greater rates of violent injury. Further study of neighborhood factors is needed to develop targeted effective interventions to reduce violent injuries among children living in low opportunity areas.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

摘要

背景

先前的研究表明，个体社区社会经济因素与暴力事件的发生率之间存在复杂关系，如贫困水平、人口密度和收入不平等。我们使用儿童机会指数和区域劣势指数来评估洛杉矶县（LA）各个邮政编码区域特征与儿童暴力事件数量之间的关系。

方法

我们对 2017 年至 2019 年期间因枪击、刺伤或袭击等暴力机制受伤而进入 LA 县创伤和急诊医学信息系统登记处的 18 岁以下儿童进行了回顾性横断面研究。机制分类为自我伤害的病例被排除在研究之外。使用 2019 年美国人口普查美国社区调查 5 年估计的人口数据，计算每个邮政编码每 10 万 18 岁以下人群的暴力机制发生率。使用逻辑回归模型比较每个邮政编码 18 岁以下人群每 capita 的暴力发生率与邮政编码区域剥夺指数和儿童机会指数。

结果

研究期间，LA 县有 6791 次创伤激活，其中 12.8%（n=866）是暴力引起的。每个邮政编码的儿科暴力机制损伤平均流行率为每 10 万 18 岁以下人群 4 例。大多数伤害是由枪支造成的（n=345[60.4%]），发生在西班牙裔/拉丁裔儿童（n=362[57.1%]）中。来自劣势最大（优势比，8.84）和机会最低（优势比，42.48）邮政编码的儿童暴力伤害发生率显著更高。