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外伤性脑损伤中的社会经济因素:审视地区贫困指数。

Socioeconomic factors in inflicted traumatic brain injury: Examining the area deprivation index.

作者信息

Lee Angela H, Anastasiadis William A, Hitti Stephanie A, Connery Amy K

机构信息

Children's Hospital Colorado.

出版信息

Rehabil Psychol. 2024 Aug 22. doi: 10.1037/rep0000581.

Abstract

PURPOSE/OBJECTIVE: Inflicted traumatic brain injury (iTBI), or abusive head injury, is a common cause of mortality and disability among infants and toddlers. Social determinants of health (SDoH) have a critical and multifaceted impact on iTBI, influencing both prevalence and outcomes. The area deprivation index (ADI) is a comprehensive metric of SDoH developed to assist in understanding how community-level socioeconomic factors influence patient outcomes. The current study sought to describe the sociodemographic characteristics, including ADI, of a cohort of 373 infants and young children who sustained an iTBI.

RESEARCH METHOD/DESIGN: This study was a retrospective analysis utilizing a cohort of pediatric patients treated for iTBI at a large, tertiary care children's hospital serving seven states in the Rocky Mountain region.

RESULTS

Mortality prevalence was higher among older children, and older children were more likely to have a longer stay in the pediatric intensive care unit. Children who were identified as Hispanic/Latino lived in areas with greater socioeconomic disadvantage than children identified as non-Hispanic/Latino. Specifically, participants who were identified as White Hispanic/Latino lived in areas with greater disadvantage than children who were identified as White non-Hispanic/Latino. There were no other significant differences by race. Contrary to hypotheses, ADI was not significantly related to mortality, injury severity, or follow-up visits.

CONCLUSIONS/IMPLICATIONS: While SDoH are known to influence outcomes in iTBI, it may be necessary to incorporate individual or family-level SDoH variables within this clinical sample and examine the interaction between individual and community-level factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

摘要

目的/目标:外伤性脑损伤(iTBI),即虐待性头部损伤,是婴幼儿死亡和残疾的常见原因。健康的社会决定因素(SDoH)对iTBI有至关重要且多方面的影响,影响其患病率和预后。地区剥夺指数(ADI)是一种综合的SDoH指标,旨在帮助理解社区层面的社会经济因素如何影响患者的预后。本研究旨在描述373名患有iTBI的婴幼儿队列的社会人口学特征,包括ADI。

研究方法/设计:本研究是一项回顾性分析,使用了在落基山地区为七个州服务的一家大型三级儿童医院接受iTBI治疗的儿科患者队列。

结果

年龄较大的儿童死亡率较高,且年龄较大的儿童在儿科重症监护病房的住院时间更长。被认定为西班牙裔/拉丁裔的儿童比被认定为非西班牙裔/拉丁裔的儿童生活在社会经济劣势更大的地区。具体而言,被认定为白人西班牙裔/拉丁裔的参与者比被认定为白人非西班牙裔/拉丁裔的儿童生活在劣势更大的地区。按种族划分没有其他显著差异。与假设相反,ADI与死亡率、损伤严重程度或随访次数没有显著关系。

结论/启示:虽然已知SDoH会影响iTBI的预后,但可能有必要在这个临床样本中纳入个体或家庭层面的SDoH变量,并研究个体和社区层面因素之间的相互作用。(PsycInfo数据库记录(c)2024美国心理学会,保留所有权利)

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af81/11932049/fbfe64708fc2/nihms-2056439-f0001.jpg

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