Department of Surgery, University of Michigan, Ann Arbor, Michigan; International Center for Automotive Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, University of Michigan, Ann Arbor, Michigan.
J Surg Res. 2024 Oct;302:568-577. doi: 10.1016/j.jss.2024.07.056. Epub 2024 Aug 23.
There is a growing body of literature that shows geographic social vulnerability, which seeks to measure the resiliency of a community to withstand unforeseen disasters, may be associated with negative outcomes after traumatic injury. For motor vehicle collisions (MVCs) specifically, it is unknown how the resources of a patient's home environment may interact with resources of the environment where the crash occurred.
We merged publicly available crash data from the state of Michigan with the Michigan Trauma Quality Improvement dataset. A social vulnerability index (SVI) score was calculated for each ZIP code and was then cross-referenced between the location of the MVC (Crash-SVI) and the patient's home address (Home-SVI). SVI was divided into quintiles, with higher numbers indicating greater vulnerability. Adjusted logistic regression models using least absolute shrinkage and selection operator for feature selection and regularization were performed sequentially using patient, vehicular, and environmental variables to identify associations between Home-SVI and Crash-SVI, with mortality and injury severity score (ISS) greater than 15 (ISS15).
Between January 2020 and December 2022, a total of 14,706 patients were identified. Most MVCs (75.3% of all patients) occurred in the second through fourth quintiles of SVI. In all cases, Crash-SVI occurred most frequently within the same quintile as the patient's Home-SVI. Average crash speed limits showed a significant negative association with increasing SVI. On adjusted logistic regression, there were significantly increased odds of mortality for the fifth quintile of Home-SVI in comparison to the first quintile when adjusted for patient factors; but this lost significance after the addition of vehicular or environmental variables. In contrast, there were decreased odds of ISS15 for the highest quintiles of Crash-SVI in all logistic regression models.
Geographic social vulnerability markers were associated with lower MVC-associated injury severity, perhaps in part because of the association with lower speed limit in these areas.
越来越多的文献表明，地理社会脆弱性（试图衡量社区抵御突发灾害的弹性）可能与创伤后不良结果有关。具体针对机动车碰撞（MVC），目前尚不清楚患者家庭环境的资源如何与事故发生地的环境资源相互作用。
我们合并了密歇根州公共可用的碰撞数据和密歇根创伤质量改进数据集。为每个邮政编码计算社会脆弱性指数（SVI）评分，然后将 MVC 地点（Crash-SVI）和患者家庭地址（Home-SVI）的 SVI 评分进行交叉参考。SVI 分为五分位数，数字越高表示脆弱性越大。使用最小绝对收缩和选择算子（LASSO）进行特征选择和正则化的逐步调整逻辑回归模型，使用患者、车辆和环境变量来识别 Home-SVI 和 Crash-SVI 之间的关联，死亡和损伤严重程度评分（ISS）大于 15（ISS15）。
2020 年 1 月至 2022 年 12 月期间，共确定了 14706 名患者。大多数 MVC（所有患者的 75.3%）发生在 SVI 的第二至第四五分位数。在所有情况下，Crash-SVI 最常发生在与患者 Home-SVI 相同的五分位数内。平均碰撞速度限制与 SVI 增加呈显著负相关。在调整后的逻辑回归中，与第一五分位数相比，第五五分位数的 Home-SVI 患者死亡的可能性显著增加，但在加入车辆或环境变量后，这种关联失去了显著性。相比之下，在所有逻辑回归模型中，Crash-SVI 的最高五分位数的 ISS15 可能性降低。
地理社会脆弱性标志物与 MVC 相关的损伤严重程度相关，这可能部分是因为这些地区的速度限制较低。
