Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
World J Surg. 2024 Nov;48(11):2783-2792. doi: 10.1002/wjs.12372. Epub 2024 Oct 9.
Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation.
A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model.
Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] -9.85 years and 95% confidence intervals [CI] -9.99 to -9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14-1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97-3.13), length of stay (WMD 1.15 days and 95% CI -0.32-2.62), and mortality (OR 1.04 and 95% CI 0.95-1.14) regardless of background.
Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.
严重创伤是导致年轻人死亡和残疾的主要原因，也是一个重大的公共卫生问题。人们越来越关注社会经济剥夺与严重创伤之间的复杂关系。有传闻证据表明，剥夺与更暴力和更衰弱的伤害有关。关于社会经济剥夺与严重创伤后果之间的关系，文献仍然很少。
对 MEDLINE、Embase 和 CENTRAL 数据库进行了全面检索，以确定 1947 年至 2024 年 3 月的研究。主要结果是根据剥夺情况确定损伤分布，次要结果评估手术干预率、住院时间和死亡率。数据的定量汇总基于随机效应模型。
纳入了 14 项研究和 878872 名创伤患者。相当一部分（28%）创伤事件发生在最贫困的群体中。来自社会经济地位最低组的患者年龄明显较小（加权均数差[WMD]-9.85 岁，95%置信区间[CI]-9.99 至-9.70），且更有可能为男性（比值比[OR]1.36，95%CI1.14-1.63）。手术干预（OR1.74，95%CI0.97-3.13）、住院时间（WMD1.15 天，95%CI-0.32-2.62）和死亡率（OR1.04，95%CI0.95-1.14）方面无差异，与背景无关。
严重创伤在贫困地区和年轻人中较为普遍，且男性患者的贫困程度呈上升趋势。尽管各组之间的手术、住院时间和死亡率没有差异，但公共卫生干预计划的规划应针对贫困程度较高的地区。
