财富即健康：喀麦隆的高经济地位与交通伤中防护装备的使用及更好的临床结局相关。
Wealth is health: High economic status in Cameroon correlates with protective gear use in traffic injuries and improved clinical outcomes.
作者信息
Dissak Delon Fanny N, Yost Mark T, Touko Arole Darwin, Mfondoum Roland, Oke Rasheedat, Christie S Ariane, Chichom-Mefire Alain, Hubbard Alan, Juillard Catherine
机构信息
From the Faculty of Health Sciences (F.N.D.D.), University of Bamenda, Bamenda, Cameroon; Program for the Advancement of Surgical Equity, Department of Surgery (M.T.Y., R.O., S.A.C., C.J.), University of California, Los Angeles, Los Angeles, California; Data Science Center for Surgery, Injury, and Equity in Africa (A.D.T., R.M.); Faculty of Health Sciences (A.C.-M.), University of Buea, Buea, Cameroon; and Division of Biostatistics (A.H.), School of Public Health, University of California, Berkley, California.
出版信息
J Trauma Acute Care Surg. 2025 Apr 1;98(4):570-577. doi: 10.1097/TA.0000000000004515. Epub 2025 Jan 23.
INTRODUCTION
Africa is the least motorized populated continent, yet it experiences the highest traffic fatality rate. Despite laws mandating helmet and seatbelt use, data on protective gear use among Cameroonian road traffic injury (RTI) patients remains sparse.
METHODS
We extracted Cameroon Trauma Registry data prospectively collected from 10 hospitals during July 2022 to December 2023. Protective gear users wore helmets in motorcycle and seatbelts/car seats in vehicle crashes. We categorized patients into five economic clusters based on ownership of durable goods using parallel distance matrix computation. We analyzed associations between continuous variables with Wilcoxon rank-sum and categorical variables with χ 2 and multivariate logistic regression. Our primary outcome was in-hospital death or major disability at discharge.
RESULTS
Among 3,554 RTI patients, 303 (9%) used protective gear. A larger proportion of patients who did not use protective gear were designated as majorly disabled or dead (20% vs. 16%, p < 0.001). The greatest percentage of protective gear users belonged to the richest cluster, while the poorest cluster patients comprised the smallest proportion of protective gear users (13% vs. 3%, p < 0.001). The richest cluster demonstrated the smallest percentage of major disability or death (13%), while the poorest cluster had the greatest percentage (28%, p < 0.001). When controlling for age, protective gear use, and injury severity, the three poorest clusters showed the greatest odds of major disability or death (cluster 3: adjusted odds ratio [AOR], 2.34; 95% confidence interval [CI], 1.58-3.46; cluster 4: AOR, 2.09; 95% CI, 1.59-2.74; cluster 5: AOR, 2.38; 95% CI, 1.24-4.58).
CONCLUSION
Greater economic status is associated with increased protective gear use during RTIs in Cameroon. Despite suffering the most severe outcomes, the poorest patients remain less likely to use protective gear. Enforcement of protective gear laws and economic incentives such as price subsidies for helmets and seatbelts would particularly benefit the most vulnerable population.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
引言
非洲是人口机动车化程度最低的大陆，但却是交通事故死亡率最高的地区。尽管有法律规定必须佩戴头盔和使用安全带，但喀麦隆道路交通伤害（RTI）患者使用防护装备的数据仍然稀少。
方法
我们提取了2022年7月至2023年12月期间从10家医院前瞻性收集的喀麦隆创伤登记数据。防护装备使用者在摩托车事故中佩戴头盔，在车辆碰撞事故中使用安全带/汽车座椅。我们使用平行距离矩阵计算，根据耐用品拥有情况将患者分为五个经济集群。我们分析了连续变量与Wilcoxon秩和检验以及分类变量与χ²检验和多变量逻辑回归之间的关联。我们的主要结局是住院死亡或出院时的严重残疾。
结果
在3554例RTI患者中，303例（9%）使用了防护装备。未使用防护装备的患者中，更大比例被认定为严重残疾或死亡（20%对16%，p<0.001）。防护装备使用者中最大比例属于最富裕集群，而最贫穷集群的患者在防护装备使用者中所占比例最小（13%对3%，p<0.001）。最富裕集群中严重残疾或死亡的比例最小（13%），而最贫穷集群的比例最大（28%，p<0.001）。在控制年龄、防护装备使用和损伤严重程度后，最贫穷的三个集群出现严重残疾或死亡的几率最高（集群3：调整后的优势比[AOR]，2.34；95%置信区间[CI]，1.58 - 3.46；集群4：AOR，2.09；95% CI，1.59 - 2.74；集群5：AOR，2.38；95% CI，1.24 - 4.58）。
结论
在喀麦隆，更高的经济地位与RTI期间防护装备使用增加有关。尽管最贫穷的患者遭受的后果最严重，但他们使用防护装备的可能性仍然较低。加强防护装备法律的执行以及提供经济激励措施，如对头盔和安全带的价格补贴，将特别有利于最脆弱的人群。
证据水平
预后和流行病学；四级。
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