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- Title
Racial, Gender, and Neighborhood-Level Disparities in Pediatric Trauma Care.
- Authors
Dickens, Harrison; Rao, Uma; Sarver, Dustin; Bruehl, Stephen; Kinney, Kerry; Karlson, Cynthia; Grenn, Emily; Kutcher, Matthew; Iwuchukwu, Chinenye; Kyle, Amber; Goodin, Burel; Myers, Hector; Nag, Subodh; Hillegass, William B.; Morris, Matthew C.
- Abstract
Background: Disparities in trauma outcomes and care are well established for adults, but the extent to which similar disparities are observed in pediatric trauma patients requires further investigation. The objective of this study was to evaluate the unique contributions of social determinants (race, gender, insurance status, community distress, rurality/urbanicity) on trauma outcomes after controlling for specific injury-related risk factors. Study Design: All pediatric (age < 18) trauma patients admitted to a single level 1 trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed (n = 14,398). Primary outcomes were receipt of opioids in the emergency department, post-discharge rehabilitation referrals, and mortality. Multivariate logistic regressions evaluated demographic, socioeconomic, and injury characteristics. Multilevel logistic regressions evaluated area-level indicators, which were derived from abstracted home addresses. Results: Analyses adjusting for demographic and injury characteristics revealed that Black children (n = 6255) had significantly lower odds (OR = 0.87) of being prescribed opioid medications in the emergency department compared to White children (n = 5883). Children living in more distressed and rural communities had greater odds of receiving opioid medications. Girls had significantly lower odds (OR = 0.61) of being referred for rehabilitation services than boys. Post hoc analyses revealed that Black girls had the lowest odds of receiving rehabilitation referrals compared to Black boys and White children. Conclusion: Results highlight the need to examine both main and interactive effects of social determinants on trauma care and outcomes. Findings reinforce and expand into the pediatric population the growing notion that traumatic injury care is not immune to disparities.
- Subjects
INJURY risk factors; STATISTICS; CONFIDENCE intervals; TRAUMA centers; BLACK people; RACE; POPULATION geography; PEDIATRICS; PATIENTS; RETROSPECTIVE studies; EPIDEMIOLOGY; SOCIOECONOMIC factors; SEX distribution; HOSPITAL admission &; discharge; RISK assessment; HEALTH insurance; EMERGENCY medical services; MEDICAL referrals; RESEARCH funding; SOCIODEMOGRAPHIC factors; HEALTH equity; WOUNDS &; injuries; LOGISTIC regression analysis; ODDS ratio; WHITE people; DATA analysis; REHABILITATION; NEIGHBORHOOD characteristics
- Publication
Journal of Racial & Ethnic Health Disparities, 2023, Vol 10, Issue 3, p1006
- ISSN
2197-3792
- Publication type
Article
- DOI
10.1007/s40615-022-01288-5