Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis

Abstract

Background To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex. Methods We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home). Results There were 70,478 trauma hospitalizations in North Carolina, 2019–2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change = 1.147, 95% CI = 0.634 to 1.662) and 18–44-year-old males (weekly trend change = 1.708, 95% CI = 0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women ≥ 65 years old (weekly trend change = -4.010, 95% CI = -6.166 to -1.855), but returned to pre-pandemic levels within several months. Conclusions Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18–44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.

Impact of COVID-related policies on gunshot wound assault hospitalizations in the United States: a statewide time series analysis

“…However, it is unclear whether gunshot wound (GSW) hospitalizations (fatal and nonfatal) have also increased during this time, and more importantly, whether COVID-related policies were associated with these changes. Our research group (Strassle et al 2022 ) and others (Hatchimonji et al 2020 ; Yeates et al 2021 ; Abdallah et al 2021 ) have previously reported that assault hospitalizations increased after Stay-at-Home orders in several states, but potential racial/ethnic, sex, and age disparities in the rates of GSW hospitalizations specifically during the pandemic have yet to be addressed. Thus, the purpose of this analysis was to assess changes in GSW assault hospitalizations over the first year of the pandemic among specific racial/ethnic, sex, and age groups, and the impact COVID-related policies had on hospitalization rates.…”

“…95% confidence intervals were calculated using the approximate standard errors generated for each post-policy slope. We have used these methods previously (Strassle et al 2022 ). Due to low rates, stratified models among women (all ages) and older men (≥ 65 years old) could not be performed.…”

Power outages and pediatric unintentional injury hospitalizations in New York State

“…These groupings provide a standardized approach to categorizing injuries that have previously been reported in the literature. 23 , 24 A recent single-center study by Clery et al 25 found that ICD-10 clinical modification injury codes had a sensitivity of 67% and a specificity of 90% for identifying injuries at large. Notably, these were provider-assigned codes in an emergency department as opposed to the hospitalization claims data used in SPARCS.…”

Racial and ethnic disparities in motor vehicle crash-related outcomes in North Carolina surrounding the COVID-19 pandemic

“…Associations between SOs, motor vehicle crashes (MVCs), and their subsequent injuries are well quantified in the period immediately following the implementation of SOs, though findings are both outcome and measure dependent. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Vehicle miles travelled (VMT) and absolute counts of MVCs decreased following the onset of SOs, 5-8 14 while the rate of MVCs per VMT remained constant or declined over the pandemic period. 3 6 However, when stratified by MVC-related injury severity, heterogeneity was observed: counts decreased for less severe injuries following SOs and increased for severe/fatal injuries.…”