Injury severity and increased socioeconomic differences: A population-based cohort study

Madsen, Christian; Gabbe, Belinda; Holvik, Kristin; Alver, Kari; Grøholt, Else Karin; Lund, Johan; Lyons, Jane; Lyons, Ronan A; Ohm, Eyvind

doi:10.1016/j.injury.2022.03.039

Cited by 6 publications

(3 citation statements)

References 43 publications

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“…Direct comparison of the health loss observed for New Zealand major trauma patients with other studies is challenging as prior studies have focused predominantly on road trauma, 20,21 or have focused on hospitalised injury rather than major trauma. 14 Prior authors reported an average of 9.7 DALYs and $486,425 AUD per case which was higher than the 3.4 DALYs and $154,366 NZD per patient observed in our study. However, important differences are noted.…”

Section: Discussioncontrasting

confidence: 93%

See 1 more Smart Citation

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma cases in New Zealand

Civil,

Gabbe,

Isles

et al. 2022

NZMJ

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aims:The aims of this study were to quantify the burden, and the cost of health loss, following hospitalisation for major trauma in New Zealand. method: Hospitalised major trauma patients injured between July 2017 and June 2020 were extracted from the New Zealand Trauma Registry. Case-mix of major trauma in each year was summarised using descriptive statistics. Disability-Adjusted Life Years (DALYs) were calculated for the cohort. A cost per DALY was applied to estimate the cost of health loss. results: A total of 6,629 major trauma cases were recorded, rising from 2,072 in 2017-2018 to 2,191 in 2019-2020. The patient casemix remained relatively consistent over the timeframe while the in-hospital mortality rate declined from 9.2% to 7.3%. Hospitalised major trauma patients accrued 22,718 DALYs (average 7,573 DALYs per year

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Section: Discussioncontrasting

confidence: 93%

“…11 This metric is widely used for measuring disease burden or "health loss". [12][13][14] The DALY combines Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) to generate DALYs for conditions.…”

Section: Burden Of Injury Measurementmentioning

confidence: 99%

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma cases in New Zealand

Civil,

Gabbe,

Isles

et al. 2022

NZMJ

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“…The alternate home residence variable likely identifies those who chronically experience homelessness. Fourth, TQIP does not contain socioeconomic status or income data, which are known factors associated with injury mechanism and outcomes . We addressed this by conducting a subanalysis of a low-income cohort as defined by Medicaid insurance, because eligibility is largely determined according to an individual’s Modified Adjusted Gross Income .…”

Section: Discussionmentioning

confidence: 99%

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

et al. 2023

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ImportanceTraumatic injury is a major cause of morbidity for people experiencing homelessness (PEH). However, injury patterns and subsequent hospitalization among PEH have not been studied on a national scale.ObjectiveTo evaluate whether differences in mechanisms of injury exist between PEH and housed trauma patients in North America and whether the lack of housing is associated with increased adjusted odds of hospital admission.Design, Setting, and ParticipantsThis was a retrospective observational cohort study of participants in the 2017 to 2018 American College of Surgeons’ Trauma Quality Improvement Program. Hospitals across the US and Canada were queried. Participants were patients aged 18 years or older presenting to an emergency department after injury. Data were analyzed from December 2021 to November 2022.ExposuresPEH were identified using the Trauma Quality Improvement Program’s alternate home residence variable.Main Outcomes and MeasuresThe primary outcome was hospital admission. Subgroup analysis was used to compared PEH with low-income housed patients (defined by Medicaid enrollment).ResultsA total of 1 738 992 patients (mean [SD] age, 53.6 [21.2] years; 712 120 [41.0%] female; 97 910 [5.9%] Hispanic, 227 638 [13.7%] non-Hispanic Black, and 1 157 950 [69.6%] non-Hispanic White) presented to 790 hospitals with trauma, including 12 266 PEH (0.7%) and 1 726 726 housed patients (99.3%). Compared with housed patients, PEH were younger (mean [SD] age, 45.2 [13.6] years vs 53.7 [21.3] years), more often male (10 343 patients [84.3%] vs 1 016 310 patients [58.9%]), and had higher rates of behavioral comorbidity (2884 patients [23.5%] vs 191 425 patients [11.1%]). PEH sustained different injury patterns, including higher proportions of injuries due to assault (4417 patients [36.0%] vs 165 666 patients [9.6%]), pedestrian-strike (1891 patients [15.4%] vs 55 533 patients [3.2%]), and head injury (8041 patients [65.6%] vs 851 823 patients [49.3%]), compared with housed patients. On multivariable analysis, PEH experienced increased adjusted odds of hospitalization (adjusted odds ratio [aOR], 1.33; 95% CI, 1.24-1.43) compared with housed patients. The association of lacking housing with hospital admission persisted on subgroup comparison of PEH with low-income housed patients (aOR, 1.10; 95% CI, 1.03-1.19).Conclusions and RelevanceInjured PEH had significantly greater adjusted odds of hospital admission. These findings suggest that tailored programs for PEH are needed to prevent their injury patterns and facilitate safe discharge after injury.

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The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta‐analysis

Koh,

Adiamah,

Melia

et al. 2024

World j. surg.

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BackgroundMajor 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.MethodsA 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.ResultsFourteen 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.ConclusionMajor 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.

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Injury severity and increased socioeconomic differences: A population-based cohort study

Cited by 6 publications

References 43 publications

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma cases in New Zealand

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma cases in New Zealand

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta‐analysis

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