Pediatric trauma in the California-Mexico border region: Injury disparities by Area Deprivation Index

Sykes, Alicia G.; Rooney, Alexandra S; Avila, Andrew G; Ghetti, Claudio B; Martin, Matthew J.; Bansal, Vishal; Sise, Michael J; Ignacio, Romeo C.

doi:10.1097/ta.0000000000003553

Cited by 15 publications

(8 citation statements)

References 28 publications

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“…No significant differences were found in Glasgow Coma Scale, Injury Severity Score, LOS, ICU admission, readmission, or mortality by ADI upon admission. However, patients within ADI quintile 3 had a significantly longer ICU length compared with those within quintiles 1 and 2 (median 3 [3][4][5][6][7][8] vs. 2 [1][2][3] days; p = 0.005).…”

Section: Resultsmentioning

confidence: 99%

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Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions

Cos

Rooney

Sykes

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:The purpose of this study was to identify clinical and traffic factors that influence pediatric pedestrian versus automobile collisions (P-ACs) with an emphasis on health care disparities. METHODS:A retrospective review was performed of pediatric (18 years or younger) P-ACs treated at a Level I pediatric trauma center from 2008 to 2018. Demographic, clinical, and traffic scene data were analyzed. Area deprivation index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) based on home addresses. Traffic scene data from the California Statewide Integrated Traffic Records System were matched to clinical records. Traffic safety was assessed by the streetlight coverage, the proximity of the collision to home addresses, and sidewalk coverage. Descriptive statistics and univariate analysis for key variables and outcomes were calculated using Kruskal-Wallis, Wilcoxon, χ 2 , or Fisher's exact tests. Statistical significance was attributed to p values of <0.05. RESULTS:Among 770 patients, the majority were male (65%) and Hispanic (54%), with a median age of 8 years (interquartile range, 4--12 years). Hispanic patients were more likely to live in more disadvantaged neighborhoods than non-Hispanic patients (67% vs. 45%, p < 0.01). There were no differences in clinical characteristics or outcomes across ADI quintiles. Using the Statewide Integrated Traffic Records System (n = 272), patients with more NSD were more likely injured during dark streetlight conditions (15% vs. 4% least disadvantaged; p = 0.04) and within 0.5 miles from home ( p < 0.01). Pedestrian violations were common (65%). During after-school hours, 25% were pedestrian violations, compared with 12% driver violations ( p = 0.02). CONCLUSION:A larger proportion of Hispanic children injured in P-ACs lived in neighborhoods with more socioeconomic disadvantage. Hispanic ethnicity and NSD are each independently associated with P-ACs. Poor streetlight conditions and close proximity to home were associated with the most socioeconomically disadvantaged neighborhoods. This research may support targeted prevention programs to improve pedestrian safety in children. (

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Section: Resultsmentioning

confidence: 99%

“…One such tool is the area deprivation index (ADI), which is based upon 17 indicators including poverty, education, housing, and employment 6,7 . Area deprivation index has been previously used to improve awareness, inform health policy, and facilitate interventions for the most disadvantaged neighborhood groups 8 …”

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confidence: 99%

Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions

Cos

Rooney

Sykes

et al. 2022

J Trauma Acute Care Surg

Self Cite

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“…On the other hand, children from the areas of lower deprivation had higher rates of sports-related and non-motorized vehicle-related injuries. Specifically, children from neighborhoods in the most deprived quintile had double the rate of motor vehicle-related injury admissions (32% vs 15%) and half the rate of non-motorized and sports-related injury admissions (6% vs 12% and 4% vs 11%, respectively) [ 23 ••].…”

Section: Introductionmentioning

confidence: 99%

“…There are similar reported outcomes based on measures of area-level SES. In the California-Mexico border region, there were higher rates of CPA with increasing ADI quintile, and the highest quintile had nearly three times the rate of CPA-related admissions as the lowest quintile (7.2% vs 2.6%) [ 23 ••]. In a multi-institutional study, lower neighborhood median income quartile was associated with increased mortality from CPA [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Factors and Pediatric Injury

Trinidad

Kotagal

2023

Curr Trauma Rep

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Purpose of Review The goal of this review is to describe how socioeconomic status (SES) is evaluated in the pediatric trauma literature and further consider how differences in SES can lead to inequities in pediatric injury. Recent Findings Insurance status, area-level income, and indices of socioeconomic deprivation are the most common assessments of socioeconomic status. Children from socioeconomically disadvantaged backgrounds experience higher rates of firearm-related injuries, motor vehicle-related injuries, and violence-related injuries, contributing to inequities in morbidity and mortality after pediatric injury. Differences in SES may also lead to inequities in post-injury care and recovery, with higher rates of readmission, recidivism, and PTSD for children from socioeconomically disadvantaged backgrounds. Summary Additional research looking at family-level measures of SES and more granular measures of neighborhood deprivation are needed. SES can serve as an upstream target for interventions to reduce pediatric injury and narrow the equity gap.

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“…It includes factors for the domains of income, education, employment, and housing quality. It has been used extensively across medicine; a few such examples are in chronic medical diseases, 17 , 19 , 42 , 48 trauma, 16 , 45 joint arthroplasty, 14 , 28 and pediatrics/pediatric orthopaedics. 3 , 4 , 21 , 23 …”

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confidence: 99%

Association of Socioeconomic Status With Relapse After Ponseti Method Treatment of Idiopathic Clubfeet

Akinyoola

Gunderson

Sun

et al. 2022

Foot & Ankle Orthopaedics

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Background: The Ponseti method is today’s standard treatment of idiopathic talipes equinovarus (ITEV). Compliance with foot abduction bracing (FABO) and socioeconomic factors have been shown to impact treatment outcome. We wished to further study socioeconomic factors using the Area Deprivation Index (ADI), a more comprehensive way to evaluate socioeconomic status, which has not been done before. Methods: All TEV patients from 2010 through 2019 treated with the Ponseti method were reviewed. Standard demographic variables, as well as the number of casts to complete initial correction, FABO compliance, and occurrence of relapse were tabulated. Socioeconomic level was quantified with the 2018 ADI. Results: There were 168 children; 151 had typical and 17 complex TEV. Average follow-up was 4.3 ± 1.8 years; relapse occurred in 46%. There were no significant differences in the percentage of relapse by sex, race, or ADI. FABO noncompliance was present in 46%. Relapse increased with increasing time of follow-up and FABO noncompliance (76% vs 21%, P < 10−6). Multivariate logistic regression analysis revealed that only FABO compliance and length of follow-up were associated with relapse. The OR of relapse for FABO noncompliance was 17.9 (7.6, 42.4, P < 10–6) and for follow-up >4 years the OR was 4.97 (2.1, 11.70, P = .0003). Conclusion: The outcome of the Ponseti method for TEV treatment is dependent on local circumstances. In our state, socioeconomic status, as determined by the ADI, was not associated with the occurrence of relapse. Thus, each center needs to assess its results, and analyze its own reasons for relapse. There were no other demographic variables associated with relapse except FABO compliance and length of follow-up. Parents should be strongly advised that FABO compliance and follow-up appears paramount to achieving the best results, and that complex TEV are at greater risk for relapse. Level of Evidence: Level IV, case series

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Pediatric trauma in the California-Mexico border region: Injury disparities by Area Deprivation Index

Abstract: This study analyzed differences in demographics and mechanism of injury in children using the Area Deprivation Index (ADI), a composite measure of 17 markers of neighborhood socioeconomic disadvantage.

Cited by 15 publications

References 28 publications

Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions

Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions

Socioeconomic Factors and Pediatric Injury

Association of Socioeconomic Status With Relapse After Ponseti Method Treatment of Idiopathic Clubfeet

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