Racial disparities in pedestrian-related injury hospitalizations in the United States

Abstract

Background Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity. Methods Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009–2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries. Results The annual average of pedestrian-related deaths exceeded 5000 per year and hospitalizations exceeded 47,000 admissions per year. The burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89–1.94) and 1.20 (95% CI: 1.19–1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%). Conclusions Results from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.

US children of minority race are less likely to be admitted to the pediatric intensive care unit after traumatic injury, a retrospective analysis of a single pediatric trauma center

“…Our results align with previous database studies showing higher rates of pedestrian injuries in minority populations. (Hamann et al, 2020 )…”

“…(Cassidy et al, 2013 ) Poor neighborhood and housing conditions may increase risk of severe traumatic injuries, including those resulting from accidental falls and violent injury. (Hutchings et al, 2016 ; Stolbach & Anam, 2017 ) There is a documented association between minority race and higher mortality rates in firearm injuries and pedestrian trauma (Rubenstein et al, 2019 ; Hamann et al, 2020 ). Public insurance status is associated with differences in pre-hospitalization triage patterns and post-hospitalization disposition.…”

Trauma and US Minority Children and Youth

“…These fears are likely based on both historical trauma and the recent violence against Black men that has received significant media attention. The historical marginalization of African Americans contributes to health inequities, such as lack of safe transportation among injured Black pedestrians leading to higher hospitalization rates compared to injured White pedestrians [ 25 ]. History of being subjected to unethical clinical studies, such as the Tuskegee study, has contributed to the African American youth’s mistrust of the government and the healthcare system which results in low influenza vaccination rates [ 26 ], COVID-19 vaccination hesitancy [ 27 ], and higher susceptibility to dying from COVID-19 than other racial groups [ 28 ].…”

The time is now: why we must identify and address health disparities in sport and recreation injury

“…With more complete data we could examine variations in injuries and outcomes between settings with athletic trainers and those without, providing more evidence to support expansion of access to athletic trainers. We can use our new data to examine questions other areas of injury have pursued – racial disparities (Hamann et al 2020 ), impacts of SES (Goldman et al 2018 ) – and take a more advanced statistical approach to questions such as the impact of safe housing, food security, and social networks on initial and subsequent SRI.…”