Racial inequality in the trauma of women: A disproportionate decade

Abstract

BACKGROUND Historically, women have been largely underrepresented in the body of medical research. Given the paucity of data regarding race and trauma in women, we aimed to evaluate the most common types of traumas incurred by women and analyze temporal racial differences. METHODS A 10-year review (2007–2016) of the National Trauma Data Bank was conducted to identify common mechanisms of injuries among women. Trends of race, intent of injury, and firearm-related assaults were assessed using the Cochran-Armitage Trend test. Multivariable multinomial logistic regressions were utilized to examine the association between race and trauma subtypes. RESULTS Of the 2,082,768 women identified as a trauma during this study period, the majority presented due to an unintentional intent (94.5%), whereas fewer presented secondary to an assault (4.4%) or self-inflicted injury (1.1%). While racioethnic minority women encompassed a small percentage of total traumas (19%), they accounted for roughly three fifths of assault-related traumas (p < 0.001). Though total assaults decreased by 20.8% during the study period, black and Hispanic women saw a disproportionately smaller decrease of 15.1% and 15.8%, respectively. On regression analysis, compared with white women, black women had more than four times the odds of being an assault-related trauma compared with unintentional trauma (odds ratio, 4.48; 95% confidence interval, 4.41–4.55). On subset analysis, firearm-related assault was 17.3 times more prevalent among black women (white, 0.3% vs. black: 5.2%; p < 0.001). In fact, history of alcohol abuse was found to be an effect modifier of the association of race/ethnicity and firearm-related trauma. CONCLUSION Compelling data highlight a disproportionate trend in the assault-related trauma of minority women. Specifically, minority women, especially those with a history of alcohol abuse, were at increased risk of being involved in a firearm assault. Further studies are essential to help mitigate disparities and subsequently develop preventative services for this diverse population. LEVEL OF EVIDENCE Epidemiological, Level III.

Trends in Disparities Research on Trauma and Acute Care Surgery Outcomes: A 10-Year Systematic Review of Articles Published in the Journal of Trauma and Acute Care Surgery

“…Of these publications, 4,104 were excluded and 74 articles were included (Supplemental Digital Content, Supplementary Figure 1, http://links.lww.com/TA/D174). 2–76 A bimodal distribution shows that location and access disparities represented the majority of articles, followed by age and race (Fig. 1).…”

“…The two studies assessing ICU-LOS, hospital-LOS, complications, and disposition found that men had worse organ dysfunction and organ failure recovery time (9.0 vs. 6.5 days, p < 0.01) than female counterparts, and showed that minority females were at a higher risk of involvement in a firearm assault, especially in the context of prior alcohol use disorder (Black females: OR, 3.02; 95% CI, 2.56-3.57; p < 0.05) (Table 1). 17,18 Racial/Ethnic Disparities and Outcomes…”

“…No difference in mortality. Morrison et al 76 2018 Surgical outcomes Little information is available regarding transgender patients and surgical outcomes Velopulos et al 12 2019 Homicide Women and Black men are at highest risk for homicide caused by IPV Izadi et al 18 2020 Association of outcomes between race and trauma subtypes Minority women, especially those with a history of alcohol abuse, were at increased risk of being involved in a firearm assault.…”

Assessment of the Accuracy of Firearm Injury Intent Coding at 3 US Hospitals

“…Trauma centers are required to maintain a registry of data collected by trauma registrars that, although not a population-based sample of ED visits, had been used to study intent-specific firearm injuries. [6][7][8][9][10][11][12]…”

“…By contrast, medical records coders are hired for billing purposes to review charts and code diagnoses, procedures, and a nonbillable “external cause of injury” ICD code (for patients with injury) specifying the mechanism (eg, firearm, knife) and the intent that caused the injury. Trauma centers are required to maintain a registry of data collected by trauma registrars that, although not a population-based sample of ED visits, had been used to study intent-specific firearm injuries …”