Socioeconomic characteristics of pediatric traumatic brain injury patients

Salik, Irim; Dominguez, Jose F.; Vazquez, Sima; Ng, Christina; Das, Ankita; Naftchi, Alexandria; Spirollari, Eris; Subah, Galadu; Zhang, Alice; Sukul, Vishad; Pisapia, Jared; Muh, Carrie R.; Stewart, Dylan

doi:10.1016/j.clineuro.2022.107404

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…On one hand, low socioeconomic status environments during childhood can heighten aggressive traits ( 36 ). Meanwhile, pediatric traumatic brain injury (TBI) is more prevalent in lower socioeconomic status, which can also affect mental health wellbeing ( 37 ). Furthermore, those with a background of low education and rural childhood residency carry a 6.5 times greater risk of developing Alzheimer’s disease compared to those with high education and urban childhood residency.…”

Section: Discussionmentioning

confidence: 99%

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes

Buddenbaum,

Recht,

Rodriguez

et al. 2024

Front. Psychiatry

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IntroductionRepetitive head impacts (RHI) have been suggested to increase the risk of developing a neurodegenerative disease, and many of these individuals develop a preceding mental health diagnosis. Given the lack of studies among amateur athletes, this study aimed to examine mental health outcomes in middle-aged amateur athletes who have been exposed to RHI through contact sport participation.MethodsThis is a single site, cohort study involving former amateur athletes aged between 30 and 60 with at least 10 years of organized contact or non-contact sport participation. All participants completed demographic and mental health questionnaires. Mental health outcomes included symptoms related to depression, anxiety, post-traumatic stress disorder (PTSD), attention deficit hyperactive disorder (ADHD), and aggression. Self-reported data on mental health diagnoses and associated prescription were elicited and used to estimate odds ratios (OR).ResultsData from 41 contact athletes and 22 age/sex-matched non-contact athletes were available for analysis. The contact group exhibited a 2.25-fold higher likelihood of being diagnosed with mental health disorders and 1.29-fold higher likelihood of using associated medications compared to the non-contact group. The contact group reported significantly higher PTSD-related symptoms [4.61 (0.03,9.2), p=0.05] compared to the non-contact control group. While not statistically significant, the contact group showed increased depressive [2.37 (0.05, 4.79), p=0.07] and ADHD symptoms [4.53 (0.51, 9.57), p=0.08] compared to controls. In a secondary analysis, a distinct trend emerged within the contact group, revealing pronounced elevations in mental health symptoms among individuals with lower socioeconomic status (<$50,000/year) compared to higher income subgroups, and these symptoms decreased as income levels rose [depression: -3.08 (-4.47, -1.7), p<0.001; anxiety: -1.95 (-3.15, -0.76), p=0.002; ADHD: -4.99 (-8.28, -1.69), p=0.004; PTSD: -4.42 (-7.28, -1.57), p=0.003; aggression: -6.19 (-11.02, -1.36), p=0.01]. This trend was absent in the non-contact control group.DiscussionOur data suggest that even individuals at the amateur level of contact sports have an increased likelihood of being diagnosed with mental health disorders or experiencing mental health symptoms compared to non-contact athletes. Our findings indicate that socioeconomic status may have an interactive effect on individuals’ mental health, particularly among those with a long history of RHI exposure.

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Section: Discussionmentioning

confidence: 99%

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes

Buddenbaum,

Recht,

Rodriguez

et al. 2024

Front. Psychiatry

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“…3 The prolonged effects of sustaining a severe TBI at an early age include long-term dependence on others, higher hospital utilization, and loss of future workforce productivity, which have direct detrimental effects on families and society as a whole. 3,8,18 Many studies have described the disproportionate burden of injury experienced by children who live in socioeconomically disadvantaged environments. [18][19][20][21] Three equity gaps have been broadly described: differences in injury epidemiology (including frequency and severity), 3,17,22 differences in postinjury care (including access to resources such as rehabilitation), 18,19 and differences in child and family resilience to recover and thrive after sustaining such an injury.…”

Section: Discussionmentioning

confidence: 99%

“…3,8,18 Many studies have described the disproportionate burden of injury experienced by children who live in socioeconomically disadvantaged environments. [18][19][20][21] Three equity gaps have been broadly described: differences in injury epidemiology (including frequency and severity), 3,17,22 differences in postinjury care (including access to resources such as rehabilitation), 18,19 and differences in child and family resilience to recover and thrive after sustaining such an injury. 7,23,24 This study demonstrated that patients living in neighborhoods with a higher MCDI were at a significantly higher risk of sustaining a severe TBI than patients living in more socioeconomically advantaged neighborhoods.…”

Section: Discussionmentioning

confidence: 99%

“…It calls to action policymakers and governing bodies to reflect and reassess local policies and laws that would make these children safer and healthier. With the knowledge that patients with low socioeconomic status have a significantly higher healthcare consumption, 18,19,27 the implementation of reimbursement incentives for healthcare providers who deliver care to patients in a neighborhood with a higher MCDI could also help encourage change. Targeted education programs could be created in school districts in which students with higher MCDI values are enrolled to provide necessary education on gun safety, interpersonal violence, and preventive safety measures.…”

Section: Discussionmentioning

confidence: 99%

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Utility of the material community deprivation index as a metric to identify at-risk children for severe traumatic brain injury

Gaulden,

Trinidad,

Moody

et al. 2023

Neurosurgical Focus

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OBJECTIVE Pediatric traumatic brain injury (TBI) is a significant cause of morbidity and mortality with lasting effects including neurological deficits and psychological comorbidities. Recent studies have shown that social determinants of health are key factors that impact clinical outcomes in other pediatric traumatic injuries, suggesting that these health disparities may have a significant impact on patients sustaining TBI as well. The purpose of this study was to retrospectively review a cohort of pediatric patients diagnosed with TBI and elucidate the relationships among socioeconomic deprivation, patient-specific demographics, and morbidity and mortality. METHODS The authors conducted a retrospective cross-sectional analysis of pediatric patients (≤ 18 years of age) treated for TBI at a level I pediatric trauma center between 2016 and 2020. Patients with concussion-related injuries without intracranial findings and those with nonaccidental trauma were excluded from the study. In addition to evaluating basic patient demographics, the authors geocoded patient addresses to allow identification of the patient’s home census tract using the material community deprivation index (MCDI). The MCDI is a unique composite index score created by the combination of six census variables and ranges from 0 to 1 in severity. RESULTS Of the 513 patients included in this study, 71 (13.8%) were diagnosed with severe TBI, 28 (5.5%) with moderate TBI, and 414 (80.7%) with mild TBI. Patients in quartile 4 (MCDI ≥ 0.45) were at a significantly higher risk of having a severe TBI than patients in quartile 1 (OR 2.29, 95% CI 1.1–4.71; p = 0.02). Black patients were more likely to have a firearm-related TBI (OR 3.74, 95% CI 2.01–8.7; p = 0.018) than non-Black patients. Patients who lived in a neighborhood with a lower MCDI were significantly more likely to be discharged home than those who lived in an area with a higher MCDI (OR 2.78, 95% CI 7.90–32.93; p < 0.001). CONCLUSIONS This study demonstrated that inequities continue to exist within the pediatric TBI population and that the MCDI is a valuable tool to identify at-risk subpopulations. More specifically, patients who lived in a neighborhood with a higher MCDI were at higher risk of sustaining a severe TBI. By partnering with communities, families, and policymakers, healthcare providers could serve as advocates for these patients and work to minimize the social disparities that continue to exist.

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“…When looking at neighborhood socioeconomic status, children from more deprived neighborhoods, evaluated using zip code level ADI, report worse pain and quality of life outcomes after upper extremity fracture [ 45 , 46 ]. Children from disadvantaged backgrounds also experience worse outcomes after TBI, possibly as a result of greater severity in initial presentation or differences in care post-injury [ 47 , 48 ]. For every $10,000 increase in the median income for a child’s home zip code, their odds of mortality after TBI decreased by 6% (OR 0.96).…”

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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Socioeconomic characteristics of pediatric traumatic brain injury patients

Cited by 10 publications

References 37 publications

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes

Associations between repetitive head impact exposure and midlife mental health wellbeing in former amateur athletes

Utility of the material community deprivation index as a metric to identify at-risk children for severe traumatic brain injury

Socioeconomic Factors and Pediatric Injury

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