The Distressed Communities Index: A Measure of Community-Level Economic Deprivation and Rate of Firearm Injuries in Maryland

Abstract

Background This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically significant association was found between economic deprivation and ED visits for firearm injuries. Compared to prosperous communities, the odds ratios (ORs) were comfortable (OR = 1.33, 95% CI 1.04-1.71, P = .03), mid-tier (OR = 1.69, 95% CI 1.33-2.15, P < .001), at-risk (OR = 1.53, 95% CI 1.17-1.99, P < .001), and distressed (OR = 2.65, 95% CI 2.11-3.33, P < .001). Discussion The study highlights the significant association between community-level economic deprivation, as measured by the Distressed Communities Index, and the incidence of firearm injuries in Maryland. The findings underscore the importance of addressing socioeconomic disparities and implementing targeted interventions to reduce firearm-related injuries in economically distressed communities.

Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California

“…Those from distressed or the most disadvanta ged neighborhoods had the highest risk. This study confirms the utility of the Distressed Communities Index in predicting important health outcomes because it has successfully predicted mortality after cardiac surgery, 12 COVID-19, 13 limb amputation rates, 14 emergency department visits for firearm injuries, 15 and HIV prevalence among hospital admissions. 16 Although other ophthalmic studies have evaluated state and national emergency department databases, 17 to our knowledge this is the first study to present detailed data on emergency department presentation primarily for DR. As seen in outpatient and survey-based studies, [2][3][4]18 we found race to be predictive of a more advanced presentation of DR, with minority groups being more likely to present to the emergency department for PDR than Whites.…”