Disparities in Non-Fatal Health Outcomes in Pediatric General Trauma Studies

Abstract

When prevention efforts fail, injured children require high-quality health services to support their recovery. Disparities in non-fatal injury outcomes, an indicator of health-care quality, have received minimal attention. We evaluated the extent to which general trauma follow-up studies published in the peer-reviewed scientific literature provide evidence of socially patterned inequities in health, functional or disability outcomes ≥4 weeks after childhood injuries. Using a systematic search, we identified 27 eligible cohort studies from 13 high-income countries. We examined the extent to which the reported health outcomes varied across the PROGRESS criteria: place of residence, race/ethnicity, occupation, gender/sex, religion, socio-economic status, and social capital. The available evidence on differential outcomes is limited as many studies were compromised by selection or retention biases that reduced the participation of children from demographic groups at increased risk of adverse outcomes, or the analyses mainly focused on variations in outcomes by sex. Given the limited research evidence, we recommend greater attention to systematic collection and reporting of non-fatal injury outcomes disaggregated by socio-demographic indicators in order to identify disparities where these exist and inform equity-focused interventions promoting the recovery of injured children.

Health-Related Quality of Life (HRQoL) Outcomes Following Injury in Childhood and Adolescence Using EuroQol (EQ-5D) Responses with Pooled Longitudinal Data

“…Children from moderate and high SES areas had a higher HRQoL on average post-injury over time compared to children from low SES areas. This finding is consistent with systematic reviews of HRQoL and functional outcomes in children after injury [ 28 , 29 ]. There was a 12% higher relative risk over time of reporting no pain problems for children and adolescents from high SES areas compared to children and adolescents from low SES areas.…”

Are There Changes in Inequalities in Injuries? A Review of Evidence in the WHO European Region

“…There may even be scenarios that go in different directions—e.g., increases among social groups for some causes and decreases for others. Furthermore, a recent review of disparities in non-fatal injury outcomes found limited evidence of socially patterned inequities; the authors point to selection or retention biases being key limiting factors, as well as the focus on variations in outcomes only by sex [13]. These issues may explain the scarcity of studies on injury interventions identified in this review.…”

“…People from low socioeconomic status and from less affluent areas tend to die by injury to a greater extent than others [12]. Other reviews were target specific, by age group [13,14,15,16,17,18], injury cause, such as road traffic [19,20], falls [21], burns [22,23,24], or housing and neighbourhood conditions [25,26]. From among those reviews, only a few are specific to the European context, which is the focus of the present review, and to the best of our knowledge only one study [27] reviewed the literature on trends in social inequalities in injuries.…”

How does orofacial trauma in children affect the developing dentition? Long‐term treatment and associated complications

“…10 In a large study, children between 1 and 4 years old accounted for the highest percentage of accidents in all ages (26.3%), sustaining mainly dentoalveolar injury to the primary dentition and soft tissue injuries. 2, 3,12 There is a need to identify whether most severe injuries are caused by a lack of supervision, especially when children come from lower economic groups. Moreover, the long-term outcome after severe injuries to the face, alveolar bone, and primary teeth is uncertain and unknown.…”

“…Moreover, the long-term outcome after severe injuries to the face, alveolar bone, and primary teeth is uncertain and unknown. 2, 3,12 There is a need to identify whether most severe injuries are caused by a lack of supervision, especially when children come from lower economic groups. 4…”