Evaluating the complex association between Social Vulnerability Index and trauma mortality

Neiman, Pooja U.; Flaherty, Melanie M; Salim, Ali; Sangji, Naveen F.; Ibrahim, Andrew M.; Fan, Zhaohui; Hemmila, Mark R.; Scott, John W.

doi:10.1097/ta.0000000000003514

Cited by 16 publications

(17 citation statements)

References 44 publications

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“…When evaluated based on differences in compositescores, independent factors associated with the worst older adult trauma quality included longer travel times by road from an index hospital to the nearest level 1 or 2 trauma center, increased rurality, decreased older adult trauma volume, increased neighborhood ADI, decreased percentages of older adult racial and ethnic minority trauma patients, and increased percentages of CMS dual-eligible older adult trauma patients. Worse trauma quality in rural areas located farther from larger, more resourced trauma centers, [24][25][26] particularly those treating a greater extent of older adults who come from more socioeconomically disadvantaged backgrounds (eg, dualeligible Medicare and Medicaid status) and neighborhoods (eg, greater ADI) [27][28][29][30][31] is in keeping with expectations. While it unquestionably speaks to the need to reduce disparities among older trauma patients and highlights potential associations between hospital-level factors and emerging quality metrics that must be carefully monitored so as not to place unintentional burdens on hospitals caring for underserved populations, 32 the associations make sense.…”

Section: Discussionmentioning

confidence: 95%

Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality

Zogg,

Cooper,

Peduzzi

et al. 2023

JAMA Surg

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ImportanceLack of knowledge about longer-term outcomes remains a critical blind spot for trauma systems. Recent efforts have expanded trauma quality evaluation to include a broader array of postdischarge quality metrics. It remains unknown how such quality metrics should be used.ObjectiveTo examine the utility of implementing recommended postdischarge quality metrics as a composite score and ascertain how composite score performance compares with that of in-hospital mortality for evaluating associations with hospital-level factors.Design, Setting, and ParticipantsThis national hospital-level quality assessment evaluated hospital-level care quality using 100% Medicare fee-for-service claims of older adults (aged ≥65 years) hospitalized with primary diagnoses of trauma, hip fracture, and severe traumatic brain injury (TBI) between January 1, 2014, and December 31, 2015. Hospitals with annual volumes encompassing 10 or more of each diagnosis were included. The data analysis was performed between January 1, 2021, and December 31, 2022.ExposuresReliability-adjusted quality metrics used to calculate composite scores included hospital-specific performance on mortality, readmission, and patients’ average number of healthy days at home (HDAH) within 30, 90, and 365 days among older adults hospitalized with all forms of trauma, hip fracture, and severe TBI.Main Outcomes and MeasuresAssociations with hospital-level factors were compared using volume-weighted multivariable logistic regression.ResultsA total of 573 554 older adults (mean [SD] age, 83.1 [8.3] years; 64.8% female; 35.2% male) from 1234 hospitals were included. All 27 reliability-adjusted postdischarge quality metrics significantly contributed to the composite score. The most important drivers were 30- and 90-day readmission, patients’ average number of HDAH within 365 days, and 365-day mortality among all trauma patients. Associations with hospital-level factors revealed predominantly anticipated trends when older adult trauma quality was evaluated using composite scores (eg, worst performance was associated with decreased older adult trauma volume [odds ratio, 0.89; 95% CI, 0.88-0.90]). Results for in-hospital mortality showed inverted associations for each considered hospital-level factor and suggested that compared with nontrauma centers, level 1 trauma centers had a 17 times higher risk-adjusted odds of worst (highest quantile) vs best (lowest quintile) performance (odds ratio, 17.08; 95% CI, 16.17-18.05).Conclusions and RelevanceThe study results challenge historical notions about the adequacy of in-hospital mortality as the single measure of older adult trauma quality and suggest that, when it comes to older adults, decisions about how quality is evaluated can profoundly alter understandings of what constitutes best practices for care. Composite scores appear to offer a promising means by which postdischarge quality metrics could be used.

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Section: Discussionmentioning

confidence: 95%

Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality

Zogg,

Cooper,

Peduzzi

et al. 2023

JAMA Surg

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“…Doucet et al 50 2022 Predictors of assault Geographic analysis of trauma registry data can identify high-risk areas for youth violence and related social/structural determinants. Neiman et al 3 2022 Mortality Neighborhoods with higher rates of social vulnerability experience high mortality rates after trauma. Phelos et al 52 2022 Mortality Social determinants of health measures based on a patient's zip code of residence, were significantly associated with a patient's risk of mortality after injury.…”

Section: Age Disparities and Outcomesmentioning

confidence: 99%

“…Health care disparities, defined as differences in measurable outcomes related to social, economic, and environmental disadvantage, are linked to many trauma and ACS patient outcomes including mortality and complications. [2][3][4] Evaluating the cause and effect of these disparities is necessary to improve patient outcomes of those from disadvantaged backgrounds. 5 Over the past decade, trauma and ACS literature has exhibited an increased focus on the link between health care disparities and patient outcomes.…”

mentioning

confidence: 99%

“…The growing field of acute care surgery (ACS) plays an integral role in the treatment of trauma patients, critically ill patients, and those with acute surgical emergencies. Health care disparities, defined as differences in measurable outcomes related to social, economic, and environmental disadvantage, are linked to many trauma and ACS patient outcomes including mortality and complications 2–4 . Evaluating the cause and effect of these disparities is necessary to improve patient outcomes of those from disadvantaged backgrounds 5 …”

mentioning

confidence: 99%

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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

Breeding

Ngatuvai

Rosander

et al. 2023

J Trauma Acute Care Surg

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This is a 10-year review of The Journal of Trauma and Acute Care Surgery (JTACS) literature related to health care disparities, health care inequities, and patient outcomes. A retrospective review of articles published in JTACS between January 1, 2013, and July 15, 2022, was performed. Articles screened included both adult and pediatric trauma populations. Included articles focused on patient populations related to trauma, surgical critical care, and emergency general surgery. Of the 4,178 articles reviewed, 74 met the inclusion criteria. Health care disparities related to gender (n = 10), race/ethnicity (n = 12), age (n = 14), income status (n = 6), health literacy (n = 6), location and access to care (n = 23), and insurance status (n = 13) were described. Studies published on disparities peaked in 2016 and 2022 with 13 and 15 studies respectively but dropped to one study in 2017. Studies demonstrated a significant increase in mortality for patients in rural geographical regions and in patients without health insurance and a decrease in patients who were treated at a trauma center. Gender disparities resulted in variable mortality rates and studied factors, including traumatic brain injury mortality and severity, venous thromboembolism, ventilator-associated pneumonia, firearm homicide, and intimate partner violence. Under-represented race/ethnicity was associated with variable mortality rates, with one study demonstrating increased mortality risk and three finding no association between race/ethnicity and mortality. Disparities in health literacy resulted in decreased discharge compliance and worse long-term functional outcomes. Studies on disparities in JTACS over the last decade primarily focused on location and access to health care, age, insurance status, and race, with a specific emphasis on mortality. This review highlights the areas in need of further research and funding in the Journal of Trauma and Acute Care Surgery regarding health care disparities in trauma aimed at interventions to reduce disparities in patient care, ensure equitable care, and inform future approaches targeting health care disparities. LEVEL OF EVIDENCE Systematic Review; Level IV.

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“…However, after adjusting for co-variates available to claims data, the association became weaker. After further adjusting for multiple robust co-variates available to trauma registries including, for example, a patient’s shock index, mechanism of injury, and need for blood transfusions, there was no longer an association between SVI and mortality [ 53 ••]. Therefore, the association between deprivation and mortality may be mediated by initial presenting characteristics.…”

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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Evaluating the complex association between Social Vulnerability Index and trauma mortality

Abstract: Trauma patients from more vulnerable communities (higher SVI) die at higher rates. But this association goes away after risk adjustment. This suggests its not due to differences in care, but differences in injury lethality. Time to invest “upstream” to improve outcomes for all.

Cited by 16 publications

References 44 publications

Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality

Changes in Older Adult Trauma Quality When Evaluated Using Longer-Term Outcomes vs In-Hospital Mortality

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

Socioeconomic Factors and Pediatric Injury

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