Research on Injury Disparities: A Scoping Review

Abstract

Background: Research on disparities in traumatic injury has not been well characterized, limiting understanding of gaps in research and development of successful interventions. We conducted a scoping review to identify and synthesize research on disparities in intentional and unintentional traumatic injuries.Methods: The review was guided by PRISMA Extension for Scoping Reviews. PubMed, PsycINFO, Web of Science, and CINAHL and systematic reviews from 2007 to 2017 were searched. Eligible articles were peer reviewed; conducted in the United States; and reported on clearly defined physical trauma and disparity, defined by Cochrane PROGRESS-Plus criteria. One reviewer assessed article titles and a second reviewer validated the inclusion with a random sample. Abstract and full-text review by two reviewers determined final inclusion.Results: Of 7382 unique articles screened, 653 articles were included; inter-rater agreement was high (K=0.995). Studies reported on disparities in the acute hospital setting (104) or postacute/rehabilitation (86), with fewer focused on prevention (57) and policy development (6). Research methods used were quantitative (593) with 25 intervention studies, qualitative (45), qualitative/quantitative (7), and community-based participatory research (8). Age ranges of included studies were all ages (124), adults (318), pediatric/youth/adolescents (172), and older adults (40). Racial disparities were most commonly measured (439 studies); 38 created a white/nonwhite binary. Other commonly measured disparities were place of residence (122), insurance (111 studies), gender (89), age (75), and socioeconomic status measures (61). Disparities were noted in all of the categories. Studies commonly aggregated all types of traumatic injuries (129) or all types of violence (105).Conclusions: The extant injury literature lacks research on prevention and policy to address disparities. Many studies aggregated types of trauma and patient groups, preventing an understanding of distinctions between groups and potential interventions. Intervention and community-based research strategies were limited. Future research can better specify measurement of understudied equity categories, trauma types and intent, and racial groups.

Transforming injury prevention for youth (TrIPY): an intersectionality model for youth injury prevention

“…Youth injury encompasses essential concepts including youth injury risk, types of injury, the severity of the injury, as well as access and opportunity for prevention. Multiple intersecting and interacting factors operating at different levels of society impact these aspects of youth injury2 4 51–54 and are represented within the model. The main element of the model is the circular image on the left side which represents the concepts of intersectionality.…”

“…The first dimension (ellipticals) displays social identity factors which may be biological or non-biological but related to birth affecting the risk for and experience of youth injury, including: gender and sexual orientation; culture/ethnicity/religion; SES; intellectual disability; biological sex; race/caste/peoplehood; age; and physical disability. These factors were informed by evidence within injury prevention and intersectionality - they intersect with other factors to influence health, behaviour and inequities through systems of oppression, including racism and discrimination 2 4 51 52 54–59. For example, income, social status, education, access to resources, safe housing, workplaces and neighbourhoods are aspects of SES impacting an individual’s risk of injury as well as subsequent access to care and, if needed, rehabilitation 2.…”

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

“…Although this qualitative research suggests that interactions between SA survivors and ED providers may impact disparities in post-assault help-seeking and health, research exploring potential disparities in ED SA survivor care is minimal. A review of the literature regarding healing from all types of violence noted that available research “aggregated types of trauma and patient groups, preventing an understanding of distinctions between groups and potential interventions” (Moore et al, 2019). Racial disparities are often flattened to a white-nonwhite binary and meaningful studies of the impact of sexual and gender identity, disability, and socioeconomic status in healing from SA are lacking.…”

The time is now: why we must identify and address health disparities in sport and recreation injury

“…Significant inequities exist in injury prevention and control in the US as demonstrated by health disparities across age, race, ethnicity, region, and sex for motor-vehicle crashes, homicide, suicide, traumatic brain injuries, drug use, and work-related injuries (Daugherty et al 2019 ; National Academies of Sciences, Engineering, and Medicine, et al n.d. ; Moore et al 2019 ; CDC Health Disparities and Inequalities Report (CHDIR) - Minority Health - CDC n.d. ). Health disparities are differences that are “closely linked with social, economic, and/or environmental disadvantage” (Healthy People 2020 Disparities 2020) and “affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion” (U.S. Department of Health Human Services 2010 ; U.S. Department of Health and Human Services 2008 ).…”