The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash

Kwon, Eustina G.; Nehra, Deepika; Hall, Matthew; Herrera-Escobar, Juan P.; Rivara, Frederick P.; Rice-Townsend, Samuel E.

doi:10.1016/j.surg.2023.04.011

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…Disparities in trauma care are well-described, with significant research aimed at understanding differences in outcomes based on patient- and ecological-level determinants of health . Prior research has demonstrated that patients from economically disadvantaged communities are generally more vulnerable to injury, have more severe injuries, and suffer worse outcomes . Consistent with this work, we found that the largest proportion of patients in both injury cohorts presenting to trauma centers—a reflection of injury severity—were from the most distressed communities.…”

Section: Discussionsupporting

confidence: 90%

“…[20][21][22] Prior research has demonstrated that patients from economically disadvantaged communities are generally more vulnerable to injury, have more severe injuries, and suffer worse outcomes. 9,11 Consistent with this work, we found that the largest proportion of patients in both injury cohorts presenting to trauma centers-a reflection of injury severity-were from the most distressed communities. We further found that patients from the most distressed communities had a significantly higher odds of presenting with a firearm injury, rather than an MVC injury, and that housing vacancy rate and poverty rate were the factors with the highest adjusted odds of presenting with firearm injury.…”

Section: Jama Network Open | Surgerysupporting

confidence: 82%

“…Using these indices, prior work has demonstrated that patients experiencing community-level disadvantage are more vulnerable to injury, and sustain more severe injuries . While the association between community-level determinants of health and injury mechanism has been compared among pediatric patients, this has not been examined at the national level in the adult population. Additionally, prior evaluations of the associations between community-level socioeconomics and firearm injury compared with other injury mechanisms have reported geographically limited experiences with relatively small sample sizes .…”

Section: Introductionmentioning

confidence: 99%

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Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle–Related Injuries

Agoubi,

Banks,

Hink

et al. 2024

JAMA Netw Open

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ImportanceMotor vehicle crash (MVC) and firearm injuries are 2 of the top 3 mechanisms of adult injury-related deaths in the US.ObjectiveTo understand the differing associations between community-level disadvantage and firearm vs MVC injuries to inform mechanism-specific prevention strategies and appropriate postdischarge resource allocation.Design, Setting, and ParticipantsThis multicenter cross-sectional study analyzed prospectively collected data from the American College of Surgeons (ACS) Firearm Study. Included patients were treated either for firearm injury between March 1, 2021, and February 28, 2022, or for MVC-related injuries between January 1 and December 31, 2021, at 1 of 128 participating ACS trauma centers.ExposuresCommunity distress.Main outcome and MeasureOdds of presenting with a firearm as compared with MVC injury based on levels of community distress, as measured by the Distressed Communities Index (DCI) and categorized in quintiles.ResultsA total of 62 981 patients were included (mean [SD] age, 42.9 [17.7] years; 42 388 male [67.3%]; 17 737 Black [28.2%], 9052 Hispanic [14.4%], 36 425 White [57.8%]) from 104 trauma centers. By type, there were 53 474 patients treated for MVC injuries and 9507 treated for firearm injuries. Patients with firearm injuries were younger (median [IQR] age, 31.0 [24.0-40.0] years vs 41.0 [29.0-58.0] years); more likely to be male (7892 of 9507 [83.0%] vs 34 496 of 53 474 [64.5%]), identified as Black (5486 of 9507 [57.7%] vs 12 251 of 53 474 [22.9%]), and Medicaid insured or uninsured (6819 of 9507 [71.7%] vs 21 310 of 53 474 [39.9%]); and had a higher DCI score (median [IQR] score, 74.0 [53.2-94.8] vs 58.0 [33.0-83.0]) than MVC injured patients. Among admitted patients, the odds of presenting with a firearm injury compared with MVC injury were 1.50 (95% CI, 1.35-1.66) times higher for patients living in the most distressed vs least distressed ZIP codes. After controlling for age, sex, race, ethnicity, and payer type, the DCI components associated with the highest adjusted odds of presenting with a firearm injury were a high housing vacancy rate (OR, 1.11; 95% CI, 1.04-1.19) and high poverty rate (OR, 1.17; 95% CI, 1.10-1.24). Among patients sustaining firearm injuries patients, 4333 (54.3%) received no referrals for postdischarge rehabilitation, home health, or psychosocial services.Conclusions and RelevanceIn this cross-sectional study of adults with firearm- and motor vehicle–related injuries, we found that patients from highly distressed communities had higher odds of presenting to a trauma center with a firearm injury as opposed to an MVC injury. With two-thirds of firearm injury survivors treated at trauma centers being discharged without psychosocial services, community-level measures of disadvantage may be useful for allocating postdischarge care resources to patients with the greatest need.

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Section: Discussionsupporting

confidence: 90%

Section: Jama Network Open | Surgerysupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle–Related Injuries

Agoubi,

Banks,

Hink

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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“…These data showed non-Hispanic Black males and adolescents as being most affected, a trend which has been observed nationally (2). The association between lower COI and pediatric firearm injury also mirrors findings from a large national retrospective study using the Pediatric Health Information System (PHIS) database (6) as well as a city-level study assessing injury in Milwaukee (7). There is notable overlap of social determinants of After adjusting for race/ethnicity, there was nearly two-fold increased odds of firearm-related death in Low compared to High COI zip codes (Table 2), though this finding was not statistically significant.…”

Section: Discussionsupporting

confidence: 70%

“…The burden of firearm injury is intimately related to social determinants of health and physical environment, resulting in inequalities in firearm-related deaths by homicide, suicide, or accidental injury ( 4 , 5 ). Geospatial analysis is one strategy to further understand the unequal distribution of firearm injury and has primarily been used to characterize adult firearm injury, with emerging pediatric data ( 6 – 9 ). Prior studies have shown associations between firearm injury and lack of green space ( 10 ), vacant lots ( 11 , 12 ), different policing practices ( 13 ), and social vulnerability ( 14 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania

Reddy

2024

Front. Public Health

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IntroductionFirearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates.MethodsPediatric firearm injury data for children aged 0–19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as “High” or “Low” based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression.ResultsOf 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93–3.22]; p < 0.01). After adjusting for age, sex, and race/ethnicity, odds of mortality in low COI zip codes was nearly twice that of high COI zip codes (aOR 1.95 [0.77–4.92]), though did not demonstrate statistical significance (p = 0.16).ConclusionChild opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.

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Child Opportunity Index Disparities in Pediatric Surgical Encounters During the Coronavirus 2019 Pandemic

Berry,

Ferrari,

Ward

et al. 2024

Academic Pediatrics

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The association between childhood opportunity index and pediatric hospitalization for firearm injury or motor vehicle crash

Cited by 7 publications

References 34 publications

Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle–Related Injuries

Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle–Related Injuries

Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania

Child Opportunity Index Disparities in Pediatric Surgical Encounters During the Coronavirus 2019 Pandemic

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