Association Of Individual And Neighborhood Social Determinants Of Health With Non-accidental Trauma
Steven C Mehl, Hannah Todd, Tim Singer, Abiodun Oluyomi, Omar Rosales, *David E Wesson, *Adam M Vogel, Trey Babino, Chris Greeley, *Bindi Naik-Mathuria
Baylor College of Medicine, Houston, TX
Background (issue): Social factors are associated with increased incidence and poor outcomes in nonaccidental trauma (NAT). Our purpose was to assess the association of individual and neighborhood Social Determinants of Health (SDOH) with NAT.
Methods: A single-center retrospective review was performed to compare accidental trauma (AT) and NAT for children 0-5 years from 2018-2020. SDOH variables included age, sex, race, ethnicity, health insurance, government assistance, unemployment, major life stressors (e.g. job loss, teen pregnancy), and area deprivation index (ADI) based on home address at the state (0-10) and national (0-100) level (higher scores represent more disadvantaged neighborhoods). Outcomes included injury mechanism, hospital complications, and mortality. Correlations were evaluated using t-test and chi-square.
Findings: We identified 222 NAT and 1864 AT cases. NAT cases were younger, more frequently males, and more frequently African American (Figure). Of the NAT cases, 46% (102/222) used government assistance, 53% (117/222) reported unemployment of at least 1 parent, and 18% (41/222) reported a recent major life stressor. NAT cases were associated with higher ADI at the state and national level. NAT was also associated with higher rates of hospital complications (NAT 10%, AT 0.8%; p<0.0001) and mortality (NAT 9%, AT 0.6%; p<0.0001).
Conclusions (implications for practice): Compared to AT, victims of NAT have worse individual and neighborhood SDOH, and are more likely to suffer complications or die of their injuries.
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