Socioeconomic and Health Disparities Among Pediatric Trauma Patients in the United States
Introduction: Low socioeconomic status is a determinant of pediatric trauma incidence and severity. This study utilized the National Inpatient Sample (NIS) data to evaluate socioeconomic and health disparities among children hospitalized after trauma.
Methods: This retrospective study identified patients aged 0–18 years with ICD9 codes for traumatic injury in the NIS database from 2012-2015. Socioeconomic variables included race, gender, age, census region, and median income of patient zip code. Outcomes included length-of-stay (LOS), cost, disposition at discharge, death, and inpatient complications. Linear regressions in log scale were built for LOS and cost. Ordinal regression was built for disposition. Logistic regression was built for death and in-hospital complication.
Results: Relative to Caucasians and higher income quartiles, LOS for children sustaining trauma was increased among African Americans (B=0.092, p<0.001) and Native Americans (B=0.125, p=0.009), and patients within the lowest income quartile (B=0.126, p<0.001). Relative to the New England region residents in the East South Central (B=0.15, p<0.001) and West South Central (B=0.08, p=0.004), older patients (OR=2.8, 95% CI 2.6-3.1, p<0.001) and lowest income group (OR=1.2, 95%CI 1.1-1.3) showed worse discharge disposition. Death was increased among younger patients (OR=2.0:95%CI 1.6-2.7, p<0.001) and lowest median income patients (OR=2.4 95%CI 1.8-3.2, p<0.001). Overall hospital costs were increased in all racial minority groups (p<0.05) and highest in the Pacific region (B=0.16, p<0.001). The lowest income quartile had increased rate of inpatient complications (OR=1.3:95%CI:1.2-1.5, p<0.001).
Conclusions: This study demonstrated that significant socioeconomic and health disparities exist among injured children. Patients in minority race groups, certain geographic regions, and lower income regions experienced longer LOS, increased rates of hospital complications, increased overall hospital costs, worse disposition at discharge, and increased rates of death. These findings highlight the need for initiatives to address health disparities before and after injury with prevention strategies designed for unique cultural environments.