O2018: The Association Between Community-level Social Determinants of Health and Pediatric Hospitalizations for Firearm Injury or Motor Vehicle Crash

Background: Community-level factors can have a profound impact on the health of a child. The purpose of this study is to understand the relationship between community-level determinants measured by Child Opportunity Index and pediatric hospitalizations from firearm injury or motor vehicle crash.

Methods: All pediatric patients ( < 18 years) who presented with an initial encounter for a firearm injury or motor vehicle crash (MVC; comparison group) between 2016-2021 were identified from 35 hospitals in the Pediatric Health Information System (PHIS) database. Unintentional and self-inflicted firearm injuries were excluded. Community-level vulnerability was determined by Child Opportunity Index (COI), a composite score of neighborhood opportunity level data that is specific to pediatric populations. Univariate and multivariable analyses were performed to identify risk factors for firearm injury.

Results: We identified a total of 67,667 pediatric trauma patients who were treated for injuries due to a MVC (n=61,774) or a firearm (n=5,893). The overall cohort had an average age of 9.3 (SD 5.4) years with 50.0% being male, 43.9% Non-Hispanic Black and 60.7% publicly insured. Most patients had low injury severity and 96.5% were discharged home. Compared to those with MVC injuries, patients injured by a firearm were older and more likely to be male, Non-Hispanic Black, and to have public insurance (all p< 0.001). Firearm injury patients were also more severely injured, more likely to be admitted to the hospital and ICU, and have higher hospital cost and mortality (all p< 0.001). Patients presenting with firearm injuries were more likely to be from lower COI communities with the majority (55%) residing in communities with very low COI (Table 1).
In multivariable analysis, after adjusting for age, sex, race/ethnicity, and public insurance, children living in lower levels of COI were more likely to be admitted for a firearm injury than a MVC injury compared to children living in communities with very high COI; the odds increased as the level of COI decreased (OR 1.33, 1.60, 1.73, 2.00 for high, moderate, low, and very low COI respectively, all p≤0.001). During the 6-year study period, there was a trend toward increased firearm injuries in all COI groups (Figure 1).

Conclusion: In this cohort study, children living in communities with lower COI had increased odds of presenting with firearm injury compared with those from high COI communities, and odds increased as COI decreased. We observed an increase over the last 6 years in the number of children from lower COI neighborhoods presenting with firearm injuries with relative stability in the number of MVC injuries. These findings indicate the need for children’s hospitals to engage with low COI communities to decrease the risk of firearm injuries to children and adolescents.