Relationship between the COVID-19 pandemic and structural inequalities within the pediatric trauma population

Christina Georgeades; Amelia T Collings; Manzur Farazi; Carisa Bergner; Mary E Fallat; Peter C Minneci; K Elizabeth Speck; Kyle J Van Arendonk; Katherine J Deans; Richard A Falcone Jr; David S Foley; Jason D Fraser; Samir K Gadepalli; Martin S Keller; Meera Kotagal; Matthew P Landman; Charles M Leys; Troy A Markel; Nathan S Rubalcava; Shawn D St Peter; Thomas T Sato; Katherine T Flynn-O'Brien; Midwest Pediatric Surgery Consortium (MWPSC)

doi:10.1186/s40621-023-00475-0

Relationship between the COVID-19 pandemic and structural inequalities within the pediatric trauma population

Inj Epidemiol. 2023 Nov 28;10(Suppl 1):62. doi: 10.1186/s40621-023-00475-0.

Authors

Christina Georgeades^{1

2}, Amelia T Collings³, Manzur Farazi^{4

5}, Carisa Bergner^{4

5}, Mary E Fallat^{6

7}, Peter C Minneci⁸, K Elizabeth Speck⁹, Kyle J Van Arendonk^{4

5}, Katherine J Deans¹⁰, Richard A Falcone Jr^{11

12}, David S Foley^{6

7}, Jason D Fraser¹³, Samir K Gadepalli⁹, Martin S Keller¹⁴, Meera Kotagal^{11

12}, Matthew P Landman³, Charles M Leys¹⁵, Troy A Markel³, Nathan S Rubalcava⁹, Shawn D St Peter¹³, Thomas T Sato^{4

5}, Katherine T Flynn-O'Brien^{4

5}; Midwest Pediatric Surgery Consortium (MWPSC)

Affiliations

¹ Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. cgeorgeades@mcw.edu.
² Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA. cgeorgeades@mcw.edu.
³ Department of Surgery, Indiana University, Indianapolis, IN, USA.
⁴ Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
⁵ Division of Pediatric Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92Nd St, Milwaukee, WI, 53226, USA.
⁶ Norton Children's Hospital, Louisville, KY, USA.
⁷ Hiram C. Polk Jr., Department of Surgery, University of Louisville, Louisville, KY, USA.
⁸ Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
⁹ Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, USA.
¹⁰ Department of Surgery, Nemours Children's Health Delaware Valley, Wilmington, DE, USA.
¹¹ Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹² Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹³ Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
¹⁴ Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, USA.
¹⁵ Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.

Abstract

Background: The COVID-19 pandemic disrupted social, political, and economic life across the world, shining a light on the vulnerability of many communities. The objective of this study was to assess injury patterns before and after implementation of stay-at-home orders (SHOs) between White children and children of color and across varying levels of vulnerability based upon children's home residence.

Methods: A multi-institutional retrospective study was conducted evaluating patients < 18 years with traumatic injuries. A "Control" cohort from an averaged March-September 2016-2019 time period was compared to patients injured after SHO initiation-September 2020 ("COVID" cohort). Interactions between race/ethnicity or social vulnerability index (SVI), a marker of neighborhood vulnerability and socioeconomic status, and the COVID-19 timeframe with regard to the outcomes of interest were assessed using likelihood ratio Chi-square tests. Differences in injury intent, type, and mechanism were then stratified and explored by race/ethnicity and SVI separately.

Results: A total of 47,385 patients met study inclusion. Significant interactions existed between race/ethnicity and the COVID-19 SHO period for intent (p < 0.001) and mechanism of injury (p < 0.001). There was also significant interaction between SVI and the COVID-19 SHO period for mechanism of injury (p = 0.01). Children of color experienced a significant increase in intentional (COVID 16.4% vs. Control 13.7%, p = 0.03) and firearm (COVID 9.0% vs. Control 5.2%, p < 0.001) injuries, but no change was seen among White children. Children from the most vulnerable neighborhoods suffered an increase in firearm injuries (COVID 11.1% vs. Control 6.1%, p = 0.001) with children from the least vulnerable neighborhoods having no change. All-terrain vehicle (ATV) and bicycle crashes increased for children of color (COVID 2.0% vs. Control 1.1%, p = 0.04 for ATV; COVID 6.7% vs. Control 4.8%, p = 0.02 for bicycle) and White children (COVID 9.6% vs. Control 6.2%, p < 0.001 for ATV; COVID 8.8% vs. Control 5.8%, p < 0.001 for bicycle).

Conclusions: In contrast to White children and children from neighborhoods of lower vulnerability, children of color and children living in higher vulnerability neighborhoods experienced an increase in intentional and firearm-related injuries during the COVID-19 pandemic. Understanding inequities in trauma burden during times of stress is critical to directing resources and targeting intervention strategies.

Keywords: Pediatric trauma; Race/ethnicity; Socioeconomic status; Violent injury.