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Dyas AR, Carmichael H, Bronsert MR, Stuart CM, Garofalo DM, Henderson WG, Colborn KL, Schulick RD, Meguid RA, Velopulos CG. Social vulnerability is associated with higher risk-adjusted rates of postoperative complications in a broad surgical population. Am J Surg 2024; 229:26-33. [PMID: 37775458 DOI: 10.1016/j.amjsurg.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if an association between Social Vulnerability Index (SVI) and risk-adjusted complications exists in a broad spectrum of surgical patients. SUMMARY BACKGROUND DATA Growing evidence supports the impact of social circumstances on surgical outcomes. SVI is a neighborhood-based measure accounting for sociodemographic factors putting communities at risk. METHODS This was a multi-hospital, retrospective cohort study including a sample of patients within one healthcare system (2012-2017). Patient addresses were geocoded to determine census tract of residence and estimate SVI. Patients were grouped into low SVI (score<75) and high SVI (score≥75) cohorts. Perioperative variables and postoperative outcomes were tracked and compared using local ACS-NSQIP data. Multivariable logistic regression was performed to generate risk-adjusted odds ratios of postoperative complications in the high SVI cohort. RESULTS Overall, 31,224 patients from five hospitals were included. Patients with high SVI were more likely to be racial minorities, have 12/18 medical comorbidities, have high ASA class, be functionally dependent, be treated at academic hospitals, and undergo emergency operations (all p < 0.05). Patients with high SVI had significantly higher rates of 30-day mortality, overall morbidity, respiratory, cardiac and infectious complications, urinary tract infections, postoperative bleeding, non-home discharge, and unplanned readmissions (all p < 0.05). After risk-adjustment, only the associations between high SVI and mortality and unplanned readmission became non-significant. CONCLUSIONS High SVI was associated with multiple adverse outcomes even after risk adjustment for preoperative clinical factors. Targeted preventative interventions to mitigate risk of these specific complications should be considered in this high-risk population.
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Affiliation(s)
- Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Denise M Garofalo
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - William G Henderson
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn L Colborn
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine G Velopulos
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO, USA
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Siu M, Perez Coulter A, Knee A, Tirabassi MV. Association Between Social Vulnerability Index and Hospital Readmission Following Gunshot Injuries. J Surg Res 2024; 293:50-56. [PMID: 37716100 DOI: 10.1016/j.jss.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION No association regarding classification of social vulnerability and outcomes of patients with gunshot injury have been described. Our goal was to assess whether the socioeconomic vulnerability index (SVI), is associated with an increased risk of hospital readmission following gunshot wounds. METHODS We conducted an exploratory retrospective cohort study on Massachusetts patients with trauma following gunshot wounds from January 1, 2012 to December 31, 2020 using the institutional trauma registry. We estimated the association between high social vulnerability (defined by the Centers for Disease Control and Prevention as ≥90th percentile) and incidence of all-cause readmission at 30, 60, and 90 d (overall and stratified over sex, race, and age groups). Estimates from unadjusted log-binomial regression were reported using relative risks (RRs) and 95% confidence intervals. Time-to-event (readmission) was assessed using Kaplan-Meier plots. RESULTS A total of 386 patients were included for analysis: 211 (55%) with SVI <0.90 and 175 (45%) with SVI ≥0.90. The mean (standard deviation) age was 29 (13) y, with majority being male (89%). There was no strong risk of readmission associated with SVI ≥0.90; the interval with the greatest risk was at 60 d (RR = 1.34; 95% confidence interval [0.73, 2.45]). Among stratified analyses, the strongest associations were observed when restricting to young adults (aged 18-35) with RRs of 2.49, 2.62, and 2.45 for 30, 60, and 90 d readmission, respectively. CONCLUSIONS Overall, high SVI was not associated with all-cause readmission; however, subanalyses suggest an association among young adults. Future research should explore SVI as a tool for identifying patients with trauma at risk for readmission.
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Affiliation(s)
- Margaret Siu
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts.
| | - Aixa Perez Coulter
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Alexander Knee
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts; Baystate Medical Center, Epidemology/Biostatistics Research Core, Office of Research, Springfield, Massachusetts
| | - Michael V Tirabassi
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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3
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Wulz AR, Sharpe JD, Miller GF, Wolkin AF. Association between social vulnerability factors and unintentional fatal injury rates - United States, 2015-2019. JOURNAL OF SAFETY RESEARCH 2023; 86:245-252. [PMID: 37718052 PMCID: PMC10505702 DOI: 10.1016/j.jsr.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/03/2023] [Accepted: 07/14/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Differences in social and environmental factors can contribute to disparities in fatal injury rates. The purpose of this study was to examine the relationship between social and environmental factors and unintentional fatal injury across counties in the United States and how this relationship varies by geography. METHODS County-level vital statistics on age-adjusted unintentional fatal injury rates for 2015-2019 were linked with county-level data from the 2018 Social Vulnerability Index (SVI), a dataset identifying socially vulnerable communities. We conducted linear regression to examine the association between SVI and unintentional fatal injury, overall and by Census region/division. We mapped county-level data for SVI and unintentional fatal injury rates in bivariate choropleth maps using quartiles. RESULTS SVI was positively associated with unintentional fatal injury (β = 18.29, p < 0.001) across U.S. counties. The geographic distribution of SVI and unintentional fatal injury rates varied spatially and substantially for U.S. counties, with counties in the South and West regions having the greatest levels of SVI and rates of unintentional fatal injury. CONCLUSIONS Our findings demonstrate that the social vulnerability of counties is associated with unintentional fatal injury rates. Modification of the SVI for injury research could include additional social determinants and exclude variables not applicable to injuries. A modified SVI could inform unintentional injury prevention strategies by prioritizing efforts in areas with high levels of social vulnerability. PRACTICAL APPLICATIONS This study is the first step in combining the SVI and injury mortality data to provide researchers with an index to investigate upstream factors related to injury.
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Affiliation(s)
- Avital R Wulz
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, S106-9, Atlanta, GA 30341, United States.
| | - J Danielle Sharpe
- Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gabrielle F Miller
- Division of Injury Prevention, National Centers for Injury, Prevention and Control, Centre for Diseases Control and Prevention, Atlanta, GA, United States
| | - Amy F Wolkin
- Division of Injury Prevention, National Centers for Injury, Prevention and Control, Centre for Diseases Control and Prevention, Atlanta, GA, United States
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Garg A, Lobner K, Song J, Mitchell R, Egbunine A, Kudchadkar SR. Social Determinants of Health in Pediatric Rehabilitation for Children with Traumatic Injury: A Systematic Review. J Pediatr 2023; 259:113459. [PMID: 37172806 PMCID: PMC10524504 DOI: 10.1016/j.jpeds.2023.113459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/05/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To examine the current evidence regarding health care disparities in pediatric rehabilitation after hospitalization with traumatic injury. STUDY DESIGN This systematic review utilized both PubMed and EMBASE, and each was searched with key MESH terms. Studies were included in the systematic review if they (1) addressed social determinants of health including, but not limited to, race, ethnicity, insurance status, and income level; (2) focused on inpatient and outpatient rehabilitation services posthospital stay; (3) were based in the pediatric population; and (4) addressed traumatic injury requiring hospitalization. Only studies from within the US were included. RESULTS From 10 169 studies identified, 455 abstracts were examined for full-text review, and 24 studies were chosen for data extraction. Synthesis of the 24 studies revealed 3 major themes: (1) access to services; (2) outcomes from rehabilitation; and (3) service provision. Patients with public insurance had decreased availability of service providers and had longer outpatient wait times. Non-Hispanic Black and Hispanic children were more likely to have greater injury severity and decreased functional independence after discharge. Lack of interpreter services was associated with decreased utilization of outpatient services. CONCLUSIONS This systematic review identified significant effects of health care disparities on the rehabilitation process in pediatric traumatic injury. Social determinants of health must be thoughtfully addressed to identify key areas of improvement for the provision of equitable health care.
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Affiliation(s)
- Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Ariel Egbunine
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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5
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Stevens J, Reppucci ML, Pickett K, Acker S, Carmichael H, Velopulos CG, Bensard D, Kulungowski A. Using the Social Vulnerability Index to Examine Disparities in Surgical Pediatric Trauma Patients. J Surg Res 2023; 287:55-62. [PMID: 36868124 DOI: 10.1016/j.jss.2023.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/31/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION The Social Vulnerability Index (SVI) is a composite measure geocoded at the census tract level that has the potential to identify target populations at risk for postoperative surgical morbidity. We applied the SVI to examine demographics and disparities in surgical outcomes in pediatric trauma patients. METHODS Surgical pediatric trauma patients (≤18-year-old) at our institution from 2010 to 2020 were included. Patients were geocoded to identify their census tract of residence and estimated SVI and were stratified into high (≥70th percentile) and low (<70th percentile) SVI groups. Demographics, clinical data, and outcomes were compared using Kruskal-Wallis and Fisher's exact tests. RESULTS Of 355 patients included, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Patients with high SVI were more likely to have government insurance (73.7% versus 37.2%, P < 0.001), be of minority race (49.8% versus 19.1%, P < 0.001), present with penetrating injuries (32.9% versus 19.7%, P = 0.007), and develop surgical site infections (3.9% versus 0.4%, P = 0.03) compared to the low SVI group. CONCLUSIONS The SVI has the potential to examine health care disparities in pediatric trauma patients and identify discrete at-risk target populations for preventative resources allocation and intervention. Future studies are necessary to determine the utility of this tool in additional pediatric cohorts.
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Affiliation(s)
- Jenny Stevens
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Marina L Reppucci
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Kaci Pickett
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon Acker
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Heather Carmichael
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Denis Bensard
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Ann Kulungowski
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Flynn-O’Brien KT, Collings AT, Farazi M, Fallat ME, Minneci PC, Speck KE, Van Arendonk K, Deans KJ, Falcone RA, Foley DS, Fraser JD, Gadepalli S, Keller MS, Kotagal M, Landman MP, Leys CM, Markel TA, Rubalcava N, St. Peter SD, Sato TT. Pediatric Injury Transfer Patterns During the COVID-19 Pandemic: An Interrupted time Series Analysis. J Surg Res 2023; 281:130-142. [PMID: 36155270 PMCID: PMC9424522 DOI: 10.1016/j.jss.2022.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/07/2022] [Accepted: 08/21/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION With the expected surge of adult patients with COVID-19, the Children's Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatric Trauma Centers (PTCs) during the first 6 mo of the pandemic. METHODS Children aged < 18 y injured between January 1, 2016 and September 30, 2020, who met National Trauma Databank inclusion criteria from 9 PTCs were included. An interrupted time-series analysis was used to estimate an expected number of transferred patients compared to observed volume. The "COVID" cohort was compared to a historical cohort (historical average [HA]), using an average across 2016-2019. Site-based differences in transfer volume, demographics, injury characteristics, and hospital-based outcomes were compared between cohorts. RESULTS Twenty seven thousand thirty one/47,382 injured patients (57.05%) were transferred to a participating PTC during the study period. Of the COVID cohort, 65.4% (4620/7067) were transferred, compared to 55.7% (3281/5888) of the HA (P < 0.001). There was a decrease in 15-y-old to 17-y-old patients (10.43% COVID versus 12.64% HA, P = 0.003). More patients in the COVID cohort had injury severity scores ≤ 15 (93.25% COVID versus 87.63% HA, P < 0.001). More patients were discharged home after transfer (31.80% COVID versus 21.83% HA, P < 0.001). CONCLUSIONS Transferred trauma patients to Level I PTC increased during the COVID-19 pandemic. The proportion of transferred patients discharged from emergency departments increased. Pediatric trauma transfers may be a surrogate for referring emergency department capacity and resources and a measure of pediatric trauma triage capability.
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Affiliation(s)
- Katherine T. Flynn-O’Brien
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Children's Wisconsin, Milwaukee, Wisconsin,Corresponding author. Children's Wisconsin Corporate Center, 999 N. 92nd Street, Ste 320, Milwaukee WI 53266. Tel.: +1 414 266 6557
| | | | - Manzur Farazi
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Children's Wisconsin, Milwaukee, Wisconsin
| | - Mary E. Fallat
- Norton Children's Hospital, Louisville, Kentucky,Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - K. Elizabeth Speck
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, Michigan
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Children's Wisconsin, Milwaukee, Wisconsin
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Richard A. Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David S. Foley
- Norton Children's Hospital, Louisville, Kentucky,Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jason D. Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Samir Gadepalli
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, Michigan
| | - Martin S. Keller
- Division of Pediatric Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio,Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Charles M. Leys
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Troy A. Markel
- Department of Surgery, Indiana University, Indianapolis, Indiana
| | - Nathan Rubalcava
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, Michigan
| | | | - Thomas T. Sato
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin,Children's Wisconsin, Milwaukee, Wisconsin
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Kwon EG, Wang BK, Iverson KR, O'Connell KM, Nehra D, Rice-Townsend SE. Interpersonal violence affecting the pediatric population: Patterns of injury and recidivism. J Pediatr Surg 2023; 58:136-141. [PMID: 36273921 DOI: 10.1016/j.jpedsurg.2022.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE We aim to describe interpersonal violence-related injury patterns in the pediatric trauma population and to identify predictors of recidivism. METHODS In this retrospective analysis from a single institution, we included pediatric patients (≤17 years) treated (2006-2020) for traumatic injury related to interpersonal violence (IPV). Patient characteristics were compared among mechanism types and between recidivists and non recidivists using two sample t-tests, Wilcoxon rank-sum tests, and Pearson's chi-squared. Multivariate analysis was performed using logistic regression to identify predictors of repeat injury. RESULTS We identified 635 pediatric patients who sustained injuries owning to IPV: firearm (N = 266), assault (stab/blunt; N = 243), and abuse (N = 126). The average age of the firearm, assault, and abuse groups was 15.5, 14.7, and 1.1 years (SD = 2.2, 3.4, 2.4 years), respectively. Majority of the overall cohort was male (77.5%) and publicly- or un insured (67.8%), with 28.0% being Black. Of the 489 firearm and assault patients who survived the first injury, 30 (6.1%) had repeat injury owning to IPV requiring treatment at our center with a median time of 40 months (IQR 17-62 months) between first and second injury. The majority of recidivists (83.3%) were victims of gun violence whereas the distribution between assault and firearm in the non recidivists was more even at 51 and 49%, respectively (p < 0.001). Eighteen (60.0%) of the recidivist patients had the same mechanism between the first and second injury. In the logistic regression analysis, Black race and firearm injury were associated with greater than 3-fold higher likelihood of repeat injury compared to white race after adjusting for age, sex, insurance, and child opportunity index. CONCLUSIONS We found that survivors of firearm injuries and assault comprise a vulnerable patient cohort at risk for repeat injury, and Black race is an independent predictor of repeat injury owning to IPV. These findings provide guidance for developing violence prevention programs. TYPE OF STUDY Retrospective Comparative Study LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Eustina G Kwon
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - Benjamin K Wang
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Katherine R Iverson
- Division of Trauma, Burn & Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Kathleen M O'Connell
- Division of Trauma, Burn & Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Deepika Nehra
- Division of Trauma, Burn & Critical Care Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Samuel E Rice-Townsend
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA.
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8
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Pediatric injury trends and relationships with social vulnerability during the COVID-19 pandemic: A multi-institutional analysis. J Trauma Acute Care Surg 2023; 94:133-140. [PMID: 35995783 PMCID: PMC9812296 DOI: 10.1097/ta.0000000000003687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on pediatric injury, particularly relative to a community's vulnerability, is unknown. The objective of this study was to describe the change in pediatric injury during the first 6 months of the COVID-19 pandemic compared with prior years, focusing on intentional injury relative to the social vulnerability index (SVI). METHODS All patients younger than 18 years meeting inclusion criteria for the National Trauma Data Bank between January 1, 2016, and September 30, 2020, at nine Level I pediatric trauma centers were included. The COVID cohort (children injured in the first 6 months of the pandemic) was compared with an averaged historical cohort (corresponding dates, 2016-2019). Demographic and injury characteristics and hospital-based outcomes were compared. Multivariable logistic regression was used to estimate the adjusted odds of intentional injury associated with SVI, moderated by exposure to the pandemic. Interrupted time series analysis with autoregressive integrated moving average modeling was used to predict expected injury patterns. Volume trends and observed versus expected rates of injury were analyzed. RESULTS There were 47,385 patients that met inclusion criteria, with 8,991 treated in 2020 and 38,394 treated in 2016 to 2019. The COVID cohort included 7,068 patients and the averaged historical cohort included 5,891 patients (SD, 472), indicating a 20% increase in pediatric injury ( p = 0.031). Penetrating injuries increased (722 [10.2%] COVID vs. 421 [8.0%] historical; p < 0.001), specifically firearm injuries (163 [2.3%] COVID vs. 105 [1.8%] historical; p = 0.043). Bicycle collisions (505 [26.3%] COVID vs. 261 [18.2%] historical; p < 0.001) and collisions on other land transportation (e.g., all-terrain vehicles) (525 [27.3%] COVID vs. 280 [19.5%] historical; p < 0.001) also increased. Overall, SVI was associated with intentional injury (odds ratio, 7.9; 95% confidence interval, 6.5-9.8), a relationship which increased during the pandemic. CONCLUSION Pediatric injury increased during the pandemic across multiple sites and states. The relationship between increased vulnerability and intentional injury increased during the pandemic. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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9
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Yap A, Laverde R, Thompson A, Ozgediz D, Ehie O, Mpody C, Vu L. Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California. Am J Surg 2023; 225:122-128. [PMID: 36184328 DOI: 10.1016/j.amjsurg.2022.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/27/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Area-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions. METHODS This retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1-2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015-2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery. RESULTS Among 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.02-2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03-2.98). CONCLUSION Neighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention.
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Affiliation(s)
- Ava Yap
- University of California San Francisco, Department of Surgery, USA.
| | - Ruth Laverde
- University of California San Francisco, School of Medicine, USA
| | - Avery Thompson
- University of California San Francisco, School of Medicine, USA
| | - Doruk Ozgediz
- University of California San Francisco, Department of Surgery, USA
| | | | - Christian Mpody
- Nationwide Children's Hospital, Department of Anesthesiology and Pain Medicine, USA
| | - Lan Vu
- University of California San Francisco, Department of Surgery, USA
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10
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Zambrano LD, Ly KN, Link-Gelles R, Newhams MM, Akande M, Wu MJ, Feldstein LR, Tarquinio KM, Sahni LC, Riggs BJ, Singh AR, Fitzgerald JC, Schuster JE, Giuliano JS, Englund JA, Hume JR, Hall MW, Osborne CM, Doymaz S, Rowan CM, Babbitt CJ, Clouser KN, Horwitz SM, Chou J, Patel MM, Hobbs C, Randolph AG, Campbell AP. Investigating Health Disparities Associated With Multisystem Inflammatory Syndrome in Children After SARS-CoV-2 Infection. Pediatr Infect Dis J 2022; 41:891-898. [PMID: 36102740 PMCID: PMC9555608 DOI: 10.1097/inf.0000000000003689] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complication that has disproportionately affected racial/ethnic minority children. We conducted a pilot study to investigate risk factors for MIS-C aiming to understand MIS-C disparities. METHODS This case-control study included MIS-C cases and SARS-CoV-2-positive outpatient controls less than 18 years old frequency-matched 4:1 to cases by age group and site. Patients hospitalized with MIS-C were admitted between March 16 and October 2, 2020, across 17 pediatric hospitals. We evaluated race, ethnicity, social vulnerability index (SVI), insurance status, weight-for-age and underlying medical conditions as risk factors using mixed effects multivariable logistic regression. RESULTS We compared 241 MIS-C cases with 817 outpatient SARS-CoV-2-positive at-risk controls. Cases and controls had similar sex, age and U.S. census region distribution. MIS-C patients were more frequently previously healthy, non-Hispanic Black, residing in higher SVI areas, and in the 95th percentile or higher for weight-for-age. In the multivariable analysis, the likelihood of MIS-C was higher among non-Hispanic Black children [adjusted odds ratio (aOR): 2.07; 95% CI: 1.23-3.48]. Additionally, SVI in the 2nd and 3rd tertiles (aOR: 1.88; 95% CI: 1.18-2.97 and aOR: 2.03; 95% CI: 1.19-3.47, respectively) were independent factors along with being previously healthy (aOR: 1.64; 95% CI: 1.18-2.28). CONCLUSIONS In this study, non-Hispanic Black children were more likely to develop MIS-C after adjustment for sociodemographic factors, underlying medical conditions, and weight-for-age. Investigation of the potential contribution of immunologic, environmental, and other factors is warranted.
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Affiliation(s)
- Laura D. Zambrano
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen N. Ly
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Link-Gelles
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Margaret M. Newhams
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Manzilat Akande
- Department of Pediatrics-Section of Critical Care, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Michael J. Wu
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R. Feldstein
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Keiko M. Tarquinio
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Leila C. Sahni
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Immunization Project, Houston, Texas
| | - Becky J. Riggs
- Department of Anesthesiology and Critical Care Medicine; Division of Pediatric Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aalok R. Singh
- Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Julie C. Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Disease, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
| | - John S. Giuliano
- Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Janet A. Englund
- Department of Pediatrics, School of Medicine, Seattle Children’s Research Institute, University of Washington, Seattle, Washington
| | - Janet R. Hume
- Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Mark W. Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Christina M. Osborne
- Department of Pediatrics, Sections of Critical Care Medicine and Infectious Diseases, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Sule Doymaz
- Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Courtney M. Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Babbitt
- Division of Pediatric Critical Care Medicine, Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California
| | - Katharine N. Clouser
- Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Steven M. Horwitz
- Department of Pediatrics, Division of Critical Care, Bristol-Myers Squibb Children’s Hospital, New Brunswick, New Jersey
| | - Janet Chou
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of
| | - Manish M. Patel
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Charlotte Hobbs
- Pediatrics
- Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Departments of
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Angela P. Campbell
- From the COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Collings AT, Farazi M, Van Arendonk K, Fallat ME, Minneci PC, Sato TT, Speck KE, Deans KJ, Falcone RA, Foley DS, Fraser JD, Keller MS, Kotagal M, Landman MP, Leys CM, Markel T, Rubalcava N, St Peter SD, Flynn-O'Brien KT. Impact of "Stay-at-Home" orders on non-accidental trauma: A multi-institutional study. J Pediatr Surg 2022; 57:1062-1066. [PMID: 35292165 PMCID: PMC8842346 DOI: 10.1016/j.jpedsurg.2022.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND It is unclear how Stay-at-Home Orders (SHO) of the COVID-19 pandemic impacted the welfare of children and rates of non-accidental trauma (NAT). We hypothesized that NAT would initially decrease during the SHO as children did not have access to mandatory reporters, and then increase as physicians' offices and schools reopened. METHODS A multicenter study evaluating patients <18 years with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT. "Historical" controls from an averaged period of March-September 2016-2019 were compared to patients injured March-September 2020, after the implementation of SHO ("COVID" cohort). An interrupted time series analysis was utilized to evaluate the effects of SHO implementation. RESULTS Nine Level I pediatric trauma centers contributed 2064 patients meeting NAT criteria. During initial SHO, NAT rates dropped below what was expected based on historical trends; however, thereafter the rate increased above the expected. The COVID cohort experienced a significant increase in the proportion of NAT patients age ≥5 years, minority children, and least resourced as determined by social vulnerability index (SVI). CONCLUSIONS The COVID-19 pandemic affected the presentation of children with NAT to the hospital. In times of public health crisis, maintaining systems of protection for children remain essential. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Amelia T. Collings
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson 125, Indianapolis, IN 46203, United State,Corresponding author
| | - Manzur Farazi
- Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | | | - Mary E. Fallat
- Norton Children's Hospital, Louisville, KY, United States,Hiram C. Polk Jr, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, United State
| | - Peter C. Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | - Thomas T. Sato
- Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - K. Elizabeth Speck
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, United States
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | - Richard A. Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David S. Foley
- Norton Children's Hospital, Louisville, KY, United States,Hiram C. Polk Jr, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, United State
| | - Jason D. Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
| | - Martin S. Keller
- Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Matthew P. Landman
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson 125, Indianapolis, IN 46203, United State
| | - Charles M. Leys
- Department of Surgery, Division of Pediatric Surgery, University of Wisconsin, Madison, WI, United States
| | - Troy Markel
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., Emerson 125, Indianapolis, IN 46203, United State
| | - Nathan Rubalcava
- Division of Pediatric Surgery, Mott Children's Hospital, Ann Arbor, MI, United States
| | - Shawn D. St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, United States
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Abstract
OBJECTIVE To evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury. BACKGROUND The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors. METHODS Moderate-severely injured adult patients treated at one of three level-1 trauma centers were prospectively followed six to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle two quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury. RESULTS A total of 3,153 patients were included [54% male, mean age 61.6 (SD = 21.6)]. The median overall SVI percentile rank was 35th (IQR: 16th-65th). Compared to low SVI patients, high SVI patients were more likely to have new functional limitations (OR, 1.51; 95% CI, 1.19-1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40-2.89), and to screen positive for PTSD (OR, 1.56; 95% CI, 1.12-2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes. CONCLUSIONS The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.
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13
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Odegard MN, Endorf FW, Richardson CJ, Hess DJ, Segura BJ, Nygaard RM. Analysis of pediatric sternal fractures using the Kid's Inpatient Database (KID). Injury 2022; 53:1627-1630. [PMID: 35078621 DOI: 10.1016/j.injury.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aims to determine if sternal fracture is a predictor of discharge requiring additional care and mortality. METHODS Blunt pediatric trauma admissions (<18 years) in the Kid's Inpatient Database (2016) were included in analysis. Weighted incidence of sternal fracture was calculated and adjusted for using survey weight, sampling clusters, and stratum. Regression analysis was used to identify factors associated with poor outcomes. RESULTS Annual incidence of sternal fracture in the pediatric blunt trauma population was 0.43 per 100,000. Of 50,076 patients identified, 236 had sternal fractures. The sternal fracture patients were older (median 16 vs 10 years, P < 0.001) and motor vehicle accident was more frequently the mechanism of injury (78% vs 24%, P < 0.001). Common injuries associated with sternal fracture included clavicle fracture (43%), abdominal organ injury (28%), spinal fracture (47%), lung injury (65%), and rib fracture (47%). Sternal fracture patients were more frequently discharged to receive additional care (22% vs 5%, P < 0.001) and to die of their injuries (3.8% vs 0.9%, P < 0.001). When adjusting for other factors associated with poor outcomes, sternal fracture was not an independent predictor of mortality or discharge to care. CONCLUSIONS Sternal fracture is a severe injury in the pediatric population, but it is not independently associated with need for a higher level of care after discharge or mortality.
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Affiliation(s)
- Marjorie N Odegard
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA.
| | - Frederick W Endorf
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA
| | - Chad J Richardson
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA
| | - Donavon J Hess
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA
| | - Bradley J Segura
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA
| | - Rachel M Nygaard
- Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55416, USA
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Weston BW, Swingen ZN, Gramann S, Pojar D. Targeting Equity in COVID-19 Vaccinations Using the "Evaluating Vulnerability and Equity" (EVE) Model. Am J Public Health 2022; 112:220-222. [PMID: 35080941 PMCID: PMC8802590 DOI: 10.2105/ajph.2021.306585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic has highlighted racial and ethnic disparities, most recently in vaccine administration. The EVE (Evaluating Vulnerability and Equity) Model combines a community's vulnerability with vaccination rates to enhance the equity of vaccine distribution in an intentional, targeted manner. When applied to Milwaukee County, Wisconsin, two extreme categories of vaccination status were identified to aid in resource allocation and messaging: populations with high vulnerability and low vaccination levels, and, conversely, those with low vulnerability and high vaccinations levels. (Am J Public Health. 2022;112(2):220-222. https://doi.org/10.2105/AJPH.2021.306585).
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Affiliation(s)
- Benjamin W Weston
- Benjamin W. Weston is with the Medical College of Wisconsin, Milwaukee. Benjamin W. Weston, Zachary N. Swingen, Shannon Gramann, and Dan Pojar are with the Milwaukee County Office of Emergency Management, Milwaukee, WI
| | - Zachary N Swingen
- Benjamin W. Weston is with the Medical College of Wisconsin, Milwaukee. Benjamin W. Weston, Zachary N. Swingen, Shannon Gramann, and Dan Pojar are with the Milwaukee County Office of Emergency Management, Milwaukee, WI
| | - Shannon Gramann
- Benjamin W. Weston is with the Medical College of Wisconsin, Milwaukee. Benjamin W. Weston, Zachary N. Swingen, Shannon Gramann, and Dan Pojar are with the Milwaukee County Office of Emergency Management, Milwaukee, WI
| | - Dan Pojar
- Benjamin W. Weston is with the Medical College of Wisconsin, Milwaukee. Benjamin W. Weston, Zachary N. Swingen, Shannon Gramann, and Dan Pojar are with the Milwaukee County Office of Emergency Management, Milwaukee, WI
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