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Agoubi LL, Banks S, Hink AB, Kuhls D, Kirkendoll SD, Winchester A, Hoeft C, Patel B, Nathens A. Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle-Related Injuries. JAMA Netw Open 2024; 7:e2419844. [PMID: 38967925 PMCID: PMC11227070 DOI: 10.1001/jamanetworkopen.2024.19844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024] Open
Abstract
Importance Motor vehicle crash (MVC) and firearm injuries are 2 of the top 3 mechanisms of adult injury-related deaths in the US. Objective To understand the differing associations between community-level disadvantage and firearm vs MVC injuries to inform mechanism-specific prevention strategies and appropriate postdischarge resource allocation. Design, Setting, and Participants This multicenter cross-sectional study analyzed prospectively collected data from the American College of Surgeons (ACS) Firearm Study. Included patients were treated either for firearm injury between March 1, 2021, and February 28, 2022, or for MVC-related injuries between January 1 and December 31, 2021, at 1 of 128 participating ACS trauma centers. Exposures Community distress. Main outcome and Measure Odds of presenting with a firearm as compared with MVC injury based on levels of community distress, as measured by the Distressed Communities Index (DCI) and categorized in quintiles. Results A total of 62 981 patients were included (mean [SD] age, 42.9 [17.7] years; 42 388 male [67.3%]; 17 737 Black [28.2%], 9052 Hispanic [14.4%], 36 425 White [57.8%]) from 104 trauma centers. By type, there were 53 474 patients treated for MVC injuries and 9507 treated for firearm injuries. Patients with firearm injuries were younger (median [IQR] age, 31.0 [24.0-40.0] years vs 41.0 [29.0-58.0] years); more likely to be male (7892 of 9507 [83.0%] vs 34 496 of 53 474 [64.5%]), identified as Black (5486 of 9507 [57.7%] vs 12 251 of 53 474 [22.9%]), and Medicaid insured or uninsured (6819 of 9507 [71.7%] vs 21 310 of 53 474 [39.9%]); and had a higher DCI score (median [IQR] score, 74.0 [53.2-94.8] vs 58.0 [33.0-83.0]) than MVC injured patients. Among admitted patients, the odds of presenting with a firearm injury compared with MVC injury were 1.50 (95% CI, 1.35-1.66) times higher for patients living in the most distressed vs least distressed ZIP codes. After controlling for age, sex, race, ethnicity, and payer type, the DCI components associated with the highest adjusted odds of presenting with a firearm injury were a high housing vacancy rate (OR, 1.11; 95% CI, 1.04-1.19) and high poverty rate (OR, 1.17; 95% CI, 1.10-1.24). Among patients sustaining firearm injuries patients, 4333 (54.3%) received no referrals for postdischarge rehabilitation, home health, or psychosocial services. Conclusions and Relevance In this cross-sectional study of adults with firearm- and motor vehicle-related injuries, we found that patients from highly distressed communities had higher odds of presenting to a trauma center with a firearm injury as opposed to an MVC injury. With two-thirds of firearm injury survivors treated at trauma centers being discharged without psychosocial services, community-level measures of disadvantage may be useful for allocating postdischarge care resources to patients with the greatest need.
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Affiliation(s)
- Lauren L. Agoubi
- Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle
| | - Samantha Banks
- Firearm Injury and Policy Research Program, University of Washington, Seattle
| | - Ashley B. Hink
- Department of Surgery, Medical University of South Carolina, Charleston
| | - Deborah Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas
| | - Shelbie D. Kirkendoll
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
- American College of Surgeons
| | | | | | | | - Avery Nathens
- American College of Surgeons
- Department of Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Maholtz D, Page-Goertz CK, Forbes ML, Nofziger RA, Bigham M, McKee B, Ramgopal S, Pelletier JH. Association Between the COI and Excess Health Care Utilization and Costs for ACSC. Hosp Pediatr 2024; 14:592-601. [PMID: 38919989 DOI: 10.1542/hpeds.2023-007526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/09/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND OBJECTIVES The authors of previous work have associated the Childhood Opportunity Index (COI) with increased hospitalizations for ambulatory care sensitive conditions (ACSC). The burden of this inequity on the health care system is unknown. We sought to understand health care resource expenditure in terms of excess hospitalizations, hospital days, and cost. METHODS We performed a retrospective cross-sectional study of the Pediatric Health Information Systems database, including inpatient hospitalizations between January 1, 2016 and December 31, 2022 for children <18 years of age. We compared ACSC hospitalizations, mortality, and cost across COI strata. RESULTS We identified 2 870 121 hospitalizations among 1 969 934 children, of which 44.5% (1 277 568/2 870 121) were for ACSCs. A total of 49.1% (331 083/674 548) of hospitalizations in the very low stratum were potentially preventable, compared with 39.7% (222 037/559 003) in the very high stratum (P < .001). After adjustment, lower COI was associated with higher odds of potentially preventable hospitalization (odds ratio 1.18, 95% confidence interval [CI] 1.17-1.19). Compared with the very high COI stratum, there were a total of 137 550 (95% CI 134 582-140 517) excess hospitalizations across all other strata, resulting in an excess cost of $1.3 billion (95% CI $1.28-1.35 billion). Compared with the very high COI stratum, there were 813 (95% CI 758-871) excess deaths, with >95% from the very low and low COI strata. CONCLUSIONS Children with lower neighborhood opportunity have increased risk of ACSC hospitalizations. The COI may identify communities in which targeted intervention could reduce health care utilization and costs.
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Affiliation(s)
- Danielle Maholtz
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Christopher K Page-Goertz
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Michael L Forbes
- Division of Critical Care Medicine, Department of Pediatrics
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Michael Bigham
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Bryan McKee
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
| | - Sriram Ramgopal
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan H Pelletier
- Division of Critical Care Medicine, Department of Pediatrics
- Department of Pediatrics, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio
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Wang AP, Griffith G, Otto-Meyer S, Ward K. The Child Opportunity Index 2.0 and Disparities in Pediatric Cardiorespiratory Fitness. J Pediatr 2024; 268:113964. [PMID: 38369240 DOI: 10.1016/j.jpeds.2024.113964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate the effect of neighborhood-level characteristics on cardiorespiratory fitness (CRF) via peak oxygen consumption (VO2peak) for healthy pediatric patients. STUDY DESIGN The institutional cardiopulmonary exercise testing (CPET) database was analyzed retrospectively. All patients aged ≤ 18 years without a diagnosis of cardiac disease and with a maximal effort CPET were included. Patients were divided into three self-identified racial categories: White, Black, and Latinx. The Child Opportunity Index (COI) 2.0 was used to analyze social determinants of health. CRF was evaluated based on COI quintiles and race. Assessment of the effect of COI on racial disparities in CRF was performed using ANCOVA. RESULTS A total of 1753 CPETs met inclusion criteria. The mean VO2peak was 42.1 ± 9.8 mL/kg/min. The VO2peak increased from 39.1 ± 9.6 mL/kg/min for patients in the very low opportunity cohort to 43.9 ± 9.4 mL/kg/min for patients in the very high opportunity cohort. White patients had higher percent predicted VO2peak compared with both Black and Latinx patients (P < .01 for both comparisons). The racial differences in CRF were no longer significant when adjusting for COI. CONCLUSION In a large pediatric cohort, COI was associated with CRF. Racial disparities in CRF are reduced when accounting for modifiable risk factors.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Garett Griffith
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL
| | - Sebastian Otto-Meyer
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Kendra Ward
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Reddy AR. Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania. Front Public Health 2024; 12:1339334. [PMID: 38327580 PMCID: PMC10847309 DOI: 10.3389/fpubh.2024.1339334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Firearm injury is the leading cause of death in children. This study uses geospatial mapping to illustrate the burden of pediatric firearm injury in Philadelphia and assesses the relationship between Child Opportunity Index (COI) and injury, hypothesizing that lower COI zip codes would have higher injury and mortality rates. Methods Pediatric firearm injury data for children aged 0-19 years in Philadelphia, from 2015 to February 2023, was visualized by race/ethnicity, fatal versus non-fatal status, and COI for zip code. COI was then dichotomized as "High" or "Low" based on nationally normed scores and used to compare incidence and odds of mortality. Injury incidence rates by COI were calculated using weighted Poisson regression, to adjust for the total number of children in each COI category. Odds of mortality by COI, adjusted for age, sex and race/ethnicity, were calculated using multivariable logistic regression. Results Of 2,339 total pediatric firearm injuries, 366 (16%) were fatal. Males (89%), adolescents (95%) and Black children (88%) were predominately affected. Geospatial mapping showed highest burden in North and West Philadelphia, which corresponded with areas of low COI. The incidence rate ratio (IRR) of injury in low COI zip codes was 2.5 times greater than high COI (IRR 2.5 [1.93-3.22]; p < 0.01). After adjusting for age, sex, and race/ethnicity, odds of mortality in low COI zip codes was nearly twice that of high COI zip codes (aOR 1.95 [0.77-4.92]), though did not demonstrate statistical significance (p = 0.16). Conclusion Child opportunity index is associated with pediatric firearm injury in Philadelphia, Pennsylvania.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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Berry JG, Ferrari L, Ward VL, Hall M, Desmarais A, Raval MV, Tian Y, Mathieu D, Incorvia J, Meara JG. Child Opportunity Index Disparities in Pediatric Surgical Encounters During the Coronavirus 2019 Pandemic. Acad Pediatr 2024; 24:43-50. [PMID: 37625667 DOI: 10.1016/j.acap.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Surgical encounters decreased during the coronavirus disease (COVID-19) pandemic and may have been deferred more in children with impeded health care access related to social/community risk factors. We compared surgery trends before and during the pandemic by Child Opportunity Index (COI). METHODS Retrospective analysis of 321,998 elective surgical encounters of children ages 0-to-18 years in 44 US children's hospitals from January 1, 2017 to December 31, 2021. We used auto-regression to compare observed versus predicted encounters by month in 2020-21, modeled from 2017 to 2019 trends. Encounters were compared by COI score (very low, low, moderate, high, very high) based on education, health/environment, and social/economic attributes of the zip code from the children's home residence. RESULTS Most surgeries were on the musculoskeletal (28.1%), ear/nose/pharynx (17.1%), cardiovascular (15.1%), and digestive (9.1%) systems; 20.6% of encounters were for children with very low COI, 20.8% low COI, 19.8% moderate COI, 18.6% high COI, and 20.1% very high COI. Reductions in observed volume of 2020-21 surgeries compared with predicted varied significantly by COI, ranging from -11.3% (95% confidence interval [CI] -14.1%, -8.7%) for very low COI to -2.6% (95%CI -3.9%, 0.7%) for high COI. Variation by COI emerged in June 2020, as the volume of elective surgery encounters neared baseline. For 12 of the next 18 months, the reduction in volume of elective surgery encounters was the greatest in children with very low COI. CONCLUSIONS Children from very low COI zip codes experienced the greatest reduction in elective surgery encounters during early COVID-19 without a subsequent increase in encounters over time to counterbalance the reduction.
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Affiliation(s)
- Jay G Berry
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass; Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass; Department of Pediatrics (JG Berry), Harvard Medical School, Boston, Mass.
| | - Lynne Ferrari
- Perioperative Anesthesia (L Ferrari), Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, Mass
| | - Valerie L Ward
- Department of Radiology (VL Ward), Boston Children's Hospital and Harvard Medical School, Mass; Office of Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass
| | - Matt Hall
- Children's Hospital Association (M Hall), Lenexa, Kans
| | - Anna Desmarais
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass
| | - Mehul V Raval
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Division of Pediatric Surgery (MV Raval), Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Derek Mathieu
- Department of Finance (D Mathieu), Boston Children's Hospital, Mass; Department of Surgery (D Mathieu), Harvard Medical School, Boston, Mass
| | - Joseph Incorvia
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
| | - John G Meara
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
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O'Guinn ML, Siddiqui S, Ourshalimian S, Chaudhari PP, Spurrier R. Firearm Injuries in Lower Opportunity Neighborhoods During the COVID Pandemic. Pediatrics 2023; 152:e2023062530. [PMID: 37599643 DOI: 10.1542/peds.2023-062530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES We aimed to describe changes in pediatric firearm injury rates, severity, and outcomes after the coronavirus disease 2019 stay-at-home order in Los Angeles (LA) County. METHODS A multicenter, retrospective, cross-sectional study was conducted on firearm injuries involving children aged <18-years in LA County before and after the pandemic. Trauma activation data of 15 trauma centers in LA County from the Trauma and Emergency Medicine Information System Registry were abstracted from January 1, 2018, to December 31, 2021. The beginning of the pandemic was set as March 19, 2020, the date the county stay-at-home order was issued, separating the prepandemic and during-pandemic periods. Rates of firearm injuries, severity, discharge capacity, and Child Opportunity Index (COI) were compared between the groups. Analysis was performed with χ2 tests and segmented regression. RESULTS Of the 7693 trauma activations, 530 (6.9%) were from firearm injuries, including 260 (49.1%) in the prepandemic group and 270 (50.9%) in the during-pandemic group. No increase was observed in overall rate of firearm injuries after the stay-at-home order was issued (P = .13). However, firearm injury rates increased in very low COI neighborhoods (P = .01). Mechanism of injury, mortality rates, discharge capacity, and injury severity score did not differ between prepandemic and during-pandemic periods (all P values ≥.05). CONCLUSIONS Although there was no overall increase in pediatric firearm injuries during the pandemic, there was a disproportionate increase in areas of very low neighborhood COI. Further examination of community disparity should be a focus for education, intervention, and development.
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Affiliation(s)
- MaKayla L O'Guinn
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Sami Siddiqui
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Shadassa Ourshalimian
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Pradip P Chaudhari
- Department of Pedicatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
- Division of Emergency Medicine & Transport Medicine, Children's Hospital Los Angeles, 4650 W Sunset Blvd, Los Angeles, California
| | - Ryan Spurrier
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
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