Racial disparities in pedestrian-related injury hospitalizations in the United States

Exploring racial disparities and inequalities among children and youth with acquired brain injury: a systematic review

PURPOSE

Racial minoritized children and youth with acquired brain injury (ABI) often experience multiple forms of discrimination. The purpose of this systematic review was to understand the racial disparities in health care among children and youth with ABI and their caregivers.

METHOD

Six international databases (Ovid Medline, Embase, Healthstar, Psychinfo, Scopus, and Web of Science) were systematically searched for peer-reviewed articles. Studies were screened by two researchers who also conducted the data extraction and quality appraisal. A narrative synthesis approach was used to analyze the data.

RESULTS

Of the 8081 studies identified in the search, 34 met the inclusion criteria, which involved 838,052 children and youth with brain injuries (or caregivers representing them) across two countries. The following themes were noted in the studies in our review: (1) racial disparities in accessing care (i.e., diagnosis, hospital admission, length of stay, rehabilitation treatment); (2) racial disparities in ABI-related health outcomes (i.e., functional outcomes and mortality rates); and (3) factors affecting racial disparities (i.e., sources in injury, insurance and expenditures, and intersectionality).

CONCLUSIONS

Our findings reveal the concerning racial disparities among children and youth with ABI. Further research should explore solutions for addressing such racial disparities and solutions to address them.

Emergency Department Visits for Pedestrians Injured in Motor Vehicle Traffic Crashes - United States, January 2021-December 2023

Traffic-related pedestrian deaths in the United States reached a 40-year high in 2021. Each year, pedestrians also suffer nonfatal traffic-related injuries requiring medical treatment. Near real-time emergency department visit data from CDC's National Syndromic Surveillance Program during January 2021-December 2023 indicated that among approximately 301 million visits identified, 137,325 involved a pedestrian injury (overall visit proportion = 45.62 per 100,000 visits). The proportions of visits for pedestrian injury were 1.53-2.47 times as high among six racial and ethnic minority groups as that among non-Hispanic White persons. Compared with persons aged ≥65 years, proportions among those aged 15-24 and 25-34 years were 2.83 and 2.61 times as high, respectively. The visit proportion was 1.93 times as high among males as among females, and 1.21 times as high during September-November as during June-August. Timely pedestrian injury data can help collaborating federal, state, and local partners rapidly monitor trends, identify disparities, and implement strategies supporting the Safe System approach, a framework for preventing traffic injuries among all road users.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs)

BACKGROUND

Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode.

METHODS

Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population.

RESULTS

We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes.

CONCLUSIONS

This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Mechanisms of traumatic injury by demographic characteristics: an 8-year review of temporal trends from the National Trauma Data Bank

BACKGROUND/PURPOSE

This 8-year retrospective study of the National Trauma Data Bank describes temporal trends of traumatic injury by mechanism of injury (MOI) by demographic characteristics from 2012 to 2019 for adult patients 18 years and older.

METHODS

Overall, 5 630 461 records were included after excluding those with missing demographic information and International Classification of Disease codes. MOIs were calculated as proportions of total injury by year. Temporal trends of MOI were evaluated using two-sided non-parametric Mann-Kendall trend tests for (1) all patients and (2) within racial and ethnic groups (ie, Asian, 2% of total patient sample; Black, 14%; Hispanic or Latino, 10%; Multiracial, 3%; Native American, <1%; Pacific Islander, <1%; White, 69%) and stratified by age and sex.

RESULTS/OUTCOMES

For all patients, falls increased over time (p=0.001), whereas burn (p<0.01), cut/pierce (p<0.01), cyclist (p=0.01), machinery (p<0.001), motor vehicle transport (MVT) motorcyclist (p<0.001), MVT occupant (p<0.001) and other blunt trauma (p=0.03) injuries decreased over time. The proportion of falls increased across all racial and ethnic groups and significantly for those aged 65 and older. There were further differences in decreasing trends of MOI by racial and ethnic categories and by age groups.

CONCLUSIONS

These results suggest that falls are an important injury prevention target with an ageing US population across all racial and ethnic groups. Differing injury profiles by racial and ethnic identity indicate that injury prevention efforts be designed accordingly and targeted specifically to individuals most at risk for specific MOIs.

STUDY TYPE

Level I, prognostic/epidemiological.

Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019

Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420-428. https://doi.org/10.2105/AJPH.2022.307192).

Pedestrian crash frequency: Unpacking the effects of contributing factors and racial disparities

In this paper, we unpack the magnitude effects of the determinants of pedestrian crashes using a multivariate analysis approach. We consider four sets of exogenous factors that characterize residential neighborhoods as well as potentially affect pedestrian crashes and the racial composition of such crashes: (1) crash risk exposure (CE) attributes, (2) cultural variables, (3) built environment (BE) features, and (4) sociodemographic (SD) factors. Our investigation uses pedestrian crash and related data from the City of Houston, Texas, which we analyze at the spatial Census Block Group (CBG) level. Our results indicate that social resistance considerations (that is, minorities resisting norms as they are perceived as being set by the majority group), density of transit stops, and road design considerations (in particular in and around areas with high land-use diversity) are the three strongest determinants of pedestrian crashes, particularly in CBGs with a majority of the resident population being Black. The findings of this study can enable policymakers and planners to develop more effective countermeasures and interventions to contain the growing number of pedestrian crashes in recent years, as well as racial disparities in pedestrian crashes. Importantly, transportation safety engineers need to work with social scientists and engage with community leaders to build trust before leaping into implementing planning countermeasures and interventions. Issues of social resistance, in particular, need to be kept in mind.

A decade of child pedestrian safety in England: a bayesian spatio-temporal analysis

BACKGROUND

Child pedestrian injury is a public health and health equality challenge worldwide, including in high-income countries. However, child pedestrian safety is less-understood, especially over long time spans. The intent of this study is to understand factors affecting child pedestrian safety in England over the period 2011-2020.

METHODS

We conducted an area-level study using a Bayesian space-time interaction model to understand the association between the number of road crashes involving child pedestrians in English Local Authorities and a host of socio-economic, transport-related and built-environment variables. We investigated spatio-temporal trends in child pedestrian safety in England over the study period and identified high-crash local authorities.

RESULTS

We found that child pedestrian crash frequencies increase as child population, unemployment-related claimants, road density, and the number of schools increase. Nevertheless, as the number of licensed vehicles per capita and zonal-level walking/cycling increase, child pedestrian safety increases. Generally, child pedestrian safety has improved in England since 2011. However, the socio-economic inequality gap in child pedestrian safety has not narrowed down. In addition, we found that after adjusting for the effect of covariates, the rate of decline in crashes varies between local authorities. The presence of localised risk factors/mitigation measures contributes to variation in the spatio-temporal patterns of child pedestrian safety.

CONCLUSIONS

Overall, southern England has experienced more improvement in child pedestrian safety over the last decade than the northern regions. Our study revealed socio-economic inequality in child pedestrian safety in England. To better inform safety and public health policy, our findings support the importance of a targeted system approach, considering the identification of high-crash areas while keeping track of how child pedestrian safety evolves over time.

Cognability: An Ecological Theory of neighborhoods and cognitive aging

While a growing body of evidence points to potentially modifiable individual risk factors for dementia, the built and social environments in which people develop and navigate cognitive decline are largely overlooked. This paper proposes a new theoretical concept, Cognability, to conceptualize how supportive an area is to cognitive health among aging residents. Cognability incorporates a constellation of both positive and negative neighborhood features related to physical activity, social interaction and cognitive stimulation in later life. We analyzed data from the REasons for Geographic And Racial Differences in Stroke Study, a national sample of older Black and white adults in the United States (n = 21,151; mean age at assessment = 67; data collected 2006-2017). Generalized additive multilevel models examined how cognitive function varied by neighborhood features. Access to civic and social organizations, recreation centers, fast-food and coffee establishments, arts centers, museums, and highways were significantly associated with cognitive function. Race-, gender-, and education-specific models did not yield substantial improvements to the full-model. Our results suggest that the unequal distribution of amenities and hazards across neighborhoods may help account for considerable inequities observed in cognitive health among older adults. Cognability advances ecological theories of aging through an innovative "whole neighborhood" approach. It aims to identify which specific neighborhood features are most protective of cognitive health among aging adults to inform upstream public health initiatives, community interventions, and policy.

Disparities in Activity and Traffic Fatalities by Race/Ethnicity

INTRODUCTION

Traffic fatalities remain a major public health challenge despite progress made during recent decades. This study develops exposure-based estimates of fatalities per mile traveled for pedestrians, cyclists, and light-duty vehicle occupants and describes disparities by race/ethnicity, including a subanalysis of fatality rates during darkness and in urban areas.

METHODS

Estimates of person-miles traveled by mode and race/ethnicity group were derived from the 2017 National Household Travel Survey using replicate weights. Three-year average (2016‒2018) traffic fatalities were measured by mode and race/ethnicity group with the U.S. Fatality Analysis Reporting System. Fatality rates per mile traveled and CIs were calculated for each subgroup as well as separately for trips occurring during darkness and in urban areas. Analysis was conducted in 2021‒2022.

RESULTS

Exposure to traffic fatality differs by race/ethnicity group and by mode, indicating that adjustment for differential exposure is needed when estimating disparities. The authors find that fatality rates per 100 million miles traveled are systematically higher for Black and Hispanic Americans for all modes and notably higher for vulnerable modes (e.g., Black Americans died at more than 4 times the rate for White Americans while cycling, 33.71 [95% CI: 21.84, 73.83] compared with 7.53 [95% CI: 6.64, 8.69], and more than 2 times the rate while walking, 40.92 [95% CI: 36.58, 46.44] compared with 18.77 [95% CI: 17.30, 20.51]). Previous estimates that do not adjust for differential exposure may underestimate disparities by race/ethnicity. Observed disparities remained when considering only urban areas and appear to be exacerbated during darkness.

CONCLUSIONS

Traffic fatalities are a substantial and preventable public health challenge in America. Black and Hispanic Americans have higher traffic fatality rates per mile traveled than White Americans across the transportation system, requiring urgent attention.

Improving identification of crash injuries: Statewide integration of hospital discharge and crash report data

OBJECTIVE

The availability of complete and accurate crash injury data is critical to prevention and intervention efforts. Relying solely on hospital discharge data or police crash reports may result in a biased undercount of injuries. Linking hospital data with crash reports may allow for a more robust identification of injuries and an understanding of which populations may be missed in an analysis of one source. We used the New Jersey Safety and Health Outcomes (NJ-SHO) data warehouse to examine the share of the entire crash-injured population identified in each of the two data sources, overall and by age, race/ethnicity, sex, injury severity, and road user type.

METHODS

We utilized 2016-2017 data from the NJ-SHO warehouse. We identified crash-involved individuals in hospital discharge data by applying the ICD-10-CM external cause of injury matrix. Among crash-involved individuals, we identified those with injury- or pain-related diagnosis codes as being injured. We also identified crash-involved individuals via crash report data and identified injuries using the KABCO scale. We jointly examined the two sources; injuries in the hospital discharge data were documented as being related to the same crash as injuries found in the crash report data if the date of the crash report preceded the date of hospital admission by no more than two days.

RESULTS

In total, there were 262,338 crash-involved individuals with a documented injury in the hospital discharge data or on the crash report during the study period; 168,874 had an injury according to hospital discharge data, and 164,158 had an injury in crash report data. Only 70,694 (26.9%) had an injury in both sources. We observed differences by age, race/ethnicity, injury severity, and road user type: hospital discharge data captured a larger share of those ages 65+, those who were Black or Hispanic, those with higher severity injuries, and those who were bicyclists or motorcyclists.

CONCLUSIONS

Each data source in isolation captures approximately two-thirds of the entire crash-injured population; one source alone misses approximately one-third of injured individuals. Each source undercounts people in certain groups, so relying on one source alone may not allow for tailored prevention and intervention efforts.

Association of Race With Postoperative Mortality Following Major Abdominopelvic Trauma in Children

BACKGROUND

The leading cause of mortality among children is trauma. Race and ethnicity are critical determinants of pediatric postsurgical outcomes, with minority children generally experiencing higher rates of postoperative morbidity and mortality than White children. This pattern of poorer outcomes for racial and/or ethnic minority children has also been demonstrated in children with head and limb traumas. While injuries to the abdomen and pelvis are not as common, they can be life-threatening. Racial and/or ethnic differences in outcomes of pediatric abdominopelvic operative traumas have not been examined. Our objective was to determine whether disparities exist in postoperative mortality among children with major abdominopelvic trauma.

MATERIALS AND METHODS

We performed a retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2003, 2006, 2009, and 2012. Patients were included if they were < 18 years, sustained a major abdominopelvic injury, and underwent subsequent surgical intervention. Our primary outcome was inpatient mortality, comparing children of different race and/or ethnicity.

RESULTS

We identified a weighted cohort of 13,955 children, of whom 6765 (48.5%) were White, 3614 (25.9%) Black, and 2647 (19.0%) Hispanic. After adjusting for covariates, Black children were 94% more likely to die than their White peers (3.3% versus 1.6%, adjusted-RR:1.94, 95%CI: 1.33-2.82, P = 0.001). Hispanic children (adjusted-RR:1.99, 95%CI: 1.36-2.91, P < 0.001) and those of other race and/or ethnicity (adjusted-RR: 2.02, 95%CI:1.20-3.40, P = 0.008) were also more likely to die compared to their White peers.

CONCLUSIONS

Black and Hispanic children who require operative intervention following major abdominopelvic trauma have a higher risk of postoperative mortality compared with White children.

Trauma and US Minority Children and Youth

PURPOSE OF REVIEW

This paper reviews the literature on the prevalence, risk factors, and effects of traumatic experiences on the mental health outcomes of minority youth in the USA.

RECENT FINDINGS

The USA has an increasing number of children and youth from minority backgrounds. Research reveals that traumatic experiences disproportionately affect minority youth. These experiences include historical/generational trauma, immigration and acculturation stressors, natural and manmade disasters, experiences of discrimination, family violence, and community violence. The COVID-19 pandemic has also disproportionately affected minority youth resulting in illness and hospitalizations. Despite the higher incidence of trauma exposure, minority youth are less likely to access medical and mental health care. These disparities are resulting in increasing rates of depression, anxiety, post-traumatic stress, substance use disorders, and suicide in minority youth. Recognizing and understanding the impact of trauma is critical to the healthy development and successful functioning of minority youth, and to the success of our nation.

Fatal hit-and-run crashes: Factors associated with leaving the scene

INTRODUCTION

Hit-and-run crashes are a criminal offense that leave the victim without prompt medical care or the ability to receive financial compensation.

METHOD

The purpose of the current study was to quantify the factors associated with the probability that a driver leaves the scene of a fatal crash, using multiple imputation to incorporate information from drivers who were never apprehended and thus whose characteristics were unknown.

RESULTS

The results of this study show that in addition to driver, vehicle, and environmental factors having significant impacts on the likelihood of a driver fleeing the scene, economic and demographic factors are important as well. Practical Applications: This analysis allows for a more holistic understanding of hit-and-run crashes and informs potential countermeasures and future research.

The time is now: why we must identify and address health disparities in sport and recreation injury

BACKGROUND

Social and structural determinants of health (SDOH) are the conditions in which individuals are born, live, learn, work, play, worship, and age. These drivers of health are integral in contextualizing the understanding and prevention of sport and recreation injury (SRI), and recognizing their impact is necessary to provide a complete and accurate picture of health and health outcomes related to injury. MAIN: Reducing disparities and achieving equity in sports and recreation is possible in part by improving data collection methodologies and utilization. Often, many SDOH have considerable effect on SRI. Although SRI epidemiology frequently examines differences by sex, there is limited inclusion of factors such as socioeconomic status, housing, gender, and food security, in sport specific data sources or in analysis of sport recreation and injury using other sources (e.g. administrative data). The ongoing dual epidemics in the United States - racism and COVID-19 - have emphasized the importance of having and utilizing SDOH data to reduce the burden of injury and disproportionate effects on our diverse population.

CONCLUSION

Moving forward, to address disparities in SRI, SDOH must be included as a part of research priorities, health related goals, and policies. This difference can be made in developing consistency in data collection and utilization. This will provide an accurate picture of the intersections and interdisciplinary changes required to design the best approach to problems to develop solutions. Future data collection and utilization should prioritize SDOH.

US children of minority race are less likely to be admitted to the pediatric intensive care unit after traumatic injury, a retrospective analysis of a single pediatric trauma center

Background

The public health impact of pediatric trauma makes identifying opportunities to equalize health related disparities imperative. The influence of a child’s race on the likelihood of admission to the pediatric intensive care unit (PICU) is not well described. We hypothesized that traumatically injured children of minority race would have higher rates of PICU admission, compared to White children.

Methods

This was a retrospective review of a single institution’s trauma registry including children ≤18 years of age presenting to the emergency department (ED) whose injury necessitated pediatric trauma team activation at a Level 1 Pediatric Trauma Center from July 1, 2011 through June 30, 2016. Demographics, injury characteristics and hospital utilization data were collected. Race was categorized as White or racial minority, which included patients identifying as Black, Hispanic ethnicity, Native American or “other.” The primary outcome measure was admission to the PICU. Chi square or Mann Whitney rank sum tests were used, as appropriate, to compare differences in demographics and injury characteristics between those children who were and were not admitted to the PICU setting. Variables associated with PICU admission in univariate analyses were included in a multivariate analysis. Data are presented as median values and interquartile ranges, or numbers and percentages.

Results

The median age of the 654 included subjects was 8 [IQR 4–13] years; 55.2% were a racial minority. Nine (1.4%) children died in the ED and 576 (88.1%) were admitted to the hospital. Of the children requiring hospitalization, 195 (33.9%) were admitted to the PICU. Children admitted to the PICU were less likely to be from a racial minority group (26.1% vs 42.5%, p < 0.001). After adjusting for age and injury characteristics in a multivariable analysis, racial minority children had a lower odds of PICU admission compared to White children (OR 0.492 [95% C.I. 0.298–0.813, p = 0.006]).

Conclusions

In this retrospective analysis of traumatically injured children, minority race was associated with lower odds of PICU admission, suggesting that health care disparities based on race persist in pediatric trauma-related care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40621-021-00309-x.