P. T. Hendzlik1,2, J. Lam3, N. A. Wilson1,2,3 1University Of Rochester, School Of Medicine & Dentistry, Rochester, NY, USA 2University Of Rochester, Department Of Surgery, Rochester, NY, USA 3University Of Rochester, Department Of Biomedical Engineering, Rochester, NY, USA
Introduction: Individuals exposed to high levels of social deprivation (e.g., poverty, neighborhood violence, poor housing quality) have higher odds of experiencing trauma during their lifespan. Our purpose was to explore the relationships between social determinants of health (SDOH) and outcomes in a large population of patients with traumatic injuries. We hypothesized that patients with high social deprivation would have increased mortality and other adverse outcomes after their index trauma.
Methods: After IRB approval, we retrospectively reviewed all patients who triggered a trauma activation at an ACS-verified Level 1 Trauma Center (2014-2021) using our institutional trauma registry. Demographics, home addresses, and outcomes, including 30-day mortality, injury severity score (ISS), and hospital length of stay (LOS), were collected. The Area Deprivation Index (ADI) was calculated using home addresses geocoded to the 2020 US Census block (neighborhood) level. Logistic or linear regression were used to test for associations between ADI and outcome variables, as appropriate.
Results: Of the 12,505 individuals who presented with traumatic injuries, 265 subjects were excluded due to inability to determine ADI (e.g., international address, censored census blocks), leaving 12,240 subjects included in the analysis. Overall, the ADI distribution was skewed towards areas with higher social deprivation (p<0.01, Figure A). There were no meaningful associations between ADI and mortality (p=0.48), ISS (r2<0.01), or LOS (r2<0.01). However, violent mechanisms of injury (gunshot wound, stab, assault, abuse) were associated with increased ADI (p<0.01, Figure B).
Conclusion: Despite the finding that patients from areas with high social deprivation are more likely to experience a violent injury, injury severity and outcomes after trauma were not associated with SDOH in this cohort. This mirrors other studies in that mortality and ISS were uninfluenced by SDOH. These results suggest that care within the index hospitalization was not directly affected by the social or area vulnerability of the patient. Future studies are needed to investigate the role SDOH play in initial access to care, resource availability, access to post-trauma care, and long-term patient outcomes.
