Social determinants of health (SDOH) affect pediatric injury patterns as vulnerable populations are likely to experience more frequent or severe injuries. This study evaluates the association of COVID-19 and neighborhood-level sociodemographic deprivation with pediatric traumatic injuries. Institutional level I pediatric trauma encounters relative to the U.S. pandemic declaration date (3/11/2020): pre-COVID (1/1/2018-3/10/2020), early COVID (3/11/2020-3/11/2021), and late COVID (3/12/2021-8/30/2022) were retrospectively evaluated. The Area Deprivation Index (ADI) measured neighborhood-level sociodemographic distress at a census block tract group level. Associations between ADI and COVID-19 and injury mechanism and outcomes (intensive care unit [ICU]/ventilator duration, hospital length of stay, and mortality) were assessed using chi-square for categorical and Spearman’s rank correlation for continuous variables. 4,055 patients were included in the study. There was variability in injury patterns relative to the level of deprivation and the timing of COVID-19. MVCs (12.7% pre vs. 14.3% early vs. 18.6% late, p<0.0001) and GSWs (1.2% pre vs. 2.6% early vs. 2.0% late, p=0.018) were more common after COVID-19 and more frequently experienced by children with higher deprivation indices. Higher ADI was also associated with worse outcomes (ICU days, r=0.049, p=0.006; ventilator days, r=0.035, p=0.047). Children vulnerable to disparities among SDOH were disproportionately impacted by injury mechanisms that became more frequent following the COVID-19 pandemic. National-level stressors (COVID-19) impact behaviors on a population level and shift exposure risk to different injury mechanisms. Multi-level public health initiatives are needed to address disparate injury patterns among children.
Pace, Devon, "Perfect Storm? COVID-19, Area Deprivation, and Their Association with Pediatric Trauma" (2023). Master of Public Health Capstone Presentations. Presentation 475.