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An analysis of pediatric social vulnerability in the Pennsylvania trauma system
Madison E Morgan1, Michael A Horst2, Tawnya M Vernon2
1Trauma & Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA.
Insights
Social vulnerability did not impact pediatric trauma patient rehab admission rates. Patient insurance status, age, and injury severity were significant factors influencing rehab discharge. This highlights individual-level determinants over neighborhood characteristics.
Area of Science:
- Public Health
- Trauma Surgery
- Health Services Research
Background:
- Social vulnerability impacts healthcare access for pediatric patients.
- The Social Vulnerability Index (SVI) assesses resilience to health-related external influences.
- Previous research suggests social vulnerability may hinder healthcare access for pediatric trauma patients.
Purpose of the Study:
- To investigate the association between the Social Vulnerability Index (SVI) and rehabilitation admission rates for pediatric trauma patients in Pennsylvania.
- To determine if neighborhood-level social vulnerability influences post-hospitalization rehabilitation access for pediatric trauma survivors.
- To compare the impact of neighborhood factors versus individual patient characteristics on rehabilitation admission decisions.
Main Methods:
- Utilized 2014 CDC SVI data and HUD zip code crosswalk files to determine SVI for Pennsylvania zip codes.
- Extracted data on pediatric trauma admissions (age <15) from 2003-2015 using the PA Healthcare Cost Containment Council (PHC4) database, excluding in-hospital mortality.
- Employed a multi-level logistic model to assess the odds of rehab admission based on SVI, undertriage rates, and primary payer status, adjusting for patient and injury characteristics.
Main Results:
- Social Vulnerability Index (SVI) and zip code undertriage rates were not significantly associated with rehabilitation admission.
- Individual patient's primary payer status (Medicaid, Commercial, other/unknown) was significantly associated with higher odds of rehab admission compared to self/uninsured.
- Factors such as patient age, injury severity (ISS), specific injury types (head/chest with AIS >=3), admission year, and hospital type also significantly influenced rehab admission.
Conclusions:
- Individual patient-level factors, particularly primary payer status, appear to be more strongly associated with rehabilitation admission than neighborhood-level social vulnerability.
- Findings suggest that insurance status and clinical factors play a more critical role in determining access to post-acute rehabilitation for pediatric trauma patients.
- Future research should focus on individual determinants of care access to address disparities in pediatric trauma rehabilitation.
Background:
The social vulnerability index (SVI) is used to assess resilience to external influences that may affect human health. Social vulnerability has been noted to be a barrier to healthcare access for pediatric patients. We hypothesized that Pennsylvania (PA) pediatric trauma patients high on the social vulnerability index would have significantly lower rates of rehab admission following admission to a hospital for traumatic injury.
Methods:
The SVI was determined for each PA zip code area utilizing the census tract based 2014 SVI provided by the CDC along with a weighted crosswalk between census tracts and zip code areas using the Housing and Urban Development zip code crosswalk files. The rate of the uninsured population was extracted from the CDC SVI files in addition to other US Census variables based upon estimates from the 2014 American Community Survey (ACS). We also included the individual primary payer status of each subject. Pediatric (age <15 years) trauma admissions with in-hospital mortality excluded, were extracted from the PA Healthcare Cost Containment Council (PHC4) for all hospital admissions for the period of 2003-2015 (n = 63,545). Complete case analysis was conducted based upon the final model providing a sample of 52,794. Cases were coded as rehab patients based upon discharge status (n = 603; 1.1%). A multi-level logistic model was used to determine if subjects had a higher odds of being discharged to rehab based on SVI, undertriage rates of their zip code area of residence and their own primary payer status; this was adjusted for age, multi-system injury and a head, chest or abdomen injury with abbreviate injury scale (AIS) severity > = 3.
Results:
SVI and undertriage rates of the zip code areas of residence were not significantly associated with admission to rehab. The individual primary payer status of the subject was significantly associated with admission to rehab (OR 95%CI vs. self/uninsured; Medicaid 3.65 1.84-7.24; Commercial = 3.09 1.56-6.11; other/unknown = 2.85 1.02-7.93). Admission to rehab was also significantly associated with age, injury severity (ISS), head or chest injury with AIS scores > = 3, year of admission and hospital type.
Conclusion:
Individual patient level factors (primary payer of patient) may be associated with the odds of rehab admission rather than neighborhood factors.
Level Of Evidence:
Epidemiologic: Level III.
