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Social Determinants of Severe Injury Among Pediatric Patients During the COVID-19 Pandemic: An Exploratory Study
Rebeccah L Sokol1, Usha Sethuraman2, Katherine Oag3
1School of Social Work, University of Michigan, Ann Arbor, MI.
Insights
Identifying patterns in social determinants of health (SDH) is crucial for preventing severe pediatric injuries. Combined factors like childcare needs and neighborhood violence significantly increase injury risk, unlike isolated SDH.
Area of Science:
- Pediatric trauma research
- Public health
- Data mining in healthcare
Background:
- Severe pediatric injuries are a significant public health concern.
- Understanding the social determinants of health (SDH) is essential for injury prevention.
- Previous research often examined SDH in isolation, potentially missing complex interactions.
Purpose of the Study:
- To identify patterns of social determinants of health (SDH) associated with severe pediatric injuries.
- To explore the utility of association rule mining (ARM) in uncovering complex SDH patterns.
- To compare the predictive power of SDH patterns versus individual SDH factors for severe injury risk.
Main Methods:
- Cross-sectional study of 360 children (≤18 years) admitted to a pediatric trauma center.
- Application of association rule mining (ARM) to identify co-occurring SDH associated with severe injury.
- Multivariable logistic regression using ARM-identified patterns, controlling for demographics, and comparison with naive models.
Main Results:
- Three SDH patterns linked to severe pediatric injury were identified: childcare needs with neighborhood violence, caregiver lacking health insurance, and caregiver lacking social support.
- The combination of childcare needs and neighborhood violence (aOR, 2.77) and caregiver lacking health insurance (aOR, 2.29) were significantly associated with increased odds of severe injury.
- Individual SDH types, when analyzed in isolation, did not show a significant association with severe injury in naive logistic regressions.
Conclusions:
- The co-occurrence of multiple negative social determinants of health (SDH) provides greater insight into severe pediatric injury than isolated factors.
- This approach can inform more effective and targeted prevention strategies for severe pediatric injuries.
- Future research should consider the complex interplay of SDH in understanding and mitigating pediatric trauma.
Introduction:
This study sought to identify social determinants of health (SDH) patterns associated with severe pediatric injuries.
Method:
We used cross-sectional data from children (≤18 years) admitted to a pediatric trauma center between March and November 2021 (n = 360). We used association rule mining (ARM) to explore SDH patterns associated with severe injury. We then used ARM-identified SDH patterns in multivariable logistic regressions of severe injury, controlling for patient and caregiver demographics. Finally, we compared results to naive hierarchical logistic regressions that considered SDH types as primary exposures rather than SDH patterns.
Results:
We identified three SDH patterns associated with severe injury: (1) having child care needs in combination with neighborhood violence, (2) caregiver lacking health insurance, and (3) caregiver lacking social support. In the ARM-informed logistic regression models, the presence of a child care need in combination with neighborhood violence was associated with an increased odds of severe injury (aOR, 2.77; 95% CI, 1.01-7.62), as was caregiver lacking health insurance (aOR, 2.29; 95% CI, 1.02-5.16). In the naive hierarchical logistic regressions, no SDH type in isolation was associated with severe injury.
Discussion:
Our exploratory analyses suggest that considering the co-occurrence of negative SDH that families experience rather than isolated SDH may provide greater insights into prevention strategies for severe pediatric injury.
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