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Relationship between the COVID-19 pandemic and structural inequalities within the pediatric trauma population
Christina Georgeades1,2, Amelia T Collings3, Manzur Farazi4,5
1Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. cgeorgeades@mcw.edu.
Insights
Children of color and those in vulnerable neighborhoods faced increased intentional and firearm injuries during COVID-19 stay-at-home orders. White children and those in less vulnerable areas did not experience these changes.
Area of Science:
- Pediatric Trauma
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted global social, political, and economic structures.
- It highlighted existing vulnerabilities within communities worldwide.
- Assessing the pandemic's differential impact on child injury patterns is crucial.
Purpose of the Study:
- To evaluate changes in injury patterns among children before and after stay-at-home orders (SHOs).
- To compare injury trends between White children and children of color.
- To analyze injury variations across different levels of neighborhood socioeconomic vulnerability.
Main Methods:
- A multi-institutional retrospective study analyzed traumatic injuries in patients under 18.
- A control cohort (2016-2019) was compared to a COVID-19 cohort (post-SHO implementation).
- Statistical analyses examined interactions between race/ethnicity, social vulnerability index (SVI), and the pandemic timeframe on injury outcomes.
Main Results:
- Significant interactions were found between race/ethnicity and the pandemic period for injury intent and mechanism.
- Children of color showed increased intentional and firearm injuries post-SHO implementation.
- Children in high SVI neighborhoods experienced a rise in firearm injuries, unlike those in lower SVI areas.
Conclusions:
- Children of color and those in high-vulnerability neighborhoods experienced a disproportionate increase in intentional and firearm injuries during the pandemic.
- These findings underscore critical inequities in trauma burden during public health crises.
- Targeted interventions are necessary to address these disparities and direct resources effectively.
Background:
The COVID-19 pandemic disrupted social, political, and economic life across the world, shining a light on the vulnerability of many communities. The objective of this study was to assess injury patterns before and after implementation of stay-at-home orders (SHOs) between White children and children of color and across varying levels of vulnerability based upon children's home residence.
Methods:
A multi-institutional retrospective study was conducted evaluating patients < 18 years with traumatic injuries. A "Control" cohort from an averaged March-September 2016-2019 time period was compared to patients injured after SHO initiation-September 2020 ("COVID" cohort). Interactions between race/ethnicity or social vulnerability index (SVI), a marker of neighborhood vulnerability and socioeconomic status, and the COVID-19 timeframe with regard to the outcomes of interest were assessed using likelihood ratio Chi-square tests. Differences in injury intent, type, and mechanism were then stratified and explored by race/ethnicity and SVI separately.
Results:
A total of 47,385 patients met study inclusion. Significant interactions existed between race/ethnicity and the COVID-19 SHO period for intent (p < 0.001) and mechanism of injury (p < 0.001). There was also significant interaction between SVI and the COVID-19 SHO period for mechanism of injury (p = 0.01). Children of color experienced a significant increase in intentional (COVID 16.4% vs. Control 13.7%, p = 0.03) and firearm (COVID 9.0% vs. Control 5.2%, p < 0.001) injuries, but no change was seen among White children. Children from the most vulnerable neighborhoods suffered an increase in firearm injuries (COVID 11.1% vs. Control 6.1%, p = 0.001) with children from the least vulnerable neighborhoods having no change. All-terrain vehicle (ATV) and bicycle crashes increased for children of color (COVID 2.0% vs. Control 1.1%, p = 0.04 for ATV; COVID 6.7% vs. Control 4.8%, p = 0.02 for bicycle) and White children (COVID 9.6% vs. Control 6.2%, p < 0.001 for ATV; COVID 8.8% vs. Control 5.8%, p < 0.001 for bicycle).
Conclusions:
In contrast to White children and children from neighborhoods of lower vulnerability, children of color and children living in higher vulnerability neighborhoods experienced an increase in intentional and firearm-related injuries during the COVID-19 pandemic. Understanding inequities in trauma burden during times of stress is critical to directing resources and targeting intervention strategies.
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