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Association between social determinants of health and pediatric traumatic brain injury outcomes
Kendall Parsons1, Makda G Mulugeta1, Gabrielle Bailey1
1Children's Healthcare of Atlanta, Atlanta, GA, United States.
Insights
Social determinants of health (SDH) did not impact pediatric traumatic brain injury (TBI) outcomes, despite minority groups experiencing more severe injuries and social vulnerability. Further research is needed to understand these complex relationships.
Area of Science:
- Pediatric Traumatic Brain Injury (TBI)
- Social Determinants of Health (SDH)
- Health Outcomes Research
Background:
- Social determinants of health (SDH) significantly influence health outcomes, particularly following pediatric traumatic brain injuries (TBI).
- Understanding the interplay between race, SDH, and TBI outcomes is crucial for equitable healthcare.
- Existing research often lacks comprehensive analysis of SDH factors in diverse pediatric TBI populations.
Purpose of the Study:
- To investigate the relationship between race and functional outcomes in a diverse pediatric TBI population.
- To explore the modifying effects of SDH factors (insurance, social vulnerability, child opportunity) on the race-outcome association.
- To identify potential disparities in TBI severity and outcomes among different racial/ethnic groups.
Main Methods:
- A cohort study of 401 children (0-18 years) with mild to severe head injuries treated at Level I and II Trauma Centers.
- Evaluation of SDH using geocoded variables, including insurance status, social vulnerability, and child opportunity.
- Analysis using inverse propensity treatment weights (IPTW) and logistic/generalized linear regression models for mortality and functional outcomes (GOS-E scores).
Main Results:
- The study sample was diverse, with 52.37% White, 35.91% Black/African American, and 11.72% Hispanic children.
- Minority groups experienced higher rates of severe TBI and greater social vulnerability, with lower neighborhood opportunity.
- No significant differences were found in mortality or functional outcomes (GOS-E scores) between racial and ethnic groups.
Conclusions:
- Despite experiencing more severe injuries and facing greater social disadvantages, minority pediatric TBI patients did not exhibit worse mortality or functional outcomes.
- SDH factors, including insurance status, social vulnerability, and child opportunity, did not appear to modify the relationship between race and TBI outcomes in this cohort.
- Further research is essential to elucidate the complex impact of social and environmental variables on pediatric TBI health outcomes.
Introduction:
Social determinants of health (SDH) are factors that may impact outcomes following pediatric traumatic brain injuries (TBI). The purpose of this study was to investigate the relationship between race and functional outcomes in a diverse pediatric population. We further explored how this association may be modified by SDH factors, including insurance status, social vulnerability, and child opportunity.
Methods:
A cohort study (N = 401) of children aged 0-18 [median = 9.22 years (IQR: 3.56-13.59)] presenting to the Emergency Department at Level I and II Trauma Centers with mild to severe head injuries. Geocoded variables were used to evaluate SDH. The sample was described overall and by racial/ethnic group, which were adjusted for confounders using inverse propensity treatment weights (IPTW). Weighted and unweighted Firth logistic regression models (mortality) and generalized linear regression models (GOS-E scores) were reported without and then with potential effect modifiers.
Results:
The sample is majority male (65.84%); race/ethnicity are as follows: White (52.37%), Black/African Americans (35.91%), and Hispanic (11.72%). Black (31.25%) and Hispanic (27.66%) patients had higher rates of severe TBI. 35.89% of White patients were categorized as more socially vulnerable compared to 62.68% Black and 70.21% Hispanic patients. A total 63.64% of White patients were from higher opportunity neighborhoods, compared to 25.87% of Black and 51.06% of Hispanic patients. A total 50.95% of White patients, 25.87% of Black patients, and 17.02% of Hispanic patients were privately insured. There were no differences found between racial and ethnic groups on mortality or GOS-E scores.
Discussion:
Patients from minority backgrounds had more severe injuries, many resulting from pedestrian vs. motor vehicle accidents. Additionally, patients from minority backgrounds experience more social vulnerability and lower opportunity. Despite these discrepancies, we did not observe differences on rates of mortality or functional outcomes in either racial or ethnic groups. SDH were not found to impact outcomes. Further research is needed to determine how these complex social and environmental variables impact health outcomes.
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