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Social and Economic Factors and Disparities in Pediatric Trauma Care: A Systematic Review and Meta-Analysis
Janyce Eunice Gnanvi1, Gabrielle Freire2, Natalie Yanchar3
1Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec-Université Laval (Hôpital de l'Enfant-Jésus), Université Laval (JE Gnanvi, P-A Tardif, M Bérubé, S Gnanou, C Du̥val, L Moore), Quebec City, Quebec, Canada; Department of Social and Preventive Medicine, Faculté de médecine, Université Laval (JE Gnanvi, J Adadja, S Gnanou, C Duval, L Moore), Quebec City, Quebec, Canada.
Insights
Social and economic factors significantly impact pediatric trauma care, leading to disparities in treatment. Standardized protocols are crucial to ensure equitable care for all injured children.
Area of Science:
- Pediatric Trauma Care
- Health Disparities
- Socioeconomic Factors in Healthcare
Background:
- Social and economic determinants are recognized influences on childhood injury risks and outcomes.
- The specific impact of these factors on pediatric trauma care delivery remains under-explored.
Purpose of the Study:
- To investigate the association between social and economic factors, utilizing the PROGRESS-Plus framework, and the delivery of healthcare for injured children and adolescents.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Academic Search Premier) up to July 27, 2024.
- Studies focusing on associations between social/economic factors and healthcare delivery in children (≤19 years) with injuries were included.
- Study selection, data extraction, and risk of bias assessment (ROBINS-E) were performed by two independent reviewers, with meta-analyses conducted using random-effects models.
Main Results:
- Of 73 eligible studies, 28 were included in meta-analyses. No disparities were found in imaging or transfer to pediatric centers.
- Non-Hispanic Black and Hispanic children showed increased likelihood of receiving any analgesic but reduced odds of receiving opioids in the ED and at discharge.
- Girls had lower odds of opioid prescription; self-pay and public insurance were linked to reduced opioid access and disparities in hospital admission, surgery, and rehabilitation.
Conclusions:
- Significant disparities exist in the delivery of pediatric trauma care, influenced by social and economic factors.
- Methodological biases and a predominance of U.S.-based studies were noted limitations.
- Implementing standardized protocols may serve as a protective measure against these observed care disparities.
Background:
Social and economic factors are known to influence childhood injury risks and outcomes. However, the relationship between these factors and the delivery of pediatric trauma care remains unclear.
Objective:
To examine the association between social and economic factors, defined using the Place of residence, race and ethnicity/culture/language, occupation, gender and sex, religion, education, socioeconomic status, social capital-Plus framework, and health care delivery among injured children and adolescents.
Data Sources:
We searched PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Academic Search Premier from inception to July 27, 2024.
Study Eligibility Criteria:
Studies evaluating associations between one or more social and economic factors and health care delivery in injured children aged ≤19 years, regardless of injury type or health care setting.
Appraisal And Synthesis Methods:
Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Risk of Bias in Non-randomized Studies - of Exposure tool. We performed meta-analyses using random-effects models.
Results:
Among 73 eligible studies, 28 contributed to meta-analyses. No disparities were observed in imaging or in transfer to a pediatric center. Non-Hispanic Black (OR = 1.68, 95% CI: 1.51-1.87) and Hispanic (OR = 1.35, 95% CI: 1.22-1.50) children were more likely to receive any analgesic in the emergency department, but less likely to receive opioids during emergency department visits or at discharge. Girls had lower odds of opioid prescription (OR = 0.95, 95% CI: 0.92-0.97). Self-pay and public insurance were associated with reduced opioid access and differences in hospital admission, surgery, and access to rehabilitation services.
Limitations:
Predominance of U.S.-based studies and high risk of methodological bias.
Conclusions:
There are disparities in pediatric trauma care delivery. Standardized protocols may protect against disparities.
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