Survival and Risk Factors in Interpersonal Injuries: A Secondary Ecosocial Study

Interpersonal injuries are a major public health concern disproportionately affecting young men. This study evaluated survival and risk factors in patients with interpersonal injuries, by applying Krieger's ecosocial model to integrate biological and structural determinants.

A secondary analysis was conducted using data from an observational cohort of trauma patients at four referral centers in Cali, Colombia. Patients with interpersonal injuries were classified by mechanism. Macro-level factors (sociodemographics, insurance, and institutional complexity) and microlevel factors (physiology and anatomical severity) were analyzed with Cox regression.

Of 856 trauma patients, 539 (61.5%) sustained interpersonal injuries. Crude mortality was 12.8%, with half of the deaths within 72 h. In multivariate models, undetectable systolic blood pressure (hazard ratio [HR], 106.3; 95% confidence interval [CI], 2.97-3799.9; P = 0.011) and Glasgow Coma Scale score of 3 (HR, 29.7, 95% CI, 8.1-108.6; P < 0.001) were strongly linked to mortality. Severe traumatic brain injury (Abbreviated Injury Scale (AIS) 5; HR, 7.6; 95% CI, 1.4-39.8; P = 0.017) and abdominal trauma (AIS 5; HR, 11.5, 95% CI, 2.1-64.3; P = 0.005) increased risk, while thoracic trauma (AIS 3; HR, 0.25; 95% CI, 0.07-0.91; P = 0.035) was protective. Treatment at high-complexity hospitals reduced mortality (HR, 0.09; 95% CI, 0.02-0.46; P = 0.004). Patients with no or subsidized insurance had lower mortality than those in the contributory regime, suggesting structural determinants shape survival.

Trauma survival depends on both physiological severity and structural factors. Strengthening trauma systems and reducing inequities are essential, with the ecosocial framework offering a valuable lens for trauma epidemiology and policy.