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. 2024 Mar 14:15:1339255.
doi: 10.3389/fneur.2024.1339255. eCollection 2024.

Association between social determinants of health and pediatric traumatic brain injury outcomes

Kendall Parsons  1 , Makda G Mulugeta  1 , Gabrielle Bailey  1 , Scott Gillespie  2 , Laura M Johnson  2 , Hannah E Myers  3 , Andrew Reisner  1   4 , Laura S Blackwell  1   2
Affiliations

Association between social determinants of health and pediatric traumatic brain injury outcomes

Kendall Parsons et al. Front Neurol. .

Abstract

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.

Keywords: mortality; outcomes; pediatric; race; social determinants of health; traumatic brain injury.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Taylor C, Bell J, Breiding M, Xy L. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. MMWR Surveill Summ. (2017) 66:SS-9. 10.15585/mmwr.ss6609a1 - DOI - PMC - PubMed
    1. Kochanek PM, Tasker RC, Carney N, et al. . guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines, executive summary. Pediatr Crit Care Med. (2019) 20:280–9. 10.1097/PCC.0000000000001736 - DOI - PubMed
    1. Maas A, Lingsma H, Roozenbeek B. Predicting outcome after traumatic brain injury. Handb Clin Neurol. (2005) 128:455–74. 10.1016/B978-0-444-63521-1.00029-7 - DOI - PubMed
    1. Perel PA, Olldashi F, Muzha I, et al. . Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. (2008) 336:425–9. 10.1136/bmj.39461.643438.25 - DOI - PMC - PubMed
    1. Johnson LW, Diaz I. Exploring the social determinants of health and health disparities in traumatic brain injury: a scoping review. Brain Sci. (2023) 13:707. 10.3390/brainsci13050707 - DOI - PMC - PubMed

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