The Complexity of Social Vulnerability of Person and Place on Mortality After Penetrating Trauma

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-24 DOI:10.1016/j.jss.2025.03.048

Monica Patten MD , Quintin W.O. Myers PhD , Madeline Thomas MD , Denise Garofalo MD , Heather Carmichael MD , Rachel Graham MD, MPH , Josue Estrella MD , Wesley Tran MD , Kaitlyn Dickinson MS , Shane Urban BSN, RN , Catherine G. Velopulos MD, MHS

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引用次数: 0

Abstract

Introduction

Social determinants of health impact outcomes after traumatic injury. Patient factors, including race, insurance status, and household income, have been associated with increased risk of mortality and worse outcomes. The social vulnerability index (SVI) is a comprehensive tool that quantifies these factors at the census tract or county level. We hypothesized that mortality after admission for penetrating trauma would be associated with higher vulnerability.

Materials and methods

We queried our level 1 trauma center supplemental database from 2019 to 2021 for mortality among adult patients presenting with a penetrating traumatic injury (n = 103). We assigned SVI based on patient address and location of injury. We used chi-square tests for association for all categorical variables and Mann–Whitney U tests for continuous variables. We then conducted a logistic regression and mediation analysis to assess the effect of injury severity score on mortality.

Results

We found a significant association between SVI and mortality after comparing low and high SVI. While most patients with penetrating trauma came from the areas of highest SVI (64%), patients with low SVI (2^nd and 3^rd quartiles) had a higher mortality than those of the highest quartile (33.3% versus 14.1%, P = 0.021). High vulnerability was associated with improved survival and lower rates of all-cause mortality; however, this association was entirely mediated by the greater range of injury severity seen in the high-vulnerability group. The correlation between individual SVI and SVI of place of injury was strong.

Conclusions

SVI is associated with patient mortality after penetrating trauma in our locale, but not in the ways that we assumed. Our data suggest that we are missing the areas where disparity in care exists when considering only patients who make it to a trauma center. This may reflect the vulnerability of the immediate area around our institution such that a greater range of survivable injury presents and emphasizes the utility of secondary and tertiary violence prevention in the communities immediately surrounding our hospital.

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人与地的社会脆弱性对穿透性创伤后死亡的影响

创伤性损伤后影响健康结果的社会决定因素。患者因素，包括种族、保险状况和家庭收入，与死亡风险增加和预后恶化有关。社会脆弱性指数（SVI）是在人口普查区或县一级量化这些因素的综合工具。我们假设穿透性创伤入院后的死亡率与较高的易感性有关。材料和方法我们查询了2019年至2021年一级创伤中心补充数据库中出现穿透性创伤损伤的成人患者的死亡率（n = 103）。我们根据患者的地址和受伤位置来分配SVI。我们对所有分类变量使用卡方检验，对连续变量使用Mann-Whitney U检验。然后，我们进行了逻辑回归和中介分析，以评估损伤严重程度评分对死亡率的影响。结果通过比较低SVI和高SVI，我们发现SVI与死亡率之间存在显著相关性。虽然大多数穿透性创伤患者来自SVI最高的区域（64%），但低SVI（第二和第三四分位数）患者的死亡率高于最高四分位数的患者（33.3%比14.1%,P = 0.021）。高易感性与生存率提高和全因死亡率降低相关；然而，这种关联完全是由在高易损性组中观察到的更大范围的损伤严重程度介导的。个体SVI与损伤部位SVI相关性较强。结论：在我们的地区，ssvi与穿透性创伤后的患者死亡率相关，但与我们假设的方式不同。我们的数据表明，当只考虑那些进入创伤中心的病人时，我们忽略了存在护理差异的领域。这可能反映了我们医院周边地区的脆弱性，因此存在更大范围的可存活伤害，并强调了在我们医院周边社区预防二级和三级暴力的效用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.