Association Between Social Determinants of Health and Severity of Traumatic Brain Injury in Children: A Retrospective Cohort Study

Abstract

Background

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality among children in the United States (US), with severity and outcomes linked to social determinants of health (SDOH) and regional differences. Data on the impact of SDOH including race, sex, and Child Opportunity Index (COI) level on TBI severity in southeastern US are sparse in children.

Methods

We analyzed data retrospectively in 1063 children with TBI, admitted at a Level I Pediatric Trauma Center in the Southeast US between January 2017-June 2023. TBI severity was categorized using the Glasgow Coma Scale (GCS). Outcomes were length of hospital stay (LOHS), intensive care unit stay (LOICUS), and craniotomy frequency. Patients were classified by race (white, Black, non-Black people of color [NBPOC]), COI (low, moderate, high), and sex (male, female). Statistical analyses included chi-square tests, one-way analysis of variance (ANOVA), and post-hoc comparisons.

Results

Significant disparities were observed by race and COI. Black children and children with low COI had lower GCS scores (P < 0.01), longer LOHS and LOICUS (P < 0.01) compared to white children and those with high COI. Additionally, Black and NBPOC children were more likely to undergo craniotomies than white children (P < 0.05). No sex-based differences in TBI severity or outcomes were found.

Discussion

This study highlights the significant impact of SDOH, particularly race and COI, on pediatric TBI severity, surgical interventions, and outcomes. These findings underscore the need for targeted interventions to address health care disparities in vulnerable pediatric populations.