Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Abstract

Background

When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities.

Method

We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015–2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015–Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts.

Results

For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury; increased injury for Hispanic or Latino patients was driven by falls and MVCs.

Conclusions

The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.

Keywords

Traumatic injury SARIMA COVID-19 racial health disparities social determinants

Get full access to this article

View all access options for this article.

References

Asnaani

Hall-Clark

. Recent developments in understanding ethnocultural and race differences in trauma exposure and PTSD. Curr Opin Psychol 2017 Apr; 14: 96–101.

Chikani

Brophy

Vossbrink

, et al. Racial/ethnic disparities in rates of traumatic injury in arizona, 2011–2012. Public Health Rep 2016 Sep; 131: 704–710.

World Health Organization. Injuries and Violence [Internet]. 2021 [cited 2022 Jul 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence

Centers for Disease Control and Prevention. Web-based injury statistics query and reporting system (wisqars) [Internet]. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2003. Available from: www.cdc.gov/injury/wisqars

Hussong

Midgette

Richards

, et al. COVID-19 Life events spill-over on family functioning and adolescent adjustment. J Early Adolesc 2021; 42: 359–388.

Hatchimonji

Swendiman

Seamon

, et al. Trauma does not quarantine: violence during the COVID-19 pandemic. Ann Surg 2020 Aug; 272: e53–e54.

Yeates

Grigorian

Barrios

, et al. Changes in traumatic mechanisms of injury in southern california related to COVID-19: penetrating trauma as a second pandemic. J Trauma Acute Care Surg 2021 Apr; 90: 714–721.

Gravlee

. Systemic racism, chronic health inequities, and COVID -19: A syndemic in the making? Am J Hum Biol [Internet] 2020 Sep [cited 2022 Mar 31]; 32. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ajhb.23482

Kessler

Chiu

Hwang

, et al. Changes in prevalence of mental illness among US adults during compared with before the COVID-19 pandemic. Psychiatr Clin North Am 2022 Mar; 45: 1–28.

10.

Elm

Altman

Egger

, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007 Oct 20; 335: 806–808.

11.

American College of Surgeons. National Trauma Data Standard [Internet]. 2022. Available from: https://www.facs.org/quality-programs/trauma/quality/national-trauma-data-bank/national-trauma-data-standard/

12.

R Core Team. R: A language and environment for statistical computing. R Found Stat Comput Vienna Austria [Internet]. 2020; Available from: https://www.R-project.org/

13.

Bisgaard

Kulahci

. Time series analysis and forecasting by example. Hoboken, N.J: Wiley, 2011. 366 p. (Wiley series in probability and statistics).

14.

Box

GEP

Jenkins

Reinsel

. Time series analysis: forecasting and control. 4th ed. Hoboken, N.J: John Wiley, 2008. 746 p. (Wiley series in probability and statistics).

15.

Hyndman

Khandakar

. Automatic Time Series Forecasting: The forecast Package for R. J Stat Softw [Internet] 2008 [cited 2022 May 27]; 27. Available from: http://www.jstatsoft.org/v27/i03/

16.

Lewis

. Industrial and business forecasting methods: a practical guide to exponential smoothing and curve fitting. London ; Boston: Butterworth Scientific, 1982. 143 p.

17.

United States Census Bureau. American Community Survey 5-Year Estimates Subject Tables [Internet]. Available from: https://data.census.gov/cedsci/table?q=S0101

18.

Katrakazas

Michelaraki

Sekadakis

, et al. Identifying the impact of the COVID-19 pandemic on driving behavior using naturalistic driving data and time series forecasting. J Safety Res 2021 Sep; 78: 189–202.

19.

Katrakazas

Michelaraki

Sekadakis

, et al. A descriptive analysis of the effect of the COVID-19 pandemic on driving behavior and road safety. Transp Res Interdiscip Perspect 2020 Sep; 7: 100186.

20.

Sekadakis

Katrakazas

Michelaraki

, et al. Analysis of the impact of COVID-19 on collisions, fatalities and injuries using time series forecasting: the case of Greece. Accid Anal Prev 2021 Nov; 162: 106391.

21.

Law

Wolkin

Patel

, et al. Injury-Related emergency department visits during the COVID-19 pandemic. Am J Prev Med 2022 Jul; 63: 43–50.

22.

Andraska

Alabi

Dorsey

, et al. Health care disparities during the COVID-19 pandemic. Semin Vasc Surg 2021 Sep; 34: 82–88.

23.

Parolin

Lee

. The role of poverty and racial discrimination in exacerbating the health consequences of COVID-19. Lancet Reg Health - Am 2022 Mar; 7: 100178.

24.

Webb Hooper

Nápoles

Pérez-Stable

. COVID-19 and racial/ethnic disparities. JAMA 2020 Jun 23; 323: 2466.

25.

Federal Bureau of Investigations. NICS Firearm Checks: Month/Year [Internet]. 2022. Available from: https://www.fbi.gov/file-repository/nics_firearm_checks_-_month_year.pdf/view

26.

Schleimer

McCort

Shev

, et al. Firearm purchasing and firearm violence during the coronavirus pandemic in the United States: a cross-sectional study. Inj Epidemiol 2021 Dec; 8: 43.

27.

Price

Khubchandani

Foh

. Unintentional firearm mortality in African–American youths, 2010–2019. J Natl Med Assoc 2021 Oct; 113: 580–586.

28.

Formica

. An eye on disparities, health equity, and racism—the case of firearm injuries in urban youth in the United States and globally. Pediatr Clin North Am 2021 Apr; 68: 389–399.

29.

Barrett

Lee

Monuteaux

, et al. Association of county-level poverty and inequities with firearm-related mortality in US youth. JAMA Pediatr 2022 Feb 7; 176: e214822.

30.

Houghton

Jackson-Weaver

Toraih

, et al. Firearm homicide mortality is influenced by structural racism in US metropolitan areas. J Trauma Acute Care Surg 2021 Jul; 91: 64–71.

31.

Karb

Subramanian

Fleegler

. County poverty concentration and disparities in unintentional injury deaths: a fourteen-year analysis of 1.6 million U.S. Fatalities. Schanzer DL, editor. PLOS ONE 2016 May 4; 11: e0153516.

32.

Fernandez

J-G

. Redlining, Racial Covenants and Suburbia: How Milwaukee Became a Hyper-Segregated City. Shepherd Express [Internet]. 2020 Jul 7; Available from: https://shepherdexpress.com/news/features/redlining-racial-covenants-and-suburbia-how-milwaukee-became/

33.

Alber

Dalton

Uribe-Leitz

, et al. A multistate study of race and ethnic disparities in access to trauma care. J Surg Res 2021 Jan; 257: 486–492.

34.

Martino

Russo

Santonastaso

, et al. Long-term outcomes in major trauma patients and correlations with the acute phase. World J Emerg Surg 2020 Dec; 15: 6.

35.

Watkins

Sprang

Rothbaum

. Treating PTSD: a review of evidence-based psychotherapy interventions. Front Behav Neurosci 2018 Nov 2; 12: 258.

36.

Miranda

Snowden

Legha

. Policy effects on mental health status and mental health care disparities. In: Goldman

Frank

Morrissey

(eds) The palgrave handbook of American mental health policy [internet]. Cham: Springer International Publishing, 2020 [cited 2022 Jul 15], pp.331–364. Available from: http://link.springer.com/10.1007/978-3-030-11908-9_12

37.

The Health Alliance for Violence Intervention. What is a hospital-vased violence intervention program? [Internet]. 2022. Available from: https://www.thehavi.org/what-is-an-hvip

38.

Richards

. Incorporating racial equity into trauma-informed care. Cent Health Care Strateg [Internet]. 2021; Available from: https://www.chcs.org/resource/incorporating-racial-equity-into-trauma-informed-care/

39.

Williams

Lawrence

Davis

. Racism and health: evidence and needed research. Annu Rev Public Health 2019 Apr; 40: 105–125.

40.

Moore

Conrick

Fuentes

, et al. Research on injury disparities: a scoping review. Health Equity 2019 Oct 1; 3: 504–511.

41.

Ebel

Coronado

Thompson

, et al. Child passenger safety behaviors in latino communities. J Health Care Poor Underserved 2006; 17: 358–373.

42.

Johnston

Bennett

Quan

, et al. Factors influencing booster seat use in a multiethnic community: lessons for program implementation. Health Promot Pract 2009 Jul; 10: 411–418.

43.

Bryant

O’Donnell

Creamer

, et al. The psychiatric sequelae of traumatic injury. Am J Psychiatry 2010 Mar; 167: 312–320.

44.

Mein SA. COVID-19 and Health Disparities: the Reality of “the Great Equalizer.” J GEN INTERN MED. 2020 Aug;35(8):2439–40.

45.

Corbin

Rich

Bloom

, et al. Developing a trauma-informed, emergency department–based intervention for victims of urban violence. J Trauma Dissociation 2011 Oct; 12: 510–525.

46.

Juillard

Cooperman

Allen

, et al. A decade of hospital-based violence intervention: benefits and shortcomings. J Trauma Acute Care Surg 2016 Dec; 81: 1156–1161.

47.

Strong

Shipper

Downton

, et al. The effects of health care–based violence intervention programs on injury recidivism and costs: a systematic review. J Trauma Acute Care Surg 2016 Nov; 81: 961–970.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.59 MB