Evaluating the complex association between Social Vulnerability Index and trauma mortality.
Evaluating the complex association between Social Vulnerability Index and trauma mortality.
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评估社会脆弱性指数与创伤死亡率之间的复杂关联。
DOI：
10.1097/ta.0000000000003514
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Scott,JohnW
中科院分区：
文献类型：
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作者：
Neiman,PoojaU;Flaherty,MelanieM;Salim,Ali;Sangji,NaveenF;Ibrahim,Andrew;Fan,Zhaohui;Hemmila,MarkR;Scott,JohnW
方法在这项回顾性研究中，我们将SVI数据与全州创伤登记处合并，并使用三种分析模型来评估SVI四分位数与住院创伤死亡率之间的关联：（1）未调整模型，（2）仅使用索赔数据集可用协变量的基于索赔的模型，以及（3）根据国家创伤数据标准收集的稳健临床变量的基于登记处的模型。在未校正模型中，较高的SVI与较差的死亡率相关（最高与最低SVI五分位数的比值比为1.72 [95%置信区间为1.30-2.29]）。在调整了索赔数据中常见的协变量后，SVI和死亡率之间的关联较弱。最后，在对稳健创伤登记中常见的协变量进行调整后，SVI和住院死亡率之间没有显著相关性（最高与最低SVI五分位数的调整优势比为1.10 [95%置信区间为0.80-1.53]）。SVI越高，出现穿透伤的可能性越大，休克指数> 0.9，任何简化损伤量表评分> 5，或需要输血（所有患者均p< 0.05）。然而，在用稳健的临床协变量进行风险调整后，这种关联不再显著。我们的研究结果表明，创伤死亡率的不公平负担不是由治疗质量的变化驱动的，而是由伤害的致命性驱动的。因此，提高高风险社区的创伤生存率将需要针对创伤中心入院上游的社会和结构性不平等的干预措施和政策。
METHODSIn this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality:(1) an unadjusted model,(2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard.RESULTSWe identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30–2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80–1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of> 0.9, any Abbreviated Injury Scale score of> 5, or in need of a blood transfusion (p< 0.05 for all).CONCLUSIONPatients living in communities with greater social vulnerability are more likely to die after trauma admission. However, after risk adjustment with robust clinical covariates, this association was no longer significant. Our findings suggest that the inequitable burden of trauma mortality is not driven by variation in quality of treatment, but rather in the lethality of injuries. As such, improving trauma survival among high-risk communities will require interventions and policies that target social and structural inequities upstream of trauma center admission.