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Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre

Published:November 09, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.023

      Highlights

      • Lower socioeconomic status is associated with a small increase in the odds of all-cause trauma.
      • Increased odds of all-cause trauma seen with lower socioeconomic status is accounted for not by common mechanisms and intents such as fall from standing and accidental injury, but rather by greatly increased odds of less common violent and higher energy mechanisms and injury intents such as falls greater than 2 meters, stabbing, high risk behaviour and assault.
      • Targeted public health education and intervention within these demographics, appropriate to mechanisms observed as over-represented, may prove beneficial in the primary prevention of trauma.

      Abstract

      Background

      Lower socioeconomic status (SES) is linked to poorer health, health outcomes and higher rates of trauma. The aim of this study was to investigate the impact SES had on the mechanism and intent of trauma in patients presenting to a UK regional Major Trauma Centre (MTC).

      Materials and Methods

      Trauma data from a UK MTC over a five-year period was obtained from the Trauma Audit and Research Network. Deprivation data was obtained from English Indices of Multiple Deprivation 2019 data and the study population classified into quintiles. Odds ratios were calculated, comparing mechanism and intent of trauma with each SES quintile with the least deprived quintile as the baseline for comparison.

      Results

      Lower SES was associated with an increased odds ratio of undifferentiated trauma (OR 1.32, P<0.001). Falls from less than 2m constitute most trauma presentations and were not associated with SES (OR 1.09, P=0.114, 58.3% of trauma). The greater odds ratios for trauma in the socially deprived was accounted for by an increase in high-energy mechanisms and injury intents that include falls more than 2m (OR 1.75), stabbing (OR 5.18), blow injury (OR 2.75), high-risk behaviour (OR 4.61), assault (OR 6.63) and self-harm (OR 2.94) (P-values <0.001).

      Conclusion

      In this large, retrospective analysis of a UK MTC, we have shown that the increased risk of trauma seen with lower SES is not uniform across all mechanisms or intents and is mediated by high-energy and violent mechanisms. Targeted public health education and intervention within these demographics, appropriate to mechanisms observed as over-represented, may prove beneficial in the primary prevention of trauma, and help to guide local health service planning.

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