Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study.
BACKGROUND
While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data.


METHODS
Data on infants (<12 months old) with abusive injuries over a 5-year period were obtained from nine U.S. pediatric trauma centers. Demographics, insurance status, Injury Severity Scores, Glasgow Coma Scale scores, median household income and outcomes were recorded. Logistic regression was used to evaluate the impact of race, income and insurance status on mortality.


RESULTS
There were 867 patients identified with a mortality of 8.8%. Patients without private insurance had a 3.8 times greater odds (give 95% confidence interval) of dying. Those in the lower three quartiles of income also had a higher odds of death even after controlling for race, injury severity, and Glasgow Coma Scale. Although African American infants had a higher overall mortality than whites (11.2% vs. 7.8%, p = 0.14), race was not an independent predictor of mortality (p = 0.98).


CONCLUSIONS
There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.
Rangel
Erika L
EL
Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Burd
Randall S
RS
Falcone
Richard A
RA
D002649:Child Abuse / Q000401:mortality* / Q000706:statistics & numerical data; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D015601:Injury Severity Score; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D017057:Medically Uninsured / Q000706:statistics & numerical data; D016017:Odds Ratio; D044469:Racial Groups / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality