A population-based analysis of neighborhood socioeconomic status and injury admission rates and in-hospital mortality.
BACKGROUND
Research indicates that neighborhood socioeconomic status (N-SES) is inversely related to injury and injury-related mortality. We hypothesized that injury-related hospitalization rates would vary by N-SES and that N-SES would be related to in-hospital mortality.


METHODS
Adults (age 18 to 84 years) living in Shelby County, TN, were eligible for the study. Addresses of adults admitted to the only Level I trauma center in the county from 1996 to 2005 were geocoded and matched to 1 of 214 census tract groups. Census tract groups were divided into quintiles based on percent of the population living below the poverty level (lowest to highest income N-SES). Crude injury admission rate ratios (CIRR) and 95% confidence intervals (CI) were calculated. Multivariable logistic regression was used to determine if N-SES was associated with in-hospital mortality.


RESULTS
Compared with the highest N-SES, those in the lowest N-SES suffered significantly higher rates of blunt (CIRR 5.74; 95% CI 5.35, 6.15) and penetrating injuries (CIRR 20.98; 95% CI 18.03, 24.42). On multivariable logistic regression analysis, compared with the highest N-SES, decreasing N-SES was not associated with in-hospital mortality for blunt (high-middle [0.90; 95% CI 0.57, 1.44]; middle [1.22; 95% CI 0.78, 1.87]; low-middle [0.89; 95% CI 0.58, 1.39]; lowest [0.67; 95% CI 0.42, 1.08]); or penetrating injury (high-middle [1.35; 95% CI 0.48, 3.81]; middle [2.77; 95% CI 0.99, 7.25]; low-middle [1.44; 95% CI 0.55, 3.74]; and lowest [1.03; 95% CI 0.39, 2.73]).


CONCLUSIONS
N-SES was inversely related to crude injury rates for all mechanisms. However, in-hospital mortality was not associated with N-SES level.
Zarzaur
Ben L
BL
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA. bzarzaur@uthsc.edu
Croce
Martin A
MA
Fabian
Timothy C
TC
Fischer
Peter
P
Magnotti
Louis J
LJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012923:Social Class; D013714:Tennessee / Q000453:epidemiology; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy; D055815:Young Adult