title: Demographic and socioeconomic factors influencing disparities in prevalence of alcohol-related injury among underserved trauma patients in a safety-net hospital.
abstract: BACKGROUND
  Alcohol-related trauma remains high among underserved patients despite ongoing preventive measures. Geographic variability in prevalence of alcohol-related injury has prompted reexamination of this burden across different regions. We sought to elucidate demographic and socioeconomic factors influencing the prevalence of alcohol-related trauma among underserved patients and determine alcohol effects on selected outcomes.
  
  
  METHODS
  A retrospective analysis examined whether patients admitted to a suburban trauma center differed according to their blood alcohol concentration (BAC) on admission. Patients were stratified based on their BAC into four categories (undetectable BAC, BAC 1-99mg/dL, BAC 100-199mg/dL, and BAC ≥ 200mg/dL). T-tests and X2 tests were used to detect differences between BAC categories in terms of patient demographics and clinical outcomes. Multivariate linear and logistic regressions were used to investigate the association between patient variables and selected outcomes while controlling for confounders.
  
  
  RESULTS
  One third of 738 patients analyzed were BAC-positive, mean (SD) BAC was 211.4 (118.9) mg/dL, 80% of BAC-positive patients had levels ≥ 100mg/dL. After risk adjustments, the following patient characteristics were predictive of having highly elevated BAC (≥200mg/dL) upon admission to the Trauma Center; Hispanic patients (adjusted odds ratio (OR)=1.91, 95% confidence interval (CI): 1.14-3.21), unemployment (OR=1.74, 95% CI: 1.09-2.78), Medicaid beneficiaries (OR=3.59, 95% CI: 1.96-6.59), and uninsured patients (OR=2.86, 95% CI: 1.60-5.13). Patients with BAC of 100-199mg/dL were likely to be more severely injured (P=0.016) compared to undetectable-BAC patients. There was no association between being intoxicated, and being ICU-admitted or having differences in length of ICU or hospital stay.
  
  
  CONCLUSIONS
  Demographic and socioeconomic factors underlie disparities in the prevalence of alcohol-related trauma among underserved patients. These findings may guide targeted interventions toward specific populations to help reduce the burden of alcohol-related injury.
authors: Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA. Electronic address: inweze@numc.edu.
authors: Ikenna C
authors: IC
authors: Nweze
authors: Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA. Electronic address: jdigiac1@numc.edu.
authors: Jody C
authors: JC
authors: DiGiacomo
authors: Department of Family Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA. Electronic address: sshin@numc.edu.
authors: Silvia S
authors: SS
authors: Shin
authors: Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA. Electronic address: camilla.gupta@gmail.com.
authors: Camilla
authors: C
authors: Gupta
authors: Department of Epidemiology & Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA. Electronic address: rramakr1@health.usf.edu.
authors: Rema
authors: R
authors: Ramakrishnan
authors: Department of Surgery, Nassau University Medical Center, East Meadow, NY 11554, USA; Division of Trauma, Kings County Hospital Medical Center, Brooklyn, NY 11203, USA. Electronic address: langus@numc.edu.
authors: Lambros D G
authors: LDG
authors: Angus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000097:blood / Q000453:epidemiology; D000431:Ethanol / Q000097:blood*; D005260:Female; D006293:Health Promotion; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000431:Ethanol
keywords: Alcohol-related trauma; Alcoholism; Blood alcohol concentration; Injury; Safety-net hospitals; Socio-economic factors; Socioeconomic status; Targeted interventions; Targeted preventive strategies; Underserved patients