Citation

Herrera-Escobar JP, Seshadri AJ, Rivero R, Toppo A, Al Rafai SS, Scott JW, Havens JM, Velmahos G, Kasotakis G, Salim A, Haider AH, Nehra D. J. Trauma Acute Care Surg. 2019; 87(1): 104-110.

Affiliation

Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School. Boston, MA. USA.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000002329

PMID

31033884

Abstract

BACKGROUND: Lower socioeconomic status (SES) is known to be associated with higher morbidity and mortality following injury. However, the impact of individual SES on long-term outcomes after trauma is unknown. The objective of this study is to determine the impact of educational level and income on long-term outcomes after injury.

METHODS: Trauma patients with moderate to severe injuries admitted to three Level-I trauma centers were contacted 6-12-months post-injury to evaluate functional status, return to work/school, chronic pain, and post-traumatic stress disorder (PTSD). SES was determined by educational level and income. Adjusted logistic regression models were built to determine the association between educational level and income (lowest vs. highest quartile determined by census-tract area) on each of the long-term outcomes. A sensitivity analysis was performed using the national median household income ($57,617) as threshold for defining low vs. high income.

RESULTS: A total of 1,516 patients were followed during a 36-month period. 49% had a low educational level and 26% were categorized in the low-income group. Mean age and injury severity score were 60 (SD:21.5) and 14.3 (SD:7.3) respectively, with most patients (94%) suffering blunt injuries. After adjusting for confounders, low educational level was associated with poor long-term outcomes: functional limitation [OR:1.78 (95% CI:1.41-2.26)], not yet return to work/school [OR:2.48 (95% CI:1.70-3.62)], chronic pain [OR:1.63 (95% CI:1.27-2.10)], and PTSD [OR:2.23 (95% CI:1.60-3.11)]. Similarly, low-income level was associated with not yet return to work/school [OR:1.97 (95% CI:1.09-3.56)], chronic pain [OR:1.70 (95% CI:1.14-2.53)], and PTSD [OR:2.20 (95% CI:1.21-3.98)]. In sensitivity analyses, there were no significant differences in long-term outcomes between income levels.

CONCLUSION: Low educational level is strongly associated with worse long-term outcomes after injury. However, even though household income is associated with long-term outcomes, it matters where the threshold is. The impact of different socioeconomic measures on long-term outcomes after trauma cannot be assumed to be interchangeable. LEVEL OF EVIDENCE: Level III - Prognostic and Epidemiological.

Language: en