THE EFFECT OF AREA SOCIAL DEPRIVATION ON HEALTH BEHAVIOR AND HEALTH CARE UTILIZATION IN AN ADULT TRAUMA POPULATION

Objectives: Beyond demographics, there exist social and geographic determinants of health that are important mediators of disparities but are not routinely measured in clinical practice. The effects of these factors on clinical outcomes are not well understood. In this study, we closely examine key social determinants of health in adult trauma patients and evaluate the effect of area social deprivation on outcomes.

Methods: We performed a retrospective review of adult patients admitted to a single, Level 1 trauma center between January 2019 and December 2020. After matching census tracts and patient zip code to high disparity regions across the state, patients were stratified into either low (LSD) or high (HSD) social deprivation cohorts. Clinical and sociodemographic cohort factors were collected. Regression modeling was used to analyze the effect of area social deprivation on clinical outcomes.

Results: There were 4,602 adult trauma patients included: 3,243 in the LSD and 1,359 in the HSD cohort. Patients in the HSD cohort more often were younger, male, and identified as a non-White race. There were no differences between cohorts in terms of level 1 trauma activation, injury severity, and presence of comorbidities. Mortality rates did not differ between cohorts (3.5 vs 2.8%, p=0.21). However, patients in the HSD cohort were more likely to have a positive drug or alcohol screen on admission, suffer a penetrating injury, and were more likely to be uninsured. HSD cohort patients were less likely to be discharged with additional services (OR 0.73; 95% CI 0.57–0.94, p=0.02). Patients in the HSD cohort were also less likely to be admitted to the ICU (OR 0.84; 95% CI 0.73-0.96, p=0.01).

Conclusion: At our institution, more than 1 in 4 adult trauma patients list a zip code of residence that corresponds to an area of high social deprivation. Independently, area social deprivation affects trauma outcomes and the resources a patient is provided after discharge. Because geography is inextricable with social determinants of health, improving institutional trauma outcomes must begin with an area-specific understanding of the communities served.