Social and Economic Factors and Disparities in Pediatric Trauma Care: A Systematic Review and Meta-Analysis.

BACKGROUND

Social and economic factors are known to influence childhood injury risks and outcomes. However, the relationship between these factors and the delivery of pediatric trauma care remains unclear.

OBJECTIVE

To examine the association between social and economic factors, defined using the Place of residence, race and ethnicity/culture/language, occupation, gender and sex, religion, education, socioeconomic status, social capital-Plus framework, and health care delivery among injured children and adolescents.

DATA SOURCES: We searched PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Academic Search Premier from inception to July 27, 2024.

STUDY ELIGIBILITY CRITERIA: Studies evaluating associations between one or more social and economic factors and health care delivery in injured children aged ≤19 years, regardless of injury type or health care setting.

APPRAISAL AND SYNTHESIS

METHODS

Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Risk of Bias in Non-randomized Studies - of Exposure tool. We performed meta-analyses using random-effects models.

RESULTS

Among 73 eligible studies, 28 contributed to meta-analyses. No disparities were observed in imaging or in transfer to a pediatric center. Non-Hispanic Black (OR = 1.68, 95% CI: 1.51-1.87) and Hispanic (OR = 1.35, 95% CI: 1.22-1.50) children were more likely to receive any analgesic in the emergency department, but less likely to receive opioids during emergency department visits or at discharge. Girls had lower odds of opioid prescription (OR = 0.95, 95% CI: 0.92-0.97). Self-pay and public insurance were associated with reduced opioid access and differences in hospital admission, surgery, and access to rehabilitation services.

LIMITATIONS: Predominance of U.S.-based studies and high risk of methodological bias.

CONCLUSIONS

There are disparities in pediatric trauma care delivery. Standardized protocols may protect against disparities.